1/19. Disseminated zygomycosis due to rhizopus schipperae after heatstroke.A 21-year-old woman suffered heatstroke and developed diarrhea while trekking across south texas. The heatstroke was complicated by seizures, rhabdomyolysis, pneumonia, renal failure, and disseminated intravascular coagulation. The patient's stool and blood cultures grew campylobacter jejuni. The patient subsequently developed paranasal and gastrointestinal zygomycosis and required surgical debridement and a prolonged course of amphotericin b. The zygomycete cultured was rhizopus schipperae. This is only the second isolate of R. schipperae that has been described. R. schipperae is characterized by the production of clusters of up to 10 sporangiophores arising from simple but well-developed rhizoids. These asexual reproductive propagules are produced on Czapek Dox agar but are absent on routine mycology media, where only chlamydospores are observed. Despite multiorgan failure, bacteremia, and disseminated zygomycosis, the patient survived and had a good neurological outcome. Heatstroke has not been previously described as a risk factor for the development of disseminated zygomycosis.- - - - - - - - - - ranking = 1keywords = heat, stroke (Clic here for more details about this article) |
2/19. Acute dissecting thoracic aortic aneurysm presenting with stroke, consumptive coagulopathy, and gastrointestinal hemorrhage.We report the case of a 70-year-old man who had an acute dissection of a previously undiagnosed thoracic aortic aneurysm. The diagnosis was challenging because of the neurologic and hematologic complications that overwhelmed the clinical presentation. Three simultaneous complications of thoracic aortic aneurysm with dissection (ischemic stroke, consumption coagulopathy, and superior mesenteric infarction with gastrointestinal hemorrhage) made the case unique and the diagnosis difficult.- - - - - - - - - - ranking = 0.13720220879731keywords = stroke (Clic here for more details about this article) |
3/19. Expression of interleukin-6 in cerebral neurons and ovarian cancer tissue in Trousseau syndrome.interleukin-6 (IL-6) is reportedly increased in serum and CSF from acute stroke patients. However, the cellular origin and possible role of IL-6 in CNS after stroke are unclear. We describe a woman with recurrent stroke, disseminated intravascular coagulation (DIC) and non-bacterial thrombotic endocarditis (NBTE) caused by ovarian cancer (Trousseau syndrome). The patient died 50 days after the final episode of cerebral embolism. The immunohistochemical study revealed IL-6 protein to have been expressed both in cerebral neurons spared from ischemic insult and in epithelial cells of the ovarian tumor. We speculate that IL-6 produced in ovarian cancer may be associated with the hypercoagulable state and the development of NBTE in this patient. In contrast, IL-6 induction in cerebral neurons may contribute to the survival of these neurons after a stroke.- - - - - - - - - - ranking = 0.10976176703785keywords = stroke (Clic here for more details about this article) |
4/19. Cerebrovascular complications in patients with malignancy: report of three cases and review of the literature.A cerebrovascular thromboembolic event may precede the identification of cancer, and be the first clinical evidence of an underlying malignancy. The malignancy can cause either nonbacterial thrombotic endocarditis or hypercoagulable state, both of which may have clinical manifestions such as thrombotic or embolic occlusion of multiple major cerebral vessels. We present three cases with unusual cerebrovascular events. The first case is a 62-year-old woman who was admitted due to acute left limbs weakness and consciousness disturbance. brain computed tomographic (CT) scan showed right middle cerebral artery (MCA) and posterior cerebral artery (PCA) infarctions with uncal herniation. The second case is a 44-year-old woman who was hospitalized due to acute bilateral limb weakness and consciousness disturbance. Bilateral MCA, left PCA, anterior cerebral artery (ACA) infarctions and deep vein thrombosis in the left leg were diagnosed. The third case is a 63-year-old man who developed sudden onset of right hemiplegia and consciousness disturbance. brain CT scan showed bilateral MCA and left ACA infarction. The results of a series of examinations including biochemistry, lipid profile, carotid duplex, and transthoracic and transesophageal echocardiography were unremarkable. All patients had positive disseminated intravascular coagulation (DIC) tests with elevated D-dimers and fibrinogen degradation products (FDP). Further systemic evaluation for malignancy revealed ovarian cancer in the first patient, endometrial carcinoma in the second patient, and adenocarcinoma of lung in the third patient. They all died of the underlying malignancy. Because the hemostatic system can be altered by malignancy, intravascular coagulation abnormalities of these malignancy-related strokes may be disclosed by laboratory assays of hemostasis.- - - - - - - - - - ranking = 0.027440441759462keywords = stroke (Clic here for more details about this article) |
