Selection of patients for percutaneous closure in nonlacunar cryptogenic stroke associated with patent foramen ovale. Data from the NORDICTUS cooperative registry.

INTRODUCTION: There is an extending use of percutaneous closure of patent foramen ovale (PFO) as therapy for PFO-associated cryptogenic strokes. The aim of our study was to investigate the clinical practice of percutaneous closure of PFO and to analyse the variables for decision-making on the selection of patients for this procedure. METHOD: A prospective observational multicentric survey was conducted using all the cases of cryptogenic stroke/transient ischaemic attack associated with PFO recorded in the NORDICTUS hospital registry during the period 2018-2021. Clinical data, radiological patterns, echocardiogram data and factors related to PFO-associated stroke (thromboembolic disease and paradoxical embolism criteria) were recorded. The indication for closure was analysed according to age (≤/> 60 years) and the characteristics of the PFO. RESULTS: In the group ≤ 60 years (n = 488), 143 patients (29.3%) underwent PFO closure. The most influential variables for this therapy were detection of a high-risk PFO (OR 4.11; IC 2.6-6.5, P < .001), criteria for paradoxical embolism (OR 2.61; IC 1.28-5.28; P = .008) and previous use of antithrombotics (OR 2.67; IC 1.38-5.18; P = .009). In the > 60 years group (n = 124), 24 patients had PFO closure (19%). The variables related to this option were history of pulmonary thromboembolism, predisposition to thromboembolic disease, paradoxical embolism criteria, and high-risk PFO. CONCLUSIONS: The detection of a high-risk PFO (large shunt, shunt with associated aneurysm) is the main criterion for a percutaneous closure-based therapy. Other conditions to consider in the eligibility of patients are the history of thromboembolic disease, paradoxical embolism criteria or the previous use of antithrombotics.

Complicaciones neurológicas de la infección por el virus de la inmunodeficiencia humana / Neurological complications of the human immunodeficiency virus (HIV) infection

La infección por el virus de la inmunodeficiencia humana (VIH) entra en su tercera década, afectando a más de 40 millones de personas en el planeta, con una incidencia extraordinaria en el mundo subdesarollado, particularmente en el continente africano, donde hay más de 25 millones de afectados, más de 3 millones de nuevas infecciones anuales, y cuya esperanza de vida se encuentra en 47 años. Aunque la vacuna queda aún lejos, la introducción de la terapia antirretroviral combinada a mediados de la década de 1990 supuso un importante avance que contribuyó a cronificar una infección que previamente tenía una elevadísima tasa de mortalidad a corto plazo. Las complicaciones neurológicas de esta infección son enormemente variadas, afectan a cualquier localización del neuroeje y pueden aparecer en cualquier estadio de la infección; no es infrecuente que coexista más de una complicación neurológica. Tales complicaciones pueden ser consecuencia de la propia infección (primarias) o relacionadas con la depresión inmunitaria que la acompaña (secundarias). Entre las primeras destacan la demencia asociada al VIH y la polineuropatía periférica. Entre las segundas, son frecuentes las infecciones oportunistas virales y fúngicas y el linfoma del sistema nervioso. En los últimos años se han desarrollado diferentes pruebas que ayudan a establecer el diagnóstico de estas entidades, un paso necesario para instaurar las terapias adecuadas. El estado inmunitario del paciente, reflejado por el recuento periférico de linfocitos CD4 y por la carga viral sérica, nos ayudan a establecer las causas más probables de los problemas neurológicos que aparecen en el contexto de esta infección. Revisaremos brevemente en este trabajo las características más notables de cada uno de ellos

Human immunodeficiency virus infection (HIV) is entering into its third decade affecting more than 40 million persons on the plane, with an extraordinary incidence in the underdeveloped world, especially in the African continen where more than 25 million are affected, with more than 3 million new yearly infections and where the life expectancy is at 47 years. Although the vaccination is still far away, the introduction of combined antiretroviral therapy in the middle of the 90's was an important advance that contributed to converting an infection that previously had a very high rate of short-term mortality into a chronic disease. The neurological complications of this infection vary enormously. They affect any location of the neuroaxis and can appear at any stage of infection. It is not rare that more than one neurological complication exists. Such complications may be a consequence of the infection itself (primary) or related with immune depression accompanying it (secondary). Among the former, dementia associated to HIV and peripheral polyneuropathy stant out. Among the latter, opportunistic viral and fungal infections and lymphoma of the nervous systems stand out. In recent years different tests that help to establish the diagnoses of these entities have been developed, a necessary step to initiate adequate therapies. The immune state of the patient, reflected by the peripheral count of CD4 lymphocytes and serum viral load, helps us to establish the most likely causes of the neurological problems that appear in the context of this infection. We briefly review the most outstanding characteristics of each one of them in this work

[Neurological complications of the human immunodeficiency virus (HIV) infection]. / Complicaciones neurológicas de la infección por el virus de la inmunodeficiencia humana.

Human immunodeficiency virus infection (HIV) is entering into its third decade affecting more than 40 million persons on the plane, with an extraordinary incidence in the underdeveloped world, especially in the African continent where more than 25 million are affected, with more than 3 million new yearly infections and where the life expectancy is at 47 years. Although the vaccination is still far away, the introduction of combined antiretroviral therapy in the middle of the 90's was an important advance that contributed to converting an infection that previously had a very high rate of short-term mortality into a chronic disease. The neurological complications of this infection vary enormously. They affect any location of the neuroaxis and can appear at any stage of infection. It is not rare that more than one neurological complication exists. Such complications may be a consequence of the infection itself (primary) or related with immune depression accompanying it (secondary). Among the former, dementia associated to HIV and peripheral polyneuropathy stand out. Among the latter, opportunistic viral and fungal infections and lymphoma of the nervous systems stand out. In recent years different tests that help to establish the diagnoses of these entities have been developed, a necessary step to initiate adequate therapies. The immune state of the patient, reflected by the peripheral count of CD4 lymphocytes and serum viral load, helps us to establish the most likely causes of the neurological problems that appear in the context of this infection. We briefly review the most outstanding characteristics of each one of them in this work.