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1.
Rev Prat ; 70(6): 621-625, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058602

RESUMO

Acute stroke imaging. Imaging, within the first 24 hours of stroke, supports its clinical diagnosis and allows a careful patient selection for treatment. It excludes hemorrhage and stroke mimics, provides an estimate of potentially salvageable brain tissue, locates and characterizes the intra-arterial thrombus before treatment decision in acute ischaemic stroke. In cerebral hemorrhage, it plays a pivotal role in establishing the diagnosis and identifying causes and complications. We outline the role of neuroimaging applied to patients presenting with acute stroke within the first 24 hours.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Encéfalo , Hemorragia Cerebral , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/diagnóstico por imagem , Terapia Trombolítica
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1080-1083, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018173

RESUMO

Cerebral vascular territories are related to the clinical progression and outcome of ischemic stroke. The vascular territory map (VTM) helps to understand stroke pathophysiology and potentially the clinical prognosis. A VTM can be generated from the bolus arrival time map. However, previous methods require initial seed points to be chosen manually, and the region inferior to the circle of Willis is not included. In this paper, we propose a method to automatically generate a map of the whole cerebral vascular territory from CT perfusion imaging. We applied the proposed method to 19 cases of ischemic stroke to generate VTM for each case.Clinical Relevance- The proposed map may improve the interpretation of the physiological status of collateral flow for ischemic stroke, and aid in treatment decision making.


Assuntos
Isquemia Encefálica , Sistema Cardiovascular , Acidente Vascular Cerebral , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Mapeamento Encefálico , Humanos , Acidente Vascular Cerebral/diagnóstico por imagem
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1274-1277, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018220

RESUMO

Multiphase computed tomographic angiography (CTA) have been demonstrated to be a reliable imaging tool for evaluating cerebral collateral circulation that can be used to select acute ischemic patients for recanalization therapy. We proposed using bone subtraction techniques to visualize multiphase CTA for clinicians to make fast and consistent decisions in the imaging triage of acute stroke patients. A total of 40 multiphase brain CTA datasets were collected and processed by two bone subtraction methods. The reference method used pre-contrast (phase 0) scans to create ground truth bone masks by thresholding. The tested method used only contrast enhanced (phases 1, 2, and 3) scans to extract bone masks with two versions (U-net and atrous) of 3D multichannel convolution neural networks (CNNs) in a supervised deep learning paradigm for semantic segmentation. Half (n = 20) of the datasets were used to train and half (n = 20) were used to test the conventional 3D U-net and a patch-based 3D multichannel atrous CNN. The tested U-net and atrous CNNs achieved a mean intersection over union (IoU) scores of 90.0% +/- 2.2 and 93.9% +/- 1.2 respectively.Clinical Relevance-This bone subtraction technique helps to visualize CTA volumetric datasets in the form of full brain angiogram-like images to assist the clinicians in the emergency department for evaluating acute ischemic stroke patients.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Angiografia , Angiografia por Tomografia Computadorizada , Humanos , Redes Neurais de Computação , Acidente Vascular Cerebral/diagnóstico por imagem
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3727-3730, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018811

RESUMO

The coupling between neuronal activity and cerebral blood flow (CBF), known as neurovascular coupling, has been reported to be impaired after stroke. This study aims to investigate the neurovascular coupling impairment at the acute stage after ischemic stroke. Laser speckle contrast imaging (LSCI) was applied to measure the hemodynamic response to optogenetic excitation of sensorimotor neurons in healthy and ischemic brain. The results showed that the hemodynamic response to optogenetic stimulation decreased and the regional CBF response was correlated with the distance from the ischemic core at the acute stage, regardless of the change in resting CBF. Our results also demonstrated that excitatory neuronal stimulation of intact area could promote the recovery of neurovascular coupling, whereas peri-infarct neuronal excitation failed to restore neurovascular function 24 hrs after ischemia. These results suggested the intact periphery of penumbra as the target for excitatory stimulation in aspect of restoring the perfusion after ischemic stroke.


