1/6. Vertebral artery anomaly with atraumatic dissection causing thromboembolic ischemia: a case report.STUDY DESIGN: A case report is presented. OBJECTIVES: To illustrate a rare cause of atraumatic vertebral artery dissection resulting from anomalous entry of the vessel at the C3 transverse foramen induced by normal physiologic head and neck motion, and to review vertebral artery anatomy and mechanisms whereby it is vulnerable to pathologic compression. SUMMARY OF BACKGROUND DATA: The vertebral artery usually enters the transverse foramen at C6. Rarely, the artery enters at C5 or C4. Only one prior case with entry at C3 has been reported. That patient experienced recurrent quadriplegia and locked-in syndrome caused by vertebral artery obstruction. A 27-year-old woman with a history of classic migraine experienced neurologic symptoms on three occasions related to physiologic neck and arm movements. Magnetic resonance angiogram was not diagnostic, but standard arteriography demonstrated anomalous vertebral artery entry into the C3 transverse foramen and focal dissection. methods: Pertinent literature and the patient's history, physical examination, and radiologic studies were reviewed. RESULTS: Standard cervico-cerebral arteriogram demonstrated focal dissection at C4 and thromboembolic complications in distal vertebral and basilar arteries. Initially, diagnosis by magnetic resonance angiogram was elusive. However, arteriography allowed prompt diagnosis followed by anticoagulation with resolution of neurologic symptoms. CONCLUSIONS: vertebral artery dissection without trauma is rare, but should be considered when neurologic symptoms accompany physiologic cervical movements. For cases in which vertebrobasilar thromboembolic ischemia is suspected, magnetic resonance angiogram may prove inadequate for demonstrating the causative vascular pathology. Therefore, standard cervico-cerebral arteriography should be performed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Idiopathic venous thromboembolism and malignant disease: a case report.BACKGROUND: The association between cancer and venous thromboembolism (VTE) is well known. patients with idiopathic VTE have an increased risk of occult malignancy or subsequent development of cancer, compared with secondary VTE. CASE: A 43-year-old woman presented with idiopathic deep vein thrombosis (DVT) and menorrhagia. She had a history of hereditary non-polyposis colon cancer (HNPCC). One year later, investigations for persistent menorrhagia revealed uterine adenocarcinoma. CONCLUSION: Although there is no evidence that invasive screening for malignancy improves survival, recent findings have suggested that a directed search, based on family history, suspicious physical findings, or abnormal routine blood work, may be appropriate to rule out malignancy in women who present with VTE.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/6. Hypercoagulability in a patient with marfan syndrome.A 39 year old man with marfan syndrome presented with multiple pulmonary emboli and renal, hepatic, and splenic infarcts of unknown aetiology. The combination of thromboemboli and physical features initially suggested homocystinuria; however, laboratory examination showed no evidence for this disorder. Laboratory evaluation identified no coagulation abnormalities. This patient represents the unusual occurrence of hypercoagulability in a patient with marfan syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. Fibrinolytic study in a homozygous protein C deficient patient.The fibrinolytic system was evaluated in a patient with homozygous protein c deficiency as well as in several members of his family with a partial deficiency of this protein. Before anticoagulant therapy the patient showed skin lesions which quickly disappeared after administration of fresh plasma. After anticoagulant treatment, the propositus suffered two clinical episodes of "ecchymotic" lesions, which were controlled with fresh plasma. The patient has remained free of new lesions and other clinical episodes up to the present date. The fibrinolytic activity of both the propositus and his family was normal. The patient's father showed adequate release of tissue plasminogen activator after controlled physical exercise. According to clinical and analytical data from our patient and his family, it is suggested that, in spite of the preservation of the fibrinolytic system in this case, a localized deficiency in fibrinolysis could exist in view of the clinical behaviour of the skin lesions described.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Umbilical artery occlusion and fetoplacental thromboembolism.BACKGROUND: To our knowledge, fetoplacental thromboembolism has been described only in autopsy specimens. We report the antepartum diagnosis of an umbilical artery occlusion and neonatal diagnosis of an aortic thrombus and placental emboli. CASE: A gravida at 31 weeks' gestation was referred for evaluation of decreased fetal movement and an enlarged fetal bladder. A two-vessel umbilical cord with a collapsed, echogenic third vessel was noted, whereas views of a normal three-vessel cord were available from an examination 5 weeks earlier. A positive oxytocin contraction test prompted delivery. Neonatal color flow Doppler imaging demonstrated an aortic thrombus below the renal arteries and above the bifurcation. Gross and microscopic study of the placenta demonstrated necrosis of the collapsed umbilical artery and numerous placental emboli. The aortic thrombus resolved gradually, and the infant went home on the 39th day of life. CONCLUSION: Umbilical artery occlusion can be diagnosed ultrasonographically and may be a sign of fetoplacental thromboembolism. Assessment of fetal oxygenation status by biophysical profile or contraction stress test may be helpful in the evaluation of umbilical artery occlusion.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Recurrent thromboembolism as a hallmark of Cushing's syndrome.The present report describes a 54-year-old woman with a history of recurrent thromboembolic events. The clinical and physical examination led to suspect Cushing's syndrome. Screening tests (urinary free cortisol excretion and 1 mg dexamethasone) were inconclusive, but a detailed endocrine work up confirmed the presence of ACTH-dependent hypercortisolism. The patient was cured by the removal of a ACTH-secreting microadenoma by transsphenoidal route. The present case provides a clinical demonstration of a previous experimental evidence that a hypercoagulable state is present in Cushing's syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |