1/14. Spontaneous internal carotid artery dissection.Once considered uncommon, spontaneous dissection of the carotid artery is an increasingly recognized cause of stroke, headache, cranial nerve palsy, or ophthalmologic events, especially in young adults. Even in the presence of existing signs and symptoms, the diagnosis can be missed by experienced physicians of all specialties. We report a case of spontaneous internal carotid artery dissection in a 38-year-old woman with a cortical stroke and visual disturbances as initial symptoms. The diagnosis was confirmed by magnetic resonance imaging/angiography and by angiography. Prompt anticoagulation was instituted, and the patient had complete resolution of symptoms. Cervicocephalic arterial dissection should be included in the differential diagnosis of the causes of cerebrovascular events.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. Detection of clinically silent infarcts after carotid endarterectomy by use of diffusion-weighted imaging.BACKGROUND AND PURPOSE: Intraprocedural transcranial Doppler sonography has identified multiple microembolic events during and immediately after carotid endarterectomy (CEA) or angioplasty, yet the rate of clinically evident stroke is small. To determine the significance of the transcranial Doppler sonography findings, we examined patients by use of diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging before and immediately after CEA for evidence of clinically silent ischemic events. methods: Twenty-five patients with atherosclerotic disease of the carotid arteries underwent diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging performed, on average, 3 days before and 12 hours after CEA. diffusion-weighted images were acquired in three orthogonal directions at b = 900. Pre- and postoperative neurologic examinations were performed by the same physician. RESULTS: After endarterectomy, 4.0% of the patients (one of 25 patients) showed a single, cortical focus of restricted diffusion and new fluid-attenuated inversion recovery hyperintensity, measuring <1 cm in diameter, ipsilateral to the CEA. The postoperative neurologic examination showed no change in status from the preoperative baseline state. This patient had an intraoperative course complicated by the development of a large luminal thrombus, necessitating thrombectomy. CONCLUSION: The use of diffusion-weighted imaging may serve to improve conspicuity of clinically silent infarcts after CEA. An important next step is to determine the risk factors that predispose to detectable parenchymal ischemic events.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. Adverse metabolic and cardiovascular risk following treatment of acute lymphoblastic leukaemia in childhood; two case reports and a literature review.We report two patients who survived childhood acute lymphoblastic leukaemia (ALL) following treatment with chemotherapy, total body irradiation (TBI) and bone marrow transplantation (BMT). The first case presented with an acute cerebral infarction at 23 years of age and was found to have non-ketotic diabetes and gross mixed hyperlipidaemia; the second presented with non-ketotic diabetes, hypertension, proteinuria and dyslipidaemia at age 16 years. The association of glucose intolerance with other vascular risk factors in young adult survivors of BMT was recently highlighted in a follow-up study of 23 survivors of BMT [1], but none presented with such gross mixed hyperlipidaemia. The improving survival rates of childhood malignancy over the last two decades will present adult physicians with patients who have accelerated vascular risk at a young age who will require early treatment to modify it.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. diffusion-weighted MRI as a screening tool of stroke in the ED.This report describes a novel imaging technology for the evaluation of stroke patients. diffusion-weighted magnetic resonance imaging can visualize hyperacute ischemic stroke which cannot be seen on computed tomography; moreover, it only takes few minutes to scan. We believe that diffusion-weighted magnetic resonance imaging, rather than routine computed tomography, should be considered when the emergency physician evaluates a patient with acute ischemic stroke.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. Emergency department presentation of pediatric stroke.Pediatric stroke is not a common occurrence. When compared with adults, the pediatric population has a much more diverse group of risk factors, and while numerous rare congenital disorders are possible, most known etiologies are cardiac, vascular, or hematologic. The emergency department (ED) presentation of pediatric stroke does not differ greatly from that of adults, although posterior circulation ischemia is less common, and neurologic findings may be more difficult to recognize. ED treatment is also largely the same, with an attention to resuscitation and avoidance of hypoxia, hypotension, hyperthermia, and changes in blood sugar. Use of specialized agents such as aspirin and heparin should be considered in certain cases. It is important for the emergency physician to recognize acute neurologic events in pediatric patients to minimize complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. Radiological and clinical features of basal ganglia infarction in tuberculous meningitis.A patient with choreoathetosis and dystonia who had computerized tomography evidence of basal ganglia damage resulting from tuberculous meningitis is presented. It is important to distinguish these extrapyramidal movements from fits, and the observation of such movements in a clinical setting of meningitis should alert physicians to the diagnosis of tuberculous meningitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. Altered mental status in the elderly.Misdiagnosis of treatable dementia in the aged is costly to society and the family, and is unmeasurable in personal tragedy. The 4 Ds of the elderly--dementia, depression, delirium, and delusion--are discussed. family physicians are encouraged to seek out treatable disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. Carotid injury and cerebral infarction in a revascularization hand injury case.A case of internal carotid artery thrombosis with cerebral infarction occurring in a patient with a massive hand injury is presented. In this case it can be postulated that the mechanism of injury was that of traction of the carotid during the patient's attempts at release of an immobilized extremity. Although the diagnosis of such an injury is difficult, the knowledge that such injuries occur and a suspicion of the examining physician at the time of the initial examination may help avoid such problems in the future.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. cerebrospinal fluid pleocytosis following hemorrhagic cerebral infarction.A polymorphonuclear pleocytosis of the cerebrospinal fluid is an occasional occurrence following hemorrhagic cerebral infarction. Because the peak of this neutrophilic reaction occurs 3 to 4 days after the event it is usually missed and not widely appreciated. We have described an example of this response in an attempt to alert physicians to an important differential diagnostic consideration when faced with a neutrophilic CSF pleocytosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Nonhemorrhagic pontine infarct in a child following mild head trauma.A child who presented with hemiparesis secondary to a delayed non-hemorrhagic pontine infarction following mild head trauma is described. The results of the child's workup, including computed tomography (CT), were negative. The diagnosis of nonhemorrhagic pontine infarct was made by magnetic resonance imaging (MRI). The diagnostic evaluation excluded other possible etiologies of cerebral infarction, including vasculitides, CNS infection, congenital heart disease, hypercoagulable states, and demyelinating diseases. Although trauma cannot be proven as the cause of the infarct, other known causes of infarct were excluded. There are few cases of traumatic nonhemorrhagic cerebral infarction among children in the literature; none describes diagnostic MRI findings. MRI is important in these cases, because it may reveal delayed infarction from small-vessel injury, which is not apparent on CT. This article discusses the etiology of and the diagnostic evaluation of pediatric cerebrovascular accidents and suggests the need for emergency physicians to consider trauma as a potential cause of delayed nonhemorrhagic cerebral infarct in children.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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