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1.
Clin Appl Thromb Hemost ; 27: 10760296211002274, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33870763

RESUMO

The purpose of this article is to address several challenging questions in the management of young patients (those age 60 and under) who present with ischemic stroke. Do genetic thrombophilic states, strongly associated with venous thrombosis, independently cause arterial events in adults? Should cases of patent foramen ovale be closed with mechanical devices in patients with cryptogenic stroke? What are the optimal treatments for cerebral vein thrombosis, carotid artery dissection, and antiphospholipid syndrome and are DOACs acceptable treatment for these indications? What is the mechanism underlying large vessel stroke in patients with COVID-19? This is a narrative review. We searched PubMed and Embase and American College of physicians Journal club database for English language articles since 2000 looking mainly at randomized clinical trials, Meta analyses, Cochran reviews as well as some research articles viewed to be cutting edge regarding anticoagulation and cerebrovascular disease. Searches were done entering cerebral vein thrombosis, carotid dissection, anticoagulation therapy and stroke, antiphospholipid antibody and stroke, stroke in young adults, cryptogenic stroke and anticoagulation, patent foramen ovale and cryptogenic stroke, COVID-19 and stroke.


Assuntos
/complicações , /terapia , Adulto , Aneurisma Dissecante/complicações , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/complicações , Vértebras Cervicais/irrigação sanguínea , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/cirurgia , Humanos , Trombose Intracraniana/etiologia , Trombose Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Fatores de Risco , Trombofilia/complicações
2.
Medicine (Baltimore) ; 100(10): e24708, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725828

RESUMO

RATIONALE: Pathogeny of thrombosis in COVID-19 is related to interaction of SARS-Cov-2 with vascular wall through the angiotensin converting enzyme 2 (ACE2) receptor. This induces 2 pathways with immunothrombosis from activated endothelium (cytokine storm, leukocyte and platelet recruitment, and activation of coagulation extrinsic pathway), and rise of angiotensin II levels promoting inflammation. While thrombosis is widely described in COVID-19 patients admitted in intensive care unit, cerebrovascular diseases remains rare, in particular cerebral venous thrombosis (CVT). PATIENT CONCERNS: We describe 2 cases of women admitted during the spring of 2020 for intracranial hypertension signs, in stroke units in Great-east, a French area particularly affected by COVID-19 pandemia. DIAGNOSES: Cerebral imaging revealed extended CVT in both cases. The first case described was more serious due to right supratentorial venous infarction with hemorrhagic transformation leading to herniation. Both patients presented typical pneumonia due to SARS-Cov-2 infection, confirmed by reverse transcription polymerase chain reaction on a nasopharyngeal swab in only one. INTERVENTIONS: The first patient had to undergo decompressive craniectomy, and both patients were treated with anticoagulation therapy. OUTCOMES: Favorable outcome was observed for 1 patient. Persistent coma, due to bi thalamic infarction, remained for the other with more serious presentation. LESSONS: CVT, as a serious complication of COVID-19, has to be searched in all patients with intracranial hypertension syndrome. Data about anticoagulation therapy to prevent such serious thrombosis in SARS-Cov-2 infection are lacking, in particular in patients with mild and moderate COVID-19.


Assuntos
/complicações , Trombose Intracraniana/etiologia , Anticoagulantes/uso terapêutico , Craniectomia Descompressiva/métodos , Feminino , Humanos , Trombose Intracraniana/imunologia , Trombose Intracraniana/terapia , Pessoa de Meia-Idade , Adulto Jovem
3.
J Stroke Cerebrovasc Dis ; 30(4): 105621, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33581546

RESUMO

Here we describe a case of brainstem infarction secondary to rapid thrombus formation in a giant vertebrobasilar fusiform aneurysm (GVBFA) that was preceded clinically by several months of headaches and dizziness initially attributable to mass effect. Less than a month after initial identification of the aneurysm, a large partially-occluding thrombus formed leading to infarction of the brainstem. Interestingly, this patient also had ulcerative colitis, which has been associated with acquired hypercoagulability. Balancing risk versus benefit in the management of GVBFA to prevent morbidity and mortality is very challenging; thus more information is needed to better stratify treatment options for patients, particularly those that may have an accelerating clinical course or co-morbidities that increase clotting risk.


