RESUMO
BACKGROUND: While migraine, particularly migraine with aura, is a recognized risk factor for ischemic stroke, the association of migraine with silent brain infarction is a matter of debate, as studies on this topic have yielded conflicting results. METHODS: A systematic review of the literature was conducted of studies reporting migraine and silent brain infarction, assessed by magnetic resonance imaging, between January 1980 and April 2022, by consulting Medline and Embase databases. Studies with a control group were included in a meta-analysis of population-based studies. An exploratory meta-analysis of both population-based and clinical-based studies was further performed to test the association between migraine with aura and silent brain infarction. RESULTS: A total of 2,408 articles were identified, among which 24 were included in the systematic review and 10 in the meta-analysis. The meta-analysis of population-based studies showed no association of migraine with silent brain infarction (odds ratio (OR)=1.32 [95% CI 0.92;1.90], P=0.13) and migraine with aura with silent brain infarction (OR=1.56 [0.74;3.30], P=0.24). However, in the exploratory meta-analysis of population-based and clinical-based studies, migraine with aura was significantly associated with silent brain infarction (OR=1.91 [1.02;3.59], P=0.04) and to silent cerebellar infarcts (OR=2.57 [1.01;6.56], P=0.05). CONCLUSION: In this updated systematic review and meta-analysis of population-based studies, migraine and migraine with aura were not associated with silent brain infarction.
RESUMO
Large artery intracranial stenosis (ICS) is a common finding in stroke patients, but is much less prevalent in Western countries than in Asia and in young adults than in the elderly. We investigated the prevalence and causes of ICS among French young adults with ischaemic stroke. Clinical and radiological data of patients aged 18-54 years treated consecutively for acute ischaemic stroke in the anterior circulation at a tertiary stroke centre were analysed retrospectively. Patients with>50% ICS were identified. ICS was evaluated using TOF-MRA, vessel wall-MRI, digital subtraction angiography and CT-angiography. A total of 316 patients were included. ICS was diagnosed in 29 patients, resulting in a prevalence of 9.2% (95% CI, 6.2 to 13.3). The leading cause of ICS was atherosclerosis (n=13), ahead of moyamoya disease (n=4), dissection (n=2), vasculitis (n=2), and reversible cerebral vasoconstriction syndrome (n=1). The cause of ICAS could not be determined in 7 patients. ICS was found in nearly one in 10 ischaemic strokes among French young adults. Atherosclerosis was the leading cause of ICS. The cause of ICS could not be determined in almost a quarter of the patients.
Assuntos
Isquemia Encefálica , Arteriosclerose Intracraniana , AVC Isquêmico , Acidente Vascular Cerebral , Adolescente , Adulto , Idoso , Artérias , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Constrição Patológica/complicações , Constrição Patológica/epidemiologia , Humanos , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/epidemiologia , Angiografia por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: The ICA is the most common site of cervical artery dissection. Prompt and reliable identification of the mural hematoma is warranted when a dissection is clinically suspected. The purpose of this study was to assess to capacity of a standard DWI sequence acquired routinely on the brain to detect dissecting hematoma related to cervical ICA dissections. MATERIALS AND METHODS: This was a retrospective study of a cohort of 110 patients younger than 55 years of age (40 women; mean age, 46.79 years) admitted at the acute phase of a neurologic deficit, headache, or neck pain and investigated by at least a standard 3T diffusion-weighted sequence of the brain. Among them were 50 patients (14 women; mean age, 46.72 years) with subsequently confirmed ICA dissection. In the whole anonymized cohort, both a senior and junior radiologist separately assessed, on the DWI sequences only, the presence of a crescent-shaped or circular hypersignal projecting on the subpetrosal segment of the ICA arteries, assuming that it would correspond to a mural hematoma related to an ICA dissection. RESULTS: The senior radiologist found 46 subpetrosal hyperintensities in 43/50 patients with ICA dissection and none in patients without dissection (sensitivity, 86%; specificity, 100%). The junior radiologist found 48 subpetrosal hyperintensities in 45/50 patients with dissection and none in patients without dissection (sensitivity, 90%; specificity, 100%). CONCLUSIONS: In our cohort, a standard DWI sequence performed on the brain at the acute phase of a stroke or for a clinical suspicion of dissection detected nearly 90% of cervical ICA dissections.
