J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 8, Number 7, July 2017, pages 219-223

Acute Ischemic Stroke Associated With OrthoVisc (Hyaluronic Acid) Injection

Figures

Figure 1. Acute ischemic left cerebellar infarct on MRI (arrows). (a) Diffusion-weighted imaging showing hyperattenuation in the left cerebellum posterior to the pons and the third ventricle. (b) Corresponding apparent diffusion coefficient map showing the hypoattenuation of the same location in the left cerebellum suggestive of acute infarct.

Figure 2. CT angiogram of the head in patient with acute ischemic left cerebellar infarct. Note the absence of left anterior inferior cerebellar artery (AICA) as opposed to the right AICA (arrow).

Table

**Table 1.** Patient’s Pertinent Laboratory Data
Labs	Value	Units	Reference range
LDL: low-density lipoprotein; HDL: high-density lipoprotein; VLDL: very low-density lipoprotein; BUN: blood urea nitrogen; ALT: alanine aminotransferase; AST: aspartate aminotransferase; hsCRP: high-sensitive C-reactive protein; ESR: erythrocyte sedimentation rate; WBC: white blood cell; RBC: red blood cell; RDW: red cell distribution width; PT: prothrombin time; INR: international normalized ratio; PTT: partial thromboplastin time.
Lipid panel
Total triglyceride	164	mg/dL	30 - 150
Total cholesterol	189	mg/dL	< 199
LDL cholesterol	110	mg/dL	< 100
HDL cholesterol	46	mg/dL	> 41
VLDL cholesterol	33	mg/dL	< 30
Total cholesterol/HDL	4.1
LDL/HDL	2.4
Chemistry
Sodium	139	mmol/L	135 - 145
Potassium	4.1	mmol/L	3.4 - 5.5
Chloride	102	mmol/L	95 - 105
CO₂	24	mmol/L	20 - 30
BUN	14	mg/dL	7 - 22
Creatinine	1.0	mg/dL	0.44 - 1.03
Fasting blood glucose	101	mg/dL	70 - 99
Calcium	9.1	mg/dL	8.4 - 10.8
Magnesium	2.1	mg/dL	1.7 - 2.3
HbA1C	5.2	%	3.5 - 5.5
Liver function
Total protein	6.7	g/dL	6.4 - 8.2
Albumin	4.3	g/dL	3.4 - 5.0
ALT	20	units	12 - 78
AST	15	units	15 - 37
Total bilirubin	0.8	mg/dL
Alkaline phosphatase	39	units	45 - 117
Inflammation markers
HsCRP	1.78	mg/dL	< 3.5
ESR	8	mm/h	0 - 20
Complete blood count
WBC	7.6	10³/µL	4.0 - 11.0
RBC	4.85	10⁶/µL	3.8 - 5.2
Hemoglobin	15.4	g/dL	12.0 - 15.4
Hematocrit	45.6	%	35 - 45
RDW	13	%	11.5 - 14.5
Platelet	282	10³/µL	150 - 400
Coagulation
Prothrombin time	12	s	9.0 - 11.6
INR	0.89		2.0 - 3.0
PTT	23.8	s	24.0 - 32.0