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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Acute cholecystitis in patients with stroke
Yasuhiro Kuroi1, Daisuke Imazato1, Kei Yamazaki1
1Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Insights
Acute cholecystitis can occur after a stroke, necessitating prompt diagnosis. Stroke patients may present with subtle or no symptoms of gallbladder inflammation, highlighting the need for vigilance.
Area of Science:
- Neurology
- Gastroenterology
- Critical Care Medicine
Background:
- Acute cholecystitis is an uncommon complication following stroke.
- Early diagnosis and intervention are crucial for managing this condition.
Purpose of the Study:
- To investigate the occurrence and characteristics of acute cholecystitis in patients hospitalized for stroke.
- To identify potential risk factors and clinical presentations of acute cholecystitis in the stroke population.
Main Methods:
- A retrospective review of six patients diagnosed with acute cholecystitis during initial stroke hospitalization over five years.
- Analysis of stroke etiology, cholecystitis type (calculous vs. acalculous), and presenting symptoms.
Main Results:
- Six patients with acute cholecystitis post-stroke were identified.
- Common stroke etiologies included cardiac embolism and cerebrovascular hemorrhage.
- Fever was the most frequent symptom; however, many patients were asymptomatic or had atypical presentations, including hemorrhagic cholecystitis in one acalculous case.
Conclusions:
- A strong association exists between acute cholecystitis and stroke.
- Risk factors for stroke patients include atherosclerotic disease, potential medication side effects (anti-thromboembolic drugs leading to hemorrhagic cholecystitis), and stroke-related complications like hemiparesis and fasting.
- Clinical vigilance, including abdominal examination for stroke patients with altered consciousness or aphasia, is essential for timely diagnosis.
Background:
Although acute cholecystitis after stroke is rare, an immediate diagnosis and treatment is required.
Material And Methods:
In the past five years, we observed six patients with acute cholecystitis during the initial hospitalization for stroke.
Results:
Three patients had cardiac embolism, two had subarachnoid hemorrhage, and one had intra-cerebral hemorrhage. Four had calculous cholecystitis and two had acalculous cholecystitis. One of the patients with acalculous cholecystitis had hemorrhagic cholecystitis. The most commonly presented symptom was fever (50%), whereas only one patient (17%) had abdominal pain. Three patients (50%) were completely asymptomatic.
Conclusions:
Acute cholecystitis and stroke are closely associated, and anti-thromboembolic drugs may cause hemorrhagic cholecystitis. Stroke patients tend to have atherosclerotic risk factors resulting in ischemic injury of the gallbladder. Furthermore, severe hemiparesis, a fasting state, dehydration, or bacteremia, which are occasionally exhibited by stroke patients, are known risk factors for acalculous cholecystitis. Stroke patients, especially patients with aphasia and consciousness disturbance, require immediate abdominal examination, if acute cholecystitis is suspected.
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