Evoluția unui caz clinic de hemoragie subarahnoidiană perimezencefalică

Introduction. Perimesencephalic subarachnoid hemorrhage (SAH) accounts for 5% of all cerebrovascular diseases. This is usually spontaneous and in 15% of cases, the etiology remains unknown, but the evolution of the patients is favorable in most cases. Objective of the study. Presentation of a clinical case of spontaneous perimesencephalic HSA in a young patient without cerebrovascular risk factors. Material and methods. Anamnestic, clinical and laboratory data were taken from the medical history file. Computed tomography (CT) of the brain, angio-CT of the brain and brachiocephalic vessels, duplex examination of the cerebral and extracerebral vessels, magnetic resonance imaging (MRI) of the brain and digital subtraction angiography were performed. The literature on similar cases has been revised. Results. Patient, male, 34 years old, addressed in the Department of Emergency Medicine (DEM) with the most severe headache in his life, VAS 10 p. Following the neurological evaluation of the patient and after performing brain CT scan, the diagnosis of perimesencephalic HSA was established. The patient was examined in detail to determine the source of the bleeding, with no results, confirming the spontaneous etiology of the hemorrhage. Prophylaxis of intracerebral vasospasm with calcium channel blockers was performed and blood pressure was rigorously monitored. The patient was discharged after 20 days of treatment, fully recovered neurologically. Conclusions. Imaging differentiation between spontaneous perimesencephalic HAS and that of aneurysmal etiology, which is found in 80%, is essential because the former has a favorable prognosis due to its natural resolution without sequelae.Introducere. Hemoragia subarahnoidiană (HSA) perimezencefalică reprezintă 5 % din totalitatea bolilor cerebro-vasculare. Aceasta de obicei este spontană și în 15 % din cazuri etiologia rămâne a fi necunoscută, dar evoluția pacienților este favorabilă în majoritatea cazurilor. Scopul lucrării. Prezentarea unui caz clinic de HSA perimezencefalică spontană la un pacient cu vârstă tânără fără factori de risc cerebro-vasculari. Material și metode. Datele anamnestice, clinice și de laborator au fost prelevate din fișa medicală. Au fost efectuate: tomografie computerizată (CT) cerebrală, angio-CT cerebral și al vaselor brahiocefalice, examenul duplex al vaselor cerebrale și extracerebrale, imagistica prin rezonanță magnetică (IRM) cerebrală și angiografia cu substracție digitală. A fost revizuită literatura privind cazurile similare. Rezultate Pacient, bărbat, 34 ani, s-a adresat în Departamentul de Medicină Urgentă (DMU) cu cefalee în lovitură de trăsnet, VAS 10 p. În urma evaluării neurologice a pacientului și examinării prin CT cerebral s-a stabilit diagnosticul de HSA perimezencefalică. Pacientul a fost examinat detaliat pentru determinarea sursei HSA, fără rezultate, confirmându-se etiologia spontană a hemoragiei. A fost efectuată profilaxia evoluției vasospasmului intracerebral cu blocante ale canalelor de calciu și monitorizată riguros tensiunea arterială. Pacientul a fost externat peste 20 zile de tratament, recuperat neurologic complet. Concluzii. Diferențierea imagistică între HAS perimezencefalică spontană și cea de etiologie anevrismală, care se întâlnește în 80% este esențială deoarece prima are un prognostic favorabil datorată rezolvării naturale fără sechele a acesteia

