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1.
Medicine (Baltimore) ; 99(19): e20013, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384459

RESUMEN

INTRODUCTION: Clinically, anterior communicating artery complex fenestration combined with fenestration-related aneurysms is rare, and combination of this condition with tandem aneurysms is even rarer. PATIENT CONCERNS: A case of a 43-year-old man with spontaneous subarachnoid hemorrhage. DIAGNOSIS: A computed tomography angiography examination revealed a fenestrated anterior communicating artery complex combined with 2 aneurysms. Then, a digital subtraction angiography examination was performed to further determine the diagnosis, which showed a complex anatomical structure of the local tissue. After the aneurysms ruptured, they were partially wrapped by a hematoma and compressed, which increased the difficulty of surgery. INTERVENTIONS: An endovascular interventional therapy method was chosen, and a simple coil was successfully inserted through the blood vessel into the tandem aneurysms to maintain the integrity of the anatomical structure. OUTCOMES: The patient recovered well postoperatively. An imaging review after the operation did not show the aneurysms, and the upper and lower branches were patent. CONCLUSION: Therefore, endovascular treatment is an appropriate choice for arterial fenestration combined with tandem aneurysms, once the aneurysms have ruptured.


Asunto(s)
Aneurisma Roto , Angiografía Cerebral/métodos , Arterias Cerebrales , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Procedimientos Neuroquirúrgicos/métodos , Hemorragia Subaracnoidea , Adulto , Aneurisma Roto/diagnóstico , Aneurisma Roto/fisiopatología , Aneurisma Roto/cirugía , Angiografía de Substracción Digital/métodos , Arterias Cerebrales/diagnóstico por imagen , Arterias Cerebrales/patología , Arterias Cerebrales/cirugía , Angiografía por Tomografía Computarizada/métodos , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/cirugía , Resultado del Tratamiento
4.
N Engl J Med ; 382(15): 1395-1407, 2020 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-32227755

RESUMEN

BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).


Asunto(s)
Cateterismo Cardíaco , Puente de Arteria Coronaria , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/cirugía , Revascularización Miocárdica/métodos , Intervención Coronaria Percutánea , Anciano , Angina Inestable/epidemiología , Teorema de Bayes , Enfermedades Cardiovasculares/mortalidad , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/terapia , Calidad de Vida
5.
Medicine (Baltimore) ; 99(16): e19814, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32312000

RESUMEN

RATIONALE: Behçet Disease (BD) is a chronic inflammatory vasculitis with thrombogenicity and multisystem involvement. Deep vein thrombosis (DVT) in the lower extremities is the most frequent manifestation of vascular involvement in BD. The causes of thrombosis vary widely and include congenital predisposition and acquired factors, but of all the thrombosis, the cause is rarely BD. Furthermore, there are few reports of treatment for thrombosis in BD. PATIENT CONCERNS: We herein describe the case of an Asian male patient aged 40 years, admitted to our hospital for left leg pain, edema, and swelling. DIAGNOSES: We confirmed the DVT and pulmonary artery thrombosis (PAT) by contrast computed tomography angiogram. At the same time, the patient developed oral ulcerations and skin lesions consistent with BD. INTERVENTIONS: The patient was initially treated with anticoagulants. However, because the improvement of DVT was inadequate, we added colchicine in anticipation of anti-inflammatory effects. After that, anticoagulation was discontinued, and only colchicine was continuously prescribed. OUTCOMES: We observed an almost complete resolution of DVT and PAT with no recurrence of thrombosis for 6 months after discharge. LESSONS: This case shows us that we should consider BD as a differential diagnosis of DVT and that colchicine therapy is effective for inflammation-induced thrombosis in BD.