Assuntos
Infartos do Tronco Encefálico/etiologia , Colite Ulcerativa/complicações , Aneurisma Intracraniano/complicações , Trombose Intracraniana/etiologia , /etiologia , Idoso , Anticoagulantes/uso terapêutico , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/tratamento farmacológico , Colite Ulcerativa/diagnóstico , Progressão da Doença , Evolução Fatal , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/tratamento farmacológico , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , /tratamento farmacológico , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Fatores de Risco
4.
Neurosciences (Riyadh) ; 26(1): 15-20, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33530038

RESUMO

OBJECTIVES: To assess cerebral venous thrombosis risk factors, and associated clinical outcomes in Jazan region, Kingdom of Saudi Arabia. METHODS: This study is a retrospective review of the medical records of patients diagnosed with cerebral venous thrombosis and admitted to King Fahad Central Hospital in Jazan between 2010 and 2019. Data concerning socio-demographics, clinical features, risk factors, laboratory, and imaging investigations were retrieved. Furthermore, data about cases management, and outcomes, including death, were collected and analysed. RESULTS: A total of 51 medical records were identified. The majority of the patients were females (68.6%), and the mean age of the patients was 33.3 years, of which three patients were under 18 years old. The most frequently recorded symptom was headache (76.5%), followed by seizure (45.1%). The most commonly recorded risk factor was protein S deficiency (57%), followed by anaemia (51%). Venous infarction and haemorrhage were the most common acute complications (13.7%). The majority of the patients had a favourable prognosis where only 27.5% recovered with disability and only one patient died due to the disease. CONCLUSION: Clinical presentation of cerebral venous thrombosis in Jazan region is similar to other local and international studies. However, anaemia was recorded as a main risk factor for the disease, which might require further investigation to assess the possible association between prevalence of anaemia in Jazan region and the incidence of cerebral venous thrombosis.


Assuntos
Anemia/complicações , Trombose Intracraniana/etiologia , Deficiência de Proteína S/complicações , Trombose Venosa/etiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Trombose Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Fatores Sexuais , Trombose Venosa/epidemiologia , Adulto Jovem
5.
Medicine (Baltimore) ; 100(4): e24008, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530197

RESUMO

RATIONALE: Cerebrovascular accidents (CVAs) after percutaneous coronary intervention (PCI), although rare, are associated with high in-hospital morbidity and mortality rates. Cerebral venous thrombosis (CVT) is an uncommon cause of CVAs compared with arterial disease but is associated with favorable outcomes in most cases. We present a rare case of CVT following a simple PCI procedure with stent implantation, which has not been previously reported in the literature. PATIENT CONCERNS: A 78-year-old woman with hypertension, hyperlipidemia, and coronary artery disease received simple PCI with stent implantation. After PCI, she developed a throbbing headache with nausea and vomiting, with her blood pressure increasing to 190/100 mmHg. Drowsiness, disorientation, and neck stiffness were noted. Neurological complication due to the PCI procedure was highly suspected. DIAGNOSIS: Noncontrast brain computed tomography was performed along with emergency neurological consultation, and the patient was diagnosed as having acute CVT. INTERVENTIONS: The patient was treated with anti-intracranial pressure therapy and anticoagulation therapy through low-molecular-weight heparin and was subsequently treated with warfarin. OUTCOMES: After treatment, the patient's symptoms and signs gradually subsided, and her clinical condition improved. She was discharged with full recovery thereafter. LESSONS: A case of acute CVT, a rare, and atypical manifestation of venous thromboembolism and CVA, complicated simple PCI with stent implantation. During PCI, identifying patients with a high risk of a CVA is critical, and special care should be taken to prevent this devastating complication.


Assuntos
Trombose Intracraniana/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Acidente Vascular Cerebral/etiologia , Trombose Venosa/etiologia , Idoso , Anticoagulantes/uso terapêutico , Feminino , Humanos , Trombose Intracraniana/terapia , Acidente Vascular Cerebral/terapia , Trombose Venosa/terapia
7.
J Stroke Cerebrovasc Dis ; 30(3): 105583, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33412400

