Troponin T changes in acute ischemic stroke.

Elevation of cardiac troponin T (cTnT) in serum reflects myocardial injury, but it was also observed in other conditions with cardiac injury including acute ischemic stroke. The objective was to identify the relationship between elevated cTnT and stroke severity, location and outcome, cTnT levels were prospectively performed in 385 patients with different subtypes of acute ischemic stroke admitted in NICU within 72 hours of onset, as TOAST criteria. The patients were divided into two groups: an elevated cTnT (group 1) (n = 42) and a normal cTnT (group 2) (n = 343). The short-term prognosis was assessed by 30-days modified Rankin Scale responder analysis and the NIHSS. Serum cTnT levels were determined using a high sensitive troponin T assay (Roche Elecsys Troponin, Mannheim, Germany), cut-off value of 0.01 ng/ml. Statistical analysis was performed. Serum cTnT level was elevated in 10.91% (42/385) of patients, cTnT positivity on admission is an independent and powerful prognosis predictor in acute ischemic stroke. It was observed a more frequent insular lobe involvement in elevated cTnT group (17/42) (31%) than in group 2 (55/343) (16%) (p = 0.040). Stroke severity was greater in elevated cTnT group. The outcome was worse in elevated cTnT group as compared to group 2 (13/43) (30.95%) vs. (68/343) (19.82%) (p = 0.013). cTnT in acute ischemic stroke is a marker of stroke severity, of insular lobe lesion and of prognosis prediction. cTnT is a highly specific and sensitive marker of myocardial damage in acute ischemic stroke due to insular lesion that induces disturbances of autonomic balance.

Meningeal carcinomatosis in a patient with Crohn's disease.

Leptomeningeal carcinomatosis, also known as carcinomatous meningitis, is defined by spreading of neoplastic cells to the meninges and ventricles, and is a form of cancer dissemination. In this case, a patient with inflammatory bowel disease had developed a neoplastic process that spread to the meninges. A 49-year-old woman developed an abdominal pain, and was diagnosed the same month with Crohn's disease, complicated with intestinal perforation, for which she was hospitalized. Pathological examination revealed acute phase-terminal ileitis. She undergone many hospitalizations during which she was suspected to have celiac disease, inflammatory bowel disease, and tuberculous meningitis, as well as femoral head necrosis after she had been unsuccessfully treated with Prednisone for Crohn's disease. After she developed peripheral bilateral facial paresis, bilateral hypoacusia, hypotonia, tetraparesis and diminished osteotendinous reflexes at the legs, the patient was admitted in our department. Several lumbar punctures were performed but no specific disease could be detected. The MRI performed showed pachymeningeal and leptomeningeal inflammation. Tuberculous meningitis was taken into consideration and the patient was transferred into an Infectious Disease Department where this diagnostic was infirmed. The patient was retransferred into the Department of Neurology where after an episode of hematemesis she had a cardiac arrest and deceased. Inflammatory bowel disease may involve different segments of the intestine, and may be accompanied by a variety of conditions, such as neurologic findings, osteoarticular manifestations and also may be the starting point of a neoplastic process. The patient had an inflammatory bowel condition, which by the time it was appropriately diagnosed as being Crohn's disease, a neoplastic process spread to the meninges, causing multiple cranial nerve palsy, tetraparesis, along other neurological manifestations.