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1.
Medicine (Baltimore) ; 99(2): e18694, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914070

RESUMO

RATIONALE: Some patients with pulmonary arteriovenous malformation (PAVM) present with hypoxemia and life-threatening complications, including stroke and cerebral abscess. Catheter embolization is currently the preferred treatment for PAVM. However, previous studies have revealed that the incidence of PAVM recanalization is approximately 10% 5 to 7 years after embolization. In contrast, there are no studies where recanalization has occurred over 10 years after embolization. PATIENT CONCERNS: Herein, we report 2 cases diagnosed with cerebral embolism due to PAVM recanalization 13 years and 30 years after catheter treatment, in case I and II, respectively. DIAGNOSES: Both cases were diagnosed with PAVM recanalization on chest computed tomography (CT) examination performed after cerebral embolism development. Furthermore, pulmonary artery angiography revealed blood flow from the pulmonary artery to the vein in the PAVM, confirming PAVM recanalization. INTERVENTIONS: Coil re-embolization was performed for the all recanalized PAVM. OUTCOMES: All the target lesions were successfully re-embolized in both cases. However, in case I, the second recanalization of embolized PAVM was confirmed 1 year after coil re-embolization. Consequently, the third embolization was performed in case I. In contrast to case I, the patient in case II was followed up without recanalization for 2 years after embolization. LESSONS: We described the first 2 cases diagnosed with PAVM recanalization >10 years after the first catheter embolization. These cases suggest that patients with PAVMs should undergo life-long follow-up after catheter embolization.


Assuntos
Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Embolia Intracraniana/complicações , Embolia Intracraniana/terapia , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Idoso , Feminino , Humanos
2.
Georgian Med News ; (294): 83-87, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687955

RESUMO

The aim of the research was to investigate the relationship between cerebral microembolization and the development of postoperative cognitive impairment in patients after coronary artery bypass grafting with and without prophylactic administration of nitroglycerin at the end of artificial blood circulation. The study included 72 patients (43 male and 29 female) who had ACBPS using an ABCA. The patients were randomized into two clinical groups. The number of patients in the control group was 34 patients, in the study group - 38 patients. The study of the cognitive sphere was performed using a battery of clinical tests that included MSA and MMSE scales, Trail-making test, Grooved Pageboard, fine hands-motor test, 10 words test by AR Luria, Wexler's test, Schultz tables. The assessment was carried out on a day before the intervention and on the fifth day after the surgical intervention. It was shown that by all patients undergoing aorto-coronary bypass syrgery microembolization within the cerebral blood flow had been determined. The vast majority of microemboli is formed at the beginning of artificial blood circulation, at the moment of clamping aorta, as well as during the restoration of effective cardiac activity. Intraoperative microembolization of cerebral blood flow in excess of 750 microemboli leads to clinically significant deterioration of the brain functions in the early postoperative period. When used as a peripheral vasodilator, nitroglycerin, at a dose of 8-10 µg/kg*min in high (120-130%) volume perfusion rate, decreases the number of microemboluses in the basin of СМА by 2.4%.


Assuntos
Aorta/diagnóstico por imagem , Substitutos Sanguíneos , Ponte Cardiopulmonar/efeitos adversos , Disfunção Cognitiva/etiologia , Ponte de Artéria Coronária/efeitos adversos , Embolia Intracraniana/psicologia , Infarto do Miocárdio/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar/métodos , Circulação Cerebrovascular , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle
3.
Neurology ; 93(23): e2094-e2104, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31662492