Assuntos
Isquemia Encefálica , Acoplamento Neurovascular , Acidente Vascular Cerebral , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Humanos , Neuroimagem , Optogenética , Acidente Vascular Cerebral/diagnóstico por imagem
5.
Artigo em Russo | MEDLINE | ID: mdl-33081455

RESUMO

Paradoxical embolism is one of the mechanisms of ischemic stroke in patients younger than 45 years of age, due to opening between the right and left chambers of the heart through a patent foramen ovale, an atrial or ventricular septal defect, pulmonary arteriovenous malformations (PAVMs), etc. The PAVMs are structurally abnormal vessels that provide direct capillary-free communication between the pulmonary and systemic circulations, and hence an anatomic "right-to-left" shunt. Most pulmonary malformations are congenital and associated with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease). This publication highlights the issues of pathogenesis, clinical presentation, diagnosis and treatment of this pathology, and also describes a clinical case in which multiple PAVMs caused repeated ischemic strokes.


Assuntos
Fístula Arteriovenosa , Embolia Paradoxal , Veias Pulmonares , Acidente Vascular Cerebral , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/etiologia , Humanos , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
6.
J Clin Neurosci ; 79: 169-171, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33070890

RESUMO

COVID-19 is the disease caused by Novel Coronavirus (SARS-CoV-2) infection and world current main public health problem, due to its easy transmissibility and multiple clinical presentations. The main symptoms reported worldwide are dry cough, dyspnea, and fever, as well as anosmia and ageusia. COVID-19 diagnosis is made with RT-PCR, but many other complementary exams may be used to guide clinical practice, such as Chest Computerized Tomography (CT), showing ground glass opacities; increase in inflammatory markers, as C-Reactive Protein and Erythrocyte Sedimentation Rate; hemogram might show hypoalbuminemia, thrombocytopenia. Severe cases may evolve to thromboembolic and atheroembolic events, leading to stroke, myocardial infarction, pulmonary thromboembolism. Male, 28 years old, went for neurological appointment after presenting episode of intense headache, dysarthria, deviation of lip rhyme on appointment's eve. Previously healthy, no comorbidities or risk factors. Underwent brain MRI and serum serological analysis. SARS-CoV-2 capacity of affecting brain homeostasis by breaking blood-brain barrier, makes it easier to develop ischemic or inflammatory damage, and invading central nervous system. Neurological symptoms and syndromes are the main consequences of COVID-19 pandemic and must be prevented through adequate clinical management.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Vasculite/diagnóstico por imagem , Vasculite/etiologia , Adulto , Humanos , Imagem por Ressonância Magnética , Masculino , Imagem Multimodal , Pandemias , Tomografia Computadorizada por Raios X
7.
J Clin Neurosci ; 79: 60-66, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33070919

RESUMO

BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) is a global pandemic that causes flu-like symptoms. There is a growing body of evidence suggesting that both the central and peripheral nervous systems can be affected by SARS-CoV-2, including stroke. We present three cases of arterial ischemic strokes and one venous infarction from a cerebral venous sinus thrombosis in the setting of COVID-19 infection who otherwise had low risk factors for stroke. METHODS: We retrospectively reviewed patients presenting to a large tertiary care academic US hospital with stroke and who tested positive for COVID-19. Medical records were reviewed for demographics, imaging results and lab findings. RESULTS: There were 3 cases of arterial ischemic strokes and 1 case of venous stroke: 3 males and 1 female. The mean age was 55 (48-70) years. All arterial strokes presented with large vessel occlusions and had mechanical thrombectomy performed. Two cases presented with stroke despite being on full anticoagulation. CONCLUSIONS: It is important to recognize the neurological manifestations of COVID-19, especially ischemic stroke, either arterial or venous in nature. Hypercoagulability and the cytokine surge are perhaps the cause of ischemic stroke in these patients. Further studies are needed to understand the role of anticoagulation in these patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Acidente Vascular Cerebral/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem
8.
J Clin Neurosci ; 79: 80-83, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33070924

