The authors report clinical correlations of single photon emission computerized tomography (SPECT) findings in reversible posterior leukoencephalopathy (RPL). These are observations that have not received wide attenti...The authors report clinical correlations of single photon emission computerized tomography (SPECT) findings in reversible posterior leukoencephalopathy (RPL). These are observations that have not received wide attention in literature. A 31-year-old hypertensive gentleman, on discontinuing antihypertensive medications, presented with vomiting, headache, focal motor to bilateral tonic-clonic seizures, altered sensorium, right gaze palsy and right hemiparesis. Accelerated hypertension was noted and he improved well with antihypertensive and anticonvulsant therapy. While cranial magnetic resonance imaging (MRI) revealed extensive bilateral lesions, SPECT imaging revealed perfusion defects involving bilateral basal ganglia, left parieto-occipital, right cerebellar and right occipital regions, which corresponded with clinical deficits on examination. While MRI is the standard of care for the evaluation of RPL, this case suggests that SPECT abnormalities may be better localized to the pathogenic lesions. Furthermore, this may begin to explain the pathophysiology of injury in RPL.展开更多
The authors report the first case of thrombolysis in a patient already receiving both aspirin and prasugrel following a recent ischemic coronary event. A 55-year-old gentleman was treated for inferior wall myocardial ...The authors report the first case of thrombolysis in a patient already receiving both aspirin and prasugrel following a recent ischemic coronary event. A 55-year-old gentleman was treated for inferior wall myocardial infarction with aspirin, prasugrel and percutaneous angioplasty of right coronary artery. Three days following the procedure he developed acute ischemic stroke due to a left middle cerebral artery infarction with a National Institute of Health Stroke Scale (NIHSS) of 24 and was treated with alteplase. Therapy was interrupted after completion of 29 mg (for a body weight of 65 kg) dose due to oral bleeding. Fifteen minutes post thrombolysis NIHSS was 5 and dropped to zero after 12 h. This report highlights the benefits of alteplase in the context of several relative contraindications like the setting of acute myocardial infarction treated with percutaneous intervention and high NIHSS.展开更多
文摘The authors report clinical correlations of single photon emission computerized tomography (SPECT) findings in reversible posterior leukoencephalopathy (RPL). These are observations that have not received wide attention in literature. A 31-year-old hypertensive gentleman, on discontinuing antihypertensive medications, presented with vomiting, headache, focal motor to bilateral tonic-clonic seizures, altered sensorium, right gaze palsy and right hemiparesis. Accelerated hypertension was noted and he improved well with antihypertensive and anticonvulsant therapy. While cranial magnetic resonance imaging (MRI) revealed extensive bilateral lesions, SPECT imaging revealed perfusion defects involving bilateral basal ganglia, left parieto-occipital, right cerebellar and right occipital regions, which corresponded with clinical deficits on examination. While MRI is the standard of care for the evaluation of RPL, this case suggests that SPECT abnormalities may be better localized to the pathogenic lesions. Furthermore, this may begin to explain the pathophysiology of injury in RPL.
文摘The authors report the first case of thrombolysis in a patient already receiving both aspirin and prasugrel following a recent ischemic coronary event. A 55-year-old gentleman was treated for inferior wall myocardial infarction with aspirin, prasugrel and percutaneous angioplasty of right coronary artery. Three days following the procedure he developed acute ischemic stroke due to a left middle cerebral artery infarction with a National Institute of Health Stroke Scale (NIHSS) of 24 and was treated with alteplase. Therapy was interrupted after completion of 29 mg (for a body weight of 65 kg) dose due to oral bleeding. Fifteen minutes post thrombolysis NIHSS was 5 and dropped to zero after 12 h. This report highlights the benefits of alteplase in the context of several relative contraindications like the setting of acute myocardial infarction treated with percutaneous intervention and high NIHSS.
