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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by venous malformations usually affecting the skin and the gastrointestinal tract. These skin haemangiomas are present at birth and deteriorate as the body grows, causing primarily cosmetic problems. The haemangiomas of the gastrointestinal tract may appear later in life and may bleed, causing chronic anaemia, or may present with severe complications such as rupture, intestinal torsion, and intussusception. Other organs may also be involved. This article describes a 13-year-old boy with multiple haemangiomas of the skin, the mucous membranes, and the gastrointestinal tract, which caused anaemia and ileoileic intussusception. In this patient, the nervous system was significantly affected with a haemangioma of the left occipital lobe, with complications of stroke. He also had multiple paravertebral heamangiomas, which caused pressure signs and symptoms. This boy suffered from complex partial and generalized seizures and cerebral palsy. Multiple skeletal anomalies were also present from birth. In the relevant literature, this is the first case of BRBNS with simultaneous neurological and skeletal involvement. Such cases should be recognized early, as they can lead to serious multiple health problems and handicaps.
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PMID:Blue rubber bleb nevus syndrome with simultaneous neurological and skeletal involvement. 1793 57

We evaluate our preliminary experience using the Cyberknife Radiosurgery System in treating benign spinal tumors. A retrospective review of 16 consecutively treated patients, comprising 19 benign spinal tumors, was performed. Histologic types included neurofibroma [11], chordoma [4], hemangioma [2], and meningioma [2]. Three patients had Neurofibromatosis Type 1 (NF1). Only one tumor, recurrent chordoma, had been previously irradiated, and as such not considered in the local failure analysis. Local failure, for the remaining 18 tumors, was based clinically on symptom progression and/or tumor enlargement based on imaging. Indications for spine stereotactic body radiotherapy (SBRT) consisted of either adjuvant to subtotal resection (5/19), primary treatment alone (12/19), boost following external beam radiotherapy (1/19), and salvage following previous radiation (1/19). Median tumor follow-up is 25 months (2-37), and one patient (with NF1) died at 12 months from a stroke. The median total dose, number of fractions, and prescription isodose was 21 Gy (10-30 Gy), 3 fx (1-5 fx), 80% (42-87%). The median tumor volume was 7.6 cc (0.2-274.1 cc). The median V100 (volume V receiving 100% of the prescribed dose) and maximum tumor dose was 95% (77-100%) and 26.7 Gy (15.4-59.7 Gy), respectively. Three tumors progressed at 2, 4, and 36 months post-SR (n=18). Two tumors were neurofibromas (both in NF1 patients), and the third was an intramedullary hemangioblastoma. Based on imaging, two tumors had MRI documented progression, three had regressed, and 13 were unchanged (n=18). With short follow-up, local control following Cyberknife spine SBRT for benign spinal tumors appear acceptable.
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PMID:Image-guided robotic stereotactic body radiotherapy for benign spinal tumors: theUniversity of California San Francisco preliminary experience. 1799 89

Hemangiomas are rare benign tumors of the heart. Clinical presentation is highly variable according to the location, size, and extension of the tumor. Hemangiomas have been described in all cardiac chambers, but most occur on the right side of the heart and in the left atrium. Although diagnosis is typically made by echocardiography, the definite diagnosis can be made with certainty only from a very careful histopathologic examination. The authors report a case of atypically located hemangiomas originating from the left atrial appendage and right atrium in a 71-year-old woman who presented with ischemic stroke. Transthoracic and transesophageal echocardiography demonstrated an elongated left atrial mass originating in the atrial appendage and extending well into the left atrium to the mitral orifice, as well as a right atrial mass and intense biatrial spontaneous echo contrast. It was unclear whether the masses represented thrombus or an unusually located atrial tumor. Immunohistologic examinations revealed a biatrial cavernous hemangioma with no signs of malignancy.
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PMID:Multisided cardiac hemangiomas mimicking biatrial thrombus: atypically located cardiac hemangiomas of left atrial appendage and right atrium. 1920 72

