Cerebral venous thrombosis is an uncommon cause of cerebral infarction. A 31-year-old man complained of headache, weakness, and numbness of the left leg a day before being admitted to the hospital. After admission, brain computed tomography and brain magnetic resonance imaging revealed superior sagittal sinus thrombosis with cerebral infarction in the right hemisphere. He had no significant medical history. On the fourth hospital day, he suddenly collapsed and died. Medicolegal autopsy was performed 3 days later; medical malpractice was suspected. External examination revealed a few conjunctival petechiae. Internal examination revealed thrombi in the superior sagittal sinus and superficial cortical veins. Thrombi were noted in the pulmonary trunk and both pulmonary arteries. Upon dissection of the left leg, we found thrombi in the posterior tibial vein. A microscopic examination revealed vasculitis of the same cortical veins, and we therefore assumed that vasculitis of the cortical veins gave rise to thrombosis. In typical autopsy practice, an examination of the dura mater is often overlooked, but careful examination of this region should be performed in cases of cerebral infarction in young adults, such as this one.
Adult ; Autopsy ; Brain ; Cerebral Infarction ; Dura Mater ; Headache ; Humans ; Hypesthesia ; Intracranial Thrombosis ; Leg ; Magnetic Resonance Imaging ; Malpractice ; Pulmonary Artery ; Pulmonary Embolism* ; Purpura ; Superior Sagittal Sinus ; Thrombosis ; Vasculitis ; Veins ; Venous Thrombosis* ; Young Adult

Adolescent ; Humans ; Male ; Pulmonary Embolism ; etiology ; Sinus Thrombosis, Intracranial ; complications ; diagnosis

Congenital sinus of Valsalva (SOV) aneurysm is a rare cardiac abnormality. Rarely the aneurysm enlarges without rupture, cause symptoms of the mass effect by compressing the adjacent structures, obstruction of the right ventricular outflow with tricuspid regurgitation, infectious endocarditis, thrombus formation and myocardial ischemia/infarction. And SOV aneurysm can also be a source of embolism. We observed a patient with cerebral infarction in whom a huge SOV aneurysm, was diagnosed as the presumed source of cerebral embolism and the cause of hypoplastic tricuspid valve.
Aneurysm* ; Cerebral Infarction ; Embolism ; Endocarditis ; Humans ; Intracranial Embolism* ; Rupture ; Sinus of Valsalva* ; Thrombosis ; Tricuspid Valve Insufficiency ; Tricuspid Valve*

Intracranial atherosclerosis-related occlusion (ICAS-O) is frequently encountered at the time of endovascular revascularization treatment (ERT), especially in Asian countries. However, because baseline angiographic findings are similar between ICAS-O and embolism-related occlusion (EMB-O), it is difficult to differentiate the etiologies before the ERT procedure. Moreover, despite successful randomized trials on ERT, results from studies examining the optimal treatment protocol in ICAS-O patients remain unclear. In this review, we describe the clinical and imaging factors that may possibly differentiate ICAS-O from EMB-O. We will also discuss some current hurdles for treating ICAS-O in the hyperacute period and suggest the optimal ERT strategy for ICAS-O patients.
Asian Continental Ancestry Group ; Clinical Protocols ; Diagnosis ; Endovascular Procedures ; Humans ; Intracranial Arteriosclerosis ; Intracranial Embolism ; Intracranial Thrombosis

Hemorrhagic conversion (HC) of a cerebral infarct is a radiological sign of reperfusion to the infarcted tissue. Recently the concept on HC needs to be revised in relation to advanced therapeutic trials for acute ischeniic strokes. To investigate the clinical significance of HC of a bland cerebral infarct, we analyzed the clinical and neuroimaging files of 70 stroke patients showing HC on the brain CT and/or MRI scans. We also studied the best-possible stroke mechanisms on clinicolaboratory grounds, the factors that might have contributed to HC, and the prognostic impact of HC. Of 70 patients with HC, 51 had infarcts in the carotid artery system, 18 in the vertebrobasilar system, and 1 in cerebral venous system. Definite cardioembolic sources were identified in 21 patients (30%). HC was associated with antithrombotic therapy in 21 patients (30%). Other stroke mechanisms included migraine (23 cases), moyamoya disease (2, cases), thrombotic thrombocytopenic purpura (I case), postoperative vasospasm (1 case), and dural sinus thrombosis (I case). We identified a subset of 14 patients with HC of isolated subcortical infarcts but without definite embolic sources. Sixty-four of 70 patients (91.5%) remained clinically stable or improved after HC, suggesting a relative safety of HC in this retrospective study. In conclusion HC follows cerebral infarctions caused by various non-embolic mechanisms as well as by embolism. HC was not a bad prognostic sign in tl-iis small series.
Brain ; Carotid Arteries ; Cerebral Infarction ; Embolism ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Migraine Disorders ; Moyamoya Disease ; Neuroimaging ; Purpura, Thrombotic Thrombocytopenic ; Reperfusion ; Retrospective Studies ; Sinus Thrombosis, Intracranial ; Stroke