RESUMO

OBJECTIVE: A tool to stratify the risk of stroke recurrence in patients with embolic stroke of undetermined source (ESUS) could be useful in research and clinical practice. We aimed to determine whether a score can be developed and externally validated for the identification of patients with ESUS at high risk for stroke recurrence. METHODS: We pooled the data of all consecutive patients with ESUS from 11 prospective stroke registries. We performed multivariable Cox regression analysis to identify predictors of stroke recurrence. Based on the coefficient of each covariate of the fitted multivariable model, we generated an integer-based point scoring system. We validated the score externally assessing its discrimination and calibration. RESULTS: In 3 registries (884 patients) that were used as the derivation cohort, age, leukoaraiosis, and multiterritorial infarct were identified as independent predictors of stroke recurrence and were included in the final score, which assigns 1 point per every decade after 35 years of age, 2 points for leukoaraiosis, and 3 points for multiterritorial infarcts (acute or old nonlacunar). The rate of stroke recurrence was 2.1 per 100 patient-years (95% confidence interval [CI] 1.44-3.06) in patients with a score of 0-4 (low risk), 3.74 (95% CI 2.77-5.04) in patients with a score of 5-6 (intermediate risk), and 8.23 (95% CI 5.99-11.3) in patients with a score of 7-12 (high risk). Compared to low-risk patients, the risk of stroke recurrence was significantly higher in intermediate-risk (hazard ratio [HR] 1.78, 95% CI 1.1-2.88) and high-risk patients (HR 4.67, 95% CI 2.83-7.7). The score was well-calibrated in both derivation and external validation cohorts (8 registries, 820 patients) (Hosmer-Lemeshow test χ2: 12.1 [p = 0.357] and χ2: 21.7 [p = 0.753], respectively). The area under the curve of the score was 0.63 (95% CI 0.58-0.68) and 0.60 (95% CI 0.54-0.66), respectively. CONCLUSIONS: The proposed score can assist in the identification of patients with ESUS at high risk for stroke recurrence.


Assuntos
Medição de Risco/métodos , Acidente Vascular Cerebral , Adulto , Idoso , Feminino , Humanos , Embolia Intracraniana/complicações , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
4.
Neurol Res ; 41(11): 1034-1042, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31584350

RESUMO

Objectives: To investigate the thrombolysis with recombinant human prourokinase (rhPro-UK) on thromboembolic stroke in rats at different therapeutic time windows (TTW). Methods: Rats were subjected to embolic middle cerebral artery occlusion. RhPro-UK and positive control drugs rt-PA,UK were administered 3 h, 4.5 h, 6 h after inducing thromboem-bolic stroke. Neurological deficit scoring (NDS) was evaluated at 6 h and 24 h after the treatment. The lesion volume in cerebral hemispheres was measured by MRI scanning machine after 6 h of thrombolysis, and the infarct volume was measured by TTC stain, together with hemorrhagic volume quantified by a spectrophotometric assay after 24 h of thrombolysis. Results: RhPro-UK 10, 20 × 104 U/kg significantly improved the NDS after cerebral thromboembolism in rats at 3 h, 4.5 h TTW, and at the 6 h TTW, the NDS was improved by 28.0% (P = 0.0690) and 29.2% (P = 0.0927) at 6 h and 24 h after rhPro-UK 20 ×104 U/kg administration, respectively. RhPro-UK 10, 20 × 104 U/kg significantly reduced the brain lesions measured by MRI at 3 h and 4.5 h TTW. RhPro-UK 10, 20 × 104 U/kg significantly reduced the cerebral infarction measured by TTC at 3 h, 4.5 h TTW. There was no increase in cerebral hemorrhage compared with untreated group after rhPro-UK administration. Conclusions: RhPro-UK had an obvious therapeutic effect on ischemic stroke caused by thrombosis, and could be started within 4.5 h TTW with less side effects of cerebral hemorrhage than that of UK.


Assuntos
Hemorragia Cerebral/tratamento farmacológico , Embolia Intracraniana/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Ativador de Plasminogênio Tecidual/farmacologia , Animais , Hemorragia Cerebral/patologia , Modelos Animais de Doenças , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/tratamento farmacológico , Embolia Intracraniana/complicações , Masculino , Ratos Sprague-Dawley , Acidente Vascular Cerebral/complicações , Tromboembolia/complicações , Tromboembolia/tratamento farmacológico , Terapia Trombolítica/métodos , Fatores de Tempo
5.
Emerg Med J ; 36(7): 415-422, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31320334

