RESUMEN
BACKGROUND: Cognitive deficits in patients with asymptomatic carotid stenosis have been reported. The ultimate mechanism of cognitive deficits remains unclear and might be related to subtle structural brain damage. AIMS: The aim of the present study was to evaluate the presence of subtle white and grey matter abnormalities associated with asymptomatic carotid stenosis. METHODS: Twenty-five patients with asymptomatic ≥70%/occlusion carotid stenosis and 25 healthy controls, matched for gender and age, underwent 3 Tesla brain magnetic resonance imaging. Gray and white matter macrostructural abnormalities were evaluated with voxel-based morphometry using spm8 software. White matter microstructural abnormalities were evaluated with diffusion tensor images with the Diffusion Toolbox package and tract-based spatial statistics from FMRIB Software Library. RESULTS: We observed significant macro- and microstructural white matter abnormalities, and these findings were diffuse and symmetrical in both hemispheres. In contrast, gray matter atrophy was observed in the areas corresponding to the anterior circulation of the hemisphere ipsilateral to the carotid stenosis. CONCLUSIONS: Patients with asymptomatic carotid stenosis have different patterns of gray and white matter abnormalities. While the white matter damage is diffuse, the gray matter atrophy is localized in the territory of anterior circulation ipsilateral to the stenosis. The role of asymptomatic carotid stenosis in the gray matter damage must be further investigated with longitudinal studies and comparison with neuropsychological evaluation.
Asunto(s)
Encéfalo/patología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/patología , Sustancia Gris/patología , Sustancia Blanca/patología , Anciano , Atrofia/complicaciones , Atrofia/patología , Estudios Transversales , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Programas InformáticosRESUMEN
Os autores estudaram 50 pacientes portadores de lesoes reacionais disseminadas e classificados tanto como tuberculóides reacionais ou dimorfos reacionais (casos com reaçoes tipo I, segundo Jopling). A partir de anamnese cuidadosa e de um exame clínico-dermatológico minucioso, verificaram que todos os pacientes apresentavam histórias clínicas semelhantes com relaçao ao início da sua doença, independente do seu grau de imunidade. As lesoes iniciais ou lesoes "mae" sao máculas hipocrômicas ou áreas circunscritas da cor da pele com distúrbios de sensibilidade e que nao devem ser confundidas com as "áreas imunes" descritas por Wade. Essas lesoes parecem preceder uma fase de bacilemia com destruiçao de bacilos nos locais onde eles se depositaram, e a liberaçao de antígenos com a conseqüente manifestaçao de hipersensibilidade retardada desencadeada pelos mesmos, que é o surto reacional. A terapêutica teria um papel eventual somente naqueles casos em que devido a uma imunidade mais baixa estariam sujeitos a novos surtos reacionais. Sem tratamento esses pacientes continuariam apresentando novos surtos indefinidamente.