Реферат
Abstract Case description: 37-year-old female with PCR-RT swab for COVID-19 positive, with neurological manifestation as a result of internal carotid artery occlusion. Clinical findings: Nasal congestion and sneezing of 5 days duration; pulsatile headache in the left hemicranium 3 days prior to admission, with intensity 6/10 according to the visual analogue scale, accompanied by phosphenes, photophobia and diplopia; with subsequent developing right hemiparesis over a 26-hour period. Treatment and result: She was given medical management with oral antiplatelet agents and anticoagulants (subcutaneous and oral) during his hospitalization, it was not possible to perform thrombolysis and thrombectomy due to the high risk of complications. He was discharged at 14 days, without functional limitation, symmetrical strength in upper and lower limbs, bilateral visual acuity 20/20, denying headache. Clinical relevance: The case presented here describes a pattern in how data supporting an association between COVID-19 and stroke in young populations with or without typical vascular risk factors, sometimes with only mild respiratory symptoms, is increasing. Prospective studies are required to further evaluate this association, as well as anticoagulation studies to prevent these potentially life-threatening events.
Resumen Descripción del caso: Mujer de 37 años con hisopado PCR-RT para COVID-19 positivo, con manifestación neurológica por oclusión de la arteria carótida interna. Hallazgos clínicos: Congestión nasal y estornudos de 5 días de duración; cefalea pulsátil en hemicráneo izquierdo 3 días antes del ingreso, con intensidad 6/10 según la escala visual analógica, acompañada de fosfenos, fotofobia y diplopía; con posterior desarrollo de hemiparesia derecha durante un período de 26 horas. Tratamiento y resultado: Se le brindó manejo médico con antiagregantes plaquetarios orales y anticoagulantes (subcutáneos y orales) durante su internación, no fue posible realizar trombólisis y trombectomía por alto riesgo de complicaciones. Fue dado de alta a los 14 días, sin limitación funcional, fuerza simétrica en miembros superiores e inferiores, agudeza visual bilateral 20/20, negando cefalea. Relevancia clínica: Se describe un patrón que indica cómo están aumentando los datos que apoyan una asociación entre COVID-19 y el accidente cerebrovascular en poblaciones jóvenes con o sin factores de riesgo vascular típicos, a veces con solo síntomas respiratorios leves. Se requieren estudios prospectivos para evaluar más a fondo esta asociación, así como estudios de anticoagulación para prevenir estos eventos potencialmente mortales.
Тема - темы
Adult , Female , Humans , Carotid Artery, Internal/pathology , Carotid Artery Thrombosis/etiology , COVID-19/complications , Platelet Aggregation Inhibitors/therapeutic use , Carotid Artery Thrombosis/diagnosis , Carotid Artery Thrombosis/drug therapy , Reverse Transcriptase Polymerase Chain Reaction , COVID-19/diagnosis , Anticoagulants/therapeutic useРеферат
Central nervous system (CNS) ischemic events, besides being a common and devastating disease, are accompanied by severe disability and other morbidities. The cause of such events is not always that simple to diagnose, and among the young, a broad spectrum of possibilities should be considered. We present the case of a young man who presented two episodes of CNS ischemia with a 1 year gap between them, which occurred in the same situation while he was walking and carrying a heavy backpack. The second event first presented as a transient ischemic attack followed by a stroke the day after. The diagnostic work-up showed an indentation of the greater cornu of the hyoid bone over the internal carotid artery, which injured the media and intimal layers. At the arterial injury site, a micro thrombus was found, which explained the source of the embolic event to the CNS. The patient was operated on, and the procedure included the resection of the posterior horn of the hyoid bone, the resection of the injured segment of the internal carotid artery followed by carotidcarotid bypass with the great saphenous vein. The postoperative period and the recovery were uneventful as was the 5-month follow-up. We call attention to this unusual cause of stroke and present other cases reported in the literature.
