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1.
Zhen Ci Yan Jiu ; 46(3): 235-9, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-33798298

RESUMEN

OBJECTIVE: To explore the clinical effect of "Jin's three-needle" therapy and motor relearning regime for the recovery of upper limb motor function in the patients with ischemic stroke. METHODS: A total of 60 patients with ischemic stroke were randomly divided into an experiment group (30 cases) and a control group (30 cases). In the control group, the routine rehabilitation regimen was adopted. In the experimental group, on the base of the treatment regimen as the control group, the "Jin's three-needle" therapy was supplemented. The neurological function deficit score was used to assess the neurological function. The modified Fugel-Meyer assessment for upper extremities (FMA) and motor assessment scale (MAS) were adopted to assess the upper limb motor function in patients. The modified Barthel Index (MBI) was used to evaluate the activity of daily living (ADL) in patients. RESULTS: After treatment, the neurological function deficit score, the upper limb motor function (FMA and MAS) and ADL (MBI) were all improved obviously as compared with those before treatment (P<0.05). In the experimental group, the reducing range of neurological function deficit score (difference value) was larger than that in the control group (P<0.05). The increases of FMA score (upper arm function), the total score of MAS, the score for hand movement in MAS and the score for advanced hand activities of MAS, as well as MBI score in the experimental group were significantly larger than those in the control group successively (P<0.05). CONCLUSION: "Jin's three-needle" therapy combined with exercise relearning regimen effectively reduces the degree of neurological deficit and improve the upper limb motor function and ADL in patients with ischemic stroke.


Asunto(s)
Terapia por Acupuntura , Isquemia Encefálica , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Isquemia Encefálica/tratamiento farmacológico , Humanos , Accidente Cerebrovascular/tratamiento farmacológico , Resultado del Tratamiento , Extremidad Superior
2.
Artículo en Ruso | MEDLINE | ID: mdl-33834717

RESUMEN

OBJECTIVE: To evaluate the efficacy of the intravenous form of dimephosphon at the first stage of rehabilitation in patients with ischemic stroke in the carotid system. MATERIAL AND METHODS: The article presents the results of examination of 60 patients in the acute period of ischemic stroke in the carotid system (30 patients were treated with dimephosphon and 30 patients were in the comparison group). The dynamics of the clinical picture (according to the NIHSS), functional dependence in self-service (according to the modified Rankin scale), state of autonomic response using spectral analysis of heart rate variability, cerebrovascular reactivity using functional tests were assessed during the treatment. RESULTS: A significant decrease in NIHSS points was recorded (on average by 60% from the initial level) in the main group, relative to the comparison group (on average by 33% from the initial points). On the 10th day of therapy, there was a significantly more improvement in cerebrovascular reactivity to hypercapnic and hypocapnic loads, the index of vasomotor reactivity, as well as the state of cerebral blood flow autoregulation in the main group compared with the comparison group. In addition, by the 10th day of therapy relative to the initial values in the main group, a statistically significant increase (by 30%) was revealed in the number of patients with adaptive sympathicotonic type of autonomic regulation with a decrease in the number of patients with hypersympathetic and asymptomatic types of autonomic regulation after orthostatic test (by 10% and 20%, respectively). By the 10th day of hospitalization, there were more patients with no or mild signs of disability (0-2 points according to the modified Rankin scale) in the main group (83%) compared with the comparison group (60%). CONCLUSION: The use of the multimodal drug dimephosphon in complex therapy in patients in the acute period of ischemic stroke in the carotid system contributes to the normalization of the regulatory mechanisms of cerebral circulation and autonomic regulation. This helps to improve functional recovery and enhance the rehabilitation potential of patients.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Isquemia Encefálica/complicaciones , Isquemia Encefálica/tratamiento farmacológico , Circulación Cerebrovascular , Humanos , Recuperación de la Función , Accidente Cerebrovascular/tratamiento farmacológico , Resultado del Tratamiento
3.
Artículo en Ruso | MEDLINE | ID: mdl-33834736

RESUMEN

Cardioembolic stroke (CS) is the one of the most severe and requiring dynamic monitoring among the all subtypes of ischemic stroke. Patients with CS require joint treatment with cardiologists. CS is characterized by a greater severity of neurological deficits, a high risk of repeated acute cerebral circulatory disorders and fatal outcomes. This review considers the main causes of CS, the etiopathogenesis of thrombus formation in the heart chambers, current verification criteria and therapeutic aspects of CS, recommendations for the prescription of anticoagulant therapy for primary and secondary preventive treatment.


