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Related Concept Videos

Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
Stroke: Introduction and Types01:29

Stroke: Introduction and Types

A stroke is an acute neurological event caused by the sudden disruption of cerebral blood flow, leading to rapid loss of neuronal function. Neurons depend on continuous oxygen and glucose supply, so even brief interruptions can cause irreversible injury within minutes. Strokes are classified into ischemic and hemorrhagic types.Ischemic StrokeIschemic strokes are most common and occur due to arterial occlusion, depriving brain tissue of oxygen and nutrients. This leads to energy failure, ionic...
Pulmonary Embolism I: Introduction01:29

Pulmonary Embolism I: Introduction

Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...

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Transient Middle Cerebral Artery Occlusion Model of Stroke
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Published on: August 11, 2023

Paradoxical embolism causing stroke and migraine.

S Nightingale1, G S Ray

  • 1Department of Cardiology, Wythenshawe Hospital, Wythenshawe, Manchester, UK. sam_nightingale@hotmail.com

Journal of Postgraduate Medicine
|August 27, 2010
PubMed
Summary
This summary is machine-generated.

This case report highlights a patient with cryptogenic stroke and migraine, revealing a patent foramen ovale and hereditary hemorrhagic telangiectasia. Interventions for both conditions led to significant symptom improvement, underscoring their interconnectedness.

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Area of Science:

  • Cardiology
  • Neurology
  • Genetics

Background:

  • A 32-year-old woman with a history of migraine with aura, deep vein thrombosis, and epistaxis presented with two cryptogenic strokes.
  • Routine investigations did not reveal an obvious cause for the recurrent strokes.

Observation:

  • Contrast echocardiogram revealed a patent foramen ovale (PFO).
  • Factor V Leiden mutation was identified.
  • Pulmonary angiography showed multiple arterio-venous malformations (AVMs), leading to a diagnosis of hereditary hemorrhagic telangiectasia.

Findings:

  • Percutaneous closure of the PFO was performed, but a significant right-to-left shunt (14%) persisted.
  • Embolization of the AVMs was successful.
  • The patient experienced no further cerebral events post-intervention.
  • Migraine episodes significantly improved after PFO closure and AVM embolization.

Implications:

  • This case illustrates the complex interplay between right-to-left shunts, PFO, hereditary hemorrhagic telangiectasia, cryptogenic stroke, and migraine.
  • It emphasizes the importance of comprehensive investigation in patients with cryptogenic stroke and associated comorbidities.
  • The findings suggest potential benefits of addressing both cardiac and vascular malformations in select patient populations.