Cervical anterior spinal artery syndrome associated with cardiopulmonary arrest

Nontraumatic spinal cord ischemia is uncommon, especially when the cervical cord is involved. We present an elderly man who sustained acute occlusion of the anterior spinal artery at a high cervical level. This was followed by a respiratory arrest due to the paralysis of the diaphragm and chest wall muscles. A review of the vascular supply to the cord and of nontraumatic ischemic myelopathy is provided.     

Aortic dissection presenting with acute pulmonary edema

Background

Acute aortic dissection is a cardiovascular emergency with high mortality that necessitates prompt diagnosis and immediate treatment. Though asymmetric extremity pulses/blood pressures and mediastinal widening on chest roentgenogram are often clues to diagnosis, aortic regurgitation (AR) of variable degrees could be the only sign on initial assessment. Mostly resulting from dilated aortic ring with valvular insufficiency, the AR could be caused by different pathogenic mechanisms. Herein we report a case of Stanford type A aortic dissection presenting with acute pulmonary edema. Physical examination detected severe AR murmur and bedside echocardiogram confirmed prolapsed dissecting intima flap with interference of aortic valve closure as a specific mechanism.

Nephrotic syndrome presenting as deep vein thrombosis or pulmonary embolism

A patient presenting with a swollen left leg and pleuritic chest pain was shown to have deep vein thrombosis (DVT) by Doppler studies. He was anticoagulated but required two further admissions with swelling of both legs before a diagnosis of nephrotic syndrome was considered and confirmed. Renal biopsy showed that this was caused by membranous nephropathy. Two audits were subsequently conducted. The first was of diagnostic discharge codes for nephrotic syndrome and venous thromboembolism in south west Scotland (population 147,000) from 1997 to 2006. A diagnosis of nephrotic syndrome was confirmed in 32 patients, four (12.5%) of whom (including the index case) had presented with DVT (two) or pulmonary embolus (PE) (two). A second audit of 98 consecutive patients with Doppler-positive lower limb DVT presenting to A&E in Dumfries from July 2005 to July 2006 showed that the urine had been tested for protein in one case only. Although nephrotic syndrome remains an uncommon cause of DVT or PE, it is complicated by venous thromboembolism sufficiently frequently for the diagnosis to be considered in all patients with DVT or PE, for whom the take-home message should simply be-Don't forget to dip the urine or ignore a low serum albumin.     

Catastrophic antiphospholipid syndrome presenting as dilated cardiomyopathy with bilateral branch retinal artery thrombosis

Cardiac manifestation of antiphospholipid syndrome (APS) is mainly in the form of left-sided valvular insufficiency, intra-cardiac thrombi or coronary artery occlusion. Dilated cardiomyopathy is a rare but important cardiac manifestation of APS, and responds well to adequate anticoagulation and steroids. We describe a case in which APS presented with dilated cardiomyopathy and bilateral retinal artery thrombosis.     

A pulmonary embolism case presenting with upper abdominal and flank pain.

BACKGROUND: The clinical manifestations of pulmonary thromboembolism are non-specific, which makes this condition difficult to diagnose. A case of helical computerized tomography angiographically documented pulmonary thromboembolism, which initially presented as upper abdominal and flank pain, is described. CASE REPORT: A 46-year-old woman was referred to the emergency department for left flank and upper abdominal pain with diaphoresis and nausea. Her history included rheumatoid arthritis 3 years previously. During her examination the only abnormal finding was abdominal tenderness at the right upper quadrant and a positive Murphy sign without other systemic signs. A chest radiograph demonstrated an atelectatic line at the left lung base. The alveolar-arterial gradient was increased, and a ventilation-perfusion scan revealed a mismatch at the left upper and lower lobes, indicative of pulmonary thromboembolism. Helical computerized tomography angiography revealed filling defects on that side. The patient received anticoagulant therapy and gradually improved. CONCLUSION: The pathogenesis of the pain in the flank and upper abdomen is not known in this case. Unexplained upper abdomen and flank pain in a patient with risk factors for pulmonary thromboembolism, such as rheumatoid arthritis, should be investigated to rule out this treatable but potentially fatal condition.     

Myxoma on anterior mitral leaflet presenting with symptoms of cerebellar artery infarction.

This report describes a patient who had dizziness and loss of balance. During routine investigation, a mass located on the anterior mitral valve leaflet was detected on transthoracic echocardiography. The patient underwent surgery for a mass located on the mitral valve, and histopathologic examination determined the mass was a myxoma.     

Acute concomitant pulmonary artery and aortic dissection with rupture

Pulmonary artery (PA) dissection is uncommon and may lead to rupture and sudden death if encountered. A 63-year-old man presented to our emergency room with episodic left chest pain radiating to the back followed by shortness of breath. A 64-row multidetector computed tomography (MDCT) revealed ruptured dissection of the PA and the aorta with hemopericardium, hemomediastinum, and prominent extravasated blood along the central bronchovascular bundles of both lungs. The patient experienced cardiogenic shock immediately following CT study and died after resuscitation. Concomitant PA and aortic dissection with rupture is extremely rare with the pathogenesis remaining investigated. MDCT proves to be a powerful tool in its diagnosis for a timely surgical repair if the patient could survive to have the operation.     

