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Malignant middle-cerebral artery territory infarction in tuberculous vasculitis

Neuroimmunology and Neuroinflammation 2014年第1期1卷 95-97页

作者： Salvadeeswaran Meenakshi-Sundaram Sundararajan Srinivasan somalinga nagendran karthik Suresh Pandi Alagappan Periyakaruppan Bharathi Sundar Department of Neurosciences Apollo Speciality HospitalsMadurai 625020Tamil NaduIndia Department of Radiology Apollo Speciality HospitalsMadurai 625020Tamil NaduIndia

Intracranial large vessel involvement is an unusual complication of tuberculous *** authors report a 39-year-old female presenting with an episode of seizure,followed by rapid decline in sensorium without prominent systemic *** initial cranial magnetic resonance imaging revealed tuberculomata and patchy *** antituberculous therapy,she progressively worsened.A cranial computed tomography scan done following the worsening revealed a massive middle-cerebral artery(MCA)***,the patient died in spite of decompressive *** MCA territory infarct is a rare and potentially fatal complication of tuberculous meningitis.

关键词： Arteritis malignant middle-cerebral artery territory infarct tuberculous meningitis

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Reversible posterior leukoencephalopathy syndrome: single photon emission computerized tomography observations

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Neuroimmunology and Neuroinflammation 2017年第2期4卷 28-32页

作者： Salvadeeswaran Meenakshi-Sundaram Sathyam Senthilnathan Kaliappan Gurusamy Srinivasan somalinga nagendran karthik Pandi Suresh Somasundaram Palanirajan Department of Neurosciences Apollo Speciality HospitalsMadurai625020Tamil NaduIndia Department of Nuclear Medicine Meenakshi Mission Hospital and Research CentreMadurai625020Tamil NaduIndia KGS Advanced MR and CT Scan Centre Madurai625020Tamil NaduIndia Department of Nephrology Apollo Speciality HospitalsMadurai625020Tamil NaduIndia.

The authors report clinical correlations of single photon emission computerized tomography (SPECT) findings in reversible posterior leukoencephalopathy (RPL). These are observations that have not received wide attention in literature. A 31-year-old hypertensive gentleman, on discontinuing antihypertensive medications, presented with vomiting, headache, focal motor to bilateral tonic-clonic seizures, altered sensorium, right gaze palsy and right hemiparesis. Accelerated hypertension was noted and he improved well with antihypertensive and anticonvulsant therapy. While cranial magnetic resonance imaging (MRI) revealed extensive bilateral lesions, SPECT imaging revealed perfusion defects involving bilateral basal ganglia, left parieto-occipital, right cerebellar and right occipital regions, which corresponded with clinical deficits on examination. While MRI is the standard of care for the evaluation of RPL, this case suggests that SPECT abnormalities may be better localized to the pathogenic lesions. Furthermore, this may begin to explain the pathophysiology of injury in RPL.

关键词： Reversible posterior leukoencephalopathy single photon emission computerized tomography imaging accelerated hypertension crossed cerebellar diaschisis

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Dramatic recovery from stroke following intravenous thrombolysis in a patient on prasugrel for recent percutaneous coronary angioplasty

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Neuroimmunology and Neuroinflammation 2017年第10期4卷 216-218页

作者： Salvadeeswaran Meenakshi-Sundaram Palanikumar Subburamakrishnan Jude Vinoth Simon Victor Rajah Sanjeevi Madhan-Rajah somalinga nagendran karthik Pandi Suresh Department of Neurosciences Apollo Speciality HospitalsLake View RoadKK NagarMaduraiTamil Nadu625020India Department of Cardiology Apollo Speciality HospitalsLake View RoadKK NagarMaduraiTamil Nadu625020India Department of Emergency Services Apollo Speciality HospitalsLake View RoadKK NagarMaduraiTamil Nadu625020India.

The authors report the first case of thrombolysis in a patient already receiving both aspirin and prasugrel following a recent ischemic coronary event. A 55-year-old gentleman was treated for inferior wall myocardial infarction with aspirin, prasugrel and percutaneous angioplasty of right coronary artery. Three days following the procedure he developed acute ischemic stroke due to a left middle cerebral artery infarction with a National Institute of Health Stroke Scale (NIHSS) of 24 and was treated with alteplase. Therapy was interrupted after completion of 29 mg (for a body weight of 65 kg) dose due to oral bleeding. Fifteen minutes post thrombolysis NIHSS was 5 and dropped to zero after 12 h. This report highlights the benefits of alteplase in the context of several relative contraindications like the setting of acute myocardial infarction treated with percutaneous intervention and high NIHSS.

关键词： Intravenous thrombolysis ischemic stroke percutaneous coronary angioplasty prasugrel

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