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1.
Ann Vasc Surg ; 2024 Sep 27.
Article in English | MEDLINE | ID: mdl-39343364

ABSTRACT

OBJECTIVE: The present study aims to describe the clinical characteristics and treatment outcomes of patients with symptomatic carotid web treated at a single institution in South America. MATERIALS AND METHODS: Retrospective study of a single-center experience of patients with carotid webs surgically treated from September 2019 to September 2023. RESULTS: 10 patients had carotid webs, six (60%) were females. Median age was 54.5 years (range: 35-77 years). All patients were symptomatic. Diagnosis was made in 90% (n=9) of the patients with either computed tomography angiography or magnetic resonance alone. One (10%) patient underwent angiography for definite diagnosis. The median interval from the first neurological event to intervention was 90 months (range: 3 days- 108 months). Four (40%) patients underwent surgical treatment within one month from symptom onset and carotid web diagnosis, with a median of 3.5 days (range: 3-9 days). Six (60%) patients underwent delayed surgical treatment since the cause of the neurological event was uncertain, with a median of 54 months (range: 6 - 108 months). These six patients had recurrent neurological events. Three (30%) patients underwent carotid endarterectomies with polyurethane patch and three (30%) by eversion technique. Three (30%) patients underwent segmental resection and reanastomosis of the internal carotid artery. One underwent internal carotid artery plasty with saphenous vein. At a median follow-up of 30 months (range: 6-46 months), one patient persists with mild aphasia, another patient has severe aphasia and right hemiparesis, both as sequalae of their initial strokes, and another patient has suffered 3 non-ischemic episodes of brief transient right hemiparesis attributed to epileptic seizures. The other seven patients remain without new neurological events. CONCLUSION: Neurological events of carotid distribution deserve accurate imaging work up, keeping in mind the diagnosis of carotid web. Surgical treatment for carotid web seems effective for preventing recurrences; nevertheless, further studies are warranted to define the best management for these patients.

2.
J Stroke Cerebrovasc Dis ; 31(6): 106470, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35398625

ABSTRACT

OBJECTIVE: To present a rare cause of recurrent posterior embolic strokes originating from a partially thrombosed pseudoaneurysm of a shoulder artery after arthroscopy. MATERIALS AND METHODS: The clinical history, complementary studies and follow-up were reviewed. RESULTS: The patient was successfully embolized and presented no new ischemic episodes at the 3-month follow-up visit. CONCLUSIONS: Shoulder artery pseudoaneurysm should be considered as an unusual source of posterior embolic strokes.


Subject(s)
Aneurysm, False , Embolic Stroke , Embolism , Embolization, Therapeutic , Stroke , Aneurysm, False/complications , Aneurysm, False/diagnostic imaging , Arteries , Cerebral Infarction/complications , Embolism/complications , Embolism/diagnostic imaging , Embolization, Therapeutic/adverse effects , Humans , Stroke/diagnostic imaging , Stroke/etiology , Stroke/therapy
3.
J Stroke Cerebrovasc Dis ; 29(2): 104530, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31813735

ABSTRACT

INTRODUCTION: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare hereditary stroke disorder caused by mutations in the NOTCH3 gene. We report the first Chilean CADASIL family with complete radiological and histological studies. METHODS: The family tree was constructed from an autopsy-confirmed confirmed patient, and includes 3 generations. We performed clinical, pathologic, genetic, and radiologic examinations on members of a family with CADASIL. RESULTS: In the second generation, findings compatible with CADASIL were identified in 6 individuals, all of whom had a missense mutation in exon 3 (c.268C>T) resulting in an arginine to cysteine amino acid substitution at position 90 (R90C). In the third generation, a missense mutation was detected in one of the 4 asymptomatic individuals. CONCLUSIONS: There are similarities in clinical presentation between this family and previously described Asian and European series with R90C mutations. Detecting genotypes with a gain or loss of cysteine residues opens the door to future gene transfection-based therapies.


