Increased plasma levels of N-terminal pro-B-type natriuretic peptide as biomarker for the diagnosis of cardioembolic ischaemic stroke.

BACKGROUND: Despite comprehensive study, the aetiology of stroke is not identified in 35% of cases. AIMS: We conducted a study to assess the diagnostic capacity of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the identification of ischaemic stroke of cardioembolic origin. The secondary purpose of the study was to evaluate the prognostic value of NT-proBNP for predicting 90-day all-cause mortality. METHODS: We designed a prospective observational study including patients hospitalised due to stroke between March 2019 and March 2020. Blood samples were collected on admission to the emergency department and serum NT-proBNP levels were determined. Statistical analysis was performed using a bivariate logistic regression model and receiver operating characteristic (ROC) and Kaplan-Meier curves. Statistical significance was established at p<.05. RESULTS: The study included 207 patients with first ischaemic stroke. Plasma NT-proBNP levels were significantly higher (p<.001) in the cardioembolic stroke group (2069pg/mL±488.5). ROC curves showed that NT-proBNP>499pg/mL was the optimum value for diagnosing cardioembolic ischaemic stroke (sensitivity, 82%; specificity, 80%). Moreover, plasma NT-proBNP levels>499pg/mL were independently associated with cardioembolic stroke (OR: 9.881; p=.001). Finally, NT-proBNP>1500pg/mL was useful for predicting 90-day mortality (sensitivity, 70%; specificity, 93%). CONCLUSIONS: NT-proBNP was independently associated with cardioembolic stroke and should be quantified in blood tests within 24h of stroke onset. High plasma levels (>499pg/mL) may indicate an underlying cardioembolic cause, which should be further studied, while NT-proBNP >1500pg/mL was associated with increased 90-day mortality.

[Megadolicobasilar, ulcerative colitis and ischemic stroke]. / Megadolicobasilar, colitis ulcerosa e ictus isquémicos.

Megadolichobasilar (MDB) is a rare arterial anomaly consisting of excessive elongation, widening and tortuosity of the basilar artery. It may be associated with different neurological disturbances, including cerebral ischemic stroke, compression of the cranial nerves, hydrocephalus, headache and vertigo. Ulcerative colitis (UC) is an inflammatory bowel disease of unknown aetiology which may be complicated by arterial or venous cerebral illness, among others neurological anomalies. We report a patient suffering from UC who presented ischemic stroke. The neurorradiological studies showed incompletely thrombosed MDB accompanied by a distal aneurysm from narrow zone. These findings advised anticoagulant treatment which leads to neurological stability. To our knowledge, it is the first report of MDB associated with UC. Although this association is probably fortuitous, we discuss both the etiopatogeny and the possibly influence of each one on the clinical picture.

[Aetiological diagnosis of cerebral infarction in a county hospital]. / Diagnóstico etiológico del infarto cerebral en el hospital comarcal.

INTRODUCTION: Cerebral infarction (CI) can be classified aetiologically in several different ways using explicit diagnostic criteria. However, the extent to which these diagnostic criteria are actually implemented in clinical practice is unknown. Aims. The aim of this study was to analyse the management and use of diagnostic tests in the aetiological diagnosis of CI in two county hospitals and to compare this with the most common recommendations. We also sought to analyse the clinical and demographic variables that may help to explain why these guidelines are not followed. PATIENTS AND METHODS: We reviewed the discharge abstracts of 307 cases of CI attended in two county hospitals between 1999 and 2000 and we analysed the clinical data, diagnostic tests and the final diagnosis. The diagnoses were reorganised using the TOAST, Laussane, NINDS and SEN 98 classifications and we analysed the frequency with which the diagnostic tests were employed in each aetiological subtype. RESULTS: Average age: 71.3 years; 59.3% were males. CAT scans were performed in 97.1% of cases, neurosonology was used in 40.1% and echocardiography was performed in 8.5%. The aetiological diagnosis was: atherothrombotic 22.4%, cardioembolic 10.7%, lacunar 26%, unusual causes 0.3% and unknown causes 1.6%. In 37.4% of cases the diagnosis was given as unspecified CI. On reclassifying the diagnoses according to SEN 98 criteria, we obtained the following: atherothrombotic 19.5%, cardioembolic 2.8%, lacunar 13.7% and of unknown origin 63.5%. 0.6% of the cases were unclassifiable. Factors that exerted an influence on the fact that diagnostic tests were less frequently carried out included age, level of awareness and mortality. The most frequent cause of incomplete studies was the absence of carotid Doppler. CONCLUSIONS: The guidelines for aetiological diagnosis of CI are not often followed. Systematic performance of a neurosonological study would improve aetiological diagnosis of CI.

