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1.
J Stroke Cerebrovasc Dis ; 29(2): 104582, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31859033

RESUMO

BACKGROUND AND PURPOSE: Post-stroke anxiety (PSA) is common and disabling. PSA should be considered as an important outcome in stroke. However, there is a lack of understanding of factors that may be linked to PSA. The purpose of this study was to determine the frequency of PSA and sociodemographic and clinical factors associated with PSA in a cohort of racially and ethnically diverse stroke patients. METHODS: We conducted a retrospective study of ischemic and hemorrhagic stroke patients seen in a stroke outpatient clinic from August 1, 2017 to June 30, 2018. Patients were eligible if a Generalized Anxiety Disorder 7-Item (GAD-7) instrument was available. GAD-7 scores greater than or equal to 10 indicated the presence of moderate to severe PSA. Multivariable logistic regression was used to identify independent sociodemographic and clinical factors associated with PSA. RESULTS: Records from 289 stroke patients with a GAD-7 instrument were analyzed. PSA was common (21%; GAD-7 ≥ 10). Fifty-seven percent of females had a GAD-7 greater than or equal to 10 compared to 41% of females who had a GAD-7 less than 10 (P = .03). Multivariable analysis found that self-reported nonmarried status (odds ratio, 3.27; 95% confidence interval, 1.44-7.44), excessive fatigue (odds ratio, 4.46; 95% confidence interval, 1.87-10.63), and depression (odds ratio, 1.24; 95% confidence interval, 1.16-1.33) were independently associated with PSA. CONCLUSIONS: PSA may occur more frequently in those who report non-married, excessive fatigue, or depression. Trials of PSA interventions should consider the potential impact of social support, depression, and comorbid conditions contributing to post-stroke fatigue, including sleep apnea.


Assuntos
Ansiedade/psicologia , Isquemia Encefálica/psicologia , Hemorragias Intracranianas/complicações , Ataque Isquêmico Transitório/psicologia , Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Comorbidade , Depressão/epidemiologia , Depressão/psicologia , Fadiga/epidemiologia , Fadiga/psicologia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/psicologia , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Pessoa Solteira/psicologia , Isolamento Social , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Texas/epidemiologia
2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(8. Vyp. 2): 70-74, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825365

RESUMO

AIM: To study the clinical and neurological manifestations of hemorrhagic stroke (HI) in infants. MATERIAL AND METHODS: The retrospective analysis of case histories of 140 infants with MI hospitalized in the children emergency department is carried out. RESULTS AND CONCLUSION: Clinical manifestations of HI in infants are accompanied by signs of cerebral edema, general cerebral symptoms, meningeal, focal symptoms.


Assuntos
Hemorragias Intracranianas , Acidente Vascular Cerebral , Humanos , Lactente , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
3.
World Neurosurg ; 132: 177-181, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505281

RESUMO

BACKGROUND: Reconstructive endovascular treatment is a method that can ameliorate vertebral artery dissecting aneurysm (VADA) and preserve the parent artery. Recently, 2 or 3 overlapping stents have been used to treat VADAs through the flow-diversion effect. However, little is known about the use of >3 overlapping stents for acute treatment of hemorrhagic VADA. CASE DESCRIPTION: A 69-year-old woman was admitted to our institute with the sudden onset of a headache. Brain computed tomography revealed a subarachnoid hemorrhage. Cerebral angiography revealed a VADA in the right intracranial vertebral artery. The contralateral vertebral artery was hypoplastic; thus we performed a reconstructive endovascular procedure using multiple overlapping stents combined with coiling. We used 5 overlapping stents with the aim of preventing coil herniation, fixing the jailed microcatheter, and reinforcing flow diversion and achieved immediate occlusion of the aneurysmal component. Postoperative imaging showed no apparent infarction in the brainstem. Six months after the treatment, angiography revealed complete occlusion of the aneurysm. Therefore in this case, hemorrhagic VADA was successfully treated in the acute setting by 5 overlapping Enterprise stents and coiling, which also preserved the parent artery. CONCLUSIONS: Reconstructive endovascular treatment using multiple overlapping stents and coiling may be a beneficial therapy for hemorrhagic VADA, especially when the contralateral vertebral artery is aplastic or hypoplastic. Using >3 overlapping stents may represent a promising, feasible technique for achieving immediate occlusion by increasing flow diversion.


