Traumatic common carotid artery dissection (CCAD) is rare. To our knowledge, only 14 case reports have described traumatic CCAD previously. Here, we report a case of CCAD in a patient with severe trauma. A 50-year-old man was lying on the road after drinking alcohol when a car drove over him. Computed tomography (CT) revealed multiple rib fractures with hemopneumothorax, lung contusion, flail chest, large amount of hematoma with bladder rupture, and fractures on the C6 spinous process, sacral ala, iliac bone, and pubic ramus. Repair of the bladder rupture, exploratory thoracotomy, and open reduction of multiple rib fractures were performed. Right side hemiparesis was observed on hospital day 4. Brain CT showed a large acute left middle cerebral artery infarction. CT angiography showed focal carotid dissection at the left common carotid artery with intimal flap. The CCAD was located at the C6 level. Clexane (enoxaparin sodium) treatment was initiated. An abdominal CT scan revealed a huge retroperitoneal hematoma and increased amount of hematoma in the prevesical and perivesical space, 10 days later. The patient died two days later. Although traumatic CCAD is rare, this case report provides useful information for trauma surgeons regarding the treatment and diagnosis of similar cases.
Angiography ; Brain ; Carotid Artery, Common* ; Contusions ; Deception ; Diagnosis ; Drinking ; Enoxaparin ; Flail Chest ; Hematoma ; Hemopneumothorax ; Humans ; Infarction, Middle Cerebral Artery ; Lung ; Middle Aged ; Paresis ; Rib Fractures ; Rupture ; Surgeons ; Thoracotomy ; Tomography, X-Ray Computed ; Urinary Bladder

Brain ; pathology ; Brain Infarction ; diagnosis ; Cerebral Angiography ; Cerebral Arterial Diseases ; diagnosis ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Posterior Cerebral Artery ; pathology

Posterior reversible encephalopathy syndrome (PRES) is usually a reversible clinical and radiological entity associated with typical features on brain MR or CT imaging. However, the not-so-uncommon atypical radiological presentations of the condition are also present and they may go unrecognised as they are confused with other conditions. Here, we report a very rare case of atypical, unilateral PRES in a 49-year-old uremic, post-transplant female patient who presented with seizures. Initial MRI showed high-grade occlusion of the left middle cerebral artery (MCA) and lesions suggestive of subacute infarction in the ipsilateral frontotemporoparietal lobe. Patient symptoms had resolved a day after the onset without any specific treatment but early follow-up CT findings suggested hemorrhagic transformation. Follow-up MRI performed 2 years later showed complete disappearence of the lesions and persisting MCA occlusion.
Acute Kidney Injury/complications ; Brain/radiography ; Diagnosis, Differential ; Female ; Humans ; Infarction, Middle Cerebral Artery/diagnosis/radiography ; Lung Transplantation ; Magnetic Resonance Imaging ; Middle Aged ; Posterior Leukoencephalopathy Syndrome/complications/*diagnosis ; Tomography, X-Ray Computed

No abstract available.
*Aorta, Thoracic/ultrasonography ; Aortic Diseases/*complications/diagnosis ; Catheterization, Peripheral/*adverse effects ; Cerebral Angiography/*adverse effects ; Electrocardiography ; Fatal Outcome ; *Femoral Artery ; Heart Arrest/diagnosis/etiology ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis/*etiology ; Punctures ; *Sinus of Valsalva/ultrasonography ; Thrombosis/diagnosis/*etiology

OBJECTIVETo evaluate the thrombus length on CT perfusion imaging and to assess its predictive value for recanalization and clinical outcome after intravenous thrombolysis therapy (IVT).

METHODSFifty-six consecutive acute ischemic stroke patients with proximal middle cerebral artery (M1 segment) occlusion underwent CT perfusion imaging examination before IVT between June 2009 and May 2015. The onset-to needle time was (214.3 ± 82.0) min, and the pretreatment NIHSS score of patients was 13 (IQR 8-17). The thrombus length was determined as the distance between the proximal and distal thrombus end delineated on dynamic angiography, which was reconstructed from CT perfusion source images. Recanalization was evaluated according to Arterial Occlusive Lesion (AOL) scale, and functional outcome was based on modified Rankin scale (mRS) 3 months after IVT. Logistic regression model was used to investigate the relationship between thrombus length and recanalization, and the optimal cut-off points were determined by receiver operating characteristic curve (ROC).