RESUMO

CLINICAL INTRODUCTION: An 88-year-old woman presented with acute onset of involuntary limb movements for one day. Two days prior she had fallen a suffered a left hip contusion but no head trauma. There was no fever or difficulty breathing. Her heart rate was 72 bpm with blood pressure of 109/68 mm Hg. Physical examination revealed restricted left hip motion due to pain and a sustained twisted posture of the upper extremity without paresis. Glasgow Coma Scale was 15, and there was no evidence of Kernig's or Brudzinski's sign. She underwent a hip X-ray and non-contrast CT scan (figures 1 and 2).emermed;36/7/415/F1F1F1Figure 1Anteroposterior X-radiograph of the hip.emermed;36/7/415/F2F2F2Figure 2A non-contrast brain CT. QUESTION: What is the most likely cause of the clinical presentation?Acute meningitisCerebral fat embolismHaemorrhagic strokeHypertensive encephalopathy For answer see page 2 For question see page 1.


Assuntos
Embolia Gordurosa/complicações , Embolia Intracraniana/complicações , Perna (Membro)/anormalidades , Transtornos dos Movimentos/etiologia , Idoso de 80 Anos ou mais , Embolia Gordurosa/epidemiologia , Feminino , Humanos , Embolia Intracraniana/epidemiologia , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/fisiopatologia , Imagem por Ressonância Magnética/métodos , Transtornos dos Movimentos/epidemiologia , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos
6.
J Clin Neurosci ; 66: 277-279, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31097380

RESUMO

A 72-year-old man without obvious risk factors initially presented with acute ischemic stroke and fever, without concomitant infection. Broad spectrum antibiotic therapy was initiated. Transthoracic and Transesophageal echocardiography, and cardiac MRI revealed a 20 mm round mass attached to the anterior mitral valve leaflet, suggesting the diagnosis of a benign cardiac tumor or a vegetation. At the site of infarction an abscess of 11 mm in diameter developed 30 days later. The patient underwent surgical valve repair for the prevention of further embolic complications. Histology revealed a cardiac papillary fibroelastoma (PFE). He made complete clinical recovery. Secondary abscess formation after ischemic stroke is rare: 11 other cases have been reported. Because they develop at the site of a previous ischemic infarct, these abscesses usually do not manifest by additional neurologic deficits, making difficult their diagnosis. In most cases a concomitant infection cannot be individualized. Even if these abscesses are a rare entity, patients with cerebral infarct presenting with fever must be closely follow-up with cerebral imaging. Even if PFE is a rare cardiac source of embolic stroke, it should be considered in the differential diagnosis of stroke in a patient where an alternative etiology has not been established.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Abscesso Encefálico/complicações , Abscesso Encefálico/cirurgia , Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Diagnóstico Diferencial , Fibroma/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/cirurgia , Masculino , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/cirurgia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia
7.
Herz ; 44(4): 289-295, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31062047

RESUMO

The clinical construct of embolic stroke of unknown source (ESUS) was first described in 2014. It is defined as cryptogenic ischemic stroke after the exclusion of a lacunar infarct, a significant (≥50%) stenosis of extracranial or intracranial arteries and a cardiac source of embolism. Initially, there was hope that these patients would benefit from anticoagulation. This was based on the suspicion that imaging criteria of stroke mimic features of embolism from cardiac sources or the great arteries. In two large randomized trials with 12,600 patients neither rivaroxaban nor dabigatran could reduce the risk of recurrent stroke. Based on these results, current research is focused on paroxysmal atrial fibrillation as a potential cause of stroke in these patients. Several randomized trials could show that by prolongation of monitoring to 30 days atrial fibrillation can be detected in approximately 10% of the patients. Using continuous monitoring (e. g. by implantable loop recorders) atrial fibrillation can even be detected in one quarter of the patients. Not all stroke patients can receive such an intensive monitoring. Therefore, this article summarizes the evidence and presents the resulting recommendations for patient selection and staged rhythm diagnostics and discusses a recently presented algorithm of an expert group for use in daily clinical practice.


