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Ur12 4 4


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Ur12 4 4

  1. 1. PTA 24/3/53 <ul><li>Successful PTA Rt SFA with 20% residual stenosis, balloon dilatation Lt popliteal artery was also done but ultimately recoil (residual stenosis 80%). </li></ul><ul><li>หลังทำ PTA อาการปวดขาขวา ขาขวาเย็นของผู้ป่วยลดลง ชีพจรชัดขึ้นแต่ยังเบากว่าข้างซ้าย </li></ul><ul><li>ABI 25/3/53 Rt ABI 0.66 Lt ABI 0.53 </li></ul>
  2. 2. PrePTA
  3. 3. PostPTA
  4. 4. Progress admit day 3 (27/3/53) <ul><li>ขณะคุยโทรศัพท์มือถือ แขนซ้ายอ่อนแรง โทรศัพท์หลุดมือ ปวดศีรษะด้านขวาตื้อๆ ไม่ชา ไม่มีหน้าเบี้ยว ไม่มีอ่อนแรง </li></ul><ul><li>Pupil 4 mm BRTL, EOM full, no facial palsy </li></ul><ul><li>Motor: Lt arm gr IV, other gr V </li></ul><ul><li>Reflex: Lt arm 3+, other 2+ </li></ul><ul><li>Imp: Acute monoparesis Lt arm </li></ul>
  5. 5. CT brain with contrast 27/3/53 <ul><li>Hyperdense lesion along cortical gyral interface of Rt high frontal lobe with perilesional edema </li></ul>
  6. 6. CT brain
  7. 7. CT brain
  8. 8. MRI, MRA, MRV brain & Neck 30/3/53 <ul><li>Two abnormal signal intensity lesions at RT high frontal lobe and Rt cerebellar hemisphere, probably gyral hemorrhage </li></ul><ul><li>Total occlusion of Lt subclavian and Lt vertebral arteries </li></ul><ul><li>Severe stenosis of Rt ICA above carotid bifurcation </li></ul><ul><li>Fusiform dilatation of ACoA and proximal Lt A2 segment </li></ul><ul><li>Unremarkable MRV study </li></ul><ul><li>Anormaly of aortic arch </li></ul>
  9. 9. <ul><li>MRA head and neck: อ . สุกัลยาคิดว่าลักษณะ perilesional edema เหมือน vasogenic edema ใน venous infarction มากกว่า arterial infarction </li></ul><ul><li>ให้การรักษาด้วย Fondaparinaux 2.5 mg sc OD </li></ul>
  10. 10. MRI brain
  11. 11. MRI brain
  12. 12. MRI brain
  13. 13. Lab 30/3/53 <ul><li>ANA < 80 </li></ul><ul><li>Anti B2 glyoprotein 1 Negative </li></ul><ul><li>Lupus Anticoagulant </li></ul><ul><ul><li>aPTT Negative </li></ul></ul><ul><ul><li>aRVVT Positive </li></ul></ul><ul><li>Anticardiolipin IgG, IgM: Negative </li></ul>
  14. 14. The stroke syndrome of cortical vein thrombosis <ul><li>Cortical vein thrombosis without sinus involvement is rarely diagnosed, although it may commonly be overlooked . </li></ul><ul><li>We report four cases of cerebral venous thrombosis limited to the cortical veins . The diagnosis was made on surgical intervention in 1 patient and by angiography in 3 patients . </li></ul><ul><li>Focal or generalized seizures followed by hemiparesis, aphasia, hemianopia, or other focal neurologic dysfunction in the absence of signs of increased ICP should suggest this possibility . </li></ul>K. Jacobs,Moulin et al. The stroke syndrome of cortical vein thrombosis. NEUROLOGY 1996;47:376-382
  15. 15. The stroke syndrome of cortical vein thrombosis <ul><li>Neuroimaging ( CT, MRI ) shows an ischemic lesion that does not follow the boundary of arterial territories and often has a hemorrhagic component, without signs of venous sinus thrombosis . </li></ul><ul><li>Conventional angiography demonstrates no arterial occlusion but may show cortical vein thrombosis corresponding to the infarct, although these may also be nonspecific findings . </li></ul><ul><li>The role of MR angiography, which is well - established in sinus thrombosis, remains to be assessed in patients with brain ischemia due to isolated cortical vein occlusion . </li></ul>K. Jacobs,Moulin et al. The stroke syndrome of cortical vein thrombosis. NEUROLOGY 1996;47:376-382