1/76. Antiphospholipid antibodies syndrome in 'stroke in young'.Antiphospholipid antibodies syndrome has emerged as an important entity responsible for stroke in young. Seven cases of young stroke (< 40 years of age) with mean age of 30.1 years (age range 25-39 years, 2 males and 5 females), who tested positive for antiphospholipid antibodies are being reported. All subjects had completed strokes. Six had arterial ischaemic and one patient had venous stroke. One patient suffered from four episodes, three ischaemic and one intracerebral haemorrhage. Two patients suffered from foetal loss. Generalised tonic clonic seizures occurred in three patients. Deep vein thrombosis was observed in one case. thrombocytopenia was not observed in any case. All the patients had elevated anticardiolipin antibodies (aCL) IgM or IgG, while Lupus anticoagulant (LA) was elevated in 4 cases. Six cases belonged to primary antiphospholipid antibodies syndrome and one to lupus like illness. Oral anticoagulants were administered to maintain a high intensity international normalized ratio (INR). No recurrences were observed during a follow up period of 6-18 months.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/76. A 10-year-old boy with marfan syndrome exhibiting cerebrovascular abnormalities.A young male with marfan syndrome, diagnosed at the age of 10 years, presented with conspicuous elongation and tortuosity of the internal carotid, middle cerebral, vertebral and basilar arteries on cranial magnetic resonance and computed tomography angiography. There is a little mention of cerebral blood vessel examinations in the guidelines of the American Academy of pediatrics for marfan syndrome. Guidelines may be provided for the evaluation of cerebrovascular system for the patients with marfan syndrome who have family history of marfan syndrome as well as a family history of death from subarachnoid hemorrhage.- - - - - - - - - - ranking = 1.2988509725155keywords = subarachnoid (Clic here for more details about this article) |
3/76. Intracerebral haematomas with agenesis of the internal carotid artery and tetralogy of fallot.We report a rare case with tetralogy of fallot (TOF) and agenesis of the internal carotid artery (ICA) who presented serious intracerebral haematomas. In the literature, this is the first documented case having these complications simultaneously. Extreme hypoxic insults followed by recovery were detected by O2 saturation monitor before two bleeds. Chronic brain hypoxia could make the vasculature weak, which was shown in the histological examination. A 2-year-old girl was transferred to us with a general convulsion due to intracerebral haematoma. She had been showing general cyanosis from birth due to TOF. Repeated intracerebral haemorrhages ended her life. Histological study showed dilated vascular channels in the subarachnoid space and necrotizing vasculature obstructed by fibrinous thrombi adjacent to the haematoma. fibrosis of the vessel wall with infiltration of macrophages suggested subacute or chronic lesions rather than acute necrosis due to the multiple haemorrhages. The intracerebral haematomas and agenesis of the ICA were observed as unilateral hemispheric vascular complications of TOF. Chronic brain hypoxia could play an important role in weakening the vessel wall and erythrocytosis caused obstructing thrombi. We speculate these factors generated the intracerebral haematomas.- - - - - - - - - - ranking = 3.2988509725155keywords = subarachnoid, haemorrhage (Clic here for more details about this article) |
4/76. Three cases of hyperperfusion syndrome identified by daily transcranial Doppler investigation after carotid surgery.BACKGROUND: cerebral hyperperfusion syndrome (HS), occurs in 0.5-1% of patients undergoing carotid endarterectomy (CEA), and may result in intracerebral haemorrhage and death. Aim: to diagnose HS by means of postoperative Transcranial Doppler (TCD). methods: between 1998 and 2001 nearly all 112 patients who underwent CEA were monitored for four days postoperatively by Transcranial Doppler. RESULTS: there were 3 patients with HS. All three showed TCD abnormalities hours before developing symptoms. One patient developed a full blown HS. Presumably, symptoms in the other two patients could be prevented by timely starting or restoring anti-hypertensive treatment. CONCLUSION: daily TCD investigation in all patients undergoing CEA seems an effective strategy for the presymptomatic detection of HS.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
5/76. Acute basilar artery occlusion treated with combined intravenous Abciximab and intra-arterial tissue plasminogen activator: report of 3 cases.BACKGROUND: Acute vertebrobasilar occlusion remains a disease with a high mortality even after treatment by local intra-arterial fibrinolysis. Adjunctive treatment with platelet glycoprotein IIb/IIIa receptor inhibitors such as abciximab may facilitate recanalization and improve the neurological outcome. Results after treatment of 3 patients by combined intravenous abciximab and local intra-arterial tissue plasminogen activator (tPA) are reported. CASE DESCRIPTIONS: Treatment was performed within 6 hours of stroke onset. Angiography revealed embolic occlusion of the basilar artery in 2 patients and atherothrombotic occlusion at the vertebrobasilar junction in 1 patient. Therapy consisted of intravenous abciximab bolus administration (0.25 mg/kg) followed by 12-hour infusion therapy (0.125 microg/kg per minute) and local intra-arterial thrombolysis with tPA (10 mg/h). heparin was only applied for catheter flushing (500 IU/h). The patient with the atherothrombotic occlusion was treated with additional percutaneous transluminal angioplasty and stenting. Complete recanalization of the basilar artery occurred in 2 patients, whose conditions improved clinically to functional independence. In the third patient only partial recanalization was seen, with only slight clinical improvement. This patient died of cardiac failure 2 months later. Besides a subtle subarachnoid hemorrhage (n=1), no intracranial or extracranial bleeding complication was observed. CONCLUSIONS: The combination of glycoprotein IIb/IIIa receptor inhibitor with local intra-arterial tPA might be a promising therapy for patients with acute vertebrobasilar occlusion. Further studies are necessary to define the clinical benefit and the bleeding rate of this new pharmacological approach.- - - - - - - - - - ranking = 1.2988509725155keywords = subarachnoid (Clic here for more details about this article) |
