The Experts below are selected from a list of 2832 Experts worldwide ranked by ideXlab platform
Kazumi Kimura - One of the best experts on this subject based on the ideXlab platform.
-
paradoxical Brain Embolism with klippel trenaunay syndrome
Internal Medicine, 2011Co-Authors: Kenichiro Sakai, Kazumi Kimura, Kensaku Sibazaki, Kazuto Kobayashi, Noriko Matsumoto, Yasuyuki IguchiAbstract:Cerebrovascular diseases in patients with Klippel-Trenaunay Syndrome (KTS) are uncommon, and the mechanism of stroke has remained elusive. We describe a patient with KTS who experienced a transient ischemic attack (TIA). Contrast-transcranial Doppler with the Valsalva maneuver revealed a right-to-left shunt and contrast-transesophageal echocardiography confirmed patent foramen ovale. Ultrasonography revealed dilated superficial and deep veins in the lower extremities; the D-dimer level was high and indicated hypercoagulability. Therefore, the mechanism of TIA was diagnosed as paradoxical Embolism. To the best of our knowledge, this is the first case report of paradoxical Embolism in a patient with KTS.
-
paradoxical Brain Embolism may not be uncommon prospective study in acute ischemic stroke
Journal of Neurology, 2007Co-Authors: Yuji Ueno, Takao Urabe, Yasuyuki Iguchi, Takeshi Inoue, Kensaku Shibazaki, Kazumi KimuraAbstract:Proving that right-to-left shunt (RLS) represents the precise causative mechanism in ischemic stroke patients with RLS is difficult. The aim of this study was to examine the frequency and clarify the clinical characteristics of paradoxical Brain Embolism (PBE). We prospectively enrolled consecutive acute ischemic stroke patients, who underwent transcranial Doppler and/or transesophageal echocardiography. For patients with RLS, diagnostic criteria for PBE were established as follows: 1) Brain images suggesting embolic strokes; 2) presence of deep venous thrombus or pulmonary Embolism; and 3) absence of any embolic sources. Patients were divided into 4 groups: patients meeting all 3 criteria (Definite); fulfilling 2 criteria (Probable); fulfilling 1 or 0 criteria (Possible); and patients without RLS (Non-RLS). A total of 240 subjects were analyzed for this study. The Definite group comprised 5% of patients, and displayed significantly more females (p = 0.038), and infarcts involving both anterior and posterior circulations (p < 0.001). Patients having neither hypertension nor diabetes mellitus also predominantly belonged to the Definite group (p < 0.001). Clinical characteristics of PBE are a female preponderance, infarcts affecting both anterior and posterior circulations, and an absence of risk factors.
-
paradoxical Brain Embolism in an acute stroke
Journal of the Neurological Sciences, 2007Co-Authors: Takeshi Iwanaga, Takeshi Inoue, Yasuyuki Iguchi, Kensaku Shibazaki, Kazumi KimuraAbstract:Paradoxical Embolism to the cerebral circulation is often difficult to diagnose clinically. We report a case that illustrates the usefulness of transesophageal echocardiography in the detection of paradoxical Embolism. An 84-year-old woman presented with bilateral hemispheric strokes. Despite the presence of atrial fibrillation, clinical suspicion of paradoxical Embolism led to further investigation. An underlying lower limb deep venous thrombosis was found, lung scintigraphy showed pulmonary Embolism, and a right-to-left shunt was detected using contrast-transcranial Doppler ultrasound even without the Valsalva maneuver. Transesophageal echocardiography confirmed a mobile 4-cm serpiginous thrombus wedged into a patent foramen ovale, extending from the right into the left atria. Multiple imaging modalities were used, allowing rapid diagnosis of paradoxical Embolism, with an underlying DVT as the mechanism of stroke. Of all the investigations, visualization with TEE proved crucial in confirming the diagnosis.
