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2.
J Stroke Cerebrovasc Dis ; 29(1): 104489, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31706752

RESUMO

BACKGROUND: Impairment of endothelial function is associated with atherosclerosis and atrial fibrillation, and could underlie several types of ischemic stroke. Embolic stroke of undetermined source (ESUS) recently attracted much attention as the major cause of cryptogenic stroke. This study aimed to clarify the endothelial function of patients with ESUS. METHODS AND RESULTS: Between 2015 September and July 2017 July, we used flow-mediated vasodilation (FMD) test to evaluate vascular endothelial function in 182 patients with any vascular risk factors or a history of cerebrovascular events. The subject group was classified into the No Stroke group and 5 stroke subtype groups, large artery atherosclerosis (LAA), cardiogenic embolism (CE), small vessel disease (SVD), ESUS, and others (Other). Endothelial function was expressed as percentage increase in brachial vessel diameter (%FMD) after the interruption of blood flow with mechanical compression for 5 minutes. Mean FMD in the No stroke, LAA, CE, SVD, ESUS and Other groups were 7.03 ± 2.14%, 5.02 ± 2.75%, 4.97 ± 1.62%, 5.19 ± 2.67%, 3.55 ± 1.42%, and 6.55 ± 3.50%, respectively. After the adjustment for confounding factors, FMD was significantly lower in the ESUS group than in the No stroke, SVD, and Other groups. FMD tended to be lower in the ESUS group than in the LAA and CE groups, but the difference was not significant. CONCLUSIONS: Endothelial function was impaired in patients with ESUS and may underlie its pathophysiology.


Assuntos
Artéria Braquial/fisiopatologia , Isquemia Encefálica/fisiopatologia , Endotélio Vascular/fisiopatologia , Embolia Intracraniana/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Vasodilatação , Idoso , Idoso de 80 Anos ou mais , Artéria Braquial/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Estudos Transversais , Endotélio Vascular/diagnóstico por imagem , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
3.
J Stroke Cerebrovasc Dis ; 29(2): 104528, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31806451

RESUMO

BACKGROUND: Elevated high-sensitivity cardiac troponin T (hs-cTnT) levels have been related to clinical outcome in stroke patients. However, the role of hs-cTnT and its potential as a biomarker in ischaemic stroke (IS) has not been well established. This study aims to determine whether basal hs-cTnT determination in the hyperacute phase of undetermined IS and transient ischaemic attack (TIA) can predict the cardioembolic aetiology and clinical outcome. METHODS: We prospectively studied 110 consecutive patients with undetermined acute IS and TIA. hs-cTnT levels were determined at hospital arrival. Large vessel stenosis/occlusion and previously known aetiologies at admission were exclusion criteria for this study. All patients were subjected to a complete aetiological evaluation. A 12-month follow-up was performed in all patients. The subtype of IS was evaluated following the SSS-TOAST criteria. We established two groups at admission: cardioembolic aetiology (group A) and noncardioembolic aetiologies (group B). RESULTS: The number of patients in each group was similar (group A: 52, 47.27%; group B, 58, 52.73%). Patients in group A had elevated hs-cTnT more frequently (61.54% versus 17.24%; P < .001). Group A patients had significantly higher mortality at 3 months (14.29% versus 1.82%, P = .025). In the multivariate analysis, elevated hs-cTnT was the only independent predictor of cardioembolic aetiology (odds ratio: 14.821; 95% confidence interval: 3.717-59.102, P < .001). CONCLUSION: Baseline hs-cTnT assessment in undetermined strokes and TIA during the hyperacute phase is independently associated with cardioembolic aetiology.