Assuntos
Procedimentos Endovasculares/métodos , Hemorragias Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Stents , Dissecação da Artéria Vertebral/cirurgia , Idoso , Implante de Prótese Vascular , Angiografia Cerebral , Feminino , Humanos , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Artéria Vertebral/cirurgia , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/diagnóstico por imagem
4.
World Neurosurg ; 131: 53-57, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376556

RESUMO

BACKGROUND: Intracranial schwannomas are rarely confined to the skull. We here report a large schwannoma localized in the petrous apex that presented with intratumoral hemorrhage. CASE DESCRIPTION: A 35-year-old woman with mild hearing disturbance and ear fullness underwent computed tomography scan and magnetic resonance imaging, which demonstrated a tumor accompanied with intratumoral hematoma in the right petrous apex. Bone marrow was totally destroyed, but the bone cortex was relatively preserved. Pathologic specimen showed that the tumor was composed of proliferation of elongated neoplastic cells and positive for S-100 protein. It showed a nuclear palisading pattern, compatible with schwannoma. The lack of any cranial nerve signs and relative preservation of canals through which cranial nerves pass suggested the neurilemma cells surrounded vessels or mismigrated fetal neurilemma cells in the petrous apex as origin of the tumor. Benign nature of the tumor and total disappearance of the symptoms, supposedly due to the spontaneous absorption of the hematoma, made the patient choose a wait-and-watch approach. Magnetic resonance imaging studied 7 years after the diagnosis showed significant decrease of the tumor volume and disappearance of the hematoma. CONCLUSIONS: Although it is a large intraosseous schwannoma in the petrous apex, it has a benign nature, its size is reduced due to the hematoma absorption, and the patient is asymptomatic. We observed the patients for 7 years after the diagnosis.


Assuntos
Hemorragias Intracranianas/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Osso Petroso/diagnóstico por imagem , Adulto , Biópsia , Feminino , Perda Auditiva Condutiva/etiologia , Humanos , Hemorragias Intracranianas/complicações , Imagem por Ressonância Magnética , Neurilemoma/irrigação sanguínea , Neurilemoma/complicações , Neurilemoma/patologia , Carga Tumoral
5.
Neurol Res ; 41(11): 980-990, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31378168

RESUMO

Background. As the survival of preterm infants has increased significantly, germinal matrix hemorrhage (GMH) has become an important public health issue. Nevertheless, treatment strategies for the direct neuronal injury are still scarce. The present study aims to analyze the neuroprotective properties of cannabidiol in germinal matrix hemorrhage. Methods. 112 Wistar rat pups (P7) were submitted to an experimental collagenase induced model of GMH. Inflammatory response and neuronal death were analyzed both at the perilesional area as at the distant ipsilateral CA1 hippocampal area. Immunohistochemistry for GFAP and caspase 3 was used. The ipsilateral free water content was assessed for stimation of cerebral edema, and neurodevelopment and neurofunctional tests were conducted. Results. Reduction of reactive astrocytosis was observed both in the perilesional area 24 hours and 14 days after the hemorrhage lesion (p < 0.001) and in the Stratum oriens of the ipsilateral hippocampal CA1 14 days after the hemorrhage lesion (p < 0.05) in the treated groups. Similarly, there was a reduction in the number of Caspase 3-positive astrocytes in the perilesional area in the treated groups 24 hours after the hemorrhage lesion (p < 0.001). Finally, we found a significant increase in the weight of the rats treated with cannabidiol. Conclusion. The treatment of GMH with cannabidiol significantly reduced the number of apoptotic cells and reactive astrocytes in the perilesional area and the ipsilateral hippocampus. In addition, this response was sustained 14 days after the hemorrhage. These results corroborate our hypothesis that cannabidiol is a potential neuroprotective agent in the treatment of germinal matrix hemorrhage.


