Subject(s)
Aortic Dissection/etiology , Aortic Dissection/therapy , Carotid Artery, Internal, Dissection/complications , Carotid Artery, Internal, Dissection/therapy , Carotid Artery, Internal/pathology , Adult , Aged , Aortic Dissection/physiopathology , Aneurysm, Ruptured/etiology , Aneurysm, Ruptured/physiopathology , Aneurysm, Ruptured/therapy , Anticoagulants/therapeutic use , Aspirin/therapeutic use , Carotid Artery, Internal/physiopathology , Carotid Artery, Internal, Dissection/physiopathology , Clinical Protocols , Cranial Nerve Diseases/etiology , Cranial Nerve Diseases/physiopathology , Cranial Nerve Diseases/prevention & control , Disease Progression , Female , Headache/etiology , Headache/physiopathology , Headache/prevention & control , Horner Syndrome/etiology , Horner Syndrome/physiopathology , Horner Syndrome/prevention & control , Humans , Male , Middle Aged , Neck Pain/etiology , Neck Pain/physiopathology , Neck Pain/prevention & control , Platelet Aggregation Inhibitors/therapeutic use , Prognosis , Prospective Studies , Retrospective Studies , Risk Assessment , Stroke/etiology , Stroke/physiopathology , Stroke/prevention & control , Time FactorsABSTRACT
We examined the seasonal variability of spontaneous cervical artery dissection (sCAD) by analysing prospectively collected data from 352 patients with 380 sCAD (361 symptomatic sCAD; 305 carotid and 75 vertebral artery dissections) admitted to two university hospitals with a catchment area of 2,200,000 inhabitants between 1985 and 2004. Presenting symptoms and signs of the 380 sCAD were ischaemic stroke in 241 (63%), transient ischaemic attack in 40 (11%), retinal ischemia in seven (2%), and non-ischaemic in 73 (19%) cases; 19 (5%) were asymptomatic sCAD. A seasonal pattern, with higher frequency of sCAD in winter (31.3%; 95% confidence interval (CI): 26.5 to 36.4; p=0.021) compared to spring (25.5%; 95% CI: 21.1 to 30.3), summer (23.5%; 95% CI: 19.3 to 28.3), and autumn (19.7%; 95% CI: 15.7 to 24.1) was observed. Although the cause of seasonality in sCAD is unclear, the winter peaks of infection, hypertension, and aortic dissection suggest common underlying mechanisms.
Subject(s)
Carotid Artery, Internal, Dissection/epidemiology , Seasons , Vertebral Artery Dissection/epidemiology , Adult , Aortic Dissection/epidemiology , Aortic Aneurysm/epidemiology , Carotid Artery, Internal, Dissection/diagnosis , Carotid Artery, Internal, Dissection/etiology , Cerebral Infarction/diagnosis , Cerebral Infarction/epidemiology , Cerebral Infarction/etiology , Cohort Studies , Comorbidity , Cross-Sectional Studies , Female , Hospitals, University , Humans , Hypertension/epidemiology , Incidence , Infections/epidemiology , Magnetic Resonance Angiography , Male , Middle Aged , Neurologic Examination/statistics & numerical data , Prospective Studies , Risk Factors , Statistics as Topic , Switzerland , Tomography, X-Ray Computed , Ultrasonography, Doppler, Transcranial , Vertebral Artery Dissection/diagnosis , Vertebral Artery Dissection/etiologyABSTRACT
Patients with non-rheumatic atrial fibrillation (AF) have an increased risk for ischemic stroke. The presence of risk factors such as a history of ischemic stroke, transient ischemic attack, diabetes mellitus, arterial hypertension or advanced age allows the classification of patients with AF in three groups with high, moderate, and low stroke risk. High-risk patients should receive oral anticoagulants, low-risk patients aspirin, and moderate-risk patients one of both antithrombotic agents. However, primary stroke prevention studies suggest that many high-risk patients are not anticoagulated, whereas low risk patients receive anticoagulants instead of aspirin. Our retrospective analysis of prospectively collected data examined the antithrombotic therapy of patients with first-ever stroke and known non-valvular AF and compared the results with the recommendations of the Atrial Fibrillation Investigators (AFI) and the Stroke Prevention in Atrial Fibrillation (SPAF) study. Contraindications against anticoagulation were taken into consideration. High-risk patients received in 36% an appropriate antithrombotic therapy according to the AFI-guidelines, and in 28% according to the SPAF-guidelines. About one quarter of low-risk patients were anticoagulated unnecessarily. Our study confirms that many patients with AF and high stroke risk do not get the appropriate antithrombotic therapy, while some patients with low-risk are anticoagulated without cause.
