Female ; Humans ; Ossification, Heterotopic ; diagnosis ; Stroke ; complications

Female ; Humans ; Ossification, Heterotopic ; diagnosis ; Stroke ; complications

In rare instances, stroke may precede a diagnosis of cancer and be the first clinical evidence of an underlying malignancy.Cerebral infarction mostly complicates lymphomas, carcinomas, and solid tumors. Malignancy-related thromboembolism can present as acute cerebral infarction, nonbacterial thrombotic endocarditis and migratory thrombophlebitis. It is generally attributed to a cancer-related hypercoagulable period, chronic disseminated intravascular coagulopathy (DIC), or tumor embolism. We reported a case of malignancy-related thromboembolism from an undiagnosed pancreatic adenocarcinoma in a 54-year-old man, who presented with recurrent ischemic stroke due to chronic DIC. He died of the underlying malignancy despite the appropriate institution of anticoagulation therapy.This case emphasizes that cerebral infarction may be the first manifestation of an undiagnosed cancer. If there is laboratory or clinical evidence associated with DIC, patients with a cerebral infarct of an unknown etiology should be investigated for a malignant process. The optimal method of anticoagulation in cancer patients with thromboembolic disease (TED) remains unclear.
Adenocarcinoma ; complications ; diagnosis ; physiopathology ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms ; complications ; diagnosis ; physiopathology ; Stroke ; diagnosis ; etiology ; Thrombosis ; diagnosis ; etiology

No abstract available.
Adult ; Brain Ischemia/diagnosis/*etiology ; Cerebral Angiography ; Fatal Outcome ; Female ; Humans ; Hyperventilation/complications ; Moyamoya Disease/*complications/diagnosis/therapy ; Risk Factors ; Stroke/diagnosis/*etiology ; Thyroid Crisis/*complications/diagnosis/therapy

Brain ; blood supply ; pathology ; surgery ; Diagnosis, Differential ; Humans ; Middle Aged ; Pituitary Neoplasms ; cerebrospinal fluid ; complications ; diagnosis ; Stroke ; cerebrospinal fluid ; complications ; diagnosis ; Tuberculosis ; cerebrospinal fluid ; complications ; diagnosis

Lambl's excrescences are filiform structures attached to the edges of cardiac valves and have been associated with stroke. Here we report two patients with Lambl's excrescences who developed migraine-like headaches followed by cerebral infarction. Their Lambl's excrescences were first identified by transesophageal echocardiography. One patient was given aspirin and another had surgery for debridement of excrescences. Their outcomes were good. The migraine-like headache might be the first symptom of cerebral ischemia and might be triggered by micro-emboli originated from Lambl's excrescences. Patients with Lambl's excrescences should be closely monitored and surgery should be considered in recurrent stroke cases.
Adult ; Headache ; diagnosis ; etiology ; Heart Valve Diseases ; complications ; diagnosis ; pathology ; Humans ; Male ; Middle Aged ; Stroke ; diagnosis ; etiology

OBJECTIVETo summarize the clinical presentation, pathogenesis, neuroimaging, treatment, and outcome of stroke-like migraine attacks after radiation therapy (SMART) syndrome, and to propose diagnostic criteria for this disorder.

DATA SOURCESWe searched the PubMed database for articles in English published from 1995 to 2015 using the terms of "stroke-like AND migraine AND radiation." Reference lists of the identified articles and reviews were used to retrieve additional articles.

STUDY SELECTIONData and articles related to late-onset effects of cerebral radiation were selected and reviewed.

RESULTSSMART is a rare condition that involves complex migraines with focal neurologic deficits following cranial irradiation for central nervous system malignancies. The recovery, which ranges from hours to days to weeks, can be partial or complete. We propose the following diagnostic criteria for SMART: (1) Remote history of therapeutic external beam cranial irradiation for malignancy; (2) prolonged, reversible clinical manifestations mostly years after irradiation, which may include migraine, seizures, hemiparesis, hemisensory deficits, visuospatial defect, aphasia, confusion and so on; (3) reversible, transient, unilateral cortical gadolinium enhancement correlative abnormal T2 and fluid-attenuated inversion recovery signal of the affected cerebral region; (4) eventual complete or partial recovery, the length of duration of recovery ranging from hours to days to weeks; (5) no evidence of residual or recurrent tumor; (6) not attributable to another disease. To date, no specific treatment has been identified for this syndrome.

CONCLUSIONSSMART is an extremely rare delayed complication of brain irradiation. However, improvements in cancer survival rates have resulted in a rise in its frequency. Hence, awareness and recognition of the syndrome is important to make a rapid diagnosis and avoid aggressive interventions such as brain biopsy and cerebral angiography.

