A 44-year-old Chinese man developed severe occipital headache, nausea, and vomiting during acupuncture treatment of the posterior neck for chronic neck pain. Computed tomography of the head showed hemorrhage in the fourth, third, and lateral ventricles. A lumbar puncture confirmed the presence of blood. Magnetic resonance angiography with gadolinium did not reveal any saccular aneurysms or arteriovenous malformations. The patient's headache resolved over a period of 28 days without any neurological deficits. Acupuncture of the posterior neck can cause acute intracranial hemorrhage.
SummaryBackground: Spontaneous echo contrast (SEC) is a phenomenon that is commonly seen in areas of blood stasis. It is a slowly moving, cloud-like swirling pattern of "smoke" or increased echogenicity recorded on echocardiography. SEC is commonly seen in the left atrium of patients with mitral stenosis or atrial fibrillation. The prescence of SEC has been shown to be a marker of increased thromboembolic risk.Hypothesis: By using transesophageal echocardiography during percutaneous balloon mitral valvotomy (PBMV), the study investigated the relationship between SEC and varying left atrial appendage (LAA) blood flow velocity in the human heart.Methods: Thrty-five patients with rheumatic mitral stenosis underwent percutaneous balloon mitral valvotomy withintraoperative transesophageal echocardiography monitoring. We alternatively measured LAA velocities and observed the left atrium for various grades of SEC (0 = none to 4 = severe) before and after each balloon inflation.Results: Left atrial appendage maximal ejection velocity was reduced from 35 & 14 to 6 2 2 m m / s at peak balloon inflation and increased to 40 k 16 m m / s after balloon deflation. In comparison with the values before balloon inflation and after balloon deflation, LAA velocities were significantly lower
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