[Fever of central origin during stroke]. / Fiebre de origen central en el ictus.

INTRODUCTION: Fever appears in a fourth of stroke, approximately. Its origins, (the most of them are infectious) are unknown in a minority of the cases. Some hypotheses indicate that central mechanisms like hypothalamic lesions or segregation of endogenous pyrogens may be implicated. OBJECTIVE: To evaluate the frequency of central fever during stroke and to notice if there are clinical differences between infectious and central origins of the fever. PATIENTS AND METHODS: 103 patients were evaluated prospectively, if someone had fever, an investigation about an infectious origin was made. We divided the fever patients into two groups: "infectious fever" and "fever without infection documented" and we analyzed the clinical differences between them. RESULTS: 23% of the patients had fever, 33% without infection documented. This last group had earlier fevers. They had more clinical severity and more mortality. The fever was higher and it didn't response to the antipyretic treatment also. The others parameters didn't show any difference between the two groups. CONCLUSION: The patients with fever without infection documented ( probably fever of central origin)had a defined model with its own characteristics, in a different way from infectious fever.

Brainstem lesions decrease heart rate variability.

OBJECTIVE: Brainstem is an essential region in the regulation of the autonomic cardiovascular functions. Some authors have reported that medulla oblongata is very important in this regulation, but probably is not the unique because the sympathetic cardiovascular centers are spread in the brainstem. Since some years ago, we are able to measure heart rate variability which is a useful tool for assessing quantitatively both sympathetic and parasympathetic autonomic effects on the heart. The objective is to evaluate the effects of isolated brainstem lesion (IBL) on sympathetic and parasympathetic cardiovascular regulatory functions. PATIENTS AND METHODS: We analyzed the heart rate variability in time and frequency domains in 14 IBL patients and 25 age and sex matched healthy control subjects, measured from 24-h electrocardiogram. RESULTS: Low frequency power (0.001) and low frequency/high frequency power (0.05) were significantly higher in control subjects independently, all together or in subgroups (medulla oblongata affected or not). High frequency power (0.05) were higher too in control subjects. Variability in time domain (0.001 and 0.01) was lower when the medulla oblongata was affected. CONCLUSIONS: These results confirm that brainstem lesions cause cardiovascular autonomic dysregulation overall when the medulla oblongata is affected. The importance of this region in parasympathetic and sympathetic cardiovascular functions is showed. However, pontine and mesencephalic lesions seem to provoke a decrease only in sympathetic regulation.

Autosomal dominant endosteal hyperostosis. Report of a Spanish family with neurological involvement.

The first reported Spanish family with autosomal dominant endosteal hyperostosis is presented and two members in two different generations studied. Neurological involvement with sensorineural hearing loss, chronic intracranial hypertension, and mild corticospinal tract abnormalities were found in one case with radiological evidence of progressive bone disease at follow-up. In addition to mild hydrocephalus, CT-scan of the head documented a reduction in size of the posterior fossa and encroachment of the foramen magnum. A pattern of selective increase in the bone fraction of serum alkaline phosphatase was also recorded. This family supports the view that severe forms of endosteal hyperostosis are not confined to the autosomal recessive variant, as individuals with the autosomal dominant form may also show relentless progression to neurological involvement during adulthood.