Low NIHSS score large vessel occlusion caused by infective endocarditis treated with thrombectomy

Low NIHSS score large vessel occlusion caused by infective endocarditis treated with thrombectomy

OBJECTIVESLarge vessel occlusion (LVO)-related acute ischemic stroke due to infective endocarditis (IE) is a rare condition. At onset, most patients are severely ill, whereas on rare occasion, they develop mild neurological symptoms. As far as we are aware, this is the first report of IE related int...

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Veröffentlicht in:Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 2023, Vol.32 (2), p.106915-106915
Hauptverfasser: Matsukawa, So, Go, Kohichi, Yang, Tao, Katsuki, Takahisa, Takenobu, Yohei, Hashimoto, Kenji
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container_title Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
container_volume 32
creator Matsukawa, So
Go, Kohichi
Yang, Tao
Katsuki, Takahisa
Takenobu, Yohei
Hashimoto, Kenji
description OBJECTIVESLarge vessel occlusion (LVO)-related acute ischemic stroke due to infective endocarditis (IE) is a rare condition. At onset, most patients are severely ill, whereas on rare occasion, they develop mild neurological symptoms. As far as we are aware, this is the first report of IE related internal carotid artery (ICA) occlusion with low National Institutes of Health Stroke Scale (NIHSS) (
doi_str_mv 10.1016/j.jstrokecerebrovasdis.2022.106915
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At onset, most patients are severely ill, whereas on rare occasion, they develop mild neurological symptoms. As far as we are aware, this is the first report of IE related internal carotid artery (ICA) occlusion with low National Institutes of Health Stroke Scale (NIHSS) (&lt;6) score treated with endovascular thrombectomy. CASE PRESENTATIONA 24-year-old woman had undergone dental treatment 3 weeks before and had a persistent low-grade fever for a week. She presented to the emergency department with a chief complaint of motor weakness of the right upper limb after waking up. She had only mild paralysis of the right upper limb (NIHSS score 1). Magnetic resonance imaging showed scattered infarcts in the left frontal lobe and cerebral angiography showed that the left ICA had been occluded immediately distal to its origin. The symptom disappeared after the occluded artery was completely recanalized by mechanical thrombectomy. On postoperative day 1, blood cultures were positive and echocardiography was performed, which revealed a verrucous mitral valve and a diagnosis of IE. On postoperative day 2, the patient underwent cardiac surgery for valve replacement. Thereafter, there was no recurrence of cerebral infarction, and the patient was discharged home on day 50 with a modified Rankin Scale 0. CONCLUSIONSEarly endovascular thrombectomy for low NIHSS score LVO due to IE resulted in a good treatment course. IE should be part of the differential diagnosis of LVO in the young patients.</description><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2022.106915</identifier><language>eng</language><ispartof>Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2023, Vol.32 (2), p.106915-106915</ispartof><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>776,780,4476,27902</link.rule.ids></links><search><creatorcontrib>Matsukawa, So</creatorcontrib><creatorcontrib>Go, Kohichi</creatorcontrib><creatorcontrib>Yang, Tao</creatorcontrib><creatorcontrib>Katsuki, Takahisa</creatorcontrib><creatorcontrib>Takenobu, Yohei</creatorcontrib><creatorcontrib>Hashimoto, Kenji</creatorcontrib><title>Low NIHSS score large vessel occlusion caused by infective endocarditis treated with thrombectomy</title><title>Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association</title><description>OBJECTIVESLarge vessel occlusion (LVO)-related acute ischemic stroke due to infective endocarditis (IE) is a rare condition. At onset, most patients are severely ill, whereas on rare occasion, they develop mild neurological symptoms. As far as we are aware, this is the first report of IE related internal carotid artery (ICA) occlusion with low National Institutes of Health Stroke Scale (NIHSS) (&lt;6) score treated with endovascular thrombectomy. CASE PRESENTATIONA 24-year-old woman had undergone dental treatment 3 weeks before and had a persistent low-grade fever for a week. She presented to the emergency department with a chief complaint of motor weakness of the right upper limb after waking up. She had only mild paralysis of the right upper limb (NIHSS score 1). Magnetic resonance imaging showed scattered infarcts in the left frontal lobe and cerebral angiography showed that the left ICA had been occluded immediately distal to its origin. The symptom disappeared after the occluded artery was completely recanalized by mechanical thrombectomy. On postoperative day 1, blood cultures were positive and echocardiography was performed, which revealed a verrucous mitral valve and a diagnosis of IE. On postoperative day 2, the patient underwent cardiac surgery for valve replacement. Thereafter, there was no recurrence of cerebral infarction, and the patient was discharged home on day 50 with a modified Rankin Scale 0. CONCLUSIONSEarly endovascular thrombectomy for low NIHSS score LVO due to IE resulted in a good treatment course. 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At onset, most patients are severely ill, whereas on rare occasion, they develop mild neurological symptoms. As far as we are aware, this is the first report of IE related internal carotid artery (ICA) occlusion with low National Institutes of Health Stroke Scale (NIHSS) (&lt;6) score treated with endovascular thrombectomy. CASE PRESENTATIONA 24-year-old woman had undergone dental treatment 3 weeks before and had a persistent low-grade fever for a week. She presented to the emergency department with a chief complaint of motor weakness of the right upper limb after waking up. She had only mild paralysis of the right upper limb (NIHSS score 1). Magnetic resonance imaging showed scattered infarcts in the left frontal lobe and cerebral angiography showed that the left ICA had been occluded immediately distal to its origin. The symptom disappeared after the occluded artery was completely recanalized by mechanical thrombectomy. On postoperative day 1, blood cultures were positive and echocardiography was performed, which revealed a verrucous mitral valve and a diagnosis of IE. On postoperative day 2, the patient underwent cardiac surgery for valve replacement. Thereafter, there was no recurrence of cerebral infarction, and the patient was discharged home on day 50 with a modified Rankin Scale 0. CONCLUSIONSEarly endovascular thrombectomy for low NIHSS score LVO due to IE resulted in a good treatment course. IE should be part of the differential diagnosis of LVO in the young patients.</abstract><doi>10.1016/j.jstrokecerebrovasdis.2022.106915</doi></addata></record>
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title Low NIHSS score large vessel occlusion caused by infective endocarditis treated with thrombectomy
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