Catálogo de publicaciones - libros

A 69-yr-old man presented with new-onset atrial fibrillation, complaining of shortness of breath. His past medical history is significant for coronary artery disease, ischemic cardiomyopathy (ejection fraction 15%), diabetes mellitus, and hypertension. He was admitted to hospital and started on intravenous heparin. The day after admission, he developed right hemiplegia with deviation of his eyes to the left. Immediate noncontrast brain computed tomography (CT) showed remote left cerebellar infarct but no evidence of acute intracranial abnormality. However, brain magnetic resonance imaging (MRI) showed extensive cortical and basal ganglia subacute infarction involving two thirds of the left middle cerebral artery (MCA) territory. Therefore, he underwent urgent cerebral angiography at 6 h after symptom onset.

A 78-yr-old Caucasian man presented with left eye amaurosis fugax that resolved within 3-4 min. He had a past history of myocardial infarction, coronary artery bypass surgery in 1987, ischemic cardiomyopathy with ejection fraction 25-30%, and permanent pacemaker insertion for sick-sinus syndrome. His risk factors include hyperlipi-demia and hypertension; he quit smoking 16 yr ago. He denied chest pain, shortness of breath, palpitations, or other neurologic symptoms. He has NYHA Class II congestive heart failure. His carotid duplex ultrasound showed moderate bilateral internal carotid artery (ICA) stenosis 60-79% (left ICA PSV 239cm/s, EDV 62cm/s, ratio 4.87; right ICA PSV 174cm/s, EDV 46cm/s, ratio 1.75). Thus, he was referred for further evaluation and management for symptomatic left ICA stenosis.

A 68-yr-old Caucasian man with a history of atrial fibrillation, myocardial infarction in 1994 (with subsequent ejection fraction of 30%), and thoracic aortic aneurysm who underwent coronary artery bypass grafting and thoracic aneurysm repair in 1999. His cardiac risk factors include hyperlipidemia and hypertension; he quit smoking years ago. In 2003, he was diagnosed with a type B aortic dissection extending from just beyond his left subclavian artery into his common and external iliac arteries bilaterally. The dissection was managed medically, and he was discharged home on medical therapy. He was subsequently referred for further evaluation. In 2004, his aortic artery slowly increased in size (aortic isthmus went from 5.1 cm to 5.7cm, and mid-thoracic aorta from 3.1 cm to 4.0 cm). He subsequently presented with interscapular back pain and severe hypertension. Repeat CT scan revealed that his aortic isthmus had increased to 7.1 cm. His blood pressure and pain were controlled, and he underwent presurgical evaluation.

A 65-yr-old Caucasian woman with risk factors of hypertension, dyslipidemia, and smoking had presented with a left-hemispheric stroke. She was well until the morning of the event, when she complained of several episodes of right-sided weakness and mild slurred speech. She presented to the Emergency Room approx 8 h after the onset of symptoms. At that point, she still had mild right arm and leg weakness, but her slurred speech had resolved. On physical examination, her strength was 4/5 on both right upper and lower extremities, decreased sensation, and brisk reflexes on the right. Her NIH stroke scale score was 1. She was treated with aspirin and clopidogrel and underwent urgent magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA).