Bilateral pontine infarction with basilar artery fenestration: A case report.

RATIONALE: Basilar artery (BA) fenestration is a congenital anomaly with duplicated BA, which can cause ischemic stroke. However, the stroke mechanism is not clearly verified in patients with BA fenestration. PATIENT CONCERNS: Here, we report a case of 64-year-old man with well-controlled hypertension admitted with dysarthria, only. DIAGNOSES: Diffusion weighted image showed a bilateral symmetric pontine infarction sparing the midline. BA fenestration was observed from magnetic resonance angiography. INTERVENTION: High-resolution magnetic resonance image (MRI) and 4D flow MRI was performed to verify the mechanism of stroke associated with BA fenestration. OUTCOMES: No plaque was observed at the area of BA fenestration from high-resolution MRI. 4D flow MRI showed bifurcated flow with high flow velocity and low shear stress at the area of BA fenestration. LESSONS: A turbulent flow with high flow velocity and low shear stress at the BA fenestration area may have influenced the flow through the bilateral perforating arteries resulting in a bilateral symmetric pontine infarction with sparing the midline where the septa of BA is located. 4D flow dynamic studies may be beneficial for verifying the mechanism of stroke.

Robotic assessment of rapid motor decision making in children with perinatal stroke.

BACKGROUND: Activities of daily living frequently require children to make rapid decisions and execute desired motor actions while inhibiting unwanted actions. Children with hemiparetic cerebral palsy due to perinatal stroke may have deficits in executive functioning in addition to motor impairments. The objective of this study was to use a robotic object hit and avoid task to assess the ability of children with hemiparetic cerebral palsy to make rapid motor decisions. METHODS: Forty-five children with hemiparetic cerebral palsy due to perinatal stroke and 146 typically developing children (both groups ages 6-19 years) completed a robotic object hit and avoid task using the Kinarm Exoskeleton. Objects of different shapes fell from the top of the screen with increasing speed and frequency. Children were instructed to hit two specific target shapes with either hand, while avoiding six distractor shapes. The number of targets and distractors hit were compared between children with hemiparetic cerebral palsy and typically developing children, accounting for age effects. We also compared performance to a simpler object hit task where there were no distractors. RESULTS: We found that children with hemiparetic cerebral palsy hit a greater proportion of total distractors compared to typically developing children, demonstrating impairments in inhibitory control. Performance for all children improved with age. Children with hemiparetic cerebral palsy hit a greater percentage of targets with each arm on the more complex object hit and avoid task compared to the simpler object hit task, which was not found in typically developing children. CONCLUSIONS: Children with hemiparetic cerebral palsy due to perinatal stroke demonstrated impairments in rapid motor decision making including inhibitory control, which can impede their ability to perform real-world tasks. Therapies that address both motor performance and executive functions are necessary to maximize function in children with hemiparetic cerebral palsy.

Perinatal arterial ischemic stroke.

Perinatal arterial ischemic stroke is a relatively common and serious neurologic disorder that can affect the fetus, the preterm, and the term-born infant. It carries significant long-term disabilities. Herein we describe the current understanding of its etiology, pathophysiology and classification, different presentations, and optimal early management. We discuss the role of different brain imaging modalities in defining the extent of lesions and the impact this has on the prediction of outcomes. In recent years there has been progress in treatments, making early diagnosis and the understanding of likely morbidities imperative. An overview is given of the range of possible outcomes and optimal approaches to follow-up and support for the child and their family in the light of present knowledge.

Imaging functional motor connectivity in hemiparetic children with perinatal stroke.