Asunto(s)
Accidente Cerebrovascular , Anticoagulantes/uso terapéutico , Humanos , Prevención Secundaria , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/etiología
4.
Medicine (Baltimore) ; 100(9): e24978, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655967

RESUMEN

RATIONALE: Severe hypofibrinogenemia after intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is rare and easily overlooked, but hypofibrinogenemia increases the risk of major bleeding. However, it is unclear when hypofibrinogenemia reaches the peak and when hypofibrinogenemia is resolved. PATIENT CONCERNS: Case 1 was of a 66-year-old man who was hospitalized due to sudden onset of vague speech and right hemiplegia for 4 hours. Case 2 was of an 84-year-old woman who was hospitalized for sudden onset of left hemiplegia and vague speech for 4 hours. In case 1, fibrinogen levels decreased from normal values to <0.25 g/L within 4.5 hours after commencing IVT and returned to normal at 35 hours later. In case 2, fibrinogen levels decreased from 1.1 to <0.25 g/L within 2 hours after commencing IVT and normalized 36.5 hours later. DIAGNOSES: Both patients were diagnosed with rt-PA-related hypofibrinogenemia. INTERVENTIONS: No antiplatelet or symptomatic treatment was administered during the period of hypofibrinogenemia. OUTCOMES: Fibrinogen levels gradually recovered. In case 1, the patient did not experience cerebral hemorrhage during hypofibrinogenemia. His symptoms improved significantly within 1 week. In case 2, repeat computed tomography revealed minor cerebral hemorrhage, but no deterioration in her condition was noted until she was discharged. LESSONS: Rapid, severe, and prolonged hypofibrinogenemia may occur after IVT with rt-PA, which may increase the risk of massive hemorrhage and affect the related therapy. Prompt diagnosis of hypofibrinogenemia is important for preventing complications. We recommend checking the fibrinogen levels routinely after IVT. Fibrinogen replacement therapy and platelet transfusion are the main management routes for rt-PA-related symptomatic intracranial hemorrhage.


Asunto(s)
Afibrinogenemia/inducido químicamente , Fibrinógeno/metabolismo , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Afibrinogenemia/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Femenino , Fibrinolíticos/efectos adversos , Humanos , Masculino , Enfermedades Raras , Índice de Severidad de la Enfermedad
5.
Braz J Med Biol Res ; 54(5): e10000, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33729386

RESUMEN

This study aimed to explore the effect of intravenous thrombolysis with alteplase on clinical efficacy, inflammatory factors, and neurological function in patients with acute cerebral infarction. A total of 120 patients with acute cerebral infarction were divided into two groups by the random number table method, with 60 patients in each group: observation group (intravenous thrombolysis with alteplase) and control group (intravenous thrombolysis with batroxobin). The clinical efficacy after a 14-day treatment was observed. Serum C-reactive protein (CRP), tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), CD62p, GMP-140, and neuron-specific enolase (NSE) were measured. Scores of National Institutes of Health Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) were determined. The total effective rate in the observation group was 81.67%, which was higher than the 61.67% in the control group (P<0.05). The improvement of inflammatory factors (CRP, TNF-α, IL-6, CD62p, GMP-140, and NSE), NIHSS, MMSE, and MoCA in the observation group was superior to that in the control group (all P<0.05). The modified Rankin scale at three months after hospital discharge in the observation group was lower than that in the control group (P<0.01). Intravenous thrombolysis with alteplase for acute cerebral infarction can enhance the clinical efficacy, alleviate inflammatory response and brain injury, and improve cognitive function, which is worthy of further clinical application and study.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Isquemia Encefálica/tratamiento farmacológico , Infarto Cerebral/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Humanos , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Activador de Tejido Plasminógeno , Resultado del Tratamiento
6.
Life Sci ; 274: 119343, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33716063

