pica and Brain-Ischemia

Horizontal gaze deviation (HGD) is a predictor of acute large vessel occlusion (LVO) and helps to expedite the triage of patients to CTA and endovascular-capable sites. Patients with acute cerebellar ischemia, particularly involving the PICA territory, can also exhibit HGD.. We reviewed 2260 CTA stroke assessment cases between January 2016 and May 2020. Forty-six patients with CTA-proven acute PICA occlusions were identified and compared with 114 patients with acute LVO (ICA, M1, and M1/2). Both clinical and radiographic HGD were examined. The degree of radiographic HGD was measured for each patient. Site of ischemia was confirmed on subsequent MRI.. Of the 46 patients with acute PICA occlusions, 20 (43.5%) patients had radiographic (+) HGD with either ipsilateral or contralateral gaze deviation, 6 of whom (13.0%) displayed clinical HGD. Of the 114 patients with LVO (control group), 72 (63.2%) patients had radiographic (+) HGD, all ipsilateral, 49 of whom (68.0%) displayed clinical HGD. The mean degree of HGD between PICA and LVO were 30.0° vs. 22.9°, respectively, p < 0.001; AUC = 0.68.. Patients with acute PICA occlusion can exhibit either ipsilateral or contralateral HGD and a higher degree of HGD than LVO occlusion on NECT. In hyperacute stroke, the presence of radiographic HGD > 30° in the absence of ischemic changes in the MCA territory should prompt clinicians to closely evaluate for features of early ischemic changes in the cerebellar hemispheres that suggest acute PICA occlusion.

Topics: Brain Ischemia; Humans; Ischemia; Pica; Stroke

The authors report five, mortal, vasculo-cerebral hemorrhage complications in anaemic and geographic patients. The five observations are stereotyped, the accidents occurring two weeks after the start of treatment, which included a complete blood transfusion and the admission of injectable iron and oral folic acid. Physiopathogenesis is obscure, and no identical case seems to be described in literature. The authors link these accidents to less serious neurological manifestations normally observed during iron-deficient anaemia. They blame cerebral anoxia and the deficient terrain.

Topics: Adolescent; Anemia, Hypochromic; Anemia, Macrocytic; Blood Transfusion; Brain Ischemia; Cerebral Hemorrhage; Child; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Iron Deficiencies; Male; Nutrition Disorders; Pica; Pseudotumor Cerebri; Retrospective Studies; Senegal; Syndrome

The case history is presented of a 4-year-old boy, with a history of pica, who aspirated table pepper with subsequent respiratory arrest, severe anoxia, and death. We believe this to be the first case reported in the literature of fatal accidental aspiration of pepper.

Topics: Brain Ischemia; Child, Preschool; Condiments; Death, Sudden; Humans; Male; Pica; Pneumonia, Aspiration