The carotid stump is a known source of cerebral embolisms. Direct ultrasound sonographic visualization of a thrombus in the common carotid stump after development of a cerebral infarction is rare. We report a case of a 69-year-old man who presented with acute ipsilateral ischemic stroke with occlusion of the left common carotid artery, forming a stump proximal to the carotid bifurcation. Carotid duplex sonography revealed a mobile thrombus in the stump. An ipsilateral microembolic signal was observed by transcranial Doppler imaging.
Aged ; Carotid Artery, Common ; Cerebral Infarction ; Embolism ; Humans ; Intracranial Embolism ; Stroke ; Thromboembolism ; Thrombosis ; Ultrasonography, Doppler

BACKGROUND AND PURPOSE: The goal of stent retriever-based thrombectomy is removal of embolic clots in patients with intracranial large artery occlusion. However, outcomes of stent retrieval may differ between acute arterial occlusions due to intracranial atherosclerotic disease (IAD) and those due to embolism. This case series describes the outcomes of stent retriever-based thrombectomy and rescue treatments in 9 patients with IAD-related occlusion. METHODS: Among patients who underwent endovascular treatment for acute intracranial large artery occlusion, those in whom stent retrieval was attempted as first-line treatment were included in this review. IAD was defined as significant fixed focal stenosis at the occlusion site, which was evident on final angiographic assessment or observed during endovascular treatment. RESULTS: Median number of stent retriever passes was 2 (range, 1-3), and temporary bypass was seen in all patients. Immediate partial recanalization (arterial occlusive lesion grade 2-3) was observed in 7 patients. Immediate modified thrombolysis in cerebral infarction grade 2b-3 was seen in 6 patients, but the lesions often required rescue treatment due to reocclusion or flow insufficiency. In terms of rescue treatments, angioplasty and intra-arterial tirofiban infusion seemed to be effective. CONCLUSIONS: Our findings suggest that stent retrieval can effectively remove thrombi from stenotic lesions and achieve partial recanalization despite the tendency toward reocclusion in most patients with IAD-related occlusion. Further research into the use of rescue treatments, such as tirofiban infusion and angioplasty, is warranted.
Angioplasty ; Arteries* ; Cerebral Infarction ; Constriction, Pathologic ; Embolism ; Humans ; Intracranial Arteriosclerosis ; Intracranial Embolism and Thrombosis ; Mechanical Thrombolysis ; Stents* ; Thrombectomy

BACKGROUND AND PURPOSE: The goal of stent retriever-based thrombectomy is removal of embolic clots in patients with intracranial large artery occlusion. However, outcomes of stent retrieval may differ between acute arterial occlusions due to intracranial atherosclerotic disease (IAD) and those due to embolism. This case series describes the outcomes of stent retriever-based thrombectomy and rescue treatments in 9 patients with IAD-related occlusion. METHODS: Among patients who underwent endovascular treatment for acute intracranial large artery occlusion, those in whom stent retrieval was attempted as first-line treatment were included in this review. IAD was defined as significant fixed focal stenosis at the occlusion site, which was evident on final angiographic assessment or observed during endovascular treatment. RESULTS: Median number of stent retriever passes was 2 (range, 1-3), and temporary bypass was seen in all patients. Immediate partial recanalization (arterial occlusive lesion grade 2-3) was observed in 7 patients. Immediate modified thrombolysis in cerebral infarction grade 2b-3 was seen in 6 patients, but the lesions often required rescue treatment due to reocclusion or flow insufficiency. In terms of rescue treatments, angioplasty and intra-arterial tirofiban infusion seemed to be effective. CONCLUSIONS: Our findings suggest that stent retrieval can effectively remove thrombi from stenotic lesions and achieve partial recanalization despite the tendency toward reocclusion in most patients with IAD-related occlusion. Further research into the use of rescue treatments, such as tirofiban infusion and angioplasty, is warranted.
Angioplasty ; Arteries* ; Cerebral Infarction ; Constriction, Pathologic ; Embolism ; Humans ; Intracranial Arteriosclerosis ; Intracranial Embolism and Thrombosis ; Mechanical Thrombolysis ; Stents* ; Thrombectomy