Subject(s)
Anticoagulants/therapeutic use , Aspirin/therapeutic use , Atrial Fibrillation/complications , Fibrinolytic Agents/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Stroke/drug therapy , Administration, Oral , Age Factors , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Aspirin/administration & dosage , Coumarins/administration & dosage , Coumarins/therapeutic use , Female , Fibrinolytic Agents/administration & dosage , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/administration & dosage , Practice Guidelines as Topic , Primary Prevention , Prospective Studies , Randomized Controlled Trials as Topic , Retrospective Studies , Risk Assessment , Risk Factors , Stroke/classification , Stroke/diagnosis , Stroke/etiology , Stroke/prevention & controlABSTRACT
We report the case of a near-fatal heat stroke in a 41-year-old patient. The comatose patient had a body core temperature of 41.5 degrees C. The clinical course was complicated by systemic inflammatory response syndrome and multiorgan failure. The EEG showed an alpha coma that did not react to external stimuli and, in general, has a poor prognosis. The patient regained consciousness and was discharged from our intensive care unit after 16 days. In the further course cerebral toxoplasmosis developed which was treated with a combination therapy of sulfadiazine and pyrimethamine. The patient was transferred to a neurorehabilitation clinic with a moderate neurological deficit 65 days after heat stroke onset.
Subject(s)
Coma/diagnosis , Coma/etiology , Heat Stroke/complications , Heat Stroke/diagnosis , Multiple Organ Failure/diagnosis , Multiple Organ Failure/etiology , Adult , Coma/therapy , Heat Stroke/therapy , Humans , Male , Multiple Organ Failure/therapyABSTRACT
BACKGROUND: Piloerection is a rare clinical symptom described during seizures. Previous reports suggested that the temporal lobe is the ictal onset zone in many of these cases. One case series concluded that there is a predominant left hemispheric representation of ictal cold. The aim of this study is to evaluate the localising and lateralising value of pilomotor seizures. METHODS: Medical records of patients who underwent video electroencephalogram (EEG) monitoring at the Cleveland Clinic between 1994 and 2001 were reviewed for the presence of ictal piloerection. The clinical history, physical and neurological examination, video EEG data, neuroimaging data, cortical stimulation results, and postoperative follow ups were reviewed and used to define the epileptogenic zone. Additionally, all previously reported cases of ictal piloerection were reviewed. RESULTS: Fourteen patients with ictal piloerection were identified (0.4%). Twelve out of 14 patients had temporal lobe epilepsy. In seven patients (50%), the ictal onset was located in the left hemisphere. Four out of five patients with unilateral ictal piloerection had ipsilateral temporal lobe epilepsy as compared with the ipsilateral side of pilomotor response. Three patients became seizure free after left temporal lobectomy for at least 12 months of follow up. An ipsilateral left leg pilomotor response with simultaneously recorded after-discharges was elicited in one patient during direct cortical stimulation of the left parahippocampal gyrus. CONCLUSIONS: Ictal piloerection is a rare ictal manifestation that occurs predominantly in patients with temporal lobe epilepsy. Unilateral piloerection is most frequently associated with ipsilateral focal epilepsy. No hemispheric predominance was found in patients with bilateral ictal piloerection.
Subject(s)
Brain Mapping/methods , Functional Laterality/physiology , Piloerection/physiology , Seizures/diagnosis , Adolescent , Adult , Electroencephalography/methods , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/physiopathology , Epilepsy, Temporal Lobe/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Seizures/physiopathology , Seizures/surgery , Temporal Lobe/physiopathology , Temporal Lobe/surgery , Videotape RecordingABSTRACT
A 31-year-old woman suffered a brainstem infarction secondary to chiropractic neck manipulation. A dissection of both vertebral arteries could be demonstrated by MR tomography. This case report should alert therapists to be aware of vertebrobasilar complications after spinal manipulations.
Subject(s)
Brain Stem Infarctions/diagnosis , Brain Stem Infarctions/etiology , Magnetic Resonance Imaging , Manipulation, Chiropractic/adverse effects , Vertebral Artery Dissection/diagnosis , Vertebral Artery Dissection/etiology , Adult , Female , HumansABSTRACT
A 37-year-old woman suffered from middle cerebral artery infarction secondary to dissection of the left internal carotid artery. Nine days before, a cesarean section had been performed on her after 20 h of unsuccessful labor. Cerebral angiography at admission revealed no further vascular abnormalities. A few days later, however, the patient developed additional dissections of the right internal carotid artery and both vertebral arteries. Pregnancy, childbirth, and a history of rheumatoid arthritis in this patient may have contributed to the dissections; however, due to the unknown etiology of cervical dissections, the pathogenetic contribution of all of these factors is incompletely understood.