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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.
J Stroke Cerebrovasc Dis ; 29(1): 104486, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31706753

RESUMO

BACKGROUND AND AIM: Predicting outcome after stroke is a major goal and research field. The Embolic Stroke of Undetermined Source (ESUS) is a recently introduced clinical construct, and the prediction of outcome in this population has to be further explored. The aim of the study was to evaluate the prognostic validity and accuracy of the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) score in patients with ESUS. METHODS: Consecutive patients hospitalized for acute ischemic stroke who met the ESUS diagnostic criteria were identified and the ASTRAL scores estimated. The study endpoint was the 3-month unfavorable outcome (modified Rankin Scale>2). Predictive performance was investigated through logistic regression analysis and discrimination and calibration tests. RESULTS: Among 202 patients with ESUS, 67 (33.2%) had unfavourable 3-month outcome. The ASTRAL score was an independent predictor of poor outcome [adjOR = 1.44, 95% confidence interval (CI) 1.30-1.60, P < .001], showed good discriminatory power (area under the receiver operating characteristic curve .913, 95% CI .871-.956) and was well calibrated (Hosmer-Lemeshow test P = .496). CONCLUSIONS: The ASTRAL score was an independent predictor of 3-month functional outcome and showed high predictive accuracy in patients with ESUS.


Assuntos
Isquemia Encefálica/diagnóstico , Técnicas de Apoio para a Decisão , Embolia Intracraniana/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Avaliação da Deficiência , Feminino , Humanos , Embolia Intracraniana/fisiopatologia , Embolia Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Resultado do Tratamento
3.
J Stroke Cerebrovasc Dis ; 29(2): 104491, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761736

RESUMO

BACKGROUND AND PURPOSE: Various pathogenesis are presumed to be involved in the etiology of embolic stroke of undetermined source (ESUS), which has a high recurrence rate, and much remains unknown about the clinical subtype of recurrent stroke. The purpose of this study was to clarify the pathogenesis of ESUS using the ASCOD classification for ESUS patients and to examine the factors involved in the recurrence of ischemic stroke. METHODS: The subjects of this study were 236 of these patients who fulfilled the criteria for ESUS. The rate of stroke recurrent, subtype of recurrent ischemic stroke, and new-onset atrial fibrillation (AF) in these patients were surveyed retrospectively, and each patient was graded for the A, S, and C categories of the ASCOD classification. RESULTS: Ischemic stroke recurred in 32 patients during the follow-up period (7 days to 12.9 years [median 54.3 months]), and new-onset AF was seen in 44 (18.6%) patients. The most subtype of recurrent ischemic stroke was ESUS again (19 patients). Multivariate analysis with a Cox proportional hazards model, the S score (hazard ratio 5.21; 95% confidence interval (CI) 2.38-11.42; P < .001) and the number of A, S, C categories (hazard ratio 1.90; 95% CI 1.14-3.10; P = .013) were factors significantly related to recurrent ischemic stroke. CONCLUSIONS: Assessment of comorbid conditions in ESUS patients based on the ASCOD classification may be useful in predicting the likelihood of recurrence of ischemic stroke.


Assuntos
Fibrilação Atrial/epidemiologia , Isquemia Encefálica/epidemiologia , Embolia Intracraniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Comorbidade , Feminino , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/terapia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Fenótipo , Intervalo Livre de Progressão , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Fatores de Tempo
4.
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
5.
J Stroke Cerebrovasc Dis ; 28(12): 104390, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31607440

RESUMO

BACKGROUND: Embolic stroke of undetermined source (ESUS) is a newly introduced clinical construct to better characterize cryptogenic stroke. It is associated with considerable morbidity and mortality and a high recurrence rate. It has not previously been investigated in Saudi stroke patients. We aimed to conduct a descriptive analysis of ESUS in Saudi Arabia, including its frequency among patients with acute stroke, characteristics, and outcomes. METHODS: We reviewed all ischemic stroke patients admitted to the stroke unit at King Abdulaziz Medical City-Riyadh, Saudi Arabia, from February 2016 to July 2018. We applied the criteria proposed by the Cryptogenic Stroke/ESUS International Working Group, which defines ESUS as a radiologically confirmed nonlacunar brain infarct without (a) extracranial or intracranial atherosclerosis causing ≥50% stenosis in arteries supplying the ischemic area, (b) a major-risk cardioembolic source, (c) any other specific cause of stroke. We compared ESUS patients with the other stroke patients. Study was approved by local institutional review board. RESULTS: Of the 736 patients admitted with ischemic stroke, 147 (20%) had ESUS. Patients with ESUS had fewer vascular risk factors compared to patients without ESUS. Nearly third were either dead or dependent at discharge. There were no significant differences between ESUS and other types of ischemic strokes in mortality rate and independence at discharge. CONCLUSION: ESUS is common in Saudi stroke patients. Despite of the lack of definite etiology, it is associated with considerable morbidity and mortality.