RESULTSAmong 56 patients, 42 (75%) achieved recanalization 24 h after IVT with mean thrombus length of (9.0 ± 4.7) mm; and 14 (25%) patients remained occlusion with mean thrombus length of (10.0 ± 5.4) mm. Logistic regression analysis demonstrated that thrombus length was an independent predictor for both recanalization (OR=0.869; 95% CI:0.764-0.987; P=0.031) and unfavorable outcome (OR=1.180;95% CI:1.023-1.362; P=0.023). Thrombus length of 11.3 mm was identified as the optimal cut-off value for recanalization (AUC=0.697, sensitivity 71.4%, specificity 76.2%), while thrombus length of 9.9 mm was the optimal cut-off value for unfavorable functional outcome (AUC=0.689, sensitivity 64.7%, specificity 71.4%).

CONCLUSIONThe thrombus length evaluated on CT perfusion imaging is an effective predictor for recanalization and unfavorable outcome after IVT in acute ischemic stroke patients with middle cerebral artery occlusion.

Angiography ; Humans ; Infarction, Middle Cerebral Artery ; pathology ; Logistic Models ; Perfusion Imaging ; Sensitivity and Specificity ; Stroke ; diagnosis ; drug therapy ; Thrombolytic Therapy ; Thrombosis ; diagnosis ; drug therapy ; Tomography, X-Ray Computed

Spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of spinal cord compression. Early diagnosis and appropriate management are important, however, diagnosis is often difficult due to variable neurologic deficit. We report on the case of a 69-year-old female patient in right hemiparesis. She was treated with thrombolysis therapy for acute cerebral infarction before being transferred to our hospital. Findings on a cervical spine magnetic resonance image showed spinal epidural hematoma and cord compression. She was prepared to undergo decompressive surgery, however, neurologic deficits began to show improvement. She was managed conservatively and was discharged without deficits approximately nine days after onset.
Aged ; Cerebral Infarction ; Diagnosis ; Early Diagnosis ; Female ; Hematoma, Epidural, Spinal* ; Humans ; Infarction, Middle Cerebral Artery* ; Neurologic Manifestations ; Paresis ; Spinal Cord Compression ; Spine

Neurosyphilis is a rare infection of the brain and spinal cord caused by a spirochete named Treponema pallidum. We describe the magnetic resonance imaging of a 53-year-old man with syphilis who manifested as both meningovascular, and spinal meningomyelitic types, which involved the optic, trigeminal, facial and vestibulocochlear nerves, both middle and left posterior cerebral arteries, thoracic spinal cord and meninges of the lumbar spine. This case report suggests that neurosyphilis should be considered as a possible diagnosis in patients showing complex brain and spinal imaging features. These features include enhancing meningeal lesions with multiple cranial nerve involvement, stenoses in large to medium size cerebral arteries, and intramedullary and meningeal lesions of spine.
Brain ; Cerebral Arteries ; Cerebral Infarction* ; Constriction, Pathologic ; Cranial Nerve Diseases* ; Cranial Nerves ; Diagnosis ; HIV* ; Humans ; Magnetic Resonance Imaging* ; Meninges ; Meningitis ; Middle Aged ; Neurosyphilis* ; Posterior Cerebral Artery ; Spinal Cord ; Spine ; Spirochaetales ; Syphilis ; Tabes Dorsalis ; Treponema pallidum ; Vestibulocochlear Nerve