Assuntos
Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Encéfalo/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Dissecação da Artéria Carótida Interna/complicações , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologiaRESUMO
BACKGROUND AND PURPOSE: Up to 50% of ischaemic strokes in young adults are classified as cryptogenic despite extensive work-up. We sought to evaluate the prevalence of non-obstructive carotid atherosclerosis (NOCA) and its association with patent foramen ovale (PFO) in young adults with cryptogenic stroke (CS). METHODS: Patients aged 18-54 years, consecutively treated for first-ever CS in an academic stroke service, were included. NOCA was assessed using carotid ultrasound examination and was defined as carotid plaque with <50% stenosis. PFO was diagnosed with transesophageal echocardiography. RESULTS: A total of 164 patients [mean age (SD) = 43.7 (8.5) years; 104 men] were included. A PFO was found in 79/164 (48.2%) patients. NOCA was demonstrated in 41/164 (25%) patients. NOCA was more common in patients without PFO [37.6% vs. 11.4%, P < 0.001; adjusted odds ratio (95% confidence interval), 0.24 (0.10-0.56)]. Older age (P = 0.046) and subcortical location of cerebral infarct (P = 0.015) were also associated with the absence of PFO, whereas hypertension, diabetes and smoking were not. CONCLUSIONS: This study demonstrates that NOCA is common in young adults with CS. NOCA is negatively associated with PFO. Detecting NOCA is an important component of stroke investigation in young adults.
Assuntos
Isquemia Encefálica/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Forame Oval Patente/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Isquemia Encefálica/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Feminino , Forame Oval Patente/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Population-based studies have shown a heightened prevalence of clinically silent brain infarcts in subjects who have migraine with aura (MA). We sought to determine whether this association could be confirmed in young patients with cryptogenic ischemic stroke, and explored the role of patent foramen ovale (PFO) as a potential underlying mechanism. METHODS: Patients were selected from a registry of young patients consecutively treated for ischemic stroke in a tertiary university hospital among those without definite cause of stroke. Patients with PFO were matched for age and gender with patients with normal atrial septum. Migraine and MA were evaluated after patient selection and matching. Silent brain infarcts were independently evaluated on MRI. RESULTS: We included 100 patients [60 men; mean age (SD), 44.8 years (8.3)], 50 patients with PFO. We found silent brain infarcts in 36 patients and MA in 13 patients. MA was more frequent in patients with silent brain infarcts than in patients without silent brain infarcts (25.0% vs. 6.3%; OR, 5; 95% CI, 1.4-17.6; P = 0.01). Traditional cardiovascular risk factors were not associated with silent brain infarcts. PFO was neither associated with MA (OR, 1.7; 95% CI, 0.5-5.3) nor silent brain infarcts (OR, 0.7; 95% CI, 0.3-1.5). The association of MA with silent brain infarcts was not altered after adjustment for PFO. CONCLUSION: Findings suggest that silent brain infarcts in young patients with cryptogenic stroke is associated with MA. We found no evidence for a mediating effect of PFO on this association.
Assuntos
Infarto Encefálico/epidemiologia , Forame Oval Patente/epidemiologia , Enxaqueca com Aura/epidemiologia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
BACKGROUND AND PURPOSE: Patients with transient ischaemic attack (TIA) with a high risk of imminent stroke can be identified with the ABCD(2) score and findings on MRI and CT angiography. The predictive value of transcranial color-coded sonography (TCCS) has not been evaluated in this setting. METHODS: A retrospective analysis was conducted of patients consecutively treated for TIA or minor stroke in a TIA clinic within 24 h of symptom onset. Agreement between TCCS and MRI three-dimensional time-of-flight images for the diagnosis of proximal (internal carotid artery, vertebral artery, basilar artery, circle of Willis and main stem of the middle cerebral artery) >50% stenosis or occlusion of the intracranial symptomatic artery was evaluated. The sensitivity, specificity, predictive values and likelihood ratio of TCCS for predicting recurrent TIA/stroke at 7 days were calculated. RESULTS: Of 159 patients with a TIA or minor stroke within the last 24 h, 142 had a readable acoustic temporal bone window (89.3%). TCCS and MRI were performed within 4 h of each other in 116 patients. MRI showed a symptomatic proximal intracranial steno-occlusive lesion in six patients. Agreement between MRI and TCCS was perfect (κ coefficient = 1). Recurrent TIA/stroke occurred in 10 patients (eight TIA and two minor strokes). All recurrences occurred within 24 h of symptom onset. A symptomatic proximal intracranial steno-occlusive lesion was found on TCCS in 4/10 patients with recurrence and 3/132 patients without recurrence [sensitivity 40%; specificity 97.7%; likelihood ratio 18.1; odds ratio (95% CI) adjusted for ABCD(2) score 31.5 (4.5-218.6)]. CONCLUSION: Our study shows that TCCS can be used to guide triage of patients with TIA.