EVOLUTION OF A CLINICAL CASE OF PERIMESENCEPHALIC SUBARACHNOID HEMORRHAGE

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Hemoragia subarahnoidiană (HSA) perimezencefalică reprezintă 5 % din totalitatea bolilor cerebro-vasculare. Aceasta de obicei este spontană și în 15 % din cazuri etiologia rămâne a fi necunoscută, dar evoluția pacienților este favorabilă în majoritatea cazurilor. Scopul lucrării. Prezentarea unui caz clinic de HSA perimezencefalică spontană la un pacient cu vârstă tânără fără factori de risc cerebro-vasculari. Material și metode. Datele anamnestice, clinice și de laborator au fost prelevate din fișa medicală. Au fost efectuate: tomografie computerizată (CT) cerebrală, angio-CT cerebral și al vaselor brahiocefalice, examenul duplex al vaselor cerebrale și extracerebrale, imagistica prin rezonanță magnetică (IRM) cerebrală și angiografia cu substracție digitală. A fost revizuită literatura privind cazurile similare. Rezultate Pacient, bărbat, 34 ani, s-a adresat în Departamentul de Medicină Urgentă (DMU) cu cefalee în lovitură de trăsnet, VAS 10 p. În urma evaluării neurologice a pacientului și examinării prin CT cerebral s-a stabilit diagnosticul de HSA perimezencefalică. Pacientul a fost examinat detaliat pentru determinarea sursei HSA, fără rezultate, confirmându-se etiologia spontană a hemoragiei. A fost efectuată profilaxia evoluției vasospasmului intracerebral cu blocante ale canalelor de calciu și monitorizată riguros tensiunea arterială. Pacientul a fost externat peste 20 zile de tratament, recuperat neurologic complet. Concluzii. Diferențierea imagistică între HAS perimezencefalică spontană și cea de etiologie anevrismală, care se întâlnește în 80% este esențială deoarece prima are un prognostic favorabil datorată rezolvării naturale fără sechele a acesteia.Introduction. Perimesencephalic subarachnoid hemorrhage (SAH) accounts for 5% of all cerebrovascular diseases. This is usually spontaneous and in 15% of cases, the etiology remains unknown, but the evolution of the patients is favorable in most cases. Objective of the study. Presentation of a clinical case of spontaneous perimesencephalic HSA in a young patient without cerebrovascular risk factors. Material and methods. Anamnestic, clinical and laboratory data were taken from the medical history file. Computed tomography (CT) of the brain, angio-CT of the brain and brachiocephalic vessels, duplex examination of the cerebral and extracerebral vessels, magnetic resonance imaging (MRI) of the brain and digital subtraction angiography were performed. The literature on similar cases has been revised. Results. Patient, male, 34 years old, addressed in the Department of Emergency Medicine (DEM) with the most severe headache in his life, VAS 10 p. Following the neurological evaluation of the patient and after performing brain CT scan, the diagnosis of perimesencephalic HSA was established. The patient was examined in detail to determine the source of the bleeding, with no results, confirming the spontaneous etiology of the hemorrhage. Prophylaxis of intracerebral vasospasm with calcium channel blockers was performed and blood pressure was rigorously monitored. The patient was discharged after 20 days of treatment, fully recovered neurologically. Conclusions. Imaging differentiation between spontaneous perimesencephalic HAS and that of aneurysmal etiology, which is found in 80%, is essential because the former has a favorable prognosis due to its natural resolution without sequelae

Efficacy of implementation of the FeSS protocol in thrombolysed stroke patients from Institute of Emergency Medicine

Background: Implementation of intravenous thrombolysis for acute ischemic stroke has significant impact on stroke outcome by reducing disability and post-stroke mortality rates. However, high risk for developing early complications persists. That’s why, FeSS Protocol (additional screenings for blood glucose, temperature control and swallowing monitoring) has been implemented. The purpose of the study was to analyze the efficacy of the FeSS Protocol in reduction of complication rate after intravenous thrombolysis. We compared the data before and after its implementation. Material and methods: Patients from Institute of Emergency Medicine who underwent thrombolytic treatment were included in this study. The rates of general and hemorrhagic complications were analyzed by comparing the period before (2015 – 2017) and after (2018 – 2020) implementation of the FeSS Protocol. Results: According to the obtained data, in 2015 – 2017 period, 63 patients underwent the thrombolysis procedure, and in 2018 – 2020 – 124 patients. The rate of hemorrhagic complications in the first period was 11 (17.5%), 4 of which (6.3%) were fatal. In the second period there were 14 (11.2%) hemorrhagic complications, without any fatal cases. The percentage of general complications was higher in the first group – 32%, compared to 19.4% in the second group. Conclusions: Hyperglycemia, fever and swallowing disturbances in the early post-stroke period are predisposing factors for the development of hemorrhagic and general complications, which negatively affect recovery after stroke. Tight monitoring and management of these parameters can improve the clinical and functional outcome of stroke patients