Assuntos
Embolia Intracraniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Registros Eletrônicos de Saúde , Feminino , Mortalidade Hospitalar , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/mortalidade , Embolia Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Fatores de Tempo
6.
Stroke ; 50(4): 901-908, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31633899

RESUMO

Background and Purpose: Endovascular therapy (EVT) is strongly recommended for acute cerebral large vessel occlusion with the Alberta Stroke Program Early CT Score (ASPECTS) ≥6 due to occlusion of the internal carotid artery or M1 segment of the middle cerebral artery. However, the effect of EVT for patients who have ischemic core with ASPECTS ≤5 (0­5) was not established. The purpose of this study was to elucidate the outcomes of EVT for patients with large ischemic core. Methods: Based on the data of The Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2, patients with internal carotid artery or M1 segment of the middle cerebral artery occlusion and pretreatment ASPECTS 0 to 5 on noncontrast CT or diffusion-weighted image were extracted, and the outcomes by EVT were analyzed. Primary end point was defined as a good functional outcome (modified Rankin Scale score of ≤2) after 90 days. Result: Among 2420 registered patients, 504 patients were with internal carotid artery or M1 segment of the middle cerebral artery occlusion and ASPECTS 0 to 5. Among these 504 patients, 172 (34.1 %) were treated with EVT (EVT group) and 332 (65.9 %) without (no-EVT group). In the no-EVT group, elderly patients, females, poor prestroke modified Rankin Scale, high National Institutes of Health Stroke Scale, low ASPECTS, and late admission were significantly more observed. Good functional outcomes were significantly more observed in the EVT group than in the no-EVT group (19.8 % versus 4.2 %; P<0.0001; adjusted odds ratio, 2.33; 95% CI, 1.10­4.94). The incidences of symptomatic intracranial hemorrhage within 72 hours did not significantly different between the EVT group and the no-EVT group (3.7 % versus 4.9%; P=0.55; adjusted odds ratio, 0.50; 95% CI, 0.14­1.73). Conclusions: Although outcomes in this group of patients were usually poor, the data suggested EVT may increase the likelihood of a good functional outcome.


Assuntos
Procedimentos Endovasculares , Infarto da Artéria Cerebral Média/terapia , Embolia Intracraniana/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Japão , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores Sexuais , Trombectomia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
J Stroke Cerebrovasc Dis ; 28(12): 104403, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31563566

RESUMO

BACKGROUND: Air embolism is an extremely rare complication that can follow gastrointestinal endoscopy. The most accepted treatment of cerebral air embolism (CAE) is hyperbaric oxygen (HBO). Limited evidence suggests that lidocaine may have a neuroprotective effect. The exact mechanism does not appear to be well elucidated. METHODS: We conducted a literature search using multiple combinations of keywords from PubMed and Ovid Medline databases according to the PRISMA guidelines. We included articles with cases of air embolism caused by an esophagogastroduodenoscopy (EGD). We excluded cases related to other procedures e.g. colonoscopy, endoscopic retrograde cholangiopancreatography, cholangioscopy, Kasai procedure, bronchoscopy, laparoscopy or thoracoscopy. We were able to identify 30 cases of CAE associated with EGD. We included our experience in treating one patient with CAE after elective EGD. RESULTS: Given the results of our literature search and this patient's characteristics, we chose to treat our patient with HBO and lidocaine infusion. Our case series consists of 31 patients of post EGD CAE, the mean age was 63.7 ± 11.14 years, 38.7% of the patients were women (n = 12). 38.7% of the cases underwent esophageal dilatation (n = 12), while 19.35% had EGD biopsy (n = 6), 9.6% had variceal ligation (n = 3), and 3.22% had variceal banding (n = 1). In 20 out of 31 cases, echocardiography has been documented, 20% of those patients (n = 4) had patent foramen ovale. HBO was used in treatment of 48% of cases (n = 15), among the included patients, 61% survived (n = 19). Our patient showed significant neurological improvement. CONCLUSIONS: Despite the rare incidence of CAE during or after EGD, physicians should be aware of this potential complication. In patients who develop sudden acute neurological symptoms, early diagnosis and intervention may prevent devastating neurological injury and death. The most accepted emergent treatment for CAE includes HBO, consideration of lidocaine, and work-up of source of the air embolism.


