London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 375 174 Interesting and challenging cases Encephalitis presenting as a mimic of acute stroke: a case report M.P. Marques1, A.L. Cruz2, M. Ferreira3, P. Beleza4, C. Guedes5, S. Pereira6, A. Duarte7 Centro Hospitalar Médio Ave - Unidade Famalicão, Vila Nova Famalicão, PORTUGAL1, Cen-tro Hospitalar Médio Ave - Unidade Famalicão, Vila Nova Famalicão, PORTUGAL2, Centro Hos-pitalar Médio Ave - Unidade Famalicão, Vila Nova Famalicão, PORTUGAL3, Centro Hospitalar Médio Ave - Unidade Famalicão, Vila Nova Famalicão, PORTUGAL4, Centro Hospitalar Médio Ave - Unidade Famalicão, Vila Nova Famalicão, PORTUGAL5, Centro Hospitalar Médio Ave - Unidade Famalicão, Vila Nova Famalicão, PORTUGAL6, Centro Hospitalar Médio Ave - Unidade Famalicão, Vila Nova Famalicão, PORTUGAL7 An eighty-five years old, female patient, was brought into the Emergency Room with sudden agita-tion, incoherent speech. She was previously seen normal one hour before. On admission, her vital signs were normal. She was arousal but with abnormal attention and repeti-tive speech (praying). She demonstrated no objective motor weaknesses or sensory deficits; menin-geal signs were absent. The blood investigation, including full blood count, glucose, renal function and ionogram was nor-mal; urinary drugs’ sampling was negative. Cerebral Computerized Tomography Scan (CT) showed past isquemic lacunar disease and excluded acute lesions. During the observation, patient started with fever (38ºC), so a Lumbar Puncture (LP) was per-formed; the result of the Cerebrospinal fluid (CSF) was normal. Patient then progressed with right homonymous hemianopia and right hemiparesis. An ischemic stroke on left middle cerebral artery territory was suspected. 24 hours later, her neuro-logical status progressed into the state of right hemiplegia and global aphasia. CT scan was repeated and remained normal. At the Clinical Group Reunion it was decided to start acyclovir, with a progressive improvement of mental status, aphasia and motor deficit. Cerebrospinal fluid culture, polymerase chain reaction, and serology were all negative. After 14 days of endovenous acyclovir, patient was well awake, preserved mental status, superior cognitive functions intact. A discrete hemiparesis was the only deficit on discharge. The sudden onset of neurologic symptoms often leads immediately to a diagnostic of stroke. In this particular case, the presence of fever triggered the initial suspicion of encephalitis but a normal CSF was misleading. The development of the deficits and lack of correspondence on CT scan placed back encephalitis as the most likely diagnosis.The high suspicion and prompt acyclovir initiation were important require-ments for successful management. 175 Interesting and challenging cases Embolic stroke in a patient with hereditary haemorrhagic telangiectasia (HHT) S. El Tawil1, Y. Duodu2 Milton Keynes General Hospital, Milton Keynes, UNITED KINGDOM1, Milton Keynes Gener-al Hospital, Milton Keynes, UNITED KINGDOM2 Background HHT (Osler Weber Rendu syndrome) is an autosomal disorder characterized by abnormal vessel formation affecting the skin, mucosa and viscera. Epistaxis is the most common presentation, but bleeding from other sites can occur. CNS involvement is most commonly related to either bleeding from cerebral AVMs or paradoxical embolization from pulmonary AVMs. However, as the life ex-pectancy of patients with HHT is usually not shortened, they are liable to develop strokes due to oth-er reasons. There are no guidelines on primary or secondary prevention of stroke in these patients. Methods: We present a case of HHT with recurrent ischemic stroke secondary to AF and discus difficulties in management. Results: An 82 years old lady admitted to hospital with recurrent stroke. She was diagnosed with HHT at the age of 59 after recurrent episodes of epistaxis requiring extensive local treatment. She was also di-agnosed with AF one year before admission. A trial of aspirin resulted in extensive epistaxis requir-ing blood transfusion and further thromboembolic prophylaxis was abandoned. She suffered an ex-tensive left MCA infarction leading to right sided weakness and dysphasia, followed 7 months later by right MCA territory infarction. The second stroke led to loss of swallowing ability. Gastrostomy feeding tube insertion proved a major challenge and the patient required total parenteral nutrition. She suffered recurrent chest infections which eventually lead to death. Conclusions HHT is an uncommon disorder sometimes associated with ischemic stroke. Despite abundant liter-ature on prevention of stroke related to AVMs, there is little data on the practical difficulties of man-aging ischemic strokes and secondary prevention strategies in this group of patients. Management demands close collaboration between various specialities and disciplines working closely with pa-tients and their families.
Karger_ESC London_2013
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