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Sakuta K, Yaguchi H, Nakada R, Miyagawa S, Hasegawa I, Okuno K, Teshigawara A, Fuga M, Shimizu K, Iguchi Y. Yield of Whole Body Computed Tomography in Hyper-Acute Stroke Patients With Large Vessel Occlusion. Vasc Endovascular Surg 2024; 58:287-293. [PMID: 37858317 DOI: 10.1177/15385744231209877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE In the majority of cases, large vessel occlusion (LVO) in ischemic stroke patients has an embolic origin. Systemic embolism can occur simultaneously with brain thrombosis. This retrospective study evaluated the frequency and locations of systemic embolism in LVO stroke patients receiving revascularization therapy. MATERIALS AND METHODS In our facility, we use contrast-enhanced computed tomography (CE-CT) to assess suspected stroke patients and routinely perform CE-CT from the chest to the abdomen after brain CT angiography to rule out contraindications like aortic dissection and trauma for thrombolysis. Systemic embolism is also assessed using these images, while myocardial infarction is evaluated based on electrocardiograms and laboratory findings. Other relevant clinical features of each patient are also analyzed. RESULTS In total, 612 consecutively admitted stroke patients and 32 LVO patients who underwent revascularization therapy were included in the present study. Systemic embolism was identified in four patients (13%). The spleen was the most commonly affected organ, followed by the heart, kidneys, limbs, and lungs. All four patients with systemic embolism exhibited LVO resulting from embolism as the underlying mechanism. CONCLUSION Systemic embolism was observed in 13% of our LVO patients, all of whom had LVO of embolic origin.
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Affiliation(s)
- Kenichi Sakuta
- Department of Neurology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Hiroshi Yaguchi
- Department of Neurology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Ryoji Nakada
- Department of Neurology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Shinji Miyagawa
- Department of Neurology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Izumu Hasegawa
- Department of Emergency Medicine, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Kenji Okuno
- Department of Emergency Medicine, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Michiyasu Fuga
- Department of Neurosurgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Kanichiro Shimizu
- Department of Radiology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
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Desai R, Mondal A, Prasad A, Vyas A, Jain A, Rupareliya C, Shah M, Paul T, Kumar G, Sachdeva R. Concurrent Cardio-Cerebral Infarctions in COVID-19: A Systematic Review of Published Case Reports/Series. Curr Probl Cardiol 2023; 48:101814. [PMID: 37209804 PMCID: PMC10193814 DOI: 10.1016/j.cpcardiol.2023.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Twelve CCI patients were studied with confirmed or suspected COVID-19 infection. The majority of these patients were males (83.3%) with a median age of 55 years from three geographical locations, constituting the Middle East (7), Spain (3), and the USA (1). In 6 patients, IgG/IgM was positive for COVID-19, 4 with high pretest probability and 2 with positive RT-PCR. Type 2 DM, hyperlipidemia, and smoking were the primary risk factors. Right-sided neurological impairments and verbal impairment were the most common symptoms. Our analysis found 8 (66%) synchronous occurrences. In 58.3% of cases, neuroimaging showed left Middle Cerebral Artery (MCA) infarct and 33.3% right. Carotid artery thrombosis (16.6%), tandem occlusion (8.3%), and carotid stenosis (1%) were also reported in imaging. Dual antiplatelet therapy (DAPT) and anticoagulants were conservative therapies (10). Two AMI patients had aspiration thrombectomy, while three AIS patients had intravenous thrombolysis/tissue plasminogen activator (IVT-tPA), 2 had mechanical thrombectomy (MT), and 1 had decompressive craniotomy. Five had COVID-19-positive chest X-rays, whereas 4 were normal. four of 8 STEMI and 3 NSTEMI/UA patients complained chest pain. LV, ICA, and pulmonary embolism were further complications (2). Upon discharge, 7 patients (70%) had residual deficits while 1 patient unfortunately died.
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Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA.
| | - Avilash Mondal
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA
| | | | - Ankit Vyas
- Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX
| | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA
| | - Chintan Rupareliya
- Department of Vascular Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Manan Shah
- Department of Neurocritical Care, Department of Neurology and Neurosurgery, Medical College of Georgia at Augusta University, Augusta, GA
| | - Timir Paul
- Division of Cardiology, University of Tennessee Health Sciences Center at Nashville, Saint Thomas Heart Institute, Nashville, TN
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA
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Lodeen H, Esmati S, Okan T, Arastu A, Vilendecic D, Singh G, Mangla A, Moshayedi P, Lasic Z. The Simultaneous Occurrence of Acute ST-Elevation Myocardial Infarction, Acute Ischemic Stroke, and Pulmonary Embolism. Cureus 2023; 15:e44222. [PMID: 37767245 PMCID: PMC10522405 DOI: 10.7759/cureus.44222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Acute ST-elevation myocardial infarction (STEMI), acute ischemic stroke (AIS), and acute pulmonary embolism (PE) are life-threatening conditions, each posing a high risk of morbidity and mortality. When all three of these acute conditions occur simultaneously, the overall prognosis for the patient becomes considerably worse. We report a case of a 70-year-old woman who presented to the emergency department (ED) with a triad of acute STEMI, AIS, and PE as a consequence of atherosclerotic heart disease, atrial fibrillation, and a prolonged transatlantic flight. The diagnoses were promptly confirmed through emergent coronary and cerebral angiography, along with a computerized tomography pulmonary angiogram (CTPA). The patient underwent a combination of medical therapy and endovascular thrombectomy. However, she later developed a subarachnoid hemorrhage and eventually progressed to brain death.
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Affiliation(s)
- Homayoon Lodeen
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Saliman Esmati
- Internal Medicine, Jamaica Hospital Medical Center, New York , USA
| | - Tetyana Okan
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Azeem Arastu
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Dora Vilendecic
- Internal Medicine, Jamaica Hospital Medical Center, New York, USA
| | - Gagandeep Singh
- Cardiology, Northwell Health Lenox Hill Hospital, New York, USA
| | - Aditya Mangla
- Cardiology, Northwell Health Lenox Hill Hospital, New York, USA
| | - Pouria Moshayedi
- Interventional Neurology, Jamaica Hospital Medical Center, New York, USA
| | - Zoran Lasic
- Cardiology, Northwell Health Lenox Hill Hospital, New York, USA
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Muacevic A, Adler JR. Acute Cerebral Infarct and Saddle Pulmonary Embolism in a Post-COVID-19 Patient Treated With Thrombolytics. Cureus 2023; 15:e33877. [PMID: 36819369 PMCID: PMC9934941 DOI: 10.7759/cureus.33877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has been associated with a prothrombotic state during active infection with the severe acute respiratory syndrome coronavirus (SARS-CoV-2). However, reports of delayed multisystemic COVID-19-associated thromboembolic sequelae are limited in the current literature. In addition, the initiation of prophylactic antithrombotic therapy in patients for the prevention of such events during and after infection remains controversial due to conflicting reports. Here, we present evidence to support that patients with comorbid conditions are at higher risk for multisystemic COVID-19-associated thromboembolic events and propose that beginning prophylactic therapy in this population could lead to more favorable outcomes. We describe a 67-year-old male who presented with left-sided weakness and worsening shortness of breath and was diagnosed with COVID-19 approximately one month prior. Initial computed tomography (CT) of the brain showed an age-indeterminate cerebellar infarct. On CT angiography (CTA) of the neck, a saddle embolus was incidentally found and was confirmed on an immediate follow-up chest CT. After consultation with neurology, a decision was made to administer thrombolytics at the standard recommended stroke dosing. The patient was admitted to the ICU and received mechanical thrombectomy two days later. At the time of hospital discharge, the patient still had left-sided weakness on examination and required no additional oxygen support. This report reviews the prevalence of delayed sequelae of COVID-19 and the benefit of prophylactic antithrombotic therapy during active and post-SARS-CoV-2 infection. It is important for emergency medicine physicians to recognize that patients who have recovered from COVID-19 are at high risk for delayed thromboembolic disease, even in the absence of personal or family history of coagulopathy. This underscores the necessity of obtaining imaging studies in high-risk patients who present with acute symptoms that cannot be explained by other probable causes. In addition, patients should be encouraged to follow up with their primary care providers to discuss prophylactic anticoagulation therapy as it could be beneficial during and post-COVID-19.
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Ianniciello A, Attena E, Carpinella G, Uccello A, Mauro C, Russo V. Late Onset Occurrence of Concomitant Myocardial Infarction and Ischemic Stroke in Hospitalized COVID-19 Patient: A Case Report. Int J Gen Med 2022; 15:6621-6626. [PMID: 35996597 PMCID: PMC9392459 DOI: 10.2147/ijgm.s370297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
We described the case of a 68-year-old COVID-19 patient with hypertension and dyslipidemia who discontinued the cardiovascular medications during hospitalization and experienced a late onset occurrence of concomitant ST-elevation myocardial infarction and ischemic stroke at resolution of SARS-CoV-2 pneumonia.
