Achieved blood pressures in the secondary prevention of small subcortical strokes (SPS3) study: challenges and lessons learned.

BACKGROUND: Lowering blood pressure (BP) after stroke remains a challenge, even in the context of clinical trials. The Secondary Prevention of Small Subcortical Strokes (SPS3) BP protocol, BP management during the study, and achieved BPs are described here. METHODS: Patients with recent symptomatic lacunar stroke were randomized to 1 of 2 levels of systolic BP (SBP) targets: lower: <130mm Hg, or higher: 130-149mm Hg. SBP management over the course of the trial was examined by race/ethnicity and other baseline conditions. RESULTS: Mean SBP decreased for both groups from baseline to the last follow-up, from 142.4 to 126.7mm Hg for the lower SBP target group and from 143.6 to 137.4mm Hg for the higher SBP target group. At baseline, participants in both groups used an average of 1.7±1.2 antihypertensive medications, which increased to a mean of 2.4±1.4 (lower group) and 1.8±1.4 (higher group) by the end-study visit. It took an average of 6 months for patients to reach their SBP target, sustained to the last follow-up. Black participants had the highest proportion of SBP ≥150mm Hg at both study entry (40%) and end-study visit (17%), as compared with whites (9%) and Hispanics (11%). CONCLUSIONS: These results show that it is possible to safely lower BP even to a SBP goal <130mm Hg in a variety of patients and settings, including private and academic centers in multiple countries. This provides further support for protocol-driven care in lowering BP and consequently reducing the burden of stroke.

[Cerebral salt wasting syndrome associated with Listeria monocytogenes encephalitis. Report of one case]. / Encefalopatía perdedora de sal en romboencefalitis por listeria.

Hyponatremia is common in patients with severe neurological diseases and is often secondary to a syndrome of inappropriate antidiuretic hormone secretion (SIADH). However, in some patients, hyponatremia is due to cerebral salt wasting syndrome (CSWS). SIADH and CSWS treatments are opposite and misdiagnosis can lead to increased morbidity and mortality. We report a 52 years old female with a rhom-boencephalitis caused by Listeria Monocytogenes (LM), ventriculitis and abscesses in cerebellum and brainstem. It was associated with hyponatremia, hypotension, increased natriuresis, hypouricemia, and low creatinine and blood urea nitrogen levels. Large amounts of sodium were needed and the condition persisted after hospital discharge. Hyponatremia is common in central nervous system involvement by LM, however we are not aware of CSWS reports of this condition.

Encefalopatía perdedora de sal en romboencefalitis por listeria / Cerebral salt wasting syndrome associated with Listeria monocytogenes encephalitis. Report of one case

Hyponatremia is common in patients with severe neurological diseases and is often secondary to a syndrome of inappropriate antidiuretic hormone secretion (SIADH). However, in some patients, hyponatremia is due to cerebral salt wasting syndrome (CSWS). SIADH and CSWS treatments are opposite and misdiagnosis can lead to increased morbidity and mortality. We report a 52 years old female with a rhom-boencephalitis caused by Listeria Monocytogenes (LM), ventriculitis and abscesses in cerebellum and brainstem. It was associated with hyponatremia, hypotension, increased natriuresis, hypouricemia, and low creatinine and blood urea nitrogen levels. Large amounts ofsodium were needed and the condition persisted after hospital discharge. Hyponatremia is common in central nervous system involvement by LM, however we are not aware of CSWS reports of this condition.

Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data.

BACKGROUND AND PURPOSE: Herniation attributable to unilateral mass effect is the major cause of death in cerebral venous thrombosis (CVT). Decompressive surgery may be lifesaving in these patients. METHODS: Retrospective registry of cases of acute CVT treated with decompressive surgery (craniectomy or hematoma evacuation) in 22 centers and systematic review of all published cases of CVT treated with decompressive surgery. The primary outcome was the score on the modified Rankin Scale (mRS) score at last follow-up, dichotomized between favorable (mRS score, 0-4) and unfavorable outcome (mRS score, 5 or death). Secondary outcomes were complete recovery (mRS score 0-1), independence (mRS score, 0-2), severe dependence (mRS score, 4-5), and death at last available follow-up. RESULTS: Sixty-nine patients were included and 38 were from the registry. Decompressive craniectomy was performed in 45 patients, hematoma evacuation was performed in 7, and both interventions were performed in 17 patients. At last follow-up (median, 12 months) only 12 (17.4%) had un unfavorable outcome. Twenty-six (37.7%) had mRS score 0 to 1, 39 (56.5%) had mRS score 0 to 2, 4 (5.8%) were alive with mRS score 4 to 5, and 11 (15.9%) patients died. Three of the 9 patients with bilateral fixed pupils recovered completely. Comatose patients were less likely to be independent (mRS score 0-2) than noncomatose patients (45% versus 84%; P=0.003). Patients with bilateral lesions were more likely to have unfavorable outcomes (50% versus 11%; P=0.004) and to die (42% versus 11%; P=0.025). CONCLUSIONS: In CVT patients with large parenchymal lesions causing herniation, decompressive surgery was lifesaving and often resulted in good functional outcome, even in patients with severe clinical conditions.