Evolution of a clinical case of perimesencephalic subarachnoid hemorrhage

Introduction Perimezencephalic subarachnoid hemorrhage (SAH) accounts for 5% of all cerebrovascular diseases. This is usually spontaneous and in 15% of cases the ethylology remains unknown, but the evolution of the patients is favorable in most cases. Purpose. Presentation of a clinical case of spontaneous perimezencephalic SAH in a young patient without cerebrovascular risk factors. Material and methods. Anamnestic, clinical and laboratory data were taken from the medical history file. The following investigations were performed: computed tomography (CT) of the brain, angioCT of the brain and brachiocephalic vessels, duplex examination of the cerebral and extracerebral vessels, magnetic resonance imaging (MRI) of the brain and digital subtraction angiography. The literature on similar cases has been revised. Results. Patient, male, 34 years old, employee of special state services, addressed in the Department of Emergency Medicine (DEM) with the most severe headache in his life, VAS 10 p. Following the neurological evaluation of the patient and after performing brain CT scan, the diagnosis of perimezencephalic HSA was established. The patient was examined in detail to determine the source of the bleeding, with no results, confirming the spontaneous etiology of the haemorrhage. Prophylaxis of intracerebral vasospasm with calcium channel blockers was performed and blood pressure was rigorously monitored. The patient was discharged after 20 days of treatment, fully recovered neurologically. Conclusions. Imaging differentiation between spontaneous perimezencephalic HAS, that is quite rare and that of aneurysmal etiology, which is found in 80%, is essential because the first has a favorable prognosis due to its natural resolution without sequelae

Treatment of acute ischemic stroke by systemic thrombolysis combined with endovascular thrombectomy: case report

Background: A small number of acute ischemic stroke (AIS) patients meets eligibility criteria for systemic thrombolysis (ST) with recombinant tissue plasminogen activator, but its efficacy for large vessel occlusion is poor. Therefore, an increasing number of patients with large-vessel stroke are treated with endovascular mechanical thrombectomy (EMT). Material and methods: We describe consequent events of our clinic’s patient with AIS who underwent endovascular thrombectomy combined with thrombolytic therapy after conventional imaging – a brain non-contrast computed tomography (NCCT) and CT angiogram (CTA). Results: A 51-year-old man was admitted in our clinic with signs and symptoms of a left middle cerebral artery (MCA) territory infarct. His National Institute of Health Stroke Scale (NIHSS) score was 22 on presentation and his brain NCCT showed left MCA M1 hyperdensity and Alberta Stroke Programme Early CT Score (ASPECTS) of 9. ST was initiated with door-needle time of 40 min and was ineffective. His CTA confirmed a left MCA distal M1 occlusion. Afterwards he successfully underwent thrombectomy, with a door-to-groin-puncture time of 120 min. His NIHSS score improved to 8 over the next 24 hours and he was discharged with NIHSS 4. Conclusions: EMT seems to be a perfect option for patients with large-vessel stroke who did not benefit from ST. The presented case confirmed that early presentation and combined treatment with ST and EMT could be lifesaving options for patients with large-vessel stroke

Evoluția infecției COVID-19 la un pacient cu accident vascular cerebral după tromboliză sistemică