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Affiliation(s)
- Antonio Ianniciello
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Emilio Attena
- Cardiology Unit, Monaldi and Cotugno Hospital, Naples, Italy
| | | | - Ambra Uccello
- Cardiology Unit, Marcianise Hospital, Caserta Health Authority, Caserta, Italy
| | - Ciro Mauro
- Cardiology Unit, Cardarelli Hospital, Naples, Italy
| | - Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
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Song X, Zhang X, Weng Y, Liu Y, Shan Q, Chen W, Ma W, Dong Q, Qu D, Guo Y, Xiong J, Deng F, Fu Q, Xin Y. Effects of Acupuncture Combined with Biofeedback Therapy on Limb Motor Rehabilitation in Patients with Acute Stroke: Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9582077. [PMID: 35845965 PMCID: PMC9277156 DOI: 10.1155/2022/9582077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
Objective The purpose of the systematic review is to verify the effect of biofeedback therapy on limb motor rehabilitation in patients with acute stroke and to provide evidence-based medicine for the promotion and use of biofeedback therapy. Methods The randomized controlled trials (RCT) of biofeedback therapy in the treatment of cerebral palsy were searched in PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP Database, Wanfang Database, and Chinese Biomedical Literature Database (CBM). The starting time and ending time of this study are from the time of building the database of the number of pieces to October 31, 2018. The data included in this study were extracted by two independent researchers and evaluated the bias risk of all the literature included in the study according to the Cochrane manual 5.1.0 criteria. RevMan5.4 statistical software was used to analyze the collected data by meta. Results This systematic review included 9 RCT studies with a total of 1410 patients. The results of meta-analysis showed that there were significant differences in the improvement of lower limb muscle tension, comprehensive spasm scale score, EMG score, and passive range of motion of ankle joint between biofeedback therapy and routine rehabilitation therapy. Conclusion Biofeedback therapy can improve lower limb muscle tension, spasticity, EMG integral value, and passive range of motion of ankle joint in children with cerebral palsy and provide better conditions for improving the motor ability of lower extremities in children with cerebral palsy. However, more studies and follow-up with higher methodological quality and longer intervention time are needed to further verify.
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Affiliation(s)
- Xinrong Song
- The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Xiaoge Zhang
- Department of Rehabilitation, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471003, China
| | - Yan Weng
- The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Yu Liu
- The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Qi Shan
- Department of Intensive Care Unit(Internal Medicine), The First Affiliated Hospital, And College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Wenna Chen
- Department of Intensive Care Unit(Internal Medicine), The First Affiliated Hospital, And College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Wanwan Ma
- Department of Intensive Care Unit(Internal Medicine), The First Affiliated Hospital, And College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Qi Dong
- Department of Intensive Care Unit(Internal Medicine), The First Affiliated Hospital, And College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Dandan Qu
- Department of Intensive Care Unit(Internal Medicine), The First Affiliated Hospital, And College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Yibo Guo
- Department of Intensive Care Unit, Songxian People's Hospital, Luoyang 471400, China
| | - Jie Xiong
- Department of Neurology, The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang 471003, China
| | - Fuhua Deng
- Harbin Medical University, Pharmacy College, Harbin, Heilongjiang 150081, China
| | - Qizhi Fu
- Department of Intensive Care Unit(Internal Medicine), The First Affiliated Hospital, And College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Yufu Xin
- Department of Rehabilitation, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471003, China
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Radhakrishna A, Abdelaziz MO, Mulvihill N. Two is not always better than one: ST-segment elevation myocardial infarction and acute pulmonary embolism in COVID-19. Oxf Med Case Reports 2022; 2022:omac056. [PMID: 35769187 PMCID: PMC9235018 DOI: 10.1093/omcr/omac056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has become a significant global health burden with potential consequences on the cardiovascular system. We describe a case of a healthy male with no prior cardiovascular risk factors who developed ST-segment elevation myocardial infarction and pulmonary embolism following a diagnosis of severe COVID-19 pneumonitis. The patient made a significant recovery following coronary thromboaspiration and anticoagulation therapy. Multiple mechanisms including an indirect hyperinflammatory immune response and/or direct endothelial damage may explain the prothrombotic state related to COVID-19. The cytokine storm leads to endothelial dysfunction and subsequent thromboembolism. Awareness of the lethal cardio-pulmonary sequalae of COVID-19 is important as surges continue across the world owing to new variants.
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Affiliation(s)
- Avinash Radhakrishna
- Department of Cardiology , St. Vincent’s University Hospital, Dublin 4 , Ireland
| | | | - Niall Mulvihill
- Department of Cardiology , St. Vincent’s University Hospital, Dublin 4 , Ireland
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Wolf S, Rhoads A, Gomes W, Overby P, McGoldrick P. Aortic Thrombus Embolization in A Patient with Tuberous Sclerosis. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1739261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractTuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder affecting many organ systems. Patients commonly develop a variety of benign tumors as well as neurological disease, including seizures, autism, and cognitive delay. We report here the case of an adolescent patient with TSC and a history of mild COVID-19 who presented with a 1-day history of altered mental status. The patient was found to have ischemic cerebral infarction of the right MCA and ACA territories. Initial angiography showed an occlusion of the right internal carotid artery without a demonstrable etiology, with follow-up echocardiography and angiography revealing a large aortic thrombus. The patient was not a candidate for thrombus removal due to her cerebral infarct and received medical anticoagulation. Thrombosis progressed to involve the left ICA, with left cerebral infarction and subsequent death. Aortic thrombus embolization as a cause of cerebrovascular accident (CVA) is a novel finding in the setting of TSC and should be considered for pediatric patients with CVA of unknown etiology. It is unclear whether this was related to the prior COVID-19 infection.
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Affiliation(s)
- Steven Wolf
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, New York, United States
| | - Andrew Rhoads
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, New York, United States
| | - William Gomes
- Department of Radiology, Division of Neuroradiology, Westchester Medical Center, Valhalla, New York, United States
| | - Philip Overby
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, New York, United States
| | - Patricia McGoldrick
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, New York, United States
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