Cerebral venous sinus thrombosis (CVST) may be complicated with various intracranial hemorrhage such as petechial hemorrhage, hemorrhagic infarction, parenchymal hemorrhage, subarachnoid hemorrhage (SAH), and subdural hematoma (SDH). However, combination of these types of intracranial hemorrhages supervening on CVST is seldom reported. A 55-year-old female with rectal cancer presented with severe headache, nausea, vomiting and diplopia. She was diagnosed as having CVST in the superior sagittal sinus with left frontal parenchymal hemorrhage and was treated with anticoagulants. The CVST were extended to inferior sagittal and straight sinuses. Moreover, SDH along the left cerebral convexity and SAH in the left sylvian fissure were simultaneously observed. Our present case shows that combination of various types of hemorrhages is rare but may occur in advanced CVST.
Anticoagulants ; Diplopia ; Female ; Headache ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Infarction ; Intracranial Hemorrhages ; Nausea ; Rectal Neoplasms ; Sinus Thrombosis, Intracranial ; Subarachnoid Hemorrhage ; Superior Sagittal Sinus ; Vomiting

Cilostazol is a phosphodiesterase inhibitor that has been shown to have similar efficacy in stroke prevention but fewer hemorrhagic events compared with aspirin. We report a case of spontaneous spinal epidural hematoma (SSEH) in a 67-year-old woman who has been treated with cilostazol for cerebral infarction. The patient was presented with sudden neck pain and right hemiparesis. Thirteen days after the onset, she recovered completely. Even cilostazol, which is a relatively safer drug in terms of bleeding risk compared to other antiplatelet agents, may cause SSEH. Therefore, physicians should keep in mind rare, but potentially fatal, bleeding complications such as SSEH when prescribing antiplatelet agents.
Aspirin ; Cerebral Infarction ; Female ; Hematoma, Epidural, Spinal ; Hemorrhage ; Humans ; Neck Pain ; Paresis ; Platelet Aggregation Inhibitors ; Stroke ; Tetrazoles

Hypertensive brainstem encephalopathy (HBE) is a variant of hypertensive encephalopathy characterized by brainstem and cerebellar involvement. Simultaneous supratentorial involvement in HBE is rarely reported as a vasogenic edema in subcortex and/or periventricular white matter. A 36-year-old woman visited hospital due to headache lasting 7 days before admission. Initial blood pressure was 270/170mmHg. T2-weighted and fluid-attenuated inversion recovery magnetic resonance imaging revealed multifocal high signal intensity lesions in upper medulla, pons, midbrain and cerebellar hemisphere. Especially, atypical periventricular lesions were shown as perpendicular fingers to the lateral ventricle like multiple sclerosis. Her clinical symptoms and radiological lesions were subsided with lowering blood pressure. We herein report a HBE with unusual supratentorial involvement mimicking multiple sclerosis.
Blood Pressure ; Brain Stem ; Edema ; Female ; Fingers ; Headache ; Humans ; Hypertensive Encephalopathy ; Lateral Ventricles ; Magnetic Resonance Imaging ; Mesencephalon ; Multiple Sclerosis ; Pons ; Posterior Leukoencephalopathy Syndrome

A cerebral infarction involving the nodulus usually produce contralateral lateropulsion and ipsilateral spontaneous nystagmus to the lesion. Here, we report a case of atypical isolated nodular infarction showed ipsilateral lateropulsion and contralateral spontaneous nystagmus to the lesion with a normal head impulse test. A right-handed 70-year-old man developed sudden vertigo with an unsteady gait. Neurologic examination revealed spontaneous left-beating nystagmus with a torsional component. He also displayed imbalance of walking and axial lateropulsion to the right side. Head impulse test was normal. Magnetic resonance imaging indicated acute infarction in the right nodulus on diffusion-weighted images.
Cerebral Infarction ; Gait Disorders, Neurologic ; Head ; Infarction ; Magnetic Resonance Imaging ; Neurologic Examination ; Vertigo ; Vestibular Neuronitis ; Walking

The link between hemodialysis and cerebrovascular disease has become more apparent. Several reports have suggested that the incidence of ischemic stroke on hemodialysis patients is greater than that on the general populations. We report a case with lacunar infarction following recurrent transient ischemic attack during consecutive hemodialysis.
Aluminum Hydroxide ; Carbonates ; Hemodiafiltration ; Humans ; Incidence ; Ischemic Attack, Transient ; Renal Dialysis ; Stroke ; Stroke, Lacunar