Perinatal stroke causes lifelong disability, particularly hemiparetic cerebral palsy. Arterial ischemic strokes (AIS) are large, cortical, and subcortical injuries acquired near birth due to acute occlusion of the middle cerebral artery. Periventricular venous infarctions (PVI) are smaller, subcortical strokes acquired prior to 34 weeks gestation involving injury to the periventricular white matter. Both stroke types can damage motor pathways, thus, we investigated resulting alterations in functional motor networks and probed function. We measured blood oxygen level dependent (BOLD) fluctuations at rest in 38 participants [10 arterial patients (age = 14.7 ± 4.1 years), 10 venous patients (age = 13.5 ± 3.7 years), and 18 typically developing controls (TDCs) (age = 15.3 ± 5.1 years)] and explored strength and laterality of functional connectivity in the motor network. Inclusion criteria included MRI-confirmed, unilateral perinatal stroke, symptomatic hemiparetic cerebral palsy, and 6-19 years old at time of imaging. Seed-based functional connectivity analyses measured temporal correlations in BOLD response over the whole brain using primary motor cortices as seeds. Laterality indices based on mean z-scores in lesioned and nonlesioned hemispheres explored laterality. In AIS patients, significant differences in both strength and laterality of motor network connections were observed compared with TDCs. In PVI patients, motor networks largely resembled those of healthy controls, albeit slightly weaker and asymmetric, despite subcortical damage and hemiparesis. Functional connectivity strengths were not related to motor outcome scores for either stroke group. This study serves as a foundation to better understand how resting-state fMRI can assess motor functional connectivity and potentially be applied to explore mechanisms of interventional therapies after perinatal stroke.

Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging, alloimmune thrombocytopaenia and monochorionic twins.

Fetal stroke is an important cause of cerebral palsy but is difficult to diagnose unless imaging is undertaken in pregnancies at risk because of known maternal or fetal disorders. Fetal ultrasound or magnetic resonance imaging may show haemorrhage or ischaemic lesions including multicystic encephalomalacia and focal porencephaly. Serial imaging has shown the development of malformations including schizencephaly and polymicrogyra after ischaemic and haemorrhagic stroke. Recognised causes of haemorrhagic fetal stroke include alloimmune and autoimmune thrombocytopaenia, maternal and fetal clotting disorders and trauma but these are relatively rare. It is likely that a significant proportion of periventricular and intraventricular haemorrhages are of venous origin. Recent evidence highlights the importance of arterial endothelial dysfunction, rather than thrombocytopaenia, in the intraparenchymal haemorrhage of alloimmune thrombocytopaenia. In the context of placental anastomoses, monochorionic diamniotic twins are at risk of twin twin transfusion syndrome (TTTS), or partial forms including Twin Oligohydramnios Polyhydramnios Sequence (TOPS), differences in estimated weight (selective Intrauterine growth Retardation; sIUGR), or in fetal haemoglobin (Twin Anaemia Polycythaemia Sequence; TAPS). There is a very wide range of ischaemic and haemorrhagic injury in a focal as well as a global distribution. Acute twin twin transfusion may account for intraventricular haemorrhage in recipients and periventricular leukomalacia in donors but there are additional risk factors for focal embolism and cerebrovascular disease. The recipient has circulatory overload, with effects on systemic and pulmonary circulations which probably lead to systemic and pulmonary hypertension and even right ventricular outflow tract obstruction as well as the polycythaemia which is a risk factor for thrombosis and vasculopathy. The donor is hypovolaemic and has a reticulocytosis in response to the anaemia while maternal hypertension and diabetes may influence stroke risk. Understanding of the mechanisms, including the role of vasculopathy, in well studied conditions such as alloimmune thrombocytopaenia and monochorionic diamniotic twinning may lead to reduction of the burden of antenatally sustained cerebral palsy.

Ictus isquémico presumiblemente perinatal: factores de riesgo, hallazgos clínicos y radiológicos / Presumed perinatal ischemic stroke: risk factors and clinical and radiological findings

Introducción. El ictus isquémico presumiblemente perinatal es una causa frecuente de secuelas neurológicas importantes. Los objetivos del estudio son describir las características clínicas y los factores de riesgo implicados, y analizar las diferencias según su origen vascular. Pacientes y métodos. Estudio descriptivo retrospectivo que incluye pacientes con diagnóstico de ictus isquémico presumiblemente perinatal atendidos en un hospital terciario entre 1990-2015. Resultados. Se incluyeron 44 pacientes: 24 (55%) fueron de origen arterial, frente a 20 (45%) de origen venoso. El diagnóstico fue significativamente más tardío en los de origen venoso que en los de origen arterial (14 y 8 meses respectivamente; p = 0,025). La mayoría comenzó con un déficit motor (90%), y las crisis epilépticas y el retraso psicomotor global fueron menos frecuentes en ambos grupos (< 5%). La prevalencia de epilepsia posterior fue significativamente más frecuente entre los de origen arterial (p = 0,020). Se analizaron los factores de riesgo teóricamente implicados en su patogenia: prenatales, obstétricos, perinatales, protrombóticos y cardíacos, sin hallarse diferencias significativas en la presencia de éstos entre los infartos arteriales y los venosos. Encontramos la presencia de al menos una alteración en el estudio de hipercoagulabilidad en el 48,3% de los pacientes. Conclusión. Es preciso investigar el papel que desempeñan los factores de riesgo implicados en el ictus isquémico presumiblemente perinatal para establecer medidas preventivas. Su diagnóstico es más tardío si el origen es venoso (AU)

