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Crispino P. Hemorrhagic Coagulation Disorders and Ischemic Stroke: How to Reconcile Both? Neurol Int 2023; 15:1443-1458. [PMID: 38132972 PMCID: PMC10745771 DOI: 10.3390/neurolint15040093] [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: 10/15/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Coagulation and fibrinolytic system disorders are conditions in which the blood's ability to clot is impaired, resulting in an increased risk of thrombosis or bleeding. Although these disorders are the expression of two opposing tendencies, they can often be associated with or be a consequence of each other, contributing to making the prognosis of acute cerebrovascular events more difficult. It is important to recognize those conditions that are characterized by dual alterations in the coagulation and fibrinolytic systems to reduce the prognostic impact of clinical conditions with difficult treatment and often unfortunate outcomes. Management of these individuals can be challenging, as clinicians must balance the need to prevent bleeding episodes with the potential risk of clot formation. Treatment decisions should be made on an individual basis, considering the specific bleeding disorder, its severity, and the patient's general medical condition. This review aims to deal with all those forms in which coagulation and fibrinolysis represent two sides of the same media in the correct management of patients with acute neurological syndrome. Precision medicine, personalized treatment, advanced anticoagulant strategies, and innovations in bleeding control represent future directions in the management of these complex pathologies in which stroke can be the evolution of two different acute events or be the first manifestation of an occult or unknown underlying pathology.
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Affiliation(s)
- Pietro Crispino
- Medicine Unit, Santa Maria Goretti Hospital, Via Scaravelli Snc, 04100 Latina, Italy
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2
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Tentolouris-Piperas V, Lymperopoulos L, Tountopoulou A, Vassilopoulou S, Mitsikostas DD. Headache Attributed to Reversible Cerebral Vasoconstriction Syndrome (RCVS). Diagnostics (Basel) 2023; 13:2730. [PMID: 37685270 PMCID: PMC10487016 DOI: 10.3390/diagnostics13172730] [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: 07/10/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a condition with variable outcomes presenting a new onset thunderclap headache accompanied by focal neurological symptoms or seizures. It can be idiopathic or arise secondarily to a variety of trigger factors. The condition is increasingly recognized in clinical practice, but many facets remain poorly understood. This article aims to clarify the headache characteristics in RCVS, the temporal association of angiographic findings, the potential association of the condition with SARS-CoV-2 infection, and the clinical presentation of RCVS in children and is based on a systematic PRISMA search for published analytical or large descriptive observational studies. Data from 60 studies that fulfilled specific criteria were reviewed. Most people with RCVS exhibit a typical thunderclap, explosive, or pulsatile/throbbing headache, or a similar acute and severe headache that takes longer than 1 min to peak. Atypical presentations or absence of headaches are also reported and may be an underrecognized phenotype. In many cases, headaches may persist after resolution of RCVS. Focal deficits or seizures are attributed to associated complications including transient ischemic attacks, posterior reversible encephalopathy syndrome, ischemic stroke, cerebral edema, and intracranial hemorrhage. The peak of vasoconstriction occurs usually within two weeks after clinical onset, possibly following a pattern of centripetal propagation, and tends to resolve completely within 3 months, well after symptoms have subsided. There are a few reports of RCVS occurring in relation to SARS-CoV-2 infection, but potential underlying pathophysiologic mechanisms and etiological associations have not been confirmed. RCVS occurs in children most often in the context of an underlying disease. Overall, the available data in the literature are scattered, and large-scale prospective studies and international collaborations are needed to further characterize the clinical presentation of RCVS.
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Affiliation(s)
| | | | | | | | - Dimos D. Mitsikostas
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (V.T.-P.); (L.L.); (A.T.); (S.V.)
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3
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Reversible Cerebral Vasoconstriction Syndromes. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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4
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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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5
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Hostettler IC, Wilson D, Fiebelkorn CA, Aum D, Ameriso SF, Eberbach F, Beitzke M, Kleinig T, Phan T, Marchina S, Schneckenburger R, Carmona-Iragui M, Charidimou A, Mourand I, Parreira S, Ambler G, Jäger HR, Singhal S, Ly J, Ma H, Touzé E, Geraldes R, Fonseca AC, Melo T, Labauge P, Lefèvre PH, Viswanathan A, Greenberg SM, Fortea J, Apoil M, Boulanger M, Viader F, Kumar S, Srikanth V, Khurram A, Fazekas F, Bruno V, Zipfel GJ, Refai D, Rabinstein A, Graff-Radford J, Werring DJ. Risk of intracranial haemorrhage and ischaemic stroke after convexity subarachnoid haemorrhage in cerebral amyloid angiopathy: international individual patient data pooled analysis. J Neurol 2021; 269:1427-1438. [PMID: 34272978 PMCID: PMC8857171 DOI: 10.1007/s00415-021-10706-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Objective To investigate the frequency, time-course and predictors of intracerebral haemorrhage (ICH), recurrent convexity subarachnoid haemorrhage (cSAH), and ischemic stroke after cSAH associated with cerebral amyloid angiopathy (CAA). Methods We performed a systematic review and international individual patient-data pooled analysis in patients with cSAH associated with probable or possible CAA diagnosed on baseline MRI using the modified Boston criteria. We used Cox proportional hazards models with a frailty term to account for between-cohort differences. Results We included 190 patients (mean age 74.5 years; 45.3% female) from 13 centers with 385 patient-years of follow-up (median 1.4 years). The risks of each outcome (per patient-year) were: ICH 13.2% (95% CI 9.9–17.4); recurrent cSAH 11.1% (95% CI 7.9–15.2); combined ICH, cSAH, or both 21.4% (95% CI 16.7–26.9), ischemic stroke 5.1% (95% CI 3.1–8) and death 8.3% (95% CI 5.6–11.8). In multivariable models, there is evidence that patients with probable CAA (compared to possible CAA) had a higher risk of ICH (HR 8.45, 95% CI 1.13–75.5, p = 0.02) and cSAH (HR 3.66, 95% CI 0.84–15.9, p = 0.08) but not ischemic stroke (HR 0.56, 95% CI 0.17–1.82, p = 0.33) or mortality (HR 0.54, 95% CI 0.16–1.78, p = 0.31). Conclusions Patients with cSAH associated with probable or possible CAA have high risk of future ICH and recurrent cSAH. Convexity SAH associated with probable (vs possible) CAA is associated with increased risk of ICH, and cSAH but not ischemic stroke. Our data provide precise risk estimates for key vascular events after cSAH associated with CAA which can inform management decisions. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10706-3.