Assuntos
Isquemia Encefálica/etiologia , Cardiopatias/sangue , Embolia Intracraniana/etiologia , Ataque Isquêmico Transitório/etiologia , Acidente Vascular Cerebral/etiologia , Troponina T/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Feminino , Cardiopatias/complicações , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/mortalidade , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Regulação para Cima
4.
J Stroke Cerebrovasc Dis ; 29(2): 104509, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31759913

RESUMO

BACKGROUND: There is ambiguity regarding the role of left ventricle wall motion abnormalities (LVWMAs) as a potential cardioembolic source in patients, who satisfy embolic stroke of undetermined source (ESUS) criteria. METHODS AND RESULTS: We analyzed prospectively collected data in 345 acute stroke patients, 185 (53.6%) stroke with atrial fibrillation (SwAF), and 160 (46.4%) stroke with LVWMA. LVWMA were younger (P = .003), had significantly higher frequency of stroke risk factors and lower ejection fraction (P < .001). No significant difference was found between the stroke pattern in SwAF and LVWMA except focal cortical, cortical-subcortical lesions were more frequent in LVWMA (P = .002). Mean wall motion score index (WMSI) was 1.523 (range 1.05-2.71) without any correlation between the severity of WMSI and multiple strokes (P = .976). In subgroup analyses vertical basal WMSI (P = .030) and vertical mid cavity WMSI (P = .010) was significantly related to branch arterial stroke. LVWMA 94 (65%) patients were on antiplatelet/anticoagulation compared to 47 (52.4%) with atrial fibrillation (AF), with no significant difference in stroke recurrence during 4 years follow-up (P = .15). CONCLUSIONS: Patients with LVWMA who satisfy ESUS criteria, have stroke pattern on diffusion-weighted magnetic resonance imaging and risk of stroke recurrence similar to AF-related stroke despite being on appropriate antiplatelet medications. Further studies with anticoagulation therapy may be required in this group of patients to improve the high risk of recurrent stroke.


Assuntos
Fibrilação Atrial/complicações , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/etiologia , Disfunção Ventricular Esquerda/complicações , Função Ventricular Esquerda , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/fisiopatologia
5.
J Stroke Cerebrovasc Dis ; 29(2): 104534, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31810721

RESUMO

BACKGROUND: Differentiating stroke due to Trousseau's syndrome from other types of cerebral embolism is challenging, especially in patients with occult cancer. The current study aimed to determine predicting factors and biomarkers of stroke due to Trousseau's syndrome. METHODS: This retrospective study comprised 496 consecutive patients with acute cerebral embolism, including 19, 85, 310, and, 82 patients with stroke due to Trousseau's syndrome, artery-to-artery embolism, cardioembolic stroke, and embolic stroke with undetermined source, respectively. All patients were evaluated within 72 hours of onset. The clinical characteristics, laboratory findings, and patterns on diffusion-weighted magnetic resonance imaging (DWI) were compared among the groups. RESULTS: Plasma D-dimer and C-reactive protein (CRP) levels were significantly higher in the Trousseau's syndrome than in the other causes of cerebral embolism. Multivariate analyses demonstrated that female sex, multiple lesions on DWI, high D-dimer and CRP levels, and low platelet and low brain natriuretic peptide levels were independent predictors that could distinguish Trousseau's syndrome from the other causes of cerebral embolism. The cutoff values of D-dimer and CRP to identify stroke due to Trousseau's syndrome was 2.68 µg/mL fibrinogen equivalent units and .29 mg/dL, respectively. CONCLUSIONS: The elevated D-dimer and CRP levels on admission in addition to specific clinical features may be useful for diagnosis of Trousseau's syndrome in patients with cerebral embolism.


Assuntos
Proteína C-Reativa/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Embolia Intracraniana/sangue , Neoplasias/sangue , Acidente Vascular Cerebral/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Masculino , Neoplasias/complicações , Neoplasias/diagnóstico , Admissão do Paciente , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Síndrome , Regulação para Cima
6.
Medicina (B Aires) ; 79(6): 502-505, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829953

RESUMO

May-Thurner syndrome is an anatomic abnormality that predisposes patients to increase risk of paradoxical embolism and stroke. It consists of chronic compression of the left common iliac vein by the overlying right common iliac artery and lumbar spine. This may lead to deep venous thrombosis and paradoxical embolism that could provoke cerebral ischemia in patients with a cardiac shunt from right-to-left. Embolic cerebral ischemic event is reported in a 30-year-old man after sexual intercourse. Further studies revea led suggestive findings of May-Thurner syndrome coupled with a patent foramen ovale and a factor V Leiden thrombophilia. He was placed on anticoagulation therapy and has not had any recurrent events.


