Safety of Early Repeated Thrombolysis: A Case Report Introduction: Intravenous thrombolysis within 4.5 hours from symptom onset improves functional outcome in acute ischemic stroke patients. Repeated intravenous tissue plasminogen activator (IVtPA) is contraindicated in patients presenting with early recurrent stroke (ERS) within 3 months from the initial stroke because of a greater risk of intracranial hemorrhage. Case Presentation: A 59-year-old man presented with ERS, National Institute of Health Stroke Scale of 16, 10 days after a previous stroke. Brain computed tomography (CT) showed a previous hypodensity with 4 cm3 volume. Angio-CT highlighted the left middle cerebral artery and left internal carotid occlusion. Perfusion CT showed small deep core and large penumbra. The patient underwent IVtPA. After 24 hours, the National Institute of Health Stroke Scale was 7, and CT scan showed an acute ischemic lesion in the left basal ganglia area and frontal lobe without hemorrhagic transformation. Conclusion: This case report suggests that further randomized studies may evaluate whether repeated IVtPA may be safe and effective in ERS occurring shortly after a previous stroke when patients experience a period of complete neurological regression, minor disability, and a small infarct volume. Should the hypothesis be confirmed, small volume core and wide volume penumbra at perfusion CT may support the decision of adopting IVtPA repetition. |
Intravenous Thrombolysis For Acute Ischemic Stroke in Fabry Disease Introduction: Fabry is a rare X-linked recessive genetic disease caused by α-galactosidase A deficiency. Cerebrovascular events occur in ∼13% of patients, whereas stroke may be the presenting clinical manifestation. There are very limited case reports of tissue plasminogen activator administration for acute ischemic stroke in patients with Fabry disease. Case report: A 46-year-old man presented with right-sided hemiparesis with a National Institutes of Health Stroke Scale score of 3. Brain computed tomography showed a hyperdense lesion resembling carvenous angioma. The patient received intravenous thrombolysis 265 minutes after symptom onset, with clinical improvement (discharge National Institutes of Health Stroke Scale score of 1). Brain magnetic resonance imaging disclosed acute thalamic infarction, cavernous angioma, and multiple cerebral microbleeds. The presence of skin angiokeratomas and cardiac hypertrophy prompted further positive investigation for Fabry disease (nondetectable α-galactosidase activity, excessively elevated lyso-Gb3, and pathogenic deletion in the GLA gene). Conclusion: The present case supports the scarce data underscoring the safety of intravenous thrombolysis for acute ischemic stroke in Fabry disease patients even when cerebral microbleeds are present. |
Dupuytren, Ledderhose, and Peyronie Diseases After Primidone Use For Essential Tremor Introduction: Dupuytren, Ledderhose, and Peyronie diseases are chronic fibrotic conditions related to progressive fibrosis of the palmar fascia, plantar fascia, and tunica albuginea, respectively. These conditions have been associated with antiepileptic drug use, mainly phenobarbital and primidone. Case Report: A 71-year-old man developed simultaneous Dupuytren, Ledderhose, and Peyronie diseases after primidone use for essential tremor. Conclusions: There are a few reports associating barbiturate use to connective tissue disorders, and some suggest that drug withdrawal may result in a better prognosis. Therefore, physicians must be aware of such adverse events when caring for patients on long-term barbiturate use. |
Glial Fibrillary Acidic Protein (GFAP) Autoimmunity in the Setting of Seropositive Rheumatoid Arthritis Treated With Etanercept Introduction: Glial fibrillary acidic protein (GFAP) immunoglobulin G is a recently discovered biomarker of an autoimmune central nervous system disorder characterized by a steroid-responsive meningoencephalomyelitis. Case Report: A 63-year-old man with rheumatoid arthritis on etanercept presented with steroid-responsive subacute encephalopathy and foot drop. Brain and sural nerve biopsies demonstrated a T-cell perivascular infiltrate. Cerebrospinal fluid studies 18 months into the course of the illness demonstrated a GFAP antibody on mouse tissue immunofluorescence confirmed by cell-based assay. The patient was treated with steroids and cyclophosphamide leading to resolution of his symptoms. Conclusion: This case expands on the previously reported cases of GFAP immunoglobulin G autoimmunity by describing an associated inflammatory large fiber peripheral neuropathy. |
Cause or Consequence: The Relationship Between Cerebral Venous Thrombosis and Idiopathic Intracranial Hypertension Aim: The aims of our study were to refer to the complex relationship between idiopathic intracranial hypertension (IIHT) and cerebral sinovenous thrombosis (CSVT), and to determine the differences and commonalities between the patients with and without CSVT in their etiology, along with documenting the uncertainties in concluding on the diagnosis and treatment of these patients. Material and Methods: IIHT was diagnosed according to Dandy criteria, while CSVT was screened for by way of a cranial magnetic resonance imaging for all patients and cranial magnetic resonance venography only if the magnetic resonance imaging was nebulous or there was a family history. Results: We retrospectively evaluated a total of 26 patients (9 of whom had CSVT) diagnosed with IIHT between 2014 and 2018. A total of 9 patients with concurrent CSVT were described as suffering from vascular IIHT, while the remaining 17 were described as suffering from other IIHT. Demographic characteristics were similar in both groups (mean age: 12 vs. 11; male/female ratio: 2/7 vs. 5/12 in vascular IIHT and other IIHT, respectively). Clinical findings, cerebrospinal fluid-opening pressure values, and pathologies of etiology were also similar (vitamin D deficiency: 66% vs. 52%; vitamin B12 deficiency: 11% vs. none; iron deficiency: 22% vs. 11%; obesity: 22% vs. 23%). A mixture of acetazolamide, topiramate, anticoagulant therapy, and acetylsalicylic acid were given according to the diagnoses. Conclusion: CSVT is a common clinical entity among the causes of IIHT, and it should be taken into consideration in this patient group. However, there is a need for a common guideline for laboratory and imaging methods to understand the etiopathogenesis of childhood IIHT and determine the patients at risk. |
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Πληροφορίες
Ετικέτες
Τετάρτη 4 Σεπτεμβρίου 2019
Αναρτήθηκε από
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
στις
11:52 μ.μ.