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Affiliation(s)
- Isabel Charlotte Hostettler
- Stroke Research Centre, University College London, National Hospital of Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, WC1N, UK
| | - Duncan Wilson
- Stroke Research Centre, University College London, National Hospital of Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, WC1N, UK
| | | | - Diane Aum
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Markus Beitzke
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Thanh Phan
- Department of Neurology, Monash Health and Stroke and Ageing Research Group, Melbourne, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Sarah Marchina
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Maria Carmona-Iragui
- Memory Unit, Department of Neurology, Hospital de la Santa Creu I Sant Pau, Institut Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andreas Charidimou
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Isabelle Mourand
- Department of Neurology, CHU de Montpellier, Hôpital Gui-de-Chauliac, Montpellier, France
| | - Sara Parreira
- Stroke Unit, Department of Neuroscience, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Gareth Ambler
- Department of Statistical Science, UCL, London, WC1E 6BT, UK
| | - Hans Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair & Rehabilitation, University College London, Institute of Neurology, London, UK
| | - Shaloo Singhal
- Department of Neurology, Monash Health and Stroke and Ageing Research Group, Melbourne, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - John Ly
- Department of Neurology, Monash Health and Stroke and Ageing Research Group, Melbourne, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Henry Ma
- Department of Neurology, Monash Health and Stroke and Ageing Research Group, Melbourne, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Emmanuel Touzé
- Normandy University, UNICAEN, INSERM U1237, Caen, France
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK.,Neurology department, Frimley Health Foundation Trust, Camberley, UK
| | - Ana Catarina Fonseca
- Stroke Unit, Department of Neuroscience, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Teresa Melo
- Stroke Unit, Department of Neuroscience, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Pierre Labauge
- Department of Neurology, CHU de Montpellier, Hôpital Gui-de-Chauliac, Montpellier, France
| | - Pierre-Henry Lefèvre
- Department of Neuroradiology, CHU de Montpellier, Hôpital Gui-de-Chauliac, Montpellier, France
| | - Anand Viswanathan
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven Mark Greenberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu I Sant Pau, Institut Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marion Apoil
- Department of Neurology, CHU Caen Normandie, Caen, France
| | - Marion Boulanger
- Department of Neurology, CHU Caen Normandie, Caen, France.,Normandy University, UNICAEN, INSERM U1237, Caen, France
| | - Fausto Viader
- Department of Neurology, CHU Caen Normandie, Caen, France
| | - Sandeep Kumar
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Velandai Srikanth
- Department of Neurology, Monash Health and Stroke and Ageing Research Group, Melbourne, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Ashan Khurram
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Veronica Bruno
- Institute for Neurological Research, Fleni, Buenos Aires, Argentina
| | - Gregory Joseph Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel Refai
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | | | | | - David John Werring
- Stroke Research Centre, University College London, National Hospital of Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, WC1N, UK.
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6
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Glössmann K, Baumgartner C, Koren JP, Riederer F. Recurrent migraine aura-like symptoms in an elderly woman: symptomatic cortical spreading depression? BMJ Case Rep 2021; 14:e241479. [PMID: 34226251 PMCID: PMC8258541 DOI: 10.1136/bcr-2020-241479] [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] [Accepted: 06/11/2021] [Indexed: 11/04/2022] Open
Abstract
Cortical spreading depression (CSD) has been directly observed in humans with malignant stroke, traumatic brain injury and subarachnoid haemorrhage and is also considered to be the correlate of migraine aura. We report on a 76-year-old woman with new-onset episodes of headache, paraesthesia, hemiparesis and dysarthria, in whom a small cortical subarachnoid haemorrhage was diagnosed with MRI. Repeated diffusion-weighted MRI scans shortly after transient focal neurological episodes as well as diagnostic workup were normal, which makes recurrent transient ischaemic attacks unlikely. Ictal electroencephalogram recordings showed no epileptic activity. Long-term follow-up revealed a diagnosis of probable cerebral amyloid angiopathy. We propose that CSD could be a pathophysiological correlate of transient focal neurological deficits in patients with cortical bleeding.
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Affiliation(s)
| | - Christoph Baumgartner
- Department of Neurology, Clinic Hietzing, Wien, Austria
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
- Sigmund Freud Private University, Vienna, Austria
| | - Johannes Peter Koren
- Department of Neurology, Clinic Hietzing, Wien, Austria
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Franz Riederer
- Department of Neurology, Clinic Hietzing, Wien, Austria
- University of Zurich, Zurich, Switzerland
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7
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Smith EE, Charidimou A, Ayata C, Werring DJ, Greenberg SM. Cerebral Amyloid Angiopathy-Related Transient Focal Neurologic Episodes. Neurology 2021; 97:231-238. [PMID: 34016709 PMCID: PMC8356377 DOI: 10.1212/wnl.0000000000012234] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/19/2021] [Indexed: 12/22/2022] Open
Abstract
Transient focal neurologic episodes (TFNEs) are brief disturbances in motor, somatosensory, visual, or language functions that can occur in patients with cerebral amyloid angiopathy (CAA) and may be difficult to distinguish from TIAs or other transient neurologic syndromes. They herald a high rate of future lobar intracerebral hemorrhage, making it imperative to differentiate them from TIAs to avoid potentially dangerous use of antithrombotic drugs. Cortical spreading depression or depolarization triggered by acute or chronic superficial brain bleeding, a contributor to brain injury in other neurologic diseases, may be the underlying mechanism. This review discusses diagnosis, pathophysiology, and management of CAA-related TFNEs.
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Affiliation(s)
- Eric E Smith
- From the Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Hemorrhagic Stroke Research Program (A.C., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School; Stroke Service and Neurovascular Research Lab (C.A.), Department of Neurology, Massachusetts General Hospital, Boston; and Stroke Research Centre (D.J.W.), University College London Queen Square Institute of Neurology, UK.
