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Gomaa A, Biyanwila C, Jantre M. Synchronous subarachnoid haemorrhage and ischaemic stroke as a result of complete internal carotid artery occlusion. BMJ Case Rep 2024; 17:e258341. [PMID: 38589243 PMCID: PMC11015294 DOI: 10.1136/bcr-2023-258341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
A previously healthy man in his 60s presents with a one-day history of insidious onset headache and 'walking into doors'. He reported transient right arm pain and tingling but no weakness. A CT brain showed a right middle cerebral artery (MCA) infarct as well as a synchronous right frontal lobe convexal subarachnoid haemorrhage (cSAH). An arch to vertex CT angiogram demonstrated right MCA occlusion and complete right internal carotid artery (ICA) occlusion from its origin. Reconstitution of flow was seen within the distal right ICA at the level of the distal foramen lacerum. A repeat CT of the brain after one week showed a stable appearance of the bleeding and infarct. He was commenced on antiplatelet therapy for the treatment of the ischaemic stroke as well as secondary prevention.This is a rare case of synchronous right MCA infarct as well as a right frontal cSAH secondary to ipsilateral carotid artery occlusion.
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Affiliation(s)
- Aysha Gomaa
- General Internal Medicine, East Sussex Healthcare NHS Trust, Eastbourne, East Sussex, UK
| | - Chemindra Biyanwila
- Stroke Medicine, East Sussex Healthcare NHS Trust, Eastbourne, East Sussex, UK
| | - Mansi Jantre
- Radiology, East Sussex Healthcare NHS Trust, Eastbourne, East Sussex, UK
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Weller JM, Meissner JN, Stösser S, Dorn F, Petzold GC, Bode FJ. Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Concomitant Intracranial Hemorrhage. Clin Neuroradiol 2022; 32:809-816. [PMID: 34989816 PMCID: PMC9424164 DOI: 10.1007/s00062-021-01128-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Intravenous thrombolysis and mechanical thrombectomy (MT) are standard of care in patients with acute ischemic stroke due to large vessel occlusion. Data on MT in patients with intracranial hemorrhage prior to intervention is limited to anecdotal reports, as these patients were excluded from thrombectomy trials. METHODS We analyzed patients from an observational multicenter cohort with acute ischemic stroke and endovascular treatment, the German Stroke Registry-Endovascular Treatment trial, with intracranial hemorrhage before MT. Baseline characteristics, procedural parameters and functional outcome at 90 days were analyzed and compared to a propensity score matched cohort. RESULTS Out of 6635 patients, we identified 32 patients (0.5%) with acute ischemic stroke due to large vessel occlusion and preinterventional intracranial hemorrhage who underwent MT. Risk factors of intracranial hemorrhage were head trauma, oral anticoagulation and intravenous thrombolysis. Overall mortality was high (50%) but among patients with a premorbid modified Rankin scale (mRS) of 0-2 (n = 15), good clinical outcome (mRS 0-2) at 90 days was achieved in 40% of patients. Periprocedural and outcome results did not differ between patients with and without preinterventional intracranial hemorrhage. CONCLUSION Preinterventional intracranial hemorrhage in acute ischemic stroke patients with large vessel occlusion is rare. The use of MT is technically feasible and a substantial number of patients achieve good clinical outcome, indicating that MT should not be withheld in patients with preinterventional intracranial hemorrhage.
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Affiliation(s)
- Johannes M Weller
- Section for Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Julius N Meissner
- Section for Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Sebastian Stösser
- Section for Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Gabor C Petzold
- Section for Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Felix J Bode
- Section for Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
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Safan AS, Imam Y, Akhtar N, Al‐Taweel H, Zakaria A, Quateen A, Own A, Kamran S. Acute ischemic stroke and convexity subarachnoid hemorrhage in large vessel atherosclerotic stenosis: Case series and review of the literature. Clin Case Rep 2022; 10:e5968. [PMID: 35765289 PMCID: PMC9207224 DOI: 10.1002/ccr3.5968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Atraumatic convexity subarachnoid hemorrhage (cSAH) is a rare non‐aneurysmal SAH, commonly due to ipsilateral internal carotid artery (ICA) stenosis. It is unusual for the cSAH to occur contralaterally to the infarct. We report two cases of acute ischemic stroke associated with contralateral and ipsilateral cSAH that had different presentations.
