RESUMEN
Cerebral venous thrombosis is an uncommon condition with difficulties in diagnosis and treatment. There is limited study on the best treatment option for this disease. The mainstay of treatment remains systemic anticoagulation with a lengthy duration of warfarin, which has a troublesome unpredictable drug effect, various drug and food interactions, and an increased risk of bleeding. Recent availability of direct thrombin inhibitor provides an alternative option of systemic anticoagulation in various thromboembolism conditions. We report 2 cases of cerebral venous thrombosis treated with a direct thrombin inhibitor with good clinical and radiologic results.
Asunto(s)
Antitrombinas/uso terapéutico , Bencimidazoles/uso terapéutico , Trombosis Intracraneal/tratamiento farmacológico , Trombosis de la Vena/tratamiento farmacológico , beta-Alanina/análogos & derivados , Adulto , Angiografía Cerebral/métodos , Dabigatrán , Humanos , Trombosis Intracraneal/diagnóstico , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Uso Fuera de lo Indicado , Flebografía/métodos , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico , beta-Alanina/uso terapéuticoRESUMEN
Behçet's disease is a rare systemic vasculitis that may lead to neurologic complications and rare manifestations of aortitis and aortic regurgitation. We report 2 cases of Behçet's aortitis and aortic regurgitation. The first patient presented with acute stroke. Recognition of acute aortitis on echocardiography led to the diagnosis of vasculitis as the cause of the cerebral event. This case highlights the echocardiographic features of aortic root pathology from acute aortitis to subsequent aortic valve perforation. In both cases, severe aortic regurgitation necessitated aortic valve replacement. Both were complicated by valve dehiscence requiring reoperation, illustrating the postoperative morbidity in this inflammatory condition.
Asunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Aortitis/etiología , Síndrome de Behçet/complicaciones , Adulto , Insuficiencia de la Válvula Aórtica/diagnóstico , Aortitis/diagnóstico , Síndrome de Behçet/diagnóstico , Diagnóstico Diferencial , Progresión de la Enfermedad , Ecocardiografía , Ecocardiografía Transesofágica , Humanos , Imagen por Resonancia Magnética , Masculino , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiologíaRESUMEN
BACKGROUND AND PURPOSE: Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke. METHODS: This was a single center, observational study of 1,105 consecutive Chinese ischemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality. RESULTS: Amongst 1,105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) (p<0.01). In a Cox regression model, cancer, age and atrial fibrillation were the 3 independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval (CI): 1.54-3.80), 1.01 (1.00-1.03) and 1.35 (1.01-1.82) respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs. 2.35%/year, p = 0.08). In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08-4.02), age (HR: 1.04, 95% CI 1.02-1.06), heart failure (HR: 3.06, 95% CI 1.72-5.47) and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02-2.36) were independent predictors for cardiovascular mortality. CONCLUSIONS: Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.