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1.
J Stroke Cerebrovasc Dis ; 29(2): 104511, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31784378

RESUMO

INTRODUCTION: Heat stroke is defined as high body temperature causing multiple organ failure, psychological change, seizure, and consciousness disturbance, which lead to its high mortality rate. However, the involvement of brain injury is rare, and heat-stroke has only been reported in a few case reports or case series. The purpose of this case study was to evaluate the clinical symptoms and radiological features of heat stroke. METHODS: We reviewed our hospital records and previously published reports to find cases of heat stroke. We excluded those with unknown clinical features or radiological findings. RESULTS: We retrieved 2 cases of heat stroke from our hospital, which presented as extensive lesions on brain imaging that led to disseminated intravascular coagulation and death within a few days. In 21 previously reported cases of heat stroke, similar brain lesions were noted. These were classified as infarction/posterior reversible encephalopathy syndrome (PRES)-like lesions. The patients who developed PRES-like lesions and survived often developed cerebellar sequelae. CONCLUSION: The mechanism of heat stroke is presumed to be multifactorial. Ischemic-like lesions result from hypovolemia and unusual coagulation, whereas PRES-like lesions are caused by direct heat and vasogenic edema due to hypercytokinemia. We need to consider the above mentioned conditions when evaluating heat stroke.


Assuntos
Infarto Encefálico/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Golpe de Calor/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Encéfalo/fisiopatologia , Infarto Encefálico/etiologia , Infarto Encefálico/fisiopatologia , Infarto Encefálico/terapia , Progressão da Doença , Evolução Fatal , Golpe de Calor/complicações , Golpe de Calor/fisiopatologia , Golpe de Calor/terapia , Humanos , Masculino , Síndrome da Leucoencefalopatia Posterior/etiologia , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Síndrome da Leucoencefalopatia Posterior/terapia , Valor Preditivo dos Testes , Fatores de Tempo
2.
Chem Biol Interact ; 316: 108915, 2020 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-31816286

RESUMO

Stroke has been considered the second leading cause of death worldwide, and ischemic stroke accounts for the vast majority of stroke cases. Some of the main features of ischemic stroke are increased brain permeability, ischemia/reperfusion injury, oxidative stress, and acute inflammation. Antagonism of cysLT1R has been shown to provide cardiovascular and neural benefits. In the present study, we investigated the effects of the cysLT1R antagonist zafirlukast both in vivo and in vitro using a middle cerebral artery occlusion (MCAO) mouse model and human brain microvascular endothelial cells (HBMVECs). In vivo, we found that zafirlukast pretreatment could reduce MCAO-induced increased brain permeability by rescuing the expression levels of the tight junction proteins occludin and ZO-1. In vitro, we found that zafirlukast could suppress the increase in endothelial monolayer permeability induced by OGD/R via rescue of occludin and ZO-1 expression; additionally, we found that zafirlukast prevented OGD/R-induced degradation of the extracellular matrix via inhibition of MMP-2 and MMP-9 expression. Finally, we found that zafirlukast could also inhibit OGD/R-induced activation of the critical proinflammatory regulator NF-κB by preventing phosphorylation and nuclear translocation of p65 protein. Together, our findings demonstrate a promising role for zafirlukast in preventing damage induced by ischemic stroke and reperfusion injury.


Assuntos
Barreira Hematoencefálica/efeitos dos fármacos , Compostos de Tosil/farmacologia , Animais , Barreira Hematoencefálica/metabolismo , Infarto Encefálico/etiologia , Infarto Encefálico/prevenção & controle , Permeabilidade da Membrana Celular/efeitos dos fármacos , Modelos Animais de Doenças , Regulação para Baixo/efeitos dos fármacos , Células Endoteliais/citologia , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/metabolismo , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/patologia , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 2 da Matriz/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Ocludina/genética , Ocludina/metabolismo , Compostos de Tosil/uso terapêutico , Proteína da Zônula de Oclusão-1/genética , Proteína da Zônula de Oclusão-1/metabolismo
3.
Medicine (Baltimore) ; 98(48): e18147, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770254

