title: Clinical review of 24 patients with acute cholecystitis after acute cerebral infarction.
abstract: OBJECTIVE
  Acute cholecystitis (AC) after acute cerebral infarction is rare and has not been fully investigated. Because patients with acute cerebral infarction often cannot complain of abdominal pain due to loss of consciousness, hemiparesis and aphasia, delays in diagnosis may increase the severity of the condition. It is clearly important to identify symptoms, reach a diagnosis and provide treatment as soon as possible. The purpose of this study was to investigate the clinical features of AC after acute cerebral infarction.
  
  
  METHODS
  Among the 1,682 patients with acute cerebral infarction admitted to our hospital between April 2007 and July 2012, AC after acute cerebral infarction was diagnosed in 24 (1.4%). Data regarding age, sex, past history, fasting period, period from admission to the onset of cholecystitis, clinical type, severity of cholecystitis, diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score, National Institutes of Health Stroke Scale (NIHSS) score at onset and modified Rankin scale at 90 days were investigated.
  
  
  RESULTS
  The mean age of the 24 patients (15 men, 9 women) was 74.2±11.9 years (range, 45-90 years). The clinical type was atherothrombosis in five patients, lacunar infarction in seven patients, cardiac embolism in 10 patients and dissection in two patients. The past history included atrial fibrillation in 10 (42%) patients, hypertension in 20 (83%) patients and diabetes in 11 (46%) patients. The mean duration of fasting was 10.7 days (range, 1-32 days). The mean interval between the onset of cholecystitis and admission was 8.3 days (range, 0-24 days). The median NIHSS score at onset of cerebral infarction was 10, and 23 (96%) patients were bedridden at the onset of cholecystitis.
  
  
  CONCLUSIONS
  AC after acute cerebral infarction was frequently observed in the patients with severe hemiparesis and those who were fasted. It is important to identify symptoms, accurately diagnose the condition and provide treatment as soon as possible in order to achieve early ambulation and resumption of food intake using a feeding tube.
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukuoka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kato
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Ohe
authors.forename: Ichiro
authors.initials: I
authors.lastname: Deguchi
authors.forename: Hajime
authors.initials: H
authors.lastname: Maruyama
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Horiuchi
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Sano
authors.forename: Yuito
authors.initials: Y
authors.lastname: Nagamine
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D041881:Cholecystitis, Acute / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D015331:Cohort Studies; D005215:Fasting; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D012307:Risk Factors