RESUMO

OBJECTIVES: The relationship between stroke etiology and clot pathology remains controversial. MATERIALS AND METHODS: We performed histological analysis of clots retrieved from 52 acute ischemic stroke patients using hematoxylin and eosin staining and immunohistochemistry (CD42b and oxidative/hypoxic stress markers). The correlations between clot composition and the stroke etiological group (i.e., cardioembolic, cryptogenic, or large artery atherosclerosis) were assessed. RESULTS: Of the 52 clots analyzed, there were no significant differences in histopathologic composition (e.g., white blood cells, red blood cells, fibrin, and platelets) between the 3 etiological groups (P = .92). By contrast, all large artery atherosclerosis clots showed a localized pattern with the oxidative stress marker 4-hydroxyl-2-nonenal (P < .01). From all 52 clots, 4-hydroxyl-2-nonenal expression patterns were localized in 28.8% of clots, diffuse in 57.7% of clots, and no signal in 13.5% of clots. CONCLUSIONS: A localized pattern of 4-hydroxyl-2-nonenal staining may be a novel and effective marker for large artery atherosclerosis (sensitivity 100%, specificity 82%).


Assuntos
Aldeídos/análise , Trombose Intracraniana/etiologia , Estresse Oxidativo , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , /metabolismo , Feminino , Humanos , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/metabolismo , Trombose Intracraniana/terapia , /metabolismo , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trombectomia
8.
J Clin Neurosci ; 79: 30-32, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33070913

RESUMO

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in Wuhan, China in December 2019, and is ongoing pandemic. While a majority of patients with SARS-CoV-2 infection shows asymptomatic or mild disease, hospitalized patients can develop critical condition, such as pneumonia, sepsis, and respiratory failure. Some cases deteriorate into sever systemic disease and multiorgan failure. Many patients of severe COVID-19 show hypercoagulable state and complicate with venous thromboembolism and atrial thrombosis. We herein reported a case of COVID-19 who developed cerebral venous thrombosis (CVT) co-incidence with pulmonary thromboembolism (PTE). A 56-year-old Japanese man was presented with fever and malaise and diagnosed with COVID-19. He was treated with ciclesonide and azithromycin, but his respiratory condition deteriorated. Thus, systemic corticosteroids and favipiravir were initiated and these treatments resulted in afebrile state, improving malaise and respiratory failure. However, he suddenly developed severe headache and vomiting with increased concentration of D-dimer. Brain CT and MRI showed typical images of CVT in the left transvers sinus and CT pulmonary angiography showed PE. Administration of unfractionated heparin followed by edoxaban treatment reduced the levels of D-dimer and improved his clinical presentation and thrombosis. Monitoring coagulopathy is important in COVID-19 patients and in case of venous thromboembolism, including cerebral venous system, appropriate anticoagulant therapy should be initiated.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Trombose Intracraniana/etiologia , Pneumonia Viral/complicações , Trombose Venosa/etiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Heparina/uso terapêutico , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pandemias , Piridinas/uso terapêutico , Tiazóis/uso terapêutico , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
11.
J Stroke Cerebrovasc Dis ; 29(10): 105178, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912501

RESUMO

Aortogenic embolic stroke (AES) is an important stroke mechanism. However, as many stroke patients have aortic atheromatous lesions, it is unclear whether these lesions are the cause of these strokes. Cholesterol crystals are the solid, crystalline form of cholesterol that is found in atherosclerosis, but not in cardiac diseases such as atrial fibrillation, valvular diseases, and cardiomyopathy. Therefore, if a cholesterol crystal is found in a thrombus removed by mechanical thrombectomy (MT), this makes it possible to diagnose a patient as having an atheromatous lesion. Here, we report an AES case with a cholesterol crystal found in a thrombus removed by MT. A 67-year-old man was admitted due to consciousness disturbance, aphasia, and right hemiplegia. Diffusion-weighted imaging (DWI) showed a hyperintense area in the left frontal lobe, and magnetic resonance angiography demonstrated a branch occlusion of the left middle cerebral artery (MCA). MT was performed 1.5 h after stroke onset, with the thrombus removed and a left occluded MCA completely recanalized. Carotid duplex ultrasonography did not reveal any plaque in the carotid artery. Echocardiography did not show any abnormal function or findings, including thrombus. Transesophageal echocardiography showed a 4.9 mm atheromatous lesion at the aortic arch. Therefore, we suspected this patient as having an AES due to the embolic source of atheromatous lesion at the aortic arch. Pathological examination of the embolus revealed a cholesterol crystal cleft in the thrombus. Therefore, we diagnosed this patient as having AES caused by an atheromatous lesion at the aortic arch.