| | - Andreas Charidimou
- From the Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Hemorrhagic Stroke Research Program (A.C., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School; Stroke Service and Neurovascular Research Lab (C.A.), Department of Neurology, Massachusetts General Hospital, Boston; and Stroke Research Centre (D.J.W.), University College London Queen Square Institute of Neurology, UK
| | - Cenk Ayata
- From the Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Hemorrhagic Stroke Research Program (A.C., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School; Stroke Service and Neurovascular Research Lab (C.A.), Department of Neurology, Massachusetts General Hospital, Boston; and Stroke Research Centre (D.J.W.), University College London Queen Square Institute of Neurology, UK
| | - David J Werring
- From the Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Hemorrhagic Stroke Research Program (A.C., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School; Stroke Service and Neurovascular Research Lab (C.A.), Department of Neurology, Massachusetts General Hospital, Boston; and Stroke Research Centre (D.J.W.), University College London Queen Square Institute of Neurology, UK
| | - Steven M Greenberg
- From the Department of Clinical Neurosciences (E.E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Hemorrhagic Stroke Research Program (A.C., S.M.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School; Stroke Service and Neurovascular Research Lab (C.A.), Department of Neurology, Massachusetts General Hospital, Boston; and Stroke Research Centre (D.J.W.), University College London Queen Square Institute of Neurology, UK
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8
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Khan F, Sharma N, Ud Din M, Shirke S, Abbas S. Convexal Subarachnoid Hemorrhage Caused by Infective Endocarditis in a Patient with Advanced Human Immunodeficiency Virus (HIV): The Culprits and Bystanders. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931376. [PMID: 33986239 PMCID: PMC8130978 DOI: 10.12659/ajcr.931376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Convexal subarachnoid hemorrhage (cSAH), a rare form of non-aneurysmal subarachnoid hemorrhage, is confined to cerebral convexities without extension into basal cisterns or ventricles. Typical presentation includes thunderclap/progressive headache or transient focal neurological symptoms; rare manifestations include seizures, intractable vomiting, or altered mental status. Here, we report the first case of convexal subarachnoid hemorrhage and multifocal ischemic lesions caused by infective endocarditis (IE) in a treatment-naïve advanced HIV patient. CASE REPORT A 52-year-old HAART-naïve, HIV-positive, African American man presented with altered mental status, shortness of breath, nonproductive cough, and generalized weakness. His past medical history was significant for congestive heart failure, chronic obstructive pulmonary disease, and end-stage renal disease (noncompliant with hemodialysis). Head computed tomography (CT) showed an isolated sulcal hemorrhage in the mid-left frontal lobe. Fluid-attenuated inversion recovery/gradient recalled echo sequences confirmed a hemorrhage in the left-mid-frontal sulcus, and diffusion-weighted imaging revealed multifocal bilateral ischemic lesions. Transesophageal echocardiography exhibited mitral valve vegetations. Multifocal ischemic lesions and cSAH caused by infectious endocarditis were confirmed. Initiation of intravenous vancomycin and piperacillin-tazobactam allowed the patient to have resolution of his altered mental status. A head CT 5 days later revealed the resolution of cSAH. CONCLUSIONS Infective endocarditis should be considered as an underlying etiology of cSAH, especially when present with multifocal ischemic lesions. Risk factors contributing to the development of cSAH in the IE patient population should be explored in future studies. HIV has not been previously reported in this subgroup and its prevalence should be considered. The prognosis for cSAH in relation to IE is generally favorable.
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Affiliation(s)
- Faisal Khan
- Department of Neurology, Sam Houston State University College of Osteopathic Medicine, Huntsville, TX, USA
| | - Neha Sharma
- Houston Medical Clerkship, Sugar Land, TX, USA
| | - Moin Ud Din
- Houston Medical Clerkship, Sugar Land, TX, USA
| | - Saloni Shirke
- Caribbean Medical University School of Medicine, Willemstad, Curacao, Netherlands Antilles
| | - Saima Abbas
- Department of Infectious Disease, Rockledge Regional Medical Center, Rockledge, FL, USA
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9
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Galiano Blancart R, Fortea G, Pampliega Pérez A, Martí S, Parkhutik V, Sánchez Cruz A, Soriano C, Geffner Sclarsky D, Pérez Saldaña M, López Hernández N, Beltrán I, Lago Martín A. One-year prognosis of non-traumatic cortical subarachnoid haemorrhage: a prospective series of 34 patients. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2017.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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10
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Larson AS, Brinjikji W. Subarachnoid Hemorrhage of Unknown Cause: Distribution and Role of Imaging. Neuroimaging Clin N Am 2021; 31:167-175. [PMID: 33902872 DOI: 10.1016/j.nic.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Subarachnoid hemorrhage of unknown cause represents approximately 10% to 15% of nontraumatic subarachnoid hemorrhages. The key factors in determining the management strategy for a presumed nonaneurysmal subarachnoid hemorrhage are the distribution, location, and amount of subarachnoid blood. Hemorrhage distribution on computed tomography can be categorized as follows: perimesencephalic, diffuse, sulcal, and primary intraventricular. The extent of the workup required in determining the cause of hemorrhage depends on the distribution of blood. The authors review the potential causes, differential diagnoses, and acute and long-term follow-up strategies in patients with subarachnoid hemorrhage of unknown cause.
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Affiliation(s)
- Anthony S Larson
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Neurosurgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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11
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Qin W, Xie W, Xia M, Zhao RC, Zhang J. Intracranial High-Grade Stenosis and Hyperhomocysteinemia Presenting as Cortical Subarachnoid Hemorrhage Concomitant with Acute Ischemic Stroke in a Young Man. Am J Case Rep 2020; 21:e920606. [PMID: 32579543 PMCID: PMC7327752 DOI: 10.12659/ajcr.920606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cortical subarachnoid hemorrhage (cSAH) is a rare clinical presentation with different causes, but rarely happens along with acute ischemic stroke. Intracranial high-grade stenosis originated from brain has been regarded as an unusual cause of cSAH, especially in young adults. CASE REPORT A case of 33-year-old male presented with mild headache and spontaneous left-sided body weakness. Initial brain computed tomography (CT) showed cSAH in the right superior frontal sulcus. Further neuroimaging examinations including magnetic resonance imaging (MRI), digital subtraction angiography (DSA), transesophageal echocardiogram (TEE); in addition, lumbar puncture and blood tests were performed. Diffusion-weighted imaging (DWI) showed an acute infarction in the right frontal lobe and corona radiata of the territory of middle cerebral artery (MCA). The MR angiography (MRA) displayed no flow signal in the right middle cerebral artery M1-segment, while the DSA displayed bloodstream slowness in the right MCA M1-segment which suggested high-grade stenosis of the right MCA. The abnormal laboratory data suggested hyperhomocysteinemia, and excluded causes of thrombosis, infection, or cancer. The mechanism of cSAH may come about in severe atherosclerotic stenosis of MCAs by the broken of expanded tenuous compensatory pial vessels. The patient had good recovered at follow-up. CONCLUSIONS This case demonstrates cSAH with acute ischemic stroke, which is an uncommon complication, in a young adult stroke patient; a high-grade atherosclerotic stenosis of the MCA was identified as the etiology.