Assuntos
Embolia Intracraniana/etiologia , Síndrome de May-Thurner/complicações , Adulto , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/patologia , Imagem por Ressonância Magnética , Masculino , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/patologia , Tomografia Computadorizada por Raios X
7.
Angiol Sosud Khir ; 25(4): 83-90, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855204

RESUMO

The authors carried out a prospective study aimed at revealing predictors of acute embolic lesions of cerebral vessels during angioplasty with stenting of the internal carotid artery. The study enrolled a total of 54 patients who between May 2015 and December 2018 underwent carotid angioplasty with stenting performed at the Department of Vascular and Endovascular Surgery of the Research Centre of Neurology. The procedure of internal carotid artery stenting may be accompanied by intraoperative acute embolic lesions. In order to reveal intraoperative acute embolic lesions of cerebral vessels all patients before and 24 hours after the intervention were subjected to diffusion-weighted magnetic resonance imaging. Thirty-six patients received classical carotid stents (Xact and Acculink) and 18 patients received Casper stents. The patients of both groups were comparable by 24 characteristics studied, including the incidence of intraoperative acute cerebral embolic lesions (18/36 for the classical stents and 10/18 for the Casper stent), which made it possible to unite them into one group in order to increase the power of the study. All acute embolic lesions detected by the diffusion-weighted magnetic resonance imaging (prior to stenting and 24 hours thereafter) were clinically, asymptomatic with no perioperative stroke observed. In order to reveal predictors of intraoperative acute embolic lesions of cerebral vessels we analysed 22 characteristics of the patients, with the obtained findings demonstrating the following signs: a low-intensity (below 20 dB) ultrasonographic signal reflected from fragments of an atherosclerotic plaque during ultrasound examination prior to stenting (p=0.001) - a sign strongly associated with acute embolic lesions (sensitivity - 75%, specificity - 92%); symptomatic stenosis according to the anamnestic data (p=0.02) - a sign significantly associated with acute embolic lesions; female gender (p=0.06) - a sign moderately associated with acute embolic lesions; a history previously endured (according to the anamnestic data) operations on coronary and/or carotid arteries (p=0.09) - a sign weakly associated with acute embolic lesions. Based on the obtained findings we proposed a prognostic scale to assess the risk of acute embolic lesions of cerebral vessels during internal carotid artery stenting. Knowing the factors associated with intraoperative acute embolic lesions will allow the endovascular surgeon to single out the patients at increased risk of acute embolic lesions.


Assuntos
Angioplastia/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Embolia Intracraniana/etiologia , Stents/efeitos adversos , Doença Aguda , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Dispositivos de Proteção Embólica , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/prevenção & controle , Prognóstico , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
8.
Undersea Hyperb Med ; 46(5): 673-683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683367

RESUMO

Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac "vapor lock" and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence based review of adjunctive therapies is presented.


Assuntos
Embolia Aérea/terapia , Oxigenação Hiperbárica/métodos , Algoritmos , Altitude , Artérias , Pressão Atmosférica , Descompressão/efeitos adversos , Doença da Descompressão/complicações , Mergulho/efeitos adversos , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Forame Oval Patente/complicações , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Posicionamento do Paciente/métodos , Veias
9.
J Stroke Cerebrovasc Dis ; 28(12): 104404, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31564484

