Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23.472
Filtrar
1.
JNMA J Nepal Med Assoc ; 59(234): 192-196, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506462

RESUMO

Paroxysmal nocturnal hemoglobinuria can rarely present as cerebral ischemia and stroke due to arterial thrombosis. However, it should be considered in a young patient with bone marrow failure features, systemic thromboses, and hemolysis. The variants of paroxysmal nocturnal hemoglobinuria pose a diagnostic challenge and hence are important to recognize. We report a case of a 28-years-old female with Herlyn Werner Wunderlich Syndrome who presented with an ischemic cerebrovascular accident, pancytopenia, hemoglobinuria, and widespread abdominal thromboses suggestive of paroxysmal nocturnal hemoglobinuria. The patient was managed symptomatically and referred to a hematologist.


Assuntos
Isquemia Encefálica , Hemoglobinúria Paroxística , AVC Isquêmico , Acidente Vascular Cerebral , Anormalidades Urogenitais , Adulto , Feminino , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/diagnóstico , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia
2.
J Assoc Physicians India ; 69(4): 11-12, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34470196

RESUMO

Dandy-Walker variant consists of vermian hypoplasia and cystic dilatation of the fourth ventricle, without enlargement of the posterior fossa is a distinctive entity believed to represent a mild subtype of Dandy-Walker complex. We report a case of 66 year male presented with right sided hemiparesis due to ischemic stroke whose imaging showed incidental findings Dandy walker variant. This Incidental Dandy Walker malformation finding in adult is rare with only a few cases reported till date.


Assuntos
Síndrome de Dandy-Walker , Acidente Vascular Cerebral , Adulto , Síndrome de Dandy-Walker/diagnóstico , Humanos , Hipertrofia , Masculino , Paresia , Acidente Vascular Cerebral/etiologia
3.
Isr Med Assoc J ; 23(9): 580-583, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472234

RESUMO

BACKGROUND: Oral anticoagulants (OAC) reduce the risk for stroke and death from all causes in patients with non-valvular atrial fibrillation (NVAF). OBJECTIVES: To explore adherence rates of OAC among patients with NVAF in long-term use in a real-world setting and to examine patient characteristics associated with good adherence. METHODS: We conducted a population-based cohort study with members of Clalit Health Services, Israel. All patients aged ≥ 30 years with a diagnosis of NVAF before 2016 who were treated with OAC were included. We included patients who filled at least one prescription per year in the three consecutive years 2016-2018. We analyzed all prescriptions that were filled for the medications from 1 January 2017 to 31 December 2017. We considered purchasing of at least nine monthly prescriptions during 2017 as good medication adherence. RESULTS: We identified 26,029 patients with NVAF who were treated with OAC; 10,284 (39.5%) were treated with apixaban, 6321 (24.3%) with warfarin, 6290 (24.1%) with rivaroxaban, and 3134 (12.0%) with dabigatran. Rates of good medication adherence were 88.9% for rivaroxaban, 84.9% for apixaban, 83.6% for dabigatran, and 55.8% for warfarin (P < 0.0001). Advanced age was associated with higher adherence rates (P < 0.001). Socioeconomic status was not associated with medication adherence. Good adherence with OAC was associated with lower low density lipoprotein (LDL) cholesterol and glucose levels. CONCLUSIONS: Adherence rates to OAC in chronic use among patients with chronic NAVF are high. Investing in OAC adherence may have a wider health impact than expected.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Adesão à Medicação , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Estudos de Coortes , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia
4.
J Assoc Physicians India ; 69(6): 11-12, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34472782

