Stroke

A case report of extensive cerebral venous sinus thrombosis: a sequela of COVID-19?

Case Reports, Volume 20, Issue 3, Pages 157-248 (2021)

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease that is often the trigger for thrombotic complications. Cerebral venous sinus thrombosis (CVST) represents a small percentage of strokes, frequently proving to be a diagnostic challenge. We report a 31-year-old lady presenting with a persistent headache, 18 weeks after a mild COVID-19 illness. On her second visit, CT venography revealed extensive CVST. She was commenced on low-molecular-weight heparin, and was monitored closely in the neuro-medical intensive care unit. She was discharged 2 weeks later, with no residual neurological deficit, and commenced on a direct oral anticoagulant in the community. CVST should be considered in patients presenting with a refractory headache, with greater suspicion if previously infected with SARS-CoV-2.

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An unusual presentation of dysarthria in a young patient, a stroke mimic

Case Reports, Volume 20, Issue 2, Pages 89-156 (2021)

Internal carotid artery dissection commonly affects younger patients. We present a case of a previously fit and well 43-year-old gentleman who presented with a sudden onset of slurring of speech, with right-sided tongue deviation and fasciculation on examination. Signs and symptoms began following participation in a home workout class. Magnetic resonance angiography revealed right-sided extracrainal internal carotid artery dissection leading to right-sided unilateral twelfth cranial nerve palsy.

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Dyspnoeic dysphasia: A series of unfortunate events

Case Reports, Volume 10, Issue 4, Pages 173 - 232 (2011)

Abstract

We describe a case of a 56 year old man with no previous medical history who presented with sudden onset dyspnoea, expressive dysphasia, and right arm sensory loss and paresis. A diagnosis of bilateral pulmonary embolism and transient cerebral ischaemic attack was confirmed by CT pulmonary angiogram and MRI. Paradoxical embolism through an occult patent foramen ovale (PFO) was subsequently proven by contrast echocardiography. This case highlights a number of short and long-term management conundrums, that to date are incompletely addressed by clinical trials. These include timing of anticoagulation in patients with both venous thromboembolism and cerebral infarction, and the risk:benefit ratio of surgical closure of patent foramen ovale.

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Not just a ‘simple stroke’

Case Reports, Volume 10, Issue 1, Pages 1 - 64 (2011)

Abstract

A 51-year-old man presenting with left arm weakness and slurred speech was referred to the acute medical team. Admission chest X-ray showed a cavitating lesion, which had not been present 2 weeks earlier. Systemic enquiry elicited a 2 month prodromal illness and back pain. Urgent CT of his head and chest revealed evidence of thoracic discitis spreading anteriorly into a pleural-based lung abscess and an intracerebral abscess causing his neurological deficit. He was transferred for urgent craniotomy and evacuation of a Streptococcus milleri abscess. Following several weeks of neurosurgical care and antibiotics he made a near full recovery.

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Management of Acute Ischaemic Stroke in the Acute Medical Unit

Clinical Reviews, Volume 9, Issue 3, Pages 97 - 148 (2010)

Abstract

Ischaemic stroke is a major cause of death and disability which costs the NHS £2.8 billion/year. Acute stroke care is developing rapidly in line with an increasing evidence base. Intravenous thrombolysis is now recommended by NICE. For this guidance to be effectively implemented stroke must be viewed as a medical emergency by both the public and professionals. Emergency medical services must work in partnership with stroke services to establish systems and protocols which offer high quality acute stroke care. This provides challenges, both in systems design and delivery of clinical care.

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An avoidable cause of cardioembolic stroke

Case Reports, Volume 13, Issue 3, Pages 101 - 148 (2014)

Abstract

Left Atrial Ablation for Atrial Fibrillation is safe and effective for most patients. However a rare complication is thermal damage to the integrity of the normal physical barriers between the left atrium and the adjacent oesophagus due to the ablation process. This can lead to formation of an Atrial-Oesophageal fistula with sepsis, haemorrhage and systemic cardioembolism occurring even up to 2 months post procedure. The presentation is similar to endocarditis but localised instrumentation specifically Transoesophageal echocardiography (TOE) can provoke systemic cardioembolism. This is an important differential in those presenting acutely with a Pyrexia of Unknown Origin or endocarditis-like picture within 2 months of ablation therapy.

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Stroke due to Thromboembolism from Congenital Aneurysm of Ventricular Septum

Case Reports, Volume 7, Issue 1, Pages 1 - 60 (2008)

We describe the case of a 46-year-old female who presented with recurrent episodes of cerebrovascular events. She had an unremarkable family history and no risk factors for stroke, apart from smoking. A transthoracic echocardiogram with ‘bubble’ contrast was normal. However transoesophageal echocardiography demonstrated an aneurysm of the membranous part of the ventricular septum, representing the likely source of thrombo-embolisation. This case highlights the need for a systematic and rigorous approach to the investigation of young patients with stroke.

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Management of Acute Complications Associated with Sickle Cell Disease

Clinical Reviews, Volume 5, Issue 1, Pages 1 - 40 (2006)

Abstract

Sickle cell disease is the commonest haemoglobinopathy within the United Kingdom.1 Although the majority of patients will present to hospitals within major cities, this is not invariably the case. It is therefore important that all physicians on acute medical take are familiar with the acute management of sickle cell disease. This review encompasses the initial management which is subdivided into analgesia, investigations and supportive care. In addition the more severe complications of sickle cell, including the acute chest syndrome and stroke are covered. It should be remembered that close collaboration is required with the haematology department, particularly in those patients with respiratory distress or stroke, so that prompt arrangements can be made if exchange transfusion is required.

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Sudden Hemiplegia in a young patient

A Case to Remember, Book Review, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

Stroke is more common in older patients; when it occurs in younger persons the causes may be slightly different. If adequately investigated, a cause can be ascertained in significant proportion of younger patients with stroke. Dissection of the internal carotid artery is an important cause of stroke in this age group and probably accounts for about 20% of cases. An association with elevated plasma homocysteine has been previously reported. We report a case of spontaneous internal carotid artery dissection associated with raised plasma homocysteine in a twenty-two year old, previously healthy man.

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