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Eka Melson, Sidra Amir, Lisa Shepherd, Samina Kauser, Bethan Freestone and Punith Kempegowda

infarction; (ii) evidence of non-obstructive coronary arteries on angiography; (iii) no clinically overt specific cause for the acute presentation ( 5 ). We highlight in this case report the importance of identifying and investigating for an underlying

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Joanna Prokop, João Estorninho, Sara Marote, Teresa Sabino, Aida Botelho de Sousa, Eduardo Silva and Ana Agapito

(May and August 2016), which resulted in aphasia and hemiparesis. Cerebral angiography revealed vascular lesions compatible with vasculitis and stenosis of right cerebral anterior artery and left middle cerebral artery. These complications and clinical

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Jonathan Brown and Luqman Sardar

preceding symptoms contributed to the fall itself; however, this is speculation and the sequence of events is difficult to establish. CT angiogram of the head showed no aneurysms, which was confirmed on cerebral catheter angiography. Her cognition during

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Varalaxmi Bhavani Nannaka and Dmitry Lvovsky

spontaneous coronary vasospasm documented on angiography in a hyperthyroid patient was reported in 1979 ( 4 ). Patients with thyrotoxicosis-induced AMI are rare and almost all reported cases have been associated with Graves’ disease. We describe a very rare

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Yasuhiro Oda, Masayuki Yamanouchi, Hiroki Mizuno, Rikako Hiramatsu, Tatsuya Suwabe, Junichi Hoshino, Naoki Sawa, Kenichi Ohashi, Takeshi Fujii and Yoshifumi Ubara

proliferative diabetic retinopathy was performed twice. Angina pectoris occurred at the age of 63 years; coronary angiography revealed 90% stenosis of the proximal segment of the right coronary artery, and hence, stent implantation was performed. Multiple

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Julian Choi, Perin Suthakar and Farbod Farmand

’ appearance on angiography. Stenotic lesions in MMD are described to have intimal fibrocellular thickening, expansion of elastic lamina and attenuation of media. MMVs vary morphologically as dilated arteries with thin walls or thickened walls with stenosis and

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Ana Gonçalves Ferreira, Tiago Nunes da Silva, Sofia Alegria, Maria Carlos Cordeiro and Jorge Portugal

dysfunction. In this setting, an emergency coronary angiography was performed and revealed the already known 90% LAD artery occlusion that was not treated in 2001 and now treated with angioplasty/stenting. After the procedure, he became more hypotensive (BP 90

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J K Witczak, N Ubaysekara, R Ravindran, S Rice, Z Yousef and L D Premawardhana

TRAb: 9.3. At time of decompensation Echocardiography revealed features of severe dilated cardiomyopathy (DCM) with a left ventricular EF of 12% and spherical heart geometry ( Fig. 1 ). Comprehensive investigations (including coronary angiography

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M S Draman, H Thabit, T J Kiernan, J O'Neill, S Sreenan and J H McDermott

Summary

Silent myocardial ischaemia (SMI), defined as objective evidence of myocardial ischaemia in the absence of symptoms, has important clinical implications for the patient with coronary artery disease. We present a dramatic case of SMI in a diabetes patient who attended annual review clinic with ST elevation myocardial infarction. His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day. His angiogram showed diffused coronary artery disease. We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes.

Learning points

  • Silent myocardial ischaemia (SMI) is an important clinical entity.
  • SMI is common and occurs with increased frequency in patients with diabetes.
  • SMI is an independent predictor of mortality.
  • Recognition may lead to early intervention.

Open access

Anita Kuriya, David V Morris and Michael H Dahan

Summary

Cerebral vascular accidents are caused by vasospasm when induced by preeclampsia or by dopamine agonists. However, six arteries nourish the pituitary and prevent against vasospasm-induced damage, which up until now has not been thought to occur. Bromocriptine was used to arrest lactation in a 31-year-old with secondary amenorrhea following preeclampsia and fetal demise at 28 weeks gestation. Tests and history revealed panhypopituitarism not associated with hemorrhage or mass infarction but instead caused by vasospasm. The present study is the first report of pituitary damage from a non-hemorrhagic, vaso-occlusive event in the literature. In keeping with Sheehan's and Simon's syndromes, we have named pituitary damage resulting from vaso-occlusion as Dahan's syndrome, and a literature review suggests that it may be a common and previously overlooked disorder.

Learning points

  • Vasospasm can cause damage to the pituitary gland, although it was not previously believed to do so.
  • Preeclampsia and the use of a dopamine agonist, particularly in the peripartum state, may trigger vasospasm.
  • Vasospasm resulting from dopamine agonists may be a common cause of injury to the pituitary gland, and it may have been overlooked in the past.