-
ischaemic stroke with malignancy may often be caused by paradoxical Embolism
Journal of Neurology Neurosurgery and Psychiatry, 2006Co-Authors: Yasuyuki Iguchi, Kazumi Kimura, Yuji Ueno, Kazuto Kobayashi, Takeshi InoueAbstract:Background: Although ischaemic stroke with malignancy occasionally occurs, the mechanisms of stroke in such cases have not been investigated in detail. Objective: To examine the mechanisms of ischaemic stroke with malignancy, particularly in relation to right-to-left shunt (RLS). Methods: Consecutive patients with ischaemic stroke within 24 h of stroke onset were prospectively studied. Contrast saline transcranial Doppler examination was carried out for all patients, to investigate the presence of RLS. When patients with stroke had RLS, deep venous thrombosis (DVT) or pulmonary Embolism was assessed to diagnose paradoxical Brain Embolism. Results: Participants comprised 184 consecutive patients (115 men and 69 women) with a mean (standard deviation (SD)) age of 73 (11.8) years and mean (SD) National Institutes of Health Stroke Scale (NIHSS) score of 8 (7.4). RLS was detected in 32 of 184 (18%) patients. Malignancy was present in 11 (5%) patients. RLS was more frequent in patients with malignancy than in patients without malignancy (55% v 15%, respectively; p = 0.001). All six patients with RLS and malignancy displayed DVT or pulmonary Embolism with severe disability (modified Rankin Scale 4–5) before stroke onset. Conclusion: Paradoxical Brain Embolism should be considered to be an important mechanism in patients with stroke and malignancy.
-
transcranial doppler of a paradoxical Brain Embolism associated with a pulmonary arteriovenous fistula
American Journal of Neuroradiology, 1999Co-Authors: Kazumi Kimura, Kuniyasu Wada, Masahiro Yasaka, Satoshi Kuribayashi, Kazuo Minematsu, Masafumi Tagaya, Takenori YamaguchiAbstract:Summary: We herein report the case of a patient who had paradoxical Brain Embolism owing to a pulmonary arteriovenous fistula (PAVF) who was diagnosed as having a right-to-left shunt by transcranial Doppler (TCD) with saline contrast medium. TCD with saline contrast medium failed to detect any high-intensity transient signals immediately after catheter embolization of the PAVF. Thus, TCD with saline contrast medium was useful for identifying the presence of a right-to-left shunt and for confirming that the shunt had been obliterated after endovascular treatment.
Yuji Ueno - One of the best experts on this subject based on the ideXlab platform.
-
paradoxical Brain Embolism associated with kimura disease mimics watershed infarction
Journal of Stroke & Cerebrovascular Diseases, 2015Co-Authors: Yasutaka Tanaka, Yuji Ueno, Yoshiaki Shimada, Kazuo Yamashiro, Ryota Tanaka, Takao Urabe, Nobutaka HattoriAbstract:Kimura disease (KD) is an uncommon chronic inflammatory disease presenting as subcutaneous lymphadenopathy with eosinophilia. To date, only a single case of Brain Embolism caused by fibroblastic endocarditis associated with KD has been reported. Watershed infarction was seen in patients with episodes of severe hypotension or cardiac surgery. We here report a young case of KD who developed ischemic stroke and showed multiple small infarcts in the border zones between the territories of major cerebral arteries, mimicking watershed infarction. Transesophageal echocardiography revealed patent foramen ovale and atrial septal aneurysm. Concurrently, deep venous thrombus in the femoral vein was found on duplex ultrasonography. Our case supports the notion that paradoxical Brain Embolism associated with KD can cause multiple small Embolisms and mimic watershed infarction.
-
aging aortic arch calcification and multiple Brain infarcts are associated with aortogenic Brain Embolism
Cerebrovascular Diseases, 2013Co-Authors: Yoshiaki Shimada, Yasutaka Tanaka, Yuji Ueno, Kazuo Yamashiro, Ryota Tanaka, Nobutaka Hattori, Ayami Okuzumi, Nobukazu Miyamoto, Takao UrabeAbstract:Background: Mobile or ulcerated aortic plaques (MUAPs) on transesophageal echocardiography (TEE) can cause aortogenic Brain Embolism. Aortic arch calcification (AoAC) on chest X-ray represents systemic atherosclerosis. This study focused on AoAC on chest X-ray and its link with atheromatous aortic plaques (AAPs) on TEE in stroke patients. The aim of the present study was to assess the relationship between AoAC and AAPs in unexplained stroke patients. Methods: A total of 178 patients (mean age: 64 ± 15 years; 115 males) with ischemic stroke who underwent TEE were enrolled. The patients were classified based on TEE findings: (1) AAPs Results: 104 (58%) patients had AAPs Conclusions: Older age, advanced AoAC, and multiple infarctions in multiple VTs are associated with aortogenic Brain Embolism. The CAM score can be useful for the diagnosis of aortogenic Brain Embolism.
