ABSTRACT
Introducción: El infarto cerebral isquémico (ICI) en adultos jóvenes ha emergido como un relevante problema de salud debido al incremento de su incidencia, alta mortalidad, larga duración del tiempo de la discapacidad y consecuencias sociales. Objetivo: Describir una aproximación al diagnóstico del infarto cerebral isquémico en adultos jóvenes sobre la base de la clasificación etiopatogénica, historia e investigaciones complementarias. Método: Se realizó una extensa revisión bibliográfica con el buscador Google Académico, en las bases de datos bibliográficas PubMed, SciELO y Medline, y con la búsqueda de palabras claves; siendo escogidos 32 artículos cuyo título y resumen se relacionaron con el tema de la presente revisión. Desarrollo: Los subtipos etiopatogénicos del infarto cerebral isquémico en adultos jóvenes difieren al compararlo con adultos mayores, y sus causas etiológicas son más variadas y heterogéneas. Los factores de riesgo, antecedentes patológicos personales y familiares, manifestaciones clínicas no neurológicas y neurológicas, permiten un acercamiento al diagnóstico, mientras que las investigaciones complementarias facilitan la confirmación del diagnóstico, la localización y tamaño del infarto isquémico, el establecimiento de la causa etiológica y el sustento de las decisiones terapéuticas. Consideraciones finales: La historia y manifestaciones clínicas obtenidas mediante el interrogatorio y examen físico, unido a las investigaciones complementarias, posibilita la aproximación al diagnóstico del subtipo etiopatogénico y a la causa del infarto cerebral isquémico en adultos jóvenes, lo que mejora las posibilidades de tratamiento del mismo.(AU)
Introduction: Ischemic stroke in young adults has emerged as a relevant health problem today due to its increased incidence, high mortality, the duration of the disability and social consequences. Objective: To describe an approach in diagnosis of ischemic stroke in young adults based on etiopathogenic classification, history and complementary investigations. Method: A wide-ranging bibliographic review was carried out using Google Scholar, searching in bibliographic databases like PubMed, SciELO and Medline, and searching different keywords; 32 articles were chosen in the process with title and abstract were linked with the subject of this review. Development: The etiopathogenic subtypes of ischemic stroke in young adults differ with regard to older adults, and its etiologic causes are more diverse and heterogeneous. Risk factors, personal and family pathological history, non-neurological and neurological clinical manifestations, allow an approach to diagnosis, while complementary investigations facilitate the confirmation of diagnosis, the location and size of the ischemic infarction, definition of the etiological cause and the support of therapeutic decisions. Final considerations: The history and clinical manifestations obtained through interrogation and physical examination, in association with complementary investigations, made it possible an approach to diagnosis of etiopathogenic subtype and the cause of ischemic brain infarction in young adults improving treatment possibilities.(AU)
Introdução: O acidente vascular cerebral (AVC) isquêmico em adultos jovens emergiu como um problema de saúde relevante devido à sua crescente incidência, elevada mortalidade, longa duração da incapacidade e consequências sociais. Objetivo: Descrever uma abordagem ao diagnóstico do AVC isquêmico em adultos jovens baseada na classificação etiopatogénica, na história e em exames complementares. Método: Foi realizado uma extensa revisão bibliográfica utilizando o motor de busca Google Scholar, as bases de dados bibliográficas PubMed, SciELO e Medline, e uma pesquisa por palavras-chave; foram selecionados 32 artigos cujo título e resumo estavam relacionados com o tema desta revisão. Desenvolvimento: Os subtipos etiopatogênicos do AVC isquêmico em adultos jovens diferem quando comparados aos adultos mais velhos, e suas causas etiológicas são mais variadas e heterogêneas. Os fatores de risco, os antecedentes patológicos pessoais e familiares, as manifestações clínicas não neurológicas e neurológicas permitem uma aproximação ao diagnóstico, enquanto as investigações complementares facilitam a confirmação do diagnóstico, a localização e o tamanho do infarto isquêmico, o estabelecimento da causa etiológica e o apoio às decisões terapêuticas. Considerações finais: A história e as manifestações clínicas obtidas por meio de questionamento e exame físico, juntamente com investigações complementares, permitem abordar o diagnóstico do subtipo etiopatogênico e a causa do AVC isquêmico em adultos jovens, melhorando as possibilidades de seu tratamento.(AU)