Assuntos
Isquemia Encefálica/diagnóstico por imagem , Ataque Isquêmico Transitório/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Doppler Transcraniana/métodos , Doenças Arteriais Cerebrais/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Interpretação Estatística de Dados , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Estudos RetrospectivosRESUMO
BACKGROUND AND PURPOSE: Patterns of DWI findings that predict recurrent ischemic events after TIA are well-established, but similar assessments of intracranial MRA findings are not available. We sought to determine the imaging characteristics of MRA that are predictive of early recurrent stroke/TIA in patients with TIA. MATERIALS AND METHODS: We performed a retrospective analysis of 129 consecutive patients with a clinical diagnosis of TIA in whom MR imaging was done within 24 hours of symptom onset. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of >50% stenosis or occlusion of symptomatic intracranial arteries for recurrent stroke/TIA at 7 days after TIA. We used logistic regression analysis to adjust for the clinical ABCD(2) score. We performed this analysis for symptomatic steno-occlusive lesions at any site and symptomatic steno-occlusive lesions on proximal large intracranial arteries (internal carotid artery, vertebral artery, basilar artery, and circle of Willis). RESULTS: Forty-two (32.5%) patients had acute ischemic lesions on DWI; 16 (12.4%) had significant MRA lesions, of which 11 (8.5%) were on proximal vessels. Nine patients had early recurrence (TIA, 7; minor stroke, 2). Only patients with proximal MRA lesions were at higher risk of early recurrence independent of the ABCD(2) score (adjusted odds ratio, 5.5; 95% confidence interval, 1.1-27.8; P = .04). CONCLUSIONS: Proximal lesions of cerebral arteries seen on MRA were predictive of recurrent stroke/TIA at 7 days. These findings suggest that MRA could be used to improve the selection of patients with TIA at high risk of early recurrent stroke/TIA.
Assuntos
Doenças Arteriais Intracranianas/diagnóstico , Doenças Arteriais Intracranianas/epidemiologia , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Angiografia por Ressonância Magnética/estatística & dados numéricos , Idoso , Comorbidade , Constrição Patológica/diagnóstico , Constrição Patológica/epidemiologia , Feminino , França/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Prognóstico , Recidiva , Fatores de RiscoRESUMO
Patent foramen ovale (PFO) is a common finding in healthy subjects and has not been associated with increased risk of ischemic stroke in population-based cohort studies. Nevertheless, case-control studies have consistently shown an increased prevalence of PFO in cryptogenic stroke, suggesting that PFO might be a cause of stroke. The risk of stroke recurrence in patients with cryptogenic stroke and PFO is low under aspirin therapy but may be substantially higher in patients with an associated atrial septal aneurysm (ASA). The mechanisms of stroke associated with PFO or ASA are uncertain. Paradoxical embolism through the PFO is rarely documented. The optimal treatment for secondary prevention in patients with cryptogenic stroke and PFO is still uncertain and debated. A randomized controlled trial failed to demonstrate the superiority of transcatheter PFO closure over medical therapy. Whether anticoagulation is superior to aspirin should be tested in a randomized controlled trial.