We report a 54-year-old man with right abducent nerve palsy, right facial nerve palsy, and left segmental sensory disturbance, which progressed for 2 weeks. He was found to have cavernous angioma in the lower pons. When he visited our hospital, he had right facial palsy, sensory disturbance of left half of the face and left upper limb, and diplopia. He had suffered right abducent nerve palsy 5 years previously and had recently developed hypertension. Neurological examination further revealed right abducent nerve palsy, right peripheral facial nerve palsy, sensory impairment of the left half of the face, and sensory impairment on the left side from C2 to Th3. Magnetic resonance imaging of the head revealed hemorrhage with a rim at the right dorsal part of the lower pons. No abnormalities were identified on cerebral angiography. He was diagnosed as having hemorrhage originating from a cavernous angioma. We assumed that the segmental sensory disturbance was caused by medial involvement of the lateral spinothalamic tract, which is somatotopically arranged: the fibers from the sacral segments being most lateral. The ventral trigeminothalamic tract, right abducent nerve, and right facial nerve were also disturbed. Segmental sensory disturbance usually accompanies a spinal cord lesion. But several cases with similar symptoms following a brainstem lesion have been reported. Most of them had stroke, showing acute onset of illness. Our case showed subacute onset of illness; cranial nerve palsy and segmental sensory disturbance progressed for 2 weeks.
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PMID:[A case of cavernous angioma in the lower pons, showing subacute onset of unilateral cranial nerve palsy and segmental sensory disturbance]. 1922 94

Headache is relatively common in patients with cerebrovascular disorders. The reported frequency of stroke-related headache ranges from 7% to 65% and different types of headache, such as onset headache, sentinel headache, or delayed headache, may be observed in association with stroke. Headache can be attributed to ischemic stroke, transient ischemic attack, or non-traumatic intracranial hemorrhage, including intracerebral and subarachnoid hemorrhage. Headache at stroke onset is more common in subarachnoid hemorrhage, most prominently associated with severe headache, and in intracerebral hemorrhage than in ischemic stroke or transient ischemic attack. The typical presentation of subarachnoid hemorrhage includes the sudden onset of severe headache with nausea, vomiting, neck pain, photophobia, and loss of consciousness. Headache is the only symptom in about a third of patients with subarachnoid hemorrhage. The suddenness of onset and not its severity is the characteristic feature of the headache in subarachnoid hemorrhage. Referring to unruptured vascular malformations, the headache can be attributed to saccular aneurysm, arteriovenous malformation, dural arteriovenous fistula, dural cavernous angioma, and encephalotrigeminal or leptomeningeal angiomatosis (Sturge-Weber syndrome). It is very important to recognize that in the latter forms the onset of headache may indicate an upcoming bleeding complication.
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PMID:Headache attributed to stroke, TIA, intracerebral haemorrhage, or vascular malformation. 2081 53

PHACE syndrome is a neuro-cutaneous syndrome characterized by malformations of the Posterior fossa, facial Hemangiomas, Arterial anomalies, Cardiac anomalies, and abnormalities of the Eye. The arterial abnormalities usually involve the cervical and cerebral vasculature and include congenital abnormalities and progressive cerebral vasculopathy. The progressive cerebral vasculopathy leads to increased risk for arterial ischemic stroke (AIS) in patients with PHACE syndrome. Here we described the clinical neurological sequelae, the malformation of brain, the cervical and cerebral vasculopathy in a 23-year-old female of PHACE syndrome. Besides, she presented AIS with limb-shaking transient ischemic attack, a rare clinical presentation of AIS in patients of PHACE syndrome.
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PMID:Limb-shaking transient ischemic attacks in an adult PHACE syndrome: a case report and review of the literature. 2171 Jan 24

Kasabach-Merritt syndrome (KMS) is a rare and severe coagulation disorder caused by vascular malformations within or outside the liver. It is characterized by profound thrombocytopenia, microangiopathic hemolytic anemia, and consumption coagulopathy. We successfully managed the anesthesia for a giant hemangioma resection complicated with KMS using FloTrac/Vigileo system. A 78-year-old woman (51 kg, 141 cm) was admitted for giant hemangioma with disseminated intravascular coagulation (DIC). General anesthesia was induced with sevoflurane and remifentanil. Epidural anesthesia was not induced because of coagulopathy. We evaluated arterial pressure-based cardiac output (APCO), stroke volume variation (SVV) as a predictor for fluid responsiveness, systolic blood pressure (SBP), and central venous pressure (CVP) during the operation. Prior to tumor resection, 6,000 ml of fluid was suctioned from the tumor. The increase of SVV and sudden decrease of APCO and SBP were recognized during surgical procedure. The SVV demonstrated marked changes in response to hemorrhage, and it was more sensitive than CVP change during operation. We conclude that SVV is an accurate predictor of intravascular hypovolemia, and it is a useful indicator for assessing the appropriateness and timing of applying fluid for improving circulatory stability during a giant hemoangioma resection.
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PMID:[Successful anesthetic management for resection of a giant hepatic hemangioma with Kasabach-Merritt syndrome using FloTrac system]. 2217 75

