Asunto(s)
Ilusiones , Palmitato de Paliperidona , Distorsión de la Percepción , Esquizofrenia/tratamiento farmacológico , Percepción Visual/efectos de los fármacos , Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Sustitución de Medicamentos/métodos , Tractos Extrapiramidales/efectos de los fármacos , Femenino , Humanos , Ilusiones/efectos de los fármacos , Ilusiones/etiología , Persona de Mediana Edad , Palmitato de Paliperidona/administración & dosificación , Palmitato de Paliperidona/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Atrial fibrillation is responsible for up to one-third of ischemic strokes, and is also associated with silent cerebral infarctions and transient ischemic attacks (TIAs). The self-terminating and often asymptomatic nature of paroxysmal atrial fibrillation (PAF) may lead to its underdiagnosis. A continuous and long-term heart rhythm monitoring can be useful in unmasking PAF episodes. OBJECTIVE: Prevalence of asymptomatic PAF in patients suffering a cryptogenic stroke, at risk for atrial fibrillation but without any history of arrhythmia or palpitations, using a continuous electrocardiographic monitoring. METHODS: One hundred and forty-two consecutive patients were admitted to the Stroke Unit of 'Città della Salute e della Scienza' Hospital of Turin between June 2010 and March 2013 and discharged with the diagnosis of ischemic cryptogenic stroke. Sixty fulfilled predefined inclusion criteria. Follow-up was carried on and completed for the 54 patients who consented to implantable loop recorder (ILR) implantation. After ILR implantation, trans-telephonic data were collected monthly. RESULTS: Atrial fibrillation episodes lasting more than 5âmin were recorded in 25 patients (46%), median detection time was 5.4 months (range 1-18) and median duration of atrial fibrillation episodes was 20âh (range 7âmin-8 days) with 19 patients (76%) remaining asymptomatic and the others experiencing weakness and dyspnoea but not palpitations. CONCLUSION: Long-term heart rhythm monitoring is successful in unmasking silent atrial fibrillation in 46% of patients suffering a cryptogenic stroke with concomitant atrial fibrillation risk factors, but without history of arrhythmia or palpitations.
Asunto(s)
Enfermedades Asintomáticas/epidemiología , Fibrilación Atrial/diagnóstico , Ataque Isquémico Transitorio/diagnóstico por imagen , Accidente Cerebrovascular/complicaciones , Taquicardia Supraventricular/diagnóstico , Anciano , Fibrilación Atrial/epidemiología , Ecocardiografía , Electrocardiografía Ambulatoria , Femenino , Humanos , Ataque Isquémico Transitorio/etiología , Estimación de Kaplan-Meier , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Prevención SecundariaRESUMEN
Expression of intracellular heat shock protein 27 (Hsp27) rises in the brain of animal models of cerebral ischemia and stroke. Hsp27 is also released into the circulation and the aim of the present study was to investigated if serum Hsp27 (sHsp27) levels are altered in patients with acute ischemic stroke. sHsp27 was measured in 15 patients with acute ischemic stroke and in 14 control subjects comparable for age, sex, and cardiovascular risk factors. In patients, measurements were performed at admission and 1, 2, and 30 days thereafter. At admission, mean sHsp27 values were threefold higher in patients than in controls. In patients, sHsp27 values dropped after 24 h, rose again at 48 h, and markedly declined at 30 days, indicating the presence of a temporal trend of sHsp27 values following acute ischemic stroke.