27974938 Visualization

The 21 Age - year Age - old Age patient presented Clinical_event to the closest Nonbiological_location emergency Nonbiological_location department Nonbiological_location at 8 Time PM Time for nausea Sign_symptom , numbness Sign_symptom of the left Biological_structure limbs Biological_structure , incoordination Sign_symptom of Sign_symptom walking Sign_symptom and dysarthria Sign_symptom , with the symptomatology Sign_symptom installed in a progressive Detailed_description mode 4 Time hours Time before Time presentation.
The nausea Sign_symptom was the initial symptom, starting at 4 Time PM Time (without headache Sign_symptom , nuchal Biological_structure pain Sign_symptom , or vomit Sign_symptom ) and then, after Time 5.30 Time PM Time , the numbness Sign_symptom of the left Biological_structure limbs Biological_structure and the incoordination Sign_symptom of Sign_symptom walking Sign_symptom and by 7 Time PM Time dysarthria Sign_symptom was added to the entire clinical constellation.
The History patient History did History not History have History a History medical History history History or History a History current History medication History .
He was a student Occupation .
He History did History not History smoke History and History did History not History use History recreational History drugs History .
He History only History drank History alcohol History occasionally History .
There Family_history was Family_history no Family_history family Family_history history Family_history of Family_history thromboembolism, Family_history cardiovascular Family_history problems, Family_history or Family_history hematologic Family_history diseases Family_history .
He was first evaluated Diagnostic_procedure by a neurosurgeon Nonbiological_location in the emergency Nonbiological_location unit Nonbiological_location and had a brain Biological_structure CT Diagnostic_procedure scan that highlighted infracentimetric Detailed_description hypodensity Sign_symptom in the thalamic Biological_structure nucleus Biological_structure , on the left Detailed_description side Detailed_description and at the level Biological_structure of Biological_structure the Biological_structure right Biological_structure cerebellar Biological_structure hemisphere Biological_structure in the PICA Biological_structure territory Biological_structure , and also a chest Biological_structure X Diagnostic_procedure - ray Diagnostic_procedure that revealed a widened Sign_symptom projection Sign_symptom area Sign_symptom of the right Biological_structure side Biological_structure hilum Biological_structure , without any other Sign_symptom pathological Sign_symptom findings Sign_symptom .
Following this evaluation, he was sent Clinical_event to the National Nonbiological_location Institute Nonbiological_location of Nonbiological_location Neurology Nonbiological_location and Nonbiological_location Cerebrovascular Nonbiological_location Diseases Nonbiological_location for consultation Clinical_event and special Therapeutic_procedure treatment Therapeutic_procedure .
During the ambulance Detailed_description transportation Clinical_event , he had repeated Detailed_description episodes of vomiting Sign_symptom .
The initial physical Diagnostic_procedure examination Diagnostic_procedure (at 10 Time P.M Time ) showed normal Lab_value vital Diagnostic_procedure signs Diagnostic_procedure : blood Diagnostic_procedure pressure Diagnostic_procedure 130/ Lab_value 80mmHg Lab_value , heart Diagnostic_procedure rate Diagnostic_procedure 100 Lab_value beats Lab_value per Lab_value minute Lab_value and normal Lab_value body Diagnostic_procedure temperature Diagnostic_procedure 36,8°C Lab_value .
The cardiopulmonary Diagnostic_procedure exam Diagnostic_procedure was normal Lab_value .
No carotid Sign_symptom bruits Sign_symptom were registered.
The neurological Diagnostic_procedure examination Diagnostic_procedure was notable for normal Lab_value orientation Lab_value .
The patient had equal Lab_value , reactive Lab_value pupils Diagnostic_procedure , divergent Detailed_description strabismus Sign_symptom to the left Biological_structure eye Biological_structure , horizontal Detailed_description nystagmus Sign_symptom , normal Lab_value deglutition Diagnostic_procedure , mild Severity paresis Disease_disorder of the left Biological_structure arm Biological_structure , ataxia Disease_disorder of all Biological_structure limbs Biological_structure , with an accent Biological_structure on Biological_structure the Biological_structure left Biological_structure extremities Biological_structure , numbness Sign_symptom of the left Biological_structure limbs Biological_structure , bilateral Lab_value response Lab_value present at all Biological_structure deep Biological_structure tendons Biological_structure reflex Diagnostic_procedure , Babinski Sign_symptom sign Sign_symptom on the left Detailed_description side Detailed_description , stereotypical Lab_value language Diagnostic_procedure .
