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Fulltext Cough-Induced Extracranial Internal Carotid Artery Dissection

Tai MS, Sia SF, Kadir KAA, Idris MI, Tan KS

Case Rep Neurol, 2020 12 14;12(Suppl 1):149-155.

Background: Coughing due to respiratory tract infections may lead to internal carotid artery (ICA) dissection.

Aim: We are presenting a patient with an unusual cough-induced ICA dissection.

Case Report: A 42-year-old health care worker presented with bilateral hand numbness which resolved spontaneously. This initial episode was followed 9 days later with intermittent episodes of right hand and leg weakness with speech difficulty. Two days later, he had another episode of speech difficulty. One week prior to the first presentation, he had upper respiratory tract infection with ongoing strong bouts of coughing. Magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) of the brain showed early ischaemic changes at the left frontal and left parietal regions. MR angiography (MRA) showed high signal intensity at the left proximal ICA and poor flow beyond the left carotid bulb. Cerebral angiography revealed left ICA dissection.

Conclusion: Proper identification of cough-induced extracranial ICA dissection is important because this is treatable.

Fulltext Streptococcus pneumoniae Meningitis and Intracranial Vasculopathy: Clinical Correlation with Improving Transcranial Doppler Hemodynamics

Idris MI, Tai SML, Tan CT, Tan KS

Case Rep Neurol, 2020 12 14;12(Suppl 1):106-109.

PMID: 33505281 DOI: 10.1159/000500950

Streptococcus pneumoniae are Gram-positive bacteria that are responsible for many types of illnesses including pneumonia, sinus infections, and community-acquired meningitis. One important complication of bacterial meningitis is intracranial vasculopathy. Possible etiologies include vasculitis, vasospasm, endocarditis, or intra-arterial thrombosis. We present a case report of S. pneumoniae meningitis treated with antibiotics in which clinical improvement correlated with serial transcranial Doppler ultrasonography (TCD) improvement, suggesting vasospasm or vasculitis as a possible mechanism for intracranial vasculopathy.

Fulltext Acute Ischaemic Stroke Successfully Treated with Thrombolytic Therapy and Endovascular Thrombectomy with Non-Contrast Computed Tomography and Computed Tomography Angiogram Protocol

Toh TH, Abdul Kadir KA, Tai MS, Tan KS

Case Rep Neurol, 2020 12 14;12(Suppl 1):15-21.

PMID: 33505267 DOI: 10.1159/000501820

Early endovascular thrombectomy leads to improved outcomes for patients with proximal occlusions when started within 6 h from onset of symptoms. We present a case illustrating the flow of events for a patient who underwent endovascular thrombectomy in our centre after conventional imaging - a brain non-contrast computed tomography (NCCT) and CT angiogram (CTA) - achieving a door-to-groin time of 195 min. The patient is a 65-year-old who presented with signs and symptoms of a left middle cerebral artery (MCA) territory infarct. His National Institute of Health Stroke Scale (NIHSS) score was 15 on presentation and his brain NCCT showed an Alberta Stroke Programme Early CT Score (ASPECTS) of 8. His CTA showed a left MCA distal M1 occlusion with focal calcification and stenosis of the proximal left internal carotid artery. He was subsequently thrombosed and underwent thrombectomy successfully, with a door-to-groin-puncture time of 195 min. A TICI 2b reperfusion was achieved. His NIHSS score improved to 9 over the next 2 days. For cases with straightforward NCCT and CTA with no contraindications, endovascular thrombectomy should be pursued without delay. A review of the current available literature for the usage of NCCT and CTA as well as the importance of ASPECTS scoring in patient selection for endovascular thrombectomy was included.

Fulltext Mechanical Thrombectomy for Life-Threatening Cerebral Venous Thrombosis: A Case Report

Lau KF, Toh TH, Kadir KAA, Tai MS, Tan KS

Case Rep Neurol, 2020 12 14;12(Suppl 1):63-69.

PMID: 33505274 DOI: 10.1159/000507343

Cerebral venous thrombosis (CVT) is a rare cause of stroke worldwide with a wide range of clinical presentations. Anticoagulation therapy has been regarded as the first line of management of CVT to prevent the progression of thrombosis and to re-establish the venous flow. We present a case of severe CVT who did not respond to conventional anticoagulation therapy but responded well to mechanical thrombectomy (MT). This report highlights the features of CVT to consider for early MT.

Fulltext Stroke in Asia: Teaching Cases in Stroke Medicine

Tan KS, Venketasubramanian N

Case Rep Neurol, 2020 12 14;12(Suppl 1):1-3.

PMID: 33505264 DOI: 10.1159/000510037

Fulltext Unusual Presentation of Cerebral Lupus: A Case Report of Parkinsonism in Cerebral Lupus

Chang CK, Mohd Noh M, Liew Sat Lin C, Payus AO

Case Rep Neurol, 2021 09 13;13(3):591-594.

PMID: 34703447 DOI: 10.1159/000518912

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystem involvement that follows a relapsing and remitting course. It is characterized by an immune-mediated response to own body defense mechanism and mistakenly attacked healthy cells of the skin, joints, kidneys, blood cells, and nervous system. Cerebral lupus refers to a constellation of neurological and/or behavioral clinical syndromes in patients with SLE. The spectrum of presentation can vary widely ranging from mild symptoms such as headaches, slight cognitive dysfunction, and mood disorders to more serious conditions like seizures, stroke, or coma. This case report is about a case of cerebral lupus manifested with symptoms of Parkinsonism. The purpose of this case report is to share an uncommon occurrence of cerebral lupus which manifested as Parkinsonism and to highlight the importance of early diagnosis of the condition which is potentially reversibility with prompt treatment [4].

Fulltext Stroke in Asia: Neurosonology in Neurocritical Care

Arjundas D, Pandian JD, Tan KS, Venketasubramanian N

Case Rep Neurol, 2020;12(Suppl 1):104-105.

PMID: 33505280 DOI: 10.1159/000509858

Fulltext Uncommon Causes of Cardioembolic Stroke and Related Complications

Yongchai N, Venketasubramanian N, Tan KS

Case Rep Neurol, 2020;12(Suppl 1):176-177.

PMID: 33505291 DOI: 10.1159/000509506

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