Asunto(s)
Síndrome de Behçet/complicaciones , Colchicina/uso terapéutico , Moduladores de Tubulina/uso terapéutico , Trombosis de la Vena/tratamiento farmacológico , Adulto , Anticoagulantes/uso terapéutico , Grupo de Ascendencia Continental Asiática/etnología , Síndrome de Behçet/patología , Colchicina/administración & dosificación , Angiografía por Tomografía Computarizada/métodos , Quimioterapia Combinada , Edema/diagnóstico , Edema/etiología , Humanos , Pierna/fisiopatología , Pulmón/irrigación sanguínea , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Dolor/diagnóstico , Dolor/etiología , Arteria Pulmonar/patología , Trombosis/tratamiento farmacológico , Resultado del Tratamiento , Moduladores de Tubulina/administración & dosificación , Trombosis de la Vena/etiología
6.
Internist (Berl) ; 61(5): 513-517, 2020 May.
Artículo en Alemán | MEDLINE | ID: mdl-32246182

RESUMEN

This article presents the case of a 75-year-old male patient, who underwent a percutaneous abscess puncture of a liver abscess. A few days after the puncture and drainage there was a sudden onset of right upper quadrant abdominal pain accompanied by hematochezia. The patient presented with markedly elevated liver enzyme levels and a significant drop in hemoglobin concentration. After gastroscopy and abdominal computed tomography (CT) in the portal venous phase no bleeding source could be identified. A false aneurysm of the cystic artery was identified only after a CT angiography of the abdomen. Due to spontaneous cessation of the bleeding a cholecystectomy was subsequently performed for definitive treatment of the false aneurysm.


Asunto(s)
Dolor Abdominal/etiología , Aneurisma/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Hemorragia Gastrointestinal/etiología , Arteria Hepática/diagnóstico por imagen , Absceso Hepático/cirugía , Punciones/efectos adversos , Anciano , Aneurisma/cirugía , Colecistectomía , Drenaje , Arteria Hepática/cirugía , Humanos , Masculino , Resultado del Tratamiento
7.
Medicine (Baltimore) ; 99(15): e19507, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282700

RESUMEN

RATIONALE: Paradoxical embolism (PE) is an important cause of cryptogenic stroke, particularly in young patients, which usually have a relation with an unexpected route in circulation. Here we report a rare case of cryptogenic stroke carried 2 uncommon malformations. PATIENT CONCERNS: A 48-year-old female experienced double neurological events in just 2 months. DIAGNOSIS: Patent foramen ovale was diagnosed with transesophageal echocardiography and successfully occluded in the first admission due to stroke. In the second admission, chest tomographic angiography found a chordae shadow in the right middle lobe, was the first clue for pulmonary arteriovenous fistula (PAVF), thereafter further confirmed by the enhanced pulmonary computed tomographic angiography. INTERVENTIONS: This patient then received intervention occlusion therapy with coils for PAVF under the help of microcatheter. Given the possible native origin of the thrombus in PAVF due to the spiral morphology, dual antiplatelet therapy was prescribed for this patient for the first 3 months to prevent device-related embolism after discharge, and the following single antiplatelet therapy was mandated. OUTCOMES: No recanalization was detected on the follow-up enhanced pulmonary computed tomographic angiography (PCTA), no neurological defect event recurred in the 16 months of follow-up. LESSONS: Computed tomograph (CT) deserved more value in screening and depicting the morphology of the PAVF, particular in young adults with no apparent arteriosclerotic risk factor. Microcatheter would be helpful for intervention treatment. Antiplatelet therapy might be adequate in specific patients, yet definitely need more evidence to verify.


