Bilateral Infarction Research Articles

Clinical features of two cases of bilateral medial medullary infarction

Clinical features of two cases of bilateral medial medullary infarction

Bilateral precentral gyrus infarction in a patient with patent foramen ovale: A case report

Bilateral precentral gyrus infarction in a patient with patent foramen ovale: A case report

Case of ischemic stroke with reccurent hypoglycemia in pregnant woman during the period of pregnancies

Background: We report a rare case, 30 years-old woman 12 weeks of her first pregnancy admit to emergency department Immanuel Hospital with impaired of conciousness for 3 days, laboratory finding present hypoglycaemia, after four days there was paraparetic, CT scan finding bilateral infarction.

Post traumatic vertebro basilar dissection: case report and review of literature

Abstract Posterior circulation territory stroke following mild head injury is a known entity although rarely seen. Numerous case reports appear in literature from time to time highlighting this complication. Blunt trauma to the head and neck possibly causes injury to the vertebrobasilar system in the form of angiorrhexis, subintimal, intramural and perivascular hemorrhage which causes secondary narrowing of the injured vessel. These processes can be complicated by progressive thrombosis & vascular occlusion. Here we are reporting a case of post traumatic vertebra-basilar dissection causing bilateral cerebellar and brainstem infarct.

Acute Paraplegia with Cognitive Alterations After Bilateral Infarcts in Cerebral Small Vessel Disease.

Cerebral small vessel disease (SVD) affects the small arteries, arterioles, venules and capillaries in the brain and can be identified clinically and/or radiologically. We describe the case of a 71-year-old man with sporadic cerebral SVD who presented with acute paraplegia with urinary incontinence and recent cognitive impairment that developed after the occurrence of ischaemic lesions.LEARNING POINTSCerebral small vessel disease (SVD) is extremely common and can mimic severe injury of lower motor neurons.Newer imaging techniques have significantly helped in the diagnosis of SVD.A combination of bilateral motor and/or sensory deficits located only in the lower limbs should raise the possibility of the bilateral deep lesions that can be observed in cerebral SVD.

Amnesia due to Bilateral Fornix Infarction

Amnesia due to Bilateral Fornix Infarction

The cause of the stroke: a diagnostic uncertainty

A 39-year-old man with a history of sickle cell disease (SCD) presented with left leg weakness. He had a normal CT head and CT angiogram, but MRI head showed multiple...

Bilateral Calvarial Infarctions That Lead to Epidural Hematomas in a Patient With Sickle Cell Disease

Bilateral Calvarial Infarctions That Lead to Epidural Hematomas in a Patient With Sickle Cell Disease

Epidemiology, Clinical Presentation, and Prognosis of Posterior Circulation Ischemic Stroke in Children

BackgroundAnterior and posterior circulation strokes are often different in terms of presentation and recurrence risk, but there are few studies that focused on posterior circulation stroke. MethodsWe performed a longitudinal retrospective study of children, birth to 18 years, with posterior circulation ischemic stroke at the Children's Hospital Winnipeg from January 1992 to December 2012. Clinical and radiological features and outcomes were collected using standardized tools. ResultsOf the 158 children with arterial ischemic stroke, 23 (14.5%) children, 21 non-neonates, and 11 males were identified. For posterior circulation ischemic stroke, mean crude incidence of 0.38 and crude mortality rate of 0.11 per 100,000 person-years was estimated. The crude total period prevalence rate for the study period was estimated as 8.1 per 100,000 children. Nonspecific symptoms before stroke presentation were present in 38% and impaired consciousness in 71%. Identifiable risk factors were present in two thirds: vasculopathy 24%, infection 19%, trauma 14%, and congenital heart disease 9.5%. Average Pediatric National Institutes of Health Stroke Scale score at presentation was 11. Poor outcome was noted in 45%. Outcome did not change significantly between 12 and 24 months. Aboriginal ethnicity (P = 0.01), high Pediatric National Institutes of Health Stroke Scale score (P = 0.001), bilateral infarction (P = 0.001), and large caliber artery territory infarction (P = 0.02) predicted poor outcome. ConclusionsOur hospital-based incidence and outcome data provide valuable information to help direct treatment strategies and prognosticate children with posterior circulation ischemic stroke. Our study calls for close observation and early management of children with posterior circulation stroke, in particular with aboriginal ancestry and bilateral and large artery territory infarction.

