Factores pronósticos tras paro cardiorrespiratorio. Utilidad del vídeo-electroencefalograma precoz / Prognostic factors after cardiac arrest. Usefulness of early video-electroencephalogram

Fundamento y objetivo: La valoración de los enfermos tras un paro cardiorrespiratorio (PCR) es importante para la toma de decisiones sobre la limitación del esfuerzo terapéutico. El estudio buscó factores pronósticos en los pacientes tras un PCR recuperado. Material y método: Estudio retrospectivo de enfermos en coma tras un PCR. Se analizaron la edad, el sexo, el Glasgow Score Coma (GCS), los reflejos pupilares, las variables relacionadas con el PCR (causa, duración, presenciado o no presenciado), el estatus mioclónico y los patrones del electroencefalograma (EEG): mal pronóstico, pronóstico incierto y benigno. Resultados: Se estudiaron 50 enfermos. Las variables asociadas con mortalidad fueron la ausencia de reflejos pupilares (riesgo relativo [RR] 0,277, intervalo de confianza del 95% [IC 95%] 0,103-0,741, p = 0,01), el GCS bajo (RR 0,701, IC 95% 0,542-0,908, p = 0,007) y el estatus mioclónico (RR 0,38, IC 95% 0,176-0,854, p = 0,01). En 22 pacientes se analizaron los patrones del EEG, sin apreciarse significación estadística. Conclusiones: La ausencia de reflejos pupilares, la baja puntuación del GCS y el estatus mioclónico son factores de mal pronóstico en pacientes tras un PCR. Los patrones del EEG mostraron una tendencia no significativa de asociación con el pronóstico (AU)

Background and objective: Predictors of unfavorable outcome in patients after cardiopulmonary arrest (CPA) are important to make decisions about the limitation of therapeutic efforts. The aim was to analyze the clinical variables in the prognosis of patients recovered after CPA. Material and method: Retrospective study on comatose patients with recovered CPA. The variables were: age, sex, Glasgow Coma Score (GCS), pupillary light reflex, other variables related to CPA (cause, duration, witnessed or not witnessed), myoclonic status and electroencephalographic (EEG) patterns. Results: Fifty patients were studied. The variables associated with mortality were the absence of pupillary light reflex (hazard ratio [HR] 0.277, 95% confidence interval [95% CI] 0.103-0.741, P = .01), a low GCS (HR 0.701, 95% CI 0.542-0.908, P = .007) and myoclonic state (HR 0.38, 95% CI 0.176-0.854, P = .01). We evaluated the EEG patterns in 22 patients. No statistical significance was observed. Conclusions: The absence of pupillary light reflex, a low GCS and myoclonic state are prognostic factors in patients recovered after a CPA. The EEG patterns showed a nonsignificant association with prognosis (AU)

[Prognostic factors after cardiac arrest. Usefulness of early video-electroencephalogram]. / Factores pronósticos tras paro cardiorrespiratorio. Utilidad del vídeo-electroencefalograma precoz.

BACKGROUND AND OBJECTIVE: Predictors of unfavorable outcome in patients after cardiopulmonary arrest (CPA) are important to make decisions about the limitation of therapeutic efforts. The aim was to analyze the clinical variables in the prognosis of patients recovered after CPA. MATERIAL AND METHOD: Retrospective study on comatose patients with recovered CPA. The variables were: age, sex, Glasgow Coma Score (GCS), pupillary light reflex, other variables related to CPA (cause, duration, witnessed or not witnessed), myoclonic status and electroencephalographic (EEG) patterns. RESULTS: Fifty patients were studied. The variables associated with mortality were the absence of pupillary light reflex (hazard ratio [HR] 0.277, 95% confidence interval [95% CI] 0.103-0.741, P=.01), a low GCS (HR 0.701, 95% CI 0.542-0.908, P=.007) and myoclonic state (HR 0.38, 95% CI 0.176-0.854, P=.01). We evaluated the EEG patterns in 22 patients. No statistical significance was observed. CONCLUSIONS: The absence of pupillary light reflex, a low GCS and myoclonic state are prognostic factors in patients recovered after a CPA. The EEG patterns showed a nonsignificant association with prognosis.