Background. Ischemic stroke (IS) remains a medical emergency even during the pandemic. COVID- 19 infection is associated with hypercoagulation and may contribute to the onset, development and can influence the prognosis of the IS. Objective of the study. Presentation of the first clinical case of an IS associated with COVID-19 infection in a patient who was treated with systemic thrombolysis (ST). Material and Methods. Anamnesis, clinical and paraclinical data were taken from the medical databases. The patient was investigated by electrocardiography, lung radiography, brain and lung computed tomography (CT), duplex examination of the cerebral and extracerebral vessels. The literature about similar cases has been studied. Results. A 59-year-old man, with a single lung, was hospitalized in the neurology department with speech disorders and weakness in right limbs. The patient presented in the therapeutic window and because of that he was eligible for the treatment with ST, Alteplaza solution was administered according to the protocol. Due to the appearance of fever and cough over 2 days after admission, was performed lung CT and the result of RT-PCR for detectection of COVID-19 was positive. The patient was treated according to the protocol for COVID-19 infection and anticoagulant drugs until his discharge. After 28 days of treatment, the patient has been neurologically and somatically completely recovered. Conclusion. It is possible that COVID-19 infection contributed to the development of IS due to hypoxemia, endothelial dysfunction and platelet aggregation. ST in eligible patients has a positive influence on the evolution and prognosis of the disease in patients with associated IS with COVID-19 infection. Introducere. Accidentul vascular cerebral ischemic (AVCI) ramâne o urgență medicală și în perioada pandemiei. Infecția cu COVID-19 se asociază cu hipercoagulare și poate contribui la apariția, dezvoltarea și influențarea prognosticului pentru AVCI. Scopul lucrării. Prezentarea primului caz de AVCI asociat cu infecția COVID-19 la un pacient care a fost tratat prin tromboliză sistemică (TS). Material și Metode. Datele anamnestice, clinice și paraclinice au fost prelevate din fișa medicală. Pacientul a fost investigat prin electrocardiografie, radiografie pulmonară, tomografie computerizată (CT) cerebral și pulmonară, examenul duplex al vaselor cerebrale și extracerebrale. A fost studiată literatura de specialitate privind cazurile similare. Rezultate. Barbat de 59 ani, cu plamân unic, a fost internat în departamentul de neurologie cu dereglări de vorbire, slăbiciune în hemicorpul drept. Luând în considerație că pacientul s-a prezentat în fereastra terapeutică și a fost eligibil pentru tratament prin TS, a fost administrată soluțiea Alteplaza, conform protocolului. Din cauza aparitiei febrei și tusei la a 2-a zi după internare, a fost efectuat CT pulmonar și RT-PCR pentru detectarea infectiei COVID-19, rezultat-pozitiv. Pacientul a fost tratat conform protocolului în vigoare pentru infecția COVID-19 și anticoagulante până la externare. Peste 28 de zile de tratament, pacientul s-a recuperat complet neurologic și somatic. Concluzii. Putem presupune că infecția cu COVID-19 a contribuit la dezvoltarea unui AVCI prin hipoxemie, disfuncție endotelială și agregarea trombocitară. Efectuarea TS la pacienții eligibili are impact pozitiv asupra evoluției și prognosticului bolii la pacienții cu AVCI asociat cu infecție COVID-19