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Affiliation(s)
- Weiwei Qin
- Department of Neurology, Henan Provincial People's Hospital, School of Clinical Medicine, Henan University, Zhengzhou, Henan, China (mainland)
| | - Weizheng Xie
- Department of Neurology, Anyang People's Hospital, Anyang, Henan, China (mainland)
| | - Mingrong Xia
- Department of Neurology, Henan Provincial People's Hospital, School of Clinical Medicine, Henan University, Zhengzhou, Henan, China (mainland)
| | - Robert Chunhua Zhao
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China (mainland)
| | - Jiewen Zhang
- Department of Neurology, Henan Provincial People's Hospital, School of Clinical Medicine, Henan University, Zhengzhou, Henan, China (mainland)
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12
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Boukobza M, Ilic-Habensus E, Duval X, Laissy JP. Acute convexity subarachnoid hemorrhage (cSAH) in infectious endocarditis (IE): imaging features and follow-up. J Neurol 2020; 267:2971-2982. [PMID: 32494850 DOI: 10.1007/s00415-020-09953-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
AIM To assess: (1) the prevalence of convexity subarachnoid hemorrhage (cSAH) in infective endocarditis (IE); (2) its relationship with IE features; (3) the associated lesions; (4) whether cSAH is a predictor of future hemorrhage; (5) whether cSAH could cause cortical superficial siderosis (cSS). METHODS We retrospectively evaluated the MRI data in 240 IE-patients: At baseline, the location of cSAH and associated lesions; at follow-up, the occurrence of new lesions and of cSS. Patients with and without cSAH were compared. RESULTS There were 21 cSAH-IE patients without (Group 1a) and 10 with intracranial infectious aneurysms (IIAs) (Group 1b). cSAH was revealed by headache (16.1%), confusion (9.7%), acute meningeal syndrome (3.2%) and was incidental in 71%. In most cases, the cSAH was: in the frontal (61.3%) and the parietal lobe (16.1%), unifocal, and mainly localized within a single sulcus (80.7%), appearing as a thick intrasulcal dark line on T2* in 70% of IIA patients. Valvular vegetations (87.1%, p < 0.0001), vegetations length ≥ 15 mm (58.1%, p < 0.0001) and mitral valve involvement (61.3%; p = 0.05) were significantly associated. There was no significant difference between the two groups in terms of pathogen distribution, valve characteristics and clinical expression. Associated lesions were: CMBs (77.4%), DWILs (51.6%), brain hemorrhages (16.1%) brain micro-abscesses (3.2%) meningitis (3.2%), visceral emboli (45.2%). At follow-up: no SAH recurrence or neurological event. cSS disappeared in 7/12 cases. CONCLUSION cSAH in IE is mostly an incidental finding but may be the telltale sign of an IIA. cSAH is not a marker of poor prognosis in non-IIA patients.
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Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Emila Ilic-Habensus
- Center of Clinical Investigations, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Xavier Duval
- Center of Clinical Investigations, Inserm 1425, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris-Diderot University, Inserm U1137, Paris, France
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris-Diderot University, Inserm U1148, Paris, France
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13
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Yost M, Fiebelkorn CA, Rabinstein AA, Klaas J, Aakre JA, Brown RD, Mielke MM, Knopman DS, Lowe V, Petersen RC, Jack CR, Vemuri P, Graff-Radford J. Incidence of Convexal Subarachnoid Hemorrhage in the Elderly: The Mayo Clinic Study of Aging. J Stroke Cerebrovasc Dis 2019; 28:104451. [PMID: 31668581 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Nontraumatic convexal subarachnoid hemorrhages in the elderly can be a manifestation of cerebral amyloid angiopathy associated with a high risk of future intracerebral hemorrhage. The incidence in the elderly population is unknown. Our objectives were to: 1) determine the incidence of convexal subarachnoid hemorrhage in a population-based study, and, 2) to compare apopolipoprotein-E genotype and amyloid positron emission tomographic (PET) imaging for those with versus without hemorrhage. METHODS Between 11/29/2004 and 3/11/2017, 4462 individuals without hemorrhage at baseline participated in the population-based Mayo Clinic Study of Aging. We used the Rochester Epidemiology Project medical records-linkage system to identify intracerebral hemorrhages. Records and images were reviewed to identify convexal subarachnoid hemorrhage. Neuroimaging characteristics, demographics, medications, and apopolipoprotein-E genotype were recorded. RESULTS Four cases were identified. The incidence of convexal subarachnoid hemorrhage was 14.1 per 100,000 person years. Three occurred in women, median age, 79 (range: 71-84). One patient had coexisting cerebral microbleeds. Two participants developed a subsequent lobar intracerebral hemorrhage at a median of 4.75 years after convexal subarachnoid hemorrhage. The apopolipoprotein-E -allele combinations of the 4 were: 3/3, 3/3, 2/2, and 2/3. On Pittsburgh Compound B-PET imaging, median standardized uptake value ratio with convexal subarachnoid hemorrhage was 1.86 (range: 1.38-2.34). CONCLUSIONS Convexal subarachnoid hemorrhage is rare in the older population, occurring with an incidence of about 14 per 100,000 person years. Yet, when present, it may be associated with a high risk of future intracerebral hemorrhage.
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Affiliation(s)
- Micah Yost
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | - James Klaas
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Val Lowe
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Prashanthi Vemuri
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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14
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Calviere L, Viguier A, Patsoura S, Rousseau V, Albucher JF, Planton M, Pariente J, Cognard C, Olivot JM, Bonneville F, Raposo N. Risk of Intracerebral Hemorrhage and Mortality After Convexity Subarachnoid Hemorrhage in Cerebral Amyloid Angiopathy. Stroke 2019; 50:2562-2564. [PMID: 31337297 DOI: 10.1161/strokeaha.119.026244] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background and Purpose- Convexity subarachnoid hemorrhage (cSAH) is an increasingly recognized presentation of cerebral amyloid angiopathy (CAA), usually revealed by transient symptoms, but data on its outcome are limited. We compared the risk of future intracerebral hemorrhage (ICH), cSAH, and death in patients with CAA after cSAH and after lobar ICH. Methods- Consecutive patients with probable CAA, based on the Boston criteria, presenting with cSAH (CAA-cSAH) or lobar ICH (CAA-ICH) were included. We obtained baseline clinical and magnetic resonance imaging data and follow-up information. Univariable and multivariable analyses were used to compare incidence rate for symptomatic ICH, symptomatic cSAH, and late-death (beyond 30 days) between patients with CAA-cSAH and CAA-ICH. Results- Among 105 patients (mean age, 76.7±7.5 years) enrolled, 44 participants presented with CAA-cSAH and 61 with CAA-ICH. The median follow-up was 22.2 months (interquartile range, 12.6-34.4). The symptomatic ICH rate (per person-year) was 10.5% (95% CI, 5.6-19.4) in patients with CAA-cSAH compared with 8.5% (95% CI, 4.4-16.4) in those with CAA-ICH (adjusted hazard ratio, 1.05; 95% CI, 0.32-3.43). The annual incidence rates of symptomatic cSAH (9.9% versus 3.8%; adjusted hazard ratio, 1.77; 95% CI, 0.43-7.28) and death (9.5% versus 17.8%; adjusted hazard ratio, 0.56; 95% CI, 0.22-1.43) were not significantly different between patients with CAA-cSAH and those with CAA-ICH. Conclusions- Patients with CAA-related cSAH have a poor outcome, with similar high risk of future ICH and long-term mortality than CAA patients after lobar ICH. Our findings may have important prognostic implication and guide management of patients with cSAH in CAA.