6/76. Mechanisms in cerebral lesions in trauma to high cervical portion of the vertebral artery--rotation injury.Three cases have been described illustrating the mechanisms and effects of lesions from acute rotation injury to the vertebral artery. These indicate that the portion of artery at risk is in the C1 to C2 region, where stretching and shearing strains can produce intramural dissection and haemorrhage. Such changes can radically alter flow to produce acute arterial obliteration or later cerebral embolism. Such alteration can also produce a change in relationships between artery and surrounding structures and thus cause intermittent occlusion of a vertebral artery upon cervical rotation.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
7/76. Traumatic posterior cerebral artery occlusion in a 14-month-old child.Following a head injury, a 14-month-old male presented with neck stiffness and 24 hours later developed bilateral lateral rectus palsies. An unenhanced cerebral computed tomographic scan performed on admission revealed evidence of subarachnoid hemorrhage, cerebral edema, and mild-to-moderate compensated supratentorial hydrocephalus. A second scan performed 96 hours after the head injury revealed a mural thrombus at the tip of the basilar artery without any evidence of infarction. A third scan performed 12 days later revealed that the thrombus had resolved. However, a left posterior cerebral artery territory infarct was visualized. We postulate that the thrombus had embolized to the left posterior cerebral artery and caused occlusion of its cortical branch and subsequent infarction. A magnetic resonance angiography performed 20 days later excluded any vascular abnormality. The bilateral lateral rectus palsies persisted at the 6-month follow-up. To our knowledge, a head injury leading to a posterior cerebral artery territory infarct has not been reported earlier in a young child.- - - - - - - - - - ranking = 1.2988509725155keywords = subarachnoid (Clic here for more details about this article) |
8/76. Takayasu's arteritis presented with subarachnoid hemorrhage: report of two cases.Takayasu's arteritis is a chronic inflammatory disease that produces a narrowing of the aorta and its major branches. fibrosis and thickening of the arterial wall often occur in later stages, resulting in a cerebrovascular accident. The authors report two young women patients who presented with subarachnoid hemorrhage (SAH) and occlusive cerebrovasular disease associated with Takayasu's arteritis. Both patients had sudden headache and hemiparesis. physical examination showed weak radial pulse, carotid bruit, and asymmetrical blood pressure. Erythrocyte sedimentation rate (ESR) was elevated in both patients. SAH was confirmed by brain computerized tomography (CT) or lumbar puncture. Occlusive cerebrovascular disease was diagnosed by brain magnetic resonance imaging (MRI), brain magnetic resonance angiography (MRA), and cerebral angiography. The findings of aortography and cerebral angiography were compatible with Takayasu's arteritis, but intracranial aneurysm was not found in either patient.- - - - - - - - - - ranking = 6.4942548625777keywords = subarachnoid (Clic here for more details about this article) |
9/76. Obliteration of bilateral dissecting aneurysms of the vertebral arteries following repeated subarachnoid hemorrhage: a case report.A 51-year-old man presented with loss of consciousness when he underwent urological examination at another hospital. CT scans showed subarachnoid hemorrhage, and cerebral angiography showed bilateral dissecting aneurysms of the vertebral arteries. Following ventricular drainage, the lesion was managed conservatively with blood pressure control but again ruptured on day 8. Cerebral angiography revealed narrowing of both the dissecting aneurysms. On day 11, the right vertebral artery had been spontaneously obliterated and the right dissecting aneurysm was filled in a retrograde fashion via the left vertebral artery. Proximal occlusion of the right vertebral artery was performed to prevent recanalization. Two months later, cerebral angiography revealed that both vertebral arteries were obliterated and the basilar artery and right posterior inferior cerebellar artery were filled via the right posterior communicating artery. The present case demonstrated that the hemodynamic status of bilateral dissecting aneurysms of the vertebral artery changed variably indicating the necessity of careful angiographic observation.- - - - - - - - - - ranking = 6.4942548625777keywords = subarachnoid (Clic here for more details about this article) |
10/76. Traumatic internal carotid artery occlusion--case report.A 20-year-old male was admitted comatose immediately after a motorcycle accident. Initial computed tomography demonstrated traumatic subarachnoid hemorrhage, and the diagnosis of traumatic internal carotid artery occlusion was established by angiography. Conservative management improved his symptoms, but eventually he died from delayed traumatic apoplexy. Traumatic internal carotid artery occlusion is relatively rare, but is serious and requires early diagnosis and treatment. For patients with severe head trauma and vascular occlusion, anticoagulants are contraindicated, and frequent follow-up angiography is recommended.- - - - - - - - - - ranking = 1.2988509725155keywords = subarachnoid (Clic here for more details about this article) |
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