Assuntos
Doenças da Aorta/complicações , Aterosclerose/complicações , Colesterol/análise , Embolia Intracraniana/terapia , Trombose Intracraniana/terapia , Placa Aterosclerótica , Acidente Vascular Cerebral/terapia , Trombectomia , Idoso , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/metabolismo , Aterosclerose/diagnóstico por imagem , Aterosclerose/metabolismo , Cristalização , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/etiologia , Masculino , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
12.
Stroke ; 51(9): 2810-2816, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32811390

RESUMO

BACKGROUND AND PURPOSE: Identification of acute ischemic stroke (AIS) cause is crucial for guidance of secondary prevention. Previous studies have yielded inconsistent results regarding possible correlations between AIS cause and thrombus composition, as assessed by semiquantitative histological analysis. Here, we performed a correlation analysis between AIS cause and AIS thrombus cellular composition and content, as assessed using quantitative biochemical assays. METHODS: Homogenates of 250 patients with AIS thrombi were prepared by mechanical grinding. Platelet, red blood cell, and leukocyte content of AIS thrombi were estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. AIS cause was defined as cardioembolic, noncardioembolic, or embolic stroke of undetermined source, according to the TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment). RESULTS: Cardioembolic thrombi were richer in DNA (35.8 versus 13.8 ng/mg, P<0.001) and poorer in GPVI (0.104 versus 0.117 ng/mg, P=0.045) than noncardioembolic ones. The area under the receiver operating characteristic curve of DNA content to discriminate cardioembolic thrombi from noncardioembolic was 0.72 (95% CI, 0.63-0.81). With a threshold of 44.7 ng DNA/mg thrombus, 47% of thrombi from undetermined cause would be classified as cardioembolic with a specificity of 90%. CONCLUSIONS: Thrombus DNA content may provide an accurate biomarker for identification of cardioembolic thrombi in patients with AIS with embolic stroke of undetermined source. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03268668.


Assuntos
Isquemia Encefálica/genética , DNA/genética , Embolia/genética , Cardiopatias/genética , Trombose Intracraniana/genética , Acidente Vascular Cerebral/genética , Idoso , Idoso de 80 Anos ou mais , Contagem de Células Sanguíneas , Plaquetas/patologia , Isquemia Encefálica/sangue , Diagnóstico Diferencial , Embolia/complicações , Feminino , Cardiopatias/complicações , Humanos , Trombose Intracraniana/sangue , Trombose Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Sensibilidade e Especificidade , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia
13.
Medicine (Baltimore) ; 99(34): e21757, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846801

RESUMO

RATIONALE: Cerebral venous thrombosis (CVT) is a rare cerebrovascular condition, which mainly manifests as headaches, seizures, and focal neurological deficits. JAK2 mutation in myeloproliferative diseases increases the risk of CVT. PATIENT CONCERNS: This 40-year-old woman suffered from rapidly progressive cognitive impairment and limb weakness. Her symptoms worsened while being treated with mannitol with the diagnose of cerebral hemorrhage. DIAGNOSIS: The patient was diagnosed with CVT and multiple intracranial hemorrhage caused by JAK2 V617F mutation-positive primary myelofibrosis by neuroimage and whole-exome sequencing. INTERVENTION: She received low-molecular-weight heparin sodium 3800 IU twice a day followed by oral anticoagulant therapy. OUTCOMES: The patient showed full recovery from limb weakness and in the follow-up period she noticed no change in her memory. LESSONS: Clinicians should be aware of the possibility of the JAK2 V617F mutation in CVT patients without known causes or risk factors.


Assuntos
Disfunção Cognitiva/etiologia , Trombose Intracraniana/etiologia , Janus Quinase 2/genética , Mielofibrose Primária/complicações , Trombose Venosa/etiologia , Adulto , Anticoagulantes/uso terapêutico , Feminino , Humanos , Trombose Intracraniana/tratamento farmacológico , Mielofibrose Primária/genética , Trombose Venosa/tratamento farmacológico
14.
J Stroke Cerebrovasc Dis ; 29(8): 104948, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689630