Cardiac tumor with simultaneous embolization to the heart and brain: Presenting with acute myocardial infarction and cerebral infarction

This report describes a 60 years old hypertensive and diabetic woman presenting with acute anterior myocardial infarction accompanied by electrocardiographic changes and raised cardiac enzymes. Her coronary angiography revealed a distal left anterior descending artery block; but at this stage the patient rapidly developed unconsciousness with loss of movement in all 4 limbs. Magnetic resonance imaging of the brain revealed massive multiple bilateral infarcts and transthoracic echocardiography subsequently done demonstrated a large mobile mass in the left atrium that prolapsed into the mitral annulus. This mass was heterogeneous with a satellite nodule. The patient had to be shifted to the intensive care unit where she initially required endotracheal intubation and temporary mechanical ventilation. The patient continues to be in coma and is being managed conservatively in the intensive care unit as the attendant refused to give consent for surgical removal of the left atrial tumor. There are less than a handful case report narrating simultaneous acute anterior myocardial and bilateral large cerebral infarctions subsequent to embolization from a probable left atrial myxoma.

Bilateral cerebral embolism as a characteristic feature of patients with Trousseau syndrome

Trousseau syndrome is defined as a variant of intravascular thromboembolism that is induced by cancer. It may manifest itself as cerebral embolisms in some cases; however, when the cancer is not diagnosed, this identification may be difficult. Therefore, cerebral embolisms are often treated without identifying the cancer, which can worsen a patient’s condition. The purpose of this study was to determine the differences in clinical features between cerebral embolisms induced by cancer (Trousseau syndrome) and those that are due to other causes, such as cardiogenic embolisms and artery-to-artery stroke. A total of 83 patients, admitted to our hospital between April 2005 and March 2013 with cerebral embolisms, were included in this study. Of these, 9 (10.8%) were diagnosed with Trousseau syndrome, 63 (75.9%) had cardiogenic embolisms and 11 (13.2%) had artery-to-artery embolisms. Patients with embolic stroke of undetermined source (ESUS) were excluded from the study. We retrospectively investigated the localization of the infarctions, cancer type, and pathology, and the levels of primary fibrin/fibrinogen degradation products (FDP). From the nine patients with Trousseau syndrome, eight had adenocarcinomas and all had elevated initial FDP. Bilateral cerebral embolisms were significantly more common in Trousseau syndrome patients than cardiogenic embolisms (P=0.00026) and artery-to-artery embolisms (P=0.0016). All of them contained microembolisms as observed by magnetic resonance imaging (MRI). This study suggests that bilateral infarctions presenting microembolisms are important features of cerebral embolism attributed to Trousseau syndrome.

Isolated bilateral globus pallidus infarcts in a patient with aortic dissection and Nitroprusside-induced hypotension: A case report (P5.043)

Isolated bilateral globus pallidus infarcts in a patient with aortic dissection and Nitroprusside-induced hypotension: A case report (P5.043)

Bilateral Chronic Subdural Hematoma and Blindness: Bilateral Infarction to the Posterior Cerebral Artery following Evacuation of Bilateral Chronic Subdural Hematoma — A Rare Case Report and Review of Literature

Objective The authors report a rare scenario in which evacuation of bilateral chronic subdural hematoma (CSDH) was followed by bilateral PCA infarction and blindness. A literature review was also conducted, which revealed only four cases of blindness after CSDH evacuation. Methods A 45-year-old man was admitted with the chief complaint of holocranial headache for 2 months with past history of head trauma. Clinical examination was normal. CT and MRI scanning showed bilateral frontotemperoparietal CSDH without midline shift and parenchymal and vascular abnormality. Bilateral frontal and parietal burr holes and evacuation of CSDH was done. Results The patient developed progressive blindness in both the eyes in the postoperative period. MRI revealed bilateral PCA infarction. Discussion Bilateral PCA infarction following bilateral CSDH evacuation is an extremely rare entity. Only four case of blindness following CSDH evacuation have been reported so far, and all the patients suffered permanent visual loss. The exact etiopathogenesis and mechanism of this rare complication remain unknown. Conclusion Bilateral CSDH is a separate entity with altered pathophysiology and deranged cerebral autoregulation. The authors conclude that Bilateral CSDH may be sentinel tags for bilateral PCA infarction secondary to altered hemodynamics in the posterior circulation, and hence, needs to be evaluated and treated with greater diligence.