Assuntos
Embolia Aérea , Endoscopia Gastrointestinal/efeitos adversos , Embolia Intracraniana , Idoso , Idoso de 80 Anos ou mais , Embolia Aérea/epidemiologia , Embolia Aérea/fisiopatologia , Embolia Aérea/prevenção & controle , Embolia Aérea/terapia , Feminino , Humanos , Oxigenação Hiperbárica , Incidência , Infusões Parenterais , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/fisiopatologia , Embolia Intracraniana/prevenção & controle , Embolia Intracraniana/terapia , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Fármacos Neuroprotetores/administração & dosagem , Medição de Risco , Fatores de Risco , Resultado do Tratamento
8.
J Stroke Cerebrovasc Dis ; 28(10): 104311, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31376998

RESUMO

BACKGROUND: Secondary embolism (SE) during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is the main reason for incomplete recanalization, while its risk factors are largely unknown. This study addresses a potential relationship between thrombus density on preinterventional computed tomography (CT) and the occurrence of SE. METHODS: We reviewed anterior circulation AIS patients who underwent MT from July 2015 to January 2019 in our center. Thrombus density was measured in Hounsfield Units (HU) on 1-mm and 5-mm preinterventional nonenhanced CT (NECT). Thrombus density, baseline characteristics, procedural, and clinical outcomes were compared between patients with SE and those without SE. Logistic regression was conducted to identified potential risk factors of SE. RESULTS: Sixty-four consecutively patients were included, of whom SE was identified in 16 (25.0%) patients. Compared with those without SE, patients with SE showed a higher thrombus density on both 1-mm (72.85 versus 64.28, P = .005) and 5-mm NECT (60.31 versus 49.71, P < .001), a higher proportion of atrial fibrillation (75.0% versus 45.8%, P = .043), a lower clot burden score (.5 versus 6.0, P = .029), and a higher proportion of front-line contact aspiration strategy (50.0% versus 16.7%, P = .020). Multivariate regression analysis showed that only thrombus density was the independent predictor of SE (for the model including HU values on 1-mm NECT, OR 1.11, 95%CI 1.01-1.23, P = .029; for the model including HU values on 5-mm NECT, OR 1.09, 95%CI 1.02-1.17, P = .018). CONCLUSIONS: Higher thrombus density was the independent predictor for SE. Further studies are needed to investigate its role in the optimization of thrombectomy strategy.


Assuntos
Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada/métodos , Embolia Intracraniana/terapia , Trombose Intracraniana/terapia , Tomografia Computadorizada Multidetectores/métodos , Acidente Vascular Cerebral/terapia , Trombectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Incidência , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Dados Preliminares , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
9.
J Stroke Cerebrovasc Dis ; 28(9): 2448-2452, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31307898

RESUMO

BACKGROUND AND AIMS: Increasingly, insertable cardiac monitors (ICM) have been used to detect Atrial Fibrillation (AF) in patients with cryptogenic stroke or embolic strokes of undetermined source (ESUS). We aim to examine the characteristics of these patients who were subsequently found to have AF. METHODS: We studied 83 consecutive patients who were comprehensively evaluated using neuroimaging and vessel imaging (computed tomography angiography, magnetic resonance angiography, or transcranial and extracranial Doppler sonography) to have met the previously established ESUS criteria. All 83 patients had ICM implanted between 2015 and 2017. All patients were followed up for at least 1 year, with a median follow-up period of 1.5 ± .5 years. We compared the baseline clinical, laboratory, echocardiographic, neuro-imaging profiles, and clinical outcomes in terms of functional recovery, recurrent stroke, and mortality in patients with and without detected AF. RESULTS: AF detection rate in this ESUS cohort was 12% over the study period. Patients with detected AF were associated with bilateral infarcts pattern at presentation (30% versus 5.5%, P = .035). Infarcts involving multiple vascular territories was not significantly associated with the detection of AF. There were no significant differences in the other clinical characteristics and outcomes between the AF group compared to the group without detected AF. Echocardiographic parameters including left ventricular ejection fraction and left atrial diameter were also not shown to be significantly different. CONCLUSION: Our study found that a neuroimaging profile of bilateral infarcts was associated with AF detection using insertable cardiac monitor in ESUS patients. Larger prospective studies are needed to validate our findings.