RESUMO

BACKGROUND: Atrial fibrillation (AF) often leads to large vessel occlusions (LVO) which may necessitate endovascular thrombectomy (EVT). Whether the adequacy of treatment with oral anticoagulants (OAC) prior to LVO modifies outcomes remains unknown. PATIENTS AND METHODS: Consecutive EVT-treated LVO patients were recruited and the data was analyzed retrospectively. We combined patients with known AF that were untreated with OAC or inadequately treated with those with new-onset AF to form a group of undertreated-AF patients and compared them to adequately treated AF patients. RESULTS: Of the 230 patients included, 109 (47%) had AF (86 known AF, 23 new-onset AF). AF patients were significantly older and more often reached favorable recanalization but less often had favorable outcomes compared to those without AF. Most patients with known AF (76%) were inadequately treated at stroke onset. Patients with undertreated-AF more often received tPA prior to EVT (26% vs. 4% p=0.009), more often had favorable collaterals (65% vs. 33% p<0.001) and more often reached favorable outcomes (28% vs. 9%, p=0.047) compared to adequately treated AF patients. On multivariate analyses adequately treated AF did not impact survival (Odds Ration [OR] 0.89 95% Confidence Interval [CI] 0.23-3.43), chances for favorable recanalization (OR 0.57 95%CI 0.15-2.13) or favorable outcome (OR 5.95 95%CI 0.62-57.39). CONCLUSIONS: Treatment adequacy does not affect the rates of favorable functional outcome or survival in AF patients with LVO.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Procedimentos Endovasculares , Trombose Intracraniana/terapia , Acidente Vascular Cerebral/terapia , Trombectomia , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Trombectomia/efeitos adversos , Resultado do Tratamento
15.
AJNR Am J Neuroradiol ; 41(8): 1377-1379, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32554423

RESUMO

There is growing evidence that Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has a neurotropic and neuroinvasive potential. In particular, neurologic complications associated with the infection by SARS-CoV-2 include strokes that may result from a dysregulated inflammatory response to the infection. We report an atypical deep cerebral vein thrombosis complicated with hemorrhagic venous infarction in a patient positive for SARS-CoV-2 with no risk factors for thrombosis.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Hemorragias Intracranianas/etiologia , Trombose Intracraniana/etiologia , Pneumonia Viral/complicações , Trombose Venosa/etiologia , Idoso , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Trombose Intracraniana/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Imagem Multimodal , Pandemias , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem
16.
AJNR Am J Neuroradiol ; 41(8): 1370-1376, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32554424

RESUMO

Despite the severity of coronavirus disease 2019 (COVID-19) being more frequently related to acute respiratory distress syndrome and acute cardiac and renal injuries, thromboembolic events have been increasingly reported. We report a unique series of young patients with COVID-19 presenting with cerebral venous system thrombosis. Three patients younger than 41 years of age with confirmed Severe Acute Respiratory Syndrome coronavirus 2 (SARS-Cov-2) infection had neurologic findings related to cerebral venous thrombosis. They were admitted during the short period of 10 days between March and April 2020 and were managed in an academic institution in a large city. One patient had thrombosis in both the superficial and deep systems; another had involvement of the straight sinus, vein of Galen, and internal cerebral veins; and a third patient had thrombosis of the deep medullary veins. Two patients presented with hemorrhagic venous infarcts. The median time from COVID-19 symptoms to a thrombotic event was 7 days (range, 2-7 days). One patient was diagnosed with new-onset diabetic ketoacidosis, and another one used oral contraceptive pills. Two patients were managed with both hydroxychloroquine and azithromycin; one was treated with lopinavir-ritonavir. All patients had a fatal outcome. Severe and potentially fatal deep cerebral thrombosis may complicate the initial clinical presentation of COVID-19. We urge awareness of this atypical manifestation.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Trombose Intracraniana/etiologia , Pneumonia Viral/complicações , Trombose Venosa/etiologia , Adulto , Azitromicina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Pandemias , Pneumonia Viral/tratamento farmacológico , Ritonavir/uso terapêutico , Trombose Venosa/induzido quimicamente , Adulto Jovem
17.
Stroke ; 51(7): 2249-2254, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32539672