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Affiliation(s)
- Lionel Calviere
- From the Department of Neurology, Hôpital Pierre-Paul Riquet (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier (UPS), France (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., F.B., N.R.)
| | - Alain Viguier
- From the Department of Neurology, Hôpital Pierre-Paul Riquet (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier (UPS), France (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., F.B., N.R.)
| | - Sofia Patsoura
- Department of Neuroradiology, Hôpital Pierre-Paul Riquet (S.P., C.C., F.B.), Centre Hospitalier Universitaire de Toulouse, France
| | - Vanessa Rousseau
- Department of Epidemiology (V.R.), Centre Hospitalier Universitaire de Toulouse, France.,Department of Clinical Pharmacology, CIC1436, Unité de Soutien Métholdologique et de Recherche (USMR) (V.R.), Centre Hospitalier Universitaire de Toulouse, France
| | - Jean-François Albucher
- From the Department of Neurology, Hôpital Pierre-Paul Riquet (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier (UPS), France (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., F.B., N.R.)
| | - Mélanie Planton
- From the Department of Neurology, Hôpital Pierre-Paul Riquet (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier (UPS), France (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., F.B., N.R.)
| | - Jérémie Pariente
- From the Department of Neurology, Hôpital Pierre-Paul Riquet (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier (UPS), France (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., F.B., N.R.)
| | - Christophe Cognard
- Department of Neuroradiology, Hôpital Pierre-Paul Riquet (S.P., C.C., F.B.), Centre Hospitalier Universitaire de Toulouse, France
| | - Jean-Marc Olivot
- From the Department of Neurology, Hôpital Pierre-Paul Riquet (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier (UPS), France (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., F.B., N.R.)
| | - Fabrice Bonneville
- Department of Neuroradiology, Hôpital Pierre-Paul Riquet (S.P., C.C., F.B.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier (UPS), France (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., F.B., N.R.)
| | - Nicolas Raposo
- From the Department of Neurology, Hôpital Pierre-Paul Riquet (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., N.R.), Centre Hospitalier Universitaire de Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier (UPS), France (L.C., A.V., J.-F.A., M.P., J.P., J.-M.O., F.B., N.R.)
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15
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Dakay K, Mahta A, Rao S, Reznik ME, Wendell LC, Thompson BB, Potter NS, Saad A, Gandhi CD, Santarelli J, Al-Mufti F, MacGrory B, Burton T, Jayaraman MV, McTaggart RA, Furie K, Yaghi S, Cutting S. Yield of diagnostic imaging in atraumatic convexity subarachnoid hemorrhage. J Neurointerv Surg 2019; 11:1222-1226. [PMID: 31076550 DOI: 10.1136/neurintsurg-2019-014781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Atraumatic convexity subarachnoid hemorrhage is a subtype of spontaneous subarachnoid hemorrhage that often presents a diagnostic challenge. Common etiologies include cerebral amyloid angiopathy, vasculopathies, and coagulopathy; however, aneurysm is rare. Given the broad differential of causes of convexity subarachnoid hemorrhage, we assessed the diagnostic yield of common tests and propose a testing strategy. METHODS We performed a single-center retrospective study on consecutive patients with atraumatic convexity subarachnoid hemorrhage over a 2-year period. We obtained and reviewed each patient's imaging and characterized the frequency with which each test ultimately diagnosed the cause. Additionally, we discuss clinical features of patients with convexity subarachnoid hemorrhage with respect to the mechanism of hemorrhage. RESULTS We identified 70 patients over the study period (mean (SD) age 64.70 (16.9) years, 35.7% men), of whom 58 patients (82%) had a brain MRI, 57 (81%) had non-invasive vessel imaging, and 27 (38.5%) underwent catheter-based angiography. Diagnoses were made using only non-invasive imaging modalities in 40 patients (57%), while catheter-based angiography confirmed the diagnosis in nine patients (13%). Further clinical history and laboratory testing yielded a diagnosis in an additional 17 patients (24%), while the cause remained unknown in four patients (6%). CONCLUSION The etiology of convexity subarachnoid hemorrhage may be diagnosed in most cases via non-invasive imaging and a thorough clinical history. However, catheter angiography should be strongly considered when non-invasive imaging fails to reveal the diagnosis or to better characterize a vascular malformation. Larger prospective studies are needed to validate this algorithm.