5/19. Elevated serum beta-D-glucan level and depressed neutrophil phagocytosis in a heatstroke patient.endotoxemia has been reported as a mechanism for the fatal sequela after heatstroke. Subsequent disseminated fungal infection in a heatstroke patient has been also described. Beta-D-glucan, a constituent of the fungal cell wall, is an early diagnostic measure for fungal infection. In a heatstroke case, we examined for the first time levels of serum beta-d-glucan and endotoxin. A 34-year-old man with a body temperature of 43.5 degrees C was admitted in a state of shock. Prior to the development of disseminated intravascular coagulopathy (DIC), a remarkable elevation of serum beta-D-glucan level to 116 pg/mL (normal level<6.0 pg/mL) was revealed on the first day of admission. However, serum endotoxin was not detected when using a method that excluded beta-D-glucan contamination from endotoxin measurement (normal level<1.0 pg/mL). This change of beta-D-glucan level was accompanied by a depressed neutrophil function, especially in phagocytosis of 34% (normal range 70-90%) but not in bacterocidal function (81% versus a normal range of 70-100%). After intensive care including continuous hemodiafiltration, the patient regained consciousness but remained ataxic due to cerebellar infarction, which might have resulted from DIC, and subsequent bilateral fungal oculitis were revealed 45 days after admission. This case report demonstrates the elevation of serum beta-D-glucan but normal endotoxin levels after heatstroke, which may prompt further study to re-examine the serum levels of endotoxin in such catastrophic insults.- - - - - - - - - - ranking = 1.296746077654keywords = heat, stroke (Clic here for more details about this article) |
6/19. disseminated intravascular coagulation as a complication of radiofrequency catheter ablation of atrial fibrillation.Since Haissaguerre and his colleagues demonstrated the importance of the pulmonary veins in the generation of atrial fibrillation (AF) in 1998, a variety of different ablative interventions have been performed to eliminate AF. Various complications related to catheterization, ablation itself including pulmonary vein stenosis, pericardial effusion, stroke, and atrioesophageal fistula have been reported. disseminated intravascular coagulation (DIC) is a systemic syndrome characterized by enhanced activation of coagulation with some intravascular fibrin formation and deposition. This is the first report, to our knowledge, of a patient whose condition was complicated by DIC after segmental ostial isolation of pulmonary veins for persistent AF. The patient has completely recovered from the DIC by hemodialysis, administration of blood constituents for 15 days.- - - - - - - - - - ranking = 0.027440441759462keywords = stroke (Clic here for more details about this article) |
7/19. Occlusion of the carotid artery as presenting symptom of acute promyelocytic leukemia.In a 44-year-old female acute promyelocytic leukemia (APL) presented with abrupt onset of right hemiplegia and aphasia due to occlusion of the left carotid artery at bifurcatio. There was laboratory evidence of disseminated intravascular coagulation (DIC). Thrombotic complications are unusual in APL, even in cases with evidence of DIC. This report aims at underlying the important implication of a correct timely diagnosis in young patients presenting with stroke.- - - - - - - - - - ranking = 0.027440441759462keywords = stroke (Clic here for more details about this article) |
8/19. heat stroke following Rugby League football.OBJECTIVE: To present a case of severe heat stroke after Rugby League football. CLINICAL FEATURES: A 29-year-old Rugby League forward with a mild infection of the upper respiratory tract collapsed while playing football in late March, when the ambient temperature was 24.1 degrees C and the relative humidity up to 73%. He was initially thought to have sustained a head injury and was markedly dehydrated. He suffered severe disseminated intravascular coagulation and gross neurological, renal and hepatic disturbances. INTERVENTION AND OUTCOME: He required repeated haemodialysis, assisted ventilation and supportive therapy and remained unconscious for 10 days. He then recovered fully. CONCLUSION: heat stroke is potentially fatal and can be easily mistaken for head injury in contact sports. When players are dehydrated, have febrile illness and play in warm conditions, they may succumb to heat stroke.- - - - - - - - - - ranking = 19.591861108664keywords = heat stroke, heat, stroke (Clic here for more details about this article) |
9/19. False-positive reaction for fibrin degradation products due to a monoclonal (IgM lambda) cryoglobulin with warm-reactive antibody activity for rabbit IgG.The serum of a patient with prolymphocytic leukemia and a hyperviscosity syndrome contained high levels of IgM, with a monoclonal peak on protein electrophoresis, and had a high titer for fibrin(ogen) degradation products, using a rabbit anti-fibrinogen reagent, without other evidence for disseminated intravascular coagulation. A monoclonal IgM lambda cryoglobulin was identified. It retained reactivity with the fibrin(ogen) degradation products reagent, but failed to react with human IgG by latex fixation. Binding activity for rabbit IgG (and absence of binding activity for human, goat, and bovine IgG) was also demonstrable by double diffusion in agarose, and by enzyme-linked immunoassay. By enzyme-linked immunoassay, binding of both F(ab)2 and Fab and, to a lesser extent, Fc fragments of rabbit IgG was found. Increased binding of heat-denatured rabbit IgG was observed, without inhibition by similarly denatured IgG of other species. The false-positive fibrin(ogen) degradation products reaction in the serum of this patient was due to a unique monoclonal IgM lambda cryoglobulin with warm-reactive antibody activity for an epitope displayed on native and denatured rabbit IgG, but absent on native or denatured human, goat, or bovine IgG, and present in both F(ab)2 and Fc regions of the IgG molecule.- - - - - - - - - - ranking = 0.13465281794729keywords = heat (Clic here for more details about this article) |
10/19. Fatal thermal injury.Two fatal cases of thermal injury are described, one of which was the result of heat stroke and the other was the result of the uncommon condition, neuroleptic malignant syndrome. The clinical profiles, management and post-mortem findings of these two separate conditions are compared to highlight their important differences.- - - - - - - - - - ranking = 9.7273294499332keywords = heat stroke, heat, stroke (Clic here for more details about this article) |
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