Asunto(s)
Fístula Arteriovenosa/complicaciones , Embolia Paradójica/etiología , Foramen Oval Permeable/complicaciones , Arteria Pulmonar/anomalías , Venas Pulmonares/anomalías , Accidente Cerebrovascular/etiología , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/terapia , Angiografía por Tomografía Computarizada , Femenino , Foramen Oval Permeable/terapia , Humanos , Persona de Mediana Edad , Accidente Cerebrovascular/diagnóstico por imagen
9.
J Korean Med Sci ; 35(13): e87, 2020 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-32242344

RESUMEN

BACKGROUND: It can be difficult to differentiate between vascular and neurogenic intermittent claudication. The exact diagnosis often cannot be made on clinical evidence and ultimately requires imaging. Perioperative screening for peripheral arterial disease (PAD) in lumbar spinal stenosis (LSS) patients is important because untreated PAD increases the risk of severe vascular events. The aims of this study were to study the prevalence of PAD in LSS patients with symptoms of intermittent claudication, and to study the independent risk factors for PAD. We specified the cases where it was necessary to perform computed tomography angiography (CTA) as a preoperative screening tool in surgery for spinal stenosis. METHODS: This study involved a retrospective analysis of 186 consecutive subjects with radiographic evidence of LSS and symptoms of intermittent claudication, who underwent 3D CTA of the lower extremities at our institution during a three-year period. More than 50% luminal narrowing on CT angiograms was determined to be clinically significant and placed in the PAD group. RESULTS: Thirty-two subjects were diagnosed with PAD and referred to the general vascular team in our hospital, where they received treatment for PAD. In the non-PAD group (154 subjects), 117 underwent definitive surgery for spinal stenosis such as posterior lumbar interbody fusion and a further 37 underwent conservative treatment. Only hypertension, diabetes, and men gender were found to be statistically significant predictors of PAD. CONCLUSION: The current study showed that man gender, diabetes and hypertension were the greatest risk factors for PAD. We conclude that man patients with diabetes and/or hypertension should be put under serious consideration for routine CTA examination when under evaluation for LSS and intermittent claudication.


Asunto(s)
Claudicación Intermitente , Enfermedad Arterial Periférica , Estenosis Espinal , Anciano , Angiografía , Angiografía por Tomografía Computarizada , Femenino , Humanos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Estenosis Espinal/complicaciones , Tomografía Computarizada por Rayos X
10.
Zhonghua Yi Xue Za Zhi ; 100(9): 702-705, 2020 Mar 10.
Artículo en Chino | MEDLINE | ID: mdl-32187915

RESUMEN

Objective: To analyze the correlative factors of sigmoid sinus diverticulum(SSD) formation in individuals without pulsatile tinnitus based on computed tomography angiography (CTA). Methods: A hospital-based 1∶2 matched case-control study was performed on 42 cases with unilateral SSD and 84 controls for age, gender, and side-matched in Beijing Friendship Hospital affiliated to the Capital Medical University from January 2018 to December 2018.The signs including sigmoid sinus wall dehiscence, venous outflow dominance, transverse sinus stenosis, high jugular bulb, large emissary veins, degree of mastoid pneumatization (grade Ⅰ-Ⅳ) and empty sella, were detected and analyzed. Results: In SSD group and control group, there were statistically significant differences in the incidence of the sigmoid sinus wall dehiscence (66.7%(28/42) vs 19.0%(16/84)), ipsilateral transverse sinus stenosis on the dominant side of venous outflow (26.2%(11/42) vs 4.8%(4/84)), and empty sellae (19.0%(8/42) vs 7.1%(6/84))(all P<0.05).The degree of mastoid pneumatization was worse in SSD group (P<0.05). After stepwise logistic regression analysis,the sigmoid sinus wall dehiscence (P<0.01,OR=6.794,95%CI 2.530-18.245), ipsilateral transverse sinus stenosis on the dominant side (P=0.001, OR=13.293, 95%CI 2.841-62.194), and degree of mastoid pneumatization (P<0.01, OR=0.289, 95%CI 0.156-0.536) were found independently correlated with SSD. Conclusion: Sigmoid sinus wall dehiscence, ipsilateral transverse sinus stenosis on the dominant side of venous outflow and mastoid pneumatization may be some of the independent correlative factors of SSD.


