Acute Ischemic cerebrovascular Accident


Female 57 years old.
PERSONAL HISTORY: Acute left sided numbness. NIHSS 5CT No intracranial hemorrhage  was noted. There were no early ischemic 
There was evidence of chronic bihemispheric  periventricular deep small-vessel ischemic changes. She had a small subcentimeter round lucency in the left lentiform, probably chronic lacunar infarction versus enlarged perivascular space. There appear to be evidence of a right craniotomy and a chronic encephalomalacic cavity occupying predominantly the right temporal lobe, compensatory enlargement of the ipsilateral ventricular system, enlarged right temporal horn.Diagnosis: left hemimotor and hemisensory, objective and subjective findings, probable right cerebral hemispheric ischemic stroke, but differential diagnosis exists; Recurrent transient right hemisphere focal neurological symptoms; possible transient ischemic attacks versus consideration of simple partial motor or sensory seizures, emanating from prior right craniotomy for right intracranial hemorrhage. Status post right craniotomy for right cerebral hemisphere hemorrhage; possible warfarin-associated hemorrhage.

TESTS and DIAGNOSIS: In January 2010: ECO Thyroid: Compatible with recurrence of thyroid neoplasia based on the right side, with two nodular lesions, as described, one with vein invasion yugular.Se therapeutic doses of I- 131, tracking being performed after negative antithyroid antibody negative.

  • FNA was performed of cervical lesions, being a non-specific from the point of view of the cytological and latero-cervical lymph node with invasion of spindle  cells showing  irregular jugular, suspicious of malignancy.
  • CT: Left kidney tumor, the greater than 3 cm, and pancreas.  Bilateral pulmonary nodules . Mediastinal lymphadenopathy. Consider and rule out metastatic disease. Two thyroid lesions in surgical bed, one with venous intraluminal growth, rule out recurrence or metastasis.
  • PET-CT: lesion in the right thyroidectomy bed  with endoluminal growth in the jugular vein (SUV max. 2.81).Mediastinal paratracheal, prevasculares, hilar and subcarinal of about a centimeter diameter. From the metabolic point of view we highlight those located at the lower left paratracheal (SUV max. 2.96), prevascular region (SUV max 4.97), right hilar region (SUV max 7, 74), subcarinal region (SUV max 7, 65) and left hilar region (SUV max 5, 85). A millimeter bilateral pulmonary nodules, the largest in lingula of about 6 mm. without showing significant increase of glucose metabolism. Hepatic lesions suggestive of cysts in segments 4 and 5. In one kidney left several solid-appearing lesions with diameters from 1 to 3 cm., That although have increased FDG uptake (SUV max. 4.38). Pancreatic lesions with no significant increase glucose metabolism, body and tail, with diameters of 2 to 2.5 cm.


References and articles


Prediction of Poor Mobilization of Autologous CD34+ Cells with Growth Factor in Multiple Myeloma Patients: Implications for Risk-Stratification.

Costa LJ, Nista EJ, Buadi FK, Lacy MQ, Dispenzieri A, Kramer CP, Edwards KH, Kang Y, Gertz MA, Stuart RK, Kumar S.

Biol Blood Marrow Transplant. 2013 Nov 5. doi:pii: S1083-8791(13)00508-9. 10.1016/j.bbmt.2013.11.003. [Epub ahead of print]

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Risk of Seizures in Children Receiving Busulphan Containing Regimens for Stem Cell Transplantation.

Caselli D, Rosati A, Faraci M, Podda M, Ripaldi M, Longoni D, Cesaro S, Lo Nigro L, Paolicchi O, Maximova N, Menconi MC, Ziino O, Cicalese MP, Santarone S, Nesi F, Aricò M, Locatelli F, Prete A; of the Bone Marrow Transplantation Working Group of the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP).

Biol Blood Marrow Transplant. 2013 Nov 4. doi:pii: S1083-8791(13)00505-3. 10.1016/j.bbmt.2013.10.028. [Epub ahead of print]

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Allogeneic Stem Cell Transplantation for Myelofibrosis with Leukemic Transformation. A Study of the MPN-Subcommittee of the CMWP of the EBMT.

Alchalby H, Zabelina T, Stübig T, van Biezen A, Bornhäuser M, Di Bartolomeo P, Beelen D, Cahn JY, Dreger P, Schroyens W, de Witte T, Olavarria E, Kröger N; for the CMWP of the EBMT.

Biol Blood Marrow Transplant. 2013 Nov 4. doi:pii: S1083-8791(13)00504-1. 10.1016/j.bbmt.2013.10.027. [Epub ahead of print]

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Case Comments:

  • 08 Oct 2010 17:41

    I am thinking that there are too many other things in a differential still to proceed down the thrombolysis pathway.  From simple intoxication to acute CVA.  What did you do?

  • 08 Oct 2010 17:42

    How healthy is the 57 yr old lady?  Might help me decide what sort of plan of action to take with this lady

  • 08 Oct 2010 17:47

    Your patient meets eligibility criteria for the expanded time window. I would recommend preparing the IV tPA 0.9 mg/kg (max 90 mg) and administer 10% as bolus over 1 minute; with remainder as infusion over 60 minutes. Please proceed. Unless there are any additional questions, I will dictate consult note, have it transcribed, and e-fax to you immediately.