Assuntos
Isquemia Encefálica/etiologia , Forame Oval Patente/complicações , Aneurisma Cardíaco/complicações , Acidente Vascular Cerebral/etiologia , Septo Interatrial , Aneurisma Cardíaco/diagnóstico por imagem , Humanos , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controle , UltrassonografiaRESUMO
BACKGROUND AND PURPOSE: Alteration of the cerebrovascular reserve (CVR) in the frontal lobes has been associated with cognitive dysfunction in adults with moyamoya disease (MMD). Elevation of the apparent diffusion coefficient (ADC) in normal-appearing white matter on conventional MRI may occur as a consequence of chronic haemodynamic failure. In the present study, the authors examined the relation of ADC with CVR and cognitive dysfunction in adults with MMD. METHODS: The authors measured ADC and CVR in the normal-appearing frontal white matter. CVR was calculated using dynamic susceptibility contrast-enhanced MRI and the acetazolamide challenge. A standardised and validated neuropsychological assessment test battery focusing on executive function was used. RESULTS: 14 patients, 9 women and 5 men (mean age 36.6±12.9 years), were included. The authors found executive dysfunction in 7 of 13 tested patients. ADC and CVR were negatively correlated (Spearman coefficient: -0.46; p=0.015). Elevation of ADC predicted executive dysfunction (area under receiver operating characteristic curve (95% CI): 0.85 (0.59 to 1.16); p=0.032). CONCLUSION: Elevation of ADC in the normal-appearing frontal white matter of adults with MMD was associated with reduced CVR and executive dysfunction. This preliminary study suggests that measurement of ADC might be used to detect patients at risk for cerebral ischaemia and cognitive impairment.
Assuntos
Transtornos Cognitivos/fisiopatologia , Função Executiva/fisiologia , Lobo Frontal/fisiopatologia , Doença de Moyamoya/fisiopatologia , Fibras Nervosas Mielinizadas/fisiologia , Neuroimagem/psicologia , Imagem de Perfusão/psicologia , Acetazolamida , Adulto , Transtornos Cognitivos/complicações , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Difusão por Ressonância Magnética/psicologia , Feminino , Lobo Frontal/irrigação sanguínea , Humanos , Masculino , Neuroimagem/métodos , Testes Neuropsicológicos/estatística & dados numéricos , Imagem de Perfusão/métodosRESUMO
OBJECTIVES: We attempted to classify causes of ischemic stroke in young adults using a progressive diagnostic algorithm and the ASCO (atherosclerosis, small-vessel disease, cardiac source, other cause) classification system. METHODS: Patients aged 16-54 years consecutively treated for acute ischemic stroke in a tertiary stroke unit were included in this retrospective analysis. Causes of stroke were classified using the ASCO system, which assigns a graded level of likelihood to each potential cause in individual patients. The initial etiologic workup included brain imaging, magnetic resonance or CT angiography of cerebral and cervical vessels, EKG, and routine blood studies. Patients without a definite cause of ischemic stroke after initial evaluation underwent transesophageal echocardiography. RESULTS: We included 318 patients (195 men and 123 women); 131 patients were aged 16-44 years, and 187 were aged 45-54 years. A definite cause of stroke (ASCO grade 1) could be identified in 145 patients (45.5%). An uncertain cause of stroke (ASCO grade 2) was found in 59 (18.5%) further patients. Most (130 of 145) definite causes were identified by initial evaluation. The 2 major definite or uncertain causes of stroke were patent foramen ovale associated with atrial septal aneurysm (PFO-ASA) (20 of 131 [15.3%]) and dissection of the cervical or cerebral artery (19 of 131 [14.5%]) in patients aged 16-44 years and large-vessel atherosclerosis (37 of 187 [19.8%]) and PFO-ASA (23 of 187 [12.3%]) in patients aged 45-54 years. CONCLUSIONS: Our findings suggest that PFO-ASA may be a major cause of ischemic stroke in young adults.
Assuntos
Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Diagnóstico por Imagem/métodos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Adolescente , Adulto , Aneurisma/complicações , Aneurisma/diagnóstico , Aneurisma/patologia , Aterosclerose/complicações , Aterosclerose/diagnóstico , Aterosclerose/patologia , Septo Interatrial/patologia , Isquemia Encefálica/classificação , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/classificação , Adulto JovemRESUMO
HYPOTHESIS: The mechanisms underlying impairment of dynamic cerebral autoregulation in diabetes are not well known. Cardiovascular autonomic neuropathy (CAN) could contribute to dynamic cerebral autoregulation impairment. In this study, we assessed the association between CAN and impairment of dynamic cerebral autoregulation in patients with type 1 diabetes. METHODS: We evaluated dynamic cerebral autoregulation (DCA) in patients with type 1 diabetes and no history of cerebrovascular disease. DCA was assessed with transcranial Doppler using the correlation coefficient index Mx method. Mx was calculated from slow changes in mean cerebral blood flow velocity and mean arterial blood pressure. Increase in Mx indicates weaker DCA, with a threshold for impaired DCA above 0.3. Moderate CAN was defined as reduced heart rate variability (HRV) on the following tests: deep controlled breathing, Valsalva maneuver or initiation of active standing. Severe CAN was defined as reduced HRV associated with orthostatic hypotension. RESULTS: 60 patients were included (M/F: 33/27; mean age ± SD: 46 years ± 11.5). 23 patients had moderate CAN and 15 patients severe CAN. DCA was impaired in 37 patients. CAN was associated with impaired DCA (p = 0.005). Impairment of DCA was more pronounced in patients with severe CAN (p = 0.019). Glycosylated haemoglobin (HbA1c) was associated with impaired DCA in univariate analysis (p = 0.05). In multivariate analysis, only CAN was associated with impaired DCA (p = 0.007) whereas HbA1c was not (p = 0.161). CONCLUSIONS: CAN was associated with impaired DCA in type 1 diabetes. The magnitude of DCA impairment increased with the severity of CAN.
Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Encéfalo/irrigação sanguínea , Circulação Cerebrovascular/fisiologia , Diabetes Mellitus Tipo 1/fisiopatologia , Neuropatias Diabéticas/fisiopatologia , Homeostase/fisiologia , Adulto , Idoso , Doenças do Sistema Nervoso Autônomo/etiologia , Encéfalo/fisiopatologia , Diabetes Mellitus Tipo 1/complicações , Neuropatias Diabéticas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Unruptured intracranial artery aneurysms (IAs) can be revealed by cerebral ischemia. Little is known on the clinical course and outcome of patients with this condition. We report our findings in a consecutive series of 15 such patients. METHODS: We retrospectively analyzed patients with ischemic stroke (IS) or transient ischemic attack (TIA), unruptured IA on the symptomatic cerebral artery, and no other potential cause of cerebral ischemia consecutively treated in a tertiary stroke unit. RESULTS: Fifteen patients (ten women, and five men) were identified. Their mean age was 49.7 years (range, 37-80 years). Ten patients presented with IS, and five with TIA. The median diameter of IA was 7.5mm (range, 2.5-23 mm). Aneurysm thrombosis was found on imaging in 9/10 patient with IS, and 1/5 patients with TIA (p=0.017). Thirteen patients were given an antiplatelet agent. Mean follow-up until last visit or treatment of aneurysm was 393 days (median 182 days; range, 6-1825 days). There was no ischemic recurrence. Partial or complete recanalization of aneurysm thrombosis occurred in 7/10 patients. Two patients, both with initial aneurysmal thrombosis and on antiplatelet therapy, experienced aneurysm rupture. CONCLUSION: Unruptured IA is a rare cause of IS/TIA. IS is associated with aneurysm thrombosis. Our findings suggest that aneurysm thrombosis is a dynamic process which is associated with a low rate of ischemic recurrence on antiplatelet therapy but may be followed by subarachnoid hemorrhage.
Assuntos
Isquemia Encefálica/etiologia , Aneurisma Intracraniano/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Feminino , Seguimentos , Humanos , Ataque Isquêmico Transitório/etiologia , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Hemorragia Subaracnóidea/etiologia , Trombose/etiologiaRESUMO
OBJECTIVE: Isolated, non-traumatic, cortical subarachnoid haemorrhage (cSAH) is a rare type of cerebrovascular disease caused by various disorders. In a few cases, especially in the elderly, no apparent cause can be identified. We report a case series of patients without apparent cause of cSAH. We aimed to determine whether cerebral amyloid angiopathy (CAA) could be a common cause of cSAH. METHODS: We retrospectively analysed clinical and radiological data of consecutive patients admitted to a tertiary stroke unit with cSAH. All patients had brain MRI as a part of their initial evaluation and a repeat examination during follow-up. RESULTS: Amongst 25 patients with cSAH, 10 patients had no apparent cause of cSAH (six men and four women; mean age ± SD: 73.8 ± 8.5 years). All patients with no apparent cause presented with single or recurrent focal transient neurological symptoms of short duration. Only one patient experienced headache. cSAH was limited to one or two sulci, mostly the central sulcus. MRI showed the evidence of prior asymptomatic bleeding in 9/10 patients: cortical hemosiderosis (9/10), lobar intracerebral haemorrhage (ICH) (6/10) and cortical microbleeds (9/10). Eight of ten patients met the Boston criteria for probable CAA and 2/10 for possible CAA. During follow-up, three patients had recurrent bleeding: cSAH (2) and lobar ICH (1). CONCLUSIONS: Our findings suggest that CAA could be a common cause of cSAH in the elderly with a fairly uniform clinical presentation. In addition to prior cortical bleeding (ICH, MBs), most patients from the present series had evidence of focal cortical hemosiderosis likely corresponding with prior unrecognized cSAH and suggesting that cSAH was a recurrent event.