RESUMO

INTRODUCTION: Neurosyphilis is a chronic infection of the central nervous system that is commonly found in adult with long latency periods. Neurosyphilis-attributed deaths in young patients have grown exponentially in the past decade, yet there have been few studies on the early stages of neurosyphilis. PATIENT CONCERNS: A young male patient with syphilitic cerebral arteritis was evaluated in our clinic for the clinical signs of progressive ischemic stroke. DIAGNOSIS: The progression of syphilitic cerebral arteritis was observed through computed tomography imaging, magnetic resonance imaging, magnetic resonance angiogram, and transcranial color Doppler. The pathological changes and clinical outcomes were reviewed. In this specific case, the development of syphilitic cerebral arteritis was dynamic, continuous, and rapid. The pathogenesis was related to Heubner arteritis, in which the formation of a mural thrombus (MT) causes the severe obstruction of blood flow without complete occlusion, leading to an increased risk of infarction. In this patient, formation of the MT resulted in the infarction of the smaller vessels and narrowing of the larger vessels. The partial dislodgment of the MT from the arterial wall of the larger vessels occluded the smaller vessels, leading to infarction. INTERVENTIONS: Standard pharmacotherapy for the treatment of the cerebral infarction and a single course of penicillin were applied. OUTCOMES: Muscle strength was recovered. The Glasgow Coma Scale score was 15, whereas the NIH Stroke Scale score was 0. The increase in blood flow of the right MCA was accompanied by severe stenosis with compensation of the anterior communicating artery. In addition, moderate to severe stenosis of the right vertebral artery and the basilar artery was suspected. There was a possibility that the right posterior communicating artery was recruited for compensation. CONCLUSION: Progressive stroke was the initial symptom of the neurosyphilis. Disease progression is rapid and difficult to control with a single course of penicillin.


Assuntos
Atorvastatina/administração & dosagem , Infarto Encefálico , Clopidogrel/administração & dosagem , Edaravone/administração & dosagem , Neurossífilis , Vasculite do Sistema Nervoso Central , Adulto , Anticolesterolemiantes/administração & dosagem , Infarto Encefálico/diagnóstico , Infarto Encefálico/tratamento farmacológico , Infarto Encefálico/etiologia , Infarto Encefálico/fisiopatologia , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Força Muscular , Exame Neurológico/métodos , Fármacos Neuroprotetores/administração & dosagem , Neurossífilis/complicações , Neurossífilis/tratamento farmacológico , Inibidores da Agregação de Plaquetas/administração & dosagem , Resultado do Tratamento , Ultrassonografia Doppler Transcraniana/métodos , Vasculite do Sistema Nervoso Central/diagnóstico , Vasculite do Sistema Nervoso Central/etiologia
4.
Medicine (Baltimore) ; 98(48): e18156, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770258

RESUMO

RATIONALE: Streptococcus anginosus mostly colonizes the digestive and genitourinary system, including the oropharyngeal region. It commonly causes invasive pyogenic infection, but less likely causes infective endocarditis (IE). PATIENT CONCERNS: An 18-year-old woman who had an underlying mitral valve prolapse without mitral regurgitation presented to our hospital with low-grade fever, left leg weakness, and left abdominal pain. She was diagnosed with brain infarction and microabscess as well as IE. The patient totally recovered after the 6-week course of intravenous antibiotics. DIAGNOSIS: Brain magnetic resonance imaging revealed brain infarction and microabscess. Abdominal computed tomography revealed splenic and left renal infarction. Three sets of blood culture were positive for S anginosus. Transthoracic echocardiogram identified mitral valve prolapse with moderate eccentric mitral valve regurgitation, and a 0.3 × 0.6-cm vegetation was found on the left mitral valve. All of these results meet the modified Duke criteria. INTERVENTIONS: The abdominal pain and left leg weakness were improving after 2 weeks of intravenous antibiotics treatment. No neurological sequelae were noted after completing the 6-week course of medical treatment. OUTCOMES: The patient was successfully treated and discharged after completing the 6-week intravenous antibiotics treatment. LESSONS: IE should be considered in young patients with native valve disease who have prolonged fever. Though S anginosus commonly causes invasive pyogenic infection, patients with native valve disease should be checked for IE.