RESUMEN

Aging is a risk factor for major central nervous system (CNS) disorders. More specifically, aging can be inked to neurodegenerative diseases (NDs) because of its deteriorating impact on neurovascular unit (NVU). Metformin, a first line FDA-approved anti-diabetic drug, has gained increasing interest among researchers for its role in improving aging-related neurodegenerative disorders. Additionally, numerous studies have illustrated metformin's role in ischemic stroke, a cerebrovascular disorder in which the NVU becomes dysfunctional which can lead to permanent life-threatening disabilities. Considering metformin's beneficial preclinical actions on various disorders, and the drug's role in alleviating severity of these conditions through involvement in commonly characterized cellular pathways, we discuss the potential of metformin as a suitable drug candidate for repurposing in CNS disorders.


Asunto(s)
Envejecimiento/efectos de los fármacos , Isquemia Encefálica/tratamiento farmacológico , Reposicionamiento de Medicamentos/métodos , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Enfermedades Neurodegenerativas/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológico , Envejecimiento/patología , Animales , Isquemia Encefálica/patología , Humanos , Enfermedades Neurodegenerativas/patología , Accidente Cerebrovascular/patología
7.
Zhongguo Zhong Yao Za Zhi ; 46(1): 1-5, 2021 Jan.
Artículo en Chino | MEDLINE | ID: mdl-33645044

RESUMEN

Ischemic stroke is the leading cause of death and disability in adults in China. Recent studies have shown that neutrophil extracellular traps play a crucial role in occurrence and development of ischemic stroke. This paper reviewed the literatures on NETs since the discovery of NETs more than a decade ago, and summarized the composition of NETs, the effects of NETs on stroke, the intervention targets of NETs, and the effects of traditional Chinese medicine on NETs. NETs are an important cause of brain injury after stroke. Platelets, peptidylarginine deiminase 4, reactive oxygen species and histones are the targets to regulate NET formation in stroke. There are few researches on traditional Chinese medicine targeting NETs for stroke. Studies on the intervention of traditional Chinese medicine mainly target on neutrophils, which are the main components of NETs, and platelets, which induce the formation of NETs. The paper provided a comprehensive overview of current studies of NETs in ischemic stroke, so as to provide new ideas for the treatment and drug development of ischemic stroke.


Asunto(s)
Isquemia Encefálica , Trampas Extracelulares , Medicina China Tradicional , Accidente Cerebrovascular , Adulto , Isquemia Encefálica/tratamiento farmacológico , China , Humanos , Accidente Cerebrovascular/tratamiento farmacológico
8.
Medicine (Baltimore) ; 100(8): e24811, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663100