RESUMO

BACKGROUND AND PURPOSE: Various neurological complications have been reported in association with COVID-19. We report our experience of COVID-19 with stroke at a single center over a period of eight months spanning 1 March to 31 October 2020. METHODS: We recruited all patients admitted to Internal Medicine with an acute stroke, who also tested positive for COVID-19 on RTPCR. We included all stroke cases in our analysis for prediction of in-hospital mortality, and separately analyzed arterial infarcts for vascular territory of ischemic strokes. RESULTS: There were 62 stroke cases among 3923 COVID-19 admissions (incidence 1.6%). Data was available for 58 patients {mean age 52.6 years; age range 17-91; F/M=20/38; 24% (14/58) aged ≤40; 51% (30/58) hypertensive; 36% (21/58) diabetic; 41% (24/58) with O2 saturation <95% at admission; 32/58 (55.17 %) in-hospital mortality}. Among 58 strokes, there were 44 arterial infarcts, seven bleeds, three arterial infarcts with associated cerebral venous sinus thrombosis, two combined infarct and bleed, and two of indeterminate type. Among the total 49 infarcts, Carotid territory was the commonest affected (36/49; 73.5%), followed by vertebrobasilar (7/49; 14.3%) and both (6/49; 12.2%). Concordant arterial block was seen in 61% (19 of 31 infarcts with angiography done). 'Early stroke' (within 48 hours of respiratory symptoms) was seen in 82.7% (48/58) patients. Patients with poor saturation at admission were older (58 vs 49 years) and had more comorbidities and higher mortality (79% vs 38%). Mortality was similar in young strokes and older patients, although the latter required more intense respiratory support. Logistic regression analysis showed that low Glasgow coma score (GCS) and requirement for increasing intensity of respiratory support predicted in-hospital mortality. CONCLUSIONS: We had a 1.6% incidence of COVID-19 related stroke of which the majority were carotid territory infarcts. In-hospital mortality was 55.17%, predicted by low GCS at admission.


Assuntos
COVID-19 , Acidente Vascular Cerebral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Mortalidade Hospitalar , Hospitalização , Humanos , Pessoa de Meia-Idade , SARS-CoV-2 , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Adulto Jovem
5.
J Assoc Physicians India ; 69(8): 11-12, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34472813

RESUMO

BACKGROUND: The term 'Capsular warning syndrome (CWS)' refers to recurrent, stereotypical transient ischemic attacks, either motor, sensory or both, without cortical symptoms or signs. Of these patients, 42-71% go on to develop infarcts. There are no defined treatment guidelines for this lesser known entity. METHODS: We studied 9 patients who presented over last 2 years to our hospital with recurrent and stereotypical transient ischemic attacks suggestive of capsular warning syndrome. Their clinical characteristics, neuroimaging findings, relevant etiological investigations, management and outcomes were studied. RESULTS: Seven out of 9 patients were under 40 years of age. The commonest presentation in our series was a pure motor syndrome. The duration of neurologic deficits ranged from 5 minutes to 20 minutes with complete recovery in between episodes. Three patients had concordant abnormalities on CT brain angiography. Five out of 9 patients received IV thrombolysis with t-PA. One patient worsened neurologically post thrombolysis, whilst the others improved clinically. DISCUSSION: Despite multiple hypotheses, the pathogenesis and management of CWS has not been established clearly. Due to fluctuating neurological symptoms with complete recovery in between the episodes, there is a dilemma concerning treatment of such patients with intravenous thrombolysis. However, intravenous thrombolysis appears to be safe in CWS as in acute ischemic stroke, followed by treatment with antiplatelet agents.


Assuntos
Isquemia Encefálica , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Fibrinolíticos/uso terapêutico , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/terapia , Inibidores da Agregação Plaquetária/uso terapêutico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Síndrome , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
9.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479896

RESUMO

Eight-and-a-half syndrome is a rare entity characterised by conjugate horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia and ipsilateral lower motor neuron type facial palsy. It is due to a lesion affecting median longitudinal fasciculus, paramedian pontine reticular formation and facial nerve fascicle on the same side at the level of pons. The diagnosis is easily missed as it needs detailed ocular movement examination. It is mainly caused due to infarction or demyelinating conditions. We are reporting an interesting case of a 54-year-old man with right-side eight-and-a-half syndrome due to acute ischaemic stroke and ST-elevation myocardial infarction of the inferior wall.