RESUMO

Coronavirus Disease 2019 (COVID-19) can be associated with various neurological manifestations including acute strokes. Hyper acute diagnosis and treatment are key factors which decrease mortality and morbidity in stroke patients. The COVID-19 pandemic has introduced a great strain on the healthcare system, and as a result clinicians are facing several barriers in diagnosing and treating strokes. Delayed presentation of strokes is a problem as some in the general population defer the decision to seek immediate medical attention fearing contracting the virus. Also playing a role is the paucity of healthcare professionals available during a pandemic. Recent literature demonstrates the association of acute strokes in young patients with COVID-19. Lack of clear pathophysiology of the neurological manifestations from COVID-19 intensifies the problem. A thorough examination of the intensive care unit patient has always been a challenge owing to several factors including use of sedatives, sepsis, uremia, and encephalopathy secondary to medications. Locked-In Syndrome (LIS) secondary to stroke is much more challenging to diagnose as patients are unable to communicate or elicit any motor functions apart from certain ocular movements. We present the case of a 25 year old patient with no known history of coagulopathy, but had developed COVID-19 cytokine storm which culminated in LIS secondary to pontine strokes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Síndrome do Encarceramento/etiologia , Pneumonia Viral/complicações , Adulto , Feminino , Humanos , Síndrome do Encarceramento/diagnóstico por imagem , Pandemias , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
9.
Medicine (Baltimore) ; 99(41): e22656, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031328

RESUMO

RATIONALE: Intracranial small aneurysm is a rare cause of ischemic stroke, and been described only in sparse case reports. The exact pathophysiology, treatment strategies, and prognosis remain incompletely understood. PATIENT CONCERNS: A 42-year-old man presented with an acute onset weakness of the right limbs. DIAGNOSES: Neuroimaging evaluation confirmed a diagnosis of acute ischemic stroke and left internal carotid artery (ICA) small aneurysm. INTERVENTIONS: The patient underwent oral anti-platelet therapy (100 mg aspirin daily). OUTCOMES: The patient recovered to normal status within 4 weeks following antiplatelet treatment. During a follow-up period of 1 year, he remained neurologically asymptomatic and led a virtually normal life. LESSONS: It is crucial for clinicians to be aware of this entity, as cerebral infarction caused by small cerebral aneurysm is extremely rare.


Assuntos
Doenças das Artérias Carótidas/complicações , Artéria Carótida Interna , Aneurisma Intracraniano/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Imagem de Difusão por Ressonância Magnética , Humanos , Masculino , Acidente Vascular Cerebral/diagnóstico por imagem
10.
Rev. neurol. (Ed. impr.) ; 71(5): 186-190, 1 sept., 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193458

RESUMO

INTRODUCCIÓN: La infección grave por el SARS-CoV-2 ha demostrado un incremento del riesgo de fenómenos trombóticos, especialmente venosos. Los catéteres venosos centrales también se han asociado a un mayor riesgo de complicaciones trombóticas. El embolismo paradójico como mecanismo etiológico del ictus isquémico debe tenerse en cuenta en un contexto protrombótico elevado, en el que puede ser más frecuente. CASO CLÍNICO: Mujer de 40 años, portadora de un catéter venoso central, con ictus isquémico de gran vaso, tratada con trombectomía mecánica por embolismo paradójico atípico durante el ingreso en cuidados intensivos por neumonía bilateral por COVID-19. Dentro del estudio etiológico, destacaba analíticamente una elevación del dímero D y shunt derecha-izquierda con paso masivo de contraste directamente desde la vía central de acceso periférico en la extremidad superior izquierda a la aurícula izquierda en el ecocardiograma transesofágico. Una angiotomografía torácica mostró una estructura venosa anómala con origen en la vena subclavia y drenaje a la vena segmentaria del lóbulo superior izquierdo con vaciado directo a la aurícula izquierda. Se decidió anticoagulación hasta la retirada del catéter venoso central y antiagregación simple al alta. CONCLUSIONES: El embolismo paradójico por shunt intra o extracardíaco debe considerarse en pacientes con COVID-19, dado el elevado riesgo tromboembólico venoso asociado. Para definir el manejo profiláctico y terapéutico óptimo son necesarios más estudios


