Acute Thyrotoxicosis of Graves Disease Associated with Moyamoya Vasculopathy and Stroke in Latin American Women: A Case Series and Review of the Literature.

Objective: Moyamoya disease is a cerebral vasculopathy characterized by stenosis of the terminal internal carotid artery, proximal middle cerebral artery, and anterior cerebral artery. There is an association between moyamoya vasculopathy and Graves disease, primarily in Asian populations. Here, we present the largest series of non-Asian, predominantly Latino patients with moyamoya vasculopathy in the setting of Graves thyrotoxicosis, as well as the largest review of the literature to date.

Transcranial Doppler detection of cerebral fat emboli and relation to paradoxical embolism: a pilot study.

Background: The fat embolism syndrome is clinically characterized by dyspnea, skin petechiae, and neurological dysfunction. It is associated mainly with long bone fracture and bone marrow fat passage to the systemic circulation. An intracardiac right-to-left shunt (RLS) could allow larger fat particles to reach the systemic circulation.

High-dose atorvastatin enhances impaired cerebral vasomotor reactivity.

The influence of statin therapy on cerebral vasomotor function has not been fully characterized. We report the effects of high-dose atorvastatin therapy on cerebral vasomotor reactivity (VMR) in patients with controlled hypertension and dyslipidemia. We prospectively enrolled 36 patients with controlled hypertension and a low-density lipoprotein (LDL) cholesterol concentration >100 mg/dL.

Cerebral vasomotor reactivity monitoring in posterior reversible encephalopathy syndrome.

A 25-year-old woman was admitted for vomiting, hypertension and seizures. Magnetic resonance imaging was compatible with posterior reversible encephalopathy syndrome and a transcranial Doppler/vasomotor reactivity study (TCD/VMR) demonstrated loss of vasomotor reactivity. The clinical recovery was concomitant to improvement in the TCD/VMR.

Ultrasound velocity criteria for vertebral origin stenosis.

Background: Despite remaining an important cause of posterior circulation stroke, the non-invasive diagnosis of vertebral artery origin (VAo) stenosis is problematic. We here examine peak systolic velocity (PSV) criteria for the diagnosis of VAo stenosis and assess if the PSV ratio at the origin to the distal segments improves diagnostic accuracy.

Methods: We performed a retrospective analysis of patients studied by catheter cerebral angiography and extracranial Duplex ultrasonography.

Microemboli in aneurysmal subarachnoid hemorrhage.

Background And Purpose: The determinants of ischemic complications in subarachnoid hemorrhage (SAH) are not well defined. The objective of this study is to evaluate the role of microemboli in SAH-related cerebral ischemia.

Methods: Forty patients with aneurysmal SAH were monitored with transcranial Doppler (TCD) for the presence of embolic signals (ES) and vasospasm, and followed clinically for the development of cerebral ischemic symptoms, from the time the aneurysm was secured until day 14 posthemorrhage or discharge.

Asymptomatic infection by Leishmania infantum in blood donors from the Balearic Islands (Spain).

Background: Visceral leishmaniasis (VL) caused by Leishmania infantum is a zoonotic disease endemic throughout the Mediterranean basin. The existence of asymptomatic human infection entails the risk of transmission by blood transfusion.

Study Design And Methods: The prevalence of Leishmania infection was studied in 1437 blood donors from the Balearic Islands (Majorca, Formentera, and Minorca) using immunologic (Western blot [WB] and delayed-type hypersensitivity [DTH]), parasitologic (culture), and molecular (nested polymerase chain reaction [PCR]) methods.

Rapid blood pressure reduction in acute intracerebral hemorrhage: feasibility and safety.

Background: The optimal blood pressure (BP) for treating acute intracerebral hemorrhage remains (ICH) uncertain. High BP may contribute to hematoma growth while excessive BP reduction might precipitate peri-hemorrhage ischemia. We examine here the feasibility and safety of reducing BP to lower than presently recommended levels in patients with acute ICH.

In-hospital delays to stroke thrombolysis: paradoxical effect of early arrival.

Objective: To determine the causes of in-hospital delays for thrombolysis.