RESUMO

INTRODUCTION: The Cincinnati Prehospital Stroke Severity scale (C-STAT), Los Angeles Motor Scale (LAMS), Rapid Arterial Occlusion Evaluation (RACE) score, and Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scales were designed to aid emergency responder identification of patients with stroke related to large vessel occlusion (LVO). We hypothesized that the addition of a known history of atrial fibrillation (AF) without anticoagulation to currently used scales would improve LVO detection. METHODS: Medical records of patients admitted to a Comprehensive Stroke Center with acute ischemic stroke in 2014-2015 were reviewed. LVO identification using the C-STAT, LAMS, RACE, and FAST-ED scores and the AF variable were compared using univariable analyses. The areas under the receiver operating curves (AUCs) were then compared for each score, the AF variable, and each score with the addition of the AF variable. RESULTS: The sample included 233 patients without and 188 patients with an LVO. A history of known AF, history of AF with no anticoagulation, and the C-STAT, LAMS, RACE, and FAST-ED scores were each associated with LVO in univariable analyses. The AUCs for C-STAT, LAMS, RACE, and FAST-ED were similar. The addition of the known AF and no anticoagulation variable did not appreciably change these AUCs. CONCLUSION: Although known AF with no anticoagulation was associated with LVO in patients with acute ischemic stroke, this historic feature did not improve the accuracy of existing LVO detection scales.


Assuntos
Fibrilação Atrial/complicações , Isquemia Encefálica/diagnóstico , Técnicas de Apoio para a Decisão , Embolia Intracraniana/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Feminino , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
10.
J Stroke Cerebrovasc Dis ; 28(12): 104362, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31562039

RESUMO

BACKGROUND: Intravenous recombinant tissue plasminogen activator (IV rt-PA) prior to thrombectomy may reduce the risk of intraprocedural distal embolization in acute ischemic stroke patients. METHODS: We analyzed the diffusion-weighted imaging acquired with 1.5- or 3-T magnetic resonance imaging (MRI) scans obtained within 24 hours of thrombectomy in consecutive acute ischemic stroke patients. An independent physician identified distal embolization, defined as discrete foci of restricted diffusion independent of the primary area of infarction on MRI scan. Patients were stratified based on whether they had or did not receive IV rt-PA prior to thrombectomy. RESULTS: Distal embolization was seen in 59 (ipsilateral in 56) of 63 patients (mean age ± SD; 64.6 ± 15.3 years) who underwent thrombectomy (mean number 8.6; range 0-32). There was no difference in mean number of ipsilateral hemispheric distal embolization between the 2 groups (7.9 ± 6.1 versus 7.5 ± 7.6, P = .82). After adjusting for age, admission National Institutes of Health Stroke Scale score, the time interval between symptom onset and thrombectomy, there was no association between receiving IV rt-PA prior to thrombectomy and number of ipsilateral distal emboli (P = .90). There was no relationship between the number of ipsilateral emboli and rates of favorable outcome after adjusting for other confounders (adjusted odds ratio 1.0; 95% confidence interval .89 - 1.0; P = .40). CONCLUSIONS: Although distal embolization is very common after thrombectomy, IV rt-PA prior to procedure does not reduce the risk of intraprocedural distal embolization.


Assuntos
Isquemia Encefálica/terapia , Fibrinolíticos/administração & dosagem , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/terapia , Trombectomia/efeitos adversos , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/administração & dosagem , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
11.
BMC Musculoskelet Disord ; 20(1): 377, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421672

RESUMO

BACKGROUND: Fat embolism syndrome (FES) is a rare complication that can occur between 12 and 72 h after the initial insult. Isolated cerebral FES without pulmonary symptoms is rarer. Early fracture fixation might prevent FES. We report a case of multiple-fracture with FES despite definite fixation three hours post-injury. CASE PRESENTATION: A 54-year-old man presented with multiple fractures: left femoral shaft (AO B2), left distal radius (AO C3), left comminuted patella, right comminuted 1st metatarsal base and left 2nd-4th metatarsal neck. Because he was stable, we gave him early total care and definite fixation, which required seven hours and yielded no complications. After he recovered from anesthesia, however, his eyes deviated right, his right upper arm was paralyzed, his consciousness level was poor, and his Glasgow Coma Scale score was E3VeM4. Chest X-rays showed clear lung fields, and brain computed tomography showed no intracranial hemorrhage. He did, however, have tachycardia, anemia, and thrombocytopenia. Brain magnetic resonance images showed a hyperintensive starfield pattern on diffuse weighted images, which suggested cerebral FES. After supportive care, his consciousness cleared on postoperative day 17, and he recovered full right upper arm muscle power after four months; however, he had a significant cognitive deficit. One-year post-injury, after regular rehabilitation therapy, he was able to independently perform his activities of daily living but still had a residual mild cognitive deficit. CONCLUSION: Early fixation can attenuate but not eliminate the incidence of FES. Early assessment and rehabilitation therapy might be required for patients with cerebral FES and cognitive deficits; however, such deficits are difficult to predict and need long-term follow-ups.


