14
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Evaluation and Treatment of the Acute Cerebral Infarction with Convexal Subarachnoid Hemorrhage

      case-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Non-traumatic convexal subarachnoid hemorrhage (CSAH) is a comparatively infrequent with various vascular and nonvascular causes, it rarely occurs concomitant to acute ischemic stroke. We report a case of a 59-year-old woman, visited emergency room with right side subjective weakness spontaneously. Magnetic resonance diffusion-weighted images revealed an acute infarction of anterior cerebral arterial territory. Computed tomographic angiography showed a left frontal CSAH without any vascular lesions. And other laboratory studies were non-specific. We treated with dual antiplatelet drugs (cilostazole [Otsuka Pharmaceutical Co., Ltd. tokyo, Japan] and Aspirin [Bayer Pharma AG., Leverkusen, Germany]). She has done well for a follow-up period. (5 months) This case demonstrates the CSAH with acute infarction is rare but need to work up to identify the etiology and antiplatelet dugs are taken into account for treatments.

          Related collections

          Most cited references22

          • Record: found
          • Abstract: found
          • Article: not found

          The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients.

          Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by the association of severe headaches with or without additional neurological symptoms and a 'string and beads' appearance on cerebral arteries, which resolves spontaneously in 1-3 months. We present the clinical, neuroimaging and outcome data of 67 consecutive patients prospectively diagnosed over 3 years in our institution with an angiographically confirmed RCVS. There were 43 females and 24 males with a mean age of 42 years (19-70). RCVS was spontaneous in 37% of patients and secondary in the 63% others, to postpartum in 5 and to exposure to various vasoactive substances in 37, mainly cannabis, selective serotonin-recapture inhibitors and nasal decongestants. The main pattern of presentation (94% of patients) was multiple thunderclap headaches recurring over a mean period of 1 week. In 51 patients (76%), headaches resumed the clinical presentation. Various complications were observed, with different time courses. Cortical subarachnoid haemorrhage (cSAH) (22%), intracerebral haemorrhage (6%), seizures (3%) and reversible posterior leukoencephalopathy (9%) were early complications, occurring mainly within the first week. Ischaemic events, including TIAs (16%) and cerebral infarction (4%), occurred significantly later than haemorrhagic events, mainly during the second week. Significant sex differences were observed: women were older, had more frequent single-drug exposure and a higher rate of stroke and cSAH. Sixty-one patients were treated by nimodipine: 36% had recurrent headaches, 7% TIAs and one multiple infarcts. The different time courses of thunderclap headaches, vasoconstriction and strokes suggest that the responsible vasospastic disorder starts distally and progresses towards medium sized and large arteries. No relapse was observed during the 16 +/- 12.4 months of follow-up. Our data suggest that RCVS is more frequent than previously thought, is more often secondary particularly to vasoactive substances, and should be considered in patients with recurrent thunderclap headaches, cSAH or cryptogenic strokes with severe headaches.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Atraumatic convexal subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies.

            To identify patterns of clinical presentation, imaging findings, and etiologies in a cohort of hospitalized patients with localized nontraumatic convexal subarachnoid hemorrhage. Twenty-nine consecutive patients with atraumatic convexal subarachnoid hemorrhage were identified using International Classification of Diseases-9 code from 460 patients with subarachnoid hemorrhage evaluated at our institution over a course of 5 years. Retrospective review of patient medical records, neuroimaging studies, and follow-up data was performed. There were 16 women and 13 men between the ages of 29 and 87 years. Two common patterns of presentations were observed. The most frequent presenting symptom in patients 60 years (n = 13) usually had temporary sensory or motor symptoms (n = 7; 54%); brain MRI scans in these patients showed evidence of leukoaraiosis and/or hemispheric microbleeds and superficial siderosis (n = 9; 69%), compatible with amyloid angiopathy (n = 10; p < 0.0001). In a small group of patients, the presentation was more varied and included lethargy, fever, and confusion. Four patients older than 60 years had recurrent intracerebral hemorrhages in the follow-up period with 2 fatalities. Convexal subarachnoid hemorrhage is an important subtype of nonaneurysmal subarachnoid bleeding with diverse etiologies, though a reversible vasoconstriction syndrome appears to be a common cause in patients 60 years or younger whereas amyloid angiopathy is frequent in patients over 60. These observations require confirmation in future studies.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Anterior cerebral artery infarction: stroke mechanism and clinical-imaging study in 100 patients.

              Stroke mechanisms and clinical features of anterior cerebral artery (ACA) territory infarction have rarely been investigated using MRI. To verify stroke mechanisms and to make clinical imaging correlation. Clinical, MRI, and angiographic findings of 100 consecutive patients with ACA infarction were studied. Motor dysfunction (n = 91) was the most common symptom, and severe motor dysfunction was related to supplementary motor area/paracentral lobule involvement (p = 0.016). Hypobulia/apathy (n = 43) was related to involvement of frontal pole (p = 0.002), corpus callosum/cingulate gyrus (p = 0.003), and superior frontal gyrus (p < 0.001), and occurred more frequently in patients with bilateral lesions followed by left lesions. Urinary incontinence (n = 30) was not related to any specific lesion locations. Grasp reflex (n = 25) was related to corpus callosum involvement (p = 0.035). Angiographic (mostly MR angiography) results showed that 68 patients had local ACA atherosclerosis, most often at A2 segment. The stroke mechanisms included cardiogenic embolism in 10, internal carotid artery-ACA embolism in 6, and ACA atherosclerosis in 61 patients. In the latter group, detailed stroke mechanisms included local branch occlusion (n = 20), in situ thrombotic occlusion (n = 20), artery-to-artery embolism (n = 12), and a combination (n = 9). Patients with intrinsic ACA disease more often had hypobulia (p = 0.077) and corpus callosal involvement (p = 0.016) than those with embolism either from the internal carotid artery or the heart. Anterior cerebral artery (ACA) atherosclerosis is the most important stroke etiology in our population, causing infarction with various mechanisms. Topographic lesion patterns and consequent clinical features of ACA infarction are determined by diverse pathogenic mechanisms and the status of collateral circulation.
                Bookmark

                Author and article information

                Journal
                J Cerebrovasc Endovasc Neurosurg
                J Cerebrovasc Endovasc Neurosurg
                JCEN
                Journal of Cerebrovascular and Endovascular Neurosurgery
                Korean Society of Cerebrovascular Surgeons; Society of Korean Endovascular Neurosurgeons
                2234-8565
                2287-3139
                September 2016
                30 September 2016
                : 18
                : 3
                : 271-275
                Affiliations
                Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
                Author notes
                Correspondence to Sang Uk Kim. Department of Neurosurgery, St. Vincent's Hospital, The Catholic University College of Medicine, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea. Tel: 82-31-249-8163, Fax: 82-31-245-5208, tkddnr79@ 123456daum.net
                Author information
                http://orcid.org/0000-0002-2117-8022
                Article
                10.7461/jcen.2016.18.3.271
                5104854
                2b238929-9f13-4c6e-8358-2b04c4e209bb
                © 2016 Journal of Cerebrovascular and Endovascular Neurosurgery

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 December 2015
                : 01 September 2016
                : 12 September 2016
                Categories
                Case Report

                Surgery
                convexal subarachnoid hemorrhage,ischemic stroke,antiplatelet drug,computed tomographic angiography

                Comments

                Comment on this article