Assuntos
Apoptose/efeitos dos fármacos , Canabidiol/farmacologia , Hemorragia Cerebral/tratamento farmacológico , Hemorragias Intracranianas/tratamento farmacológico , Animais , Animais Recém-Nascidos , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Edema Encefálico/complicações , Edema Encefálico/patologia , Canabidiol/administração & dosagem , Hemorragia Cerebral/complicações , Hemorragia Cerebral/patologia , Modelos Animais de Doenças , Hemorragias Intracranianas/complicações , Masculino , Fármacos Neuroprotetores/farmacologia , Ratos Wistar
6.
Acta Clin Croat ; 58(1): 107-112, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363332

RESUMO

Intraventricular hemorrhage (IVH) is usually associated with premature infants; however, it has been estimated to occur in up to 5% of infants born at term and may be associated with different prenatal, perinatal and postnatal risk factors. The present retrospective study included toddlers aged 13-24 months, born at term (≥36 weeks), referred to the Department of Rheumatology, Physical Medicine and Rehabilitation in Zagreb, Croatia, because they had at least two risk factors for neurodevelopmental delay. A total of 63 patients without hemorrhage were control subjects, while 103 case patients were children with IVH. The ordinal logistic regression revealed that neurodevelopmental outcome in term infants was associated with IVH grade (p<0.05). Although more boys than girls suffered from severe IVH (grades III and IV), there were no statistically significant gender differences in the distribution of IVH or in neurodevelopmental outcomes (p>0.05).


Assuntos
Recém-Nascido Prematuro/crescimento & desenvolvimento , Hemorragias Intracranianas/complicações , Transtornos do Neurodesenvolvimento/diagnóstico , Pré-Escolar , Croácia , Feminino , Idade Gestacional , Humanos , Lactente , Doenças do Prematuro/fisiopatologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
7.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 578-584, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448527

RESUMO

OBJECTIVE: To evaluate the effects of iso-osmolar doses of 18% mannitol and 3% sodium chloride (NaCl) solutions in decreasing intracranial pressure (ICP) in animals with severe traumatic brain injury (TBI). DESIGN: Prospective uncontrolled interventional study. SETTING: Veterinary university teaching hospital. ANIMALS: Two cats and 1 dog with TBI with a modified Glasgow Coma Scale score ≤8 after hemodynamic stabilization, and with brain magnetic resonance imaging changes suggestive of intracranial hypertension. INTERVENTIONS: Animals were surgically instrumented for direct ICP measurement, then randomly treated with iso-osmolar doses of 18% mannitol or 3% NaCl. Direct ICP and cerebral perfusion pressure (CPP) were recorded both before treatment and for 120 minutes following drug administration. MEASUREMENTS AND MAIN RESULTS: Direct ICP and CPP were recorded both before treatment and at 5 additional time points following administration over the subsequent 120 minutes. Case 1 received 3% NaCl without any response to therapy; refractory posttraumatic hypertension was suspected. Case 2 was treated with 3% NaCl; ICP decreased by 40.7% and CPP increased by 15%; however, these effects were transient. Case 3 received 18% mannitol, and ICP decreased by 19% and CPP increased to normal. However, there was a rebound increase in ICP that was higher than pretreatment values, and CPP decreased slightly before it gradually increased to normal values towards the end of the study. CONCLUSIONS: Both mannitol and hypertonic saline decrease ICP and improve CPP, but the effect observed in this pilot study suggests that there might be differences in the duration of these effects. Appropriately designed studies in a larger and homogeneous population are warranted to further investigate these findings.