[Ingestion of anabolic steroids and ischaemic stroke. A clinical case report and review of the literature]. / Ingesta de esteroides anabolizantes e ictus isquemico. Presentacion de un caso clinico y revision de la bibliografia.

INTRODUCTION. Anabolic-androgenic steroids are synthetic substances derived from testosterone that are employed for their trophic effect on muscle tissue, among other uses. Their consumption can give trigger a series of adverse side effects on the body, including the suppression of the hypothalamus-pituitary-gonadal axis as well as liver, psychiatric and cardiovascular disorders. The most common effects are altered fat profiles and blood pressure values, cardiac remodelling, arrhythmias or myocardial infarcts. CASE REPORT. We report the case of a young male, with a background of anabolic-androgenic steroids abuse, who visited because of an acute neurological focus in the right hemisphere related with an ischaemic stroke. The aetiological study, including cardiac monitoring, echocardiograph and imaging studies (magnetic resonance and arteriography) and lab findings (thrombophilia, serology, autoimmunity, tumour markers) showed no alterations. CONCLUSIONS. The association between consumption of anabolic-androgenic steroids and cardiovascular pathologies is known, but its relation with cerebrovascular disease has not received so much attention from researchers.

Ingesta de esteroides anabolizantes e ictus isquémico. Presentación de un caso clínico y revisión de la bibliografía / Ingestion of anabolic steroids and ischaemic stroke. A clinical case report and review of the literature

Introducción. Los esteroides androgénicos anabólicos son sustancias sintéticas derivadas de la testosterona, utilizados, entre otros usos, por su efecto trófico sobre el tejido muscular. Su consumo puede producir una serie de efectos adversos sobre el organismo, entre los que destacan la supresión del eje hipotálamo-pituitario-gonadal, alteraciones hepáticas, psiquiátricas y cardiovasculares, y los efectos más frecuentes al respecto son la alteración del perfil lipídico y de las cifras tensionales, la remodelación cardíaca, la producción de arritmias o el infarto de miocardio. Caso clínico. Varón joven, con antecedentes de abuso de esteroides androgénicos anabólicos, que consulta por focalidad neurológica hemisférica derecha aguda en relación con un ictus isquémico. El estudio etiológico, incluyendo monitorización cardíaca, estudio ecocardiográfico, de imagen (resonancia magnética y arteriografía) y analítico (trombofilia, serologías, autoinmunidad, marcadores tumorales), no mostró alteraciones. Conclusiones. La asociación entre consumo de esteroides androgénicos anabólicos y patología cardiovascular es conocida,pero no se ha estudiado tanto su relación con la patología cerebrovascular (AU)

Introduction. Anabolic-androgenic steroids are synthetic substances derived from testosterone that are employed for their trophic effect on muscle tissue, among other uses. Their consumption can give trigger a series of adverse side effects on the body, including the suppression of the hypothalamus-pituitary-gonadal axis as well as liver, psychiatric and cardiovascular disorders. The most common effects are altered fat profiles and blood pressure values, cardiac remodelling, arrhythmias or myocardial infarcts. Case report. We report the case of a young male, with a background of anabolic-androgenic steroids abuse, who visited because of an acute neurological focus in the right hemisphere related with an ischaemic stroke. The aetiological study, including cardiac monitoring, echocardiograph and imaging studies (magnetic resonance and arteriography) and lab findings (thrombophilia, serology, autoimmunity, tumour markers) showed no alterations. Conclusions. The association between consumption of anabolic-androgenic steroids and cardiovascular pathologies is known, but its relation with cerebrovascular disease has not received so much attention from researchers (AU)