Introduction. Presumed perinatal ischemic stroke is a frequent cause of neurological sequelae. We aimed to describe the different clinical findings and risk factors and to analyse the differences according the vascular origin. Patients and methods. Retrospective, descriptive study of patients diagnosed with presumed perinatal ischemic stroke attended at a tertiary pediatric hospital from 1990 to 2015. Results. 44 patients were included. A total of 24 patients (55%) had arterial ischemic stroke and 20 (45%) had periventricular venous infarction. Delay in diagnosis was significantly higher in patients with periventricular venous infarction compared to those with arterial ischemic stroke (14 and 8 months respectively; p = 0.025). Most patients presented with asymmetrical motor development (90%), only < 5% with seizures or non motor delays. Subsequent epilepsy at follow-up was significantly more prevalent in arterial ischemic stroke group (p = 0.020). We determined risk factors theoretically involved in the pathogenesis of presumed perinatal ischemic stroke: prenatal, obstetrical, perinatal, prothrombotic and cardiac. No significant differences between risk factors and vascular origin were found. Prothrombotic abnormalities were common (48.3%). Conclusions. Investigation in risk factors implicated in presumed perinatal ischemic stroke is required to develop prevention strategies. Delay in diagnosis is higher in periventricular venous infarction group (AU)

COL4A1 Mutation in a Neonate With Intrauterine Stroke and Anterior Segment Dysgenesis.

BACKGROUND: COL4A1 on chromosome 13q34 encodes the alpha 1 chain of type IV collagen, a component of basal membranes. It is expressed mainly in the brain, muscles, kidneys, and eyes. COL4A1 mutations can remain asymptomatic or cause devastating disease. Neonates and children may present with porencephaly, intracerebral hemorrhage, or hemiparesis, whereas adults tend to develop intracranial aneurysms or retinal arteriolar tortuosities. PATIENT DESCRIPTION: We describe a term infant with encephalomalacia, extensive intrauterine stroke and anterior segment dysgenesis with a de novo mutation in COL4A1. CONCLUSIONS: Identification of this mutation in affected individuals has implications for perinatal management and genetic counseling.

Valor pronóstico de un ingreso previo médico o quirúrgico en pacientes con embolia pulmonar sintomática ambulatoria / Prognostic value of a previous medical or surgical admission in outpatients with symptomatic pulmonary embolism

Objetivo. Determinar si el antecedente de un ingreso, médico (IM) o quirúrgico (IQ), en los 3 meses previos es un factor asociado a la mortalidad a los 30 días en pacientes con embolia pulmonar aguda sintomática ambulatoria. Método. Estudio observacional de cohortes retrospectivo que incluyó a pacientes adultos con el diagnóstico de embolia pulmonar aguda sintomática en un hospital terciario durante 6 años. Resultados. Se incluyeron 870 pacientes con una edad media de 72,7 años. Un 10,6% (92) tuvieron un IM previo y un 4,9% (43) un IQ. Ciento doce (12,9%) fallecieron en los primeros 30 días. En el grupo de IM se documentó mayor frecuencia de Pulmonary Embolism Severity Index (PESI) simplificada de alto riesgo (≥1) (IM 90,2% vs. IQ 65,1% vs. sin ingreso previo 67%; p<0,001) y de mortalidad a los 30 días (IM 20,7% vs. IQ 7% vs. sin ingreso previo 12,9%; p=0,038). Tras un análisis de regresión logística la PESI simplificada≥1 fue el único factor independiente de mortalidad a 30 días. Conclusiones. La gravedad del episodio agudo, valorada por la escala PESI simplificada, se asocia de forma independiente con la mortalidad a 30 días en los pacientes con embolia pulmonar aguda sintomática ambulatoria. El antecedente de un IM en los 3 meses previos suele conllevar mayor gravedad en el episodio agudo (AU)