RESUMEN

BACKGROUND: We performed a randomized clinical trial protocol to assess the effectiveness of edaravone for acute stroke. We hypothesized that edaravone is beneficial in improving neurological impairment resulting from acute stroke. METHOD: The protocol was reviewed and approved by the Research Ethics Board of Affiliated Hospital of Chengde Medical University (0092-2394), each participant signed a written consent before participating, and SPIRIT guidelines were followed throughout. The inclusion criteria for patients were as follows: diagnosed as acute stroke (ischemic stroke or intracerebral hemorrhage) by head CT or MRI within 72 hours; age greater than 18; motor function disorder; Glasgow Coma Scale greater than 12. Patients with the following symptoms were excluded: concurrent serious complications, such as coma, drug allergy, mental disorder, and other severe organic lesions in the brain. Sixty patients were finally included in the study. The control group accepted conventional treatment, while the treatment group received edaravone treatment on top of the conventional treatment of the control group. After treatment, the differences in functional movement, living ability score, neurological score, treatment effect, and adverse reaction of these 2 groups were tested and compared. DISCUSSION: As aging worsens, the incidence of acute stroke continues to increase. Brain damage will induce the production of oxygen radicals, which can damage the cytomembrane of brain cells and finally damage the nervous system and cause cerebral injury as well as the cerebral edema. Edaravone is an antioxidant and oxygen radical scavenger that can inhibit lipid peroxidation during the scavenging of oxygen free radicals. Besides, it can also elicit anti-inflammatory protective effects for nerve cells, increase cerebral blood flow volume, prevent the aggravation of cerebral hypoperfusion toward necrosis, reduce nerve damage, and improve neurological functions and prognosis. This is the first randomized controlled trial to assess the efficacy of edaravone for treating acute stroke. High quality, large sample size, multicenter randomized trials are still required. TRIAL REGISTRATION: researchregistry6492.


Asunto(s)
Edaravona/uso terapéutico , Depuradores de Radicales Libres/uso terapéutico , Fármacos Neuroprotectores/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Actividades Cotidianas , Circulación Cerebrovascular/efectos de los fármacos , Edaravona/farmacología , Femenino , Depuradores de Radicales Libres/farmacología , Humanos , Peroxidación de Lípido/efectos de los fármacos , Masculino , Fármacos Neuroprotectores/farmacología , Ensayos Clínicos Controlados Aleatorios como Asunto
11.
Adv Clin Exp Med ; 30(2): 139-146, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33650328

RESUMEN

BACKGROUND: Ischemic stroke, also known as cerebrovascular accident or cerebral stroke, occupies the first place in the world's top 10 causes of death, with high incidence, mortality and disability rates. OBJECTIVES: To investigate the effect of stilbene glycoside upregulated SIRT3/AMPK expression on neuronal mitochondrial autophagy and neuronal apoptosis in ischemic stroke. MATERIAL AND METHODS: The PC12 cells were cultured without serum to construct an ischemic neuron model. The cells were divided into 6 groups: normal group (untreated cells), model group (ischemic treated cells), TSG group (stilbene glycoside treatment), NC group (SIRT3 and AMPK negative control treatment), si-SIRT3 group (SIRT3 silencing treatment), TSG+si-SIRT3 group (joint treatment), and TSG+si-SIRT3+oe-AMPK group (joint treatment). Cell survival and the expression of related molecules were detected. RESULTS: Compared with normal group, the model group had significantly decreased cell survival rate, mitochondrial membrane potential, as well as the expression of Bcl-2, LC3II/I, P62, PINK1, Parkin, SIRT3, AMPK, and p-AMPK, while showing significantly increased proportion of apoptosis and the expression of caspase 3 and Bax. Compared with the model group, TSG treatment promoted cell survival rate and mitochondrial autophagy, and inhibited apoptosis, while SIRT3 silencing treatment reduced cell survival rate and mitochondrial autophagy, and increased apoptosis. The SIRT3 silencing could block the inhibitory effect of TSG on the apoptosis of ischemic PC12 cells and promote mitochondrial autophagy, and AMPK overexpression could save the apoptosis of ischemic PC12 cells caused by SIRT3 silencing, and promote mitochondrial autophagy. CONCLUSIONS: By promoting the expression of SIRT3/AMPK, TSG promotes mitochondrial autophagy in ischemic neurons and inhibits their apoptosis.