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Affiliation(s)
- Abeer Sabry Safan
- Department of Neurology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
| | - Yahia Imam
- Department of Neurology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
- Weill Cornell Medicine Doha Qatar
| | - Naveed Akhtar
- Department of Neurology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
- Weill Cornell Medicine Doha Qatar
| | | | - Ayman Zakaria
- Department of Neuroradiology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
| | - Aiman Quateen
- Department of Neuroradiology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
| | - Ahmed Own
- Department of Neurology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
- Department of Neuroradiology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
| | - Saadat Kamran
- Department of Neurology Neurosciences Institute, Hamad Medical Corporation Doha Qatar
- Weill Cornell Medicine Doha Qatar
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Chai J, Nie H, Wu X, Guan Y, Dai T, Shen Y. The clinical and neuroradiological features of patients of coexisting atraumatic convexity subarachnoid hemorrhage and large artery atherosclerosis stroke: A retrospective observational study. Medicine (Baltimore) 2021; 100:e28155. [PMID: 35049246 PMCID: PMC9191285 DOI: 10.1097/md.0000000000028155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/18/2021] [Indexed: 12/01/2022] Open
Abstract
Atraumatic convexity subarachnoid hemorrhage (c-SAH) concomitant with large artery atherosclerosis (LAA) stroke has been rarely discussed in the literature. Our aim in this study is to characterize the clinical and neuroradiological features of patients with LAA stroke and c-SAH.A retrospective study from a single institution was performed between January 2016 and June 2020. Only patients diagnosed with c-SAH and LAA stoke were included in this study. The clinical presentation and neuroimaging finding were summarized by our experienced neurologists.In total, 12 patients (8 men, 4 women), ranging in age from 45 to 75 years, were identified. All of them had cardiovascular risk factors and hypertension was the commonest (50%). Almost all patients presented hemiparesis (91.7%). Other clinical presentations included, dysarthria (41.7%), hemianesthesia (33.3%), facial palsy (33.3%), aphasia (16.7%), and cognitive impairment (8.3%). Internal border-zone (IBZ) infarction and cortical border-zone (CBZ) infarction occurred in 12 and 3 patients, respectively. c-SAH might occurred in different cortical sulcis. Percentages of frontal lobe, parietal lobe and fronto-parietal lobe were 41.7% (n = 5), 25% (n = 3) and 25% (n = 3), respectively. All ischemic lesions were ipsilateral to the sites of c-SAH. High-grade atherosclerotic stenosis of large artery was detected in all patients. The M1 segment of middle cerebral artery (MCA) is the second most common atherosclerotic artery after internal carotid artery (ICA).Our data suggest that LAA stroke is always ipsilateral to the site of c-SAH. Severe atherosclerotic changes can also been seen in the M1 segment of MCA apart from extracranial ICA. Moreover, border zone infarction may be a specific form of infarct when c-SAH is confronted with LAA stroke.