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Affiliation(s)
- Katarina Dakay
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Ali Mahta
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Shyam Rao
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Michael E Reznik
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Linda C Wendell
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Bradford B Thompson
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - N Stevenson Potter
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Ali Saad
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Justin Santarelli
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Brian MacGrory
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Tina Burton
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Mahesh V Jayaraman
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Diagnostic Imaging, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Ryan A McTaggart
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurosurgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Diagnostic Imaging, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Karen Furie
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.,Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Shawna Cutting
- Department of Neurology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
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16
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Abel WF, Funk CR, Blenda AV. Galectins in the Pathogenesis of Cerebrovascular Accidents: An Overview. J Exp Neurosci 2019; 13:1179069519836794. [PMID: 31007530 PMCID: PMC6458655 DOI: 10.1177/1179069519836794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/19/2019] [Indexed: 01/04/2023] Open
Abstract
Due to limitations of neuroimaging, such as the isodense appearance of blood to neuronal tissue in subacute hemorrhagic stroke, a body of studies have been performed to evaluate candidate biomarkers which may aid in accurate determination of cerebrovascular accident type. Beyond aiding in the delineation of stroke cause, biomarkers could also confer useful prognostic information to help clinicians plan use of resources. One of the candidate biomarkers studied for detection of cerebrovascular accident (CVA) includes a class of proteins called galectins. Galectins bind β-galactoside through a highly conserved carbohydrate recognition domain, endowing an ability to interact with carbohydrate moieties on glycoproteins, some of which are relevant to CVA response. Furthermore, galectins-1, -2, -3, -9, and -12 are expressed in tissues relevant to CVA, and some exhibit characteristics (eg, extracellular secretion) that could render feasible their detection in serum. Galectins-1 and -3 appear to have the largest amounts of preclinical evidence, consistently demonstrating increased activity and expression levels during CVA. However, a lack of standardization of biochemical assays across cohort studies limits further translation of these basic science studies. This review aims to increase awareness of the biochemical roles of galectins in CVA, while also highlighting challenges and remaining questions preventing the translation of basic science observations into a clinically useful test.
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Affiliation(s)
- William F Abel
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | | | - Anna V Blenda
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
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17
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Takamiya S, Yoshimoto T, Maruichi K. Subarachnoid Hemorrhage with Progressive Cerebral Steno-Occlusive Disease: Report of 2 Cases. J Stroke Cerebrovasc Dis 2019; 28:e14-e16. [PMID: 30679014 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/26/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022] Open
Abstract
Nontraumatic nonaneurysmal subarachnoid hemorrhage (SAH) is a rare condition. Among them, SAH with cerebral steno-occlusive disease is quite rare. Moreover there has been no report of SAH patient who had been diagnosed with steno-occlusive disease since before. We here report 2 cases of nontraumatic nonaneurysmal convexity SAH who originally had progressive cerebral steno-occlusive disease. Case 1, a woman in her 40s who had diagnosed left internal carotid artery (ICA) stenosis 6 years before complained of headache. She was diagnosed SAH and progressive ICA stenosis, then performed revascularization. Case 2, a woman in her 40s who had diagnosed right ICA stenosis 7 months before complained of headache. She was diagnosed with SAH and ICA occlusion. These 2 cases suggested that progressive cerebral steno-occlusive disease lead to SAH due to collapse of their fragile pial anastomoses.
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Affiliation(s)
- Soichiro Takamiya
- Neurosurgery, Kashiwaba Neurosurgical Hospital, Sapporo, Hokkaido, Japan.
| | | | - Katsuhiko Maruichi
- Neurosurgery, Kashiwaba Neurosurgical Hospital, Sapporo, Hokkaido, Japan
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18
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Agrawal A, García-Ballestas E, Durango-Espinosa Y, Mendoza-Flórez R, Moscote-Salazar L, Keni R, Deora H. The puzzle of spontaneous versus traumatic subarachnoid hemorrhage. APOLLO MEDICINE 2019. [DOI: 10.4103/am.am_22_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Takemaru M, Takeshima S, Hara N, Himeno T, Shiga Y, Takeshita J, Takamatsu K, Nomura E, Shimoe Y, Kuriyama M. [Reversible cerebral vasoconstriction syndrome: a clinical study of 11 cases]. Rinsho Shinkeigaku 2018; 58:377-384. [PMID: 29863100 DOI: 10.5692/clinicalneurol.cn-001143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study reports eleven cases of reversible cerebral vasospasm syndrome (RCVS). Of the 11 patients, two were males and nine were females, with the average age of 47.9 ± 14.1 years. Many of these patients were young. The rates of severe, intractable and pulsative headache, generalized convulsions, and motor hemiparesis were 64%, 27%, and 36%, respectively. As complications of intracerebral lesions in the early stage of disease onset, convexal subarachnoid hemorrhage, lobar intracerebral hemorrhage, and posterior reversible encephalopathy syndrome were observed in 63%, 9%, and 45% of cases, respectively. Cerebral infarction occurred in 45% of cases at around 1-3 weeks after onset. Improvement of cerebral vasoconstriction was recognized in several cases from about the first month of onset. The post-partum period, migraine, transfusion, rapid amelioration for anemia, renal failure, bathing, and cerebrovascular dissection were suspected as disease triggers. Abnormally high blood pressure at onset was confirmed in 55% of cases. It is important to analyze the pathophysiology of RCVS associated with these triggers from the viewpoint of the breakdown of the blood-brain barrier.
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Affiliation(s)
- Makoto Takemaru
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
| | - Shinichi Takeshima
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
- Present address: Showa University School of Medicine
| | - Naoyuki Hara
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
- Present address: Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Takahiro Himeno
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
| | - Yuji Shiga
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
- Present address: Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Jun Takeshita
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
| | | | - Eiichi Nomura
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
| | - Yutaka Shimoe
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
| | - Masaru Kuriyama
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
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20
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Galiano Blancart RF, Fortea G, Pampliega Pérez A, Martí S, Parkhutik V, Sánchez Cruz AV, Soriano C, Geffner Sclarsky D, Pérez Saldaña MT, López Hernández N, Beltrán I, Lago Martín A. One-year prognosis of non-traumatic cortical subarachnoid haemorrhage: A prospective series of 34 patients. Neurologia 2018; 36:215-221. [PMID: 29903393 DOI: 10.1016/j.nrl.2017.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/16/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Cortical subarachnoid haemorrhage (cSAH) has multiple aetiologies. No prospective study has reported the long-term progression of the condition. The objective of this study is to describe the clinical and aetiological characteristics of patients with cSAH and to gain insight into prognosis. METHODS We performed a prospective, observational, multi-centre study. Data on clinical and radiological variables were collected; during a one-year follow-up period, we recorded data on mortality, dependence, rebleeding, and the appearance of dementia. RESULTS The study included 34 patients (mean age, 68.3 years; range, 27-89). The most frequent symptoms were headache and focal neurological deficits, which were frequently transient and recurrent. CT scans returned pathological findings in 28 patients (85%). Brain MRI scans were performed in 30 patients (88%), revealing acute ischaemia in 10 (29%), old haemorrhage in 7 (21%), and superficial siderosis in 2 (6%). Aetiology was identified in 26 patients (76.5%): causes were cerebral amyloid angiopathy in 8, ischaemic stroke in 5, vasculitis in 4, reversible posterior encephalopathy in 2, venous thrombosis in 2, reversible cerebral vasoconstriction syndrome in 2, carotid occlusion in 1, Marfan syndrome in 1, and meningeal carcinomatosis in 1. Three patients died during follow-up (2 due to causes related to the cause of cSAH). Three patients developed dementia, 3 had lobar haemorrhages, and one had a second cSAH. CONCLUSIONS The most frequent causes of cSAH in our series were cerebral amyloid angiopathy, ischaemic stroke, and vasculitis. This type of haemorrhage has a worse prognosis than other non-aneurysmal cSAH. There are numerous possible causes, and prognosis depends on the aetiology. In elderly patients, intracranial haemorrhage is frequently associated with cognitive impairment.