The patient was able Detailed_description to Detailed_description repeat Detailed_description a Detailed_description few Detailed_description words Detailed_description and Detailed_description fragment Detailed_description of Detailed_description phrases Detailed_description and to perform Detailed_description simple Detailed_description commands Detailed_description of Detailed_description medium Detailed_description complexity Detailed_description .
The laboratory Diagnostic_procedure analysis Diagnostic_procedure highlighted a normal Lab_value hemoleucogram Diagnostic_procedure , normal Lab_value blood Diagnostic_procedure glucose Diagnostic_procedure level 9,11 Lab_value mmol/ Lab_value L Lab_value (normal range 3,9-5,8mmol/ L), serum Diagnostic_procedure creatinine Diagnostic_procedure 0,69mmol/ Lab_value L Lab_value (range 0,5-0,9mmol/ L), total Diagnostic_procedure serum Diagnostic_procedure cholesterol Diagnostic_procedure 5,2mmol/ Lab_value L Lab_value (normal range < 5,2 mmol/ L).
The tests for thrombophilia Diagnostic_procedure were negative Lab_value .
He also presented a normal Lab_value sinus Diagnostic_procedure rhythm Diagnostic_procedure on the ECG Detailed_description .
The brain Biological_structure CT Diagnostic_procedure performed at the first emergency unit, as mentioned above, revealed a infracentimetric Detailed_description hypodensity Sign_symptom at the level Biological_structure of Biological_structure the Biological_structure left Biological_structure thalamic Biological_structure nucleus Biological_structure and at the level Biological_structure of Biological_structure the Biological_structure right Biological_structure cerebellar Biological_structure hemisphere Biological_structure in the PICA Biological_structure territory Biological_structure .
Doppler Detailed_description ultrasound Diagnostic_procedure for cerebral Biological_structure and Biological_structure cervical Biological_structure blood Biological_structure vessels Biological_structure highlighted the marked frena Lab_value in the flow Diagnostic_procedure velocities Diagnostic_procedure of the V2 Biological_structure segment Biological_structure of Biological_structure the Biological_structure right Biological_structure vertebral Biological_structure artery Biological_structure , an accentuated Sign_symptom aspect Sign_symptom in the high Biological_structure V2 Biological_structure segments Biological_structure with the complete Lab_value disappearance Lab_value of the flow Diagnostic_procedure in the V3 Biological_structure segment Biological_structure , without carotid Biological_structure atheromatous Detailed_description lesions Sign_symptom or modifications Sign_symptom of Sign_symptom the Sign_symptom trajectories Sign_symptom or Sign_symptom the Sign_symptom arterial Sign_symptom caliber Sign_symptom .
Overall, there was a possibility of a dissection Disease_disorder of the right Biological_structure vertebral Biological_structure artery Biological_structure in the higher Detailed_description segments Detailed_description with indication of cerebral Biological_structure and angio Biological_structure MRI Diagnostic_procedure .
Cerebral and angio MRI Coreference showed: areas with T2 Detailed_description , FLAIR Diagnostic_procedure hypersignal Lab_value , with an important restriction Sign_symptom of Sign_symptom diffusion Sign_symptom and low Lab_value ADC Diagnostic_procedure , situated in the right Biological_structure cerebellar Biological_structure area Biological_structure of Biological_structure the Biological_structure postero Biological_structure - inferior Biological_structure territory Biological_structure , anterior Biological_structure bilateral Biological_structure cerebellar Biological_structure territory Biological_structure , left Biological_structure cerebellar Biological_structure peduncle Biological_structure , both Biological_structure right Biological_structure > Biological_structure left Biological_structure thalamic Biological_structure nuclei Biological_structure , as well as subcortical Biological_structure occipital Biological_structure bilateral Biological_structure , with an ischemic Sign_symptom aspect Sign_symptom that was recently constituted in Biological_structure the Biological_structure vertebrobasilar Biological_structure territory Biological_structure .