Central Nervous System Neoplasms ; therapy ; Female ; Humans ; Male ; Migraine Disorders ; diagnosis ; etiology ; Radiation Injuries ; complications ; diagnosis ; Stroke ; diagnosis

BackgroundWhether the Glasgow Coma Scale (GCS) can assess intubated patients is still a topic of controversy. We compared the test performance of the GCS motor component (GCS-M)/Simplified Motor Score (SMS) to the total of the GCS in predicting the outcomes of intubated acute severe cerebral vascular disease patients.

MethodsA retrospective analysis of prospectively collected observational data was performed. Between January 2012 and October 2015, 106 consecutive acute severe cerebral vascular disease patients with intubation were included in the study. GCS, GCS-M, GCS eye-opening component, and SMS were documented on admission and at 24, 48, and 72 h after admission to Neurointensive Care Unit (NCU). Outcomes were death and unfavorable prognosis (modified Rankin Scale: 5-6) at NCU discharge. The receiver operating characteristic (ROC) curve was obtained to determine the prognostic performance and best cutoff value for each scoring system. Comparison of the area under the ROC curves (AUCs) was performed using the Z- test.

ResultsOf 106 patients included in the study, 41 (38.7%) patients died, and 69 (65.1%) patients had poor prognosis when discharged from NCU. The four time points within 72 h of admission to the NCU were equivalent for each scale's predictive power, except that 0 h was the best for each scale in predicting outcomes of patients with right-hemisphere lesions. Nonsignificant difference was found between GCS-M AUCs and GCS AUCs in predicting death at 0 h (0.721 vs. 0.717, Z = 0.135, P = 0.893) and 72 h (0.730 vs. 0.765, Z = 1.887, P = 0.060), in predicting poor prognosis at 0 h (0.827 vs. 0.819, Z = 0.395, P = 0.693), 24 h (0.771 vs. 0.760, Z = 0.944, P = 0.345), 48 h (0.732 vs. 0.741, Z = 0.593, P = 0.590), and 72 h (0.775 vs. 0.780, Z = 0.302, P = 0.763). AUCs in predicting death for patients with left-hemisphere lesions ranged from 0.700 to 0.804 for GCS-M and from 0.700 to 0.824 for GCS, in predicting poor prognosis ranged from 0.841 to 0.969 for GCS-M and from 0.875 to 0.969 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h (P > 0.05). No significant difference between GCS-M AUCs and GCS AUCs was found in predicting death (0.964 vs. 0.964, P = 1.000) and poor prognosis (1.000 vs. 1.000, P = 1.000) for patients with right-hemisphere lesions at 0 h. AUCs in predicting death for patients with brainstem or cerebella were poor for GCS-M (<0.700), in predicting poor prognosis ranged from 0.727 to 0.801 for GCS-M and from 0.704 to 0.820 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h (P > 0.05). The SMS AUCs (<0.700) in predicting outcomes were poor.

ConclusionsThe GCS-M approaches the same test performance as the GCS in assessing the prognosis of intubated acute severe cerebral vascular disease patients. The GCS-M could be accurately and reliably applied in patients with hemisphere lesions, but caution must be taken for patients with brainstem or cerebella lesions.

Adolescent ; Adult ; Coma ; diagnosis ; etiology ; Glasgow Coma Scale ; Humans ; Intubation, Intratracheal ; Prognosis ; Retrospective Studies ; Stroke ; complications

Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.
Cerebral Hemorrhage/*complications ; Cerebral Infarction/complications ; Female ; Humans ; Male ; Middle Aged ; Pain/etiology ; Phantom Limb/*diagnosis/etiology/therapy ; Psychomotor Performance/physiology ; Stroke/complications ; Tomography, X-Ray Computed

Pulmonary embolism (PE) poses a challenge to physicians, as it can be difficult to diagnose but results in significant mortality and morbidity in patients. Diagnosing PE requires an integrated approach using clinical findings, electrocardiography (ECG), blood investigations and imaging modalities. Abnormalities in ECG are common among patients with massive acute PE and can serve as a prognostic indicator. In this article, we describe the ECG presentations of two patients diagnosed with PE, and review the literature on the various types of ECG presentations and their role in predicting the prognosis of PE.
Anticoagulants ; administration & dosage ; Blood Pressure ; Echocardiography ; Electrocardiography ; methods ; Female ; Hemorrhage ; complications ; Humans ; Hypertension ; complications ; Male ; Middle Aged ; Prognosis ; Pulmonary Embolism ; diagnosis ; Stroke ; complications