Encephalopathy hemorrhagic, caused

Sarcoid affects the cerebral vessels only rarely, usually causing a generalized encephalopathy rather than focal features owing to ischemia or hemorrhage (Zajicek 2000 Gullapalli and Phillips 2004 Spencer et al. 2005). 

Thrombotic thrombocytopenic purpura is a rare acute or subacute disease in adults, rather similar to the hemolytic uremic syndrome in children, in which there is systemic malaise, fever, skin purpura, renal failure, hematuria and proteinuria. Hemorrhagic infarcts caused by platelet microthrombi occur in many organs in the brain they may cause stroke-like episodes (Matijevic and Wu 2006) although more commonly there is global encephalopathy. The blood film shows thrombocytopenia, hemolytic anemia and fragmented red cells. The differential diagnosis includes infective endocarditis, idiopathic thrombocytopenia, heparin-induced thrombocytopenia with thrombosis, systemic lupus erythematosus, non-bacterial thrombotic endocarditis and disseminated intravascular coagulation. 

Widespread hemorrhagic brain infarcts and intracranial hemorrhages tend to cause an acute or subacute global encephalopathy rather than stroke-like episodes. The diagnosis is confirmed by a low platelet count, low plasma fibrinogen, and raised fibrin degradation products and D-dimer. 

In three men with severe chronic active hepatitis, suramin treatment prolonged the prothrombin time in all three, caused a rise in bilirubin in two, and may have led to hemorrhage from esophageal varices in one patient and to hepatic encephalopathy in another (28). 

The acute stroke evaluation should be made available for all patients with a sndden-onset nenrologic deficit, the basis of the stroke syndrome. Though focal neurologic deficits are common in stroke patients, they may not be present in some conditions, for example subarachnoid hemorrhage, or they may reqnire specific sfroke expertise to be elicited, for example top of basilar artery embolus. The most difficult diagnostic problems usually occur in patients with an altered level of consciousness, especially if there are other potential causes of encephalopathy, such as alcohol intoxication, systemic illness, head trauma, etc. There is tremendous variation in the presentation of acute stroke patients. This variation depends on whether the stroke... 

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