[Primary vasculitis of the central nervous system: report of one case]. / Vasculitis primaria del sistema nervioso central, diagnóstico diferencial de demencia subaguda: Caso clínico.

A primary central nervous system vasculitis is an uncommon and invalidating disease, which has a fatal course if left untreated. We report a 63 year-old woman presenting with a history of two months of cognitive impairment, dysarthria, gait instability and tremor. After four months of evolution a right hemianopsia and a flaccid paresis of upper right limb appeared. A brain biopsy was performed and the histological findings confirmed the suspicion of primary cerebral vasculitis. The patient was treated with cyclophosphamide and prednisone, observing a partial recovery of cognitive and motor function.

Oral metastasis of renal cell carcinoma, presentation of a case.

The oral cavity constitutes a site of low prevalence for metastasis of malignant tumors. Nevertheless, it has a high prevalence for metastasis of renal origin. Besides the kidneys, there are other primary sites with high prevalence of metastasis to the oral mucosa, such as the lungs, skin and breasts. Metastasis is common in patients with a background of treated renal tumors, thereby, it is proper to determine the possibility of oral metastasis as part of the protocol of attention. However, it constitutes a diagnostic challenge when it presents in patients with no renal antecedents. It is in this type of patients that the diagnosis of carcinoma is achieved by means of a metastasis. Survival rate in these patients is short because at the time of the metastasis diagnosis, the general compromise is high. The following report describes a case referred from the Rheumatology Unit with an intraoral tumor, that was finally diagnosed as a Metastasic Renal Cell Carcinoma with multiple metastasis.

Oral metastasis of renal cell carcinoma, presentation of a case

The oral cavity constitutes a site of low prevalence for metastasis of malignant tumors. Nevertheless, it has a highprevalence for metastasis of renal origin. Besides the kidneys, there are other primary sites with high prevalence ofmetastasis to the oral mucosa, such as the lungs, skin and breasts.Metastasis is common in patients with a background of treated renal tumors, thereby, it is proper to determine thepossibility of oral metastasis as part of the protocol of attention. However, it constitutes a diagnostic challengewhen it presents in patients with no renal antecedents. It is in this type of patients that the diagnosis of carcinomais achieved by means of a metastasis. Survival rate in these patients is short because at the time of the metastasisdiagnosis, the general compromise is high.The following report describes a case referred from the Rheumatology Unit with an intraoral tumor, that was finallydiagnosed as a Metastasic Renal Cell Carcinoma with multiple metastasis (AU)

Beckwith Wiedemann syndrome: presentation of a case report.

Beckwith Wiedemann Syndrome (BWS) is a rare congenital disease of low prevalence. However, it presents a high prevalence within the genetic pathologies of overgrowth. This syndrome presents typical manifestations such as macroglossia, macrosomy at birth, omphalocele and defects of the anterior abdominal wall. Its origin is known to be genetic, but its mechanism of generation is not clear. This syndrome has been the object of wide studies since investigators have established a relationship between the methods of assisted fertilization (assisted reproduction treatment, ART) and its appearance. Currently, research is oriented towards the improvement of the prenatal diagnostic techniques, which would allow a preparation of the multidisciplinary medical team to treat the pathologies with which these patients are born. Next we present the case of a 1 year-old child who consults this service with a diagnosis of macroglossia associated with BWS.

Beckwith Wiedemann Syndrome: Presentation of a case report

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Beckwith Wiedemann Syndrome (BWS) is a rare congenital disease of low prevalence. However, it presents a highprevalence within the genetic pathologies of overgrowth. This syndrome presents typical manifestations such asmacroglossia, macrosomy at birth, omphalocele and defects of the anterior abdominal wall. Its origin is known to be genetic, but its mechanism of generation is not clear. This syndrome has been the object of wide studies since investigators have established a relationship between the methods of assisted fertilization (assisted reproduction treatment, ART) and its appearance.Currently, research is oriented towards the improvement of the prenatal diagnostic techniques, which would allow a preparation of the multidisciplinary medical team to treat the pathologies with which these patients are born.Next we present the case of a 1 year-old child who consults this service with a diagnosis of macroglossia associated with BWS