-
paradoxical Brain Embolism may not be uncommon prospective study in acute ischemic stroke
Journal of Neurology, 2007Co-Authors: Yuji Ueno, Takao Urabe, Yasuyuki Iguchi, Takeshi Inoue, Kensaku Shibazaki, Kazumi KimuraAbstract:Proving that right-to-left shunt (RLS) represents the precise causative mechanism in ischemic stroke patients with RLS is difficult. The aim of this study was to examine the frequency and clarify the clinical characteristics of paradoxical Brain Embolism (PBE). We prospectively enrolled consecutive acute ischemic stroke patients, who underwent transcranial Doppler and/or transesophageal echocardiography. For patients with RLS, diagnostic criteria for PBE were established as follows: 1) Brain images suggesting embolic strokes; 2) presence of deep venous thrombus or pulmonary Embolism; and 3) absence of any embolic sources. Patients were divided into 4 groups: patients meeting all 3 criteria (Definite); fulfilling 2 criteria (Probable); fulfilling 1 or 0 criteria (Possible); and patients without RLS (Non-RLS). A total of 240 subjects were analyzed for this study. The Definite group comprised 5% of patients, and displayed significantly more females (p = 0.038), and infarcts involving both anterior and posterior circulations (p < 0.001). Patients having neither hypertension nor diabetes mellitus also predominantly belonged to the Definite group (p < 0.001). Clinical characteristics of PBE are a female preponderance, infarcts affecting both anterior and posterior circulations, and an absence of risk factors.
-
ischaemic stroke with malignancy may often be caused by paradoxical Embolism
Journal of Neurology Neurosurgery and Psychiatry, 2006Co-Authors: Yasuyuki Iguchi, Kazumi Kimura, Yuji Ueno, Kazuto Kobayashi, Takeshi InoueAbstract:Background: Although ischaemic stroke with malignancy occasionally occurs, the mechanisms of stroke in such cases have not been investigated in detail. Objective: To examine the mechanisms of ischaemic stroke with malignancy, particularly in relation to right-to-left shunt (RLS). Methods: Consecutive patients with ischaemic stroke within 24 h of stroke onset were prospectively studied. Contrast saline transcranial Doppler examination was carried out for all patients, to investigate the presence of RLS. When patients with stroke had RLS, deep venous thrombosis (DVT) or pulmonary Embolism was assessed to diagnose paradoxical Brain Embolism. Results: Participants comprised 184 consecutive patients (115 men and 69 women) with a mean (standard deviation (SD)) age of 73 (11.8) years and mean (SD) National Institutes of Health Stroke Scale (NIHSS) score of 8 (7.4). RLS was detected in 32 of 184 (18%) patients. Malignancy was present in 11 (5%) patients. RLS was more frequent in patients with malignancy than in patients without malignancy (55% v 15%, respectively; p = 0.001). All six patients with RLS and malignancy displayed DVT or pulmonary Embolism with severe disability (modified Rankin Scale 4–5) before stroke onset. Conclusion: Paradoxical Brain Embolism should be considered to be an important mechanism in patients with stroke and malignancy.
Thomas Fink - One of the best experts on this subject based on the ideXlab platform.
-
cerebral protection during catheter ablation of ventricular tachycardia in patients with ischemic heart disease
Journal of the American Heart Association, 2018Co-Authors: Christianhendrik Heeger, Andreas Metzner, Michael Schluter, Andreas Rillig, Shibu Mathew, Roland Richard Tilz, Peter Wohlmuth, Maria Romero, Renu Virmani, Thomas FinkAbstract:Background Catheter ablation of ventricular tachycardia (VT) is associated with the risk of cerebral Embolism. The origin of periprocedural Brain Embolism in the setting of VT ablation is often unk...