INTRODUCTION: Severe infection by SARS-CoV-2 has shown to entail an increased risk of thrombotic, especially venous, events. Central venous catheters have also been associated with an increased risk of thrombotic complications. Paradoxical embolism as an aetiological mechanism of ischaemic stroke should be considered in a highly prothrombotic context, where it may be more frequent. CASE REPORT: A 40-year-old woman with a central venous catheter, with a large vessel ischaemic stroke, treated with mechanical thrombectomy for an atypical paradoxical embolism while in intensive care for bilateral COVID-19 pneumonia. In the aetiological study, analysis highlighted an elevation of the D-dimer and right-left shunt with massive passage of contrast directly from the central peripheral access pathway in the left upper extremity to the left atrium in the transoesophageal echocardiogram. Thoracic tomographic angiography showed an anomalous venous structure with its origin in the subclavian vein and drainage to the segmental vein of the left upper lobe with direct emptying into the left atrium. Treatment consisted in anticoagulation until removal of the central venous catheter and simple anti-aggregating medication on discharge. CONCLUSIONS: Paradoxical embolism due to intra- or extra-cardiac shunt should be considered in patients with COVID-19, given the high associated risk of venous thromboembolism. Further studies are needed to be able to define optimal prophylactic and therapeutic management


Assuntos
Humanos , Feminino , Adulto , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Tromboembolia/virologia , Acidente Vascular Cerebral/virologia , Pandemias , Índice de Gravidade de Doença , Tromboembolia/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem
11.
J Comput Assist Tomogr ; 44(5): 708-713, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936578

RESUMO

OBJECTIVE: Assessing collateral status is important in acute ischemic stroke (AIS). The purpose of this study was to establish an easy and rapid method for evaluating collateral flow. METHODS: A total of 60 patients with AIS were enrolled. The patients were aged 18 to 85 years with endovascular therapy treatment within 10 hours after the appearance of stroke symptoms, prestroke modified Rankin Scale ≤1, Alberta Stroke Program Early CT Score ≥6, and the occlusion of large vessels in anterior circulation. We reformed imaging strategies by conducting a small-dose group-injection test before normal computed tomography angiography (CTA) scanning and selected the visual collateral score and the regional leptomeningeal score scales as the single-phase CTA collateral flow assessment scales with the replacement of the parasagittal anterior cerebral artery territory by anterior cerebral artery regions adjacent to the longitudinal fissure and then verified, respectively, the consistencies between the 2 single-phase CTA-based collateral scales and the digital subtraction angiography (DSA)-based American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale and compared the prognosis of endovascular therapy between the AIS patients in the poor-collateral-flow group and the other patients' group assessed by 2 single-phase CTA-based collateral scales. RESULTS: There was a high consistency between the 2 single-phase CTA-based collateral flow scales with DSA-based American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale. The assessment by using CTA-based collateral flow assessment methods generated consistent results. CONCLUSION: The single-phase CTA-based visual collateral score scale and regional leptomeningeal score scale can be used as the imaging evidence for the evaluation of collateral flow in AIS patients in the majority of grassroots hospitals where DSA is difficult to carry out.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Angiografia Cerebral/métodos , Circulação Colateral/fisiologia , Angiografia por Tomografia Computadorizada/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Angiografia Digital/métodos , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
12.
Medicine (Baltimore) ; 99(38): e22305, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957391