Methods: We performed a 4 year retrospective chart analysis of i.v.

MR imaging after hip and knee replacement.

Background: Diffusion-weighted (DW) imaging abnormalities often develop in patients after invasive procedures associated with cerebral microembolism. Cerebral microembolism has recently been shown during orthopedic surgery. We here examine the effects of intraoperative microembolism on acute magnetic resonance(MR) imaging in patients undergoing hip and knee replacement.

Signs and symptoms of sleep apnea and acute stroke severity: is sleep apnea neuroprotective?

Background: In animal models, brief periods of hypoxemia render the brain tolerant to subsequent ischemic insults. Sleep apnea leads to frequent episodes of nocturnal hypoxemia and may induce ischemic tolerance. Snoring and daytime sleepiness are cardinal symptoms of sleep apnea.

Cerebral fat microembolism and cognitive decline after hip and knee replacement.

Background And Purpose: Intra-operative cerebral microembolism may be a factor in the etiology of cognitive decline after orthopedic surgery. We here examine the impact of intra-operative microembolism on cognitive dysfunction after hip and knee replacement surgery.

Methods: We enrolled 24 patients, at least 65 years old, requiring elective knee or hip replacement surgery.

[The "Seville" Consensus Document on Alternatives to Allogenic Blood Transfusion. Sociedades españolas de Anestesiología (SEDAR), Medicina Intensiva (SEMICYUC), Hematología y Hemoterapia (AEHH), Transfusión sanguínea (SETS) Trombosis y Hemostasia (SETH)].

The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics.

High dose human serum albumin for the treatment of acute ischemic stroke: a safety study.

Introduction: In animal models of focal cerebral ischemia, albumin infusions at doses ranging from 0.6 to 2.5 g/kg are neuroprotective.

Stroke etiology among Haitians living in Miami.

The black Caribbean population continues to grow in the US and little is known about stroke etiologies in that community. We examined stroke subtypes in 175 consecutive Haitian-born patients living in Miami, admitted for acute stroke. Ischemic stroke was diagnosed in 72%.

Diffusion-weighted magnetic resonance imaging in symptomatic vertebrobasilar atherosclerosis and dissection.

Background: Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail.

Objective: To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia.

Diffusion-weighted magnetic resonance imaging in internal carotid artery dissection.

Background: Acute multiple brain infarction pattern on diffusion-weighted imaging is associated with arterial or cardiac sources of embolism.

Objectives: To review the diffusion-weighted imaging characteristics of patients with strokes secondary to internal carotid artery (ICA) dissection and to gain further insights into the mechanisms of cerebral ischemia.

Design: Patients with ICA dissection and ischemic stroke were identified by review of an angiographic database and hospital discharge codes.

Rapidly progressive dementia due to bilateral internal carotid artery occlusion with infarction of the total length of the corpus callosum.

The authors report a patient with rapidly progressive cognitive decline due to bilateral internal carotid artery occlusion (ICAO) resulting in multiple pathologically proven cerebral infarctions including the entire length of the corpus callosum. The gradual evolution of the deficits was suggestive of hemodynamic ischemia. Bilateral ICAO should be considered in the differential diagnosis of patients with rapidly cognitive decline.

Brain microembolism.

Purpose: To alert clinicians about the occurrence of a subtype of brain infarction, its suspected etiology, and its detection by specific neuroimaging techniques.

Methods: The article presents 5 nonconsecutive patients admitted to the stroke services of 2 tertiary care hospitals, who presented with acute or subacute symptoms suspicious, but at times atypical, of brain ischemia.

Findings: Each patient had evidence of 3 to > 20 small areas of recent brain infarction detected by diffusion-weighted imaging (DWI).

Subclavian steal and a persistent trigeminal artery.

A persistent trigeminal artery (PTA) has been found in a number of cerebrovascular diseases. A 73-year-old asymptomatic woman was noted to have a left PTA and left subclavian steal by catheter angiography. Carotid duplex revealed a peak systolic flow velocity of 294 cm/s in the internal carotid artery (ICA) and an ICA to common carotid artery ratio > 4, suggestive of a high-grade stenosis.