RESUMO
INTRODUCTION: Fibrinolysis in stroke should be carried out as soon as possible, but delays occur for various reasons. In the first 17 ischemic infarcts treated in our center we confirmed a tendency to exhaust the therapeutic window. We look now at whether warnings against this tendency, without other logistical or organizational modifications, have had an impact on delays. PATIENTS AND METHODS: Neurologists were encouraged to avoid procrastination. When we reached 51 treated patients, we compared features and delay times between the first 17 (February, 2002 to June, 2004) and the 17 most recent cases (October, 2005 to April, 2006). Non-parametric tests were used (significant if p < 0.05). RESULTS: Both groups were similar clinically and demographically. The onset-arrival time lengthened (46 min vs. 75 min; p = 0.01) and scattered. The CT-treatment time halved (57 min vs. 30 min; p = 0.001), with consequent shortening of the 'door-to-needle' period (121 min vs. 90 min; p = 0.002). The arrival-CT time had remained constant (50 min vs. 53 min; p = 0.9), thus the total delay from onset did not change significantly (165 min vs. 170 min; p = 0.7), and the inverse linear correlation between the onset-CT time and the CT-treatment time weakened. CONCLUSIONS: Warnings against procrastination appear to be important in terms of shortening the delays. The time used for clinical-radiologic evaluation (arrival through CT)--about which there had been no action taken--had not been modified, but the time employed in the decision to treat (CT-treatment) and the 'door-to-needle' time had decreased appreciably. This effective compensatory reduction permitted treatment of late-arriving patients, such that although the overall time from onset to treatment apparently was not modified, the actual treatment rate increased.
Assuntos
Fibrinólise , Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estatística como Assunto , Fatores de Tempo , Ativador de Plasminogênio Tecidual/uso terapêuticoAssuntos
Transtornos Cerebrovasculares/etiologia , Endarterite/etiologia , Neurossífilis/diagnóstico por imagem , Adulto , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/tratamento farmacológico , Diagnóstico Diferencial , Endarterite/diagnóstico por imagem , Endarterite/tratamento farmacológico , Imunofluorescência , Humanos , Arteriosclerose Intracraniana/diagnóstico , Masculino , Neurossífilis/complicações , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico , Tetraciclina/uso terapêuticoRESUMO
INTRODUCTION: The sign of a hyperdense middle cerebral artery (MCA) in computed tomography (CT) scan, or hyperintense MCA in magnetic resonance imaging (MRI) has been associated with recent acute occlusion of the vessel. Hyperdense or hyperintense signs in the basilar and cerebral posterior arteries in association with acute infarct have also been reported. These signs may help to clarify localization and provide prognostic information, especially when the clinical findings are not clear or conclusive. We hereby report on a case of acute infarct in the anterior cerebral artery (ACA) territory with hyperdensity and hyperintensity of the affected vessel. CASE REPORT: This is a case report of a 74 year old male patient with vascular risk factors who had the acute onset of speech impairment and left side hemiparesis, evolving over the next several hours to include depression of the level of consciousness, mutism, and right leg paresis. The A2 segment of the right ACA was found to be hyperdense in CT scan without contrast, and hyperintense in the FLAIR-MRI respectively. MR-angiography showed occlusion of the probably dominant right ACA at the A2 segment shortly after its onset. CONCLUSIONS: The finding of a hyperdense and hyperintense ACA may be useful for diagnosis of acute stroke in the ACA territory, particularly in clinically ambiguous cases. To our knowledge, this is the first reported case of hyperdense and hyperintense ACA as an early sign of acute stroke. Its prognostic value in the ACA is thus far unknown.
Assuntos
Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Artéria Cerebral Anterior/patologia , Diagnóstico Precoce , Humanos , Infarto da Artéria Cerebral Anterior/patologia , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , MasculinoRESUMO
On the basis of the author's personal experience with migraine, and occasional reports in the literature suggesting that alpha 1-adrenergic blocking drugs may have a beneficial effect in the prophylaxis of migraine, 10 patients with migraine in a general neurology practice were placed on either terazosin or doxazosin. A decrease in migraine frequency or severity or both was seen in all but 1 patient, but 5 patients discontinued the drug due to side effects. No serious adverse reactions were reported. This anecdotal experience with the alpha 1-adrenergic blockers warrants a controlled, double-blind study of this class of drugs for the prophylaxis of migraine.