Detection of crossed cerebellar diaschisis in hyperacute ischemic stroke using arterial spin-labeled MR imaging.

Background and purposeArterial spin-labeling (ASL) was recently introduced as a noninvasive method to evaluate cerebral hemodynamics. The purposes of this study were to assess the ability of ASL imaging to detect crossed cerebellar diaschisis (CCD) in patients with their first unilateral supratentorial hyperacute stroke and to identify imaging or clinical factors significantly associated with CCD.Materials and methodsWe reviewed 204 consecutive patients who underwent MRI less than 8 hours after the onset of stroke symptoms. The inclusion criteria were supratentorial abnormality in diffusion-weighted images in the absence of a cerebellar or brain stem lesion, bilateral supratentorial infarction, subacute or chronic infarction, and MR angiography showing vertebrobasilar system disease. For qualitative analysis, asymmetric cerebellar hypoperfusion in ASL images was categorized into 3 grades. Quantitative analysis was performed to calculate the asymmetric index (AI). The patients’ demographic and clinical features and outcomes were recorded. Univariate and multivariate analyses were also performed.ResultsA total of 32 patients met the inclusion criteria, and 24 (75%) presented CCD. Univariate analyses revealed more frequent arterial occlusions, higher diffusion-weighted imaging (DWI) lesion volumes and higher initial NIHSS and mRS scores in the CCD-positive group compared with the CCD-negative group (all p < .05). The presence of arterial occlusion and the initial mRS scores were related with the AI (all p < .05). Multivariate analyses revealed that arterial occlusion and the initial mRS scores were significantly associated with CCD and AI.ConclusionASL imaging could detect CCD in 75% of patients with hyperacute infarction. We found that CCD was more prevalent in patients with arterial occlusion, larger ischemic brain volumes, and higher initial NIHSS and mRS scores. In particular, vessel occlusion and initial mRS score appeared to be significantly related with CCD pathophysiology in the hyperacute stage.

Intravascular T-cell lymphoma in a patas monkey (Erythrocebus patas).

A 9-year-old female captive patas monkey (Erythrocebus patas) presented with poor general condition, inability to stand, petechiae, anaemia, thrombocytopenia, and leukocytosis. Due to poor response to treatment, the animal was euthanized 16 days later. Postmortem examination revealed hemorrhages in several organs and bilateral cerebral infarctions. Histologically, prominent accumulations of large neoplastic lymphocytes in cerebral and meningeal blood vessels were demonstrated within the lesions and in other organs (e.g., bone marrow, ovary, intestine). Immunohistochemically, neoplastic cells expressed CD3 and Ki-67. PCR revealed a lymphocryptovirus (LCV) infection, while Epstein–Barr nuclear antigen 2 (EBNA2) could not be demonstrated within neoplastic cells by means of immunohistochemistry. Based on the pathological findings, an intravascular lymphoma (IVL) of T-cell origin was diagnosed. To the authors' knowledge, this is the first report on this rare entity in a nonhuman primate.

Late onset of bilateral cerebral infarction following Russell’s viper (&lt;em&gt;Daboia russelii&lt;/em&gt;) bite

Correction: On 8th February 2017, the authors of this paper were changed from RMMK Rathnayaka and PEA Ranathunga TO RMMKN Rathnayaka and PEAN Ranathunga. The title of the paper was also amended from ' Daboia russelli ' TO ' Daboia russelii '. A 53yr old male patient presented with a history of Russell’s viper bite to his right side leg. He developed acute kidney injury (AKI) and respiratory failure and intubated and given ICU care. On day 21 of snake bite he was found to have left side weakness of body and revealed bilateral cerebral infarction in CT brain. However the patient died 26th day of snake bite due to complications of acute ischemic stroke and AKI. This is one of rare complications of snake bite and the late onset of cerebral infarction following Russell’s viper bite which was not previously documented.

