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London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 351 132 Interesting and challenging cases Stroke and Creutzfeldt-Jacob disease – a case report M. Mako1, G. Krastev2, R. Lackovic;3, M. Vomastová4, Department of Neurology, Faculty Hospital Trnava, Trnava, SLOVAKIA1, Department of Neu-rology, Faculty Hospital Trnava, Trnava, SLOVAKIA2, Department of Neurology, Faculty Hospital Trnava, Trnava, SLOVAKIA3, Department of Neurology, Faculty Hospital Trnava, Trnava, SLOVA-KIA4 Jacob-Creutzfeldt disease /JCD/ is a degenerative process of the brain induced by prions. Disease duration is approximately six months. There are several published cases of JCD presented with acute onset mimicking stroke. Authors present a case of 50-years-old man with a manifestation of genetic form of JCD in short time window after ischemic stroke in left brain hemisphere. Patient presented with weakness of right extremities, speech impairment and ataxia. Brain MRI revealed acute isch-emic lesions in left hemisphere. Patient was discharged home despite of persisting ataxia. He was rehospitalized after one week due to brainstem symptoms. Patient undervent another brain MRI with finding typical for JCD and thereafter neurophysiological and genetic testing. Based on the results definitive diagnosis of genetic form of JCD disease was made. His symptoms worsened rapidly and patient died on 18-th day. The diagnosis of stroke and JCD was also confirmed post mortem. This case is unique not only due to very fast symptoms progression but also rare coincidence of stroke and JCD. key words:stroke, creutzfeldt-jacob disease 133 Interesting and challenging cases Simultaneous bilateral thalamic hemorrhage: case report. I. Barbov1, A. Georgievska2, I. Zdravkov3, M. Milanovska4 University Clinic for neurology, Skopje, MACEDONIA1, University Clinic for neurology, Sko-pje, MACEDONIA2, University Clinic for neurology, Skopje, MACEDONIA3, University Clinic for neurology, Skopje, MACEDONIA4 Unlike of recurrent hypertensive intracerebral hemorrhage (ICH), bilateral or multilocular simulta-neous ICH are registered in <1%, with poor prognosis and high rate mortality, in the literature are described less than 30 cases. Simultaneous bilateral thalamic hemorrhage are extremely rare diseases and the most referred cases are from Asian countries. We present 65-years-old patient with premorbidal hypertension and hyperlipidemia, with acute on-set of the disease (manifesting with deterioration of consciousness -somnolent, spastic tetraplegia, anarthria, aphagia with hypertension 170/100 mmHg). Computerized tomography of the brain, made two hours after disease onset, showed bilateral hema-tomas in thalamic region. Magnetic resonance imaging do not suggests another etiologic possibilities, only occlusion of the Percheron artery (consecutive, early simultaneous or almost subsequent hemorrhagic transformation of the bilateral simultaneous thalamic infarcts after artery occlusion). Our patient was conservative treated, with improvement of consciousness , but with residual organic psycho syndrome, dysarthria with verbal contact and spastic tetraparesis. The mechanism in the basis of simultaneous bilateral symmetrical hemorrhage is still unclear, al-though structural and hemodynamic changes after initial hemorrhage may provocation secondary hemorrhage. There are maybe two possible mechanisms: simultaneous rupture of bilateral microan-eurysms or primary rupture of microaneurysm followed with secondary capillary or venous hem-orrhage produced from reflector hypertension, intracranial hypertension and subsequent hemody-namic changes that affects contra lateral hemisphere, resulting with rupture of another blood vessels which are degenerative changed of preexisting hypertension.


Karger_ESC London_2013
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