Тема - темы
Humans , Male , Adult , Brain Ischemia/complications , Carotid Artery Injuries/etiology , Hyoid Bone/blood supply , Stroke/complications , Carotid Artery Injuries/diagnosis , Carotid Artery Thrombosis/etiology , Carotid Artery, Internal , Surgical Procedures, OperativeРеферат
OBJECTIVE: To describe five cases of giant carotid cavernous aneurysms which evolved with spontaneous thrombosis of internal carotid artery (STICA), with emphasis at epidemiology, clinical presentation, natural history, related factors and neurological outcome. METHOD: There were 711 consecutives patients with 802 aneurysms with and without surgical treatment during a period of 19 years. We selected 35 patients with 40 carotid cavernous aneurysms (5 percent) of which 20 (50 percent) were giant aneurysms. Among those cases, 5 patients evolved with STICA (25 percent). Symptoms and findings at presentation were recorded and compared with those at outcome. RESULTS: Clinical presentation was commonly related to atherosclerotic factors such as elevated blood pressure (80 percent), diabetes mellitus (40 percent) and dislipidemy (40 percent). All patients presented with hemicranial headache, ophthalmparesy and retro bulbar pain, and after STICA all presented improvement of symptoms. After STICA, 4 patients had regression of deficit, 2 partial and 2 complete. Four patients had sensorial trigeminal neuropathy in V1 and V2 territories, also showing improvement of symptoms after STICA. CONCLUSION: STICA is a common outcome in giant carotid cavernous aneurysms, and is related with significant improvement of symptoms; however, it may be catastrophic for those patients without efficient collateral circulation.
OBJETIVO: Relatar cinco casos de aneurismas gigantes intracavernosos que evoluíram com trombose espontânea da artéria carótida interna (TEACI), estudando-se: prevalência, apresentação clínica, história natural, fatores associados e prognóstico neurológico. MÉTODO: Análise de 711 pacientes consecutivos com diagnóstico de 802 aneurismas cerebrais submetidos a tratamento clínico ou cirúrgico num período de 19 anos. Foram identificados 40 aneurismas intracavernosos, sendo que 20 desses eram gigantes. Dentre esses, 5 pacientes com aneurismas gigantes intracavernosos que evoluíram com TEACI (25 por cento). Os sintomas e sinais neurológicos da apresentação foram registrados e comparados ao término do acompanhamento. RESULTADOS: Todos pacientes apresentavam cefaléia hemicraniana, apresentavam oftalmoplegia e dor retro-orbitária. Freqüentemente estavam associados a fatores ateroscleróticos como HAS (80 por cento), diabetes melito (40 por cento) e dislipidemia (40 por cento) e após a TEACI evoluíram com melhora desses sintomas. Após a TEACI, 4 pacientes tiveram regressão do déficit, sendo que em 2 a regressão do déficit foi total. Quatro pacientes apresentavam hipostesia no território de V1 e V2. Todos apresentaram melhora desse sintoma. CONCLUSÃO: A TEACI é uma evolução comum em aneurismas intracavernosos gigantes, e está associada à melhora importante dos sintomas. No entanto pode ser catastrófica naqueles pacientes sem circulação colateral eficiente.
Тема - темы
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Carotid Artery, Internal , Carotid Artery Diseases/complications , Carotid Artery Thrombosis/etiology , Intracranial Aneurysm/complications , Cerebral Angiography , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/surgery , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/surgery , Magnetic Resonance Imaging , Retrospective Studies , Young AdultРеферат
In this report, we present a rare case of traumatic carotid cavernous fistula that was occluded during the interventional procedure by incidentally formed blood clot. Sudden occlusion of the fistula and the resolution process of the precarious blood clot can be clearly seen on the serial angiogram.
Тема - темы
Male , Humans , Adult , Vascular Surgical Procedures/adverse effects , Treatment Outcome , Incidental Findings , Craniocerebral Trauma/complications , Carotid-Cavernous Sinus Fistula/etiology , Carotid Artery Thrombosis/etiologyРеферат
Fulminant cerebral infarction secondary to arterial thrombosis in adults with nephrotic syndrome is rare. We report a 42 year old male with fulminant right anterior cerebral and middle cerebral artery infarction. Minimal change disease of the kidney was documented by renal biopsy. The possible pathogenesis is discussed and pertinent literature reviewed.