Assuntos
Lesões Encefálicas Traumáticas/veterinária , Doenças do Gato/tratamento farmacológico , Gatos/lesões , Diuréticos Osmóticos/uso terapêutico , Doenças do Cão/tratamento farmacológico , Cães/lesões , Hemorragias Intracranianas/veterinária , Manitol/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Animais , Lesões Encefálicas Traumáticas/complicações , Doenças do Gato/diagnóstico por imagem , Diuréticos Osmóticos/administração & dosagem , Doenças do Cão/diagnóstico por imagem , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/tratamento farmacológico , Pressão Intracraniana , Imagem por Ressonância Magnética/veterinária , Masculino , Manitol/administração & dosagem , Projetos Piloto , Estudos Prospectivos , Solução Salina Hipertônica/administração & dosagem
8.
Medicina (Kaunas) ; 55(7)2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31277348

RESUMO

Background and Objectives: Intracranial hemorrhage caused by the rupture of brain aneurysms occurs in almost 10 per 100,000 people whereas the incidence of such aneurysms is significantly higher, accounting for 4-9%.Linking certain factors to cerebral aneurysm rupture could help in explaining the significantly lower incidence of their rupture compared to their presence. The aim of this study is to determine the association between the corresponding circle of Willis configurations and rupture of cerebral aneurysms. MATERIALS AND METHODS: A group of 114 patients treated operatively for aruptured cerebral aneurysm and a group of 56 autopsied subjects were involved in the study. Four basic types of the circle of Willis configurations were formed-two symmetric types A and C, and two asymmetric types B and D. RESULTS: A statistically significantly higher presence of asymmetry of the circle of Willis was determined in the group of surgically-treated subjects (p = 0.001),witha significant presence of asymmetric Type B in this group (p < 0.001). The changeson the A1 segment in the group of surgically-treated subjects showed a statistically significant presence compared to the group of autopsied subjects (p = 0.001). Analyzing the presence of symmetry of the circle of Willis between the two groups, that is, the total presence of symmetric types A and C, indicated their statistically significant presence in the group of autopsied patients (p < 0.001). CONCLUSIONS: Changes such as hypoplasia or aplasia of A1 and the resulting asymmetry of the circle of Willis directly affect the possibility of the rupture of cerebral aneurysms. Detection of the corresponding types of the circle of Willis after diagnostic examination can be the basis for the development of a protocol for monitoring such patients.


Assuntos
Círculo Arterial do Cérebro/anatomia & histologia , Aneurisma Intracraniano/etiologia , Ruptura/complicações , Idoso , Feminino , Humanos , Aneurisma Intracraniano/fisiopatologia , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ruptura/fisiopatologia
9.
Drug Discov Ther ; 13(3): 168-171, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31327791

RESUMO

Paroxysmal sympathetic hyperactivity (PSH) is a clinical condition characterized by abnormal paroxysmal surges in sympathetic nervous system activity. PSH is known to occur after severe head injury and hypoxic encephalopathy. Cases of PSH that develop after stroke have been reported worldwide; however, PSH is not commonly reported in the field of stroke research in Japan. Some studies have suggested that gabapentin may improve the symptoms of PSH. To our knowledge, this is the first case report demonstrating the efficacy of trazodone for the treatment of PSH that developed after thalamic hemorrhage. A 45-year-old woman presented to our clinic with headache and paralysis of the left side of her body after experiencing right thalamic hemorrhage; a conservative treatment was initiated at our hospital. Immediately upon hospitalization, she developed high fever, tachycardia, tachypnea, constipation, and overactive bladder and had breathing difficulties. Blood sampling revealed elevated levels of myocardial escape enzymes; however, coronary angiography did not show any significant stenosis or occlusion. The patient's symptoms improved after the administration of trazodone. She was diagnosed with catecholamine cardiomyopathy associated with PSH after intracranial hemorrhage and was subsequently transferred to a recovery and rehabilitation hospital unit where the oral administration of trazodone continued. Prolonged PSH contributes significantly to the impairment of daily activities in patients with stroke; therefore, early diagnosis and treatment are critical. Here, we report on the efficacy of trazodone as an effective treatment option for improving clinical outcomes and reducing the stay in the stroke care unit.