Subject(s)
Humans , Male , Female , Adult , Cerebral Infarction/classification , Cerebral Infarction/diagnosis , Cerebral Infarction/etiology , Risk Factors , Young AdultABSTRACT
SUMMARY OBJECTIVE: The aim of this study was to investigate the correlation between the Trial of Org 10172 in acute stroke treatment classification and the National Institutes of Health Stroke Scale score of acute cerebral infarction as well as acute cerebral infarction's risk factors. METHODS: The clinical data of 3,996 patients with acute cerebral infarction hospitalized in Hebei Renqiu Kangjixintu Hospital from January 2014 to November 2018 were analyzed retrospectively. According to Trial of Org 10172 in acute stroke treatment, they were divided into five groups: arteriosclerosis, cardio cerebral embolism, arterial occlusion, other causes, and unknown causes. Through questionnaire design, routine physical examination, and physical and chemical analysis of fasting venous blood samples, the risk factors were evaluated, and the correlation between Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale classification was analyzed using multivariate logistic regression. In addition, the relationship between National Institutes of Health Stroke Scale score and risk factors in different groups was compared, and the correlation between Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale score was analyzed. RESULTS: Multivariate logistic regression analysis showed that diabetes, atrial fibrillation or stroke history, age, and education level were related to Trial of Org 10172 in acute stroke treatment classification. In the National Institutes of Health Stroke Scale comparison, the scores of the cardio cerebral embolism group were significantly higher than those of the other four groups, and patients with diabetes, atrial fibrillation, or stroke history had a high share, especially atrial fibrillation (33.06%). CONCLUSIONS: The nerve function defect is more serious after acute cerebral infarction with cardiogenic cerebral embolism, indicating a poor prognosis.
Subject(s)
Humans , Stroke/etiology , United States , Cerebral Infarction/complications , Cerebral Infarction/diagnosis , Chondroitin Sulfates , Retrospective Studies , Risk Factors , Dermatan Sulfate , Heparitin Sulfate , National Institutes of Health (U.S.)ABSTRACT
La mortalité à 3 mois des infarctus cérébraux demeure encore élevée en Afrique Sub Saharienne. L'objectif de notre étude était d'évaluer la mortalité intra hospitalière, à un mois et à 3 mois des patients hospitalisés pour infarctus cérébral au Burkina Faso. Il s'agissait d'une étude de cohorte prospective de patients consécutivement hospitalisés pour infarctus cérébral, de mars 2015 à février 2016, puis suivis en consultation externe durant au moins 3 mois après l'AVC au Centre Hospitalier Universitaire de Tingandogo, à Ouagadougou, au Burkina Faso. Les caractéristiques sociodémographiques, cliniques et paracliniques des patients à l'admission, les complications et la mortalité cumulée respectivement à la sortie d'hospitalisation, à un mois et à 3 mois, ont été analysées. En tout, 151 patients ont été enregistrés, avec une prédominance masculine (59,6 %) et une moyenne d'âge de 63,4 ans. Lors de l'admission, le National Institute of Health Stroke Score (NIHSS) moyen était de 14. L'oedème cérébral (39,7 %) et l'effet de masse (35,1 %) était les complications neuroradiologiques précoces les plus fréquentes. La durée moyenne d'hospitalisation était de 13,4 jours. Les taux de mortalité, intra hospitalière, à un mois et 3 mois étaient respectivement de 17,9 %, 19 % et 25,9 %. La mortalité des infarctus cérébraux reste élevée en Afrique Sub Saharienne. L'utilisation de la fibrinolyse, la mise en place des unités neurovasculaires et un accès des patients à la rééducation fonctionnelle, contribueront à l'amélioration de la survie des patients après infarctus cérébraux
Subject(s)
Africa South of the Sahara , Burkina Faso , Cerebral Infarction/complications , Cerebral Infarction/diagnosis , Cerebral Infarction/epidemiology , Cerebral Infarction/mortality , InpatientsABSTRACT
O acidente vascular cerebral (AVC) é a maior causa de incapacidade em todo mundo, e atualmente é também considerado como a segunda maior causa de morte no Brasil. O AVC isquêmico é o subtipo mais comum e pode ser subdividido etiologicamente em car-dioembólico, aterosclerótico de grandes ou pequenas artérias (lacunas), criptogênico ou de outras etiologias. Dependendo da etiologia encontrada, a profilaxia secundária de novos eventos deve ser feita através de medicações antitrombóticas específicas. Portanto, investigar adequadamente a etiologia do evento vascular isquêmico é fundamental para a instituição da profilaxia secundária apropriada. A terapia antitrombótica pós-AVC isquêmico evoluiu consideravelmente na última década. Especificamente para pacientes com AVC e fibrilação atrial, a incorporação de anticoagulantes de ação direta à prática clínica representa um grande avanço, já que tais medicações são mais eficazes e seguras para o tratamento de pacientes de alto risco. No presente artigo, discutiremos o uso de antitrombóticos em pacientes com AVC em diferentes momentos pós-icto vascular e nas distintas etiologias possíveis
Stroke is the leading cause of disability worldwide, and is currently also considered the second leading cause of death in Brazil. Ischemic stroke is the most common subtype and can be subdivided etiologically into cardioembolic, atherosclerotic (large artery atherosclero-sis or small vessel disease-lacunae), cryptogenic or strokes of other etiologies. Depending on the etiology, secondary prophylaxis of new events should be undertaken with specific antithrombotic medications. Therefore, a thorough investigation of ischemic vascular event etiology is essential for the introduction of appropriate secondary prophylaxis. Antithrombotic therapy after ischemic stroke has evolved considerably in the last decade. The incorporation of direct-acting anticoagulants into clinical practice represents a major advance, particularly for stroke and atrial fibrillation patients, since such medications are safer and more effective for the treatment of high-risk patients. In this article, we will discuss the use of antithrombo-tics in stroke patients at different post-stroke stages and in the distinct possible etiologies
Subject(s)
Humans , Male , Female , Thrombolytic Therapy/methods , Stroke/etiology , Stroke/physiopathology , Disease Prevention , Platelet Aggregation Inhibitors/therapeutic use , Cerebral Infarction/diagnosis , Aspirin/therapeutic use , Risk Factors , Diabetes Mellitus , Secondary Prevention/methods , Sedentary Behavior , Rivaroxaban/therapeutic use , Hypertension , Anticoagulants/therapeutic useABSTRACT
Objetivos: Precisar la etiología del infarto cerebral en adultos jóvenes hospitalizados en el Departamento de Enfermedades Neurovasculares del Instituto Nacional de Ciencias Neurológicas (INCN) durante el periodo 2010 al 2013. Material y métodos: Estudio descriptivo, retrospectivo, de corte transversal; en paciente jóvenes con diagnóstico de infarto cerebral, hospitalizados en el INCN, en el periodo de estudio que tuvieron tomografía y/o imagen de resonancia magnética cerebral. Resultados: Un total de 43 pacientes cumplieron los criterios de inclusión. El 55,8% fueron mujeres. La media de edad fue 37,6+/-6,4 años. El 69,8% provenían de Lima. El 44,2% de los casos fueron de etiología indeterminada, 23,3% cardioembólica. La media de edad para la etiología atero-trombótica fue de 41,8 años, y para la etiología indeterminada de 34,7 años. El territorio vascular mayormente comprometido fue el de la circulación anterior con 65,1%.Conclusiones: Se describen las características clínicas, sociodemográficas y la etiología del infarto cerebral en adultos jóvenes. Los más frecuentes fueron: indeterminada y cardioembólica. Las enfermedades metabólicas y el uso de anticonceptivos orales fueron los factores asociados más frecuentes. No hubo mortalidad. El territorio vascular cerebral mayormente comprometido fue la circulación anterior.
Objectives: Clarify the etiology of cerebral infarction in young adults hospitalized in the Department of Neurovascular Diseases at the National Institute of Neurological Sciences (INCN), during the period 2010 to 2013. Material and Methods: Descriptive, retrospective, cross-sectional study in a sample of young patients diagnosed with cerebral infarction, hospitalized during the study period and who underwent tomography and / or magnetic resonance imaging brain tests. Results: A total of 43 patients, 55.8 % of them female, met the inclusion criteria. The mean age was 37.6 +/- 6.4 years, 69.8% came from Lima, and 44.2% of the cases were of undetermined etiology and 23.3%, cardioembolic. The average age for artery occlusive disease was 41.8 years, and for undetermined etiology, 34.7 years. The vascular territory mostly compromised was that of the anterior circulation with 65.1%. Conclusions: Sociodemographic, clinical characteristics, and etiological factors of cerebral infarction in young adults were described. The most frequent etiologieswerecardioembolic and undeterminated. Metabolic diseases and the use of oral contraceptives were the most frequently associated factors. The cerebral vascular territory mostlyaffected was that of the anterior circulation. No deaths occurred.
Subject(s)
Humans , Male , Female , Young Adult , Cerebral Infarction/diagnosis , Cerebral Infarction/etiology , Epidemiology, Descriptive , Retrospective Studies , Cross-Sectional StudiesABSTRACT
We report a 61 years old male presenting with a right cerebral infarction, along with a type I persistent left proatlantal artery (PA), which is a form of primitive carotid-basilar anastomosis. The patient had an absence of the ipsilateral vertebral artery (VA) and hypoplasia of the contralateral VA, while the basilar artery was supplied by the PA. Other vascular anomalies present were a fusiform aneurysm of the right subclavian artery, and an A1 segment aplasia of the hypoplastic anterior right cerebral artery, which originated from the anterior communicating artery. To our knowledge these anomalies were not described previously.
Subject(s)
Humans , Male , Middle Aged , Intracranial Aneurysm/diagnosis , Subclavian Artery/abnormalities , Vertebral Artery/abnormalities , Brain Ischemia/complications , Cerebral Infarction/diagnosis , Endarterectomy, Carotid , Fatal Outcome , Stroke/complicationsABSTRACT
Intracranial sinus venous thrombosis (ICSVT) is a rare complication of ulcerative colitis that affects from 1.7 to 7.5% of patients. We report a 22 year-old male with ulcerative colitis in treatment with mesalazine and prednisone presenting with headache and speech disturbances. A magnetic resonance imaging of the brain showed a left temporal hemorrhagic infarct with thrombosis of the ispilateral superficial vein and sigmoid venous sinus. No cause of thrombophilia was detected. Anticoagulation with heparin was started which was changed to oral anticoagulation with warfarin. The patient was discharged ten days after admission.
Subject(s)
Humans , Male , Young Adult , Colitis, Ulcerative/complications , Sinus Thrombosis, Intracranial/etiology , Anti-Inflammatory Agents/therapeutic use , Anticoagulants/therapeutic use , Cerebral Infarction/diagnosis , Colitis, Ulcerative/drug therapy , Enoxaparin/therapeutic use , Headache/drug therapy , Headache/etiology , Mesalamine/therapeutic use , Prednisone/therapeutic use , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/drug therapy , Speech Disorders/drug therapy , Speech Disorders/etiologyABSTRACT
No abstract available.
Subject(s)
Humans , Male , Middle Aged , Aortic Dissection/diagnosis , Anticoagulants/therapeutic use , Aortic Aneurysm/diagnosis , Behcet Syndrome/complications , Cerebral Infarction/diagnosis , Diffusion Magnetic Resonance Imaging , Echocardiography, Doppler, Color , Electrocardiography , Hemodynamics , Immunosuppressive Agents/therapeutic use , Sinus of Valsalva/physiopathology , Thrombosis/diagnosis , Ventricular Septal Rupture/diagnosisABSTRACT
We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.
Subject(s)
Aged , Humans , Male , Anticoagulants/therapeutic use , Carotid Arteries/diagnostic imaging , Cerebral Infarction/diagnosis , Platelet Aggregation Inhibitors/therapeutic use , Stents/adverse effects , Thrombosis/drug therapy , Ticlopidine/analogs & derivatives , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To evaluate patterns of macular retinal ganglion cell (RGC) loss measured by spectral domain optical coherence tomography in patients with neurologic lesions mimicking glaucoma. METHODS: We evaluated four patients with neurological lesions who showed characteristic patterns of RGC loss, as determined by ganglion cell thickness (GCT) mapping. RESULTS: Case 1 was a 30-year-old man who had been treated with glaucoma medication. A left homonymous vertical pattern of RGC loss was observed in his GCT map and a past brain magnetic resonance imaging (MRI) revealed a hemorrhagic lesion around the right optic radiation. Case 2 was a 72-year-old man with a pituitary adenoma who had a binasal vertical pattern of RGC loss that corresponded with bitemporal hemianopsia. Case 3 was a 77-year-old man treated for suspected glaucoma. His GCT map showed a right inferior quadratic pattern of loss, indicating a right superior homonymous quadranopsia in his visual field (VF). His brain MRI revealed a left posterior cerebral artery territory infarct. Case 4 was a 38-year-old woman with an unreliable VF who was referred for suspected glaucoma. Her GCT map revealed a left homonymous vertical pattern of RGC loss, which may have been related to a previous head trauma. CONCLUSIONS: Evaluation of the patterns of macular RGC loss may be helpful in the differential diagnosis of RGC-related diseases, including glaucoma and neurologic lesions. When a patient's VF is unavailable, this method may be an effective tool for diagnosing and monitoring transneuronal retrograde degeneration-related structural changes.
Subject(s)
Adult , Aged , Female , Humans , Male , Brain Injuries/diagnosis , Cerebral Infarction/diagnosis , Diagnosis, Differential , Glaucoma/diagnosis , Hemianopsia/diagnosis , Magnetic Resonance Imaging , Nerve Fibers/pathology , Nervous System Diseases/diagnosis , Pituitary Neoplasms/diagnosis , Retinal Ganglion Cells/pathology , Retrospective Studies , Tomography, Optical Coherence , Tonometry, Ocular , Visual Acuity , Visual Field Tests , Visual FieldsABSTRACT
We presented two interesting cases of gastrocolocutaneous fistula that occurred after percutaneous endoscopic gastrostomy (PEG) tube placement, and its management. This fistula is a rare complication that occurs after PEG insertion, which is an epithelial connection between mucosa of the stomach, colon, and skin. The management of the fistula is controversial, ranging from conservative to surgical intervention. Endoscopists should be aware of the possibility of gastrocolocutaneous fistula after PEG insertion, and should evaluate the risk factors that may contribute to the development of gastrocolocutaneous fistula before the procedure. We reviewed complications of gastrostomy tube insertion, symptoms of gastrocolocutaneous fistula, and its risk factors.
Subject(s)
Aged , Humans , Male , Middle Aged , Cerebral Infarction/diagnosis , Digestive System Fistula/etiology , Endoscopy, Gastrointestinal , Enteral Nutrition/adverse effects , Gastrostomy , Nervous System Diseases/diagnosis , Risk Factors , Tomography, X-Ray ComputedABSTRACT
Entende-se por infarto maligno aquele que acomete mais da metade do território da artéria cerebral média, atingindo níveis de mortalidade de até 80%. A craniotomia descompressiva tem se mostrado como técnica operatória capaz de reduzir significativamente essas taxas. No entanto, persistem na literatura muitas dúvidas quanto à indicação do procedimento relacionadas a idade, hemisfério cerebral acometido, time cirúrgico e status neurológico pré-operatório. Analisamos 10 pacientes vítimas de acidente vascular cerebral (AVC) isquêmicos extensos, tratados no hospital SEMPER-BH, levando-se esses fatores em consideração. Concluímos que a idade e o quadro neurológico prévio ao momento cirúrgico são os dois fatores mais importantes no prognóstico do paciente submetido à craniotomia descompressiva.
It is understood that malignant infarction affects more than half of the middle cerebral artery territory and reaches mortality rates up to 80%. A decompressive craniotomy has been recommended as the surgical technique that can significantly reduce these rates. However, many questions persist in the literature as the indication of the procedure related to age, hemisphere affected, surgical time and preoperative neurological status. We analyzed 10 patients who suffered extensive ischemic stroke treated in hospital SEMPER-BH taking these factors into consideration. We conclude that age and neurological status prior to the surgical time are the two most important factors in the prognosis of patients undergoing decompressive craniotomy.
Subject(s)
Humans , Adult , Middle Aged , Aged, 80 and over , Decompressive Craniectomy , Cerebral Infarction/surgery , Cerebral Infarction/diagnosisABSTRACT
We present a case of cerebral venous thrombosis and cerebral infarction associated with diabetic ketoacidosis. The patient presented with vomiting, headache, lethargy and altered sensorium. CT venography provided the final diagnosis; therefore, anticoagulant was used, which resulted in the improvement of neurological outcome. Neurological deterioration during an episode of diabetic ketoacidosis is usually assumed to be caused by cerebral edema. Neuroimaging should always be performed in suspected cerebral edema associated with diabetic ketoacidosis in order to exclude other pathologies.
Subject(s)
Humans , Female , Diabetic Ketoacidosis/complications , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/etiology , Intracranial Thrombosis/complications , Cerebral Infarction/diagnosis , Magnetic Resonance Spectroscopy , Awareness , Cerebral Angiography , Neuroimaging , Cerebral Veins/diagnostic imaging , Rare DiseasesABSTRACT
The authors highlights the importance of the vestibulo-ocular reflex examination through the head impulse test as a diagnostic method for vestibular dysfunction as well as, and primarily, a bedside semiotic resource capable of differentiating between acute peripheral vestibulopathy and a cerebellar or brainstem infarction in emergency rooms.
Os autores ressaltam a importância do exame do reflexo vestíbulo-ocular por meio do teste do impulso da cabeça como método diagnóstico de hipofunção vestibular. Este método é também - e principalmente - um instrumento semiótico de beira do leito capaz de auxiliar no diagnóstico diferencial entre a vestibulopatia periférica aguda e o infarto cerebelar ou do tronco cerebral na sala de emergência.
Subject(s)
Humans , Cerebellar Diseases/diagnosis , Cerebral Infarction/diagnosis , Reflex, Vestibulo-Ocular/physiology , Vestibular Diseases/diagnosis , Vestibular Function Tests/methods , EmergenciesABSTRACT
La enfermedad cerebrovascular durante la gestación es rara. El presente trabajo tiene como objetivo describir las características clínicas de una paciente con embolismos de la arteria humeral derecha y tallo encefálico en el periodo expulsivo de un parto eutócico sin foco embolígeno causante de dicho accidente cerebrovascular. Se presenta el caso de una parturienta de 29 años con 40,2 semanas de edad gestacional que durante el periodo expulsivo de un parto eutócico comenzó a presentar dolor intenso en el miembro superior derecho con cambios de coloración y temperatura e impotencia funcional, imposibilidad para la apertura palpebral bilateral, vómitos sin náuseas, disartria y dificultad en los movimientos oculares...
The cerebrovascular disease during pregnancy is uncommon. The objective of present paper is to describe the clinical features of a patient with embolisms of the right humeral artery and of the brainstem at expulsion period of a spontaneous labor without emboligen focus causing this cerebrovascular accident...
Subject(s)
Humans , Female , Pregnancy , Adult , Intracranial Embolism and Thrombosis/surgery , Intracranial Embolism and Thrombosis/drug therapy , Cerebral Infarction/diagnosis , Puerperal Disorders/physiopathology , Case ReportsABSTRACT
A 10-yr-old HbE/Beta thalassemia child who developed subacute to chronic occipitotemporal hemorrhagic infarct with smaller chronic infarct with gliotic changes in the left frontal periventricular white matter. Genetic tests showed that patient was positive for HbE and IVS1-5 mutation and was negative for thrombogenic mutations. Hemorrhagic infarct was confirmed by magnetic resonance imaging study. Antigenic levels of Protein C and Protein S were low. Based on these outcomes, it was concluded that Protein C and Protein S deficiency were the causative factor for developing hemorrhagic infarct in the HbE/ Beta thalassemia patient.
