[Delayed white matter lesion after mechanical thrombectomy for middle cerebral artery occlusion with Libman-Sacks endocarditis]. 2022

Akihito Kutsuna, and Junya Aoki, and Hiroto Kodera, and Yasuhiro Nishiyama, and Toshinari Nakane, and Kazumi Kimura
Department of Neurology, Nippon Medical School Graduate School of Medicine.

A 59-year-old woman presented with right hemiparesis and was transported from outside hospital. MRI revealed acute infarction and the left middle cerebral artery M2 occlusion. Intravenous infusion of recombinant tissue-type plasminogen activator, and mechanical thrombectomy (MT) were performed. The cause of cerebral infarction was diagnosed as Libman-Sacks endocarditis. She discharged without sequelae. After 10 months later, she presented with mild cognitive decline, and MRI showed new white matter lesion in left deep white matter. In magnetic resonance spectroscopy, the lesion showed an increased rate of choline/creatine, and a decreased rate of N-acetylaspartate/creatine, elevated lactate peak. When new higher brain dysfunction presented after recanalization by MT, it might be related to the delayed white matter lesion.

UI MeSH Term Description Entries
D007773 Lactates Salts or esters of LACTIC ACID containing the general formula CH3CHOHCOOR.
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010959 Tissue Plasminogen Activator A proteolytic enzyme in the serine protease family found in many tissues which converts PLASMINOGEN to FIBRINOLYSIN. It has fibrin-binding activity and is immunologically different from UROKINASE-TYPE PLASMINOGEN ACTIVATOR. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases. Alteplase,Plasminogen Activator, Tissue-Type,T-Plasminogen Activator,Tissue-Type Plasminogen Activator,Actilyse,Activase,Lysatec rt-PA,TTPA,Tisokinase,Tissue Activator D-44,Lysatec rt PA,Lysatec rtPA,Plasminogen Activator, Tissue,Plasminogen Activator, Tissue Type,T Plasminogen Activator,Tissue Activator D 44,Tissue Type Plasminogen Activator
D002794 Choline A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. Bursine,Fagine,Vidine,2-Hydroxy-N,N,N-trimethylethanaminium,Choline Bitartrate,Choline Chloride,Choline Citrate,Choline Hydroxide,Choline O-Sulfate,Bitartrate, Choline,Chloride, Choline,Choline O Sulfate,Citrate, Choline,Hydroxide, Choline,O-Sulfate, Choline
D003401 Creatine An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as CREATININE in the urine.
D004696 Endocarditis Inflammation of the inner lining of the heart (ENDOCARDIUM), the continuous membrane lining the four chambers and HEART VALVES. It is often caused by microorganisms including bacteria, viruses, fungi, and rickettsiae. Left untreated, endocarditis can damage heart valves and become life-threatening. Infective Endocarditis,Endocarditides,Endocarditides, Infective,Endocarditis, Infective,Infective Endocarditides
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D017131 Thrombectomy Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called EMBOLECTOMY. Aspiration Thrombectomy,Percutaneous Aspiration Thrombectomy,Aspiration Thrombectomies,Aspiration Thrombectomies, Percutaneous,Aspiration Thrombectomy, Percutaneous,Percutaneous Aspiration Thrombectomies,Thrombectomies,Thrombectomies, Aspiration,Thrombectomies, Percutaneous Aspiration,Thrombectomy, Aspiration,Thrombectomy, Percutaneous Aspiration
D020244 Infarction, Middle Cerebral Artery NECROSIS occurring in the MIDDLE CEREBRAL ARTERY distribution system which brings blood to the entire lateral aspects of each CEREBRAL HEMISPHERE. Clinical signs include impaired cognition; APHASIA; AGRAPHIA; weak and numbness in the face and arms, contralaterally or bilaterally depending on the infarction. Cerebral Infarction, Middle Cerebral Artery,Embolic Infarction, Middle Cerebral Artery,MCA Infarct,Middle Cerebral Artery Embolus,Middle Cerebral Artery Infarction,Stroke, Middle Cerebral Artery,Thrombotic Infarction, Middle Cerebral Artery,Embolus, Middle Cerebral Artery,Left Middle Cerebral Artery Infarction,MCA Infarction,Middle Cerebral Artery Circulation Infarction,Middle Cerebral Artery Embolic Infarction,Middle Cerebral Artery Occlusion,Middle Cerebral Artery Stroke,Middle Cerebral Artery Syndrome,Middle Cerebral Artery Thrombosis,Middle Cerebral Artery Thrombotic Infarction,Occlusion, Middle Cerebral Artery,Right Middle Cerebral Artery Infarction,Thrombosis, Middle Cerebral Artery,Infarct, MCA,Infarcts, MCA,MCA Infarcts

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