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INS; cerebral infarction: A case report
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Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278
Methods: It is about a prospective study in a Tunisian population containing 121 patients with stroke who were selected from Sahloul Hospital in Sousse going from January 2012 till December 2012. The criteria of inclusion: Diagnosed stroke by the regular doctor. The criteria of exclusion: Cognitive disorders (confusions), aphasia. Measuring Instrument: Neuropathic pain was evaluated by DN4. A score upper or equal to four “4/10” defines a positive test, which confirms the positive diagnosis of a neuropathic pain. Worst pain intensity during the previous 48 h was assessed on a visual analogue scale (VAS), ranging from 0 to 100: a score of 0 to 30 was defined as no or mild pain; and 40 to 100 as moderate to severe pain. Screening for depression was done using HAD-S. SF36 was used to evaluate life quality. Results: Moderate to severe pain was reported by 63% of patients (VAS median = 70).The DN4 was positive in 52%. Predictors of pain were younger age, male sex, worse HAD-S score and short disease duration. Pain impaired quality of life in 2/3 of cases. Conclusion: Pain following stroke is common and may have a considerable effect on the everyday life of the patient. doi:10.1016/j.jns.2013.07.861
Abstract — WCN 2013 No: 1844 Topic: 3 — Stroke Juvenile stroke as presenting manifestation of essential thrombocythemia with JAK2V617F mutation L. Fancellu, P. Canu, P. Doneddu, P. Falchi, G.A. Soro, G. Sechi. Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy Thromboses of cerebral veins or arteries may herald a latent/ subclinical essential thrombocythemia (ET), which is a myeloproliferative disorder (MPD) with sustained elevated platelets. Juvenile stroke as presenting manifestation of ET has rarely been reported. Case report: A 31 year-old man, without cardiovascular risk factors, presented with acute onset of gait ataxia and transient mnesic disturbances. Brain MRI showed multiple acute ischemic lesions in the cerebellum and in the right occipital lobe. Blood tests were normal except for an elevated platelet blood count (600,000/mm3). The acquired Janus kinase 2 V617F mutation (JAK2V617F) resulted positive. Bone marrow examination showed clustered hyperlobulated megakaryocytes. He was diagnosed with ET. The patient had complete recovery from stroke and underwent therapy with antiplatelet agents and hydroxyurea. Discussion: MPD are hematologic malignant conditions that include: ET, polycythemia vera (PV), primary myelofibrosis (PMF) and chronic myeloid leukemia. Detection of the JAK2V617F mutation is a useful tool for early MPD diagnosis: it is present in over 90% of patients with PV, 50–70% with ET and 30–58% with PMF, while it is absent in healthy subjects. An early diagnosis of MPD, especially in patients with thrombotic events in the latent MPD phase, would be beneficial for preventing further morbidity. Special attention must be given to patients with acute stroke at juvenile onset, especially in the absence of cardiovascular risk factors. Therapeutic decision can be based on recent literature data where administration of antiplatelet agents, in combination of hydroxyurea, has been shown to be beneficial for MPD patients with thrombotic events carrying the JAK2V617F mutation. doi:10.1016/j.jns.2013.07.862
Abstract — WCN 2013 No: 1836 Topic: 3 — Stroke Aspergillus fumigatus ethmoidal sinusitis invading cavernous sinus responsible for cerebral infarction: A case report G.C. Garciaa, V. Sudacevschia, F. Bruneelb, M.-L. Chadenata, M. de Malherbec, S. Gentya, F. Picoa. aDepartment of Neurology and Stroke Center, Versailles Saint Quentin en Yvelines University, Versailles Hospital, France; bIntensive Care Unit, Versailles Hospital, Le Chesnay, France; cDepartment of Radiology, Versailles Hospital, Le Chesnay, France A 56-year-old immunocompetent man presented to the emergency department with a right hemiplegia of sudden onset. He reported a history of recent protracted fever after a surgery for ethmoidal chronic sinusitis. MRI showed an ischemia of the left lenticular-caudate nucleus and a tight stenosis affecting the supracavernous segment of the left internal carotid artery and the first segment of the left middle cerebral artery. Stenosis was due to a surrounding T2-hypersignal structure, enhanced by gadolinium injection, wrapping