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Affiliation(s)
- Jingyan Chai
- Department of Neurology, The Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi Province, China
| | - Hongbing Nie
- Department of Neurology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi Province, China
| | - Xiangbin Wu
- Department of Neurology, The Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi Province, China
| | - Yanqin Guan
- Department of Neurology, The Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi Province, China
| | - Tingmin Dai
- Department of Neurology, The Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi Province, China
| | - Yaoyao Shen
- Department of Neurology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi Province, China
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Thrombectomy for ischemic stroke with large vessel occlusion and concomitant subarachnoid hemorrhage. J Thromb Thrombolysis 2021; 52:1212-1214. [PMID: 34105087 DOI: 10.1007/s11239-021-02496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
To report our experience in treating one patient with nontraumatic subarachnoid hemorrhage (SAH) and concurrent acute ischemic stroke (AIS) due to large vessels occlusion (LVO). A man in his 50 s presented with acute right hemiparesis and aphasia. Brain CT showed a SAH in the left central sulcus; CT-angiography revealed a tandem occlusion of the left internal carotid artery and homolateral middle cerebral artery. He underwent an angiographic procedure with successful recanalization. Follow-up CT demonstrated a striatal-lenticular stroke without SAH progression. While the absolute contraindication to IVT during intracranial bleeding remains unquestionable, the potential injury/benefit from MT is still debatable. Such cases constitute a blind spot in the guidelines where physicians face the dilemma of choosing between an acute endovascular treatment with the risks of hemorrhage progression and a conservative treatment with the associated poor clinical outcome. We decided to treat our patient invasively, considering the young age, also given the absence of prognostic factors that generally predict post-procedural reperfusion injury. We believe that, in similar cases, MT should be considered-despite not free of risks and drawbacks-to avoid the detrimental consequences of untreated AIS from LVO.
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The frequency of central nervous system complications in the Cypriot cohort of ATTRV30M neuropathy transplanted patients. Neurol Sci 2020; 41:1163-1170. [PMID: 31897943 DOI: 10.1007/s10072-019-04176-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hereditary transthyretin amyloidosis (ATTR) is a hereditary, sensorimotor and autonomic neuropathy caused by deposits of mutated transthyretin (TTR). The commonest TTR mutation is V30M (ATTRV30M) with patients usually living for about 10 years after disease onset. Liver transplantation (LT) until recently was considered the standard treatment. OBJECTIVE AND METHODS This study aims to assess the frequency of CNS complications in post-LT patients from the Cypriot cohort. Epidemiological data were collected for all genetically confirmed ATTRV30M neuropathy patients diagnosed at CING since 1992, and CNS-associated symptoms were assessed and evaluated by two neurology specialists. RESULTS Out of the 48 transplanted patients, 10 (20.8%) presented with a CNS complication. All patients had ocular involvement, mainly glaucoma (7/10). Eight presented with transient focal neurological episodes (TFNEs), with expressive dysphasia being reported by four of them. The mean time of TFNE-emergence was 16.6 years after the LT. Three died from cerebral hemorrhage. CONCLUSIONS CNS complications in post-LT ATTRV30M patients are not rare and usually manifest themselves at a time that surpasses the mean time the patients would have survived without a LT. CNS involvement is associated with increased mortality, due to cerebral hemorrhage.
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Cao Y, Cao J, Ji S, Xu S, Liu C. Acute ischemic stroke with contralateral convexal subarachnoid hemorrhage: two cases report. BMC Neurol 2019; 19:132. [PMID: 31215417 PMCID: PMC6580630 DOI: 10.1186/s12883-019-1364-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/12/2019] [Indexed: 02/01/2023] Open
Abstract
Background Convexal subarachnoid hemorrhage (cSAH) is characterized by isolated bleeding in one or a few adjacent sulci and has diverse etiologies and symptoms. Acute ischemic stroke co-occurring with cSAH has been infrequently reported. Nearly all cases of cSAH have been described to occur on the side with acute ischemic stroke, and it is unusual for cSAH to occur on the opposite side of the infarct territory. Case presentation Our report presents two cases of acute ischemic stroke associated with contralateral cSAH. The first patient had left atherosclerotic internal carotid artery (ICA) occlusion with developing right parietal cSAH. The other patient developed left parietal cSAH in the setting of right ICA occlusion caused by cardiogenic embolism with acute right cerebral hemisphere infarction. Both patients remained clinically stable with good prognosis after antithrombotic treatment. Conclusions Our report suggest that cSAH may simultaneously occur on the opposite side of an infarction. Although there is no consensus on the etiology and treatment of this rare phenomenon, cSAH did not lead to a poor outcome in our patients.
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Affiliation(s)
- Yayun Cao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Jie Cao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Suqiong Ji
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Shabei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, People's Republic of China
| | - Chenchen Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, People's Republic of China.
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