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Cerebral Ischemia & Infarction

Knaus CMK - MedPix (2013)

View Article: MedPix Image - MedPix Case

Affiliation: Walter Reed National Military Medical Center

ABSTRACT

Diagnosis: Cerebral Ischemia & Infarction

History: 48 yo woman who was admitted to outside hospital for a seizure (reported by husband, while driving home after discharge for CHF. PMH complicated, including recently diagnosed with new onset CHF (Stage IV, EF <20%), L ventricular mural thrombus, R pulmonary embolism, L-sided pleural effusion s/p thoracentesis (transudative w/negative cytology), and multiple renal infarct w/o unifying diagnosis. Husband noticed that her right UE and LE began shaking in what he describes as repeated “flexion and extension” movements. When husband tried to ask what was wrong, pt was unresponsive and continued to seize for approx 5 minutes. Husband states that wife’s mouth began to contort and she drooled on herself. Denies any tongue biting or urinary incontinence. Paramedics arrived and pt was resistant to them, later stating that she thought it was a homeless man trying to drag her out of her car. She became oriented and responsive soon after, stating that she felt like she was in a dream during the episode where she could hear everything being said but could not speak or open her eyes. She was taken by ambulance to outside Hospital ICU and by the time she arrived was fully AOx3 and communicating without any e/o focal neurologic deficits.

Findings: DWI and ADC show multiple small matching areas of signal change suggesting restricted diffusion the right cerebral hemisphere.

Ddx: Watershed infarction Global ischemia superimposed on local vascular changes Embolic infarction MELAS (non-vascular infarction pattern)

Dxhow: Imaging and clinical

No MeSH data available.


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Cerebral Ischemia & Infarction

Knaus CMK - MedPix (2013)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1987&req=5

View Article: MedPix Image - MedPix Case

Affiliation: Walter Reed National Military Medical Center

ABSTRACT

Diagnosis: Cerebral Ischemia & Infarction

History: 48 yo woman who was admitted to outside hospital for a seizure (reported by husband, while driving home after discharge for CHF. PMH complicated, including recently diagnosed with new onset CHF (Stage IV, EF <20%), L ventricular mural thrombus, R pulmonary embolism, L-sided pleural effusion s/p thoracentesis (transudative w/negative cytology), and multiple renal infarct w/o unifying diagnosis. Husband noticed that her right UE and LE began shaking in what he describes as repeated “flexion and extension” movements. When husband tried to ask what was wrong, pt was unresponsive and continued to seize for approx 5 minutes. Husband states that wife’s mouth began to contort and she drooled on herself. Denies any tongue biting or urinary incontinence. Paramedics arrived and pt was resistant to them, later stating that she thought it was a homeless man trying to drag her out of her car. She became oriented and responsive soon after, stating that she felt like she was in a dream during the episode where she could hear everything being said but could not speak or open her eyes. She was taken by ambulance to outside Hospital ICU and by the time she arrived was fully AOx3 and communicating without any e/o focal neurologic deficits.

Findings: DWI and ADC show multiple small matching areas of signal change suggesting restricted diffusion the right cerebral hemisphere.

Ddx: Watershed infarction Global ischemia superimposed on local vascular changes Embolic infarction MELAS (non-vascular infarction pattern)

Dxhow: Imaging and clinical

No MeSH data available.