Coagulopathies are a relatively common cause of young-age stroke. We present herein a 15-year-old male who was admitted for acute cerebral infarction with dysarthria and weakness of the right side. He had previously been diagnosed with autosomal dominant protein-S deficiency. His left internal carotid artery was totally occluded. Emergency mechanical thrombolysis resulted in recanalization of that occluded artery and consequent improvement in symptoms. The patient was discharged with an oral anticoagulant.
Adolescent ; Arteries ; Carotid Artery, Internal ; Cerebral Infarction* ; Dysarthria ; Emergencies ; Humans ; Male ; Mechanical Thrombolysis ; Protein S Deficiency* ; Stroke

Primary liver tumor, especially hepatocellular carcinoma (HCC), is a common cause of cancer death worldwide. The incidence is generally higher in Asian countries than in western countries. Carcinogenesis of HCC is often associated with hepatitis viral infections. Current standard treatment of HCC is surgical resection or transplantation in patients with early stage disease. However, the patient with advanced stage disease, surgical resection is often limited. Sorafenib or other treatment modalities are not so effective as well. We report a case of unusual radiation super-sensitivity in advanced stage HCC, and review the literature.
Asian Continental Ancestry Group ; Carcinogenesis ; Carcinoma, Hepatocellular ; Hepatitis ; Humans ; Incidence ; Liver ; Radiotherapy

Extramedullary plasmacytoma (EMP) is a common plasma cell tumor often involving the upper aerodigestive tract. Although extremely rare, mediastinal involvement is possible. An 81-year-old man was presented to our emergency department with chest and back pain with weakness in both legs. Chest X-ray showed a large mass in the upper right mediastinum; subsequently, computed tomography and magnetic resonance imaging evaluated the mass. He was diagnosed with mediastinal EMP, which progressed to spinal cord compression. The patient was treated with radiotherapy and chemotherapy. Spinal cord compression, due to metastatic tumor, is an emergency clinical situation that requires prompt diagnosis and treatment. Emergency medicine physicians should be aware of the clinical presentation and complications associated with EMP.
Aged, 80 and over ; Back Pain ; Diagnosis ; Drug Therapy ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leg ; Magnetic Resonance Imaging ; Mediastinum ; Multiple Myeloma ; Plasmacytoma* ; Radiotherapy ; Spinal Cord Compression* ; Spinal Cord* ; Thorax

PURPOSE: Lacunar stroke, in the context of small vessel disease, is a type of cerebral infarction caused by occlusion of a penetrating artery. Pulsatility index (PI) is an easily measurable parameter in Transcranial Doppler ultrasound (TCD) study. PI reflects distal cerebral vascular resistance and has been interpreted as a surrogate marker of small vessel disease. We hypothesized that an increased PI, a marker of small vessel disease, might be associated with a larger infarct volume in acute lacunar stroke. MATERIALS AND METHODS: This study included 64 patients with acute lacunar stroke who underwent TCD and brain MRI. We evaluated the association between the mean PI value of bilateral middle cerebral arteries and infarct volume on diffusion-weighted MRI using univariate and multivariate linear regression. RESULTS: The mean infarct volume and PI were 482.18±406.40 mm3 and 0.86±0.18, respectively. On univariate linear regression, there was a significant positive association between PI and infarct volume (p=0.001). In the multivariate model, a single standard deviation increase of PI (per 0.18) was associated with an increase of 139.05 mm3 in infarct volume (95% confidence interval, 21.25 to 256.85; p=0.022). CONCLUSION: We demonstrated that PI was an independent determinant of infarct volume in acute lacunar stroke. The PI value measured in acute stroke may be a surrogate marker of the extent of ischemic injury.
Aged ; Cerebral Infarction/*diagnostic imaging/*physiopathology ; *Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; Middle Cerebral Artery ; Pulsatile Flow/physiology ; Retrospective Studies ; Stroke, Lacunar/*diagnostic imaging/*physiopathology ; *Ultrasonography, Doppler, Transcranial ; Vascular Resistance/physiology

BACKGROUND: When performing dental treatment under general anesthesia in adult patients who have difficulty cooperating due to intellectual disabilities, anesthesia induction may be difficult as well. In particular, patients who refuse to come into the dental office or sit in the dental chair may have to be forced to do so. However, for adult patients with a large physique, physical restraint may be difficult, while oral sedatives as premedication may be helpful. Here, a retrospective analysis was performed to investigate the effect of oral sedatives. METHODS: A hospital-based medical information database was searched for patients who were prescribed oral midazolam or triazolam between January 2009 and December 2017. Pre-anesthesia evaluation, anesthesia, and anesthesia recovery records of all patients were analyzed, and information on disability type, reason for prescribing oral sedatives, prescribed medication and dose, cooperation level during anesthesia induction, anesthesia duration, length of recovery room stay, and complications was retrieved. RESULTS: A total of 97 patients were identified, of whom 50 and 47 received midazolam and triazolam, respectively. The major types of disability were intellectual disabilities, autism, Down syndrome, blindness, cerebral palsy, and epilepsy. Analyses of changes in cooperation levels after drug administration showed that anesthesia induction without physical restraint was possible in 56.0% of patients in the midazolam group and in 46.8% of patients in the triazolam group (P = 0.312). CONCLUSIONS: With administration of oral midazolam or triazolam, general anesthesia induction without any physical restraint was possible in approximately 50% of patients, with no difference between the drugs.
Adult ; Anesthesia ; Anesthesia, General ; Autistic Disorder ; Blindness ; Cerebral Palsy ; Dental Offices ; Down Syndrome ; Epilepsy ; Humans ; Hypnotics and Sedatives ; Intellectual Disability ; Midazolam ; Premedication ; Recovery Room ; Restraint, Physical ; Retrospective Studies ; Triazolam