Objective. To determine whether an earlier medical (MA) or surgical (SA) admission in the previous three months is a factor associated with mortality at 30 days in outpatients with acute symptomatic pulmonary embolism. Method. Observational, retrospective cohort study on adult patients diagnosed with acute symptomatic pulmonary embolism in a tertiary hospital over a period of 6 years. Results. The study included 870 patients with a mean age of 72.7 years: 10.6% (92) had a prior MA, 4.9% (43) had a SA and 12.9% (112) died within the first 30 days. The MA group showed a higher frequency of simplified Pulmonary Embolism Severity Index (PESI) of high risk (≥1) (MA 90.2% vs SA 65.1% vs no prior admission 67.0%; p<0.001) and mortality at 30 days (MA 20.7% vs SA 7.0% vs no prior admission 12.9%; p=0.038). The logistic regression analysis demonstrated that a simplified PESI≥1 was the only independent risk factor for mortality at 30 days. Conclusions. The severity of the acute episode, as assessed by the simplified PESI scale, is independently associated with mortality at 30 days in outpatients with acute symptomatic pulmonary embolism. An earlier MA in the previous 3 months usually involves greater severity in the acute episode (AU)

Tratamiento de la hiperglucemia en pacientes con ictus agudo / Treatment of hyperglycaemia in patients with acute stroke

La proporción de pacientes diabéticos hospitalizados por ictus ha ido aumentando en los últimos años, alcanzando en la actualidad casi un tercio de todos los ictus. Además, prácticamente la mitad de los enfermos con ictus agudo pueden presentar hiperglucemia en las primeras horas del evento. A pesar de que la hiperglucemia en la fase aguda del ictus se asocia a un peor pronóstico, su tratamiento es en la actualidad motivo de controversia. No existen evidencias de que la administración de insulina por vía intravenosa en estos pacientes proporcione beneficios en la evolución del ictus. Nuevos estudios en desarrollo, como el estudio Stroke Hyperglycemia Insulin Network Effort (SHINE), posiblemente contribuyan a aclarar el papel del control intensivo de la glucemia durante la fase aguda del ictus. Finalmente, los pacientes que han presentado un ictus deberían ser sometidos a un cribado de diabetes (AU)

The proportion of diabetic patients who are hospitalised for stroke has been increasing in recent years, currently reaching almost a third of all cases of stroke. In addition, about half of patients with acute stroke present hyperglycaemia in the first hours of the stroke. Although hyperglycaemia in the acute phase of stroke is associated with a poor prognosis, its treatment is currently a topic of debate. There is no evidence that the adminstration of intravenous insulin to these patients offers benefits in terms of the evolution of the stroke. New studies in development, such as the SHINE study (Stroke Hyperglycemia Insulin Network Effort), may contribute to clarifying the role of intensive control of glycaemia during the acute phase of the stroke (AU)

Determinants of cognitive outcomes of perinatal and childhood stroke: A review.

Our understanding of cognitive and behavioral outcomes of perinatal and childhood stroke is rapidly evolving. A current understanding of cognitive outcomes following pediatric stroke can inform prognosis and direct interventions and our understanding of plasticity in the developing brain. However, our understanding of these outcomes has been hampered by the notable heterogeneity that exists amongst the pediatric stroke population, as the influences of various demographic, cognitive, neurological, etiological, and psychosocial variables preclude broad generalizations about outcomes in any one cognitive domain. We therefore aimed to conduct a detailed overview of the published literature regarding the effects of age at stroke, time since stroke, sex, etiology, lesion characteristics (i.e., location, laterality, volume), neurologic impairment, and seizures on cognitive outcomes following pediatric stroke. A key theme arising from this review is the importance of interactive effects among variables on cognitive outcomes following pediatric stroke. Interactions particularly of note include the following: (a) age at Stroke x Lesion Location; (b) Lesion Characteristics (i.e., volume, location) x Neurologic Impairment; (c) Lesion Volume x Time Since Stroke; (d) Sex x Lesion Laterality; and (e) Seizures x Time Since Stroke. Further, it appears that these relationships do not always apply uniformly across cognitive domains but, rather, are contingent upon the cognitive ability in question. Implications for future research directions are discussed.

