Rivaroxaban's vascular dose for the neurovascular clinician.

Rivaroxaban, a direct oral anticoagulant, has proven efficacy and safety at its standard dose in the treatment and prevention of various vascular conditions. These include the treatment of venous thromboembolism and stroke prevention in non-valvular atrial fibrillation. A "very low" vascular dose of rivaroxaban, when combined with low-dose aspirin, has been demonstrated to reduce major adverse cardiovascular events, including stroke, in both acute and chronic coronary syndrome. The combination of rivaroxaban and low-dose aspirin could potentially offer an additional strategy for stroke prevention in selected non-atrial fibrillation patients who are at a high risk of stroke.

Treatment of Acute Ischemic Stroke: The Last 30 Years of Trials and Tribulations.

The landscape of acute ischemic stroke management has undergone a substantial transformation over the past 3 decades, mirroring our enhanced comprehension of the pathology and progress in diagnostic techniques, therapeutic interventions, and preventive measures. The 1990s marked a pivotal moment in stroke care with the integration of intravenous thrombolytics. However, the most significant paradigm shift in recent years has undoubtedly been the advent of endovascular thrombectomy. This article endeavors to deliver an exhaustive analysis of this revolutionary progression.

Balancing Open-Mindedness and Sound-Mindedness: A Physician's Perspective.

Open-mindedness in the medical decision-making process is fundamental as it aids in averting mistakes, yet it can also breed ambiguity if it's too excessive. On the other hand, sound-mindedness, which is a balanced method that employs logic and evidence in problem-solving, could be the preferred approach. Both these traits have their limitations, yet they can supplement each other in various clinical contexts. Therefore, it's crucial for medical professionals to wisely cultivate and uphold both these traits.

Transient global amnesia and focal diffusion weighted imaging lesions in mesiotemporal region: A ten-year experience.

OBJECTIVE: To determine prevalence and characteristics of mesiotemporal diffusion weighted imaging (DWI) lesions in transient global amnesia (TGA), and to determine prevalence of "missed" DWI lesions on routine radiological reporting. METHODS: This is a retrospective study of patients with TGA admitted to a tertiary care hospital over ten years. Patients with TGA, who underwent magnetic resonance imaging (MRI) of the brain within one week of index event, were included in this study. MRI's were reviewed by two independent raters. Clinical data and other investigations were collated. RESULTS: Of the 55 patients of TGA, 19 (35 %) had hyperintense DWI lesions with concordant apparent diffusion coefficient (ADC) hypointensity in the mesiotemporal region. Fifteen out of 19 (79 %) had unilateral lesions (6 left, 9 right). Twelve out of 19 DWI lesions were reported at the time of index scan. The false negative reporting rate was 36.8 %. DWI slice thickness (5 mm versus 3 mm), MRI machine strength (1.5 versus 3 T) and time interval from symptom onset to MRI brain (>24 h versus ≤ 24 h) were not significantly different between patients with or without DWI lesions and as well between patients with DWI lesions missed and initially reported at the time of index scan. CONCLUSION: Punctuate DWI mesiotemporal lesions in TGA are prone to under-reporting. These lesions need to be categorically searched for at the time of reporting MRI Brain.

A case of recurrent transient global amnesia: don't forget the hippocampal punctuate diffusion restriction.

Transient global amnesia (TGA) is a syndrome characterized by reversible impairment of short-term memory. TGA itself is a benign disease, however, it is reasonable to investigate and exclude sinister causes of global amnesia; such as stroke or a seizure activity. A case of TGA is presented here with special emphasis on the typical TGA lesion that was detected on the patient's magnetic resonance imaging (MRI) of Brain. In patients with TGA, the typical MRI Brain finding is a tiny focus of diffusion restriction in the mesiotemporal lobe. This finding can potentially aid in early diagnosis and management of TGA. Although in overwhelming majority of cases, the TGA episode occurs only once, yet a second TGA episode can occur rarely. This patient, two years later, had a recurrence of TGA episode, albeit with a normal MRI brain, and without residual changes from prior episode.

Wernicke encephalopathy: (MRI) picture worth a thousand words.

A 61-year-old gentleman, with a long-standing history of alcohol abuse presented with altered sensorium and unsteady gait for 2 weeks. A diagnosis of Wernicke encephalopathy (WE) was considered. The magnetic resonance imaging brain showed features consistent with the WE, thus supporting the diagnosis. He was treated with parenteral thiamine with good outcome.

Ischemic Stroke in an HIV Positive Patient: An Initial Presentation of Neurosyphilis.

Ischemic stroke occurring in patients with human immunodeficiency virus (HIV) needs to be approached with a vast differential diagnosis in mind. We report a case of middle-aged male patient with immune reconstituted HIV on therapy without known cardiovascular risk factors who had a right middle cerebral artery territory infarct. After a thorough evaluation, he received a final diagnosis of neurosyphilis-associated vasculitis leading to stroke. He recovered without any neurological deficits following treatment with intravenous benzylpenicillin. Neurosyphilis is an easily diagnosed and treatable cause of a stroke that can be an initial presentation of neurosyphilis but requires a high index of suspicion.

Acute interstitial pneumonia as first presentation of anti-synthetase syndrome: an atypical case.

Anti-synthetase syndrome is characterized by myositis associated with interstitial lung disease (ILD), the usual pattern of ILD being non-specific interstitial pneumonia type or usual interstitial pneumonia. We report a case of anti-synthetase syndrome presenting as acute interstitial pneumonia which is reported only once before. With this case, we emphasize the need to consider anti-synthetase syndrome even in patients presenting with acute onset ILD. Physicians should raise their index of suspicion in this clinical context as timely diagnosis, early treatment, and a multidisciplinary approach is paramount for optimal care of these patients.

An unusual biconvex epidural lesion: acutely presenting extraosseous intracranial Ewing's sarcoma.

BACKGROUND: Ewing's sarcoma family of tumors consists of small round cell neoplasms, inclusive of primitive neuroectodermal tumor (PNET), Askin's tumor, and PNET of the bone. Extraosseous Ewing's sarcoma occurs commonly at bones of lower extremities and paravertebral region of the spine. It rarely presents as a primary intracranial lesion. When intracranial, it can be misdiagnosed as central PNET (e.g., medulloblastoma, pinealoblastoma, or supratentorial PNET), other intracranial lesions, or even as an epidural hematoma. CASE PRESENTATION: We report the case of a 20-year-old patient who presented to the emergency department with complaints of drowsiness, headache, and fever for 1 day. On initial computed tomography (CT) scan of the brain, a right temporal biconvex epidural lesion involving squamous-temporal bone with periosteal reaction was noted.The patient underwent urgent craniotomy, and a tumor was found and excised. Biopsy report confirmed Ewing's sarcoma. CONCLUSION: Ewing's sarcoma is a rare intracranial malignancy with only a few cases reported in literature. In a young patient with a biconvex epidural lesion, in the absence of trauma or ongoing infection, the possibility of Ewing's sarcoma should be considered as well.