Asunto(s)
Divertículo , Acúfeno , Estudios de Casos y Controles , Angiografía por Tomografía Computarizada , Senos Craneales , Humanos , Acúfeno/diagnóstico por imagen
12.
Medicine (Baltimore) ; 99(11): e19182, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176043

RESUMEN

RATIONALE: Postmortem forensic imaging technologies provide a noninvasive/minimally invasive approach for imaging of internal organ structures of the human body to detect injuries, diseases, and other morphologic changes. Currently, postmortem forensic imaging methods have been widely used in determination of the cause of death. However, these methods do not allow histologic examinations. Endoscopic autopsy emerged in the 1990s. Thoracoscopy and laparoscopy are mainly used to examine organs and tissues in the thoracic and abdominal cavity. Target tissues are also sampled for histologic examination. By combining postmortem forensic imaging with endoscopic autopsy, comprehensive examination of the corpse, organs, and sampling for histologic examination can be carried out. PATIENT CONCERNS: A 34-year-old woman was witnessed jumping into the river, sinking after struggling in the water. The body was found 24 hours later and confirmed with no vital signs. No preexisting medical conditions were known. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: Postmortem computed tomography, target coronary postmortem computed tomography angiography, and endoscopic autopsy were performed before conventional autopsy. Laparoscopic examination was used to examine the abdominal organs. The diaphragm and pericardium were cut open from the abdominal cavity to allow access to the examination of lungs and heart. Tissue samples were collected from various organs for histologic examination, and a diatom test was carried out on lung samples. Postmortem computed tomography revealed fluid in the paranasal sinuses, airways, stomach, and duodenum; emphysema aquosum; and mosaic pattern of the lung parenchyma. Endoscopic examination additionally detected Paltauf spots. The results were consistent with those of conventional autopsy. Histologic examination revealed pulmonary congestion, pulmonary edema, pulmonary emphysema, pulmonary hemorrhage, and congestion in multiple organs such as the liver, spleen, and kidneys. Diatoms were detected in lung tissues, which were identical in morphology to diatoms in water samples collected from the scene. The cause of death was determined as drowning. CONCLUSION: Combining forensic imaging and endoscopic autopsy for postmortem examination yields a more comprehensive and scientific finding, and the combination is minimally invasive and more acceptable to the family members. This method can be used as an alternative for conventional autopsy under specific circumstances.


Asunto(s)
Autopsia/métodos , Ahogamiento/diagnóstico , Adulto , Angiografía por Tomografía Computarizada , Ahogamiento/diagnóstico por imagen , Ahogamiento/patología , Endoscopía/métodos , Femenino , Patologia Forense/métodos , Humanos , Tomografía Computarizada por Rayos X
13.
Medicine (Baltimore) ; 99(11): e19489, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176087

RESUMEN

RATIONALE: Fibrous hamartoma of infancy (FHI) is a rare benign soft-tissue tumor in children with a triphasic organoid histologic appearance. PATIENT CONCERNS: We here report a case with the largest FHI published so far. A 13-month-old boy with a rapidly growing tumor 45 cm in length and 69.3 cm in circumference of the left lower extremity was identified immediately at birth. DIAGNOSES: The diagnosis was uncertain before the operation, although biopsy was conducted. The postoperation histological examination showed arranged spindle cells, adipose tissue, and nests of immature small cells embedded in a myxoid background, which is the characteristic triphasic histology of FHI. INTERVENTIONS: Under general anesthesia, hip and lower extremity amputation was performed. OUTCOMES: The patient was followed-up for 6 years and no signs of recurrence were found, suggesting a favorable prognosis, although a part of the residual tumor was present after the surgery. LESSONS: FHI exhibits pathological and clinical characteristics. However, differential diagnosis of FHI from other soft-tissue tumors before operation remains a challenge. Thus, sometimes, aggressive therapy for the treatment of FHI might be a good choice to get a satisfactory.