Asunto(s)
Isquemia Encefálica , Sirtuina 3 , Estilbenos , Accidente Cerebrovascular , Proteínas Quinasas Activadas por AMP/metabolismo , Animales , Apoptosis , Autofagia , Isquemia Encefálica/tratamiento farmacológico , Glicósidos , Neuronas/metabolismo , Ratas , Transducción de Señal , Sirtuina 3/metabolismo , Accidente Cerebrovascular/tratamiento farmacológico
13.
Medicine (Baltimore) ; 100(5): e24297, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592875

RESUMEN

RATIONALE: Cardiac thrombus and stroke are rare complications in Mycoplasma pneumoniae infection, which is a common cause of community-acquired pneumonia in children. Early detection and prevention of thrombus in children with M pneumoniae pneumonia is relatively difficult. PATIENT CONCERNS: A 5-year-old boy with severe M pneumoniae pneumonia was referred to our center. During the treatment with sufficient antibiotics, an echocardiography surprisingly revealed a thrombus in the left atrium, with significant changes in D-dimer level and anti-phospholipid antibodies. At day 12 after admission, the patient showed impaired consciousness, aphasia, and reduced limb muscle power. Magnetic resonance angiography (MRA) showed right middle cerebral artery infarction. DIAGNOSES: Cardiac thrombus and stroke associated with M pneumoniae pneumonia. INTERVENTIONS: He was started on aggressive antibiotic therapy and urokinase thrombolytic therapy for 24 hours, continued with low molecular heparin calcium and aspirin along with rehabilitation training. OUTCOMES: On follow up, the D-dimer decreased slowly and echocardiograms showed a steadily decreasing size of thrombus with eventual disappearance at day 22 after admission. His left limb muscle power was improved after rehabilitation for 2 months. LESSONS: Early diagnosis and treatment with multiple modalities maybe useful for improving prognosis of cardiac thrombus and stroke in M pneumoniae pneumonia. Changes in D-dimer level and anti-phospholipid antibodies should be routinely monitored in severe M pneumoniae pneumonia.


Asunto(s)
Cardiopatías/microbiología , Mycoplasma pneumoniae , Neumonía por Mycoplasma/microbiología , Accidente Cerebrovascular/microbiología , Trombosis/microbiología , Antibacterianos/uso terapéutico , Anticuerpos Antifosfolípidos/sangre , Preescolar , Infecciones Comunitarias Adquiridas/sangre , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Cardiopatías/sangre , Cardiopatías/tratamiento farmacológico , Humanos , Masculino , Neumonía por Mycoplasma/sangre , Neumonía por Mycoplasma/tratamiento farmacológico , Pronóstico , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/tratamiento farmacológico , Trombosis/sangre , Trombosis/tratamiento farmacológico
14.
Life Sci ; 272: 119257, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-33631176

RESUMEN

Ischemic encephalopathy is associated with a high mortality and rate of disability. The most common type of ischemic encephalopathy, ischemic stroke, is the second leading cause of death in the world. At present, the main treatment for ischemic stroke is to reopen blocked blood vessels. However, despite revascularization, many patients are not able to achieve good functional results. At the same time, the strict time window (<4.5 h) of thrombolytic therapy limits clinical application. Therefore, it is important to explore effective neuroprotective drugs for the treatment of ischemic stroke. Magnesium is a natural calcium antagonist, which exerts neuroprotective effects through various mechanisms. However, while most basic studies have shown that magnesium supplementation can help treat cerebral ischemia, intravenous magnesium supplementation in large clinical trials has failed to improve prognosis of ischemic patients. Therefore, we review the basic and clinical studies of magnesium supplementation for cerebral ischemia. According to the route of administration, treatment can be divided into intraperitoneal magnesium supplementation, intravenous magnesium supplementation, arterial magnesium supplementation and intracranial magnesium supplementation. We also summarized the potential influencing factors of magnesium ion intervention in cerebral ischemia injury. Finally, in combination with influencing factors derived from basic research, this article proposes three future research directions, including magnesium supplementation into the circulatory system combined with magnesium supplementation in the lateral ventricle, magnesium supplementation in the lateral ventricle combined with hypothermia therapy, and lateral ventricle magnesium supplementation combined with intracarotid magnesium supplementation combined with selective hypothermia.