Assuntos
Antibacterianos/administração & dosagem , Abscesso Encefálico , Infarto Encefálico , Endocardite , Prolapso da Valva Mitral , Infecções Estreptocócicas , Streptococcus anginosus/isolamento & purificação , Administração Intravenosa , Adolescente , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Ecocardiografia/métodos , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Feminino , Humanos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Recuperação de Função Fisiológica , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento
5.
J Cardiothorac Surg ; 14(1): 196, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718656

RESUMO

BACKGROUND: Primary thrombosis of the pulmonary vasculatures without extra-pulmonary sources of embolism are uncommon. Here, we report 2 cases of thrombosis of the stump of the remnant pulmonary vasculatures after lung resection complicated by embolic events with review of the literature. CASE PRESENTATION: A 75-year-old female was consulted to evaluate cardiac source of embolism for acute cerebral infarction. The patient underwent left upper lobectomy because of lung cancer 2 years ago. Cardiovascular imaging revealed about 1.6 cm × 1.4 cm sized thrombus within the remnant stump of the left superior pulmonary vein. The patient was treated by anticoagulation with warfarin, because the patients refused surgical removal of thrombus. A 57-year-old female who had a history of right pneumonectomy 10 years ago presented with dyspnea. Cardiovascular imaging revealed 1.7 × 1.5 cm sized thrombus in the right pulmonary artery stump and small pulmonary embolism in the left lower segmental pulmonary artery. The patient was treated by long-term anticoagulation with warfarin, and the thrombus and pulmonary embolism were resolved. CONCLUSION: The present cases demonstrated that very late thrombosis of the remnant pulmonary vascular structures and subsequent fatal embolic complications can develope even several years later after lung resection. Therefore, the dead space of the remnant vascular structures should be minimized during lung resection surgery, and the developement of delayed thromboembolic complications associated with vascular stump thrombosis should be carefully monitored.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Embolia Pulmonar/etiologia , Veias Pulmonares/diagnóstico por imagem , Trombose Venosa/etiologia , Idoso , Infarto Encefálico/etiologia , Dispneia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Veias Pulmonares/cirurgia , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem
6.
J Med Case Rep ; 13(1): 316, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647029

RESUMO

BACKGROUND: Immune checkpoint inhibitor therapy has changed the standard drug therapy for relapsed or advanced non-small cell lung cancer; its efficacy is well-recognized by pulmonary physicians, oncologists, and thoracic surgeons. Nivolumab, one of the anti-programmed cell death 1 antibodies, was the first immune checkpoint inhibitor to be approved and is used as a standard second-line regimen for patients with non-small cell lung cancer irrespective of the expression of programmed cell death ligand 1. Programmed cell death 1 antibodies have been generally confirmed to be less toxic than conventional cytotoxic chemotherapy, although unusual immune-related adverse events such as type I diabetes mellitus, adrenal failure, and myasthenia gravis may occur with a very low incidence. A case of severe grade V immune-related thrombocytopenia after two courses of nivolumab as second-line therapy for relapsed non-small cell lung cancer is reported. CASE PRESENTATION: An 82-year-old Japanese woman with relapsed lung adenocarcinoma was treated with nivolumab as second-line systemic therapy at our institute. Her laboratory data indicated thrombocytopenia suspected to be an immune-related adverse event following two courses of nivolumab. Subsequently, she developed a massive pulmonary hemorrhage and left cerebral infarction despite intensive treatment including systemic steroid therapy. Although there have been a few reports of thrombocytopenia caused by nivolumab, this is the first report of grade V thrombocytopenia following administration of nivolumab for relapsed non-small cell lung cancer. CONCLUSION: A very difficult case of grade V immune-related thrombocytopenia after the administration of nivolumab as second-line therapy for relapsed lung adenocarcinoma was described. Immune-related thrombocytopenia is a rare adverse event, but it must be considered a possible complication because it may become critical once it has occurred.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Nivolumabe/efeitos adversos , Trombocitopenia/induzido quimicamente , Adenocarcinoma de Pulmão/tratamento farmacológico , Idoso de 80 Anos ou mais , Antineoplásicos Imunológicos/administração & dosagem , Infarto Encefálico/etiologia , Evolução Fatal , Feminino , Hemorragia/etiologia , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Recidiva Local de Neoplasia , Nivolumabe/administração & dosagem , Índice de Gravidade de Doença , Trombocitopenia/classificação
7.
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
8.
J Stroke Cerebrovasc Dis ; 28(11): 104326, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31422006

