268 Scientific Programme 22. European Stroke Conference © 2013 S. Karger AG, Basel 4 Interesting and challenging cases Life Threatening Intracranial Hemorrhage during Dobutamine Stress Echocardiography: A Case Report A. SIVARAJU1, V. PUNIA2, M.E. HILLEN3 UMDNJ-NJMS, NEWARK, USA1, UMDNJ-NJMS, NEWARK, USA2, UMDNJ-NJMS, NEW-ARK, USA3 Objective: We report the first case of life threatening intracranial hemorrhage (ICH), as a complica-tion of dobutamine stress echocardiography (DSE). Background: DSE is a widely used method for evaluation of Coronary Artery Disease (CAD). It is considered to be relatively safe with a complication rate of 0.1%-0.3% for life threatening events. Our literature search revealed 1 case of asymptomatic ICH following DSE. We report the first case of a large, life threatening ICH during DSE. Design/Methods: We searched PubMed without date limitation using combination of terms; ICH, DSE, Stress Test. Results: A 68 year old man with a history of ischemic cardiomyopathy, CAD, and recurrent deep ve-nous thrombosis on warfarin was referred for DSE testing because of chest discomfort. During DSE, he developed a headache. His systolic blood pressure was 211 and his pulse 124. Dobutamine was stopped and it was noted that his speech was slurred and he was dragging his left leg. Patient was transferred to the emergency room. His INR was 2.7 and an emergent CAT-scan of the head showed a hemorrhage in the right putamen. Though his coagulopathy was reversed immediately, he deterio-rated. A repeat CAT scan showed worsening hemorrhage. He underwent emergent evacuation of the hematoma with hemicraniectomy and made a poor recovery. Conclusions: DSE is a well tolerated study with a low rate of life-threatening complications, which are usually cardiac in nature. Severe hypertension is described in 0.8-2.6% of patients undergoing DSE. We found one prior case report of ICH during DSE, which describes 3 asymptomatic micro bleeds. Both patients were taking warfarin, putting them at higher risk of a complicated ICH when hypertensive during DSE. 3 Interesting and challenging cases INTRAVASCULAR LYMPHOMA WITH NEUROLOGICAL PRESENTATION AS PRO-GRESSIVE ENCEPHALOPATHY SECONDARY TO MULTIPLE CEREBRAL STROKE-LIKE LESIONS: AN AUTOPSY CASE. C. de la Cruz Cosme1, F. Padilla Parrado2, T. Sanjuán Pérez3, O. Hamad Cueto4, N. Bautista5, M. Olaya6, M.V. Ortega7, R. Aguilar Cuevas8, M. Márquez Martínez9 Hospital Universitario Virgen de la Victoria, Málaga, SPAIN1, Hospital Universitario Virgen de la Victoria, Málaga, SPAIN2, Hospital Universitario Virgen de la Victoria, Málaga, SPAIN3, Hospital Universitario Virgen de la Victoria, Málaga, SPAIN4, Hospital Universitario Virgen de la Victoria, Málaga, SPAIN5, Hospital Universitario Virgen de la Victoria, Málaga, SPAIN6, Hospital Universi-tario Virgen de la Victoria, Málaga, SPAIN7, Hospital Universitario Virgen de la Victoria, Málaga, SPAIN8, Hospital Universitario Virgen de la Victoria, Málaga, SPAIN9 BACKGROUND. Intravascular large B-cell lymphoma (IVLBCL) is a rapidly progressive and dis-seminated aggressive lymphoma, characterized by selective growth of lymphoma cells only in the lumina of small vessels in various organs, with a relative predilection for the central nervous system (CNS). METHODS. A 54 years old woman was carried to emergency room due to two episodes compatible with focal seizures. Relatives reported a progressive sub-acute six-months deterioration consisting on unspecific dizziness following of gait, cognitive-behavioral and motor impairment to be partially dependent for daily life activities. CT showed abnormalities: hypodense spread lesions with irregular borders in white matter of both hemispheres with contrast enhancement in left parietal and right occipital lobes. Studies were completed with MRI with gadolinium, extensive blood, urine and spinal fluid extensive analysis, abdomen and pelvic ultrasound, thoracic-abdominal-pelvic CT. RESULTS. MRI confirmed several and extensive lesions, hyperintense in T2/Flair, hypointense in T1, in bilateral subcortical white matter, tending to coalescence, with moderate restricted diffusion and annular enhancement in parietal lobes. Other tests revealed a 20 cm splenomegaly, what drove to hematological studies with bone marrow aspiration and flow cytometry with no abnormalities. Cytology and virus JC in spinal fluid were negative too. Corticosteroids were empirically adminis-tered with initial but transitory improvement, and she died 3 weeks after income. Autopsy concluded diagnosis of IVLBCL with CNS involvement. CONCLUSIONS. IVLBCL with neurological symp-toms at presentation is seldom diagnosed before autopsy. In cases of rapidly progressive encepha-lopathy secondary to multiple cerebral infarcts or stroke-like lesions, this entity must be consider in differential diagnosis. Earlier diagnosis and consequent earlier treatment with appropriated chemo-therapy may be associated with long-term survival.
Karger_ESC London_2013
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