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Affiliation(s)
| | - G Fortea
- Servicio de Neurología, Hospital La Fe, Valencia, España
| | - A Pampliega Pérez
- Servicio de Neurología, Hospital General de Alicante, Alicante, España
| | - S Martí
- Servicio de Neurología, Hospital General de Alicante, Alicante, España
| | - V Parkhutik
- Servicio de Neurología, Hospital La Fe, Valencia, España
| | | | - C Soriano
- Servicio de Neurología, Hospital General de Castellón, Castelló de la Plana, España
| | - D Geffner Sclarsky
- Servicio de Neurología, Hospital General de Castellón, Castelló de la Plana, España
| | | | - N López Hernández
- Servicio de Neurología, Hospital General de Alicante, Alicante, España
| | - I Beltrán
- Servicio de Neurología, Hospital General de Alicante, Alicante, España
| | - A Lago Martín
- Servicio de Neurología, Hospital La Fe, Valencia, España
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21
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Topcuoglu MA, Liu L, Kim DE, Gurol ME. Updates on Prevention of Cardioembolic Strokes. J Stroke 2018; 20:180-196. [PMID: 29886716 PMCID: PMC6007290 DOI: 10.5853/jos.2018.00780] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/16/2018] [Accepted: 05/23/2018] [Indexed: 01/01/2023] Open
Abstract
Cardiac embolism continues to be a leading etiology of ischemic strokes worldwide. Although pathologies that result in cardioembolism have not changed over the past decade, there have been significant advances in the treatment and stroke prevention methods for these conditions. Atrial fibrillation remains the prototypical cause of cardioembolic strokes. The availability of new long-term monitoring devices for atrial fibrillation detection such as insertable cardiac monitors has allowed accurate detection of this leading cause of cardioembolism. The non-vitamin K antagonist oral anticoagulants have improved our ability to prevent strokes for many patients with non-valvular atrial fibrillation (NVAF). Advances in left atrial appendage closure and the U.S. Food and Drug Administration approval of the WATCHMAN (Boston Scientific) device for stroke prevention in NVAF patients who have an appropriate rationale for a nonpharmacological alternative, have revolutionized the field and provided a viable option for patients at higher hemorrhagic risk. The role of patent foramen ovale closure for secondary prevention in selected patients experiencing cryptogenic ischemic strokes at a relatively young age has become clearer thanks to the very recent publication of long-term outcomes from three major studies. Advances in the management of infective endocarditis, heart failure, valvular diseases, and coronary artery disease have significantly changed the management of such patients, but have also revealed new concerns related to assessment of ischemic versus hemorrhagic risk in the setting of antithrombotic use. The current review article aims to discuss these advances especially as they pertain to the stroke neurology practice.
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Affiliation(s)
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - M. Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Calviere L, Raposo N, Cuvinciuc V, Cognard C, Bonneville F, Viguier A. Patterns of convexal subarachnoid haemorrhage: clinical, radiological and outcome differences between cerebral amyloid angiopathy and other causes. J Neurol 2017; 265:204-210. [DOI: 10.1007/s00415-017-8693-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/23/2017] [Indexed: 12/15/2022]
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Chertcoff A, Bandeo L, Pantiu F, Cejas LL, Pacha S, Roca CU, Pardal MF, Reisin R, Bonardo P. Convexity subarachnoid hemorrhage: clinical features and etiology of an Argentinian cohort. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:858-861. [PMID: 29236888 DOI: 10.1590/0004-282x20170170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 09/25/2017] [Indexed: 11/22/2022]
Abstract
UNLABELLED Nontraumatic convexity subarachnoid hemorrhage is an increasingly recognized subtype of subarachnoid bleeding. OBJECTIVE Our aim was to describe the etiology and clinical features of a cohort of patients with convexity subarachnoid hemorrhage. METHODS We retrospectively analyzed all cases of convexity subarachnoid hemorrhage admitted to our hospital between January 2012 and April 2017. Demographic features, clinical characteristics, complementary investigations, etiology and mortality were assessed. Twenty patients (65% females) were identified. Mean age: 53 years (range, 15-86 years). RESULTS Symptoms on admission: headache (65%), sensory and/or motor symptoms (50%) and seizures (35%). Commonest causes: cerebral vein thrombosis (20%), reversible cerebral vasoconstriction syndrome (20%) and cerebral amyloid angiopathy (20%). Two patients died. CONCLUSION Convexity subarachnoid hemorrhage may be related to a wide spectrum of etiologies. In our patients, an increased prevalence of cerebral vein thrombosis was observed. Mortality was low and not related to the bleeding itself.
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Affiliation(s)
- Aníbal Chertcoff
- Hospital Británico de Buenos Aires, Department of Neurology, Perdriel, Buenos Aires, Argentina
| | - Lucrecia Bandeo
- Hospital Británico de Buenos Aires, Department of Neurology, Perdriel, Buenos Aires, Argentina
| | - Fátima Pantiu
- Hospital Británico de Buenos Aires, Department of Neurology, Perdriel, Buenos Aires, Argentina
| | - Luciana León Cejas
- Hospital Británico de Buenos Aires, Department of Neurology, Perdriel, Buenos Aires, Argentina
| | - Sol Pacha
- Hospital Británico de Buenos Aires, Department of Neurology, Perdriel, Buenos Aires, Argentina
| | - Claudia Uribe Roca
- Hospital Británico de Buenos Aires, Department of Neurology, Perdriel, Buenos Aires, Argentina
| | - Manuel Fernández Pardal
- Hospital Británico de Buenos Aires, Department of Neurology, Perdriel, Buenos Aires, Argentina
| | - Ricardo Reisin
- Hospital Británico de Buenos Aires, Department of Neurology, Perdriel, Buenos Aires, Argentina
| | - Pablo Bonardo
- Hospital Británico de Buenos Aires, Department of Neurology, Perdriel, Buenos Aires, Argentina
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24
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Schapira AHV. Advances and insights into neurological practice 2016−17. Eur J Neurol 2017; 24:1425-1434. [DOI: 10.1111/ene.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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25
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Spanou I, Vassilopoulou S, Koroboki E, Tountopoulou A, Velonakis G, Mitsikostas DD. Convexity Subarachnoid Hemorrhage Due to Cardioembolic Stroke in a Woman with Thyrotoxicosis: Α Case Report. J Stroke Cerebrovasc Dis 2017; 26:e195-e196. [PMID: 28780251 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/27/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Non-traumatic convexity subarachnoid hemorrhage (cSAH) is a rarely reported condition with a wide spectrum of etiologies. Cerebral ischemia secondary to extracranial or intracranial atherosclerotic disease has been identified as a relatively uncommon cause of cSAH. CASE REPORT We report a case of cSAH caused by cardioembolic stroke. A 69-year old female patient developed suddenly left-sided face and body weakness and numbness and visual neglect on the left. She was newly detected with paroxysmal atrial fibrillation on the ground of thyrotoxicosis. Brain magnetic resonance imaging revealed ischemia of embolic pattern with cSAH. Further evaluation excluded other cause of hemorrhage. Dilation of leptomeningeal collateral vessels and rupture of pial vessels in distal cortical arteries may caused cSAH. Full anticoagulation was initiated. After one month, her condition improved significantly (NIHSS from 6 to 2). CONCLUSIONS cSAH may be a rare complication of cardioembolic stroke.