RESUMO

Endomyocarditis in Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare complication, commonly involving an apical mass compatible with a thrombus. However, no previous report has discussed mobile structures detected by echocardiography in a patient with EGPA. A 53-year-old man with asthma presented with low-grade fever, consciousness disturbance, and vomiting. Magnetic resonance imaging showed multiple acute infarctions in the bilateral cerebrum and cerebellum. Remarkable eosinophilia was observed, and transthoracic echocardiography showed multiple mobile structures originating from the left ventricular septum. The day after admission, he developed left partial hemianopia and intracranial hemorrhage was identified in his right occipital lobe. Skin biopsy showed infiltration of eosinophils in the arterial wall, and we diagnosed EGPA. Myocardial biopsy was performed from the right ventricular wall, and eosinophilic infiltration into the endocardium and myocardium was observed. Endomyocarditis secondary to EGPA was confirmed, and steroid therapy was immediately initiated. Ten days after steroid therapy, the mobile structures in the left ventricle disappeared completely. He suffered no recurrence of stroke with continued steroid therapy. Mobile structures in the left ventricle in patients with active EGPA could be treated conservatively with steroid therapy.


Assuntos
Síndrome de Churg-Strauss/tratamento farmacológico , Miocardite/tratamento farmacológico , Miocárdio/patologia , Esteroides/administração & dosagem , Administração Intravenosa , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/patologia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Miocardite/etiologia , Miocardite/patologia , Pulsoterapia , Resultado do Tratamento
9.
Pan Afr Med J ; 33: 2, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303947

RESUMO

Ischemic stroke can result from multiple etiologies. It can also be a complication of tuberculous meningoencephalitis and determine its outcome. stroke secondary to tuberculous meningoencephalitis, occurs in 30% cases in the basal ganglia region, unusually in the thalamus. The mechanism of stroke in this condition is vasculitis. We report an unusual case of bilateral thalamic infarcts complicating tuberculous meningoencephalitis. Ischemic stroke in tuberculous meningoencephalitis is unpredictable with poor prognosis despite antituberculous drug treatment, emphasising the importance of primary prevention, particularly in tuberculosis endemic areas.


Assuntos
Infarto Encefálico/etiologia , Meningoencefalite/complicações , Acidente Vascular Cerebral/etiologia , Tuberculose Meníngea/complicações , Adolescente , Antituberculosos/administração & dosagem , Infarto Encefálico/diagnóstico , Humanos , Masculino , Meningoencefalite/tratamento farmacológico , Meningoencefalite/microbiologia , Prognóstico , Acidente Vascular Cerebral/diagnóstico , Tálamo/patologia , Tuberculose Meníngea/tratamento farmacológico
11.
Nat Commun ; 10(1): 2009, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043599

RESUMO

HIV-associated cerebrovascular events remain highly prevalent even in the current era of antiretroviral therapy (ART). We hypothesize that low-level HIV replication and associated inflammation endure despite antiretroviral treatment and affect ischemic stroke severity and outcomes. Using the EcoHIV infection model and the middle cerebral artery occlusion as the ischemic stroke model in mice, we present in vivo analysis of the relationship between HIV and stroke outcome. EcoHIV infection increases infarct size and negatively impacts tissue and functional recovery. Ischemic stroke also results in an increase in EcoHIV presence in the affected regions, suggesting post-stroke reactivation that magnifies pro-inflammatory status. Importantly, ART with a high CNS penetration effectiveness (CPE) is more beneficial than low CPE treatment in limiting tissue injury and accelerating post-stroke recovery. These results provide potential insight for treatment of HIV-infected patients that are at risk of developing cerebrovascular disease, such as ischemic stroke.