Subject(s)
CADASIL/genetics , Mutation , Receptor, Notch3/genetics , CADASIL/diagnosis , CADASIL/mortality , CADASIL/therapy , Chile , Genetic Predisposition to Disease , Heredity , Humans , Male , Middle Aged , Pedigree , Phenotype , Prognosis , Risk Factors
5.
Biomedicines ; 11(6)2023 May 25.
Article in English | MEDLINE | ID: mdl-37371620

ABSTRACT

Anti-NMDAR encephalitis has been associated with multiple antigenic triggers (i.e., ovarian teratomas, prodromal viral infections) but whether geographic, climatic, and environmental factors might influence disease risk has not been explored yet. We performed a systematic review and a meta-analysis of all published papers reporting the incidence of anti-NMDAR encephalitis in a definite country or region. We performed several multivariate spatial autocorrelation analyses to analyze the spatial variations in the incidence of anti-NMDA encephalitis depending on its geographical localization and temperature. Finally, we performed seasonal analyses in two original datasets from France and Greece and assessed the impact of temperature using an exposure-lag-response model in the French dataset. The reported incidence of anti-NMDAR encephalitis varied considerably among studies and countries, being higher in Oceania and South America (0.2 and 0.16 per 100,000 persons-year, respectively) compared to Europe and North America (0.06 per 100,000 persons-year) (p < 0.01). Different regression models confirmed a strong negative correlation with latitude (Pearson's R = -0.88, p < 0.00001), with higher incidence in southern hemisphere countries far from the equator. Seasonal analyses showed a peak of cases during warm months. Exposure-lag-response models confirmed a positive correlation between extreme hot temperatures and the incidence of anti-NMDAR encephalitis in France (p = 0.03). Temperature analyses showed a significant association with higher mean temperatures and positive correlation with higher ultraviolet exposure worldwide. This study provides the first evidence that geographic and climatic factors including latitude, mean annual temperature, and ultraviolet exposure, might modify disease risk.

6.
J Neuroimmunol ; 355: 577570, 2021 06 15.
Article in English | MEDLINE | ID: mdl-33862421

ABSTRACT

Opsoclonus-myoclonus syndrome (OMS) is a rare neurological disorder. The pathogenesis is thought to be immune-mediated. In adults, it may be idiopathic or paraneoplastic in origin. However, most cases of paraneoplastic OMS in adults are not associated with well-characterized antibodies, except for a small subgroup who have anti-Ri antibodies. Herein, we provide the first detailed description of a case of OMS associated with a Kelch-like protein-11 antibody, a newly discovered biomarker for paraneoplastic neurological syndromes associated with germ-cell tumors. This was a young female patient in whom no tumor was ever detected and who had an excellent response to rituximab.


Subject(s)
Autoantibodies/blood , Carrier Proteins/blood , Neoplasms , Opsoclonus-Myoclonus Syndrome/blood , Opsoclonus-Myoclonus Syndrome/diagnostic imaging , Adult , Female , HEK293 Cells , Humans
7.
Stroke ; 40(2): 344-9, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19109538

ABSTRACT

BACKGROUND AND PURPOSE: The metabolic syndrome (MetS) might confer a higher resistance to intravenous thrombolysis in acute middle cerebral artery (MCA) ischemic stroke. MetS increases the risk of stroke in women to a greater extent than in men. We aimed to investigate whether there might be sex differences in the impact of MetS on the response to intravenous thrombolysis for acute MCA ischemic stroke. METHODS: We prospectively studied consecutive ischemic stroke patients, treated with intravenous tissue-type plasminogen activator according to SITS-MOST criteria, with an MCA occlusion on prebolus transcranial Doppler examination. Resistance to thrombolysis was defined as the absence of complete MCA recanalization 24 hours after tissue-type plasminogen activator infusion by transcranial Doppler criteria. MetS was diagnosed according to the criteria established by the American Heart Association/National Heart, Lung, and Blood Institute 2005 statement. RESULTS: A total of 125 patients (75 men, 50 women; mean age, 67.6+/-11 years) were included. MetS was diagnosed in 76 (61%) patients. Resistance to clot lysis at 24 hours was observed in 53 (42%) patients. Two multivariate-adjusted, logistic-regression models identified that MetS was associated with a higher resistance to tissue-type plasminogen activator, independently of other significant baseline variables (odds ratio=9.8; 95% CI, 3.5 to 27.8; P=0.0001) and of the individual components of the MetS. The MetS was associated with a significantly higher odds of resistance to thrombolysis in women (odds ratio=17.5; 95% CI, 1.9 to 163.1) than in men (odds ratio=5.1; 95% CI, 1.6 to 15.6; P for interaction=0.0004). CONCLUSIONS: The effect of MetS on the resistance to intravenous thrombolysis for acute MCA ischemic stroke appears to be more pronounced in women than in men.


