Because of the unavailability of MRI in the hospital, this examination was not performed, and an additional workup was requested to understand the etiology (for more details click here)

On day 3 of hospitalization, the patient presented with fever (39ºC) without signs of meningism, without any focus of suspected infection, and without elevation of inflammatory parameters in blood tests. This febrile condition persisted for more than 48 hours and therefore a septic screening was carried out extensively due to suspected embolic septic source, in particular aerobic and anaerobic blood cultures, microscopic and microbiological examination of the urine sample, and chest X-ray. None of these tests revealed changes suggestive of infection. Despite negative blood culture and no valvular murmur, the patient underwent transthoracic echocardiography with Doppler study, which showed no images resembling endocarditis. Thoracic, abdominal, and pelvic CT scans were also performed, and a pulmonary consolidation on the apex of the left lung was found.Nosocomial pneumonia was assumed as the focus of the infection, and a promptly full dose of piperacillin and tazobactam was given empirically. On day 10 of hospitalization because of persistent fever despite antibiotic therapy and previous episodes of transient neurological signs, the diagnostic hypothesis of central nervous system (CNS) infection emerged, even in the absence of elevation of inflammatory parameters and no signs of meningism. On the same day, the HIV test was positive, while hepatitis B, C, and syphilis tests were ruled out.

To confirm HIV diagnosis, CD4 cell count and viral load were investigated, and a lumbar puncture was performed considering the hypothesis of an opportunistic infection. During the procedure, there was no evidence of increased opening pressure, and the CSF showed lymphocytic pleocytosis with increased proteins and normal glucose levels. Smear of CSF for acid-fast bacilli and VDRL were negative, and India ink preparation was positive. CM was diagnosed, and the patient was started on the induction treatment with amphotericin combined with flucytosine. Three weeks later, Cryptococcus neoformans had grown in the CSF sample, and the results confirmed a diagnosis of HIV/AIDS (CD4 count of 116/uL and viral load of 8,400,000 copies/mL).

The patient evolved favorably, with resolution of the CNS infectious and without new episodes of focal neurological deficits. After hospital discharge, he maintained follow-up in an infectious consultation. 

This is the unusual presentation of Cryptococcal Meningoencephalitis in HIV patient leading to TIA, do you consider the differential of Cryptococcal Meningoencephalitis in TIA patients with HIV?

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I confirm that covid vaccinated people can have thrombosis evidences. I noticed symptoms in patients with cephalic vein thrombosis and leg deep vein thrombosis. I treated both with heparin for one week. Other suspected symptoms seen by me are about mild transitory ischemic attack and increased fatigue.

MONDAY, July 10, 2023 (HealthDay News) -- For patients with minor stroke or transient ischemic attack (TIA) who carry the CYP2C19 loss-of-function allele, those with obesity receive more clinical benefit from ticagrelor-acetylsalicylic acid (ASA) than clopidogrel-ASA, according to a study published online July 10 in CMAJ, the journal of the Canadian Medical Association.

Jia Zhang, M.D., from The China National Clinical Research Center for Neurological Diseases in Beijing, and colleagues conducted a randomized, double-blind trial involving patients with minor stroke or TIA who carried the CYP2C19 loss-of-function allele. Participants were randomly assigned to receive ticagrelor-ASA or clopidogrel-ASA. Data were included for 6,412 patients: 876 were classified as obese and 5,536 were classified as nonobese.

The researchers found that among patients with obesity, ticagrelor-ASA was associated with a significantly lower rate of stroke within 90 days compared with clopidogrel-ASA (5.4 versus 11.3 percent; hazard ratio, 0.51; 95 percent confidence interval, 0.30 to 0.87), but not among those without obesity (6.0 versus 7.0 percent; hazard ratio, 0.84; 95 percent confidence interval, 0.69 to 1.04). No differences were seen in the rates of severe or moderate bleeding by body mass index group.

"Body mass index influences the efficacy of ticagrelor-ASA versus clopidogrel-ASA among patients with minor ischemic stroke or TIA who carry a CYP2C19 loss-of-function allele," the authors write. "Clopidogrel appears to lose its efficacy among patients with obesity."

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TUESDAY, June 13, 2023 (HealthDay News) -- Emergency department visits for transient ischemic attack (TIA) with incomplete neurovascular imaging are associated with higher odds of subsequent stroke within 90 days, according to a study published online May 31 in the American Journal of Roentgenology.

Vincent M. Timpone, M.D., from the University of Colorado Hospital in Aurora, and colleagues evaluated the association between incomplete neurovascular imaging workup during emergency department encounters for TIA and odds of subsequent stroke. Analysis included 111,417 patients with a TIA diagnosis who underwent brain computed tomography or brain magnetic resonance imaging during or within two days of the encounter identified through the Medicare Standard Analytical Files for calendar years 2016 and 2017.

The researchers found that 37.3 percent of patients had an incomplete neurovascular imaging workup. Within 90 days of the TIA encounter, a new stroke diagnosis occurred in 4.4 percent of patients with complete neurovascular imaging versus 7.0 percent of patients with incomplete neurovascular imaging. When adjusting for patient (age, sex, race and ethnicity, high-risk comorbidities, median county household income) and hospital (region, rurality, number of beds, major teaching hospital designation) characteristics, incomplete neurovascular imaging was associated with increased likelihood of stroke within 90 days (odds ratio, 1.3).

"Increased access to urgent neurovascular imaging in patients with TIA may represent a target that could facilitate detection and treatment of modifiable stroke risk factors," the authors write.

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TUESDAY, May 30, 2023 (HealthDay News) -- Women who experience an adverse pregnancy outcome (APO) have a higher risk of having a stroke in their lifetime, and at a younger age, according to a study published online May 22 in Stroke.

Eliza C. Miller, M.D., from Columbia University in New York City, and colleagues assessed whether APOs are associated with younger age at first stroke. Analysis included 144,306 Finnish women (316,789 births) who gave birth after 1969, with 17.9 percent having at least one pregnancy with an APO.

The researchers found that women with APOs had more comorbidities, including obesity, hypertension, heart disease, and migraine. APO was associated with lower age at first stroke, with median age at first stroke of 58.3 years for patients with no APO, versus 54.8 years in those with one APO and 51.6 years in those with recurrent APOs. Risk of stroke was greater in women with one APO (adjusted hazard ratio, 1.3) and recurrent APOs (adjusted hazard ratio, 1.4) versus those with no APO when adjusting for sociodemographic characteristics and stroke risk factors. Compared to those without APO, women with recurrent APOs had doubled the stroke risk before age 45 (adjusted odds ratio, 2.1).

"This emphasizes the need for women to share their pregnancy history with their doctors, especially if they experience neurologic symptoms concerning for stroke or transient ischemic attack that tends to resolve within minutes to hours," a author said in a statement.

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