Assuntos
Antirretrovirais/farmacocinética , Barreira Hematoencefálica/metabolismo , Infarto Encefálico/tratamento farmacológico , Encéfalo/patologia , Infecções por HIV/tratamento farmacológico , Animais , Antirretrovirais/uso terapêutico , Comportamento Animal/efeitos dos fármacos , Encéfalo/irrigação sanguínea , Encéfalo/efeitos dos fármacos , Encéfalo/virologia , Infarto Encefálico/diagnóstico , Infarto Encefálico/etiologia , Modelos Animais de Doenças , Infecções por HIV/complicações , Infecções por HIV/virologia , HIV-1 , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Artéria Cerebral Média/cirurgia , Permeabilidade , Recuperação de Função Fisiológica/efeitos dos fármacos , Índice de Gravidade de Doença , Resultado do Tratamento , Ativação Viral , Replicação Viral
12.
BMC Neurol ; 19(1): 100, 2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31103038

RESUMO

BACKGROUND: A revised classification of cerebellar infarctions (CI) may uncover unrecognized associations with etiologic stroke subtypes. We hypothesized that obliquely oriented small cortical cerebellar infarction (SCCI) representing end zone infarctions on MRI would be associated with cardiac embolism. METHODS: We retrospectively analyzed consecutive stroke patients recruited between January-December 2016 in our center. Analyzed baseline characteristics: sex, age, cardiovascular risk factors, history of stroke or atrial fibrillation (AF). TOAST classification was used for determining stroke subtype. Acute infarction location (anterior/posterior/mixed anterior-posterior circulation), acute uni- or multiterritorial infarction, and acute or chronic CI/SCCI/non-SCCI were assessed by MRI, and vertebrobasilar stenosis/occlusion by vessel imaging. Pre-specified analysis was also performed in patients without known high cardioembolic risk (known AF history or acute multiterritorial infarction). RESULTS: We included 452 patients (CI in 154, isolated SCCI in 55, isolated non-SCCI in 50, and mixed SCCI/non-SCCI in 49). Both SCCI and non-SCCI were associated with AF history (SCCI, p = 0.021; non-SCCI, p = 0.004), additional acute posterior circulation infarction (p < 0.001 both CI-subtypes), multiterritorial infarctions (SCCI, p = 0.003; non-SCCI, p < 0.001) and cardioembolic more frequent than large-artery atherosclerosis origin (p < 0.001 for both CI-subtypes). SCCI was associated with older age (p < 0.001), whereas non-SCCI was associated with stroke history (p = 0.036) and vertebrobasilar stenosis/occlusion (p = 0.002). SCCI were older (p = 0.046) than non-SCCI patients, had less frequently prior stroke (p < 0.001), and more frequent cardioembolic infarction (p = 0.025). In patients without known high cardioembolic risk (n = 348), SCCI was strongly associated with subsequent cardioembolism diagnosis (OR 3.00 [CI 1.58-5.73, p < 0.001]). No such association was present in non-SCCI. CONCLUSIONS: Acute or chronic SCCI are strongly associated with a cardioembolic origin.


Assuntos
Fibrilação Atrial/complicações , Infarto Encefálico/etiologia , Doenças Cerebelares/etiologia , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Infarto Encefálico/classificação , Infarto Encefálico/patologia , Doenças Cerebelares/classificação , Doenças Cerebelares/patologia , Feminino , Humanos , Embolia Intracraniana/classificação , Embolia Intracraniana/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/patologia
13.
Neurology ; 92(20): e2385-e2394, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-30996058

RESUMO

OBJECTIVE: To define the in-hospital course, complications, short- and long-term functional outcomes of patients with angiographically negative subarachnoid hemorrhage (anSAH), particularly those with aneurysmal-pattern anSAH (aanSAH). METHODS: Retrospective cohort study of patients with aneurysmal subarachnoid hemorrhage (aSAH), aanSAH, and perimesencephalic-pattern anSAH (panSAH) treated at a single tertiary referral center between January 2006 and April 2018. Ninety-nine patients with anSAH (33 aanSAH and 66 panSAH) and 464 patients with aSAH were included in this study. Outcomes included symptomatic hydrocephalus requiring CSF drainage, need for ventriculoperitoneal shunt, radiographic vasospasm, delayed cerebral ischemia (DCI), radiographic infarction, disability level within 1 year of ictus, and at last clinical follow-up as defined by the modified Rankin Scale. RESULTS: Patients with aanSAH and panSAH had similar rates of DCI and radiologic infarction, and patients with aanSAH had significantly lower rates compared to aSAH (p ≤ 0.018). Patients with aanSAH were more likely than those with panSAH to require temporary CSF diversion and ventriculoperitoneal shunt (p ≤ 0.03), with similar rates to those seen in aSAH. Only one patient with anSAH died in the hospital. Compared to those with aSAH, patients with aanSAH were significantly less likely to have a poor functional outcome within 1 year of ictus (odds ratio 0.26, 95% confidence interval 0.090-0.75) and at last follow-up (hazard ratio 0.30, 95% confidence interval 0.19-0.49, p = 0.002). CONCLUSIONS: DCI is very uncommon in anSAH, but patients with aanSAH have a similar need for short- and long-term CSF diversion to patients with aSAH. Nevertheless, patients with aanSAH have significantly better short- and long-term outcomes.