Subject(s)
Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/etiology , Cerebral Infarction/diagnosis , Cerebral Infarction/etiology , Child , Humans , Magnetic Resonance Imaging , Male , Protein C Deficiency/complications , Protein C Deficiency/diagnosis , Protein S Deficiency/complications , Protein S Deficiency/diagnosis , beta-Thalassemia/complicationsSubject(s)
Child , Humans , Male , Cerebral Infarction/etiology , Hemiplegia/etiology , Migraine Disorders/complications , Cerebral Infarction/diagnosis , Cerebral Infarction/genetics , Hemiplegia/diagnosis , Hemiplegia/genetics , Magnetic Resonance Imaging , Migraine Disorders/diagnosis , Migraine Disorders/geneticsABSTRACT
OBJECTIVE: To examine the pattern of stroke subtypes found on Computed Tomography (CT), Magnetic Resonance Imaging (MRI) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. METHOD: A retrospective review was conducted for all patients diagnosed with stroke and who were subjected to CT or MRI evaluation at UHWI between January 2001 and December 2004. Data were collected for patient age and gender and type of stroke. RESULTS: Four hundred and thirty-three patients were identified and classified as having cerebral infarct, intra-parenchymal haemorrhage or subarachnoid haemorrhage. There were 414 patients who had CT scans and 19 had MRI scans. Within and across genders, over 80% suffered infarcts with no significant statistical difference between male and female patients. Subarachnoid haemorrhage was the least frequent subtype and occurred in younger patients. CONCLUSION: The pattern of stroke subtypes seen in this population was similar to that of Australian and European cohorts of patients but differed from that reported in Asians. Ischaemic infarct was the most frequent stroke subtype followed by intra- parenchymal haemorrhage and subarachnoid haemorrhage. There was no gender predilection for any specific type of stroke.
OBJETIVO: Examinar el patrón de los subtipos de accidente cerebrovascular encontrados en las imágenes de TAC y MRI en el Hospital Universitario de West Indies (HUWI), Kingston, Jamaica. MÉTODO: Se realizó un examen retrospectivo de todos los pacientes con diagnóstico de accidente cerebrovascular, sometidos a evaluación mediante TAC o MRI, entre enero 2001 y diciembre 2004. Los datos fueron recogidos teniendo en cuenta la edad y el género del paciente, así como el tipo de accidente. RESULTADOS: Cuatrocientos treinta y tres (433) pacientes fueron identificados y clasificados como pacientes con un infarto cerebral, hemorragia intraparenquimal o hemorragia subaracnoidea (HSA). Hubo 414 pacientes examinados con TAC y 19 con MRI. Dentro de ellos, ambos géneros incluidos, más del 80% sufrió infartos sin que hubiese diferencias estadísticas significativas entre hombres y mujeres. La hemorragia subaracnoidea fue el tipo menos frecuente, y se produjo en pacientes jóvenes. CONCLUSIÓN: El patrón de subtipos de accidente cerebrovascular en esta población fue similar al de cohortes de pacientes australianos y europeos, pero diferente al reportado para los asiáticos. El infarto isquémico fue el subtipo de accidente cerebrovascular más frecuente, seguido por la hemorragia intraparenquimal y la hemorragia subaracnoidea. No hubo preferencia de géneros en relación con ninguno de los tipos específicos de accidente cerebrovascular.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Cerebral Hemorrhage/diagnosis , Cerebral Infarction/diagnosis , Stroke/classification , Subarachnoid Hemorrhage/diagnosis , Age Distribution , Cerebral Hemorrhage/epidemiology , Cerebral Infarction/epidemiology , Confidence Intervals , Jamaica/epidemiology , Logistic Models , Magnetic Resonance Imaging , Multivariate Analysis , Odds Ratio , Retrospective Studies , Sex Distribution , Stroke/epidemiology , Stroke/etiology , Subarachnoid Hemorrhage/epidemiology , Tomography, X-Ray ComputedABSTRACT
The viper is one of India’s most commonly encountered poisonous snakes and envenomation following viper bite usually leads to consumption coagulopathy. Clinical manifestations most frequently include external and internal bleeding. In the setting of viper envenomation, large-vessel thrombosis is a very rare occurrence. Also, bilateral anterior cerebral artery infarction, when unrelated to anatomical abnormalities, subarachnoid haemorrhage, surgery or trauma, itself is an exceedingly rare event. We report a case of a 24-year-old previously healthy man who presented with bilateral anterior cerebral artery infarction following a viper bite. We also present hypotheses that may explain this unusual occurrence. ©