Assuntos
Fibrilação Atrial/diagnóstico , Infarto Encefálico/epidemiologia , Frequência Cardíaca , Embolia Intracraniana/epidemiologia , Monitorização Ambulatorial/instrumentação , Telemetria/instrumentação , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/mortalidade , Fibrilação Atrial/terapia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/mortalidade , Infarto Encefálico/terapia , Feminino , Humanos , Incidência , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/mortalidade , Embolia Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Singapura/epidemiologia , Fatores de Tempo , Resultado do Tratamento
10.
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
11.
Interv Neuroradiol ; 25(3): 285-290, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30714501

RESUMO

BACKGROUND AND PURPOSE: Recent studies suggest that thrombus imaging characteristics such as Hounsfield unit (HU) and perviousness assessed on noncontrast computed tomography (NCCT) and CT angiography (CTA) can predict successful recanalization. We assessed whether these thrombus imaging characteristics could predict successful first-pass recanalization. METHODS: We retrospectively reviewed cases of mechanical thrombectomy over a three-year period in which patients received a multiphase CTA and were treated with a stent retriever on first pass. Thrombus attenuation, thrombus enhancement on arterial- and delayed-phase CTA and percentage washout were calculated and their association with first-pass recanalization, successful recanalization and distal embolic complications was studied. RESULTS: Fifty-two mechanical thrombectomy patients were included. First-pass recanalization was achieved in 59.6% and complete revascularization (Thrombolysis in Cerebral Infarction scale 2b/3) was achieved in 84.6%. There was no correlation between first-pass recanalization with thrombus density on NCCT ( p = 0.94), percentage enhancement on arterial ( p = 0.61) and delayed-phase CTA ( p = 0.23) or thrombus length ( p = 0.16). There was no correlation between number of passes and either thrombus density on NCCT ( p = 0.91) or percentage enhancement on arterial- ( p = 0.79) and delayed-phase ( p = 0.14) CTA or thrombus length ( p = 0.34). Clot length was significantly higher in patients with distal embolic complications than in those without (18.5 ± 7.9 vs 11.4 ± 6.6 mm, p = 0.005). CONCLUSIONS: Our data suggest that thrombus imaging characteristics on multiphase CTA cannot predict first-pass recanalization or successful revascularization in acute ischemic stroke patients treated with stent retrievers. Longer clot length was associated with higher risk of distal embolic complications.


Assuntos
Revascularização Cerebral/efeitos adversos , Trombose Intracraniana/etiologia , Stents/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Revascularização Cerebral/métodos , Feminino , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Trombose Intracraniana/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Trombectomia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 28(4): e33-e35, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30661972

RESUMO

BACKGROUND: Stroke is a common neurological complication of infective endocarditis (IE) and it is associated with increased morbidity and mortality but infective endocarditis in acute stroke setting is hard to discover. MATERIAL AND METHODS: A 75-year-old man referred to hospital for the onset of left hemiparesis and dysarthria. His past medical history included hypertension. He had 3 months history of fatigue, fever, and weight loss. Neurological examination revealed left hemiparesis and dysarthria. FINDINGS: Brain CT and CT angiography revealed a right M1 segment occlusion. Thrombolysis was delivered followed by mechanical thrombectomy by clot aspiration and recanalization was achieved. Anatomopathological analysis of the clot showed necrotic material and bacterial colonies consistent with septic emboli. The day after he developed fever and brain CT revealed a right parieto-occipital intraparenchymal and subarachnoid hemorrhage. Blood cultures demonstrated growth of Enterococcus faecalis. Treatment with vancomycin and ampicillin was started. CONCLUSION: Management of acute ischemic stroke related to IE is difficult. The great clinical challenge for the physician is recognizing the signs suggestive of IE in the acute stroke setting. Anatomo-pathological and bacteriological analysis of the clot in patients eligible to mechanical thrombectomy can provide the remarkable advantage to analyse directly the extracted material, allowing an early diagnosis and appropriate antibiotic therapies and treatments.