RESUMO

RATIONALE: A developmental venous anomaly (DVA) is the most common intracranial congenital anomaly and is mostly asymptomatic. Thrombosis rarely develops in a DVA due to hypercoagulation. We report a case of ischemic stroke in the area of a DVA after minor head trauma in a patient with DVA and without a predisposition thrombosis. PATIENT CONCERNS: A healthy 17-year-old male was admitted to the emergency room due to left hemiparesis, which was caused by a ball hitting the right side of his head during a soccer game. DIAGNOSIS: Brain magnetic resonance (MR) susceptibility-weighted image showed several small veins draining to the central vein in the area from the right posterior putamen to the periventricular white matter. INTERVENTIONS: We diagnosed the patient with an ischemic stroke associated with a DVA and administered antiplatelet agents. The patient's autoantibodies (including antiphospholipid antibody) and factors of blood coagulation were normal. OUTCOMES: The left hemiparesis of the patient worsened by the second day of admission. Moreover, high signal intensity was observed in the DVA region of the diffusion weighted image of brain MR. The patient's symptoms gradually improved afterward, and left hemiparesis recovered fully 3 weeks after the onset. LESSONS: DVAs may predispose to ischemic stroke due to thrombosis and hypercoagulation, although it is rare. It is necessary to consider the possibility of ischemic stroke due to minor head trauma, even without factors causing hypercoagulation.


Assuntos
Concussão Encefálica/complicações , Acidente Vascular Cerebral/etiologia , Adolescente , Concussão Encefálica/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Imagem de Difusão por Ressonância Magnética , Humanos , Angiografia por Ressonância Magnética , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Futebol/lesões , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico
13.
BMJ Case Rep ; 13(9)2020 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-32907873

RESUMO

A 71-year-old man presented to the emergency department (ED) with low oxygen saturations and symptoms consistent with COVID-19 infection. Apart from a small left-sided ischaemic stroke 10 years prior with very minor residual deficit, he had been well and in full-time employment until development of symptoms. Within minutes of commencing non-invasive ventilation (NIV) in the ED, he developed a complete left-sided paralysis and hemineglect. This case highlights the significance of the prothrombotic complications associated with COVID-19 infection. It also raises the question whether pressure changes upon commencing NIV could lead to clot migration.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Ventilação não Invasiva/métodos , Pneumonia Viral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Doença Aguda , Idoso , Infecções por Coronavirus/terapia , Evolução Fatal , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pandemias , Pneumonia Viral/terapia , Respiração com Pressão Positiva/métodos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X/métodos
14.
J Stroke Cerebrovasc Dis ; 29(10): 105047, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912511

RESUMO

COVID-19 is a pandemic disease which predominantly affects the respiratory system, however it also causes multi-organ dysfunction in a subset of patients. There is a growing evidence that it increases the propensity of strokes in younger patients. Besides producing a prothrombotic state, arterial dissection could be one of its many manifestations, increasing the risks of stroke. Herein, we report the first case of spontaneous bilateral vertebral artery dissection in a patient with COVID-19. 39-year female presented with spontaneous bilateral vertebral artery dissections without any instigating traumatic events and no history of connective tissue disorders. Whether this patient's vertebral artery dissections were triggered by exaggerated inflammatory response or arteriopathy secondary to COVID-19 remains speculative. Nonetheless, arterial dissection could be one of it's complications. It is important for the physicians to be aware of different clinical manifestations of COVID-19 as we manage these patients with no historical experience, to provide adequate care.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Acidente Vascular Cerebral/etiologia , Dissecação da Artéria Vertebral/etiologia , Adulto , Anticoagulantes/administração & dosagem , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Interações entre Hospedeiro e Microrganismos , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/virologia , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/tratamento farmacológico , Dissecação da Artéria Vertebral/virologia
15.
J Stroke Cerebrovasc Dis ; 29(10): 105074, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912559