Asunto(s)
Isquemia Encefálica/tratamiento farmacológico , Magnesio/farmacología , Administración Intravenosa , Animales , Isquemia Encefálica/metabolismo , Bloqueadores de los Canales de Calcio/administración & dosificación , Bloqueadores de los Canales de Calcio/farmacología , Infarto Cerebral/complicaciones , Suplementos Dietéticos , Humanos , Hipotermia , Magnesio/administración & dosificación , Magnesio/metabolismo , Fármacos Neuroprotectores/farmacología , Fármacos Neuroprotectores/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica
15.
Kardiologiia ; 60(12): 97-103, 2021 Jan 19.
Artículo en Ruso | MEDLINE | ID: mdl-33522473

RESUMEN

This article presents current opinions on the role of antithrombotic therapy in secondary prevention of cardiovascular diseases (CVD) in patients after noncardioembolic stroke or a transient ischemic attack on the background of sinus rhythm. This review analytically analyses evidence-based data on antithrombotic drugs used for this secondary prevention. Despite the fact that acetylsalicylic acid (ASA) is still a "gold standard" for prevention of noncardioembolic stroke, the search for rational combinations of antithrombotic drugs to increase the effectiveness of preventive treatment is relevant. The question whether the rivaroxaban treatment as monotherapy or in combination with ASA is more effective than the ASA monotherapy for secondary prevention of cardiovascular complications (CVC) was addressed in the COMPASS study. In that study, three regimens of antithrombotic therapy were compared in patients with stable atherosclerotic CVD: rivaroxaban (2.5 mg twice a day) in combination with ASA (100 mg/day); rivaroxaban (5 mg twice a day); and ASA (100 mg/day). Risk for development of major CVC (death, stroke, myocardial infarction (IM)) was lower (p<0.001) in the rivaroxaban+ASA combination treatment group than in the ASA monotherapy group; however, the risk of major bleedings was somewhat higher. Total risk based on the definition of "pure clinical benefit" was lower for the rivaroxaban+ASA combination treatment than for the ASA monotherapy. The rivaroxaban monotherapy did not result in a significant decrease in the risk of major CVC compared to the ASA monotherapy but significantly increased the risk of major bleedings. Incidence of repeated ischemic stroke for a year was 1.1% for the combination therapy, 2.6% for the rivaroxaban therapy, and 3.4% for the ASA monotherapy with significant differences between the combination treatment group and the ASA monotherapy group (p<0.01). Relative risk of repeated stroke was 67% lower for the combination therapy group compared to the ASA monotherapy group. The combination of rivaroxaban (2.5 mg twice a day) and ASA (100 mg) opens a new epoch of antithrombotic treatment for primary and secondary prevention of stroke in patients with a stable atherosclerotic CVD and sinus rhythm.


Asunto(s)
Fibrinolíticos , Accidente Cerebrovascular , Aspirina , Quimioterapia Combinada , Humanos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Rivaroxabán , Prevención Secundaria , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control
16.
Medicina (B Aires) ; 81(1): 6-10, 2021.
Artículo en Español | MEDLINE | ID: mdl-33611238

RESUMEN

Intravenous fibrinolysis with recombinant tissue plasminogen activator (rTPA) and use of stroke units improve morbidity and mortality in patients with acute ischemic stroke (AIS). However, data published in Argentina are scarce. We describe the experience in the use of fibrinolysis in patients with acute ischemic stroke (AIS) before and after the implementation of a stroke unit in a Comprehensive Stroke Center in Buenos Aires during the last 17 years. Retrospective analysis of consecutive patients treated with rTPA between January 2003 and December 2019. Treatment times, hospitalization time, post-treatment complications and disability at 3 months were evaluated. For the analysis, the pre and post opening periods of the stroke unit were evaluated, Period 1 (P1, from 2003 to 2011) and Period 2 (P2, from 2012 to 2019). Intravenous fibrinolysis was performed in 182 patients. Opening of the stroke unit resulted in an increase in the percentage of fibrinolysis over the total number of admitted strokes (4% in P1 vs. 10% in P2, p < 0.001), shortening of the door-to-needle time (75 minutes in P1 vs. 53 minutes in P2, p < 0.00001) and higher proportion of patients treated within 60 minutes of hospital admission (36% in P1 vs. 76% in P2, p < 0.00001). In addition, there was a reduction in the median hospital stay from 9 days in P1 to 5 days in P2 (p < 0.00001). In conclusion, stroke units seem to optimize the use of fibrinolysis in acute stroke, increasing the percentage of patients treated, reducing door-to-needle time, and reducing hospitalization time.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Argentina , Isquemia Encefálica/tratamiento farmacológico , Fibrinólisis , Fibrinolíticos/uso terapéutico , Humanos , Estudios Retrospectivos , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del Tratamiento
17.
Adv Clin Exp Med ; 30(1): 29-34, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33529504

RESUMEN

BACKGROUND: Cerebrovascular disease is an important cause of epilepsy. The incidence may significantly vary (from 2.3% to 43%). Post-stroke seizures occur within 2 weeks of stroke onset (as early-onset seizures) or 2 weeks after a stroke (as late-onset seizures). OBJECTIVES: To retrospectively evaluate and differentiate predictive factors for post-stroke seizures. MATERIAL AND METHODS: We retrospectively analyzed the medical histories of 164 adult patients diagnosed with post-stroke seizures but no epilepsy recognized prior to the stroke who were hospitalized at the Neurology Clinic of Wroclaw Medical University between 2012 and 2018. The seizures were classified according to the criteria of the International League Against Epilepsy (ILAE) from 2017. The relevant demographic data, type of stroke (ischemic/hemorrhagic), time of occurrence of seizures in relation to the type of stroke, score on the modified Rankin Scale, presence of cardiovascular risk factors, electroencephalography (EEG) recording, and antiepileptic treatment (AED) were collected. In the case of ischemic stroke (IS), the size of the stroke lesion was rated on the ASPECTS scale. RESULTS: The study involved 164 patients (average age = 68.83 years), including 86 men (average age = 66.2 years). In 20 out of 164 patients, the seizures were associated with hemorrhagic stroke (HS); in 144 out of 164 patients, the post-stroke epilepsy was associated with IS. Generalized tonic-clonic seizures occurred in 101 out of 164 patients, focal aware seizures occurred in 19 out of 164 patients and focal impaired-awareness seizures occurred in 44 out of 164 patients. CONCLUSIONS: Our study has confirmed that generalized seizures occur mostly after an IS and are late complications of it. Early-onset seizures occur mostly after HS associated with severe disability. Seizures are more likely to happen due to the cortical location of the stroke. There is a shift from generalized to focal seizures with an increase in the extent of IS as evaluated using the ASPECTS scale.


Asunto(s)
Epilepsia , Accidente Cerebrovascular , Anciano , Anticonvulsivantes , Electroencefalografía , Epilepsia/tratamiento farmacológico , Epilepsia/epidemiología , Epilepsia/etiología , Femenino , Humanos , Masculino , Estudios Retrospectivos , Convulsiones/tratamiento farmacológico , Convulsiones/epidemiología , Convulsiones/etiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/tratamiento farmacológico
18.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33542025

RESUMEN

Horner's syndrome results from interruption of the sympathetic innervation to the eye. This interruption may occur at three anatomical levels along the sympathetic trunk pathway. There are numerous causes of Horner's syndrome, including injury to the carotid artery, of which arterial dissection is the commonest pathology. Occlusive carotid disease secondary to atherosclerosis is a relatively rare cause of Horner's syndrome. We describe a patient with Horner's syndrome due to complete occlusion of the ipsilateral internal carotid artery.


