1/8. Transcatheter snare removal of acute middle cerebral artery thromboembolism: technical case report.OBJECTIVE AND IMPORTANCE: We describe the case of a patient in whom a snare designed for the removal of foreign bodies was successfully used to retrieve a thromboembolism from the middle cerebral artery. This technique can be used to reestablish blood flow when maximal pharmacological therapies have failed. CLINICAL PRESENTATION: A 38-year-old man with scrotal squamous cell carcinoma presented with the abrupt onset of left hemiparesis and numbness. Computed tomography of the head showed no hemorrhage or hypodensity, and right middle cerebral artery thrombosis was suspected. INTERVENTION: cerebral angiography demonstrated a near-total occlusion of the right middle cerebral artery at the M1-M2 junction. The administration of intra-arterial urokinase, systemic heparin, and systemic abciximab, and mechanical maceration failed to lyse the clot. A 4-mm goose-neck snare was guided through a microcatheter, and the clot was snared and withdrawn. Immediate postoperative angiography demonstrated the reconstitution of normal flow. Pathological examination of the snared material was consistent with clot. By postoperative Day 5, the patient had regained full strength, except for the fingers of the left hand, which remained moderately weak. Computed tomography demonstrated a right insular and extreme capsular infarct. CONCLUSION: To our knowledge, this is the first reported use of a snare to remove clot in the setting of thromboembolic stroke. As the use of intra-arterial thrombolysis increases, transcatheter snare removal of pharmacologically resistant clot may be considered as a salvage strategy.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
2/8. Isolated non-compaction of the left ventricle: a rare indication for transplantation.This report describes the diagnostic difficulty encountered in a young female patient presenting with neurologic symptoms, atrial fibrillation and severe left ventricular systolic dysfunction, eventually leading to cardiac transplantation. The scrutiny used in the evaluation of the particular aspect of the left ventricle, and the integration of the information obtained from echocardiography, angiography and magnetic resonance imaging, led to the diagnosis of a rare and mostly unknown cause of cardiac failure. The correct identification of this entity is mandatory because enhanced risk of thromboembolism and malignant arrhythmia should be anticipated. A review of the literature revealed only 6 patients in whom isolated non-compaction of the left ventricle was treated by heart transplantation.- - - - - - - - - - ranking = 0.2keywords = thromboembolism (Clic here for more details about this article) |
3/8. Small aneurysms as a cause of thromboembolic stroke.OBJECTIVE AND IMPORTANCE: A small percentage of patients with intracranial aneurysms present with embolic stroke distal to the site of the aneurysm. Thromboembolism typically occurs in large or giant aneurysms where reduction of flow within the aneurysm is thought to increase the possibility of clot formation. Only a few examples are available in the literature of patients with smaller aneurysms who develop embolic infarction distal to the lesion. We have experience with two such patients with an apparent common pathophysiology. CLINICAL PRESENTATION: Patient 1 with a distal left middle cerebral artery infarct was found to have an 18 mm carotid artery bifurcation aneurysm (patient age 49 years). Patient 2 had a 7 mm right middle cerebral artery aneurysm with a small distal embolus (patient age 65 years). At surgery both patients were found to have atherosclerotic disease involving the aneurysm base and parent vessel. In each instance, the aneurysm was opened during temporary vessel occlusion and microendarterectomy was performed. Occlusion of one of the major arterial branches exiting the aneurysm was also present with anterior cerebral artery occlusion in the case of ICA bifurcation lesion and MCA branch occlusion in the case of the MCA aneurysm. Both patients made a good recovery following surgery. CONCLUSION: In small aneurysms with atherosclerotic disease distal thromboembolism may occur. Surgical treatment with microendarterectomy is appropriate to prevent further emboli and potential for subarachnoid hemorrhage. (Fig. 5, Ref. 16.)- - - - - - - - - - ranking = 0.2keywords = thromboembolism (Clic here for more details about this article) |
