Recurrent Transient Ischemic Attacks Revealing Cerebral Amyloid Angiopathy: A Comprehensive Case

This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.

Cardioembolic Stroke as a Sequela of General Ventricular Hypokinesia Secondary to Acute Myocarditis in a 16-Year-Old Male

Paediatric cardiac disease is an established cause of ischemic stroke in the neonatal and infantile groups. These diseases may be congenital or acquired. However, clinical myocarditis is in itself, relatively uncommon in older children. The most common pathogen is Coxsackie virus B. The offending agent instigates an immune response, which causes myocardial oedema with eventual systolic and diastolic dysfunction. Cardioembolic stroke can occur secondary to an intra-mural thrombus in a dysfunctional atrium or ventricle. We describe the case of an adolescent male with acute myocarditis complicated by a thromboembolic stroke. After initial management of acute pulmonary oedema and heart failure with restricted ejection fraction (HFrEF), the child developed seizure-like symptoms on the 10th day of hospitalization, prompting urgent neuro-radio diagnosis, which revealed acute infarcts in the cerebellum and frontal lobe of the cerebrum. We believe this case to be of clinical relevance because;1) The diagnosis of an acute stroke in children is often delayed due to the atypical clinical presentation and often the absence of traditional stroke-like symptoms, and 2) There is a lack of sufficient high-quality evidence regarding the predictors and the immediate management of stroke in paediatric heart disease, as well as inadequate data on prevalence and incidence in paediatric cardioembolic strokes.

Evaluation of causal heart diseases in cardioembolic stroke by cardiac computed tomography

Cardioembolic stroke is a potentially devastating condition and tends to have a poor prognosis compared with other ischemic stroke subtypes.Therefore,it is important for proper therapeutic management to identify a cardiac source of embolism in stroke patients.Cardiac computed tomography(CCT)can detect the detailed visualization of various cardiac pathologies in the cardiac chambers,interatrial and interventricular septum,valves,and myocardium with few motion artifacts and few dead angles.Multiphase reconstruction images of the entire cardiac cycle make it possible to demonstrate cardiac structures in a dynamic manner.Consequently,CCT has the ability to provide high-quality information about causal heart disease in cardioembolic stroke.In addition,CCT can simultaneously evaluate obstructive coronary artery disease,which may be helpful in surgical planning in patients who need urgent surgery,such as cardiac tumors or infective endocarditis.This review will introduce the potential clinical applications of CCT in an ischemic stroke population,with a focus on diagnosing cardioembolic sources using CCT.

Eosinophilia:Rare cause of arterial thrombosis and cardioembolic stroke in childhood

Eosinophilia has been reported as a very rare cause of stroke in children.The thrombotic event may be either due to cardiac damage induced by eosinophils and their granular protein,that is,the major basic protein,or the systemic hypercoagulable state induced by eosinophilia.We report here a case of eosinophilia whose initial presentation was recurrent strokes and cardiac and arterial thrombosis.

Predictive clinical features of cardioembolic infarction in patients aged 85 years and older

Objective To assess predictive clinical factors of cardioembolic infarction in very old patients(85 years of age and older).Methods Prospective hospital-based stroke registry("The Sagrat Cor Hospital of Barcelona Stroke Registry")is an acute-care teaching hospital in Barcelona,Catalonia,Spain.From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period,639 were younger than 85 years of age and 317 were 85 years or older(mean age:88.9 years).Demographics,clinical characteristics,risk factors and early outcome were compared.Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses.Results In a logistic regression model based on demographics,risk factors,clinical features and complications,female gender(odds ratio[OR]=1.74,95%confidence interval[CI]:1.27–2.39),heart failure(OR=2.27,95%CI:1.46–3.56),altered consciousness(OR=1.76,95%CI:1.28–2.42),and infectious complications(OR=2.01,95%CI:1.39–2.91)were predictors of cardioembolic stroke in the oldest age group.By contrast,heavy smoking,heart valve disease,hypertension,headache,early seizures,sensory deficit,and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group.Conclusions Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.

Bayés syndrome and acute cardioembolic ischemic stroke

Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block.Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration>120 ms with biphasic morphology±in the inferior leads.The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias,particularly atypical atrial flutter and atrial fibrillation.Likewise,Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia.Advanced interatrial block can be a risk for embolic stroke due to its known sequelae of left atrial dilation,left atrial electromechanical dysfunction or atrial tachyarrhythmia(paroxysmal or persistent atrial fibrillation),conditions predisposing to thromboembolism.Bayés syndrome may be responsible for some of the unexplained ischemic strokes and shall be considered and investigated as a possible cause for cryptogenetic stroke.In summary,Bayés syndrome is a poorly recognized cardiac rhythm disorder with important cardiologic and neurologic implications.

Bioinformatic analysis for potential biological processes and key targets of heart failure-related stroke

This study aimed to uncover underlying mechanisms and promising intervention targets of heart failure(HF)-related stroke.HF-related dataset GSE42955 and stroke-related dataset GSE58294 were obtained from the Gene Expression Omnibus(GEO)database.Weighted gene co-expression network analysis(WGCNA)was conducted to identify key modules and hub genes.Gene Ontology(GO)and pathway enrichment analyses were performed on genes in the key modules.Genes in HF-and stroke-related key modules were intersected to obtain common genes for HF-related stroke,which were further intersected with hub genes of stroke-related key modules to obtain key genes in HF-related stroke.Key genes were functionally annotated through GO in the Reactome and Cytoscape databases.Finally,key genes were validated in these two datasets and other datasets.HF-and stroke-related datasets each identified two key modules.Functional enrichment analysis indicated that protein ubiquitination,Wnt signaling,and exosomes were involved in both HF-and stroke-related key modules.Additionally,ten hub genes were identified in stroke-related key modules and 155 genes were identified as common genes in HF-related stroke.OTU deubiquitinase with linear linkage specificity(OTULIN)and nuclear factor interleukin 3-regulated(NFIL3)were determined to be the key genes in HF-related stroke.Through functional annotation,OTULIN was involved in protein ubiquitination and Wnt signaling,and NFIL3 was involved in DNA binding and transcription.Importantly,OTULIN and NFIL3 were also validated to be differentially expressed in all HF and stroke groups.Protein ubiquitination,Wnt signaling,and exosomes were involved in HF-related stroke.OTULIN and NFIL3 may play a key role in HF-related stroke through regulating these processes,and thus serve as promising intervention targets.

Cardioembolic occlusion of the internal carotid artery presented with infarction in the posterior cerebral artery territory

Posterior circulation stroke may rarely be associated with occlusive disease in the anterior circulation, such as in the context of a direct （fetal） origin of the posterior cerebral artery （PCA） from the internal carotid artery （ICA）, or in the presence of a persistent trigeminal artery （PTA） or persistent hypoglossal artery （PHA）. Usually, they happened as infarction involving both ipsilateral carotid and posterior cerebral artery territories with carotid atherosclerosis etiology.3 Here, we reported a rare case with cadioembolic occlusion of the ICA presented with infarction mainly in the PCA territory.