Assuntos
Fibrilação Atrial , Embolia Intracraniana , Acidente Vascular Cerebral , Fibrilação Atrial/complicações , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia
8.
Int J Infect Dis ; 78: 31-33, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30218815

RESUMO

Isolated cardiac location is an uncommon presentation of echinococcosis (0.5-2%), and involvement of the interventricular septum is even rarer. It may lead to various complications because of rupture and embolization. We report the case of a 26 - year- old man who was diagnosed to have a large inter-ventricular hydatid cyst complicated by both cerebral and coronary embolism. Presentation, management and follow-up of the patient is discussed. This case is of particular interest because of the rarity of septal localization of a hydatid cyst, and the conflict between the severity of the complications that occurred and the absence of correlated symptoms.


Assuntos
Equinococose/diagnóstico por imagem , Septo Interventricular/parasitologia , Adulto , Animais , Equinococose/complicações , Equinococose/cirurgia , Echinococcus granulosus/isolamento & purificação , Ecocardiografia , Seguimentos , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/cirurgia , Larva , Masculino
9.
J Atheroscler Thromb ; 26(6): 528-537, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30429408

RESUMO

AIM: To evaluate the effect of prestroke aspirin (PA) use on initial stroke severity, early neurologic deterioration (END), stroke recurrence, hemorrhagic transformation (HT), and functional outcome in patients with ischemic stroke (IS). METHODS: This was a prospective, observational, multicenter cohort study. The acute IS patients with atherothrombosis (AT), small artery disease (SAD), or cardioembolic (CE) stroke within 24 hours of symptom onset were identified. National Institutes of Health Stroke Scale (NIHSS) scores on admission, clinical outcomes (END, recurrent ischemic stroke [RIS], myocardial infarction [MI], death, and hemorrhagic episodes), and functional outcome (modified Rankin Scale [mRS] scores) at three months after admission were compared between PA users and nonusers. RESULTS: Among the 1,862 patients, 401 (21.5%) reported PA use. The PA users had a significantly lower initial NIHSS score than the non-PA users. The effect was evident in AT stroke, but not in other subtypes. PA use was independently associated with the decreased risk of END. PA use increased the risk of HT; however, it was only associated with increased risk for asymptomatic HT, not for symptomatic HT. PA use was associated with better functional outcomes (mRS scores ≤2 points) irrespective of stroke subtypes at three months after admission, despite the increased risk of HT. CONCLUSIONS: PA use may reduce initial stroke severity in AT stroke and the risk of END, and can improve functional outcome at three months irrespective of stroke subtypes.


Assuntos
Aspirina/uso terapêutico , Aterosclerose/complicações , Isquemia Encefálica/prevenção & controle , Doença da Artéria Coronariana/complicações , Embolia Intracraniana/complicações , Acidente Vascular Cerebral/prevenção & controle , Trombose/complicações , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Biomarcadores/análise , Isquemia Encefálica/etiologia , Vasos Coronários , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
10.
Neurology ; 92(4): e288-e294, 2019 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-30518556

RESUMO

OBJECTIVE: To investigate the prevalence and clinical determinants of atrial cardiopathy in patients with embolic stroke of unknown source (ESUS) and compare with other established stroke etiologies. METHODS: In a cross-sectional study of 846 consecutive patients with ischemic stroke, we compared the prevalence of atrial cardiopathy (defined by p-wave terminal force in V1 >5,000 µV·ms or severe left atrial enlargement) between ESUS patients and patients with large artery atherosclerosis (LAA) and small vessel disease (SVD) strokes. Baseline characteristics were also compared between ESUS and cardioembolic (CE) patients. RESULTS: Of all, 158 (19%) patients met ESUS diagnostic criteria, while others were classified into LAA (n = 224, 26%), SVD (n = 154, 18%), and CE (n = 310, 37%). The prevalence of atrial cardiopathy was higher in ESUS patients compared to noncardioembolic stroke patients (26.6% vs 12.1% in LAA vs 16.9% in SVD; p = 0.001). ESUS patients were younger, were less hypertensive, and had higher cholesterol and low-density lipoprotein levels, but also had less left ventricular or atrial abnormalities when compared to CE patients. CONCLUSION: The prevalence of atrial cardiopathy was high in ESUS patients compared with patients with nonembolic strokes. Interestingly, ESUS patients were also clinically different from CE patients. While the presence of atrial cardiopathy may reflect a unique mechanism of thromboembolism in ESUS patients, it is still unclear if they may benefit from anticoagulation, or if the presence of atrial cardiopathy in this population could serve as a risk-stratifying marker for stroke recurrence. Further efforts are necessary to provide better characterization of the ESUS population in order to develop better stroke preventive strategies.