Subject(s)
Brain Ischemia/complications , Fibrinolytic Agents/therapeutic use , Metabolic Syndrome/complications , Stroke/complications , Stroke/drug therapy , Acute Disease , Aged , Drug Resistance , Female , Humans , Logistic Models , Male , Middle Cerebral Artery/pathology , Odds Ratio , Plasminogen Activators/therapeutic use , Prospective Studies , Sex Characteristics , Stroke/etiology , Tissue Plasminogen Activator/therapeutic use , Treatment Outcome , Ultrasonography, Doppler, Transcranial
8.
J Vet Diagn Invest ; 29(1): 91-99, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27852815

ABSTRACT

Tissue fixation, a central element in histotechnology, is currently performed with chemical compounds potentially harmful for human health and the environment. Therefore, alternative fixatives are being developed, including alcohol-based solutions. We evaluated several ethanol-based mixtures with additives to study fixative penetration rate, tissue volume changes, and morphologic effects in the bovine testis. Fixatives used were Bouin solution, 4% formaldehyde (F4), 70% ethanol (E70), E70 with 1.5% glycerol (E70G), E70 with 5% acetic acid (E70A), E70 with 1.5% glycerol and 5% acetic acid (E70AG), and E70 with 1.5% glycerol, 5% acetic acid, and 1% dimethyl sulfoxide (DMSO; E70AGD). Five-millimeter bovine testicular tissue cubes could be completely penetrated by ethanol-based fixatives and Bouin solution in 2-3 h, whereas F4 required 21 h. Bouin solution produced general tissue shrinkage, whereas the other fixatives (alcohol-based and F4) caused tissue volume expansion. Although Bouin solution is an excellent fixative for testicular tissue, ethanol-based fixatives showed good penetration rates, low tissue shrinkage, and preserved sufficient morphology to allow identification of the stages of the seminiferous epithelium cycle, therefore representing a valid alternative for histotechnology laboratories. Common additives such as acetic acid, glycerol, and DMSO offered marginal benefits for the process of fixation; E70AG showed the best preservation of morphology with excellent nuclear detail, close to that of Bouin solution.


Subject(s)
Acetic Acid , Ethanol , Fixatives , Formaldehyde , Picrates , Testis/pathology , Tissue Fixation/veterinary , Animals , Cattle , Male
10.
Rev. neurol. (Ed. impr.) ; 65(5): 193-202, 1 sept., 2017. ilus, tab, graf
Article in Spanish | IBECS (Spain) | ID: ibc-166954

ABSTRACT

Introducción. Los nuevos criterios diagnósticos de 2015 del espectro de neuromielitis óptica (NMO) están comenzando a utilizarse en diferentes poblaciones en el mundo. Objetivo. Describir las características clinicorradiológicas y pronósticas de pacientes diagnosticados de NMO con los criterios de 2015. Pacientes y métodos. Analizamos retrospectivamente 36 pacientes diagnosticados de NMO con los actuales criterios. Se generaron cuatro grupos según la serología de antiacuaporina 4 (positivos, negativos, desconocidos y negativos más desconocidos agrupados). Se compararon sus características clinicorradiológicas y se evaluaron posibles variables pronósticas de discapacidad. Resultados. Encontramos siete pacientes seropositivos, 12 negativos y 17 desconocidos. La edad de inicio fue de 36 ± 16 años, con mayor proporción de mujeres (4 a 1). La duración de la enfermedad fue de 7,4 ± 7,6 años. Los síntomas iniciales más frecuentes fueron mielitis (61%), neuritis óptica (33%) y síndrome del área postrema (11%). La lesión más frecuente en la resonancia magnética fue la mielitis longitudinalmente extensa (75%). Todos los pacientes recibieron tratamiento agudo, y el preventivo se utilizó en el 81%; la azatioprina y el rituximab fueron los que más se usaron. La mediana de la Expanded Disability Status Scale (EDSS) fue de 2 al final del seguimiento. No hubo diferencias significativas en las variables clinicorradiológicas entre los distintos grupos de pacientes. La edad de inicio fue pronóstica y presenta correlación directa con la EDSS. El inicio antes de los 30 años fue protector y, después de los 50 años, un factor de riesgo para mayor discapacidad. Conclusiones. Los actuales criterios permiten describir diferentes cohortes. La edad de inicio parece ser un factor pronóstico para desarrollar discapacidad (AU)