RESUMO

Recent evidence has underlined the association between large-vessel stroke and COVID-19, probably due to a proinflammatory and prothrombotic microenvironment induced by SARS-CoV-2. Here, we report the case of a young fit woman affected by COVID-19 without any flu-like symptom, who suffered from speech disorder and left hemiparesis. Brain magnetic resonance evidenced two small acute brain infarctions in right perirolandic cortex without signs of previous ischemic lesions and hemorrhagic infarction. Diagnostic workup excluded cardiac embolic sources, acquired and inherited thrombophilia or autoimmune diseases. Two positive nasopharyngeal swab tests and high titers of serum specific IgA/IgM confirmed COVID-19 diagnosis. In our case stroke seems to be the only manifestation of SARS-COV-2 infection. Therefore the hypothesis of an underlying viral infection, as COVID-19, should be investigated in all the cases of small vessel cryptogenic stroke.


Assuntos
Doenças de Pequenos Vasos Cerebrais/etiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Acidente Vascular Cerebral/etiologia , Betacoronavirus/patogenicidade , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/virologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Interações entre Hospedeiro e Microrganismos , Humanos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital , Pandemias , Paresia/etiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Fatores de Risco , Distúrbios da Fala/etiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/virologia
17.
BMC Neurol ; 20(1): 358, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32972381

RESUMO

BACKGROUND: The novel coronavirus (COVID-19) global pandemic is associated with an increased incidence of acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). The treatment of these patients poses unique and significant challenges to health care providers requiring changes in existing protocols. CASE PRESENTATION: A 54-year-old COVID-19 positive patient developed sudden onset left hemiparesis secondary to an acute right middle cerebral artery occlusion (National Institutes of Health Stroke Scale (NIHSS) score = 11). Mechanical thrombectomy (MT) was performed under a new protocol specifically designed to maximize protective measures for the team involved in the care of the patient. Mechanical Thrombectomy was performed successfully under general anesthesia resulting in TICI 3 recanalization. With regards to time metrics, time from door to reperfusion was 60 mins. The 24-h NIHSS score decreased to 2. Patient was discharged after 19 days after improvement of her pulmonary status with modified Rankin Scale = 1. CONCLUSION: Patients infected by COVID-19 can develop LVO that is multifactorial in etiology. Mechanical thrombectomy in a COVID-19 confirmed patient presenting with AIS due to LVO is feasible with current mechanical thrombectomy devices. A change in stroke workflow and protocols is now necessary in order to deliver the appropriate life-saving therapy for COVID-19 positive patients while protecting medical providers.


Assuntos
Infecções por Coronavirus/complicações , Procedimentos Endovasculares/métodos , Infarto da Artéria Cerebral Média/cirurgia , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Trombectomia/métodos , Betacoronavirus , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Serviços Médicos de Emergência , Feminino , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Intubação Intratraqueal , Pessoa de Meia-Idade , Pandemias , Reperfusão , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Tempo para o Tratamento , Resultado do Tratamento
18.
Medicine (Baltimore) ; 99(30): e21366, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791743

RESUMO

The utility of endovascular thrombectomy for acute occlusion of the distal intracranial artery (A2/A3/M2/M3/P2/P3) is unclear, and aspiration and stent thrombectomy are associated with risk of bleeding. We analyzed patients with acute occlusion of the distal intracranial artery to assess the safety and efficacy of microcatheter-based tirofiban infusion.We retrospectively reviewed data of the endovascular thrombectomy registry of our center between January 2018 and June 2019. Patients with distal intracranial artery occlusion who underwent endovascular thrombectomy with microcatheter-based infusion of tirofiban were recruited.Of 13 patients included, 1 presented with anterior cerebral artery occlusion, 2 with posterior cerebral artery occlusion, 2 with posterior inferior cerebellar artery occlusion, and 7 with middle cerebral artery M2 occlusion. The mean National Institute of Health Stroke scale score was 10.1 (3-19). Three patients (23.1%) underwent bridging treatment of intravenous thrombolysis with recombinant plasminogen activator and endovascular thrombectomy. The arithmetic mean onset-to-recanalization time was 696.3 minutes (140-1440) and average operating time was 47.1 minutes (30-80). After treatment, 10 patients (76.9%) underwent revascularization. No operative complications were observed in any case. All patients underwent angiography and were reviewed 7 to 14 days after surgery. Imaging revealed significant improvements in recanalization compared with the immediate postoperative period, with no reoccurrence of occlusion. The mean modified Rankin scale score at the 3-month follow-up was 0.54 (0-2).Microcatheter-based infusion of bolus-dose tirofiban can result in safe and effective recanalization of acute occlusion of the distal artery in the case of a relatively light thrombotic load.


