London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 377 178 Interesting and challenging cases Oromandibular dystonia after carotid endarterectomy J.H. KWON1, M.S. Kim2, S.J. Park3, S.H. Choi4 Department of Neurology, Ulsan University Hospital, Ulsan, SOUTH KOREA1, Department of Neurology, Ulsan University Hospital, Ulsan, SOUTH KOREA2, Department of Neurology, Ulsan University Hospital, Ulsan, SOUTH KOREA3, Department of Neurology, DongKang Medical Cen-ter, Ulsan, SOUTH KOREA4 Oromandibular dystonia (OMD) is a focal dystonia characterized by prolonged, involuntary, repet-itive muscle contractions of varying severity affecting the masticatory and lower facial muscles. It is usually induced by medication or uncertain etiology. Peripheral trauma such as dental procedure sometimes precedes the OMD. Carotid endarterectomy (CEA) is well known therapy for secondary prevention of stroke in spite of considerable related complications. As far as authors know, there is no report about OMD after CEA. We report a patient who had OMD after CEA for prevention of stroke. A 45-year-old man with history of myocardial infarction and atrial fibrillation was admitted to our hospital complaining of transient right arm weakness. He was treated with coronary stents due to 2 vessel disease 8 months ago, and after then he had taken aspirin, clopidogrel and atorvastatin. Neurologic examination at admission was unremarkable. Initial diffusion weighted image showed subacute infarction in the left caudate nucleus. MR angiography revealed severe stenosis with ulcer-ative plaque in the left carotid bulb. CEA was done under general anesthesia maintaining aspirin and clopidogrel at 6 days after symptom onset. Neurologic examination performed immediately after CEA showed hoarseness due to vagus nerve injury. Otherwise was unremarkable. He complained of deviation of jaw and lower lip to the left side due to involuntary contraction during opening the mouth at 16 days after CEA. It was suppressed with sensory trick. It was improved with clonazepam and completely disappeared 2 months later. In conclusion, OMD in this patient seems to be related with excessive traction during the CEA. Physician should inform a patient the possibility of OMD after CEA and surgeon should be concerned with adequate traction during the CEA. 179 Interesting and challenging cases TCD Embolus Detection in Native Infective Endocarditis: a case report. R.W. Keunen1, G Hoohenkerk.2, B Wokke3, M Khalilzadaa4, M.A. Falsafi5, R ten Berge6, K Prenger7, D.L. Tavy8 Haga Teaching Hospitals, The Hague, THE NETHERLANDS1-8 Background: Strokes in patients with native endocarditis are predictors of poor outcome. Stroke risk stratification of these patients is based on the echo criteria of unstable valve lesions and clinical signs and symtoms of ongoing systemic embolism. However, stability of the valve can sometimes be difficult to predict from echo images alone and clinical evidence may be subtle. Lepur et al. showed that asymptomatic cerebral emboli detected by transcranial Doppler are strong predictors of stroke in native endocarditis 1. We present a 70 years old male with asymptomatic cerebral emboli who was scheduled for rapid valve replacement to prevent strokes. Methods The patient was examined by a 2 MHz transcranial Doppler system (EMS9U/DelicaSys-tem/ Shenzen Delicate Electronics Co. Ltd./China) in combination with special software to detect the ongoing cerebral embolism (The Embolus Detection System (EDS developed by Keunen/Dis-tributed by SMT Medical /Wurzburg/Germany) . Results Presurgery EDS showed frequently very high intensity emboli (mean intensity 4.5 dB range 3-8 dB ; frequency of 1 to 2 per min) indicative for a very unstable cardiac valve. Postsur-gery EDS showed a significant decreased number and intensity of the emboli. The patient recovered fully from surgery with a good cardiac performance and without any neurological deficits. Valve specimen showed multiple unstable calcified lesions. Conculsion TCD embolus detection allows the detection of asymptomatic emboli which are the pre-dictors of imminent stroke. This knowledge might be valuable in the timing of valve replacement References 1 D Lepur et al. Incidence of neurological complications in patients with native-valve infective endocarditis and cerebral microembolism: An open cohort study. Scandinavian Journal of Infectious Diseases, 2009; 41: 708-713.
Karger_ESC London_2013
To see the actual publication please follow the link above