Ralph G Corey - One of the best experts on this subject based on the ideXlab platform.
-
the use and effect of surgical therapy for prosthetic valve infective endocarditis a propensity analysis of a multicenter international cohort
American Heart Journal, 2005Co-Authors: Andrew Wang, Paul A Pappas, Kevin J Anstrom, Elias Abrutyn, Vance G Fowler, B Hoen, Jose M Miro, Ralph G CoreyAbstract:Background Although surgical intervention is often used in the treatment of prosthetic valve infective endocarditis (PVIE), an understanding of its effect on survival has been limited by the biases of observational studies and lack of controlled trials. Methods The International Collaboration on Endocarditis Merged Database is a large, multicenter, international registry of patients with definite endocarditis by Duke criteria, including 367 patients with PVIE. Clinical, microbiologic, and echocardiographic variables were analyzed to determine those factors associated with the use of surgery for PVIE. Logistic regression analysis was performed to create a propensity model of predictors of surgery use. Patients who underwent surgery during initial hospitalization were matched by propensity score with patients treated with medical therapy alone. Logistic regression analysis was performed to determine variables independently associated with inhospital mortality in this matched subset. Results Surgical therapy for PVIE was performed in 148 (42%) of 367 patients. Inhospital mortality was similar for patients treated with surgery compared with those treated with medical therapy alone (25.0% vs 23.4%, P = .729). Surgical therapy was independently associated with patient age, microorganism, intracardiac abscess, and congestive heart failure. After adjustment for these determinants, inhospital mortality was predicted by Brain embolization (OR 11.12, 95% CI 4.16-29.73) and Staphylococcus aureus infection (OR 3.67, 95% CI 1.29-9.74), with a trend toward benefit for surgery (OR 0.56, 95% CI 0.23-1.36). Conclusions Despite the frequent use of surgery for the treatment of PVIE, this condition continues to be associated with a high inhospital mortality rate in the contemporary era. After adjustment for factors related to surgical intervention, Brain Embolism and S aureus infection were independently associated with inhospital mortality and a trend toward a survival benefit of surgery was evident.
-
valvular and congenital heart disease the use and effect of surgical therapy for prosthetic valve infective endocarditis a propensity analysis of a multicenter international cohort
2005Co-Authors: Andrew Wang, Paul A Pappas, Kevin J Anstrom, Elias Abrutyn, Vance G Fowler, B Hoen, Jose M Miro, Ralph G Corey, Lars Olaison, Judith A StaffordAbstract:Methods The International Collaboration on Endocarditis Merged Database is a large, multicenter, international registry of patients with definite endocarditis by Duke criteria, including 367 patients with PVIE. Clinical, microbiologic, and echocardiographic variables were analyzed to determine those factors associated with the use of surgery for PVIE. Logistic regression analysis was performed to create a propensity model of predictors of surgery use. Patients who underwent surgery during initial hospitalization were matched by propensity score with patients treated with medical therapy alone. Logistic regression analysis was performed to determine variables independently associated with inhospital mortality in this matched subset. Results Surgical therapy for PVIE was performed in 148 (42%) of 367 patients. Inhospital mortality was similar for patients treated with surgery compared with those treated with medical therapy alone (25.0% vs 23.4%, P = .729). Surgical therapy was independently associated with patient age, microorganism, intracardiac abscess, and congestive heart failure. After adjustment for these determinants, inhospital mortality was predicted by Brain embolization (OR 11.12, 95% CI 4.16-29.73) and Staphylococcus aureus infection (OR 3.67, 95% CI 1.29-9.74), with a trend toward benefit for surgery (OR 0.56, 95% CI 0.23-1.36). Conclusions Despite the frequent use of surgery for the treatment of PVIE, this condition continues to be associated with a high inhospital mortality rate in the contemporary era. After adjustment for factors related to surgical intervention, Brain Embolism and S aureus infection were independently associated with inhospital mortality and a trend toward a survival benefit of surgery was evident. (Am Heart J 2005;150:1086-91.)