Assuntos
Doenças do Sistema Nervoso Autônomo/tratamento farmacológico , Hemorragias Intracranianas/complicações , Acidente Vascular Cerebral/diagnóstico , Trazodona/administração & dosagem , Feminino , Humanos , Hemorragias Intracranianas/tratamento farmacológico , Japão , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia , Tálamo , Trazodona/uso terapêutico , Resultado do Tratamento
10.
J Stroke Cerebrovasc Dis ; 28(9): e127-e128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301985

RESUMO

Harlequin syndrome is a disorder of the autonomic nervous system. It clinically presents as a distinct line of hemifacial sympathetic denervation. We describe a case of Harlequin syndrome with co-existing central first-order Horner syndrome in the setting of a large thalamic hemorrhage with intraventricular extension.


Assuntos
Doenças do Sistema Nervoso Autônomo/etiologia , Rubor/etiologia , Síndrome de Horner/etiologia , Hipo-Hidrose/etiologia , Hemorragias Intracranianas/complicações , Tálamo/irrigação sanguínea , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Feminino , Rubor/diagnóstico , Rubor/fisiopatologia , Síndrome de Horner/diagnóstico , Síndrome de Horner/fisiopatologia , Humanos , Hipo-Hidrose/diagnóstico , Hipo-Hidrose/fisiopatologia , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/fisiopatologia , Pessoa de Meia-Idade
11.
J Clin Neurosci ; 66: 266-268, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31182268

RESUMO

A 48-year-old woman with intracranial hemorrhage at the right hemisphere and the right midbrain was diagnosed as Moyamoya disease (MMD). While restoring consciousness, she complained of diplopia. The left hypertropia with a compensatory right head tilt was noted. The follow up brain image showed the evidence of past hemorrhage at the level of the right inferior colliculus. In this case, the hemorrhage directly damaged the right trochlear nucleus or intra-axial trochlear nerve before decussation and caused left (contralateral) hypertropia. To our knowledge, no report has been described of the trochlear nerve palsy in hemorrhagic Moyamoya disease. Here, we present a case of the patient with trochlear nerve palsy after hemorrhagic MMD and summarize the characteristics of trochlear nerve palsy according to its lesion sites.


Assuntos
Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Doença de Moyamoya/complicações , Doença de Moyamoya/diagnóstico por imagem , Doenças do Nervo Troclear/diagnóstico por imagem , Doenças do Nervo Troclear/etiologia , Diplopia/diagnóstico por imagem , Diplopia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Nervo Troclear/diagnóstico por imagem
12.
World Neurosurg ; 132: e956-e962, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31226460

RESUMO

OBJECTIVE: To analyze the outcomes of use of a lumboperitoneal shunt (LPS) to treat all-cause communicating hydrocephalus (ACCH). METHODS: We analyzed the outcomes of adult patients with ACCH treated with an LPS between June 2015 and June 2018, using Keifer's hydrocephalus score (KHS), postoperative symptom improvement score (SIS), and the Evans index for 5 days after surgery. All patients were followed up to assess long-term outcomes and quality of life. Based on the follow-up data in shunt successful (SS) patients and shunt failure (SF) patients, multivariate analysis with binary logistic regression was used to identify risk factors for LPS failure. RESULTS: A total of 71 eligible patients were included in this study. The KHS (mean, 8.31 ± 4.80 vs. 3.65 ± 3.08; P < 0.001) and Evans index (mean, 0.35 ± 0.05 vs. 0.28 ± 0.05; P < 0.001) were significantly improved following LPS. However, the overall incidence of complications was 40.8%. According to follow-up data, 18 patients (25.4%) failed; the most common reason for failure was catheter obstruction. The majority of patients obtain good prognosis with low level of RBCs counts in CSF (P = 0.039) and postoperative Evans index (P = 0.046) were statistically different between SS and SF group. The multivariate analysis identified elevated RBC count in CSF as a dependent risk factor for LPS failure (odds ratio, 24.111; 95% confidence interval, 2.611-222.629; P = 0.005). CONCLUSIONS: Our findings indicate that LPS may be a promising option for the treatment of ACCH.


