Presentation
CASE PRESENTATION: We report the case of a 71-year-old hypertensive Caucasian woman with non-valvular atrial fibrillation treated with dabigatran 150 mg twice daily, who presented with acute ischemic stroke causing right-sided hemiparesis and aphasia. [ncbi.nlm.nih.gov]
Entire Body System
- Disability
The prognosis was death or major disability (modified Rankin Scale score ≥ 3) at 3 months after acute ischemic stroke. RESULTS: 22.87% (118/516) of patients had serum hs-cTnT elevation (≥14 ng/l). [ncbi.nlm.nih.gov]
- Weakness
However, she developed evolving left-sided motor weakness over the course of 2 days and presented to our pediatric emergency department where she was found to have an ischemic stroke in the right corona radiata with a right internal carotid artery dissection [ncbi.nlm.nih.gov]
- Falling
One ischemic infarction and two transient ischemic attacks occurred with the same symptoms (inability to walk unassisted and tendency to fall to the left) during the first 2 years post-treatment. [ncbi.nlm.nih.gov]
She has a CHA 2 DS 2 -VASc score of 2 (woman and hypertension) and falls into the category where we should have an in-depth conversation about the risks and benefits of anticoagulant therapy. [medpagetoday.com]
Gastrointestinal
- Dyspepsia
Rome IV Diagnostic Criteria for Dyspepsia Provides criteria for diagnosis of dyspepsia. Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS) Provides criteria for diagnosis of irritable bowel syndrome. [mdcalc.com]
Cardiovascular
- Heart Failure
During OAC with therapeutic INR, congestive heart failure (odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.18-4.58) and hypercholesterolemia (OR: 2.52, 95% CI: 1.51-4.19) were more common in patients with ischemic stroke/TIA, whereas a history [ncbi.nlm.nih.gov]
Myocardial ischemia and coronary disease in heart failure. Preview https://doi.org/10.1007/s10741-019-09831-z Heart Failure Reviews; Pagliaro BR, Cannata F et. al. [allmedx.com]
Steinhart Model for Acute Heart Failure (AHF) in Undifferentiated Dyspnea Diagnoses acute heart failure with NT-proBNP in undifferentiated dyspneic patients. [mdcalc.com]
Szummer KE, Solomon SD, Velazquez EJ, et al.: Heart failure on admission and the risk of stroke following acute myocardial infarction: the VALIANT registry. Eur Heart J 26(20): 2114, 2005. [PubMed: 15972293] 47. [accessmedicina.mhmedical.com]
Secondary outcome variables included the following variables recommended by the Utstein resuscitation registry templates for OHCA: age (years), sex (male or female), weight (kg), past medical history (hypertension, diabetes mellitus, heart failure, or [ccforum.biomedcentral.com]
Eyes
- Blurred Vision
Sudden feeling of dizziness, blurred vision, nausea/vomiting, weakness in both legs or double vision. A seizure is a warning of temporary impairment of cerebral blood flow. [bumrungrad.com]
Neurologic
- Stroke
KEYWORDS: Acute ischemic stroke; intravenous thrombolysis; myocardial infarction; t-PA [ncbi.nlm.nih.gov]
- Aphasia
At discharge, our patient was able to walk unassisted and had only residual aphasia. Twenty days later, she had completely recovered motor function of her right side, with further progressive improvement of aphasia. [ncbi.nlm.nih.gov]
- Seizure
We compared patients with early-onset seizures with all seizure-free patients, whereas the patients with late-onset seizures were compared with the 1-week survivors without any seizures. [ncbi.nlm.nih.gov]
A seizure is a warning of temporary impairment of cerebral blood flow. Abnormal mental confusion lasting up to several hours without loss of consciousness. [bumrungrad.com]
Prediction of Alcohol Withdrawal Severity Scale Screens hospitalized patients for complicated alcohol withdrawal (seizures, delirium tremens). [mdcalc.com]
- Dysarthria
RESULTS: The hemiparesis and the central facial palsy were fully remitted 3 days after the onset of symptoms, and the dysarthria was remitted 2 days afterwards. [ncbi.nlm.nih.gov]
- Confusion
Emotional disturbance; some patients may experience confusion, memory loss, irrational thinking. It is very important for the family to understand and show concern and support, which will benefit the patient. [bumrungrad.com]
At the level of behavior, therefore, the disease can be confuse... Ankylosing spondylitis with cervical fracture, cardiac arrest, locked-in syndrome and d... [allmedx.com]
Confusion Assessment Method for the ICU (CAM-ICU) Establishes ability to detect delirium in high risk settings. COPD Assessment Test (CAT) Quantifies impact of COPD symptoms on patients' overall health. [mdcalc.com]
Workup
Stroke workup revealed a patent foramen ovale; however, no evidence of deep venous thrombosis was found. Hypercoagulability workup revealed an elevated ANA. [ncbi.nlm.nih.gov]
Treatment
In his medical history, the patient did not have any contraindication for thrombolytic treatment. To avoid delays to thrombolytic therapy, blood samples were taken, and after that, IV bolus alteplase treatment was applied. [ncbi.nlm.nih.gov]
Prognosis
[…] in evaluating the prognosis of stroke patients. [ncbi.nlm.nih.gov]
Etiology
CONCLUSION: DWI detects AIS accurately; the positivity of these evaluations in the ER is associated only with NIHSS on admission, time to DWI, brainstem location, and AIS etiology. [ncbi.nlm.nih.gov]
Epidemiology
Further large epidemiologic studies need to be done to confirm these findings. [ncbi.nlm.nih.gov]
Appel LJ, Braun LT, Chaturvedi S, Creager MA, Culebras A, Eckel RH, Hart RG, Hinchey JA, Howard VJ, Jauch EC, Levine SR, Meschia JF, Moore WS, Nixon JV, Pearson TA; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Epidemiology [passeportsante.net]
[…] and Public Health, University of Ottawa, Ottawa, ON, Canada 4 Department of Surgery, University of Ottawa, Ottawa, ON, Canada 5 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada 6 Department of Medicine, Division of [bmj.com]
Schievink WI, Roiter V: Epidemiology of cervical artery dissection. Front Neurol Neurosci 20: 12, 2005. [PubMed: 17290107] 28. [accessmedicina.mhmedical.com]
Pathophysiology
PURPOSE OF REVIEW: This article provides an overview of cerebrovascular hemodynamics, acute stroke pathophysiology, and collateral circulation, which are pivotal in the modern imaging of ischemic stroke that guides the care of the patient with stroke. [ncbi.nlm.nih.gov]
Prevention
After receiving appropriate care the patient should be followed up with medical supervision to prevent further damage. Prevention Prevention is the top priority in caring for the patient exposed to risk factors for stroke. [bumrungrad.com]
CONCLUSIONS: There is insufficient evidence regarding cases for which DOACs would be suitable for the prevention of thromboembolism and regarding its long-term efficacy and safety in patients with cancer. [ncbi.nlm.nih.gov]
In 1991, the seminal study proving the benefits of warfarin in preventing stroke, the Stroke Prevention in Atrial Fibrillation (SPAF) trial, was published. [medpagetoday.com]