BACKGROUND AND OBJECTIVES: Dizziness is a common presenting complaint in the emergency department (ED) that had various pathologic causes. Most of dizziness can be caused by benign origin but identifying cerebrovascular causes among ED patients with dizziness is a diagnostic challenge. ABCD2 score is clinical prediction tool for assessing the risk of stroke after a transient ischemic attack. We evaluated predictors of cerebrovascular causes and whether ABCD2 score would identify cerebrovascular events among ED patients with dizziness. MATERIALS AND METHODS: We analyzed 180 patients (> or =20 years old) with dizziness in ED, Presbyterian Medical Center (single-center prospective observational study) for 2 months. Type of dizziness, associated symptoms, past medical history, ABCD2 score (0-7), neuro-otologic examination, diagnosis were recorded. RESULTS: The incidence of dizziness is 3.6% (192/5,374). After excluding 12 patients, 180 patients (56% female, mean 59 years) met our eligibility criteria and were included in the final analysis. Cerebrovascular causes of dizziness were found in 10% (18/180): 3 vertebrobasilar insufficiency, 9 cerebellar infarction, 1 right middle cerebral artery (MCA) infarction, 1 right MCA giant aneurysm, 1 lateral medullary infarction, 1 posterior limb of internal capsule infarction, 1 intracerebral hemorrhage of cerebellum. Patients with cerebrovascular cause were males and had more hypertension, diabetes mellitus, imbalance, abnormal neuro-otologic findings and ABCD2 score. CONCLUSION: Several clinical factors (hypertension, diabetes, abnormal neuro-otologic findings ABCD2 scores) favored a diagnosis of central neurological causes of dizziness. ABCD2 score is a simple and easily applied tool for distinguishing cerebrovascular from peripheral causes of dizziness in ED.
Aneurysm ; Cerebellum ; Cerebral Hemorrhage ; Diabetes Mellitus ; Diagnosis ; Dizziness ; Emergency Medicine ; Emergency Service, Hospital ; Extremities ; Female ; Humans ; Hypertension ; Incidence ; Infarction ; Internal Capsule ; Ischemic Attack, Transient ; Male ; Middle Cerebral Artery ; Prospective Studies ; Protestantism ; Stroke ; Vertebrobasilar Insufficiency

Moyamoya disease is a cerebrovascular disease of unknown etiology, which is characterized by bilateral stenosis or occlusion at terminal portion of internal carotid artery and at proximal portion of anterior cerebral artery and/or middle cerebral artery and abnormal vascular network in the vicinity of the arterial occlusions. It occurs frequently in Asian countries, particularly in Korea and Japan, but is rare in Western countries. To establish the etiology of moyamoya disease, much about the pathology from autopsies, factors involved in its pathogenesis, and its genetics have been studied. It may occur at any age from childhood to adulthood and in general, initial manifestation is cerebral ischemic symptoms in children and intracranial hemorrhage symptoms in adults. Because it progress and cause recurrent stroke, early diagnosis and proper management has been recognized. Cerebral angiography is essential for definitive diagnosis and treatment plan. Magnetic resonance imaging/magnetic resonance angiography is useful for diagnosis and follow-up tools after revascularization. Evaluation of the cerebral hemodynamics by single photon emission computed tomography and positron emission tomography is useful for diagnosis and assessment of the severity of cerebral ischemia in moyamoya patients. Surgical revascularization is effective for moyamoya disease manifesting as ischemic symptoms, to prevent further ischemia and infarction. In hemorrhagic type moyamoya disease, revascularization can be considered. Direct bypass, indirect synangiosis and combined methods are used. Outcomes of revascularization are excellent in preventing transient ischemic attacks in most patients.
Adult ; Angiography ; Anterior Cerebral Artery ; Asian Continental Ancestry Group ; Autopsy ; Brain Ischemia ; Carotid Artery, Internal ; Cerebral Angiography ; Cerebral Hemorrhage ; Child ; Constriction, Pathologic ; Early Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Infarction ; Intracranial Hemorrhages ; Ischemia ; Ischemic Attack, Transient ; Japan ; Korea ; Magnetic Resonance Spectroscopy ; Middle Cerebral Artery ; Moyamoya Disease ; Positron-Emission Tomography ; Stroke ; Tomography, Emission-Computed, Single-Photon

Although atrial fibrillation is the most frequent cause of embolic stroke, coronary embolism from atrial fibrillation is a very rare cause of acute myocardial infarction. Therefore, simultaneously presented acute ischemic stroke and acute myocardial infarction due to atrial fibrillation in the same patient has not been documented. The present report describes the case of a 58-year-old man with paroxysmal atrial fibrillation who initially presented with a large cerebral infarction due to embolic occlusion of the left middle cerebral artery. Four hours after the diagnosis of cerebral embolism, he was subsequently diagnosed with acute myocardial infarction due to concurrent coronary embolism. He underwent successful coronary revascularization with a drug-eluting stent. The possibility of combined coronary embolism as a rare etiology should be kept in mind when a patient with acute embolic stroke presents, especially when there is evidence of acute myocardial infarction.
Angioplasty, Balloon, Coronary ; Atrial Fibrillation* ; Cerebral Infarction ; Diagnosis ; Drug-Eluting Stents ; Embolism ; Humans ; Intracranial Embolism ; Middle Aged ; Middle Cerebral Artery ; Myocardial Infarction* ; Stroke*