Assuntos
Isquemia Encefálica/fisiopatologia , Hidrocefalia/fisiopatologia , Hemorragia Subaracnóidea/fisiopatologia , Vasoespasmo Intracraniano/fisiopatologia , Adulto , Idoso , Aneurisma Roto , Angiografia Digital , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Infarto Encefálico/fisiopatologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Angiografia Cerebral , Estudos de Coortes , Drenagem , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/terapia , Aneurisma Intracraniano , Masculino , Pessoa de Meia-Idade , Prognóstico , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/etiologia , Derivação Ventriculoperitoneal
15.
World Neurosurg ; 125: 217-221, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30772526

RESUMO

BACKGROUND: Intracranial vascular infections of fungal etiology are extremely rare. Most cases occur in immunocompromised patients with invasive fungal disease, most commonly originating in the paranasal sinuses or the lungs. Granulomatous invasive rhinosinusitis, which is extremely rare in North America, has been reported to affect immunocompetent patients in most cases, and its causative strain has potential to invade the intracranial arteries. We present a rare case of basilar artery rupture and infarction secondary to granulomatous invasive rhinosinusitis. CASE DESCRIPTION: A 50-year-old man in Florida presented with ischemic symptoms and a 6-month history of headache, dizziness, and falls. After biopsy, the patient developed subarachnoid hemorrhage and thrombosis. Several thrombectomy attempts were performed, resulting in persistent occlusion of the basilar artery and subsequent comatous state. After discussion with the patient's family, compassionate weaning and autopsy were authorized. CONCLUSIONS: Invasive fungal rhinosinusitis is more frequent nowadays owing to increased use of immunosuppressive therapies. However, it is still a disease that mostly affects immunocompromised patients. The development of new microbiologic investigation techniques has enabled the discovery of fungal diseases that can also affect immunocompetent hosts, such as granulomatous invasive rhinosinusitis. This is an extremely rare condition in North America, with very few cases documented in the last few decades.


Assuntos
Artéria Basilar/patologia , Neuroaspergilose/patologia , Rinite , Sinusite , Infarto Encefálico/etiologia , Evolução Fatal , Granuloma/patologia , Humanos , Masculino , Pessoa de Meia-Idade
16.
J Stroke Cerebrovasc Dis ; 28(5): 1192-1199, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30711415

RESUMO

BACKGROUND: There are limited clinical studies of bilateral vertebral artery dissection (VAD). OBJECTIVE: To compare the characteristics, imaging findings, and treatments between patients with bilateral and unilateral VAD. METHODS: Between February 2007 and May 2017, 31 (mean age: 53.0 years; 23 men, 8 women) out of 171 VAD patients were hospitalized because of bilateral VAD. Onset type, dissection site, dominant side of the VA, imaging features, treatments, and outcomes were investigated based on medical records. The dominant side of the VA was determined by basi-parallel anatomical scanning. RESULTS: Twenty (64.5%) of 31 patients exhibited bilateral VAD on both sides of V4. The dominant side of the VA was right in 16 patients and left in 15 patients. The pearl and string sign (an angiographical finding with both dilatation and stenosis) was frequently observed on the dominant VAD side, while a tapered occlusion and string sign were most common on the nondominant side. For clinical subtype of VAD, 6 (19.4%) patients had subarachnoid hemorrhage, 10 (32.3%) ischemic stroke, 3 (9.7%) infarction plus subarachnoid hemorrhage, and 12 (38.7%) only headache. The frequency of infarction was increased in bilateral VAD compared with unilateral (P < .05). Surgical intervention was performed in 3 cases, while 14 patients received endovascular intervention. CONCLUSIONS: Infarction occurred frequently in bilateral VAD patients, and 17 patients required an intervention (mainly endovascular) for VA. The treatment strategy varied depending on the clinical subtype, imaging findings of VAD, and morphology of the dominant VAD side.


