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PTA 24/3/53
Successful PTA Rt SFA with 20% residual stenosis, balloon dilatation Lt popliteal artery was also done but ultimately recoil (residual stenosis 80%).
หลั�งทำ�� PTA อ�ก�รปวดข�ขว� ข�ขว�เย็�นของผู้��ป�วย็ลัดลัง ชี�พจรชี�ดข��นแต่ ย็�งเบ�กว �ข��งซ้��ย็
ABI 25/3/53 Rt ABI 0.66 Lt ABI 0.53
PrePTA
PostPTA
Progress admit day 3 (27/3/53)
ขณะคุ&ย็โทำรศั�พทำ)มื+อถื+อ แขนซ้��ย็อ อนแรง โทำรศั�พทำ)หลั&ดมื+อ ปวดศั�รษะด��นขว�ต่+�อๆ ไมื ชี� ไมื มื�หน��เบ��ย็ว ไมื มื�อ อนแรง
Pupil 4 mm BRTL, EOM full, no facial palsy Motor: Lt arm gr IV, other gr V Reflex: Lt arm 3+, other 2+ Imp: Acute monoparesis Lt arm
CT brain with contrast 27/3/53
Hyperdense lesion along cortical gyral interface of Rt high frontal lobe with perilesional edema
CT brain
CT brain
MRI, MRA, MRV brain & Neck 30/3/53 Two abnormal signal intensity lesions at RT high frontal
lobe and Rt cerebellar hemisphere, probably gyral hemorrhage
Total occlusion of Lt subclavian and Lt vertebral arteries Severe stenosis of Rt ICA above carotid bifurcation Fusiform dilatation of ACoA and proximal Lt A2 segment Unremarkable MRV study Anormaly of aortic arch
MRI brain
MRI brain
MRI brain
Lab 30/3/53
ANA < 80 Anti B2 glyoprotein 1 Negative Lupus Anticoagulant
aPTT Negative aRVVT Positive
Anticardiolipin IgG, IgM: Negative
The stroke syndrome of cortical vein thrombosis
Cortical vein thrombosis without sinus involvement is rarely diagnosed, although it may commonly be overlooked.
We report four cases of cerebral venous thrombosis limited to the cortical veins. The diagnosis was made on surgical intervention in 1 patient and by angiography in 3 patients.
Focal or generalized seizures followed by hemiparesis, aphasia, hemianopia, or other focal neurologic dysfunction in the absence of signs of increased ICP should suggest this possibility.
K. Jacobs,Moulin et al. The stroke syndrome of cortical vein thrombosis. NEUROLOGY 1996;47:376-382
The stroke syndrome of cortical vein thrombosis Neuroimaging (CT, MRI) shows an ischemic lesion that does not
follow the boundary of arterial territories and often has a hemorrhagic component, without signs of venous sinus thrombosis.
Conventional angiography demonstrates no arterial occlusion but may show cortical vein thrombosis corresponding to the infarct, although these may also be nonspecific findings.
The role of MR angiography, which is well-established in sinus thrombosis, remains to be assessed in patients with brain ischemia due to isolated cortical vein occlusion.
K. Jacobs,Moulin et al. The stroke syndrome of cortical vein thrombosis. NEUROLOGY 1996;47:376-382