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Affiliation(s)
- Ioanna Spanou
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Sophia Vassilopoulou
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Koroboki
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyro Tountopoulou
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Research Unit of Radiology and Medical Imaging, University of Athens Medical School, Athens, Greece
| | - Dimos Dimitrios Mitsikostas
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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26
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Boukobza M, Smaali I, Duval X, Laissy JP. Convexity Subarachnoid Hemorrhage, Pseudomonas Aeruginosa (PA) Infective Endocarditis and Left Atrial Appendage Occluder (LAAO) Device Infection. A Case Report. Open Neuroimag J 2017; 11:26-31. [PMID: 28660006 PMCID: PMC5470070 DOI: 10.2174/1874440001711010026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/07/2017] [Accepted: 04/20/2017] [Indexed: 12/20/2022] Open
Abstract
An 83 year-old-man with left atrial appendage occluder (LAAO) developed Pseudomonas Aeruginosa (PA) infective endocarditis. MRI at day 3 of onset showed distal small infarcts in both middle cerebral arteries and left postero-inferior cerebellar artery territories. MRI at day 6 revealed two sites of convexity subarachnoid hemorrhage (cSAH). MRA and CTA failed to reveal a Mycotic aneurysm. The radiologic findings favor the assumption of necrosis of distal branches of mca or of pial arteries wall. This case present three unusual features: the presence of localized cSAH after initiation of antibiotherapy without mycotic aneurysm being individualized; the late occurrence of infective endocarditis after LAAO implantation; the very rare occurrence of PA in prosthetic infections.
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Affiliation(s)
- Monique Boukobza
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Ibtissem Smaali
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Xavier Duval
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, INSERM Clinical Investigation Center 007, (S.T., X.D.) and INSERM U738, (C.L., X.D.) Université Paris Diderot, Sorbonne Paris Cité, France
| | - Jean-Pierre Laissy
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1148, Paris, France; University Paris 7, Bichat Hospital, Paris, France
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27
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Abstract
Ocular or eye pain is a frequent complaint encountered not only by eye care providers but neurologists. Isolated eye pain is non-specific and non-localizing; therefore, it poses significant differential diagnostic problems. A wide range of neurologic and ophthalmic disorders may cause pain in, around, or behind the eye. These include ocular and orbital diseases and primary and secondary headaches. In patients presenting with an isolated and chronic eye pain, neuroimaging is usually normal. However, at the beginning of a disease process or in low-grade disease, the eye may appear "quiet," misleading a provider lacking familiarity with underlying disorders and high index of clinical suspicion. Delayed diagnosis of some neuro-ophthalmic causes of eye pain could result in significant neurologic and ophthalmic morbidity, conceivably even mortality. This article reviews some recent advances in imaging of the eye, the orbit, and the brain, as well as research in which neuroimaging has advanced the discovery of the underlying pathophysiology and the complex differential diagnosis of eye pain.
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Wilson D, Hostettler IC, Ambler G, Banerjee G, Jäger HR, Werring DJ. Convexity subarachnoid haemorrhage has a high risk of intracerebral haemorrhage in suspected cerebral amyloid angiopathy. J Neurol 2017; 264:664-673. [PMID: 28154972 PMCID: PMC5374182 DOI: 10.1007/s00415-017-8398-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 11/30/2022]
Abstract
The risk of future symptomatic intracerebral haemorrhage (sICH) remains uncertain in patients with acute convexity subarachnoid haemorrhage (cSAH) associated with suspected cerebral amyloid angiopathy (CAA). We assessed the risk of future sICH in patients presenting to our comprehensive stroke service with acute non-traumatic cSAH due to suspected CAA, between 2011 and 2016. We conducted a systematic search and pooled analysis including our cohort and other published studies including similar cohorts. Our hospital cohort included 20 patients (mean age 69 years; 60% male); 12 (60%) had probable CAA, and 6 (30%) had possible CAA according to the modified Boston criteria; two did not meet CAA criteria because of age <55 years, but were judged likely to be due to CAA. Fourteen patients (70%) had cortical superficial siderosis; 12 (60%) had cerebral microbleeds. Over a mean follow-up period of 19 months, 2 patients (9%) suffered sICH, both with probable CAA (annual sICH risk for probable CAA 8%). In a pooled analysis including our cohort and eight other studies (n = 172), the overall sICH rate per patient-year was 16% (95% CI 11–24%). In those with probable CAA (n = 104), the sICH rate per patient-year was 19% (95% CI 13–27%), compared to 7% (95% CI 3–15%) for those without probable CAA (n = 72). Patients with acute cSAH associated with suspected CAA are at high risk of future sICH (16% per patient-year); probable CAA might carry the highest risk.
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Affiliation(s)
- D Wilson
- Stroke Research Centre, UCL Institute of Neurology, University College London, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - I C Hostettler
- Stroke Research Centre, UCL Institute of Neurology, University College London, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - G Ambler
- Department of Statistical Science, UCL, London, WC1E 6BT, UK
| | - G Banerjee
- Stroke Research Centre, UCL Institute of Neurology, University College London, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - H R Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - D J Werring
- Stroke Research Centre, UCL Institute of Neurology, University College London, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
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