Assuntos
Embolia Gordurosa/diagnóstico , Embolia Intracraniana/diagnóstico , Traumatismo Múltiplo/complicações , Atividades Cotidianas , Encéfalo/diagnóstico por imagem , Embolia Gordurosa/etiologia , Embolia Gordurosa/reabilitação , Fixação de Fratura , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/reabilitação , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/cirurgia , Fatores de Tempo , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 28(11): 104325, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31427189

RESUMO

We report a case of atrial fibrillation with rheumatic heart disease (RHD) who had intracardiac thrombus and cardiogenic cerebral embolism with rivaroxaban therapy. Intracardiac thrombus disappeared after switching from rivaroxaban to warfarin. Patients of RHD have the possibility of gradual progression of valvular disease even if they are old, so we need to distinguish nonvalvular atrial fibrillation from RHD before starting direct oral anticoagulants.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Inibidores do Fator Xa/administração & dosagem , Cardiopatia Reumática/complicações , Rivaroxabana/administração & dosagem , Trombose/etiologia , Varfarina/administração & dosagem , Administração Oral , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Infarto Encefálico/etiologia , Substituição de Medicamentos , Inibidores do Fator Xa/efeitos adversos , Humanos , Embolia Intracraniana/etiologia , Masculino , Cardiopatia Reumática/diagnóstico , Rivaroxabana/efeitos adversos , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Resultado do Tratamento , Varfarina/efeitos adversos
13.
Cleve Clin J Med ; 86(8): 559-567, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385793

RESUMO

Infective endocarditis remains a diagnostic challenge. Although echocardiography is still the mainstay imaging test, it misses up to 30% of cases. Newer imaging tests--4-dimensional computed tomography (4D CT), fluorodeoxy-glucose positron emission tomography (FDG-PET), and leukocyte scintigraphy--are increasingly used as alternative or adjunct tests for select patients. They improve the sensitivity of clinical diagnosis of infective endocarditis when appropriately used, especially in the setting of a prosthetic valve.


Assuntos
Endocardite/diagnóstico , Ecocardiografia , Endocardite/complicações , Endocardite/diagnóstico por imagem , Tomografia Computadorizada Quadridimensional , Coração/diagnóstico por imagem , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Imagem por Ressonância Magnética , Neuroimagem , Tomografia por Emissão de Pósitrons
15.
J Stroke Cerebrovasc Dis ; 28(9): 2574-2579, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239220

RESUMO

GOALS: While mechanical thrombectomy (MT) has been shown to be effective in the treatment of acute large vessel occlusions, adjunctive measures, such as balloon guide catheters (BGC) and aspiration techniques, are utilized heterogeneously. Clarifying the effects of aspiration applied to the anterior cerebral circulation with proximal flow arrest can shed light on embolic protection during MT. MATERIALS AND METHODS: Manual and pump aspiration were applied through a BGC in a synthetic cerebrovascular model with a 60 ml syringe and a Penumbra pump, respectively. Flow direction was observed during the procedure with fluorescent particles and ultraviolet light. Flow rates were monitored at the simulated internal carotid artery and middle cerebral artery (MCA). FINDINGS: Both aspiration methods produced retrograde flow in all the modeled cerebrovascular segments. In the syringe aspiration methods, an interval phase occurred during the experimental trial in which suction forces paused and MCA flow became anterograde through posterior communication artery collateral circulation. CONCLUSION: Flow patterns vary with different methods of aspiration. With proximal flow arrest, continuous aspiration methods induce constant retrograde flow in all vessels, whereas manual aspiration demonstrates various flow changes, including periods of anterograde flow during the procedure, which may be less effective at distal re-embolization prevention.