Assuntos
Angiopatia Amiloide Cerebral/complicações , Angiopatia Amiloide Cerebral/patologia , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
Our aim was to review the etiologic background of isolated acute nontraumatic cSAH. While SAH located in the basal cisterns originates from a ruptured aneurysm in approximately 85% of cases, a broad spectrum of vascular and even nonvascular pathologies can cause acute nontraumatic SAH along the convexity. Arteriovenous malformations or fistulas, cortical venous and/or dural sinus thrombosis, and distal and proximal arteriopathies (RCVS, vasculitides, mycotic aneurysms, Moyamoya, or severe atherosclerotic carotid disease) should be sought by noninvasive imaging methods or/and conventional angiography. Additionally, PRES may also be a source of acute cSAH. In elderly patients, cSAH might be attributed to CAA if numerous hemorrhages are demonstrated by GRE T2 images. Finally, cSAH is rarely observed in nonvascular disorders, such as abscess and primitive or secondary brain tumors.
Assuntos
Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Doença Aguda , Algoritmos , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Encefalite/complicações , Encefalite/diagnóstico por imagem , Humanos , RadiografiaRESUMO
BACKGROUND AND PURPOSE: Moyamoya disease is rare among non-Asian populations and its clinical features are ill-defined. We report 12 new cases of Moyamoya disease in French, non-Asian adults. METHODS: We identified adults with Moyamoya disease managed at a French University Hospital from 1998 through 2006. We reviewed baseline clinical and radiological data and collected follow-up data between March and June 2008. The risk of recurrent stroke was determined using the Kaplan-Meier method. RESULTS: Twelve patients, 10 women and two men, were included. The mean age at baseline was 31.1 years. The initial clinical manifestation was ischemic stroke in 10 patients. The disease was clinically asymptomatic in two patients. The mean follow-up in the 10 symptomatic patients was 52.4 months. Only one patient was surgically treated. The one and five-year risk of recurrent stroke were both 50%. At the end of the follow-up, one patient was dead, four patients had no functional impairment (grade 0-1 on the Rankin scale), and seven patients had moderate functional impairment (grade 2-3 on the Rankin scale). A cognitive dysfunction as identified by failure on the Trail Making Test part B was found in six of ten patients evaluated. CONCLUSION: Moyamoya disease in this cohort of French, non-Asian adults was associated with high rates of both recurrent stroke and cognitive impairment. The findings suggest that Moyamoya disease in non-Asian adults is a potentially severe disease.
Assuntos
Doença de Moyamoya/patologia , Adolescente , Adulto , Angiografia Cerebral , Circulação Cerebrovascular , Progressão da Doença , Feminino , França , Humanos , Estimativa de Kaplan-Meier , Angiografia por Ressonância Magnética , Masculino , Doença de Moyamoya/diagnóstico , Doença de Moyamoya/diagnóstico por imagem , Testes Neuropsicológicos , Recidiva , Acidente Vascular Cerebral/etiologia , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for stroke. Impairment of cerebral autoregulation may play a potential role in the pre-disposition to stroke of OSAS patients. In this study, we aimed to assess dynamic cerebral autoregulation (DCA) during wakefulness in OSAS patients and a group of matched controls. METHODS: Patients and controls were examined in the morning after an overnight complete polysomnography. Mean cerebral blood flow velocity (CBFV) in the middle cerebral artery and mean arterial blood pressure (ABP) were continuously recorded using transcranial Doppler and Finapres. DCA was assessed using the Mx autoregulatory index. Mx is a moving correlation coefficient between mean CBFV and mean ABP. More positive value of Mx indicates worse autoregulation. RESULTS: Eleven OSAS patients (mean age +/- SD; 52.6 +/- 7.9) and 9 controls (mean age +/- SD; 49.1 +/- 5.3) were enrolled. The mean apnea-hypopnea index (AHI) in the OSAS group was of 22.7 +/- 11.6. No significant difference was found between the two groups as for age, body mass index, mean ABP and endtidal CO(2) pressure. Cerebral autoregulation was impaired in OSAS patients compared with controls (Mx index: 0.414 +/- 0.138 vs. 0.233 +/- 0.100; P = 0.009). The severity of autoregulation impairment correlated to the severity of the sleep respiratory disturbance measured by the AHI (P = 0.003). CONCLUSION: Cerebral autoregulation is impaired in patients with OSAS during wakefulness. Impairment of cerebral autoregulation is correlated with the severity of OSAS.
