Thrombolytic therapy for acute stroke in the elderly: an emergent condition in developing countries.

Elderly patients may represent an important group when considering new stroke treatments, particularly in developing countries. The aim of this study was to analyze the use of recombinant tissue plasminogen activator (rtPA) in elderly Brazilian patients with acute ischemic stroke. Clinical and neuroimaging parameters at admission, frequency of symptomatic intracranial hemorrhage, and outcome were compared between elderly (≥80 years) and nonelderly (<80 years) stroke patients treated with rtPA in the Porto Alegre Stroke Network. We evaluated 183 nonelderly patients (mean age, 63 ± 12 years) and 55 elderly patients (mean age, 84 ± 3 years). Female sex, hypertension, congestive heart failure, atrial fibrillation, and previous history of stroke or transient ischemic attack were more frequent in the elderly patients. Elderly patients also presented with higher mean systolic blood pressure (P = .03) and National Institutes of Health Stroke Scale (NIHSS) score (P < .0001), whereas the nonelderly patients had a higher serum glucose level (P = .03). The rate of symptomatic intracranial hemorrhage was 10.9% in the elderly patients and 6.6% in the nonelderly patients (P = .28), and a substantial proportion of the elderly patients achieved a favorable outcome (modified Rankin Scale score ≤1) at 90 days, although this proportion was lower than that in the nonelderly patients (42% vs 58%; P = .04). Poorer outcomes were generally seen in elderly patients with an anterior circulation stroke, a higher NIHSS score, hypoattenuation in ≥1/3 lf the middle cerebral artery territory, and an Alberta Stroke Program Early CT score of ≤7 on an initial computed tomography scan. Our results support the administration of intravenous rtPA in selected elderly stroke patients presenting early to the hospital in developing countries.

Angioedema orolingual após infusão de alteplase no tratamento de acidente vascular cerebral: relato de caso / Orolingual angioedema after alteplase infusion for treatment of brain stroke: case report

O angioedema é uma reação inflamatória local potencialmente grave. Estudos evidenciam uma incidência destes casos após uso de alteplase entre 0,02% e 5,1%. Relatamos um caso de acidente vascular cerebral isquêmico agudo tratado com alteplase que evoluiu com angioedema e piora clínica. Este paciente teve expressiva melhora neurológica com posterior declínio clínico após o angioedema. O mecanismo inflamatório neste caso pode ter desempenhado papel determinante na reoclusão.

Angioedema is a potentially severe local inflammatory reaction. There is an incidence of 0.02% to 5.1% in patients treated with alteplase. We report a case of acute ischemic stroke that was treated with alteplase and presented a life threatening allergic reaction. This patient had an important neurologic improvement in the beginning, but this benefit was lost after angioedema. The inflammatory mechanism that causes angioedema is sometimes decisive in re-occlusion.

Aplicabilidade e segurança do nitroprussiato de sódio para controle da pressão arterial durante trombólise no tratamento do acidente vascular cerebral isquêmico agudo / Applicability and safety of sodium nitroprusside to control arterial pressure during thrombolysys in the treatment of acute ischemic stroke

Objetivos: relatar a exeperiência com uso do nitroprussiato de sódio na fase aguda do acidente vascular cerebral isquêmico. Métodos: um estudo retrospectivo, consistindo na revisão de prontuários, inclui os pacientes que sofreram acidente vascular cerebral isquêmico e foram trombolisados com alteplase endovenosa, entre maio de 2005 e julho de 2007. Resultados: dos 48 pacientes que atenderam aos critérios de inclusão, 15 utilizaram nitroprussiato de sódio para controle da pressão arterial. Um paciente apresentou desfecho fatal (6,7) e nenhum apresentou hemorragia intracraniana sintomática. O escore médio, pela escala de acidente vascular cerebral no National Institute of Health, na chegada ao hospital, era 10 e, no momento da altas, 2,8. Conclusões: o nitroprussiato de sódio foi aplicável e seguro para uso no acidente vascular cerebral isquêmico. São Necessários estudos maiores e prospectivos para corroborar estes resultados e avaliar o seu potencial efeito neuprotetor.

AVC no Hospital São Lucas da PUC, 30 anos depois: "dos heróis de 1977 ao fim do niilismo em 2004": o que realmente mudou? / CVA in the Hospital São Lucas of the PUC, 30 years later: “the heroes of 1977 to the end of the niilismo in 2004”: what's really modified?

Os autores propõem uma revisão sobre o do tratamento do AVC nos últimos 30 anos no Hospital São Lucas da PUCRS