Assuntos
Gânglios da Base/irrigação sanguínea , Isquemia Encefálica/etiologia , Artéria Carótida Interna/patologia , Estenose das Carótidas/complicações , Osso Hioide/diagnóstico por imagem , Isquemia/etiologia , Vasos Retinianos/patologia , Afasia/etiologia , Gânglios da Base/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/etiologia , Lateralidade Funcional , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Tomografia Computadorizada Espiral , UltrassonografiaRESUMO
BACKGROUND: Intracranial arterial lesions are important causes of ischemic stroke, particularly in the Asian population. Of the intracranial lesions, the etiology of isolated anterior cerebral artery (ACA) territory infarction is not fully elucidated. The purpose of this study was to determine the etiological and clinical characteristics of patients with isolated ACA territory infarction, especially those with ACA dissection. METHODS: Of 3,115 consecutive patients with acute ischemic stroke, 42 patients (1.3%, 30 men, 38-88 years old) having an isolated ACA territory infarction were studied. Infarcts were principally verified by diffusion-weighted MRI, and vascular lesions were identified by MRA, CTA, or digital subtraction angiography. Three-dimensional rotational angiography was performed if needed. RESULTS: Eighteen patients (43%) were diagnosed as having ACA dissection. The stroke subtypes of the other 24 patients included cardioembolism for 6 patients and large-artery atherosclerosis for 8. Patients with dissection were younger (p < 0.001) and heavier (p = 0.026), less commonly had heart disease (p = 0.002) and previous stroke (p = 0.002), and had lower initial systolic blood pressure (p = 0.029) and lower levels of D-dimer (p = 0.041) than patients without dissection. Stroke onset more commonly followed physical exertion (p = 0.013) and headache (p = 0.041) in patients with dissection than in patients without dissection. At hospital discharge, the modified Rankin scale score was lower in patients with dissection than in patients without dissection (p = 0.005). CONCLUSIONS: Arterial dissection was the most common vascular lesion underlying an isolated ACA territory infarction in our Japanese cohort. Patients with ACA dissection had unique baseline characteristics and unique conditions at stroke onset.
Assuntos
Dissecção Aórtica/complicações , Infarto da Artéria Cerebral Anterior/etiologia , Aneurisma Intracraniano/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico , Angiografia Digital , Angiografia Cerebral/métodos , Imagem de Difusão por Ressonância Magnética , Avaliação da Deficiência , Feminino , Humanos , Imageamento Tridimensional , Infarto da Artéria Cerebral Anterior/diagnóstico , Aneurisma Intracraniano/diagnóstico , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
We present a 79-year-old woman with severe hyponatremia secondary to resumption of treatment with paroxetine, a selective serotonin-reuptake inhibitor antidepressant. Confusion and fatigue followed re-initiation of paroxetine after a 3-month hiatus. Hyponatremia, serum hypoosmolality, and urine hyperosmolality strongly suggested the syndrome of inappropriate secretion of antidiuretic hormone. Hyponatremia was quickly resolved after discontinuation of paroxetine and initiation of intravenous normal saline infusion together with oral fluid restriction. This case underscores the importance of monitoring serum sodium in elderly patients taking paroxetine, whether this represents a new prescription or reintroduction of the drug.