Assuntos
Cardiopatias/complicações , Cardiopatias/epidemiologia , Embolia Intracraniana/complicações , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Tomógrafos Computadorizados , Adulto Jovem
11.
Interv Neuroradiol ; 25(3): 254-260, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30514143

RESUMO

BACKGROUND: Therapeutic strategies and outcomes vary with stroke subtypes for patients with acute vertebrobasilar occlusion (VBAO). This study aimed to compare characteristics and outcomes of VBAO due to intracranial atherosclerotic disease (ICAD) and embolisms and identify baseline predictors of ICAD. METHODS: Patients with VBAO who received endovascular therapy (EVT) were retrospectively analyzed. Participants fulfilling the criteria were classified as the ICAD group (focal stenosis of >70%, or fixed stenosis >50% in addition to either flow and perfusion impairment on angiography or an evident reocclusion tendency) and the embolism group (defined as no evidence of focal significant stenosis after thrombolysis or thrombectomy). Baseline characteristics and outcomes after EVT were compared between the two groups, and logistic regression was performed to explore the factors associated with ICAD. RESULTS: Among the 133 patients enrolled, 95 (71.4%) patients were categorized in the ICAD group, and 38 (28.6%) in the embolism group. A history of atrial fibrillation (odds ratio (OR) 0.142; 95% confidence interval (CI) (0.028-0.707), p = 0.017), distal basilar artery occlusion (OR 0.107; 95% CI (0.040-0.289), p < 0.001) and V4 segment occlusion (OR 3.423; 95% CI (1.172-9.999), p = 0.024) were independently associated with ICAD. Patients with VBAO due to ICAD had a lower rate of recanalization (81.1% vs 100%, p = 0.004), but the 90-day good clinical outcome was comparable (41.1% vs 50.0%, p = 0.347). CONCLUSIONS: The occlusion sites and a history of atrial fibrillation might be helpful in predicting ICAD in patients with VBAO. Patients with ICAD who were treated by EVT had a lower rate of recanalization but comparable 90-day good outcomes.


Assuntos
Procedimentos Endovasculares/métodos , Arteriosclerose Intracraniana/complicações , Embolia Intracraniana/complicações , Insuficiência Vertebrobasilar/cirurgia , Idoso , Fibrilação Atrial/complicações , Angiografia Cerebral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Trombectomia , Terapia Trombolítica , Resultado do Tratamento , Insuficiência Vertebrobasilar/etiologia
13.
PLoS Med ; 15(10): e1002669, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30289919