Assuntos
Isquemia Encefálica/microbiologia , Endocardite Bacteriana/microbiologia , Enterococcus faecalis/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Embolia Intracraniana/microbiologia , Acidente Vascular Cerebral/microbiologia , Idoso , Angiografia Digital , Antibacterianos/uso terapêutico , Biópsia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/terapia , Masculino , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica , Resultado do Tratamento
14.
Pacing Clin Electrophysiol ; 42(1): 104-106, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30156304

RESUMO

Cerebral air embolism is a potentially life-threatening complication of left-sided ablation procedures. We present a 51-year-old woman with cerebral air embolism during atrial fibrillation cryoballoon ablation. Taking a deep breath while removing the dilatator was the most likely mechanism in our case. The patient was successfully treated with hyperbaric oxygen therapy at early stage and was discharged without any neurological sequelae.


Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia/efeitos adversos , Embolia Aérea/etiologia , Embolia Aérea/terapia , Oxigenação Hiperbárica , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Feminino , Humanos , Pessoa de Meia-Idade
15.
Interv Neuroradiol ; 25(3): 277-284, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30463503

RESUMO

Distal emboli and emboli to new territories occur in up to 14% and 11% of large vessel occlusion mechanical thrombectomies, respectively. A retrospective review was conducted of 18 consecutive patients with large vessel occlusion acute stroke undergoing mechanical thrombecomy, subsequently developing distal emboli and/or emboli to new territory for which thromboaspiration using the 3MAX catheter was performed. Eighteen distal emboli and two emboli to new territory in 18 patients were treated in the distal M2 and M3 middle cerebral artery, pericallosal and callosomarginal arteries, and P2 posterior cerebral artery (all arteries ≥1.5 mm in diameter). 3MAX thromboaspiration was successful in 13/18 distal emboli and 2/2 emboli to new territory (total 15/20, 75%). 3MAX thromboaspiration resulted in improvement in the final modified treatment in cerebral ischaemia (mTICI) score in 14/18 patients (78%) compared with the initial mTICI score after large vessel occlusion thrombectomy. A shift towards higher final mTICI scores was seen with 3MAX catheter aspiration of distal emboli in this series. The initial mTICI score after large vessel occlusion thrombectomy was 2A in 4/18 (22%) patients and 2B in 14/18 (78%) patients. The final mTICI score after distal emboli/emboli to new territory aspiration improved to 2B in 7/18 (39%) patients, 2C in 3/18 (17%) patients and 3 in 8/18 (44%) patients. No procedural complications were noted. In 13 patients with successful distal emboli/emboli to new territory thromboaspiration, a 90-day modified Rankin score of 0-2 was seen in 10 patients (77%). In five patients with unsuccessful distal emboli/emboli to new territory aspiration, a 90-day modified Rankin score of 0-2 was seen in three patients (60%). 3MAX thromboaspiration of select distal emboli and emboli to new territories is feasible. Larger prospective studies are needed to establish the clinical benefit and safety of this approach.


Assuntos
Arteriopatias Oclusivas/terapia , Cateterismo/métodos , Cateteres , Transtornos Cerebrovasculares/terapia , Embolia Intracraniana/terapia , Sucção/métodos , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico por imagem , Isquemia Encefálica/etiologia , Isquemia Encefálica/terapia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sucção/instrumentação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
J Stroke Cerebrovasc Dis ; 28(2): 288-294, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30391330

