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

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

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

Thromboembolic events are rare among systemic complications of inflammatory bowel disease; however, they are a significant cause of mortality when they occur. Several reports have considered thromboembolic events in patients with ulcerative colitis presenting with venous or arterial thromboembolism, such as cerebral thrombosis, deep vein thrombosis, pulmonary thromboembolism, portal vein thrombosis, or mesenteric vein thrombosis. However, increased coagulability related to Crohn's disease is extremely rare compared with that of ulcerative colitis. We report a case of a 42-year-old man with complicated portal hypertension that occurred due to extensive portal vein and mesenteric vein thrombosis. He had a monozygotic twin brother who was also in remission with Crohn's disease. The patient showed protein C and protein S deficiencies; however, he recovered with early anticoagulation therapy.
Colitis, Ulcerative ; Crohn Disease ; Humans ; Hypertension, Portal ; Intracranial Thrombosis ; Mesenteric Veins ; Portal Vein ; Protein C ; Protein S ; Pulmonary Embolism ; Siblings ; Thromboembolism ; Thrombosis ; Twins, Monozygotic ; Venous Thromboembolism ; Venous Thrombosis

Antithrombin III deficient individuals have an increased risk of venous thrombosis and thromboembolism at a young age. To our knowledge, cerebral venous thrombosis associated with antithrombin III deficiency has not yet been reported in Korea. A 27-year-old pregnant woman without any known stroke risk factors was admitted to our hospital because of convulsions. Brain MRI and MR venography showed dural sinus thrombosis of the superior sagittal sinus, straight sinus, and left lateral sinus with venous hemorrhagic infarctions in both frontal and parietal lobes. Antithrombin III concentrations were decreased to 37%. We speculated that the etiology of the cerebral venous thrombosis in this patient was associated with antithrombin III deficiency. We suggest that antithrombin III deficiency should be considered as a possible cause of cerebral venous thrombosis.
Adult ; Antithrombin III Deficiency* ; Antithrombin III* ; Brain ; Female ; Humans ; Infarction ; Korea ; Magnetic Resonance Imaging ; Parietal Lobe ; Phlebography ; Pregnant Women ; Risk Factors ; Seizures ; Sinus Thrombosis, Intracranial* ; Stroke ; Superior Sagittal Sinus ; Thromboembolism ; Transverse Sinuses ; Venous Thrombosis

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 mycotic aneurysms are secondary to infectious endocarditis, meningoencephalitis, cavernous sinus thrombophlebitis, sinusitis, and bacteremia. Usually mycotic aneurysms are arising on distal cerebral vessels, but rarely on internal carotid artery. We experienced mycotic aneurysm of ICA followed by meningoencephalitis and thrombophlebitis in both cavernous sinuses. We observed occurrence of mycotic aneurysm by sequential image, and good result after endovascular treatment. So we present our case.
Aneurysm, Infected* ; Bacteremia ; Carotid Artery, Internal* ; Cavernous Sinus ; Cavernous Sinus Thrombosis ; Endocarditis ; Intracranial Aneurysm ; Meningoencephalitis ; Sinusitis ; Thrombophlebitis

Cerebral venous sinus thrombosisis an uncommon entity and its clinical presentations are highly variable. We present the case of superior sagittal sinus thrombosis. Although it was medical refractory, successfully treated with mechanical thrombectomy using the Solitaire FR device. A 27-year-old man who presented with venous infarction accompanied by petechial hemorrhage secondary to the superior sagittal sinus (SSS) thrombosis. Due to rapid deterioration despite of anticoagulation therapy, the patient was taken for endovascular treatment. We deployed the Solitaire FR device (4×20 mm) in the anterior portion of the thrombosed SSS, and it was left for ten minutes before the retraction. Thus, we removed a small amount of thrombus. But the sinus remained occluded. We therefore performed the thrombectomy using the same methods using the Solitaire FR (6×20 mm). Thus, we were successful in removing larger clots. Our case highlights not only that the mechanical thrombectomy using the Solitaire FR is effective in achieving revascularization both rapidly and efficiently available, but also that it might be another option in patients with cerebral venous sinus thrombosis who concurrently had rapid clinical deterioration with devastating consequences.
Adult ; Hemorrhage ; Humans ; Infarction ; Sinus Thrombosis, Intracranial ; Superior Sagittal Sinus* ; Thrombectomy* ; Thrombosis*

A 33-year-old male was admitted with severe headache lasting 3 days. He did not have a focal neurologic deficit, but had a high intracranial pressure of 512 mmH2O. Cerebral angiography revealed venous sinus thrombosis that mainly involved the superior sagittal and right transverse sinuses. His headache remained severe after intravenous heparin infusion, and so interventional procedures were performed. Mechanical aspiration with the Penumbra system(TM) and other interventional procedures reopened the outflow of the superior sagittal sinus and effectively ameliorated this patient's headache.
Adult ; Cerebral Angiography ; Headache ; Heparin ; Humans ; Intracranial Pressure ; Male ; Neurologic Manifestations ; Sagittal Sinus Thrombosis ; Sinus Thrombosis, Intracranial ; Suction ; Superior Sagittal Sinus ; Thrombectomy ; Thrombolytic Therapy ; Transverse Sinuses ; Venous Thrombosis