RESUMO

BACKGROUND: As the average life expectancy increases, more people are predicted to have strokes. Recent studies have shown an increasing incidence in certain types of cerebral infarction. We aimed to estimate time trends in incidence, prior risk factors, and use of preventive treatments for ischaemic stroke (IS) aetiological subtypes and to ascertain any demographic disparities. METHODS AND FINDINGS: Population-based data from the South London Stroke Register (SLSR) between 2000 and 2015 were studied. IS was classified, based on the underlying mechanism, into large-artery atherosclerosis (LAA), cardio-embolism (CE), small-vessel occlusion (SVO), other determined aetiologies (OTH), and undetermined aetiologies (UND). After calculation of age-, sex-, and ethnicity-specific incidence rates by subtype for the 16-year period, we analysed trends using Cochran-Armitage tests, Poisson regression models, and locally estimated scatterplot smoothers (loess). A total of 3,088 patients with first IS were registered. Between 2000-2003 and 2012-2015, the age-adjusted incidence of IS decreased by 43% from 137.3 to 78.4/100,000/year (incidence rate ratio [IRR] 0.57, 95% CI 0.5-0.64). Significant declines were observed in all subtypes, particularly in SVO (37.4-18; p < 0.0001) and less in CE (39.3-25; p < 0.0001). Reductions were recorded in males and females, younger (<55 years old) and older (≥55 years old) individuals, and white and black ethnic groups, though not significantly in the latter (144.6-116.2; p = 0.31 for IS). A 4-fold increase in prior-to-stroke use of statins was found (adjusted odds ratio [OR] 4.39, 95% CI 3.29-5.86), and despite the increasing prevalence of hypertension (OR 1.54, 95% CI 1.21-1.96) and atrial fibrillation (OR 1.7, 95% CI 1.22-2.36), preventive use of antihypertensive and antiplatelet drugs was declining. A smaller number of participants in certain subgroup-specific analyses (e.g., black ethnicity and LAA subtype) could have limited the power to identify significant trends. CONCLUSIONS: The incidence of ISs has been declining since 2000 in all age groups but to a lesser extent in the black population. The reported changes in medication use are unlikely to fully explain the reduction in stroke incidence; however, innovative prevention strategies and better management of risk factors may contribute further reduction.


Assuntos
Arteriopatias Oclusivas/epidemiologia , Infarto Cerebral/epidemiologia , Arteriosclerose Intracraniana/epidemiologia , Embolia Intracraniana/epidemiologia , Londres/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Arteriopatias Oclusivas/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Infarto Cerebral/etnologia , Infarto Cerebral/etiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Incidência , Arteriosclerose Intracraniana/complicações , Embolia Intracraniana/complicações , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Prevalência , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/etiologia , Fatores de Tempo
15.
Interv Neuroradiol ; 24(6): 674-677, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29969958

RESUMO

Mechanical thrombectomy is a safe and effective treatment in patients with acute ischemic stroke caused by large vessel occlusions. However, in rare cases, the procedure may be challenging due to the composition of the embolus. We describe a case of a mechanical thrombectomy with the Embolus Retriever with Interlinked Cage (ERIC) device in a patient with an acute ischemic stroke due to calcified cerebral emboli in the middle cerebral artery. The procedure was done after a failed recanalization attempt with manual aspiration thrombectomy. An 82-year-old woman presented to the emergency department with a sudden onset of right-sided weakness. A computed tomographic angiography showed left middle cerebral (M1 branch) calcified emboli. After the administration of an intravenous thrombolytic agent, the patient was transferred to the angiographic suite for a mechanical thrombectomy. After failure to recanalize the vessel with manual aspiration thrombectomy, successful recanalization was achieved via mechanical thrombectomy using the ERIC device. Mechanical thrombectomy with an ERIC device can be a useful option in cases of acute ischemic stroke caused by calcified cerebral emboli.


Assuntos
Calcinose/complicações , Revascularização Cerebral/métodos , Embolia Intracraniana/complicações , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso de 80 Anos ou mais , Calcinose/diagnóstico por imagem , Angiografia Cerebral , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Neurologist ; 23(4): 113-117, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29953033