Abstract WMP113: Headache At Stroke Onset Is Present In Half Of All Older Children With Arterial Ischemic Stroke

Introduction: Headache at stroke onset occurs in up to a quarter of adults and is associated with younger age, female gender, right hemisphere and cerebellar infarcts. Little is known about headache at stroke onset in children. Methods: Children (29 days-18 years) with clinical and radiographic confirmation of arterial ischemic stroke were prospectively enrolled in the International Pediatric Stroke Study from 2003-2014. Details regarding demographics, stroke presentation and infarct location were obtained from the multi-center, pediatric stroke registry. Headache at stroke presentation was classified and annotated in the registry by the individual site investigators as present, absent or unclear. Results: We analyzed 2103 children. Half of all subjects ≥ 6 yo reported headache at stroke onset (N=509/1047, 49%; Figure). Headache was less prevalent in children &lt; 6 yo (N=112/1056, 11%; p&lt;0.001), though headache presentation was more commonly classified as unclear (10% vs 32%; p&lt;0.001). In children ≥ 6 yo, headache was significantly associated with papilledema (p = 0.03) and vertigo (p = 0.01), but not with hemiparesis (p = 0.11), visual field deficit (p = 0.90), aphasia (p = 0.35), dysarthria (p = 0.44), or ataxia (p = 0.50). Headache was more common in posterior than anterior circulation infarcts (p&lt;0.001). There was a significant association between headache and right or bilateral hemisphere infarcts (p = 0.04) but not with gender (p = 0.76). Conclusion: Headache is more prevalent in children than adults at stroke ictus and shares similar associations, including infarcts involving the posterior circulation and right hemisphere. Headache may be under-reported in young infants and children due to pre-verbal stages of development. These findings have implications for early identification and treatment of pediatric stroke and warrant further investigation in prospective studies to distinguish stroke from more common benign mimics, including migraine.

Papillary fibroelastoma of the aortic valve presenting with chronic angina and acute stroke: a case report

BackgroundPapillary fibroelastomas are rare, benign cardiac tumors that are often found on cardiac valvular surfaces. Most are incidental discoveries during surgery or autopsy. The clinical presentation of fibroelastoma varies widely, ranging from clinically asymptomatic to severe thromboembolic events.Case presentationWe report a case of 65-year-old white man diagnosed with scattered, bilateral acute cerebral hemisphere infarcts with a history of chronic angina. Transesophageal echocardiography identified a fibroelastoma on the right coronary cusp of the aortic leaflet. Cardiac catheterization revealed mild non-obstructive stenosis. We postulate that the etiology of his angina is related to the dynamic occlusion of his right coronary ostium by the fibroelastoma.ConclusionsTo the best of our knowledge, this is the first case report describing a patient with a cardiac papillary fibroelastoma who presented with both chronic angina and acute stroke.

Ekstazi Kullanımına Bağlı Bilateral Renal Enfarktüs

Ekstazi Kullanımına Bağlı Bilateral Renal Enfarktüs

Compromiso cerebrovascular agudo en síndrome hemolítico urémico: descripción de dos casos pediátricos

To report two pediatric cases of D+HUS with severe neurological involvement due to cerebrovascular disease, and review available literature. Two previously healthy 15- and 21-month-old children debuted with seizures and impairment of consciousness within the first week of a D+HUS. Both presented hypertension, severe acute renal failure, and focal motor deficit. One child showed significant improvement in neurologic status after five sessions of plasmapheresis. Brain magnetic resonance showed in the first child multiple bilateral infarcts of small vessels and lesions of white matter. In the second patient, large bilateral infarcts on both middle cerebral arteries territories were identified. One year after the acute event, both children showed functional impairment; The first patient evolved with language delay and spastic hemiparesis; the second patient with spastic quadriparesis, epilepsy with poor seizure control and marked functional impairment. Although most of the children with D+HUS and brain involvement do not have long-term sequelae, cerebrovascular disease in the acute period causes permanent damage, and in addition to the management of electrolyte disturbances, hypertension, and renal failure, therapies directed at specific pathophysiological mechanisms that trigger vascular compromise may improve prognosis.