The objective of this retrospective study of patients evaluated between July 2008 and October 2011 in seven pediatric dermatology centers was to combine collective clinical experience using oral propranolol therapy in 32 infants with PHACE syndrome (Posterior fossa [brain malformations present at birth], Hemangioma [usually covering a large area of the skin of the head or neck >5 cm]; Arterial lesions [abnormalities of the blood vessels in the neck or head]; Cardiac abnormalities or aortic coarctation [abnormalities of the heart or blood vessels that are attached to the heart]; Eye abnormalities) with cervical or intracranial arterial anomalies. Patients were given an average daily dose of oral propranolol of 1.8 mg/kg divided two or three times per day for an average duration of 12.3 months. The main outcome measure was adverse neurologic events. Seven (22%) patients were categorized as being at higher risk for stroke, defined on magnetic resonance imaging as severe, long-segment narrowing or nonvisualization of major cerebral or cervical vessels without anatomic evidence of collateral circulation, often in the presence of concomitant cardiovascular comorbidities. Only one patient developed a change in neurologic status during propranolol treatment: mild right hemiparesis that remained static and improved while propranolol was continued. An additional three patients had worsening hemangioma ulceration or tissue necrosis during therapy. This is the largest report thus far of patients with PHACE syndrome treated with propranolol. Although no catastrophic neurologic events occurred, serious complications, particularly severe ulcerations, were seen in a minority of patients, and given the sample size, we cannot exclude the possibility that propranolol could augment the risk of stroke in this population. We propose radiologic criteria that may prove useful in defining PHACE patients as being at high or standard risk for stroke. We continue to advise caution in using systemic beta-blockers, particularly for children with vascular anomalies at higher risk for stroke. Use of the lowest possible dosage, slow dosage titration, three times per day dosing to minimize abrupt changes in blood pressure, and close follow-up, including neurologic consultation as needed, are recommended.
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PMID:Propranolol use in PHACE syndrome with cervical and intracranial arterial anomalies: collective experience in 32 infants. 2299 62

We report the case of a 37-year-old male with Cowden disease that caused a gradual neurological deficit because of rupture of a brain stem cavernous hemangioma. Removal of the hemangioma and hematoma was performed with an infrafacial triangle approach. Nine months after the operation, magnetic resonance imaging showed abnormal vessels on the cerebellar surface. Digital subtraction angiography showed a dural arteriovenous fistula (dAVF) from part of the meningeal artery to the ectatic inferior vermian vein with cortical reflux. After embolization, surgical obliteration of the dAVF was performed. Surgical findings showed neovascularization in the thickened dura, in which dural vessels shunted to cerebellar vessels through adhesion between the dura mater and cerebellar surface. Therefore, the thickened dura was removed with the cerebellar surface. This case suggests that postoperative angiogenesis may cause arteriovenous fistula in patients with Cowden disease.
J Stroke Cerebrovasc Dis 2014 Mar
PMID:Postoperative dural arteriovenous fistula in a patient with Cowden disease: a case report. 2368 Jun 87

The paper presents the case of a 52-year-old Caucasian female with several comorbidities (diabetes mellitus II, transitory ischemic stroke, sarcoma of uterus -operated, chemotherapy), which was addressed to the pneumology department for the diagnosis of sarcoidosis, established through mediastinoscopy followed by histopathological examination of lymph node biopsies. Further investigations performed in our department sustained the diagnosis of stage I sarcoidosis and expectative without systemic corticotherapy was the clinicians' decision. The follow-up during several months showed spontaneous remission of the mediastinal adenopathies except one, in the medium lobe, which was supposed to have other ethiology than sarcoidosis. Surgical excision of this tumor and several lymph-node biopsies was performed through right thoracotomy; the histopathological exam sustained the diagnosis of "ganglionar metastasis from endometrial sarcoma' but immunohistochemical tests showed that it was a "sclerosing hemangioma of the lung" - tumor with benign evolution. The coexistence of adenopathies of different and rare etiologies make this case interesting, the different evolution of these adenopathies suggested the different morphological pattern of them.
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PMID:[Coexistence of mediastinal adenopathies of different etiologies -- case report]. 2389 94


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