Assuntos
Angiografia Digital , Angiografia Cerebral/métodos , Procedimentos Endovasculares , Fármacos Hematológicos/uso terapêutico , Procedimentos Neurocirúrgicos , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/terapia , Artéria Vertebral/diagnóstico por imagem , Adulto , Idoso , Anticoagulantes/uso terapêutico , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Infarto Encefálico/terapia , Tomada de Decisão Clínica , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Valor Preditivo dos Testes , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento , Dissecação da Artéria Vertebral/complicações
17.
Lupus ; 28(4): 483-491, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30755144

RESUMO

INTRODUCTION: Transcranial Doppler is a method that enables the assessment of different cerebral hemodynamic parameters. It also allows for the evaluation of the presence of right-to-left circulation shunts (RLS) and for the detection of microembolic signals (MESs), which might be associated with an increased risk of cerebrovascular events. For instance, the presence of MESs on transcranial Doppler in patients with systemic lupus erythematous (SLE) and antiphospholipid syndrome (APS) is associated with an increased risk of stroke. Therefore, transcranial Doppler could be a useful tool for stroke risk stratification in these patients. OBJECTIVE: Our objective was to evaluate transcranial Doppler cerebral mean blood flow velocities as well as the presence of MESs and RLS in patients with antiphospholipid syndrome and SLE. PATIENTS AND METHODS: Twenty-two patients with primary APS (PAPS), 24 patients with secondary APS (SAPS), 27 patients with SLE without APS and 21 healthy controls were evaluated. Clinical and epidemiological data were compiled from medical charts, and all subjects underwent transcranial Doppler examination with breath-holding index calculation. Both middle cerebral arteries were monitored for 60 min for the detection of MESs. RLS was investigated with agitated saline injected as a bolus. RESULTS: There were no significant differences in mean blood flow velocities among the groups. MESs were more frequently found in patients with SLE when compared with controls and patients with APS (SLE: 17.4%, SAPS: 4.3%, PAPS: 0%, controls: 0%, p = 0.03). Anticoagulant therapy was more frequently used in the APS group (PAPS: 81.8%, SAPS: 75.2%, SLE: 1.7%, p < 0.001). Patients with APS had a higher frequency of RLS when compared with volunteers (63.6% versus 38.1%, p = 0.05). Breath-holding index values tended to be lower in patients with SAPS than in control subjects and patients with PAPS and SLE ( p = 0.06). CONCLUSIONS: Patients with APS had a higher frequency of RLS than healthy controls. This finding alerts to the importance of cardiac investigation in patients with stroke and APS, because further therapies such as RLS occlusion might eventually add protection. The higher frequency of MES in patients with SLE could suggest an effect of anticoagulant therapy on MES prevention, more frequently used in patients with APS.


Assuntos
Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/fisiopatologia , Ultrassonografia Doppler Transcraniana , Adulto , Síndrome Antifosfolipídica/fisiopatologia , Artérias/diagnóstico por imagem , Autoanticorpos/análise , Contagem de Células Sanguíneas , Testes de Coagulação Sanguínea , Velocidade do Fluxo Sanguíneo , Encéfalo/irrigação sanguínea , Infarto Encefálico/etiologia , Suspensão da Respiração , Circulação Cerebrovascular , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Risco , Fatores de Risco , Estatísticas não Paramétricas , Trombose/fisiopatologia
18.
J Neuroinflammation ; 16(1): 6, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-30626393