Registro de Ictus del Hospital de Mataró: 10 años de registro en un hospital comarcal / The Mataró Stroke Registry: a 10-year registry in a community hospital

Introducción: Un registro prospectivo de ictus permite mejorar el conocimiento de la historia natural de la enfermedad. Presentamos los datos del Registro del Hospital de Mataró. Métodos: En febrero de 2002 se inició en nuestro hospital el registro prospectivo de pacientes ingresados con un ictus agudo. Se recogen variables sociodemográficas, antecedentes, clínicas, topográficas, etiológicas y pronósticas. Analizamos los resultados obtenidos después de los primeros 10 años de registro. Resultados: Se han registrado 2.165 pacientes, el 54,1% varones, con una edad media de 73 años. El factor de riesgo más frecuente es la hipertensión (65,4%). Mediana de la NIHSS al ingreso: 3 (rango intercuartílico, 1-8). Un 79,7% han sido infartos cerebrales, un 10,9% hemorragias y un 9,4% AIT. De los isquémicos, la etiología ha sido cardioembólica en el 26,5%, aterotrombótica en el 23,7% y lacunar en el 22,9%. La localización más frecuente de las hemorragias ha sido lobar (47,4%), y se han atribuido a hipertensión el 54,8%. La mediana de la estancia hospitalaria ha sido de 8 días. Al alta, un 60,7% pudieron volver directamente al domicilio y un 52,7% eran independientes para las actividades de la vida diaria. A los 3 meses, las cifras fueron 76,9 y 62,9% respectivamente. La mortalidad intrahospitalaria ha sido del 6,5% y a los 3 meses del 10,9%. Conclusiones: El perfil de los pacientes en nuestra área no difiere de las otras series, aunque la severidad de los ictus ha sido discretamente menor. Constatamos unas cifras óptimas de estancia hospitalaria y de discapacidad y mortalidad tanto a corto como a medio plazo

Introduction: A prospective stroke registry leads to improved knowledge of the disease. We present data on the Mataró Hospital Registry. Methods: In February-2002 a prospective stroke registry was initiated in our hospital. It includes sociodemographic data, previous diseases, clinical, topographic, etiological and prognostic data. We have analyzed the results of the first 10 years. Results: A total of 2,165 patients have been included, 54.1% male, mean age 73 years. The most frequent vascular risk factor was hypertension (65.4%). Median NIHSS on admission: 3 (interquartile range, 1-8). Stroke subtype: 79.7% ischemic strokes, 10.9% hemorrhagic, and 9.4% TIA. Among ischemic strokes, the etiology was cardioembolic in 26.5%, large-vessel disease in 23.7%, and small-vessel in 22.9%. The most frequent topography of hemorrhages was lobar (47.4%), and 54.8% were attributed to hypertension. The median hospital stay was 8 days. At discharge, 60.7% of patients were able to return directly to their own home, and 52.7% were independent for their daily life activities. After 3 months these percentages were 76.9% and 62.9%, respectively. Hospital mortality was 6.5%, and after 3 months 10.9%. Conclusions: Our patient's profile is similar to those of other series, although the severity of strokes was slightly lower. Length of hospital stay, short-term and medium term disability, and mortality rates are good, if we compare them with other serie

Síndrome del ocho y medio secundario a un ictus isquémico / Eight and a half syndrome caused by a stroke

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Depresión post ictus: una actualización / Post-stroke depression: an update

Introducción: La depresión post ictus (DPI) es el trastorno afectivo más frecuente tras un ictus y el principal factor que limita la recuperación y rehabilitación de los pacientes, además de poder incrementar su mortalidad hasta 10 veces. Desarrollo: La DPI se presenta en uno de cada 3 pacientes con ictus y en más de la mitad de los casos no se diagnostica ni se trata. En su etiopatogenia son varios los mecanismos implicados: biológicos, conductuales y sociales. Los síntomas suelen aparecer en los primeros 3 meses tras el ictus (DPI «precoz») y menos frecuentemente más tarde (DPI «tardía»). Los síntomas son similares a los de otras depresiones, aunque con algunas diferencias, como presentar más trastornos del sueno, síntomas vegetativos e introversión para las relaciones sociales. Para su diagnóstico se recomienda mantener una actitud vigilante y emplear herramientas diagnósticas específicas, como el Patient Health Questionaire-2 (PHQ-2). Finalmente, el tratamiento de elección son los inhibidores selectivos de la recaptación de serotonina (ISRS). No obstante, aún son muchas las cuestiones por resolver en el tratamiento de la DPI, como cuándo es el mejor momento para iniciar el tratamiento o el efecto de los antidepresivos sobre la cognición y la función motora, entre otros. Conclusiones: Los neurólogos desempenan un papel fundamental en la recuperación de los enfermos con ictus. Es necesario que estén familiarizados con la detección temprana y el tratamiento de la DPI, para así facilitar la recuperación funcional del paciente, su reinserción social y la mejora en la calidad de vida del enfermo y su familia