Assuntos
Cérebro/fisiopatologia , Homeostase , Apneia Obstrutiva do Sono/fisiopatologia , Vigília/fisiologia , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Dióxido de Carbono/metabolismo , Circulação Cerebrovascular/fisiologia , Cérebro/irrigação sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Polissonografia , Pressão , Fluxo Sanguíneo Regional , Análise de RegressãoAssuntos
Calcinose/diagnóstico por imagem , Cálcio/metabolismo , Estenose das Carótidas/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/metabolismo , Acidente Vascular Cerebral/diagnóstico por imagem , Encéfalo/irrigação sanguínea , Encéfalo/fisiopatologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Circulação Cerebrovascular/fisiologia , Endarterectomia das Carótidas , Humanos , Embolia Intracraniana/cirurgia , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate the association of atrial septal abnormalities--patent foramen ovale (PFO), atrial septal aneurysm (ASA), or the combination of both (PFO+ASA)--with cryptogenic stroke or transient ischemic attack (TIA) in older patients. METHODS: We examined the prevalences of PFO, ASA, and PFO+ASA in 132 consecutive patients aged 55 years or more who underwent transesophageal echocardiography (TEE) for evaluation of ischemic stroke or TIA. We compared patients with cryptogenic stroke/TIA and those with stroke/TIA of known cause. RESULTS: PFO+ASA was more common in patients with cryptogenic stroke/TIA than in patients with stroke/TIA of known cause (12/62 or 19% vs. 2/70 or 3%; adjusted odds ratio, 7.4; 95% CI, 1.4-38.2). Differences between groups for isolated PFO, and isolated ASA were not significant. The association of PFO+ASA with cryptogenic stroke/TIA was confirmed in the subgroup of patients aged 75 years or more (odds ratio, 15.0; 95% CI, 1.5-146.7). CONCLUSION: This study indicates a significant association of PFO+ASA with cryptogenic stroke or TIA in older patients.
Assuntos
Isquemia Encefálica/epidemiologia , Comunicação Interatrial/complicações , Comunicação Interatrial/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Aórtico/complicações , Aneurisma Aórtico/epidemiologia , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Ecocardiografia Transesofagiana , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/epidemiologia , Comunicação Interatrial/diagnóstico por imagem , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios XRESUMO
Whereas International Headache society (IHS) criteria of carotidynia were defined in 1988, its validity as a distinct nosological entity has recently been questioned, leading this entity to be removed from the second IHS classification in 2004. We report the case of a 30-year-old woman who developed a pain located at the left carotid bulb, associated with typical findings on ultrasonography and MRI. We discuss new criteria and denomination of this clinical entity.
Assuntos
Doenças das Artérias Carótidas/diagnóstico , Transtornos da Cefaleia/classificação , Transtornos da Cefaleia/complicações , Transtornos da Cefaleia/diagnóstico , Adulto , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Feminino , Transtornos da Cefaleia/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Cervicalgia/diagnóstico , Cervicalgia/diagnóstico por imagem , Cervicalgia/etiologia , UltrassonografiaRESUMO
Familial hypokalemic periodic paralysis (FHPP) is a rare inherited disease characterized by a dysfunction of the membrane ion channels. Clinical manifestations are attacks of hypokaliemia with flaccid muscle paralysis. Paralysis is sometimes severe but always reversible with symptomatic treatment. Pregnancy and delivery have been reported to exacerbate FHPP. Authors report a case of FHPP during pregnancy with a favourable outcome. Vaginal delivery is usually possible with monitoring and epidural analgesia, avoiding active maternal expulsive efforts (passive descent of the fetus and elective outlet forceps) and other stimulating factors (carbohydrate loads, maternal stress, betamimetics, epinephrine...). Administration of IV potassium supplementation is often necessary.