RESUMO

BACKGROUND: Altered neuronal connectivity in peri-infarct tissue is an important contributor to both the spontaneous recovery of neurological function that commonly develops after stroke and improvements in recovery that have been induced by experimental treatments in animal models. Microglia and astrocytes are primary determinants of the environment in peri-infarct tissue and hence strongly influence the potential for neuronal plasticity. However, the specific roles of these cells and the timing of critical changes in their function are not well understood. Minocycline can protect against ischemic damage and promote recovery. These effects are usually attributed, at least partially, to the ability of this drug to suppress microglial activation. This study tested the ability of minocycline treatment early after stroke to modify reactive responses in microglia and astrocytes and improve recovery. METHODS: Stroke was induced by photothrombosis in the forelimb sensorimotor cortex of Sprague-Dawley rats. Minocycline was administered for 2 days after stroke induction and the effects on forelimb function assessed up to 28 days. The responses of peri-infarct Iba1-positive cells and astrocytes were evaluated using immunohistochemistry and Western blots. RESULTS: Initial characterization showed that the numbers of Iba1-positive microglia and macrophages decreased in peri-infarct tissue at 24 h then increased markedly over the next few days. Morphological changes characteristic of activation were readily apparent by 3 h and increased by 24 h. Minocycline treatment improved the rate of recovery of motor function as measured by a forelimb placing test but did not alter infarct volume. At 3 days, there were only minor effects on core features of peri-infarct microglial reactivity including the morphological changes and increased density of Iba1-positive cells. The treatment caused a decrease of 57% in the small subpopulation of cells that expressed CD68, a marker of phagocytosis. At 7 days, the expression of glial fibrillary acidic protein and vimentin was markedly increased by minocycline treatment, indicating enhanced reactive astrogliosis. CONCLUSIONS: Early post-stroke treatment with minocycline improved recovery but had little effect on key features of microglial activation. Both the decrease in CD68-positive cells and the increased activation of astrogliosis could influence neuronal plasticity and contribute to the improved recovery.


Assuntos
Astrócitos/efeitos dos fármacos , Infarto Encefálico , Microglia/efeitos dos fármacos , Minociclina/uso terapêutico , Recuperação de Função Fisiológica/efeitos dos fármacos , Acidente Vascular Cerebral/complicações , Animais , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Infarto Encefálico/tratamento farmacológico , Infarto Encefálico/etiologia , Infarto Encefálico/patologia , Proteínas de Ligação ao Cálcio/metabolismo , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Membro Anterior/fisiopatologia , Trombose Intracraniana/complicações , Masculino , Proteínas dos Microfilamentos/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Desempenho Psicomotor/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , Fatores de Tempo
20.
PLoS One ; 14(1): e0210153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30605484

RESUMO

BACKGROUND: Overweight is known as a risk factor for ischemic stroke. However, the effect of weight change on the development of ischemic stroke remains controversial. We investigated the relationship between weight change and the risk of ischemic stroke using a nationwide population-based cohort. METHODS: Our study enrolled 11,084,683 participants (Mean age 49.7±13.5 years, range 20-114 years) in the Korean National Health Screening Program from 2009 to 2012. Weight change was calculated using the difference between the baseline weight and the weight at health screening four years prior to the baseline. The occurrence of newly-diagnosed ischemic stroke was observed until the end of 2015. We categorized the study population according to weight change and performed multivariable analysis to compare the risk. RESULTS: Ischemic stroke was newly diagnosed in 113,591 subjects. The crude incidence rates of ischemic stroke per 1000 person-years according to the change in body weight were 3.059, 1.906, and 1.491 in the <-5%, ±5%, and ≥+5% groups, respectively. After adjusting all variables, the hazard ratio (HR) of ischemic stroke was higher in subjects who underwent weight loss (HR 1.152) or weight gain (HR 1.087) than in those who maintained their weight. When analyzed by eight groups of 5% intervals, the risk showed a U-shaped curve with those who maintained their weight showing the lowest risk. CONCLUSIONS: The risk of ischemic stroke was gradually increased in those who lost or gained more than 5% of their weight over four years, after adjusting for confounders. We should be aware of the increased risk of ischemic stroke in people who undergo weight change and should identify and manage the cause of weight change.


Assuntos
Peso Corporal/fisiologia , Infarto Encefálico/epidemiologia , Sobrepeso/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Infarto Encefálico/etiologia , Infarto Encefálico/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sobrepeso/fisiopatologia , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Ganho de Peso/fisiologia , Perda de Peso/fisiologia , Adulto Jovem
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