ABSTRACT
BACKGROUND AND AIMS: Intracranial (IAD) and extracranial atherosclerotic diseases (EAD) have been mostly investigated using imaging methods. Autopsy studies allow for a direct and complete evaluation of the atherosclerotic disease. We aimed to investigate the frequency of IAD and EAD, their association, and related risk profiles in a large cross-sectional autopsy study. METHODS: We measured the intima-media thickness and stenosis of the common (CCA) and internal carotid arteries (ICA), using morphometric measurements. The main outcome was stenosis (≥50%) in the artery with the largest obstruction among the 12 cerebral arteries. We used multivariable logistic regression models to investigate the association between EAD and IAD. RESULTS: In 661 participants (mean age = 71.3 ± 11.7 y, 51% male), stenosis was more common in IAD than in EAD (59% vs. 51%). EAD was associated with Caucasian race, hypertension, and smoking, while IAD was associated with older age, less years of education, hypertension, diabetes, and a previous history of stroke. Stenosis in CCA and ICA was associated with more than two times the odds of having stenosis in the intracranial arteries (CCA: OR = 2.32, 95% CI = 1.64; 3.28; ICA: OR = 2.51, 95% CI = 1.76; 3.57). CONCLUSIONS: In this population-based autopsy study, IAD was common, even more common than EAD, but correlated with EAD.
Subject(s)
Carotid Artery, Common/pathology , Carotid Stenosis/pathology , Cerebral Arterial Diseases/pathology , Intracranial Arteriosclerosis/pathology , Plaque, Atherosclerotic , Aged , Aged, 80 and over , Autopsy , Brazil/epidemiology , Carotid Artery, Internal/pathology , Carotid Stenosis/mortality , Cause of Death , Cerebral Arterial Diseases/mortality , Cross-Sectional Studies , Female , Humans , Intracranial Arteriosclerosis/mortality , Male , Middle Aged , Prevalence , Risk Assessment , Risk Factors , Severity of Illness IndexSubject(s)
Aged , Female , Humans , Cerebral Arterial Diseases/pathology , Coronary Disease/pathology , Embolism, Air/pathology , Fatal OutcomeSubject(s)
Cerebral Arterial Diseases/pathology , Coronary Disease/pathology , Embolism, Air/pathology , Aged , Fatal Outcome , Female , HumansSubject(s)
Brain Ischemia/complications , Brain/pathology , Stroke , Brain Infarction/etiology , Brain Infarction/pathology , Carotid Artery Diseases/pathology , Cerebral Arterial Diseases/pathology , Humans , Magnetic Resonance Imaging/methods , Stroke/classification , Stroke/diagnosis , Stroke/etiology , Tomography, X-Ray Computed/methodsABSTRACT
Stroke is a well-documented complication of amphetamine abuse. Methylphenidate, chemically and pharmacologically similar to amphetamines, is widely used in the treatment of attention deficit disorder in children. The possibility of vasculitis connected to methylphenidate should not be surprising. A case is reported of stroke associated with ingestion of methylphenidate in an 8-year-old boy. Family history was negative and other causes of vasculitis were excluded. We draw your attention to the risk of using methylphenidate for a long period of time.
Subject(s)
Arteritis/chemically induced , Central Nervous System Stimulants/adverse effects , Cerebral Arterial Diseases/chemically induced , Methylphenidate/adverse effects , Arteritis/pathology , Cerebral Angiography , Cerebral Arterial Diseases/pathology , Child , Humans , Male , Stroke/chemically induced , Time FactorsABSTRACT
Se presentan 10 pacientes con ectasias sintomáticas de arterias cerebrales. Todos los pacientes son de sexo masculino y padecían de hipertensión arterial leve o moderada. Las ectasias estaban presentes en la arteria basilar en el 20%, en las arterias carótidas en el 20% y en ambos sistemas en el 60% restante. Predominaron los síntomas motores y sensitivos, ataxia, diplopía y demencia. Asismismo se presenta el segundo caso en la literatura con hemorragia subaracnoidea a partir de la ruptura de una arteria basilar ectásia. Se discute la presencia de trastornos autonómicos en un paciente con severo compromiso neurológico por compresión del tronco encefálico. Todos los pacientes fueron estudiados con tomografía computada cerebral con infusión de sustancia de constraste y arteriografía cerebral de los cuatro vasos. En uno de los casos la tomografía cerebral resultó insuficiente para el diagmnóstico de ectasia, sugiriendo un tumor del ángulo pontocerebeloso. Cinco pacientes fueron tratados con antiagregantes plaquetarios y dos pacientes recibieron anticoagulación. La evolución clínica fue desfavorable, no observándose benefício aparente en los casos tratados (AU)
Subject(s)
Middle Aged , Aged , Humans , Male , Dilatation, Pathologic/complications , Cerebral Arterial Diseases/pathology , Basilar Artery/pathology , Carotid Arteries/pathology , Hypertension/complications , Intracranial Aneurysm/complications , Subarachnoid Hemorrhage/complications , Dilatation, Pathologic/diagnostic imagingABSTRACT
Se presentan 10 pacientes con ectasias sintomáticas de arterias cerebrales. Todos los pacientes son de sexo masculino y padecían de hipertensión arterial leve o moderada. Las ectasias estaban presentes en la arteria basilar en el 20%, en las arterias carótidas en el 20% y en ambos sistemas en el 60% restante. Predominaron los síntomas motores y sensitivos, ataxia, diplopía y demencia. Asismismo se presenta el segundo caso en la literatura con hemorragia subaracnoidea a partir de la ruptura de una arteria basilar ectásia. Se discute la presencia de trastornos autonómicos en un paciente con severo compromiso neurológico por compresión del tronco encefálico. Todos los pacientes fueron estudiados con tomografía computada cerebral con infusión de sustancia de constraste y arteriografía cerebral de los cuatro vasos. En uno de los casos la tomografía cerebral resultó insuficiente para el diagmnóstico de ectasia, sugiriendo un tumor del ángulo pontocerebeloso. Cinco pacientes fueron tratados con antiagregantes plaquetarios y dos pacientes recibieron anticoagulación. La evolución clínica fue desfavorable, no observándose benefício aparente en los casos tratados