Assuntos
Derivações do Líquido Cefalorraquidiano/métodos , Hidrocefalia/cirurgia , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Adulto , Idoso , Lesões Encefálicas Traumáticas/complicações , Feminino , Humanos , Hidrocefalia/etiologia , Hemorragias Intracranianas/complicações , Modelos Logísticos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Peritônio , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
13.
Stroke ; 50(7): 1661-1668, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31167624

RESUMO

Background and Purpose- Circulating metals synchronously reflect multiple metal exposures from both natural and anthropogenic sources, which may be linked with the risk of stroke. However, there is a lack of prospective studies investigating the associations of multiple metal exposures with incident stroke. Methods- We performed a nested case-control study within the ongoing Dongfeng-Tongji cohort launched in 2008. A total of 1304 incident stroke cases (1035 ischemic strokes and 269 hemorrhagic strokes) were prospectively identified by December 31, 2016, and matched to incident identity sampled controls according to age (within 1 year), sex, and blood sampling date (within 1 month). We determined the concentrations of 24 plasma metals and assessed the associations of plasma multiple metal concentrations with incident stroke using conditional logistic regression and elastic net model. Results- The average follow-up was 6.1 years. After adjusting for established risk confounders, copper, molybdenum, and titanium were significantly associated with higher risk of ischemic stroke (odds ratios according to per interquartile range increase, 1.29 [95% CI, 1.13-1.46], 1.19 [95% CI, 1.05-1.35], and 1.30 [95% CI, 1.07-1.59]), whereas rubidium and selenium were associated with lower risk of hemorrhagic stroke (odds ratios according to per interquartile range increase, 0.66 [95% CI, 0.50-0.87] and 0.68 [95% CI, 0.51-0.91]). The predictive plasma metal scores based on multiple metal exposures were significantly associated with higher risk of ischemic and hemorrhagic stroke (adjusted odds ratios according to per interquartile range increase, 1.37 [95% CI, 1.20-1.56] and 1.53 [95% CI, 1.16-2.01]). Conclusions- Plasma copper, molybdenum, and titanium were associated with higher risk of ischemic stroke, whereas plasma rubidium and selenium were associated with lower risk of hemorrhagic stroke. These findings may have important public health implications given the ever-increasing burden of stroke worldwide.


Assuntos
Metais/sangue , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/epidemiologia , Adulto , Fatores Etários , Idoso , Grupo com Ancestrais do Continente Asiático , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Estudos de Casos e Controles , China/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores Sexuais
16.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133549

RESUMO

A sexual headache or coital cephalgia is a headache associated with sexual activity and is a well-recognised condition. It is usually benign, primary and self-limiting. However, occasionally sexual headaches can result from more sinister causes. Intraparenchymal and subdural haemorrhages have been reported as secondary causes of sexual headaches. We present the case of a 61-year-old woman with no comorbidities who presented acutely with a sexual headache and vision loss, and was found to have an occipital and parietal intraparenchymal haemorrhage. She was normotensive and after extensive workup was found to have no predisposing condition for her haemorrhage. The patient had an uneventful recovery with physical rehabilitation and had regular follow-ups, with no residual weakness. She was in a completely normal state of health 1 year after her event, and continued to be off any medications.


Assuntos
Coito/fisiologia , Cefaleia/etiologia , Hemorragias Intracranianas/complicações , Doença Aguda , Feminino , Cefaleia/diagnóstico , Cefaleia/fisiopatologia , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/reabilitação , Pessoa de Meia-Idade , Comportamento Sexual/fisiologia , Resultado do Tratamento
18.
Interv Neuroradiol ; 25(5): 484-490, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30991867