and compressing both arteries and infiltrating the left cavernous sinus. Blood cultures, transesophageal echocardiogram and PET scan were normal. Aspergillus antibodies were positive with high titer. CSF analysis revealed lymphocytic meningitis with elevated eosinophils. Beta-d-glucans were positive in CSF and negative in serum consistent with a fungal infection limited to CNS. Aspergillus fumigatus was identified after cultures on surgical ethmoidectomy samples. The diagnosis is an external compression of the left internal carotid secondary to an aspergilloma coming from a remaining post ethmoidectomy skull-base breach leading to cerebral infarction. An antifungal treatment by 800 mg per day of oral voriconazole has been started for 6 months. A slight lesion regression was noted after 2 months of treatment with stable blood flow in the carotid and serum anti-aspergillus IgG drop. CSF analysis improved with a decrease in beta-d-glucans level and white cell count. This case emphasizes the possibility of a local arterial damage, in an immunocompetent patient, due to A. fumigatus without systemic infection or cerebral vasculitis commonly described. doi:10.1016/j.jns.2013.07.863
Abstract — WCN 2013 No: 1891 Topic: 3 — Stroke Number of patients and current use of antithrombotic agents before the onset of intracerebral hemorrhage T. Watari, T. Mori, K. Nakazaki, Y. Miyazaki, T. Iwata. Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Kamakura, Japan Background: Antithrombotics are widely used to treat some vascular diseases. Intracerebral hemorrhage is the major risk associated with antithrombotics. Objective: To assess how many patients had taken antithrombotic agents and the type of agent used before onset of hemorrhagic stroke transferred to a suburban emergency hospital in Japan. The antithrombotic agent most used annually was also assessed. Patients and methods: This retrospective analysis focused on patients who were transferred to our institution due to intracerebral hemorrhage (ICH) from January 2009 through December 2012, inclusive. Antithrombotic agents were classified into three groups: antiplatelets (P), anticoagulants (C) and both agents (PC). Results: There were 492 consecutive patients with ICH. Mean age was 74 ± 12.67 years (males 270, female 220), including 128 (26.02%)
Abstracts / Journal of the Neurological Sciences 333 (2013) e215–e278
Methods: It is about a prospective study in a Tunisian population containing 121 patients with stroke who were selected from Sahloul Hospital in Sousse going from January 2012 till December 2012. The criteria of inclusion: Diagnosed stroke by the regular doctor. The criteria of exclusion: Cognitive disorders (confusions), aphasia. Measuring Instrument: Neuropathic pain was evaluated by DN4. A score upper or equal to four “4/10” defines a positive test, which confirms the positive diagnosis of a neuropathic pain. Worst pain intensity during the previous 48 h was assessed on a visual analogue scale (VAS), ranging from 0 to 100: a score of 0 to 30 was defined as no or mild pain; and 40 to 100 as moderate to severe pain. Screening for depression was done using HAD-S. SF36 was used to evaluate life quality. Results: Moderate to severe pain was reported by 63% of patients (VAS median = 70).The DN4 was positive in 52%. Predictors of pain were younger age, male sex, worse HAD-S score and short disease duration. Pain impaired quality of life in 2/3 of cases. Conclusion: Pain following stroke is common and may have a considerable effect on the everyday life of the patient. doi:10.1016/j.jns.2013.07.861
Abstract — WCN 2013 No: 1844 Topic: 3 — Stroke Juvenile stroke as presenting manifestation of essential thrombocythemia with JAK2V617F mutation L. Fancellu, P. Canu, P. Doneddu, P. Falchi, G.A. Soro, G. Sechi. Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy Thromboses of cerebral veins or arteries may herald a latent/ subclinical essential thrombocythemia (ET), which is a myeloproliferative disorder (MPD) with sustained elevated platelets. Juvenile stroke as presenting manifestation of ET has rarely been reported. Case report: A 31 year-old man, without cardiovascular risk factors, presented with acute onset of gait ataxia and transient mnesic disturbances. Brain MRI showed multiple acute ischemic lesions in the cerebellum and in the right occipital lobe. Blood tests were normal except for an elevated platelet blood count (600,000/mm3). The acquired Janus kinase 2 V617F mutation (JAK2V617F) resulted positive. Bone marrow examination showed clustered hyperlobulated megakaryocytes. He was diagnosed with ET. The patient had complete recovery from stroke and underwent therapy with antiplatelet agents and hydroxyurea. Discussion: MPD are hematologic malignant conditions that include: ET, polycythemia vera (PV), primary myelofibrosis (PMF) and chronic myeloid leukemia. Detection of the JAK2V617F mutation is a useful tool for early MPD diagnosis: it is present in over 90% of patients with PV, 50–70% with ET and 30–58% with PMF, while it is absent in healthy subjects. An early diagnosis of MPD, especially in patients with thrombotic events in the latent MPD phase, would be beneficial for preventing further morbidity. Special attention must be given to patients with acute stroke at juvenile onset, especially in the absence of cardiovascular risk factors. Therapeutic decision can be based on recent literature data where administration of antiplatelet agents, in combination of hydroxyurea, has been shown to be beneficial for MPD patients with thrombotic events carrying the JAK2V617F mutation. doi:10.1016/j.jns.2013.07.862
Abstract — WCN 2013 No: 1836 Topic: 3 — Stroke Aspergillus fumigatus ethmoidal sinusitis invading cavernous sinus responsible for cerebral infarction: A case report G.C. Garciaa, V. Sudacevschia, F. Bruneelb, M.-L. Chadenata, M. de Malherbec, S. Gentya, F. Picoa. aDepartment of Neurology and Stroke Center, Versailles Saint Quentin en Yvelines University, Versailles Hospital, France; bIntensive Care Unit, Versailles Hospital, Le Chesnay, France; cDepartment of Radiology, Versailles Hospital, Le Chesnay, France A 56-year-old immunocompetent man presented to the emergency department with a right hemiplegia of sudden onset. He reported a history of recent protracted fever after a surgery for ethmoidal chronic sinusitis. MRI showed an ischemia of the left lenticular-caudate nucleus and a tight stenosis affecting the supracavernous segment of the left internal carotid artery and the first segment of the left middle cerebral artery. Stenosis was due to a surrounding T2-hypersignal structure, enhanced by gadolinium injection, wrapping and compressing both arteries and infiltrating the left cavernous sinus. Blood cultures, transesophageal echocardiogram and PET scan were normal. Aspergillus antibodies were positive with high titer. CSF analysis revealed lymphocytic meningitis with elevated eosinophils. Beta-d-glucans were positive in CSF and negative in serum consistent with a fungal infection limited to CNS. Aspergillus fumigatus was identified after cultures on surgical ethmoidectomy samples. The diagnosis is an external compression of the left internal carotid secondary to an aspergilloma coming from a remaining post ethmoidectomy skull-base breach leading to cerebral infarction. An antifungal treatment by 800 mg per day of oral voriconazole has been started for 6 months. A slight lesion regression was noted after 2 months of treatment with stable blood flow in the carotid and serum anti-aspergillus IgG drop. CSF analysis improved with a decrease in beta-d-glucans level and white cell count. This case emphasizes the possibility of a local arterial damage, in an immunocompetent patient, due to A. fumigatus without systemic infection or cerebral vasculitis commonly described. doi:10.1016/j.jns.2013.07.863
Abstract — WCN 2013 No: 1891 Topic: 3 — Stroke Number of patients and current use of antithrombotic agents before the onset of intracerebral hemorrhage T. Watari, T. Mori, K. Nakazaki, Y. Miyazaki, T. Iwata. Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Kamakura, Japan Background: Antithrombotics are widely used to treat some vascular diseases. Intracerebral hemorrhage is the major risk associated with antithrombotics. Objective: To assess how many patients had taken antithrombotic agents and the type of agent used before onset of hemorrhagic stroke transferred to a suburban emergency hospital in Japan. The antithrombotic agent most used annually was also assessed. Patients and methods: This retrospective analysis focused on patients who were transferred to our institution due to intracerebral hemorrhage (ICH) from January 2009 through December 2012, inclusive. Antithrombotic agents were classified into three groups: antiplatelets (P), anticoagulants (C) and both agents (PC). Results: There were 492 consecutive patients with ICH. Mean age was 74 ± 12.67 years (males 270, female 220), including 128 (26.02%)