Takao Urabe - One of the best experts on this subject based on the ideXlab platform.
-
paradoxical Brain Embolism associated with kimura disease mimics watershed infarction
Journal of Stroke & Cerebrovascular Diseases, 2015Co-Authors: Yasutaka Tanaka, Yuji Ueno, Yoshiaki Shimada, Kazuo Yamashiro, Ryota Tanaka, Takao Urabe, Nobutaka HattoriAbstract:Kimura disease (KD) is an uncommon chronic inflammatory disease presenting as subcutaneous lymphadenopathy with eosinophilia. To date, only a single case of Brain Embolism caused by fibroblastic endocarditis associated with KD has been reported. Watershed infarction was seen in patients with episodes of severe hypotension or cardiac surgery. We here report a young case of KD who developed ischemic stroke and showed multiple small infarcts in the border zones between the territories of major cerebral arteries, mimicking watershed infarction. Transesophageal echocardiography revealed patent foramen ovale and atrial septal aneurysm. Concurrently, deep venous thrombus in the femoral vein was found on duplex ultrasonography. Our case supports the notion that paradoxical Brain Embolism associated with KD can cause multiple small Embolisms and mimic watershed infarction.
-
aging aortic arch calcification and multiple Brain infarcts are associated with aortogenic Brain Embolism
Cerebrovascular Diseases, 2013Co-Authors: Yoshiaki Shimada, Yasutaka Tanaka, Yuji Ueno, Kazuo Yamashiro, Ryota Tanaka, Nobutaka Hattori, Ayami Okuzumi, Nobukazu Miyamoto, Takao UrabeAbstract:Background: Mobile or ulcerated aortic plaques (MUAPs) on transesophageal echocardiography (TEE) can cause aortogenic Brain Embolism. Aortic arch calcification (AoAC) on chest X-ray represents systemic atherosclerosis. This study focused on AoAC on chest X-ray and its link with atheromatous aortic plaques (AAPs) on TEE in stroke patients. The aim of the present study was to assess the relationship between AoAC and AAPs in unexplained stroke patients. Methods: A total of 178 patients (mean age: 64 ± 15 years; 115 males) with ischemic stroke who underwent TEE were enrolled. The patients were classified based on TEE findings: (1) AAPs Results: 104 (58%) patients had AAPs Conclusions: Older age, advanced AoAC, and multiple infarctions in multiple VTs are associated with aortogenic Brain Embolism. The CAM score can be useful for the diagnosis of aortogenic Brain Embolism.
-
paradoxical Brain Embolism may not be uncommon prospective study in acute ischemic stroke
Journal of Neurology, 2007Co-Authors: Yuji Ueno, Takao Urabe, Yasuyuki Iguchi, Takeshi Inoue, Kensaku Shibazaki, Kazumi KimuraAbstract:Proving that right-to-left shunt (RLS) represents the precise causative mechanism in ischemic stroke patients with RLS is difficult. The aim of this study was to examine the frequency and clarify the clinical characteristics of paradoxical Brain Embolism (PBE). We prospectively enrolled consecutive acute ischemic stroke patients, who underwent transcranial Doppler and/or transesophageal echocardiography. For patients with RLS, diagnostic criteria for PBE were established as follows: 1) Brain images suggesting embolic strokes; 2) presence of deep venous thrombus or pulmonary Embolism; and 3) absence of any embolic sources. Patients were divided into 4 groups: patients meeting all 3 criteria (Definite); fulfilling 2 criteria (Probable); fulfilling 1 or 0 criteria (Possible); and patients without RLS (Non-RLS). A total of 240 subjects were analyzed for this study. The Definite group comprised 5% of patients, and displayed significantly more females (p = 0.038), and infarcts involving both anterior and posterior circulations (p < 0.001). Patients having neither hypertension nor diabetes mellitus also predominantly belonged to the Definite group (p < 0.001). Clinical characteristics of PBE are a female preponderance, infarcts affecting both anterior and posterior circulations, and an absence of risk factors.