Intraoperative somatosensory evoked responses recorded during onset of the anterior spinal artery syndrome

Somatosensory evoked responses may be used during operations on the thoracic aorta to monitor spinal cord function. A patient is described in whom the evoked responses were well maintained for the first 20 minutes of aortic occlusion and briskly returned to baseline configuration after reestablishment of aortic flow. Nonetheless, the patient was left with paralysis of the lower extremities consistent with the diagnosis of anterior spinal artery syndrome.     

Diagnosis of abdominal mural aortic thrombus following discovery of common femoral artery and vein thrombosis by point-of-care ultrasound

Acute limb ischemia (ALI) is a limb-threatening and life-threatening disease process. Mural aortic thrombosis (MAT) is a rare cause of ALI. While there is limited evidence on the use of bedside ultrasound for the detection of ALI or MAT, duplex ultrasound remains the standard in the diagnosis and ultimate medical decision-making in patients with acute and chronic limb ischemia. Point-of-care ultrasound may be used in the evaluation of patients with signs and symptoms of this disease entity. This is a case of a 79-year-old female with a complicated medical history, who presented with a pulseless right leg and abdominal tenderness. The patient quickly decompensated requiring intubation for airway protection. A post-intubation arterial blood gas (ABG) was unsuccessfully attempted in the right femoral artery, prompting an ultrasound-guided ABG. On B-mode ultrasound evaluation, echogenic material was visualized in the right common femoral artery without evidence of Doppler flow signal. Additionally, a partially obstructing echogenic material was also noted at the femoro-saphenous vein junction with only partial compressibility by compression sonography. A computed tomography angiography of the aorta was performed indicating extensive infrarenal aortic thrombosis. The patient expired despite the relatively prompt diagnosis, highlighting the importance of early identification of acute arterial occlusion.     

脊前动脉综合征MRI表现(4例分析)

脊前动脉综合征发病率低，临床少见。１９０９年Spiller首先报告并命名为脊前动脉综合征，以往仅依据临床表现诊断此病，而无客观影像学的支持，病变程度、范围及性质均较难判断。MRI对脊髓病变的诊断具有独特的优越性。我们１９９９年～２０００年MRI发现４例脊前动脉综合征，报告如下。１材料与方法本组４例，男１例，女３例。年龄最大６０岁，最小１４岁，平均４０．７５岁。４例均以突发胸背痛及四肢无力等症状就诊，其中２例出现二便潴留。查体：４例均有不同程度四肢肌力减退，腱反射异常，其中２例巴氏征阳性，３例病变水平以下深…     

A case of Noonan syndrome with pulmonary and abdominal lymphangiectasia

Noonan syndrome is characterised by a Turner-like phenotype and a normal karyotype. Although it is reported to be associated with abnormalities of the lymphatic system, involvement of the pulmonary lymphatics is rare. We present a case of Noonan syndrome where a whole body scintigraphy revealed lymphangiectasia of the lower extremities, abdomen and lungs.     

Pathogenesis and treatment of abdominal pain spinal syndrome

Development of the abdominal pain spinal syndrome is due to alterations in motor segments of the low-thoracic spine which bring about compression and dyscirculatory shifts in the nervous roots and their vegetative branches. Manual therapy was successful in recovery of physiological coordination between elements of the spinal motor segment thus correcting abnormalities in the nervous roots related to compression and affected circulation in 30 out of 36 patients treated.     

Subacute aortic prosthetic mechanical valve thrombosis complicated with acute coronary syndrome

A prosthetic valve thrombosis (PVT), which is a potentially fatal complication, refers to the presence of non-infective thrombotic material on a prosthetic valve apparatus, interfering with its function. Possible complications of a PVT include transient neurologic embolic events, cardiac arrest due to a stuck valve prosthesis, and cardio-embolic myocardial infarction (MI). The choice of treatments, including a redo surgery, a percutaneous coronary intervention (PCI), and a fibrinolysis with PVT or MI dosages, depends on the patient's clinical and hemodynamic status and thrombotic burden involving the prosthetic valve and surrounding tissues. An early postoperative mechanical valve thrombosis is associated with increased risks due to the need for unforeseen early redo surgery complications and excessive bleeding risk in case of thrombolytic therapy usage. Here, we present a fifty-seven-year old female patient who was admitted to the emergency department with the complaint of acute chest pain seven days after an aortic prosthetic mechanical valve implantation. The clinical presentation was consistent with ST segment elevated MI and echocardiography revealed a large mass on the recently implanted prosthetic aortic valve. Valvular thrombotic complications after heart valve replacement operations are associated with high morbidity and mortality rates. Efficient and urgent treatment is necessary. Considering the clinical status of the patient, we preferred fibrinolytic therapy rather than PCI or surgery. The aim of this case report was to show the efficiency and safety of low-dose slow-infusion fibrinolytic therapy in PVT complicated with acute coronary syndrome.