Aged ; Humans ; Ischemic Attack, Transient ; etiology ; Male ; Polycythemia Vera ; complications ; diagnosis

Transient global amnesia is characterized by a sudden memory loss of recent and/or remote events and transient inability to acquire new knowledge. Although mostly followed by complete recovery within a day, this rare and unexpected event in recovery phase after general anesthesia should be embarrassing and confusing, so we must proceed with prompt differential diagnosis for other organic intracranial pathology including transient ischemic attack and go on close observation. We describe a case of transient global amnesia of a 66-year-old woman after general anesthesia for excision and biopsy of left neck mass.
Aged ; Amnesia ; Amnesia, Transient Global ; Anesthesia, General ; Biopsy ; Diagnosis, Differential ; Female ; Humans ; Ischemic Attack, Transient ; Memory Disorders ; Neck

A brain tumor is rarely considered as a differential diagnosis of a transient ischemic attack. However, a 76-year old man presented with frequent attacks of transient dysarthria, right hemiparesis and right hemiparesthesia. A brain MRI showed a carpet-like mass with homogeneous enhancement along the high convexity of the left dura, which was compatible with en plaque meningioma. In this case, the symptoms were thought to be the result of cerebral ischemia, attributed to the hemodynamical change in a tumorous condition.
Aged ; Brain ; Brain Ischemia ; Brain Neoplasms ; Diagnosis, Differential ; Dysarthria ; Humans ; Ischemic Attack, Transient* ; Magnetic Resonance Imaging ; Meningioma* ; Paresis

During cerebral vasospasm (CVS) due to ruptured aneurysm the retinal arteries were photographed and evaluated with angiographic studies at various stages to study any correlation between them. Among 60 cases with angiographic CVS, ophthalmoscopic retinal artery spasm (RAS) was detected in 29 cases. Photographic demonstration of the RAS was possible in 7 cases. In general, in a series of cases, the degree of RAS seems to correspond to the severity of CVS.
Carotid Artery Diseases/complications ; Human ; Intracranial Aneurysm/complications ; Ischemic Attack, Transient/complications* ; Ophthalmoscopy* ; Retinal Artery* ; Retinal Diseases/diagnosis

A physician faced with a patient who has an episodic disorder should determine whether the episode in question is indeed a seizure in the first place. If so, he or she should characterize its pattern and other characteristics, and finally, should delineate the underlying cause. Epilepsy is primarily a diagnosis based on a history and the initial assessment is based largely on the clinical history, especially on an accurate description of the event in question. The EEG, MRI, and routine blood tests should be included in the initial diagnostic workup. The EEG is undoubtedly the most sensitive, indeed indispensable, tool for the diagnosis of epilepsy, however, it must be used in conjunction with clinical data. A proportion of epileptic patients have a perfectly normal interictal EEG. Furthermore, a small number of healthy persons show paroxysmal EEG abnormalities. MRI is the most important diagnostic tool for the detection of structural abnormalities underlying epilepsy. Some patients may later need protracted video-EEG monitoring for the diagnosis of epilepsy. The conditions most likely to simulate a seizure are syncope and transient ischemic attacks. There is a rise in serum creatine kinase and serum prolactin levels after the seizure, which findings could be used in emergency room to assist in distinguishing seizures from syncope or pseudo-seizures.
Creatine Kinase ; Diagnosis* ; Electroencephalography ; Emergency Service, Hospital ; Epilepsy* ; Hematologic Tests ; Humans ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Prolactin ; Seizures ; Syncope

Diagnosis of transient ischemic attack has been entirely dependent on the clinical history due to the absence of brain magnetic resonance imaging lesion. It is challenging to distinguish between transient ischemic attack and transient ischemic attack-mimics. Cerebral microbleeds would be found in 11.1–23.5% of incidental findings in elderly population. However, cerebral microbleeds have been known to lead to cognitive decline, dementia, seizure and even status epilepticus. We report a case of cerebral microbleeds induced epileptic seizure, visiting the emergency room with sudden onset unilateral motor weakness.
Aged ; Brain ; Dementia ; Diagnosis ; Emergency Service, Hospital ; Epilepsy ; Humans ; Incidental Findings ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Seizures ; Status Epilepticus

A 48-year-old hypertensive man had sudden onset of symptoms suggesting vertebrobasilar insufficiency, which were transient in nature lasted for only 4 hours. Brain computed tomography revealed a small hematoma in the pontomedullary junction. This is an uncommon presentation of benign brainstem hemorrhage simulating transient ischemic attack. We propose that computed tomographic scan using thin slices of 3mm to 5mm thickness at the level of brainstem is required before starting anticoagulation therapy for vertebrobasilar transient ischemic attack.
Brain Stem/*blood supply ; Cerebral Hemorrhage/*diagnosis ; Diagnosis, Differential ; Human ; Ischemic Attack, Transient/*diagnosis ; Male ; Middle Aged ; Tomography, X-Ray Computed