Asunto(s)
Hamartoma/diagnóstico por imagen , Pierna , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Tejido Adiposo/patología , Amputación , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Hamartoma/patología , Hamartoma/cirugía , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía
14.
J Comput Assist Tomogr ; 44(2): 289-294, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32195809

RESUMEN

OBJECTIVE: The purpose of this study was to quantify the reduction in radiation dose achievable by using the optimal z-axis coverage in coronary computed tomography (CT) angiography (CCTA) on a latest-generation 256-slice scanner. METHODS: A total of 408 scans were reviewed that were performed on a wide-range detector scanner allowing up to 16-cm z-axis coverage (adjustable in 2-cm increments). For each CCTA study, we assessed the radiation dose (ie, dose-length product and volume CT dose index) and measured the minimum z-axis coverage necessary to cover the complete cardiac anatomy. We calculated the potential radiation dose savings achievable through reduction of the z-axis coverage to the minimum necessary. RESULTS: The majority of the CCTA scans were performed with a z-axis coverage of 16 cm (n = 285, 69.9%), followed by 14 cm (n = 121, 29.7%) and 12 cm (n = 2, 0.5%). In the group that was scanned with a collimation of 16 cm, radiation dose could have been reduced by 12.5% in 55 patients, 25% in 195 patients, and 37.5% in 33 patients when using optimal z-axis coverage for CCTA. In the group that was scanned with a collimation of 14 cm, radiation dose could have been reduced by 14.3% in 90 patients, and 28.6% in 30 patients, whereas in the group that was scanned with a collimation of 12 cm, dose could have been reduced by 16.7% in 2 patients. CONCLUSIONS: Using correct z-axis coverage in CCTA on a latest-generation 256-slice scanner yields average dose reductions of 22.0% but may be as high as 37.5%.


Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Dosis de Radiación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos
15.
Rev Assoc Med Bras (1992) ; 66(1): 31-35, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32130378

RESUMEN

Homozygous familial hypercholesterolemia is a rarely agentic disorder of the lipoprotein metabolism intimately related to premature atherosclerotic cardiovascular disease that can lead to high disability and mortality. Homozygous familial hypercholesterolemia typically affects not only the aortic root, compromising the coronary ostia, but also affects other territories such as the carotid, descending aorta, and renal arteries. Multi-contrast high-resolution magnetic resonance imaging (MRI) provides a validated and useful method to characterize carotid artery atherosclerotic plaques quantitatively. However, very few studies have been done on assessing plaque composition in patients with Homozygous familial hypercholesterolemia using high-resolution MRI. This report is to evaluate the value of MRI in accessing carotid artery disease in patients with Homozygous familial hypercholesterolemia. We describe a 28-year-old patient from Beijing, China, who presented to the Neurology Clinic with intermittent blurred vision of the right eye, headache, nausea, and vomiting for eight years without obvious causes. Familial hypercholesterolemia was suspected based on medical history and laboratory examination. Carotid Doppler ultrasound showed bilateral common carotid artery, internal carotid artery, and external carotid artery wall thickening with hyperechoic signals. Subsequently, high-resolution multi-contrast MRI of the carotid showed calcification with hypo-intense areas located at the middle layer of the plaque, with moderate stenosis. The plaque located at the right bifurcation of the common carotid artery extended to the internal carotid artery, causing lumen stenosis close to occlusion. The patient was treated with right carotid artery endarterectomy. At a 6-month follow-up, there had been no recurrence of the patient's symptoms.


Asunto(s)
Estenosis Carotídea/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Hiperlipoproteinemia Tipo II/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Placa Aterosclerótica/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Adulto , Arteria Carótida Externa/diagnóstico por imagen , Arteria Carótida Externa/patología , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Grosor Intima-Media Carotídeo , Angiografía por Tomografía Computarizada/métodos , Femenino , Humanos , Placa Aterosclerótica/patología , Ultrasonografía Doppler en Color/métodos
16.
Medicine (Baltimore) ; 99(9): e19297, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118745

