Spontaneous coronary artery dissection presenting as an ischaemic stroke in a middle-aged man with anti-cardiolipin antibodies: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cerebrovascular disease is a major cause of mortality and morbidity worldwide. Ischemic stroke is the most common manifestation, encompassing a wide variety of causative mechanisms. We present the case of a middle-aged male patient with spontaneous coronary artery dissection in the presence of anti-cardiolipin antibodies, leading to left ventricular thrombus and presenting with stroke.</p> <p>Case presentation</p> <p>A 56-year-old Caucasian man presented with dysarthria and right-sided weakness. There was a history of chest pain with autonomic symptoms four days earlier. Examination revealed right-sided hemiparesis. Electrocardiogram showed sinus rhythm with anterior Q waves. Magnetic resonance imaging of the brain showed large left parietal and smaller multiple cerebral infarcts. Echocardiogram showed anterior wall and apical akinesis with a large mural thrombus. Anti-cardiolipin antibodies immunoglobulin G and immunoglobulin M were strongly positive. Coronary angiography showed dissection of the mid left anterior descending artery with normal flow down the distal vessel. He was treated conservatively with anticoagulation and secondary prevention. He was in good health when seen in clinic four months later.</p> <p>Conclusion</p> <p>We highlight the importance of a comprehensive approach at obtaining the correct diagnosis, input of different specialities and the fact that the presence of anti-cardiolipin antibodies is associated with coronary artery dissection in a middle-aged male patient whose presentation was stroke.</p

Tree nutrient status and nutrient cycling in tropical forest - lessons from fertilization experiments

Highly productive tropical forests often occur on nutrient-poor soils . The apparent lack of a relationship between tree growth and site fertility has generated decades of research into which nutrients, if any, limit tropical forest productivity. This chapter looks at the lessons we have learned from several decades of fertilization experiments, which investigate nutrient limitation by measuring changes in growth and productivity in response to the addition of specific nutrients. The enormous diversity of tropical forest ecosystems often confounds attempts to measure a clear ecosystem response to fertilization because tree species’ nutrient requirements differ according to life history strategy , adaptation to site fertility, and the life stage of the individuals under study. Importantly, other limiting resources, such as light and water, constrain individual responses to nutrient availability, whereas species interactions such as competition, herbivory , and symbioses can mask growth responses to nutrient amendments. Finally, fertilization changes the timing and balance of nutrient inputs to the forest, whereas litter manipulation studies demonstrate that the combined addition of many different nutrients and organic carbon minimizes nutrient losses. Most fertilization studies have investigated responses to nitrogen and phosphorus additions but there is still no general consensus on nutrient limitation in tropical forests. Future experiments will need to evaluate how the balance of multiple macro- and micronutrients affects tropical forest growth and ecosystem dynamics