Echocardiographic diagnosis of atrial myxoma may not always be straightforward, and the distinction between myxoma and thrombi is not easy, especially when we observe a mass after successful surgery. Our report describes a 72-year-old woman who presented with right upper limb hemiparesis and was subsequently diagnosed as having transient ischemic attack due to a left atrial myxoma. One month after successful surgical resection of the tumor, the patient developed left-sided weakness. Echocardiography revealed a left atrial mass attached to the interatrial septum. Intravenous heparin was administered as a therapeutic trial for postoperative thrombi, which resulted in a decrease in mass size within a week. Anticoagulation with warfarin was continued, and complete resolution was demonstrated on a 4-month follow-up transesophageal echocardiography. This case highlights the fact that thrombus formation at the surgical site should be considered an unusual but potential complication after surgical resection of left atrial myxomas.
Aged ; Diagnosis ; Diagnosis, Differential* ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Follow-Up Studies ; Heparin ; Humans ; Ischemic Attack, Transient ; Myxoma* ; Paresis ; Thrombosis* ; Upper Extremity ; Warfarin

BACKGROUND: ADPKD is one of the most common hereditary renal disease in adult and is a systemic disorder with a variety of cardiovascular manifestations. To elucidate the clinical characteristics of cerebrovascular complications in Korean ADPKD patients, we reviewed the medical records of ADPKD patients who was registered in ADPKD clinic of Seoul National University Hospital. METHODS: A total of 18 adult patients were included and their sex ratio was 8:10. The median age of ADPKD diagnosis was 45.5 year (range 19-85), and age at cerebrovascular accident(CVA) was 52 years(22-82). The median duration from hypertension to CVA was 8 years(0-30). RESULTS: There were 5 cases of infarction, 4 cases of intracerebral hemorrhage, 4 cases of subarachnoid hemorrhage, and 4 cases of transient ischemic attack. Other clinical parameters of ADPKD were not different from patients who were not complicated with CVA. Intracranial aneurysms were detected in 6 patients and their median age at diagnosis was 47.5 years(33-66). Four cases were manifested as subarachnoid hemorrhage. Five cases were diagnosed through TFCA, and two of them were revealed as multiple aneurysms. Five cases received surgical treatment and five of six cases improved without any neurologic sequeale. MR angiography(MRA) were taken in 16 asymptomatic patients, and multiple aneurysms were newly detected in one of them. CONCLUSION: Cerebrovascular complications in Korean ADPKD patients were not significantly different from western patients. Intracranial aneurysms must be included in differential diagnosis in ADPKD patients who manifest an acute neurologic symptoms, and high-risk group need to be screened selectively with MRA.
Adult ; Aneurysm ; Cerebral Hemorrhage ; Diagnosis ; Diagnosis, Differential ; Humans ; Hypertension ; Infarction ; Intracranial Aneurysm ; Ischemic Attack, Transient ; Medical Records ; Neurologic Manifestations ; Polycystic Kidney, Autosomal Dominant* ; Seoul ; Sex Ratio ; Subarachnoid Hemorrhage

BACKGROUNDAlthough transient ischemic attacks (TIA) is a clinical diagnosis, imaging findings are important for its diagnosis and treatment. This study evaluated the value and limitations of conventional CT, CT cerebral perfusion imaging and transcranial Doppler sonography (TCD) in patients with TIA.

METHODSConventional CT, CT cerebral perfusion imaging and TCD were performed in 20 patients with TIA. After regular CT examination, 40-second dynamic scans were performed on selected slice, while 40 ml of non-ionic contrast materials was bolus-injected through antecubital vein with power injector. These dynamic images were processed with the perfusion software package on workstation. Cerebral blood flow (CBF) and time to peak (TTP) were measured in specific regions of the brain. TCD was also performed in 20 patients with TIA. Comparative analysis was made on the basis of the results of conventional CT, CT cerebral perfusion imaging and TCD.

RESULTSIn the 20 patients with TIA, conventional CT turned out to be normal. However, persisting abnormal perfusion changes corresponding to clinical symptoms were found in 13 cases with the prolonged TTP. The other 7 cases were normal. TTP of the affected side (11.6 +/- 3.0) s was significantly prolonged (t = 4.782, P < 0.01) in comparison with the contralateral side (8.8 +/- 1.5) s. The difference in CBF was not statistically significant (t = 1.912, P = 0.073) between the affected side [(223.9 +/- 19.6) ml.min(-1).L(-1)] and the contralateral side [(227.7 +/- 19.8) ml.min(-1).L(-1)]. TCD revealed severe stenosis or occlusion of the carotid artery in 10 patients, arteriosclerosis in 6 patients, blood speed decrease in 2 patients, vasospasm in 1 patient.

CONCLUSIONSConventional CT can exclude intracerebral diseases. Perfusion CT provides valuable hemodynamic information and shows the extent of perfusion disturbances. TCD can demonstrate abnormalities of the involved arteries in patients with TIA. The combination of these three imaging methods can provide more diagnostic information.

Adult ; Aged ; Cerebrovascular Circulation ; Female ; Humans ; Ischemic Attack, Transient ; diagnosis ; physiopathology ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Transcranial