Introduction: Post-stroke depression (PSD) is the most common mood disorder following a stroke, and also the main factor limiting recovery and rehabilitation in stroke patients. In addition, it may increase mortality by up to ten times. Development: PSD occurs in 1 in 3 stroke patients and more than half of all cases are neither diagnosed nor treated. Several mechanisms, including biological, behavioral, and social factors, are involved in its pathogenesis. Symptoms usually occur within the first three months after stroke (early onset PSD), and less frequently at a later time (late onset PSD). Symptoms resemble those of other types of depression, although there are some differences: PSD patients experience more sleep disturbances, vegetative symptoms, and social withdrawal. For PSD diagnosis, we recommended vigilance and use of specific diagnostic tools such as the Patient Health Questionnaire-2 (PHQ-2). The treatments of choice are selective serotonin reuptake inhibitors (SSRI). However, there are still many unanswered questions in the treatment of PSD, such as the best time to start treatment or the effects of antidepressants on cognition and motor function, among others. Conclusions: Neurologists play a pivotal role in the care and management of patients recovering from stroke. They must be familiar with methods for early detection and treatment ofPSD, as this can facilitate a patient’s functional recovery and social reintegration, and improve quality of life for patients and their families

A diagnostic approach for cerebral palsy in the genomic era.

An ongoing challenge in children presenting with motor delay/impairment early in life is to identify neurogenetic disorders with a clinical phenotype, which can be misdiagnosed as cerebral palsy (CP). To help distinguish patients in these two groups, conventional magnetic resonance imaging of the brain has been of great benefit in "unmasking" many of these genetic etiologies and has provided important clues to differential diagnosis in others. Recent advances in molecular genetics such as chromosomal microarray and next-generation sequencing have further revolutionized the understanding of etiology by more precisely classifying these disorders with a molecular cause. In this paper, we present a review of neurogenetic disorders masquerading as cerebral palsy evaluated at one institution. We have included representative case examples children presenting with dyskinetic, spastic, and ataxic phenotypes, with the intent to highlight the time-honored approach of using clinical tools of history and examination to focus the subsequent etiologic search with advanced neuroimaging modalities and molecular genetic tools. A precise diagnosis of these masqueraders and their differentiation from CP is important in terms of therapy, prognosis, and family counseling. In summary, this review serves as a continued call to remain vigilant for current and other to-be-discovered neurogenetic masqueraders of cerebral palsy, thereby optimizing care for patients and their families.

A review of cognitive outcomes in children following perinatal stroke.

Perinatal stroke is a significant cause of congenital neurological disability. Although motor deficits and epilepsy are relatively easy to identify, developmental and behavioral co-morbidities are more complex and challenging to define. We provide an overview of perinatal stroke syndromes and theories relating injury in the developing brain to long-term outcomes. We present a comprehensive overview of the effects on intelligence and other specific cognitive domains, as well as investigations relating clinical features and neuroimaging to deficits. Better understanding of the impact of early stroke has potential to elucidate processes of brain development, in addition to providing guidance for prognosis and rehabilitation.

Early intervention after perinatal stroke: opportunities and challenges.

Perinatal stroke is the most common cause of hemiplegic cerebral palsy. No standardized early intervention exists despite evidence for a critical time window for activity-dependent plasticity to mould corticospinal tract development in the first few years of life. Intervention during this unique period of plasticity could mitigate the consequences of perinatal stroke to an extent not possible with later intervention, by preserving the normal pattern of development of descending motor pathways. This article outlines the broad range of approaches currently under investigation. Despite significant progress in this area, improved early detection and outcome prediction remain important goals.

