1/8. Cerebrovascular complication associated with pulmonary vein ablation.INTRODUCTION: Radiofrequency (RF) ablation has become an established treatment modality for patients with paroxysmal atrial fibrillation (AF). A principal limitation of RF catheter ablation is the risk of thromboembolism. stroke as a complication after ablation of triggers of AF has not been previously reported. methods AND RESULTS: Fifty-six patients underwent RF ablation for a focal source of AF. Forty-nine patients (86%) had AF triggers in > or = 1 pulmonary vein. Mean procedure time was 227 /- 74 minutes. Cerebrovascular event occurred in 3 (5%) patients, all >60 years old. Two of the three patients had a prior history of transient ischemic attacks. CONCLUSION: The risk of stroke from RF ablation may be higher in paroxysmal AF patients with prior transient ischemic attack.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
2/8. Recurrent transient ischemic attacks in a 15-year-old boy with beta-thalassemia minor and thrombophilia. Contribution of perfusion SPECT to clinical diagnosis.beta-Thalassemic patients exhibit an increased frequency of thrombotic events but most patients with heterozygous beta-thalassemia minor are asymptomatic and no single case with beta-thalassemia minor and concurrent stroke was reported. We present a 15-year-old boy with heterozygous beta-thalassemia minor who developed recurrent transient ischemic attacks as documented with repeated brain SPECTs whereas structural neuro-imaging was not contributory. The patient exhibited resistance to activated protein C due to heterozygosity for factor v Leiden as well as slightly decreased plasma levels of protein C and S. This unique association of risk factors might have caused clinically significant thrombophilia resulting in recurrent cerebrovascular events. This case report underlines the thrombogenic risk of heterozygous beta-thalassemia minor in children heterozygous for factor v Leiden mutation. We therefore suggest to screen for thrombophilia in children with beta-thalassemia minor when thromboembolism-related phenomena occur. This case also demonstrates that brain perfusion SPECT is a useful and sensitive tool for detecting cerebrovascular events in patients with hemoglobinopathies.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
3/8. Transient ischemic attack: a complication of mitral valve prolapse in pregnancy.A case of transient ischemic attack presumably due to cardiogenic thromboembolism during pregnancy is described in a 32-year-old woman. The patient had documented mitral valve prolapse which was uncomplicated until this episode. This is the first report in the literature of such a complication during pregnancy. The clinical management is described.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
4/8. Transient cerebral ischemic attacks associated with worn porcine heterograft prosthesis. Case report.Details are reviewed of a case of transient cerebral ischemic attacks which probably resulted from thromboembolism from a Hancock porcine heterograft prosthesis. Cause of the embolism probably was thrombus formation on the worn cloth covering of the supporting valve stent. Technical and antomic factors which assure precise seating of the prosthesis in the mitral anulus without contacting the ventricular wall appear to be important in preventing this complication.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
5/8. Temporary neurological deterioration after extracranial-intracranial bypass.Five patients who experienced temporary neurological deterioration after extracranial to intracranial bypass procedures are reported in detail. These patients suffered transient ischemic attacks or more prolonged deficits usually of a different nature than the preoperative symptoms. All patients had a good outcome and the spells ceased; the neurological deficits improved within a maximum of 2 weeks. Obvious causes of deterioration such as intra- or extracerebral hematomas, occlusion of a previously stenotic vessel, or graft occlusion were ruled out by computed tomography and angiography in each case. Intraoperative causes of neurological deterioration such as anesthetic effect, hypotension, and temporary occlusion of the cortical vessel or sacrifice of its small branches were not likely to be the cause of the deficits because in each case, the patient awoke satisfactorily and deterioration occurred hours to days later. In each case, postoperative angiography showed good perfusion of at least one major division of the middle cerebral territory. Anticoagulation with heparin in three patients did not change the clinical course. In one patient who was not anticoagulated, embolism could have been responsible for a single prolonged ischemic event, but in the other patients thromboembolism does not seem likely to have been responsible for the deficits. The cause of the deterioration in these patients remains unexplained. We speculate that hyperperfusion of chronically ischemic brain tissue and shifts in the watershed region resulting from the new flow pattern after bypass grafting are two mechanisms that may have been of importance in the etiology of these deficits.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
6/8. cerebral infarction caused by vasospasm.Fifteen patients with cerebral infarction, the majority of them being under the age of 40 years, were reviewed. patients in whom an underlying structural disease, such as atheroma or thromboembolism, was suspected on clinical grounds were excluded. On the basis of either a personal or family history of migraine, or a concomitant vascular headache, or a migratory pattern of evolution of the neurological deficit, a migrainous disorder was considered possible in 14 patients. It is postulated that cerebral vasospasm is a cause of cerebral infarction, especially in younger people.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
7/8. Familial cerebrovascular accidents due to concomitant hyperhomocysteinemia and protein c deficiency type 1.BACKGROUND AND PURPOSE: hyperhomocysteinemia and protein c deficiency are risk factors for thromboembolism. hyperhomocysteinemia has been reported to inhibit the expression of thrombomodulin and to inactivate both thrombomodulin and protein C irreversibly, leading to decreased protein C activity. CASE DESCRIPTIONS: In a 16-year-old girl, who developed a sinus sagittalis thrombosis, and in her father, who experienced a transient ischemic attack, both hyperhomocysteinemia and protein c deficiency type 1 were present. protein c deficiency alone was found in one of the two sisters, who was without any clinical vascular history. CONCLUSIONS: In this family with independently inherited hyperhomocysteinemia and protein c deficiency, clinical cerebrovascular disease occurred only in those members with a combination of both risk factors, suggesting a synergistic interaction between these thrombogenic risk factors.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
8/8. Bifid left atrial appendage with thrombus: source of thromboembolism.Three patients with embolic events were found on transesophageal echocardiography (TEE) to have bifid left atrial appendage (LAA). In these patients, large mobile thrombi were found only in the posterior limb of the appendage. The best views to demonstrate the posterior limb were between 85 and 155 degrees from the transverse plane with the use of a multiplane TEE probe. To avoid overlooking this pathologic condition, we recommend that complete evaluation of the LAA should include rotation of the TEE transducer up to 155 degrees from the transverse plane.- - - - - - - - - - ranking = 4keywords = thromboembolism (Clic here for more details about this article) |