RESUMO

BACKGROUND: Previous studies have described ischemic stroke temporally related to specific triggers, but only 1 series collected patients with acute ischemic stroke (AIS) following downhill skiing and all caused by cervical artery dissections. Here we describe our series of AIS temporally associated to ski practice, focusing on the frequency, pathogenesis, clinical presentation, and prognosis. METHODS: We maintained a prospective list of Skiing Associated Strokes (SASs) from 2003 to 2017. From all AIS patients included in our stroke registry Acute Stroke Registry and Analysis of Lausanne (ASTRAL) over the same period, we identified a comparison group of non-SAS patients, matched for age and gender. RESULTS: In the 12-year observation period, we identified 17 SASs (4 females, median age 51 years) and 51 matched control patients with nonski-associated strokes. Vascular risk factors, stroke features, and outcome were similar between the 2 groups. Stroke mechanism was arterial dissection in 11 of 17 SASs (65%) and in 7 of 51 control patients (14%, chi-square test: P < .05). In the other 6 cases of ski-associated stroke, etiology was cardiac embolism from atrial fibrillation in 2 patients, large vessel atherosclerosis with stenosis >50% in 1 patient, and undetermined in 3. Among the 11 patients with SAS caused by dissection, 8 reported minor falls while skiing, 1 had a major head trauma without loss of consciousness, and 2 had no traumatism (compared to preceding trauma in 29 of 147 [20%] of all other AIS caused by arterial dissection in ASTRAL, P < .01). CONCLUSIONS: Arterial dissection was a significantly more frequent stroke mechanism in SAS compared to matched controls, but other mechanisms occurred as well. Minor or moderate skiing-related trauma preceded most SAS with dissections.


Assuntos
Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/terapia , Esqui/lesões , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Acidentes por Quedas , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/terapia , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Estudos de Casos e Controles , Feminino , Humanos , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/terapia , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Suíça/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/terapia
17.
Semin Cardiothorac Vasc Anesth ; 23(3): 324-332, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30589392

RESUMO

Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team. All caregivers involved in this event must synchronize their responses quickly, harmoniously, and in such a way that all interventions lead to minimizing the impact of this complication. Its occurrence leaves important lessons to the surgical team that faces it. The best management strategy for a complication of this type is prevention. Nevertheless, a surgical team may ultimately be confronted with such an occurrence at some point despite all the prevention strategies, as was the case with our patient. That is why, in each institution, no effort should be spared to establish cost-effective strategies for early detection and a clear and concise management protocol to guide actions once this complication is detected. It is the duty of each surgical team to determine and clearly organize which strategies will be followed. The purpose of this case study was to demonstrate that a massive air embolism can be rapidly detected using near-infrared spectroscopy monitoring and can be successfully corrected with a multimodal neuroprotection strategy.


Assuntos
Ponte Cardiopulmonar/métodos , Embolia Aérea/terapia , Embolia Intracraniana/terapia , Embolia Aérea/diagnóstico por imagem , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/terapia , Monitorização Intraoperatória/métodos , Neuroproteção , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Adulto Jovem
18.
Stroke ; 49(12): 3054-3056, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30571401

RESUMO

Background and Purpose- This study's objective is to determine if nonstenotic carotid plaque of <50% luminal narrowing predominantly develops ipsilateral rather than contralateral to the stroke site. Methods- This was a cross-sectional observational study. We identified consecutive patients with anterior circulation embolic stroke of undetermined source (ESUS), excluding stroke in multiple vascular territories. Using ultrasonography, we measured the internal carotid plaque size and stenosis for each patient. We dichotomized the plaque size at several predefined thresholds and calculated the frequency of the plaque size and morphology above each threshold ipsilateral versus contralateral to the stroke site. Results- We included 53 patients with unilateral anterior circulation ESUS. Initially, we found that plaque with a thickness ≥1.5 mm was present ipsilateral to the stroke site in 59% of the patients, and present contralateral to the stroke site in 42% of the patients (31/53 versus 22/53 patients; P=0.049). Plaque with low echo likewise had a similar prevalence when present ipsilateral (9%) and contralateral (4%) to the stroke site (5/53 versus 2/53; P=0.25). Conclusions- Internal carotid artery plaque with a thickness ≥1.5 mm but that is nonstenotic (<50%) is considerably more common when ipsilateral to the ESUS site than when contralateral to the ESUS site, especially in plaque with a thickness ≥2.6 mm. Large but nonstenotic carotid artery plaque is associated with anterior circulation ESUS.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Estudos Transversais , Feminino , Humanos , Embolia Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Ultrassonografia
19.
Med Sci Monit ; 24: 8115-8124, 2018 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-30419569