RESUMO

BACKGROUND AND PURPOSE: Delayed neurological deficits are a devastating consequence of subarachnoid hemorrhage (SAH), which affects about 30% of surviving patients. Although a very serious concern, delayed deficits are understudied in experimental SAH models; it is not known whether rodents recapitulate the delayed clinical decline seen in SAH patients. We hypothesized that mice with SAH develop delayed functional deficits and that microthrombi and infarction correlate with delayed decline. METHODS: Adult C57BL/6J mice of both sexes were subjected to endovascular perforation to induce SAH. Mice were allowed to survive for up to 1 week post-ictus and behavioral performance was assessed daily. Postmortem microthrombi, large artery diameters (to assess vasospasm), and infarct volume were measured. These measures were analyzed for differences between SAH mice that developed delayed deficits and SAH mice that did not get delayed deficits. Correlation analyses were performed to identify which measures correlated with delayed neurological deficits, sex, and infarction. RESULTS: Twenty-three percent of males and 47% of females developed delayed deficits 3 to 6 days post-SAH. Female mice subjected to SAH had a significantly higher incidence of delayed deficits than male mice with SAH. Mice that developed delayed deficits had significantly more microthrombi and larger infarct volumes than SAH mice that did not get delayed deficits. Microthrombi positively correlated with infarct volume, and both microthrombi and infarction correlated with delayed functional deficits. Vasospasm did not correlate with either infarction delayed functional deficits. CONCLUSIONS: We discovered that delayed functional deficits occur in mice following SAH. Sex differences were seen in the prevalence of delayed deficits. The mechanism by which microthrombi cause delayed deficits may be via formation of infarcts.


Assuntos
Comportamento Animal , Infarto Cerebral/etiologia , Trombose Intracraniana/etiologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/patologia , Animais , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL
18.
J Ayub Med Coll Abbottabad ; 32(1): 124-126, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468770

RESUMO

Behcet's disease (BD) presents as uncommon inflammatory disorder involving multiple systems, identified by longstanding relapsing path. Its chief manifestations are oral and genital ulcers together with involvement of the eyes, skin and joints. Neurological and vascular complications are significant. We report a case of a twenty-four years old young male who presented with headache, fever, and vomiting along with decreased vision; and repeated oral and genital ulcers. Diagnosis of BD complicated with cerebral venous thrombosis (CVT) was made. He was treated with corticosteroids, immunosuppression therapy and colchicine along with anticoagulation therapy. He responded well to the given treatment. Cerebral venous thrombosis complications in with BD can lead to serious consequences. Early recognition and treatment may lessen poor outcomes.


Assuntos
Síndrome de Behçet , Trombose Intracraniana , Adulto , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Humanos , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/etiologia , Masculino , Adulto Jovem
20.
World Neurosurg ; 139: 215-218, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32304887

RESUMO

BACKGROUND: The American Stroke Association and the European Stroke Organization have established guidelines on cerebral venous thrombosis (CVT); however, questions remain when an individual case does not fall within the inclusion criteria on which these guidelines are based. This is relevant when considering the use of anticoagulation in cases of CVT regarding whether or not associated hemorrhage is present and whether the hemorrhage is currently expanding. CASE DESCRIPTION: A 16-year-old right-handed female G2P2 (gravidity 2 [2 pregnancies] and parity 2 [2 live births after at least 24 weeks) presented 8 days postpartum with complaints of slurred speech, right facial droop, and right upper extremity numbness that had progressed over the course of 4 hours before presentation. On imaging the patient had a CVT with associated hemorrhage progressing in size at serial 6-hour stability computed tomography scans for 24 hours post arrival. At 24 hours the patient went into disseminated intravascular coagulation and demonstrated signs of herniation. The patient underwent an emergency hemicraniectomy along with a right frontal external ventricular drain for intracranial pressure monitoring. Most recently, the patient had a Glasgow Coma Scale score of 15 and had a modified Rankin Scale score of 4 and was ultimately discovered to have antiphospholipid syndrome. CONCLUSIONS: This case of CVT demonstrates the need for critically reading guidelines, as in this case the time to anticoagulation treatment was shorter than in cases included in guideline construction and repeated computed tomography examination demonstrated expansion suggesting it is unsuitable for immediate anticoagulation. Certain cases may fall outside of the study parameters on which guidelines are constructed, and clinicians should be aware of these exceptions.


Assuntos
Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/diagnóstico , Veias Cerebrais/diagnóstico por imagem , Craniectomia Descompressiva/métodos , Coagulação Intravascular Disseminada/diagnóstico , Hemorragias Intracranianas/diagnóstico por imagem , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Transtornos Puerperais/diagnóstico por imagem , Transtornos Puerperais/terapia , Adolescente , Síndrome Antifosfolipídica/complicações , Angiografia por Tomografia Computadorizada , Progressão da Doença , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/terapia , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/terapia , Trombose Intracraniana/etiologia , Guias de Prática Clínica como Assunto , Transtornos Puerperais/etiologia , Tomografia Computadorizada por Raios X , Ventriculostomia
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