Assuntos
Artéria Carótida Interna/fisiopatologia , Circulação Cerebrovascular , Transtornos Cerebrovasculares/terapia , Artéria Cerebral Média/fisiopatologia , Trombectomia/métodos , Velocidade do Fluxo Sanguíneo , Transtornos Cerebrovasculares/fisiopatologia , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/fisiopatologia , Embolia Intracraniana/prevenção & controle , Modelos Anatômicos , Fatores de Risco , Sucção , Seringas , Trombectomia/efeitos adversos , Trombectomia/instrumentação , Fatores de Tempo , Dispositivos de Acesso Vascular
16.
J Stroke Cerebrovasc Dis ; 28(9): e139-e142, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239222

RESUMO

Postoperative cerebral embolism after left upper or lower lobectomy caused by the thrombus in the pulmonary vein stump (PVS) is a rare complication. However, it is still unclear how the cerebral embolism develop after lobectomy, and how can we prevent further embolism after thrombus removal. We present a case of a 55-year-old man without cardiovascular disease history suffering cerebral embolism 2 days after left upper lobectomy. Patient underwent endovascular thrombectomy and discharged hospital 10 days later with proper recovery. No thrombus was detected in an enhanced pulmonary CT after 1 month of aspirin intake, but the length of PVS was measured.


Assuntos
Embolia Intracraniana/etiologia , Pneumonectomia/efeitos adversos , Veias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/cirurgia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Pneumonectomia/métodos , Veias Pulmonares/diagnóstico por imagem , Trombectomia , Fatores de Tempo , Resultado do Tratamento
17.
Cerebrovasc Dis Extra ; 9(2): 57-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31203282

RESUMO

BACKGROUND: Since the advent of magnetic resonance imaging technology, cerebral microbleeds can be diagnosed in vivo. However, the underlying mechanism of cerebral microbleed formation is not fully understood. OBJECTIVES: This study aimed to identify the factors associated with cerebral microbleeds after carotid artery stenting (CAS). METHOD: We retrospectively examined 125 patients who underwent CAS for carotid stenosis. Cerebral microbleeds were investigated using T2*-weighted gradient-echo (GRE) imaging before and after CAS. We analyzed the possible association of new microbleeds with the following risk factors: the number of baseline microbleeds and ischemic cerebral lesions, the occurrence of cerebral hyperperfusion syndrome, and new ischemic cerebral lesions after CAS. RESULTS: Baseline cerebral microbleeds were detected in 53 patients (42.4%). New cerebral microbleeds after CAS were observed in 13 of 125 patients (10.4%) and were exclusively associated with new ischemic lesions but not with other risk factors. No patient showed a merged image of a new cerebral microbleed on GRE imaging or a new ischemic lesion on diffusion-weighted imaging. Lobar and deep microbleeds were noted in 12/13 (92.3%) and 1 patient (7.7%), respectively. Of 12 patients with new microbleeds, 10 (76.9%) and 2 (15.4%) had a new microbleed in the ipsilateral and contralateral hemispheres, respectively. CONCLUSIONS: We found that new cerebral microbleeds developed after CAS and that these might be associated with new ischemic lesions, mostly in the territory of the treated carotid artery. We speculate that these microbleeds result from the deoxygenation of hemoglobin in the embolus or, alternatively, small hemorrhagic transformation of ischemic lesions.


Assuntos
Estenose das Carótidas/terapia , Hemorragia Cerebral/etiologia , Procedimentos Endovasculares/efeitos adversos , Embolia Intracraniana/etiologia , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Stents , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
18.
Lakartidningen ; 1162019 Jun 18.
Artigo em Sueco | MEDLINE | ID: mdl-31237663

RESUMO

Fat Embolism Syndrome (FES) is a rare and often lethal condition, associated with trauma or surgery. It is more serious than a typical fat embolism seen after a fracture in a long bone. FES is a triad of symtoms, including respiratory failure, abnormal neurology and petechial bleeding. FES is a diagnosis of exclusion. The incidence of FES is higher among adults compared to children. One possible explanation for this is the greater proportion of fat in the adult bone marrow. Children with Duchennes muscular dystrophy have a significantly increased risk of FES compared to both other children and adults. There is no specific treatment. Treatment is supportive until the respiratory and cardiovasculatory symtoms pass.