Introduction. The new 2015 criteria for neuromyelitis optica spectrum disorders (NMOSD) have been recently incorporated in the study of different international cohorts. Aim. To describe clinical-radiological characteristics and prognostic factors in patients with NMOSD according to the 2015 criteria. Patients and methods. Retrospective analysis of 36 patients diagnosed with NMOSD according to serologic AQP4 status (positive, negative, unknown and negative + unknown). Clinical and radiological characteristics were compared and possible disability prognostic factors were evaluated. Results. AQP4 were positive in 7 patients, negative in 12 and unknown in 17. Age of presentation was 36.6 ± 16 years, with higher female proportion (4:1). Mean disease duration was 7.4 ± 7.6 years. Most frequent presenting symptoms were acute myelitis (61%), optic neuritis (33%) and area postrema syndrome (11%). Most frequent MRI lesion was longitudinally extensive transverse myelitis (75%). All patients received acute treatment during attacks, and preventive treatment was used in 81% (azathioprine and rituximab mostly prescribed). Median EDSS was 2.0 at the end of follow-up. No differences were observed in any of the variables comparing serologic status. Age of first attack was prognostic, with direct correlation with EDSS. First attack in < 30 years was protective, meanwhile > 50 years old patients had increased risk of disability. Conclusions. The 2015 criteria allow the description and classification of NMOSD patients within different cohorts. Age of first attack seems to be a prognostic factor for developing disability (AU)


Subject(s)
Humans , Neuromyelitis Optica/diagnosis , Aquaporin 4/antagonists & inhibitors , Myelitis/diagnosis , Optic Neuritis/diagnosis , Neuromyelitis Optica/epidemiology , Retrospective Studies , Biomarkers/analysis , Seroepidemiologic Studies
11.
Rev Med Chil ; 132(3): 357-60, 2004 Mar.
Article in Spanish | MEDLINE | ID: mdl-15376574

ABSTRACT

Locked-in syndrome is a dramatic clinical condition, the patient is awake, can listen and breath, but is unable to move any muscle, conserving only the vertical eye movements. The most common cause of locked-in syndrome is the thrombosis of the basilar artery and commonly leads to death, frequently due to pneumonia. Intravenous and intra arterial thrombolysis have been used successfully in a selective group of patients with ischemic stroke. There is only one report of two patients with locked-in syndrome who were treated successfully with intra arterial thrombolysis. Other authors, based in their experiences, do not recommend this treatment. We report two female patients aged 63 and 26 years, with Locked-in syndrome due to a basilar thrombosis who were treated successfully with intra arterial thrombolysis using recombinant tissue plasminogen activator (r-TPA). The lapses between the onset of the symptoms and thrombolysis were 5 and 8 hours respectively. A complete recanalization was obtained in both patients during the thrombolysis. One year after, the first patient has only a moderate ataxia, walking with assistance and the other has a normal neurological examination.


Subject(s)
Basilar Artery , Intracranial Thrombosis/drug therapy , Quadriplegia/complications , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Adult , Female , Heparin/therapeutic use , Humans , Infusions, Intra-Arterial , Middle Aged , Recombinant Proteins , Stroke/drug therapy
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