RESUMEN

To evaluate the utility of echocardiography (echo) in the diagnosis of persistent fifth aortic arch (PFAA), a very rare congenital aortic arch anomaly, and to compare echo and computed tomography angiography (CTA) imaging findings to improve our understanding of this anomaly.Data on the clinical diagnosis, imaging findings, and clinical management of PFAA were retrospectively analyzed in 10 suspected cases of PFAA admitted to our hospital between January 2012 and February 2017. We compared echo as a first line examination modality, and CTA and surgery results as the gold standard. Weinberg's classification was used to classify the type of PFAA.All patients (100%) received echo examination, eight patients (80%) received CTA examination, and four patients (40%) received sternotomy surgery; all recovered well after surgery. According to Weinberg's classification, 2, 6, and 2 cases (20%, 60%, and 20%) were classified as Type A, B, and C, respectively. Echo was able to diagnose 5 cases of PFAA (1 Type A case and 4 Type B cases) in the first instance. The diagnostic conformance rate of echo was 62.5% after comparisons with CTA and surgery results.The clinical manifestation of PFAA was atypical, and its diagnosis depended primarily on medical imaging. Echo has a relatively high diagnostic accuracy for PFAA, which is very valuable for its early detection.


Asunto(s)
Coartación Aórtica/diagnóstico , Angiografía por Tomografía Computarizada/normas , Ecocardiografía/normas , Coartación Aórtica/fisiopatología , Niño , Preescolar , Angiografía por Tomografía Computarizada/métodos , Angiografía por Tomografía Computarizada/estadística & datos numéricos , Ecocardiografía/métodos , Ecocardiografía/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos
19.
Medicine (Baltimore) ; 99(9): e19247, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118730

RESUMEN

RATIONALE: The capsular warning syndrome (CWS) is a rare and special type of transient ischemic attacks (TIAs) syndrome. The pathophysiology of CWS is very complicate, and intracranial atherosclerotic stenosis (ICAS) is rare cause. Moreover, the effective and standard therapy has not yet been established. PATIENT CONCERNS: A 47-year-old man experienced repeated and exacerbated TIAs of right hemiparesis and dysarthria. Fourteen hours after the first episode of TIAs, he developed more severe right hemiparesis and dysarthria, the National Institute of Health Stroke Scale (NIHSS) score was 12 points, and did not recover in a long time. DIAGNOSIS: The computed tomography (CT) angiography displayed high stenosis in the M1 segment of the left middle cerebral artery. The patient was diagnosed as CWS with ICAS. INTERVENTIONS: Loading dose of clopidogrel and aspirin were started but were ineffective, then we used recombinant tissue plasminogen (r-tPA) for thrombolysis therapy after repeat CT scan that showed small acute infarcts in the right putamen and no bleeding. OUTCOMES: The patient was successfully treated by r-tPA intravenous thrombolysis after loading dose of dual-anti-platelet. He recovered rapidly, and the NIHSS score was 0 point, modified Rankin Scale score was 0 point, and Barthel Index score was 100 points at 3-month follow-up. LESSONS: r-tPA combined with loading dose of dual antiplatelet appears safe and effective in carefully selected CWS patients with ICAS. The collection of similar cases and further randomized controlled trial research would be desirable.


Asunto(s)
Fibrinolíticos/uso terapéutico , Arteriosclerosis Intracraneal/tratamiento farmacológico , Ataque Isquémico Transitorio/tratamiento farmacológico , Aspirina/administración & dosificación , Aspirina/uso terapéutico , Clopidogrel/administración & dosificación , Clopidogrel/uso terapéutico , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Fibrinolíticos/administración & dosificación , Humanos , Arteriosclerosis Intracraneal/complicaciones , Arteriosclerosis Intracraneal/diagnóstico por imagen , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/diagnóstico por imagen , Síndrome , Activador de Tejido Plasminógeno/administración & dosificación , Activador de Tejido Plasminógeno/uso terapéutico , Tomografía Computarizada por Rayos X
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