RESUMO

PURPOSE: The aim of this retrospective study is to evaluate medium-term results of undersized balloon angioplasty and stenting for symptomatic high-grade (70-99%) stenosis of a major intracranial artery with Enterprise stent. METHODS: This study included 68 consecutive symptomatic (recurrent transient ischemic attack (TIA) or ischemic stroke under dual antiplatelet treatment) patients with high-grade (70-99%) stenosis of a major intracranial artery who were endovascularly treated with undersized balloon angioplasty and Enterprise stent deployment between July 2012 and December 2017. Primary outcomes were any stroke or death within 30 days after procedure. Secondary outcomes were technical success rates, stroke and restenosis during the follow-up period. RESULTS: A total of 68 lesions in 68 patients (mean age: 62 ± 7 years) were treated with a technical success rate of 99%. The degree of pre-procedural stenosis was 92 ± 6% and dropped to 12 ± 10% after stent deployment. No patient developed any stroke or death during the periprocedural period. Intracranial hemorrhage was observed in 1 (1.5%) patient. In 60 (88%) patients with available imaging follow-up in-stent restenosis was observed in 2 patients. Mean follow-up period was 22 ± 17 months (range 6-72) and none of the patients experienced recurrent TIA or stroke during the follow-up period. CONCLUSION: In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results.


Assuntos
Angioplastia/métodos , Procedimentos Endovasculares/métodos , Arteriosclerose Intracraniana/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Angiografia por Tomografia Computadorizada , Constrição Patológica , Feminino , Seguimentos , Oclusão de Enxerto Vascular , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Hemorragias Intracranianas/complicações , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento
19.
Blood Purif ; 47(4): 317-326, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30889582

RESUMO

OBJECTIVE: We investigated the epidemiology, risk factors, and predictive parameters for ischemic or hemorrhagic stroke-associated acute kidney injury (AKI) and mortality in a general intensive care unit (ICU) in China. METHODS: During 5 years, 479 stroke patients were screened, and 381 were enrolled. AKI was diagnosed within 7 days after ICU admission, based on the Kidney Disease Improving Global Outcomes criteria. Risk factors of AKI were assessed by Logistic regression analyses, and the predictive biomarkers for AKI were determined using receiver operating characteristic (ROC) curves. Also examined were factors influencing 28-day mortality, using Cox regression analyses and Kaplan-Meier curves. -Results: Among all, 115 (30.18%) patients developed AKI. Multivariate regression analyses revealed that the following features at ICU admission significantly increased the risk of developing AKI: an increased National Institutes of Health Stroke Scale score (OR 1.136, p < 0.001) and Acute Physiology and Chronic Health Evaluation II score (OR 1.107, p = 0.042); hypertension (OR 2.346, p = 0.008); use of loop diuretics (OR 1.961, p = 0.032); and higher serum cystatin C (sCysC; OR 8.156, p = 0.001). The area under the ROC curves for predicting AKI using sCysC was 0.772, slightly better than that of other biomarkers. The sCysC ≥0.93 mg/L (hazard ratio 1.844, p = 0.004) significantly predicted 28-day mortality. CONCLUSIONS: Among stroke patients in ICU, we identified significant risk factors of stroke-associated AKI. Serum CysC level at ICU admission was an important biomarker for predicting AKI and 28-day mortality.


Assuntos
Lesão Renal Aguda/complicações , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Idoso , Biomarcadores , Isquemia Encefálica/diagnóstico , Estado Terminal , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Hemorragias Intracranianas/complicações , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
20.
Pract Neurol ; 19(3): 208-224, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30826740

RESUMO

Neurologists and stroke physicians will be familiar with atrial fibrillation as a major cause of ischaemic stroke, and the role of anticoagulation in preventing cardioembolic stroke. However, making decisions about anticoagulation for individual patients remains a difficult area of clinical practice, balancing the serious risk of ischaemic stroke against that of major bleeding, particularly intracranial haemorrhage. Atrial fibrillation management requires interdisciplinary collaboration with colleagues in cardiology and haematology. Recent advances, especially the now-widespread availability of direct oral anticoagulants, have brought opportunities to improve stroke care while posing new challenges. This article gives an overview of the contemporary diagnosis and management of atrial fibrillation, and the associated evidence base. Where there is uncertainty, we describe our own approach to these areas, while highlighting ongoing research that will likely guide future practice.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Administração Oral , Fibrilação Atrial/diagnóstico , Humanos , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/tratamento farmacológico , Risco , Acidente Vascular Cerebral/diagnóstico
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