Exacerbation of Rt MCA infarction induced by pericardial effusion in the patient with Rt Middle cerebral artery occlusion

초록

Pericardial effusion is the collection of extra-fluid in the pericardiac space. Sometimes, too much fluid could make it hard for the heart to expand normally and also put pressure on the heart, which result in preventing it from pumping efficiently. This condition is called as cardiac tamponade, This could reduce the amount of oxygenated blood flow to the brain. Cardiac tamponade can occur related to various diseases including dissecting aortic aneurysm, end-stage lung cancer, pericarditis, and renal failure. Here we described the aggravation of Rt MCA infarction in the patient with Rt MCA occlusion. The 74-year old man was admitted for sudden onset mild left hemiparesis. The initial brain MR scans indicated the multiple acute cerebral infarction in Rt MCA territory and Rt MCA(M1) occlusion with perfusion delay. He had the history of renal failture, gout and hypertension. The transthoracic echocardiography revealed mild pericardial effusion without hemodynamic compromise as well as normal cardiac function and valvular structure. Brain SPECT showed the perfusion decrease and vascular reserve in Rt MCA territory. It was the first stroke and we recommended the medical treatment and rehabiliation. After one month of the first stroke, he suffered from the mental change and aggravation of left hemiparesis, suddenly during hospitalization of the rehabilitation with mild hypotension. The brain diffusion weighted images suggested the reccurence of new infarction in the borderzone area. He did not complain of chest pain or any cardiac symptoms. He had only minimal incease in cardiac panels. The hypotension persisted irrespective of hemodialysis. We worked up for the cause of hypotension. The chest CT scans and echocardiography indicated the aggravation of pericardiac effusion. After pericardiocentesis, his blood pressure recovered and the aggravation of neurologic deficit and mentality ceased. In the patients with chronic cerebral large vessel occlusion, blood pressure