There are now over a million cases of corona virus disease 2019 (Covid-19) worldwide with thousands of reported deaths.1 Based on anecdotal evidence,2 it has been hypothesized that Covid-19 patients are at risk of thromboembolism causing acute coronary syndromes and ischemic stroke. Acute treatment outside the designated quarantine units poses a threat of spreading the illness to health care workers. We report a SARS-CoV-2 positive patient who developed acute ischemic stroke during the hospital course treated with mechanical thrombectomy. We emphasize the importance of adhering to institutional protocols to protect health care workers during the interventional management of acute stroke.
Endovascular therapy is the primary treatment modality for dural arteriovenous fistulas. Pre-treatment angiographic evaluation of dural fistulas must rule out the presence of a mixed pial component or supply from pial-dural collaterals, as the pial supply must be closed before definitive occlusion of the draining vein to prevent iatrogenic rupture. In this report, we described a case of a mixed pial-dural arterial venous malformation (AVM), which was effectively treated with a sequential transarterial and trans-cortical venous embolization.
Reversible cerebral vasoconstriction syndrome (RCVS) manifests with a thunderclap headache and reversible vascular abnormalities. Red blood cell transfusions have not been well identified as a risk factor for RCVS. We report a rare case of acute brain injury resulting from RCVS after a packed red blood cell (PRBC) transfusion. A 49-year-old female with a history of menorrhagia initially presented with generalized weakness. She was found to have a hemoglobin (Hgb) of 1.7 g/dL in the setting of a fundal fibroid for which she received five units of PRBCs. Post transfusion, she complained of several days of thunderclap headache and later returned with new-onset seizures. She was admitted to the neurocritical care unit for the treatment of status epilepticus. Metabolic, infectious and toxic work-up were unremarkable except for an elevated lactate. MRI of the brain with contrast showed extensive bilateral hemispheric and cerebellar white matter T2-weighted fluid-attenuated inversion recovery (T2/FLAIR) hyperintensities with areas of enhancement. A diagnostic cerebral angiogram was performed to evaluate for a vascular etiology and revealed focal segmental stenoses in bilateral A1 segments of the anterior cerebral arteries and in branches of the bilateral middle cerebral arteries. These findings were suggestive of RCVS. Clinicians should have a high degree of suspicion for RCVS in patients presenting with neurological manifestations, such as thunderclap headache or seizures after recent transfusion. The window for injury may be longer than that seen in other organs, such as in transfusion-related acute lung injury (TRALI).
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