In patients with acute ischemic stroke, carotid duplex ultrasonography has been used to assess atherosclerotic lesions at the extracranial carotid artery. We reported a unique sonographic finding of carotid artery thrombus in a patient with acute cardioembolic stroke and atrial fibrillation. An 81-year-old woman with atrial fibrillation was presented with dysarthria and left side hemiparesis. She had undergone surgical thrombectomy and angioplasty for her right brachial artery occlusion four days before the stroke onset. Diffusion-weighted MRI revealed multiple territorial infarctions suggestive of acute cardio-embolic stroke. CT angiography showed an occlusion of the right common carotid artery. On B-mode ultrasonography, longitudinal intraluminal tortuous cylinderic oscillating thrombus was observed on the right distal common carotid artery to the proximal internal carotid artery. This case illustrates a unique ultrasonographic finding of acute cardiogenic thrombus in the extracranial carotid artery.
Angiography ; Angioplasty ; Atrial Fibrillation ; Brachial Artery ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, Internal ; Cerebral Infarction ; Dysarthria ; Female ; Humans ; Infarction ; Paresis ; Stroke ; Thrombectomy ; Thrombosis

Vertebral artery dissection (VAD) is a rare cause of young age stroke. This risky condition can be caused by even minor head or neck trauma. None of the previous studies has reported cough-related intracranial vertebral arterial dissection in Korea. We present two cases of cerebral infarctions from VAD induced by severe coughing. We should be alert to clinical manifestations of VAD to make proper diagnosis and to recognize coughing as a potential cause of VAD.
Cerebral Infarction ; Cough ; Head ; Korea ; Neck ; Stroke ; Vertebral Artery ; Vertebral Artery Dissection

Cerebral malaria is a severe neurological complication of Plasmodium falciparum infection. Cerebral malaria can lead to cerebral infarction by several mechanisms including systemic inflammatory response. The systemic inflammatory response is known to rarely occur in Plasmodium vivax infection. We report a patient who developed multiple cerebral infarctions following Plasmodium vivax infection.
Cerebral Infarction ; Humans ; Malaria, Cerebral ; Plasmodium ; Plasmodium falciparum ; Plasmodium vivax

BACKGROUND: In recent studies, by utilizing single photon emission computed tomography (SPECT) and magnetic resonance angiography (MRA), anatomical and functional evaluation became possible. Although MRA is increasingly being used to evaluate vascular status, conventional angiography is still gold standard for investigating anatomical structures. We studied the correlation between internal carotid artery (ICA) stenosis, patterns of collateral pathway, and cerebrovascular reserve using transfemoral cerebral angiography (TFCA) and SPECT. METHODS: We studied 54 patients with symptomatic ICA stenosis who were visit to our hospital between Sep 2009 and May 2011. Forms of collateral pathway were classified into primary and secondary pathway group. Severity of ICA stenosis was divided into 4 stages. Vascular reserve on SPECT was classified into favorable and poor groups. RESULTS: As a result of TFCA, collateral pathways were observed in 44 of 54 patients. Collateral flow via anterior communicating artery (AcoA) pattern occupied the highest proportion and other major patterns were collaterals via posterior cerebral artery-middle cerebral artery (PCA-MCA) and via posterior communicating artery (PCoA) pattern. Twenty-eight patients were primary pathway group and 16 patients were secondary pathway group. In both groups, most patients had moderate or severe ICA stenosis. As a result of SPECT, favorable vascular reserves were observed in 17 of 54 patients. Most of them had mild ICA stenosis and/or primary collateral pathway. Contrarily, most of secondary pathway group had poor vascular reserve even if their ICA stenosis severity was mild. CONCLUSION: In patients with symptomatic ICA stenosis with collateral pathways, rate of primary collateral pathways was higher than secondary collateral pathways. Secondary collateral pathways had insufficient compensatory effect about reduced cerebral blood perfusion.
Angiography ; Arteries ; Carotid Artery, Internal ; Carotid Stenosis ; Cerebral Angiography ; Cerebral Arteries ; Collateral Circulation ; Constriction, Pathologic ; Humans ; Magnetic Resonance Angiography ; Perfusion ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: The role of stroke risk factors as a determinant of clinical outcome is not well established. This study aimed to evaluate the prognostic value of stroke risk factors in patients with ischemic stroke by determining whether or not they contribute to stroke severity and disability after ischemic stroke. METHODS: Subjects were 433 patients with ischemic stroke. National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the severity of neurological deficit and clinical disability respectively. Multiple linear regression analysis was performed to evaluate the relation of stroke risk factors to stroke severity and disability. RESULTS: Among stroke risk factors, atrial fibrillation was significantly correlated with NIHSS (P<0.001) and mRS scores (P=0.006). Hypertension and age were significantly correlated with mRS scores (P=0.010, P=0.018, respectively). CONCLUSION: Atrial fibrillation was an independent factor associated with severe stroke and disability. Hypertension, and older age were independently correlated with serious disability after ischemic stroke.
Atrial Fibrillation ; Humans ; Hypertension ; Linear Models ; National Institutes of Health (U.S.) ; Risk Factors ; Stroke