Kata Pengantar Buku Student Exercise Series Pemrograman Web Database
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Dengan buku ini , Anda akan mempelajari bahasa skrip untuk Web yang diberi
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Talkback A condition of a text situated in a book is that it does not talkback.
Rather, it exists as a reading stasis; so a one-sided discourse; like a trick mirror
that absorbs instead of reflects. Perhaps it was the sense of philosophical
dialogue that ...
Introduction:Carotid Web (CW) is a rare cause of Ischemic Stroke (IS) in young people. It is a nonatheroscherotic alteration of carotid artery (CA), identified radiographically as a shelf-like intraluminal filling defect on the posterolateral wall of proximal internal carotid artery (ICA). CW etiology is unknown.We report a case of a young man with left CW and IS on ipsilateral Middle Cerebral Artery (MCA) territory. Case Description:A 49-years-old man was admitted to the emergency department 45 minutes after sudden onset of right hemiparesis and aphasia (NIHSS 9). He had no previous pathology and did not use medical treatment. CT perfusion showed hypoperfusion on the left temporo-parietal lobe and a steno-occlusion of distal M1 segment of left MCA. According to International Guidelines we started intravenous thrombolysis (IV) 90 minutes after symptoms onset, followed by catheter-based cerebral thrombectomy 20 minutes later, with improvement of neurological status (NIHSS=4). Cerebral Angiography showed a shelf-like intraluminal filling defect along the posterior wall of left proximal ICA with classical stasis of intravenous contrast distal to the CW. We decided to perform endovascular stenting of CW 5 days later, followed by dual antiplatelet therapy. Workup for hypercoagulability and vasculitis was normal. Renal Doppler Ultrasound was negative. MRI showed small left parietal ischemic lesion. Patient was discharged a week after stroke onset (NIHSS=0). Conclusions:CW has been accepted as a cause of 9.4-37% of cryptogenic strokes. Further studies are needed to investigate the underlying mechanism, possibly secondary to blood stasis along web surface, resulting in thrombus formation and embolism.
BACKGROUND AND AIMS:Carotid Web (CW) is a rare variant of fibromuscular dysplasia in which a band of tissue narrows the carotid lumen, and is associated with recurrent ischemic stroke, secondary to blood flow stasis and subsequent embolization. Literature revealed high stroke recurrence rate related to medical treatment whereas carotid stenting seems to be safe and efective in secondary prevention. Nevertheless, evidence and the optimal management is unclear.METHODS:Case report.RESULTS:A 61 year-old male with previous history of smoking and hypertension treated with doxazosin was admitted in our Comprehensive Stroke Center with acute right hemiparesis, hemihypoesthesia and aphasia (NIHSS 9). Non contrast CT and CT angiography showed ASPECTS 10/10 and distal carotid occlusion. CT perfusion revealed ischemic penumbra. He underwent intravenous fibrinolysis and mechanical thrombectomy (TICI 3) with progressive improvement of symptoms. Digital angiography revealed carotid web variant with lumen stenosis of left internal carotid artery (ICA). Prolonged heart rhythm monitoring did not revel any arrytmia. Blood tests including thrombophilya studies and ultrasound echocardiography were normal. Elective angioplasty and stenting of ICA was performed followed by dual antiplatelet therapy with aspirin and clopidogrel. Patient was discharged 11 days after symptoms onset with mild distal paresis of right arm. No recurrence was reportedCONCLUSIONS:There is an association between carotid artery web and ischemic stroke. Angioplasty might be safe a feasible for secondary prevention.
BACKGROUND AND AIMS:Carotid Web (CW) is a rare variant of fibromuscular dysplasia in which a band of tissue narrows the carotid lumen, and is associated with recurrent ischemic stroke, secondary to blood flow stasis and subsequent ...