Assuntos
Isquemia Encefálica , Paralisia Facial , Transtornos da Motilidade Ocular , Oftalmoplegia , Acidente Vascular Cerebral , Paralisia Facial/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/etiologia , Oftalmoplegia/diagnóstico , Oftalmoplegia/etiologia , Ponte/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia
10.
Artigo em Russo | MEDLINE | ID: mdl-34481444

RESUMO

The article is devoted to an urgent medical and social problem - secondary prevention of atherothrombotic stroke and contains current evidence on the use of combined antiplatelet and anticoagulant therapy. In the COMPASS study, the dual-pathway thrombosis inhibition scheme using rivaroxaban in combination with acetylsalicylic acid (ASA) compared with ASA monotherapy demonstrated in patients with established atherosclerotic diseases of the circulatory system, a decrease in the total risk of stroke, death from cardiovascular causes and myocardial infarction by 24%; reduced risk of recurrent stroke by 67%. The incidence of repeated ischemic stroke (IS) in the combination therapy group was 1.1% per year, in the ASA group - 3.4% per year. The total incidence of adverse outcomes included in the combined indicator «net clinical benefit¼ in the rivaroxaban group in combination with ASA was 20% lower than in the ASA group and confirms the advantages of combination therapy in the prevention of recurrent noncardioembolic IS.


Assuntos
Inibidores da Agregação Plaquetária , Acidente Vascular Cerebral , Aspirina/uso terapêutico , Quimioterapia Combinada , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Rivaroxabana , Prevenção Secundária , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
16.
BMJ Open ; 11(8): e050234, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408054

RESUMO

OBJECTIVES: Diabetes mellitus has been associated with stroke. However, the association between fasting blood glucose (FBG) and stroke risk in a general population remains not clear. The purpose of our study was to examine the FBG levels on subsequent stroke risk in a community-based cohort in China. DESIGN: Prospective cohort study, employing Cox proportional hazard model to analyse the association of FBG levels with stroke risk. SETTING: A community-based cohort study included adults participating in a baseline survey conducted in 2013 in Changshu, eastern China. PARTICIPANTS: 16 113 participants were recruited with a multistage sampling method, excluding participants with severe disability, severe cancer, severe psychiatric disturbance or previous stroke before enrolment. PRIMARY OUTCOME MEASURES: Stroke events. RESULTS: During a median follow-up of 5.5 years, 417 incident cases of stroke were identified. The adjusted HR for total and ischaemic stroke for participants in the fourth quartile of FBG compared with the first quartile was 1.44 (95% CI 1.07 to 1.94) and 1.57 (95% CI 1.11 to 2.21), respectively. FBG levels of ≥7.0 mmol/L were associated with an increased risk of stroke based on two clinical classifications (American Diabetes Association: 1.68 (1.24 to 2.27); WHO: 1.62 (1.21, 2.13)). In stratified analyses, risk associations existed in women (HR: 1.92, 95% CI 1.22 to 3.01) and postmenopausal women (HR: 1.68, 95% CI 1.06 to 2.68) for the fourth quartile versus the first. More importantly, the meta-analysis observed a positive association between FBG levels and stroke risk (pooled HR: 1.70, 95% CI 1.27 to 2.29; n=7)). CONCLUSIONS: Higher FBG level was independently associated with an increased risk of stroke in Chinese adults, especially significant in women.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Adulto , Glicemia , China/epidemiologia , Estudos de Coortes , Jejum , Feminino , Humanos , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
17.
BMJ Case Rep ; 14(8)2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362754

RESUMO

A 35-year-old Chinese man with no risk factors for stroke presented with a 2-day history of expressive dysphasia and a 1-day history of right-sided weakness. The presentation was preceded by multiple sessions of neck, shoulder girdle and upper back massage for pain relief in the prior 2 weeks. CT of the brain demonstrated an acute left middle cerebral artery infarct and left internal carotid artery dissection. MRI cerebral angiogram confirmed left carotid arterial dissection and intimal oedema of bilateral vertebral arteries. In the absence of other vascular comorbidities and risk factors, massage-induced internal carotid arterial dissection will most likely precipitate the near-fatal cerebrovascular event. The differential diagnosis of stroke in a younger population was consequently reviewed and discussed.