4/8. A case of pregnancy with a history of paradoxical brain embolism.brain embolisms in younger persons are rare but are often caused by a paradoxical embolism, the embolic entry of a venous thrombus into the systemic circulation through a right-to-left shunt. A 27-year-old pregnant woman presented with hemiplegia that had been treated with an antiplatelet agent since the occurrence of a paradoxical brain embolism via the pulmonary arteriovenous fistula. A tendency of hypercoagulation is generally observed during pregnancy, so a patient with this condition has a strong risk factor for venous thromboembolism during pregnancy and even more so for arterial thromboembolism under the intense strain of labor, which is much stronger than that of the valsalva maneuver. This case had been controlled well with an antiplatelet agent and an anticoagulant while the levels of coagulation and fibrinolytic factors were monitored and was followed by a successful pregnancy outcome.- - - - - - - - - - ranking = 0.4keywords = thromboembolism (Clic here for more details about this article) |
5/8. Trousseau's syndrome related to adenocarcinoma of the colon and cholangiocarcinoma.Malignancy-related thromboembolism, so-called Trousseau's syndrome, can present as acute cerebral infarction, non-bacterial thrombotic endocarditis (NBTE) and migratory thrombophlebitis. It is usually attributed to a cancer-related hypercoagulable state, chronic disseminated intravascular coagulopathy (DIC), or tumour embolism. We report on two patients with adenocarcinoma of the colon and cholangiocarcinoma who developed widespread thromboembolism during disease progression. Both did poorly despite aggressive institution of anticoagulation therapy. These cases emphasize that cerebral infarction or refractory thromboembolism in cancer-treated patients should prompt investigation for recurrent or metastatic disease or progression of the underlying malignancy. Optimal treatment remains to be established.- - - - - - - - - - ranking = 0.6keywords = thromboembolism (Clic here for more details about this article) |
6/8. Bithalamic infarcts: embolism of the top of basilar artery or deep cerebral venous thrombosis?Bithalamic infarcts are usually attributed to thromboembolism of the top of the basilar artery. However, in some cases, deep cerebral venous thrombosis and thrombosis of cerebral venous sinuses was proved to be the cause. The case of a 47-year-old female with ischemic thalamic and mesencephalic lesions is reported, that was attributed to thrombosis of internal cerebral veins. In cases of bithalamic infarcts, apart from the top of the basilar artery syndrome, deep cerebral venous thrombosis should be taken into consideration. neuroimaging findings such as generalized cerebral edema, multiple infarcts or hemorrhages, hyperdense appearance of cerebral sinuses or veins and filling defects in the cerebral venous sinuses in contrast-CCT, can lead to the proper diagnosis.- - - - - - - - - - ranking = 0.2keywords = thromboembolism (Clic here for more details about this article) |
7/8. stroke as a first manifestation of ovarian cancer.BACKGROUND: Gynaecologic neoplasms are reported to have the highest potential for developing of ischemic stroke. OBJECTIVES: The history of a female patient, in whom recurrent cerebral embolism was the first clinical sign of occult ovarian neoplasm is described and the casuistic literature to characterise this clinical phenomenon reviewed. RESULTS: Among a large spectrum of neoplasms complicating with ischemic stroke, ovarian carcinoma is one of the most frequently reported in the casuistic literature. The source of systemic microembolisation is endocardits of non-infectious origin; the characteristic diagnostic findings are thrombocytopenia, elevated D-dimers level, and a specific stroke pattern in magnetic resonance imaging. CONCLUSION: Meticulous diagnosis in female, otherwise 'healthy' patients with ischemic stroke, to detect the underlying neoplastic disease is of paramount importance, as early surgical intervention on cancer promises successful therapy for both, cancer and thromboembolism.- - - - - - - - - - ranking = 0.2keywords = thromboembolism (Clic here for more details about this article) |
8/8. Sudden death because of massive pulmonary thromboembolism and concomitant cerebrovascular trophoblastic embolism following artificial abortion.A rare case of sudden death due to cerebral embolization of trophoblastic tissue and concomitant massive pulmonary embolization following artificial abortion in a 42-year-old woman with poorly regulated hypertension and chronic smoking is described. Histopathological analysis showed syncytiotrophoblast cells, positive on hPL immunostaining, obstructing vascular lumina in the small perforating arteries irrigating the diencephalon. There was no trophoblast invasion of capillary walls. Severe perivascular edema and lymphocytic infiltration were observed. No trophoblastic cells were found in the pulmonary circulation.- - - - - - - - - - ranking = 0.8keywords = thromboembolism (Clic here for more details about this article) |