RESUMO

OBJECTIVES: Epicardial adipose tissue is metabolically active and is an important predictor of metabolic and cardiovascular diseases. This study investigated the echocardiographic epicardial adipose tissue measurement in young patients with embolic stroke of undetermined source (ESUS). MATERIALS AND METHODS: We studied 77 volunteers, including 40 patients with ESUS (mean age 43±8 y, 16 female patients) and 37 healthy subjects (mean age 38±7 y, 20 female subjects). All necessary biochemical parameters were analyzed, and epicardial fat thickness (EFT) was measured by echocardiography in all subjects. Additional related diagnostic work-up was conducted in each patient, according to the patients' clinical presentation. RESULTS: The patients with ESUS had a significantly higher EFT than the control group (5.51±0.82 vs. 3.96±0.51; P<0.01). Furthermore, there was a positive correlation between EFT and serum C-reactive protein levels (r=0.284; P<0.05). As an optimal cut-off point, a high-risk EFT value of 4.6 mm was determined to predict ESUS, with an 87.5% sensitivity and an 81.1% specificity. CONCLUSION: We found that echocardiographic EFT was significantly higher in young patients with ESUS than in healthy individuals. Increased EFT might be a novel risk factor in these patients.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Tromboembolia/complicações , Adulto , Ecocardiografia , Feminino , Humanos , Embolia Intracraniana/complicações , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico
19.
Rev Neurol ; 66(10): 325-330, 2018 05 16.
Artigo em Espanhol | MEDLINE | ID: mdl-29749592

RESUMO

INTRODUCTION: The concept of embolic stroke of undetermined source (ESUS) has recently appeared to better characterise patients with cryptogenic stroke. PATIENTS AND METHODS: A systematic review of studies published since 2014 was performed to evaluate the epidemiology, clinical features and prognosis of patients with ESUS and their proportion among patients with cryptogenic stroke. RESULTS: Ten studies were identified with a total of 14,810 patients. The frequency of ESUS varied between 6% and 42%. We observed a high percentage of patients with cryptogenic stroke who met ESUS criteria (37-82%). The mean age of these patients was 65-68 years. The mean severity of the stroke, as measured using the National Institutes of Health Stroke Scale, was found to be 3-7 points. A high degree of variability was seen in the proportion of atrial fibrillation (detected during follow-up) related to the electrocardiogram monitoring technique. In five studies, some minor source of cardioembolism was observed in one out of every two patients, the most frequent being the persistence of patent foramen ovale. The risk of recurrence was 5-14.5%. CONCLUSION: The application of the new ESUS criteria provides a better definition of patients with cryptogenic stroke. Applying the concept of ESUS requires not only adequate electrocardiogram monitoring, but also routine complementary examinations to rule out the presence of minor sources of cardioembolism and other sources of embolism other than atrial fibrillation.


Assuntos
Embolia Intracraniana/epidemiologia , Idoso , Doenças da Aorta/complicações , Arteriosclerose/complicações , Fibrilação Atrial/complicações , Dano Encefálico Crônico/epidemiologia , Dano Encefálico Crônico/etiologia , Feminino , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico , Masculino , Placa Aterosclerótica/complicações , Prognóstico , Recuperação de Função Fisiológica
20.
J Stroke Cerebrovasc Dis ; 27(7): e125-e127, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29628339

RESUMO

Paradoxical embolism due to isolated pulmonary arteriovenous malformation (AVM) is an uncommon cause of ischemic stroke, with the majority occurring in patients who have not yet been diagnosed with their malformation. We report a 32-year-old man who presented with an abrupt onset of right facial weakness and expressive aphasia. Brain magnetic resonance imaging revealed an acute infarct in the left middle cerebral artery territory and chronic infarcts in the bilateral cerebellar hemispheres. A cardioembolic mechanism was initially considered in the setting of perimyocarditis diagnosed a few months earlier. Transthoracic and transesophageal echocardiograms revealed high volume right to left shunting, but no septal defects. A pulmonary AVM was confirmed with computed tomography angiography and fistualization was successfully treated with embolization. This report highlights a case of undiagnosed pulmonary AVM leading to recurrent paradoxical emboli to the brain. We review the epidemiology, pathophysiology, and management of pulmonary AVMs in relation to stroke risk.


Assuntos
Malformações Arteriovenosas/complicações , Isquemia Encefálica/etiologia , Embolia Paradoxal/complicações , Embolia Intracraniana/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/epidemiologia , Malformações Arteriovenosas/terapia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/epidemiologia , Embolia Paradoxal/terapia , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/terapia , Masculino , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia
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