Ετικέτες
00302841026182,
00306932607174,
alsfakia@gmail.com,
Anapafseos 5 Agios Nikolaos 72100 Crete Greece,
Medicine by Alexandros G. Sfakianakis
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Αρχειοθήκη ιστολογίου
-
►
2023
(276)
- ► Φεβρουαρίου (133)
- ► Ιανουαρίου (143)
-
►
2022
(1976)
- ► Δεκεμβρίου (116)
- ► Σεπτεμβρίου (158)
- ► Φεβρουαρίου (165)
- ► Ιανουαρίου (161)
-
►
2021
(3661)
- ► Δεκεμβρίου (161)
- ► Σεπτεμβρίου (274)
- ► Φεβρουαρίου (64)
- ► Ιανουαρίου (368)
-
►
2020
(4554)
- ► Δεκεμβρίου (400)
- ► Σεπτεμβρίου (381)
- ► Φεβρουαρίου (638)
- ► Ιανουαρίου (691)
-
▼
2019
(4999)
- ► Δεκεμβρίου (924)
-
▼
Σεπτεμβρίου
(845)
- Medicine by Alexandros G. Sfakianakis,Anapafseos 5...
- Journal of Cosmetic Dermatology,Early View ...
- Medicine by Alexandros G. Sfakianakis,Anapafseos 5...
- Clinical Anatomy
- Journal of Voice
- What causes increased passive stiffness of plant...
- Medicine by Alexandros G. Sfakianakis,Anapafseos 5...
- Foraging consistency of coral reef fishes across...
- International Journal of Environmental Research ...
- Incidence and Outcomes of Sepsis in Korea: A Nat...
- Mucinous cystadenoma of oral minor salivary gland...
- Follow-Up of an Implant-Supported Rehabilitation...
- Ebola virus disease: Recent advancs in diagnosti...
- Social determinants of mental health – Let's not...
- Observations of Distortion Product Otoacoustic E...
- A Survey of Current Procurement Travel Practices...
- Intracranial Electroencephalography in Pediatric...
- Effect of diabetes-specific nutrition formulas ...
- Australian Skin Cancer Genetic Study Seeks to R...
- Platelet‐rich plasma improves the therapeutic e...
- Timing of voiding cystourethrography after febri...
- Karpenisi is a town in central Greece. It is the c...
- Complications Associated With the Anesthesia Tra...
- AMEDEO Otorhinolaryngologyhttp://www.amedeo.comht...
- Oncology
- Formulation of survival acceptor medium able to...
- Asthma and the Weather: What's the Link? ...
- Laudation on Professor Roland Laszig Laudation o...
- Inhaltsverzeichnis BYE BYE MADEIRA MIT MUSIK QI-...
- Spinalkanalstenose Hot Topic: Wirbelsäule Die lu...
- Directory: AAO Officers and OrganizationsPublica...
- From the American Academy of Pediatrics, Pedi...
- Adult Traumatic Brachial Plexus InjuriesAdult tr...
- Elizabeth Barrett-Connor, 1935–2019, Talc, Asbes...
- Highlights of the November issue, Bibliometric a...
- Opportunities for Healthy Learning as a Social D...
- Prevalence and Impact on Mechanical Ventilation ...
- Evaluation of Renal Function Disorder With Urina...
- Service based comparison of group cognitive beha...
- No Fellow Left Behind, Graduating Fellows’ Proce...
- Development of a combined CMV-UL97 C592F and CMV...
- Dermatology,Early View Correspondence
- The Risk and Cost of Limited Clinician and Pat...
- Dermatology and Venereology,.Accepted Articles ...
- Has spectral-domain optical coherence tomography...
- Acute epididymo-orchitis due to Salmonella Typhi...
- Waist circumference or sarcopenic obesity; which...
- Oncology
- Otolaryngology–Head and Neck Surgery , ...
- Ear, Nose & Throat Journal ,
- Medicine by Alexandros G. Sfakianakis,Anapafseos 5...
- Medicine by Alexandros G. Sfakianakis,Anapafseos 5...
- Integrative Cancer Therapies are available onli...
- Clinical OtolaryngologyAccepted Articles Accep...
- JoVE: Journal of Visualized Experiments,
- Letter about outcome differences between recanal...
- Intramedulläre Button-Refixation der distalen Bi...
- Ammoniumbituminosulfonat Panorama Dermatologisch...
- Relating response shift and cognitive appraisal ...
- Allergy & RhinologyEarly View Online Version o...
- Occupational health in Pakistan: challenges and ...
- DermatologyEarly View Online Version of Record...
- DermatologyAccepted Articles Accepted, unedite...
- Clinical and Experimental DermatologyEarly View ...
- Clinical and Experimental DermatologyAccepted Ar...
- Medicine by Alexandros G. Sfakianakis,Anapafseos 5...
- Medicine by Alexandros G. Sfakianakis,Anapafseos 5...
- Medicine by Alexandros G. Sfakianakis,Anapafseos 5...
- Antibiotics, Vol. 8, Pages 167: Comparison o...
- Prevalence of Obstructive Sleep Apnea in Pat...
- Appendectomy in Third Trimester of Pregnancy...
- A patient with conventional and follicular v...
- World Neurosurgery
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου