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Objective:To investigate the clinical characteristics, diagnosis, treatment and prognosis of infective endocarditis(IE)in elderly patients with cerebral infarction as the first presentation.Methods:The clinical data of 5 elderly infective endocarditis patients with cerebral infarction as the first presentation diagnosed and treated in Beijing Shijitan Hospital, Capital Medical University from October 2010 to December 2021 were retrospectively analyzed, and national and international reports from January 1998 to December 2021 on IE in the elderly with cerebral infarction as the first presentation were collected.The clinical characteristics, diagnosis and prognosis were analyzed and summarized.Results:A total of 18 IE cases with cerebral infarction as the first presentation were reviewed, including 5 cases from our hospital.The male to female ratio was 5∶1, and the median age was 70.5 years.IE was diagnosed several hours to 4 months after the onset of cerebral infarction.All the patients had speech impairment symptoms and most of them exhibited hemiparesis.The National Institute of Health Stroke Scale(NIHSS)scores ranged between 2-35.All 18 patients underwent blood culture, and streptococci were the most common pathogens.Most of the lesions were located in the blood supply area of the middle cerebral artery or the junction between the middle cerebral artery and the posterior cerebral artery.Echocardiography showed that mitral valve vegetations were the dominant features, followed by aortic valve vegetations.All 18 patients received antibiotic treatment, 2 underwent valve replacement and removal of vegetations, and 11 underwent intravenous thrombolysis or mechanical thrombectomy.50.0% of patients(9 cases)had a good prognosis and one third(6 cases)died.Conclusions:Cerebral infarction is the first presentation in some elderly IE patients, and misdiagnoses are common, but half of patients can have a good prognosis after timely anti-infection and surgical treatment.
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Objective To explore the clinical characteristics and risk factors of strokeassociated pneumonia (SAP) in patients with acute cerebral hemorrhage.Methods A total of 375 patients with acute cerebral hemorrhage were selected from the department of neurology and neurosurgery during January 2013 to December 2015 in our hospital.According to the incidence of SAP,they were divided into the observation group (complicated with SAP,n =79) and control group (not complicated with SAP,n =296).Clinical data were collected,and clinical characteristics and related risk factors of SAP complicated with acute cerebral hemorrhage were analyzed.Results Among all the 79 SAP patients in observation group,there were 38 cases with gram-negative bacterial infections,25 cases with gram-positive bacterial infections,16 cases with mixed infections.The SAP incidence in patients with massive hemorrhage was higher than that in patients with nonmasive hemorrhage (x2 =11.301,P＜ 0.01),and was higher in patients with cerebellum,brainstem,ventricle,thalamus and multifoeal hemorrhage than that in patients with basal ganglion and brain lobe hemorrhage(x2 =4.023,P＜0.05).The hospitalization days of the observation group was longer than that of the control group [(32.7 ± 16.2) versus (17.3 ± 6.7),t=2.93,P＜ 0.01].The mortality of the observation group was higher than that of the control group (24.1％ versus 3.7％),(x2 =8.720,P＜ 0.01).Multivariate Logistic regression analysis showed that age≥ 65 (OR =4.87),underlying lung diseases (OR =5.30),bulbar paralysis (OR =7.39),disorder of consciousness (OR=4.11),NIHSS score ＞ 4 (OR =3.96),invasive airway operations (OR=3.78),gastric tube (OR =4.37),H2-receptor blocking agents application (OR =2.09) were independent risk factors for SAP in acute intraerebral hemorrhage patients.Conclusions Gram-negative bacteria are the main pathogens of SAP in patients with acute cerebral hemorrhage.The patients complicated with SAP after acute cerebral hemorrhage have poor prognosis including prolonged hospitalization period and higher mortality.SAP in acute intraerebral hemorrhage patients is closely related to the following factors:age≥65,underlying lung diseases,bulbar paralysis,disorder of consciousness,NIHSS score ＞ 4,invasive airway operations,gastric tube,H2-receptor blocking agents.
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Objective: Diffuse muscular calcification was rare myopathological change due to abnormal metabolism of calcium, which was mainly found in dermatomyositis and myositis ossificans progressiva. Here we reported a case of diffuse muscular calcification that clinically mimicked myositis ossificans progressiva. The disease might be a new type of congenital calcium metabolic disease. Methods:A 15-year-old girl developed subcutaneous cysts in the wrist and ankle when she was 1 year old. At the age of 9, she developed recurrent fever with myalgia, fatigue and diffuse muscular calcification. It was difficult for her to squat, run or walk. Protuberance presented in the subcutaneous tissue of her trunk. Some nodules ruptured with outflow of chalky material. ESR, ENA, RF, CRP, PTH, CK were in normal limits. EMG was unremarkable. X-ray confirmed diffuse calcification in the muscle and subcutaneous tissues. Biceps muscle biopsy was performed. Results:Numerous inflammatory cells infiltrated around vessels in the perimyosium with perifascicular muscle fiber atrophy and degeneration. Many RRF and SDH positive fibers were also observed. EM showed tubular reticular inclusions in vascular endothelium. Conclusion: Diffuse muscular calcification indicated existence of systemic calcium metabolic abnormality. As the clinical symptoms and distribution pattern of calcification were different from dermatomyositis with subcutaneous calcification and myositis ossificans progressiva, our case might be a new type of disease. The microvascular changes might result in the lesion of muscle fibers.