Assuntos
Embolia Gordurosa/etiologia , Distrofia Muscular de Duchenne/complicações , Acidentes por Quedas , Adolescente , Embolia Gordurosa/diagnóstico por imagem , Embolia Gordurosa/terapia , Fraturas do Fêmur/diagnóstico por imagem , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Traumatismos do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Insuficiência Respiratória/etiologia , Fatores de Risco , Tomografia Computadorizada por Raios X
19.
J Stroke Cerebrovasc Dis ; 28(9): e135-e138, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31253482

RESUMO

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic thrombi in the pulmonary arteries, causing pulmonary hypertension and right heart failure. Early and accurate diagnosis are essential for successful treatment but are often difficult because clinical signs and symptoms can be nonspecific and risk factors, such as history of venous thromboembolism, may not always be present. Here, we report a case involving a 76-year-old woman who demonstrated paradoxical cerebral embolism as the initial manifestation of CTEPH. She developed right hemiplegia without dyspnea or edema. Brain magnetic resonance imaging revealed multiple fresh infarctions, while transesophageal echocardiography revealed a patent foramen ovale. Based on these findings, she was diagnosed as having paradoxical cerebral embolism. During the search for the embolic source, right heart catheterization showed significant pulmonary hypertension and pulmonary angiography revealed chronic thrombi in the peripheral pulmonary arteries, consistent with a diagnosis of CTEPH. To our knowledge, this is the first case of CTEPH to be diagnosed with the onset of paradoxical cerebral embolism. Because CTEPH is the only potentially curable form of pulmonary hypertension, clinicians should consider paradoxical cerebral embolism as a possible initial manifestation of CTEPH.


Assuntos
Arteriopatias Oclusivas/complicações , Embolia Paradoxal/etiologia , Hipertensão Pulmonar/etiologia , Embolia Intracraniana/etiologia , Trombose/complicações , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Doença Crônica , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Trombose/diagnóstico por imagem
20.
World Neurosurg ; 129: 28-33, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150859

RESUMO

BACKGROUND: Postoperative cerebral embolism after left upper lobectomy caused by a thrombus in the pulmonary vein stump (PVS) is a serious complication. However, it is unclear whether cerebral embolism can develop after other types of lobectomy. We present 2 cases of revascularization for in-hospital acute ischemic stroke after video-assisted thoracic surgery (VATS). CASE DESCRIPTION: Patient 1 is a 71-year-old man with a history of hypertension and dyslipidemia. VATS was performed for lung cancer in the left upper lobe. On day 0 after VATS, he developed an acute ischemic stroke (left M3 occlusion). Revascularization was performed, and TICI 2b was obtained. He was transferred to a recovery rehabilitation hospital with a modified Rankin Scale score of 3. No ischemic or hemorrhagic stroke was observed 12 months postoperatively. Patient 2 is a 76-year-old man who had a history of hypertension. VATS was performed for metastatic lung cancer in the left lower lobe. On day 6 after VATS, he developed an acute ischemic stroke (left M1 occlusion). Revascularization was performed and TICI 3 was obtained. He was transferred to a recovery rehabilitation hospital with a modified Rankin Scale score of 1. No ischemic or hemorrhagic stroke was observed 13 months postoperatively. CONCLUSIONS: Postoperative PVS thrombosis causes embolisms, and dabigatran has been effective in preventing postoperative recurrences. Further study of preventive and perioperative management is necessary.


Assuntos
Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Humanos , Embolia Intracraniana/etiologia , Trombose Intracraniana/etiologia , Masculino , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Trombectomia/métodos , Trombose Venosa/etiologia
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