A CASE OF CAROTID ARTERY THROMBOSIS CAUSED BY NECK INJURY

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere: Traumatismele regiunii cervicale rar pot duce la accident vascular cerebral ischemic secundar trombozei arterei carotide (AC). Scopul lucrării: Prezentarea cazului clinic de accident vascular cerebral ischemic după leziuni cervicale bilaterale cauzate de mușcătura de tigru. Materiale și Metode: Datele anamnestice, clinice și paraclinice au fost colectate din bazele de date medicale. Pacientul a fost investigat prin examinarea Doppler-Duplex a vaselor brahiocefalice, tomografie computerizată (CT) cerebrală, angiografia CT a arterelor cerebrale (CTA). A fost revizuită literatura de specialitate despre cazuri similare. Rezultate: Un bărbat de 58 de ani, fără factori de risc vasculari cunoscuți, a fost internat în spitalul de urgență cu plăgi cervicale bilaterale cu leziune orofaringelui după atacul unui tigru. La momentul internării CT regiunii cervicale nu a evidențiat leziuni arteriale. După 72 de ore, examenul neurologic relevă afazie globală și plegie pe partea dreaptă a corpului. CT cerebrală a confirmat o zonă ischemică pe tot teritoriul arterei cerebrale medie stângi, cu edem emisferial, compresie și dislocarea a structurilor mediene. Examinarea Doppler-Duplex a vaselor brahiocefalice a demonstrat un trombus flotant de 50 mm în lumenul ACC, care se extinde de la bifurcare până la emergența AC interne. CTA a demonstrat absența fluxului sanguin prin artera carotidă internă stângă. A fost indicată terapie anticoagulantă. Datorită leziunilor cerebrale severe, pacientul a rămas cu deficit motor și cognitiv sever. Concluzii: Traumatismele cervicale necesită abordarea multidisciplinară având in vedere existența legăturii cauzale cu tromboza AC și consecințele cerebrale.Introduction: Rarely, neck trauma may lead to ischemic stroke due to secondary carotid artery (CA) thrombosis. Aim of the study: We aimed to present the case of ischemic stroke after bilateral cervical injury caused by tiger bite. Material and Methods: History, clinical and paraclinical data were collected from the medical hospital databases. The patient was investigated by Doppler-Duplex examination of brachiocephalic vessels, brain computed tomography (CT), CT angiography of the cerebral arteries (CTA). The literature concerning similar cases has been revised. Results: A 58-year-old-man with no known vascular risk factor was admitted into the emergency hospital with bilateral cervical bite wounds and oropharynx injury after tiger attack. Neck spiral CT did not show arterial injury on admission time. After 72 hours, neurological examination revealed global aphasia and paralysis on right side. Brain CT scanning confirmed huge ischemic area extended throughout the left medial cerebral artery territory, with left hemispherical edema, compression, and displacement of the median structures. Doppler-Duplex examination of brachiocephalic vessels demonstrated presence of 50 mm floating thrombus in lumen of CCA, which extends from bifurcation to emergency of the internal CA. CTA demonstrated absent of blood flow of the left internal carotid artery. Anticoagulant therapy was prescribing. Due to severe brain damage patient remained with sever motor and cognitive deficit. Conclusions: Unfortunately, neck injury requires a multidisciplinary approach considering the causal connection between trauma and CA thrombosis and its cerebral consequences

