Objective:We report two patients with cerebral infarction who underwent endovascular treatment for internal carotid artery dissection related to an elongated styloid process. On arrival, the NIHSS score was 8. MRI showed acute-stage infarction and narrowing of the high-level internal carotid artery adjacent to the left styloid process. Conservative treatment was administered. As there was a dissecting aneurysmal change at the stenotic site, carotid-stent-assisted coil embolization was performed. In the two patients, endovascular treatment led to a favorable prognosis.
Conclusion:For the treatment of arteriogenic cerebral infarction related to atypical stenosis of the high-level cervical internal carotid artery, it is important to review therapeutic strategies, considering the possibility of an elongated styloid process.
Objective: We report a rare case of left middle cerebral artery embolism due to Takayasu's arteritis in the common carotid artery. Case presentation: A 24-year-old female presented with motor aphasia and right hemiparesis. MRI showed early ischemic changes in the left insular cortex. Cervical MRA showed occlusion of left common carotid artery and left middle cerebral artery (MCA). Because the patient was ineligible for intravenous recombinant tissue plasminogen activator, we chose endovascular therapy for recanalization. Aorta angiogram demonstrated typical findings of Takayasu's arteritis and occlusion extending from the distal M1 to M2 segment of the MCA. Therefore, we performed thrombolysis passing catheter through the Pcom and thrombectomy using a Penumbra ® system. The occluded MCA was successfully recanalized and good clinical outcome was obtained. Conclusion: We considered that the left MCA occlusion was caused by artery-to-artery embolism derived from Takayasu's arteritis. This is the first report of thrombectomy using a Penumbra ® system of the thrombus due to Takayasu's arteritis.
We report a patient with basilar artery embolism caused by vertebral artery stenosis who was successfully treated using simultaneous percutaneous transluminal angioplasty (PTA) and mechanical thrombectomy. Case Presentation: A 64-year-old male, who had undergone medical treatment for cerebellum infarction at another hospital, was referred to our hospital due to disturbance of consciousness. Angiography revealed acute occlusion of the first part of the right vertebral artery and an embolism of the top of basilar artery. After performing PTA to create an approach route for the embolism, we collected it using a clot recovering device. The postoperative course was good, and the patient was discharged with mild ataxia and dysarthria. Conclusion: We report the successful treatment of progressive cerebral infarction of the posterior circulation with revascularization 30 hours after symptom onset. Unlike the anterior circulation, the posterior circulation consists of smaller arteries and fewer collateral arteries, making it vulnerable to ischemic attack. Therefore, shortening the time until treatment may improve the outcome. Keywords▶ cerebral infarction, basilar artery occlusion, vertebral artery stenosis diseases, drugs had been orally administered. Cerebellar infarction with dizziness developed, and he was transported to a hospital by ambulance. Under a diagnosis of atherothrombotic cerebellar infarction, medical treatment was performed (Fig. 1a and 1b). Consciousness disturbance was noted in the afternoon the day after admission, and he was referred to our hospital to examine whether catheter treatment was appropriate. Due to the progression of symptoms, the infarcted cerebellar focus had enlarged in comparison with magnetic resonance imaging (MRI) findings obtained from the previous hospital. Magnetic resonance angiography (MRA) demonstrated interruption of the vertebral basilar artery (Fig. 1c and 1d). The National Institute of Health Stroke Scale (NIHSS) score was 9. The disease type was evaluated as atherothrombotic cerebral infarction. Regarding the pathogenesis, a diagnosis of arteriogenic embolism related to atherostenosis at the origin of the right vertebral artery was made. Prior to mechanical thrombectomy, angiography was started 30 hours after initial symptom onset. As a result, occlusion at the origin of the right vertebral artery (left vertebral artery: PICA ending on MRA) was observed. The right vertebral artery was slowly enhanced via a collateral pathway from the muscular branch of the deep cervical artery (Fig. 2a and 2b); an embolus floating at the terminal of the basilar This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.
Valproic acid (VPA) and levetiracetam (LEV) are used in epilepsy treatment. However, their use to treat short-bowel syndrome has not been reported. We herein report a 68-year-old man who was hospitalized for symptomatic epilepsy following cerebral infarction. He had a history of superior mesenteric arterial occlusion, and only 30 cm of his jejunum was intact. VPA and LEV were administered, and good blood levels were achieved at clinical doses. This suggests that the gastrointestinal tract absorption of LEV and VPA is good even in patients with short-bowel syndrome and a 30-cm jejunum.
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