Тема - темы
Adult , Carotid Artery Thrombosis/etiology , Cerebral Infarction/etiology , Humans , Male , Nephrotic Syndrome/complications , Tomography, X-Ray ComputedРеферат
Descrevemos caso de trauma penetrante na região oral em criança, evoluindo com oclusão da arteria carótida interna e déficit neurológico correspondente. A tomografia computadorizada e a ressonância nuclear magnética demonstram a oclusão completa da artéria carótida interna. Enfatizamos esta rara complicação de trauma oral, comum em crianças e discutimos os aspectos patogênicos.
Тема - темы
Humans , Male , Child, Preschool , Carotid Artery Thrombosis/etiology , Palate, Soft/injuries , Wounds, Penetrating/complications , Carotid Artery Thrombosis/diagnosis , Magnetic Resonance Angiography , Magnetic Resonance Spectroscopy , Tomography, X-Ray ComputedРеферат
Relato de caso, com necropsia, de um paciente com síndrome nefrótica por glomerulonefrite membranosa, que desenvolveu tromboses sistêmicas (arteriais e venosas), exceto nas veias renais. É descrito o estado de hipercoagulabilidade. Contudo, os relatos da literatura mostram ser as veias renais e pulmonares e näo as artérias os locais comuns de ocorrência dos fenômenos trombóticos.
Тема - темы
Humans , Male , Adult , Glomerulonephritis, Membranous/complications , Nephrotic Syndrome/complications , Nephrotic Syndrome/diagnosis , Thrombophilia/etiology , Carotid Artery Thrombosis/etiology , Venous Thrombosis/etiologyРеферат
1. Thrombus formations induced by electrical stimulation of the carotid artery was investigated in anesthetized rabbits and rats. Occlusive Grade III thrombi were produced consistently in 34 normal Nwe Zealand rabbits and 58 untreated albino Wistar rats. Thrombus formation was monitored continously in sosme of the animals with a magnetic flowmwter or a thermistor probe applied on the carotid. 2. The usefulnes of the model for the screeening of drugs was tested by treating the animals with warfarin, heparin, prostacyclin (PGI2), dihydroprostacyclin (DiHPGI2), prostaglandin E1(PGE), and prostaglandin D2(PGD2). 3. All of the drugs except warfarin were infused continuously into the venous circulation during the entire experimental period at a rate of 0.2 ml/min. 4. Warfarin (10 mg/Kg), administered by gavage 24 h before the experimental, prevented thrombus formation, as did heparin iv (34 U/Kg). 5. Of the foru platelet antiaggregatory prostaglandins tested, PGI2 was the most potent inhibitor of thrombus formation and DiHPGI2 the least active, as evaluted by visual inspection of stimulated arterial segments whic were excised 30 min (rabbits) or 15 min (rats) after the stimulation was stopped. PGI2 wss less active inrats than in rabbits (Thershold Protective Dose ratio ca. 4:1). PGE1 and PGD2 showed intermediate activity in both animal models
Тема - темы
Rats , Animals , Carotid Artery Thrombosis/prevention & control , Fibrinolytic Agents/therapeutic use , Carotid Artery Thrombosis/etiology , Electric Stimulation , Prostaglandins/therapeutic useРеферат
Os autores relatam um caso de obstruçäo bilateral das artérias carótidas internas em paciente adulto jovem e fazem uma revisäo da literatura sobre o assunto, considerando somente, a faixa etária abaixo dos 40 anos. A etiologia, clínica, diagnóstico e tratamento da patologia säo discutidos
Тема - темы
Adult , Humans , Female , Carotid Artery Thrombosis , Carotid Artery Thrombosis/diagnosis , Carotid Artery Thrombosis/etiology , Carotid Artery Thrombosis/therapy , Carotid Artery, Internal , PrognosisРеферат
Os autores apresentam 1 caso de nucormicose cerebral em paciente diabético que evoluiu com formaçäo de abscesso cerebral e trombose de carótida bilateral. Neste caso foi observada mucormicose cerebral pura, sem a associaçäo rinocerebral que é mais comum. O paciente foi operado comprovando-se a presença de abscesso, porem o diagnóstico definitivo foi estabelecido através da necrópsia (AH)