Clinical observation was done on 302 cases of cerebrovascular accidents admitted at Sung-Sim hospital, Chung-Ang University from January, 1968 to August, 1976. 1) Of 302 cases of cerebrovascular accidents, the incidence of cerebral hemorrhage was 28.8, cerebral thrombosis 47,7 Subarachnoid hemorrhage 20.2% and cerebral embolism 3.3%. 2) The peak age incidence was in the fifth decade in cerebral hemorrhage, subarachnoid hemorrhage, whereas in cerebral thrombosis, it was in the sixth decade. 3) The most frequent predisposing factor in cerebral hemorrhage and subarachnoid hemorrhage were physical activity and emotional stress, whereas in thrombosis and embolism, it was rest. 4) Among disease preceding the onset of cerebrovascular accidents, hypertension were presented 65.4% in cerebral hemorrhage, 63.6% in cerebral thrombosis, 56.6% in subarachnoid hemorrhage and valvular heart disease was presented 40.0% in cerebral embolism. 5) Serum cholesterol level over 200mg% was seen in 33.0% of cerebrovascular accidents. 6) Leukocytosis was seen 58.6% of cerebrovascular accidents which was predominantly found in the hemorrhagic group. 7) The pressure of cerebrospinal fluid was elevated in 61.7% of cerebrovascular accidents, predominantliny the hemorrhagic group. 8) The peak duration of admission was present in 51.7% of cerebrovascular accidents within 7 days and mortality rate during hospitalization was 38.0% in cerebral hemorrhage, 10.4% in cerebral thrombosis and 27.8% in subarachnoid hemorrhage. 9)The mortality rate during hospitalization was 35.3% in all cerebrlavascular accidents within 24 hours.
Causality ; Cerebral Hemorrhage ; Cerebrospinal Fluid ; Cholesterol ; Embolism and Thrombosis ; Heart Valve Diseases ; Hospitalization ; Hypertension ; Incidence ; Intracranial Embolism ; Intracranial Thrombosis ; Leukocytosis ; Mortality ; Motor Activity ; Stress, Psychological ; Stroke ; Subarachnoid Hemorrhage

OBJECTIVE: Thromboembolus can occur during endovascular coil embolization. The aim of our study was to show our experience of intraarterial (IA) tirofiban infusion for thromboembolism during coil embolization for ruptured intracranial aneurysms. METHODS: This retrospective analysis was conducted in 64 patients with ruptured aneurysms who had emergent endovascular coil embolization from May 2007 to April 2011 at a single institute. Thromboembolic events were found in ten patients (15.6%). Anticoagulation treatment with intravenous heparin was started after the first coil deployment in ruptured aneurysmal sac. When a thrombus or embolus was found during the procedure, we tried to resolve them without delay with an initial dosage of 0.3 mg of tirofiban up to 1.2 mg. RESULTS: Three patients of four with total occlusion had recanalizations of thrombolysis in myocardial infarction (TIMI) grade III and five of six with partial occlusion had TIMI grade III recanalizations. Eight patients showed good recovery, with modified Rankin Scale (mRS) score of 0 and one showed poor outcome (mRS 3 and 6). There was no hemorrhagic or hematologic complication. CONCLUSION: IA tirofiban can be feasible when thromboembolic clots are found during coil embolization in order to get prompt recanalization, even in patients with subarachnoid hemorrhage.
Aneurysm, Ruptured ; Embolism ; Heparin ; Humans ; Intracranial Aneurysm ; Myocardial Infarction ; Retrospective Studies ; Subarachnoid Hemorrhage ; Thromboembolism ; Thrombosis ; Tyrosine