Assuntos
Dissecação da Artéria Carótida Interna , Acidente Vascular Cerebral , Dissecação da Artéria Vertebral , Adulto , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Dissecação da Artéria Carótida Interna/etiologia , Dissecação , Humanos , Masculino , Massagem , Acidente Vascular Cerebral/etiologia , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/etiologia
18.
Zhonghua Nei Ke Za Zhi ; 60(9): 822-826, 2021 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-34445819

RESUMO

To evaluate the efficacy and safety of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) over 75 years. A total of 82 patients with AF who underwent LAAO successfully in Beijing Anzhen Hospital from March 2014 to March 2019 were divided into two groups according to age: the elderly group (aged>75 years) and the young group (aged ≤75 years). Risk of perioperative complications and incidence of ischemic stroke and major bleeding during follow-up were retrospectively analyzed. The results showed that there were no significant differences in procedure-related ischemic stroke(0 vs.1.6%,P=0.768) and major bleeding (0 vs.1.6%,P=0.768) during perioperative period between the two groups. No complications as death or pericardial tamponade occurred in the two group. During a (25.9±15.9) months period of followed up, ischemic stroke event rate was 3.6/100 person-years in the elderly group and 4.9/100 person-years in the young group, respectively. Major bleeding event rate was 2.5/100 person-years in the elderly group and 0/100 person-years in the young group, respectively. Compared with the expected ones, the relative risk reduction (RRR) of stroke in the elderly group was more profound than that in the young group (32.0% vs. 25.0%), while the risk of major bleeding in the young group was significantly lower than that in the elderly group (RRR 100% vs. 56.9%). Therefore, LAAO might be suitable for stroke prevention in the elderly AF patients.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Acidente Vascular Cerebral , Idoso , Apêndice Atrial/cirurgia , Fibrilação Atrial/complicações , Hemorragia , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
19.
Medicina (B Aires) ; 81(4): 588-596, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34453801

RESUMO

Up to 15% of all strokes affect young patients and the incidence of ischemic stroke in this population is rising. Nevertheless, there is limited information of cerebrovascular events in this population both in our country and in Latin America. The aim of our study was to evaluate the clinical characteristics and risk factors of young adults with stroke in Argentina. This is a prospective, multicenter study of stroke in young adults (18 - 55 years) in Argentina. Patients presenting with a cerebrovascular event within 180 days were included. Stroke subtypes were classified according to TOAST criteria. A total number of 311 patients were enrolled (men 53.9%, mean age: 43.3 years). Ischemic strokes occurred in 91.8% (brain infarcts 82.6%, transient ischemic attack 9.2%) and hemorrhagic strokes in 8.2%. The most frequent vascular risk factors (including ischemic and hemorrhagic strokes) were: hypertension 120 (41%), smoking 92 (31.4%), dyslipidemia 81 (27.6%) and, overweight/obesity: 74 (25.3%). Stroke subtypes were: large artery disease 12.3%, cardioembolism 7.5%, small artery occlusion 11.5%, other defined etiology 27.1%, and undetermined etiology 41.6%. Our study demonstrates that vascular risk factors are very frequent in young adults with stroke. Our findings underline that urgent strategies are required for primary and secondary stroke prevention in this group of patients.


Assuntos
Isquemia Encefálica , Hipertensão , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Adulto , Argentina/epidemiologia , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Adulto Jovem
20.
Rev Soc Bras Med Trop ; 54: e03012021, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34431948

RESUMO

Neurological manifestations add prognostic severity to the coronavirus disease (COVID-19). Here, we report a case of a pregnant patient with COVID-19 that progressed with neurological complications. Magnetic resonance imaging revealed cerebral ischemic insults associated with cortical laminar necrosis, in addition to an intraparenchymal brain hematoma. The mechanisms of vascular injury may have multifactorial origins and result in complex radiological presentations. Since stroke associated with pregnancy is one of the main causes of long-term disability in women, accurate identification of cerebrovascular events may potentially reduce sequelae.


Assuntos
COVID-19 , Acidente Vascular Cerebral , Feminino , Humanos , Imageamento por Ressonância Magnética , Gravidez , Prognóstico , SARS-CoV-2 , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...