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http://dx.doi.org/10.5762/KAIS.2017.18.10.178

Feature of cerebral infarction with tsutsugamushi disease  

Choi, Pahn Kyu (Department of Neurology, Chosun University School of Medicine)
Kang, Hyun Goo (Department of Neurology, Chosun University School of Medicine)
Publication Information
Journal of the Korea Academia-Industrial cooperation Society / v.18, no.10, 2017 , pp. 178-184 More about this Journal
Abstract
This study was performed on 16 patients diagnosed with tsutsugamushi disease and cerebral infarction from January 2007 to December 2015. An acute cerebral infarction was diagnosed by brain MRI and MRA. Tsutsugamushi disease was diagnosed using a polymerase chain reaction. To distinguish the difference between the generalized cerebral infarction and infarction with tsutsugamushi disease, the blood pressure and body temperature were measured uponadmission. In general, the blood pressure increases during an acute cerebral infarction. Interestingly, in this study, 12 patients showed a systolic blood pressure less than 130 mmHg uponadmission. The location of the cerebral infarction and whether single or multiple cerebral infarction were examined. Thirteen patients had a cerebral infarction in anterior circulation and 3 patients developed in posterior circulation. To evaluate the coagulation disorders, prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, fibrinogen, fibrin degradation product (FDP). D-dimer, which is generally known to increase in an acute cerebral infarction, showed a significant increase in the 13 patients. Fibrin degradation products (FDP) showed a significant increase in 15 patients. The pathophysiological mechanism of tsutsugamushi disease is known as vasculitis, which may result in an endothelial cell injury and proliferation of the endothelial wall, which may lead to a cerebral infarction accompanied by coagulopathy. Without endothelial cell damage and proliferation, a vasospasm caused by vasculitis may cause vasoconstriction and cerebral infarction.
Keywords
Cerebral infarction; Coagulopathy; Endothelial cell injury; TsuTsugamushi disease; Vasculitis;
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