Juvenile ischemic stroke secondary to cardiogenic embolism: a rare case report

Myxomas, the most common primary cardiac tumors, are known as a source of cardiogenic emboli. The possibility of their early detection has made them of great importance for emergency medicines. Detection of the disease is probable at early stages using echocardiography and associate complications such as syncope, cerebral embolic ischemic strokes, and sudden death. We report experience of a rare case of juvenile acute stroke in a patient with cardiac myxoma affecting all cardiac chambers presenting to the emergency department. In young stroke patients with signs and symptoms compatible with cardiovascular involvement, cardiogenic emboli should be taken into consideration; early echocardiographic studies are highly recommended. Prompt myxoma resection is required in both asymptomatic and stroke patients in whom intravenous thrombolysis course has not been implemented due to any limitations

Allopurinol as a preventive contrivance after acute ischemic stroke in patients with a high level of serum uric acid: a randomized, controlled trial

To assess the clinical relevance [functional outcome] of a 3-month allopurinol regimen in patients with high serum uric acid [SUA] levels and acute ischemic stroke without considering the changes in SUA levels. In a randomized, double-blind, controlled study, 70 patients [45 females, 25 males] with acute ischemic stroke who had elevated levels of SUA were included. They were divided in two 35-patient groups to investigate the effect of 3 months of an allopurinol [200 mg/day] regimen versus placebo on their functional outcome, which was evaluated using a modified Rankin scale. The overall mean age was 68.9 +/- 11.33 years [range 27-89]. The final favorable functional status [mRS = 0-2] was 23 [65.7%] and 14 [40.0%] in the treated and placebo groups, respectively, which was strongly associated with allopurinol consumption [OR = 4.646, p = 0.014] and age

there a correlation between hs-CRP levels and functional outcome of Ischemic Stroke?

C-reactive protein, a well known marker of inflammation is being investigated as a probable marker of predicting acute cardiovascular events and its severity. The aim of the present study was to assess the possible role of highly-sensitivity C-reactive protein [hs-CRP] in predicting short-term functional outcome of ischemic stroke. A prospective study was conducted on subjects admitted with first attack of confirmed ischemic stroke. It included 50 male and 52 female. Serum hs-CRP was measured in the 2[nd] [CRP-D2] and 5[th] days [CRP-D5] post-stroke. Modified Rankin scale [MRS] was measured in all subjects in the 2[nd] [MRS-D2], 5[th] days [MRS-D5] and also 3 month [MRS-M3] after stroke to assess the short-term functional outcome and mortality of subjects. The mean age of the patients was 71.75 +/- 11.44 years. The mortality rate was 47.1% in the third months after stroke. There was no significant correlation between CRP-D2 and MRS-M3 and also between CRP-D5 and MRS-M3 [P>0.05]. However there was a significant association between high CRP-D2 [CRP>3] and MRS-M3 and also between high CRP-D5 and MRS-M3 [P<0.005]. This study showed that the value of CRP by itself could not predict the severity of short-term functional disability and it might not be useful as a clinical tool for predicting outcome

Early and intermediate prognosis of intravenous thrombolytic therapy in acute ischemic stroke subtypes according to the causative classification of stroke system

Intravenous thrombolytic therapy has established acceptable results in treating ischemic stroke. However, there is little information on treatment outcome especially in different subtypes. The aim of current study was to evaluate early and intermediate prognosis in intravenous thrombolytic therapy for acute ischemic stroke subtypes. Forty eligible patients [57.5% male with mean age of 63.18 +/- 13.49 years] with definite ischemic stroke who were admitted to emergency department of Imam Reza University Hospital, in the first 180 minutes after occurrence received recombinant tissue plasminogen activator. All investigation findings were recorded and stroke subtypes were determined according to the Causative Classification of Stroke System. Stroke severity forms including modified Rankin Scale [mRS] and National Institutes of Health Stroke Scale [NIHSS] scores were recorded for all patients in first, seven and 90 days after stroke and disease outcome was evaluated. The etiology of stroke was large artery atherosclerosis in 20%, cardio-aortic embolism in 45%, small artery occlusion in 17.5% and undetermined causes in 17.5%. NIHSS and mRS scores were significantly improved during time [P < 0.001 in both cases]. Three months mortality rate was 25%. Among the etiologies, patients with small artery occlusion and then cardio-aortic embolism had lower NIHSS score at arrival [P = 0.04]. Caplan-meier analysis showed that age, sex and symptom to needle time could predict disease outcome. Intravenous thrombolytic therapy is accompanied by good early and intermediate outcome in most patients with ischemic stroke. Small artery occlusion subtype had less disease severity and higher improvement

Correlation between transcranial doppler findings, neuroimaging and functional status in the first days of acute intracerebral hemorrhage

To have an appropriate and accessible modality for monitoring of patients with intracerebral hemorrhage [ICH] that have a correlation with Computed tomography [CT] scan data, we conducted a study to compare Transcranial Doppler finding with CT data in the first and 5th day after ICH and clear their relations with functional status [FS] of patients. We prospectively studied 50 patients with supratentorial ICH evaluated in less than 24 hours of its onset. All selected patients underwent emergent CT scan and TCD on admission. Doppler parameters of middle cerebral arteries [including systolic, diastolic and mean velocities, Pulsatility index [PI], Diastolic flow velocity [DFV]] were recorded in first and fifth days of admission by TCD. FS of patients was measured using National Institutes of Health Stroke Scale [NIHSS] score in these days. Twenty six female patients and 24 male entered the study with NIHSS score average of 14 +/- 6.5 in first and 13.7 +/- 7.3 in 5th days. Their hematoma volume was 13.5 +/- 1.7 millimeter in average. There was a significant reverse relation between DFV of 1st day and NIHSS score in unaffected hemisphere in first and 5th days [First day: P= 0.03 and 5th day: P < 0.001]. Also there was a positive relation between PI and NIHSS score in unaffected hemisphere in 5th day [P=0.03]. PI had no difference in the patients with intraventricular hemorrhage [IVH] and patients without the IVH, even though PI cannot predict the site of hematoma but DFV in 5th day, in unaffected hemisphere can be a predictive factor for intraventricular hemorrhage. Most of TCD parameters were correlated with functional status and some of them [DFV, PI] had prediction value for intraventricular hemorrhage in acute phase of ICH. Also they had a high correlation with CT scan findings.