Carotid ultrasound features of anomalous left vertebral artery originating from the aortic arch proximal to the left subclavian artery.

We present three cases of anomalous origin of the left vertebral artery (LVA) detected during the evaluation of stroke. The VA usually enters the transverse foramen of the sixth cervical vertebra (C6), but an anomalous LVA originating from the aorta frequently enters at a higher level. In our series, ultrasound of the LVA showed entry at C4 in two patients and at C5 in one patient.

Cerebral infarction associated with accessory middle cerebral arteries: two case reports.

We herein present two cases of cerebral infarction in the middle cerebral artery (MCA) territory associated with an accessory middle cerebral artery (AMCA), which is a rare anomalous vessel arising from the anterior cerebral artery that coexists with the main trunk of the MCA. Cerebral infarction occurred in both patients: due to occlusion of the MCA main trunk in one patient and occlusion of the AMCA in the other patient. These cases suggest the importance of recognizing an AMCA when interpreting neuroradiological findings in patients with MCA ischemic stroke, especially in the hyperacute phase.

Hyponatremia upon resumption of paroxetine therapy.

We present a 79-year-old woman with severe hyponatremia secondary to resumption of treatment with paroxetine, a selective serotonin-reuptake inhibitor antidepressant. Confusion and fatigue followed re-initiation of paroxetine after a 3-month hiatus. Hyponatremia, serum hypoosmolality, and urine hyperosmolality strongly suggested the syndrome of inappropriate secretion of antidiuretic hormone.

Effects of anticoagulation on infarct size and clinical outcome in acute cardioembolic stroke.

Effects of anticoagulation on infarct size and outcome have not been fully elucidated in patients with acute cardioembolic stroke, although the anticoagulation therapy reduces both occurrence and recurrence of ischemic stroke greatly. The authors retrospectively investigated the relationship of anticoagulation intensity to infarct size and outcome. In 104 consecutive patients (mean age 70.