Asunto(s)
Arteria Carótida Interna/patología , Trastornos Cerebrovasculares , Síndrome de Horner/diagnóstico , Accidente Cerebrovascular/diagnóstico por imagen , Afasia/etiología , Angiografía por Tomografía Computarizada , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/etiología , Parestesia/etiología , Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico
19.
J Neurovirol ; 27(1): 35-51, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33534131

RESUMEN

Since the outbreak of coronavirus disease 2019 (COVID-19) in 2019, it is gaining worldwide attention at the moment. Apart from respiratory manifestations, neurological dysfunction in COVID-19 patients, especially the occurrence of cerebrovascular diseases (CVD), has been intensively investigated. In this review, the effects of COVID-19 infection on CVD were summarized as follows: (I) angiotensin-converting enzyme 2 (ACE2) may be involved in the attack on vascular endothelial cells by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), leading to endothelial damage and increased subintimal inflammation, which are followed by hemorrhage or thrombosis; (II) SARS-CoV-2 could alter the expression/activity of ACE2, consequently resulting in the disruption of renin-angiotensin system which is associated with the occurrence and progression of atherosclerosis; (III) upregulation of neutrophil extracellular traps has been detected in COVID-19 patients, which is closely associated with immunothrombosis; (IV) the inflammatory cascade induced by SARS-CoV-2 often leads to hypercoagulability and promotes the formation and progress of atherosclerosis; (V) antiphospholipid antibodies are also detected in plasma of some severe cases, which aggravate the thrombosis through the formation of immune complexes; (VI) hyperglycemia in COVID-19 patients may trigger CVD by increasing oxidative stress and blood viscosity; (VII) the COVID-19 outbreak is a global emergency and causes psychological stress, which could be a potential risk factor of CVD as coagulation, and fibrinolysis may be affected. In this review, we aimed to further our understanding of CVD-associated COVID-19 infection, which could improve the therapeutic outcomes of patients. Personalized treatments should be offered to COVID-19 patients at greater risk for stroke in future clinical practice.


Asunto(s)
Aterosclerosis/complicaciones , Coagulación Intravascular Diseminada/complicaciones , Hemorragia/complicaciones , Hiperglucemia/complicaciones , Accidente Cerebrovascular/complicaciones , Trombosis/complicaciones , Anticoagulantes/uso terapéutico , Antivirales/uso terapéutico , Aterosclerosis/diagnóstico , Aterosclerosis/tratamiento farmacológico , Aterosclerosis/virología , /tratamiento farmacológico , Fármacos Cardiovasculares/uso terapéutico , Coagulación Intravascular Diseminada/diagnóstico , Coagulación Intravascular Diseminada/tratamiento farmacológico , Coagulación Intravascular Diseminada/virología , Trampas Extracelulares/efectos de los fármacos , Trampas Extracelulares/inmunología , Hemorragia/diagnóstico , Hemorragia/tratamiento farmacológico , Hemorragia/virología , Humanos , Hiperglucemia/diagnóstico , Hiperglucemia/tratamiento farmacológico , Hiperglucemia/virología , Inflamación , Sistema Renina-Angiotensina/efectos de los fármacos , Sistema Renina-Angiotensina/inmunología , /patogenicidad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/virología , Trombosis/diagnóstico , Trombosis/tratamiento farmacológico , Trombosis/virología
20.
Rev Med Suisse ; 17(722): 142-145, 2021 Jan 20.
Artículo en Francés | MEDLINE | ID: mdl-33470571

RESUMEN

Non-vitamin K antagonist oral anticoagulants (NOAC) present several advantages over vitamin K antagonists, but data with respect to their use in patients with chronic kidney disease is limited. The decision to use oral anticoagulation as well as the choice of the molecule may be difficult in these patients. In patients with moderate kidney disease, NOACs appear to be safe and effective. In advanced kidney disease, they should be used with prudence, after careful assessment of risks and benefits, and at adapted doses. In end stage kidney disease, evidence is weak, suggesting an unfavourable risk benefit ratio. Prescription of oral anticoagulation in these patients has to be individualised in a shared decision making process.


Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial , Administración Oral , Fibrilación Atrial/tratamiento farmacológico , Coagulación Sanguínea , Fibrinolíticos/uso terapéutico , Humanos , Accidente Cerebrovascular/tratamiento farmacológico , Vitamina K/uso terapéutico
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