RESUMO

BACKGROUND The aim of this study was to retrospectively analyze the incidence of complications of intracranial complex aneurysms embolization by stent-assisted coils, and to investigate the causes of complications and corresponding treatment methods. MATERIAL AND METHODS A total of 71 patients with subarachnoid hemorrhage (SAH) underwent stent-assisted coil embolization from 2015 to 2018 were enrolled in this study. Among them, 59 cases were single aneurysm, 12 cases were multiple aneurysms (11 cases with 2 aneurysms and 1 case with 3 aneurysms), for a total of 84 aneurysms. All enrolled patients received stent angioplasty except for 1 case. RESULTS There were 62 aneurysms (73.81%) treated with complete tamponade, 21 aneurysms (25.00%) treated with near-total tamponade and 1 aneurysm (1.19%) treated with partial tamponade. All aneurysms were evaluated based on GOS (Glascow outcome scale): 55 cases had GOS of 5 scores, 12 cases had GOS of 4 scores, 3 cases had GOS of 3 scores, and 1 case had GOS of 1 score. There were 67 SAH patients with good prognosis (GOS of 4-5 scores). In our study, the incidence of complications was 12.7%. Three cases experienced acute thrombosis, 2 cases experienced aneurysm rupture during embolization, and 1 case experienced postoperative focal ischemic changes with mild neurological deficits. CONCLUSIONS Stent-assisted coil embolization is safe, effective, and feasible for the treatment of intracranial ruptured aneurysms. Patients had a favorable outcome of as high as 94.4%. However, clinical skills should be improved to reduce the occurrence of complications. Prompt and timely treatment for complications of intracranial ruptured aneurysm is also of great significance.


Assuntos
Aneurisma Roto/complicações , Aneurisma Roto/terapia , Embolização Terapêutica/métodos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Stents , Adulto , Idoso , Oclusão com Balão/métodos , Prótese Vascular , Embolização Terapêutica/instrumentação , Feminino , Humanos , Embolia Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
20.
Acta Vet Scand ; 60(1): 51, 2018 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-30189865

RESUMO

BACKGROUND: Measurement of invasive blood pressure as reflection of blood flow and tissue perfusion is often carried out in animals during general anesthesia. Intravascular cannulation offers the potential for gas to directly enter the circulation and lead to arterial gas embolism. Cerebral arterial gas embolism may cause a spectrum of adverse effects ranging from very mild symptoms to severe neurological injury and death. Although several experimental models of arterial gas embolism have been published, there are no known published reports of accidental iatrogenic cerebral arterial gas embolism from flushing of an arterial line in animals. CASE PRESENTATION: A 7-day-old Red Holstein-Friesian calf (No. 1) and a 28-day-old Holstein-Friesian calf (No. 2) underwent hot iron disbudding and sham disbudding, respectively, under sedation and cornual nerve anesthesia. Invasive arterial blood pressure was measured throughout the procedure and at regular intervals during the day. Before disbudding, a sudden and severe increase of blood pressure was observed following flushing of the arterial line. Excitation, hyperextension of the limbs and rapid severe horizontal nystagmus appeared shortly thereafter. Over the following minutes, symptoms ameliorated and blood pressure normalized in both cases. Prompt diagnosis was missed in calf 1; supportive fluid therapy was provided. Severe deterioration of neurologic status occurred in the following 24 h and culminated with stupor. The calf was euthanized for ethical reasons and the histological examination revealed extensive cerebral injury. Treatment of calf 2 consisted of supportive fluid and oxygen therapy; furosemide (1 mg/kg IV) was injected twice. Calf 2 appeared clinically normal after 2 h and showed no neurologic sequelae on a 3-month-follow up period. CONCLUSIONS: There are no known reports of cerebral arterial gas embolism following flushing of the auricular arterial line in calves. The injection of a small amount of air at high pressure in a peripheral artery may lead to a significant cerebral insult. The clinical presentation is non-specific and can favour misdiagnosis and delay of therapy.


Assuntos
Embolia Aérea/veterinária , Embolia Intracraniana/veterinária , Animais , Bovinos , Embolia Aérea/diagnóstico , Embolia Aérea/tratamento farmacológico , Evolução Fatal , Furosemida/uso terapêutico , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/terapia , Oxigênio/uso terapêutico , Resultado do Tratamento
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