Accidentes cerebrovasculares prenatales diagnosticados en la etapa de lactante: serie de 10 pacientes / Prenatal cerebrovascular accidents diagnosed in the early infant stage: a series of 10 patients

Introducción. El accidente cerebrovascular (ACV) fetal o prenatal se define como un suceso isquémico, trombótico o hemorrágico arterial o venoso que acontece entre las 14 semanas de gestación y el inicio del parto. Pacientes y métodos. Estudio retrospectivo de una serie de 10 pacientes afectos de un ictus, presumiblemente fetal, desapercibido durante el embarazo y diagnosticado en la etapa de lactante; se destacan cuáles han sido los síntomas y la edad en que se han identificado. Resultados. De los 10 pacientes estudiados, ninguno presentaba antecedentes maternos relevantes, pero se detectaron cuatro amenazas de parto pretérmino que se resolvieron con las medidas habituales y sin hallazgos de alteración fetal posterior. Entre el segundo y tercer trimestre de vida es cuando se han realizado los estudios que han llevado al diagnóstico, y se ha indicado por la familia una menor movilidad de un hemicuerpo respecto al contralateral como motivo de consulta. Dos pacientes presentaban una trombofilia. Con una media de seguimiento de seis años, todos asocian una parálisis cerebral infantil, la tercera parte una epilepsia y el 75% tiene dificultades de aprendizaje o discapacidad intelectual. Conclusión. Cuando los ACV no se detectan prenatalmente, es importante que en la atención primaria se busquen y detecten los signos de alarma del desarrollo psicomotor del lactante de forma precoz para iniciar su estudio y procurar una rehabilitación lo más pronto posible (AU)

Introduction. A foetal or prenatal cerebrovascular accident (CVA) is defined as an ischaemic, thrombotic or arterial or venous haemorrhagic event that occurs between the 14th week of gestation and the onset of labour. Patients and methods. We report a retrospective study of a series of 10 patients suffering from a, presumably foetal, stroke that went unnoticed during the pregnancy and was diagnosed in the early infant stage. The symptoms and the age at which they were identified are highlighted. Results. None of the 10 patients studied presented any relevant events in the mothers’ medical history, but there were four threats of a preterm birth that were solved using the usual means and without the occurrence of any alterations that later affected the foetus. The studies that led to the diagnosis were carried out between the sixth and ninth months of life, and the reason for visiting was reported by the family as being a lower degree of mobility on one side of the body with respect to the other. Two patients presented thrombophilia. With a mean follow-up time of six years, all the patients have an associated infantile cerebral palsy, a third of them have epilepsy and 75% have learning difficulties or intellectual disability. Conclusions. When CVA are not detected in the prenatal period, it is important in primary care to look for and detect the warning signs of the psychomotor development of the infant at an early stage in order to begin a study of the case and to undertake rehabilitation as early as possible (AU)

Blindsight in children with congenital and acquired cerebral lesions.

It has been shown that unconscious visual function can survive lesions to optical radiations and/or primary visual cortex (V1), a phenomenon termed "blindsight". Studies on animal models (cat and monkey) show that the age when the lesion occurs determines the extent of residual visual capacities. Much less is known about the functional and underlying neuronal repercussions of early cortical damage in humans. We measured sensitivity to several visual tasks in four children with congenital unilateral brain lesions that severely affected optic radiations, and in another group of three children with similar lesions, acquired in childhood. In two of the congenital patients, we measured blood oxygenation level dependent (BOLD) activity in response to stimulation of each visual field quadrants. Results show clear evidence of residual unconscious processing of position, orientation and motion of visual stimuli displayed in the scotoma of congenitally lesioned children, but not in the children with acquired lesions. The calcarine cortical BOLD responses were abnormally elicited by stimulation of the ipsilateral visual field and in the scotoma region, demonstrating a profound neuronal reorganization. In conclusion, our data suggest that congenital lesions can trigger massive reorganization of the visual system to alleviate functional effects of early brain insults.

Dietary fibers and cardiometabolic diseases.

The high prevalence of cardiovascular disease (CVD) is largely attributable to the contemporary lifestyle that is often sedentary and includes a diet high in saturated fats and sugars and low ingestion of polyunsaturated fatty acids (PUFAs), fruit, vegetables, and fiber. Experimental data from both animals and humans suggest an association between increased dietary fiber (DF) intakes and improved plasma lipid profiles, including reduced low density lipoprotein cholesterol (LDL-C) concentrations. These observations underline that the intake of DF may protect against heart disease and stroke.