Assuntos
Fibrinolíticos/administração & dosagem , Doenças Arteriais Intracranianas/terapia , Acidente Vascular Cerebral/terapia , Terapia Trombolítica/métodos , Tirofibana/administração & dosagem , Idoso , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Doenças Arteriais Intracranianas/complicações , Doenças Arteriais Intracranianas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
19.
Medicine (Baltimore) ; 99(32): e21530, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769891

RESUMO

RATIONALE: Basilar artery (BA) fenestration is a congenital anomaly with duplicated BA, which can cause ischemic stroke. However, the stroke mechanism is not clearly verified in patients with BA fenestration. PATIENT CONCERNS: Here, we report a case of 64-year-old man with well-controlled hypertension admitted with dysarthria, only. DIAGNOSES: Diffusion weighted image showed a bilateral symmetric pontine infarction sparing the midline. BA fenestration was observed from magnetic resonance angiography. INTERVENTION: High-resolution magnetic resonance image (MRI) and 4D flow MRI was performed to verify the mechanism of stroke associated with BA fenestration. OUTCOMES: No plaque was observed at the area of BA fenestration from high-resolution MRI. 4D flow MRI showed bifurcated flow with high flow velocity and low shear stress at the area of BA fenestration. LESSONS: A turbulent flow with high flow velocity and low shear stress at the BA fenestration area may have influenced the flow through the bilateral perforating arteries resulting in a bilateral symmetric pontine infarction with sparing the midline where the septa of BA is located. 4D flow dynamic studies may be beneficial for verifying the mechanism of stroke.


Assuntos
Artéria Basilar/anormalidades , Infartos do Tronco Encefálico/congênito , Disartria/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Artéria Basilar/diagnóstico por imagem , Infartos do Tronco Encefálico/diagnóstico por imagem , Disartria/etiologia , Humanos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ponte , Acidente Vascular Cerebral/congênito
20.
J Stroke Cerebrovasc Dis ; 29(9): 105016, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807431

RESUMO

OBJECTIVE: To highlight the increased risk of hemorrhagic stroke secondary to postulated COVID-19 mediated vasculopathy with concomitant ECMO related bleeding complications. BACKGROUND: COVID-19 has shown to be a systemic illness, not localized to the respiratory tract and lung parenchyma. Stroke is a common neurological complication. In particular, critically ill patients on ECMO are likely at higher risk of developing hemorrhagic stroke. CASE PRESENTATION: 38-year-old man presented with fever, cough, and shortness of breath. Due to severe respiratory failure, he required ECMO support. Subsequently, he was found to have left temporal intraparenchymal hemorrhage. Overall, his clinical course improved, and he was discharged with minimal neurological deficits. CONCLUSION: Although intracranial hemorrhage is a known complication of ECMO, patients with COVID-19 infection may be at a higher risk of cerebrovascular complications due to vasculopathy.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/terapia , Oxigenação por Membrana Extracorpórea , Hemorragias Intracranianas/etiologia , Pulmão/virologia , Pneumonia Viral/terapia , Acidente Vascular Cerebral/etiologia , Adulto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Interações Hospedeiro-Patógeno , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/virologia , Pulmão/fisiopatologia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/virologia , Resultado do Tratamento
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