1
|
Patel S, Treiber J, Johnson JN. Concurrent Middle Cerebral Artery and Basilar Artery Occlusions Treated With Mechanical Thrombectomy in a Patient With Active COVID-19 Infection. Cureus 2024; 16:e57623. [PMID: 38707024 PMCID: PMC11070204 DOI: 10.7759/cureus.57623] [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: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
We report a rare case of acute ischemic stroke from concurrent large vessel occlusions (LVOs) and subsequent successful mechanical thrombectomy revascularization in a patient with active coronavirus disease 2019 (COVID-19) pneumonia. A 59-year-old woman presented to the emergency department after one week of intermittent chest pain, dyspnea, and diarrhea found to have COVID-19 pneumonia. On hospital day three, the patient developed acute altered mental status and hemiparesis with a National Institutes of Health Stroke Scale (NIHSS) of 22. CT with angiography demonstrated concurrent occlusions of the basilar artery and the M1 segment of the right middle cerebral artery (MCA) without intracranial hemorrhage. The patient was taken for urgent mechanical thrombectomy of the basilar artery, followed by the MCA, both of which were successful (thrombolysis in cerebral infarction (TICI) 3 and 2B) and timely. Despite early revascularization, the patient did not improve clinically with absent brainstem reflexes and a full MCA territorial infarct on imaging. This case describes a rare stroke syndrome of concurrent LVOs with rapid infarct progression despite timely revascularization. This example illustrates a severe cerebrovascular complication of active COVID-19 infection and the importance of vigilance regarding stroke prevention and neurological examination monitoring.
Collapse
Affiliation(s)
- Saarang Patel
- Arts and Sciences, Seton Hall University, South Orange, USA
| | - Jeffrey Treiber
- Neurological Surgery, Baylor College of Medicine, Houston, USA
| | - Jeremiah N Johnson
- Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| |
Collapse
|
2
|
Bojalil-Alvarez L, Gertz MA, Garcia-Villaseñor E, Fernández-Gutiérrez JA, Reyes-Cisneros OA, Murrieta-Alvarez I, Cantero-Fortiz Y, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. Long term survival in multiple myeloma: a single institution experience in underprivileged circumstances. Leuk Lymphoma 2021; 63:1236-1241. [PMID: 34898338 DOI: 10.1080/10428194.2021.2012665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is data suggesting that the clinical behavior of multiple myeloma (MM) may be different in Latin Americans than in Caucasian or African-Americans, consistent with a less aggressive course of MM in Latinos. We analyzed the overall survival (OS) of 139 persons with MM in a single institution in México, as well the variables which were associated with long-term OS. Of all patients, the median OS was 11 years whereas the 5-year and 10-year OS were 75% and 55% respectively. The analysis of variables showed that the variable related with five-year survival was having hematopoietic stem cell transplantation (HSCT), whereas the variables related with 10-year survival were HSCT, age at diagnosis (patients younger than 50 survived longer), light chain type (kappa survived longer) and ISS stage (stage I patients survived longer). The only variable associated with both 5 and 10-year survival was HSCT. A plateau in the OS was reached after 10 years, both in grafted and non-grafted patients. We have confirmed the critical role of HSCT in the prognosis of persons with MM, independent of the induction treatment or the maintenance post-transplant, and we have identified a better prognosis in this cohort, as compared with African-Americans or Caucasians, since the proportion of long-term survivors in our group is seemingly better than those in other populations.
Collapse
Affiliation(s)
- Lorena Bojalil-Alvarez
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico
| | - Morie A Gertz
- Mayo Clinic/Foundation, Hematology, Rochester, MN, USA
| | - Elizabeth Garcia-Villaseñor
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - José Antonio Fernández-Gutiérrez
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico
| | - Oscar Alfonso Reyes-Cisneros
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Universidad Anáhuac Puebla, Puebla, Mexico
| | - Iván Murrieta-Alvarez
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico
| | - Yahveth Cantero-Fortiz
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Universidad de las Américas Puebla, Puebla, Mexico
| | - Guillermo J Ruiz-Delgado
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico.,Universidad Anáhuac Puebla, Puebla, Mexico
| | - Guillermo J Ruiz-Argüelles
- Clínica Ruiz, Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Puebla, Mexico.,Universidad Anáhuac Puebla, Puebla, Mexico
| |
Collapse
|