T1 Diagnostic_procedure FS Diagnostic_procedure hypersignal Lab_value was present on the entire Biological_structure intracranial Biological_structure segment Biological_structure of Biological_structure the Biological_structure right Biological_structure vertebral Biological_structure artery Biological_structure and the cranio Biological_structure - spinal Biological_structure junction Biological_structure .
On the angiographic Diagnostic_procedure arterial Detailed_description 3D Detailed_description TOF Detailed_description sequence, the presence of the rapid Lab_value flow Diagnostic_procedure of the right Biological_structure vertebral Biological_structure artery Biological_structure could be viewed, up Biological_structure to Biological_structure the Biological_structure C2 Biological_structure segment Biological_structure , where there was a progressive Detailed_description pinch Sign_symptom out Sign_symptom with an aspect of flute Shape beak Shape shape Shape .
Distal Biological_structure of Biological_structure this Biological_structure level Biological_structure , there was an absence Lab_value of the rapid Diagnostic_procedure flow Diagnostic_procedure signal and also a lack Lab_value of right Biological_structure PICA Biological_structure visualization Diagnostic_procedure .
The MRI Diagnostic_procedure aspect suggested a subacute Detailed_description dissection Disease_disorder of the right Biological_structure vertebral Biological_structure artery Biological_structure .
The cerebral Biological_structure ventricular Biological_structure system Biological_structure had normal Lab_value dimensions Diagnostic_procedure , shape Diagnostic_procedure , and topography Diagnostic_procedure .
The pericerebral Diagnostic_procedure fluid Diagnostic_procedure spaces Diagnostic_procedure and the basal Diagnostic_procedure cisterns Diagnostic_procedure were normal Lab_value .
Conclusions: there were some ischemic Detailed_description lesions Sign_symptom recently constituted in the vertebrobasilar Biological_structure territory Biological_structure and also a subacute Detailed_description dissection Disease_disorder of the right Biological_structure vertebral Biological_structure artery Biological_structure .
Heparin Medication administration was started immediately in the process of hospitalization because of the dissection.
The APTT Diagnostic_procedure value Diagnostic_procedure was kept in the range Lab_value of Lab_value 50 Lab_value - 70 Lab_value seconds Lab_value .
Also, the prophylactic Therapeutic_procedure therapy Therapeutic_procedure for stress Detailed_description ulcer Detailed_description was performed.
After Date 7 Date days Date from the debut, the patient was transitioned to acenocumarol Medication for long-term anticoagulation.
The treatment with acenocumarol Medication was instituted with the heparin Medication overlap until getting the INR Diagnostic_procedure therapeutic Lab_value in the 2 Detailed_description - 3 Detailed_description intervals Detailed_description .
The evolution Diagnostic_procedure was favorable Lab_value , the patient regaining Lab_value the verbal Diagnostic_procedure fluency Diagnostic_procedure and the capacity for autonomy Sign_symptom in Sign_symptom movement Sign_symptom .
The ataxia Disease_disorder was remitted Detailed_description at Detailed_description the Detailed_description right Detailed_description limbs Detailed_description and persisted Detailed_description at Detailed_description the Detailed_description left Detailed_description extremities Detailed_description , but registered a lot of improvement Lab_value .
The patient was discharged Clinical_event home Nonbiological_location with the recommendation Other_entity to Other_entity continue Other_entity the Other_entity treatment Other_entity with Other_entity Acenocumarol Other_entity for Other_entity 6 Other_entity months Other_entity with Other_entity clinical, Other_entity paraclinical Other_entity and Other_entity treatment Other_entity reevaluation Other_entity at Other_entity 6 Other_entity months Other_entity .
The follow Clinical_event up Clinical_event was not possible because the patient did not return Clinical_event to the hospital Nonbiological_location after Date 6 Date months Date .