Caz clinic de tromboza arterei carotide cauzată de leziune traumatică cervicală

Introduction: Rarely, neck trauma may lead to ischemic stroke due to secondary carotid artery (CA) thrombosis. Aim of the study: We aimed to present the case of ischemic stroke after bilateral cervical injury caused by tiger bite. Material and Methods: History, clinical and paraclinical data were collected from the medical hospital databases. The patient was investigated by Doppler-Duplex examination of brachiocephalic vessels, brain computed tomography (CT), CT angiography of the cerebral arteries (CTA). The literature concerning similar cases has been revised. Results: A 58-year-old-man with no known vascular risk factor was admitted into the emergency hospital with bilateral cervical bite wounds and oropharynx injury after tiger attack. Neck spiral CT did not show arterial injury on admission time. After 72 hours, neurological examination revealed global aphasia and paralysis on right side. Brain CT scanning confirmed huge ischemic area extended throughout the left medial cerebral artery territory, with left hemispherical edema, compression, and displacement of the median structures. Doppler-Duplex examination of brachiocephalic vessels demonstrated presence of 50 mm floating thrombus in lumen of CCA, which extends from bifurcation to emergency of the internal CA. CTA demonstrated absent of blood flow of the left internal carotid artery. Anticoagulant therapy was prescribing. Due to severe brain damage patient remained with sever motor and cognitive deficit. Conclusions: Unfortunately, neck injury requires a multidisciplinary approach considering the causal connection between trauma and CA thrombosis and its cerebral consequences.Introducere: Traumatismele regiunii cervicale rar pot duce la accident vascular cerebral ischemic secundar trombozei arterei carotide (AC). Scopul lucrării: Prezentarea cazului clinic de accident vascular cerebral ischemic după leziuni cervicale bilaterale cauzate de mușcătura de tigru. Materiale și Metode: Datele anamnestice, clinice și paraclinice au fost colectate din bazele de date medicale. Pacientul a fost investigat prin examinarea Doppler-Duplex a vaselor brahiocefalice, tomografie computerizată (CT) cerebrală, angiografia CT a arterelor cerebrale (CTA). A fost revizuită literatura de specialitate despre cazuri similare. Rezultate: Un bărbat de 58 de ani, fără factori de risc vasculari cunoscuți, a fost internat în spitalul de urgență cu plăgi cervicale bilaterale cu leziune orofaringelui după atacul unui tigru. La momentul internării CT regiunii cervicale nu a evidențiat leziuni arteriale. După 72 de ore, examenul neurologic relevă afazie globală și plegie pe partea dreaptă a corpului. CT cerebrală a confirmat o zonă ischemică pe tot teritoriul arterei cerebrale medie stângi, cu edem emisferial, compresie și dislocarea a structurilor mediene. Examinarea Doppler-Duplex a vaselor brahiocefalice a demonstrat un trombus flotant de 50 mm în lumenul ACC, care se extinde de la bifurcare până la emergența AC interne. CTA a demonstrat absența fluxului sanguin prin artera carotidă internă stângă. A fost indicată terapie anticoagulantă. Datorită leziunilor cerebrale severe, pacientul a rămas cu deficit motor și cognitiv sever. Concluzii: Traumatismele cervicale necesită abordarea multidisciplinară având in vedere existența legăturii cauzale cu tromboza AC și consecințele cerebrale

Tromboliza intravenoasă cu rt-PA în accidental vascular cerebral ischemic: profilul de eficienţă şi siguranţă la 40 de pacienţi

Această lucrare a fost efectuată cu scopul de evaluare a eficienţei şi siguranţei trombolizei intravenoase sistemice la pacienţii cu accident vascular cerebral ischemic acut. De asemenea ne-am propus determinarea şi evaluarea timpului necesar transportării pacientului cu AVC ischemic acut spre departamentul de medicină urgentă din momentul consultului pre-spitalicesc al medicului AMU

Профиль безопасности и эффективности внутривенного тромболизиса у 40 пациентов с острым ишемическим инсультом

Universitatea de Stat de Medicină şi Farmacie ,,Nicolae Testemiţanu”, IMSP Institutul de Medicină UrgentăRezumat Această lucrare a fost efectuată cu scopul de evaluare a eficienţei şi siguranţei trombolizei intravenoase sistemice la pacienţii cu accident vascular cerebral ischemic acut. De asemenea ne-am propus determinarea şi evaluarea timpului necesar transportării pacientului cu AVC ischemic acut spre departamentul de medicină urgentă din momentul consultului pre-spitalicesc al medicului AMU.Данная работа была выполнена с целью оценки эффективности и безопасности процедуры системного внутривенного тромболизиса у больных с острым ишемическим инсультом. Другая цель состояла в анализе ведения пациентов с острым ишемическим инсультом и времени на транспортировку в отделение скорой помощи.Our aim was to assess the efficacy and safety of intravenous thrombolysis with rt-PA in treatment of patients with acute ischemic stroke and compare the results to those provided by the international community. Another goal was to evaluate the management of patients with acute ischemic stroke and the transport time from pre-hospital examination to the emergency ward