RESUMEN
BACKGROUND: Dementia represents a potential challenge when thrombolysis is a treatment option. In this study, we assess the impact of dementia on the rate of intracerebral hemorrhage (ICH) and hospital mortality associated with acute ischemic stroke (AIS) in patients treated with thrombolysis. METHODS: A cohort of patients with AIS was identified from the National Inpatient Sample database for the years 2000 to 2007. Vascular and degenerative types of dementia were identified by the International Classification of Diseases-9-CM codes. A matched random sample without dementia was selected from a pool of those with AIS and treated with thrombolysis. RESULTS: In this analysis, 35,557 patients with diagnosis of dementia were included; 207 (0.56%) received thrombolysis. In-hospital mortality (17.48% vs 8.63%) and ICH (5.80% vs 0.38%) were higher in the thrombolysis group (p < 0.0001) compared to those who did not receive thrombolysis. Multivariate analysis showed that thrombolysis was associated with increased hospital mortality (odds ratio [OR] 16.15; 95% confidence interval [CI] 8.54-30.53) and ICH (OR 2.80; 95% CI 1.82-4.32). Compared to a matched population of patients without dementia treated with thrombolysis (n = 621), those who had dementia and were treated with thrombolysis had similar risks of ICH (5.80% vs 4.51%, p = 0.45) and mortality (17.39% vs 14.49%, p = 0.31) rates. With thrombolysis, ICH remained a predictor of mortality for both dementia and control groups (OR 2.25; 95% CI 1.02-4.99). CONCLUSION: The administration of thrombolysis for AIS in patients with dementia was not associated with increased risk of ICH or death compared to the counterparts without dementia. ICH remained as predictor of mortality.
Asunto(s)
Hemorragia Cerebral/etiología , Demencia/complicaciones , Fibrinolíticos/efectos adversos , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/complicaciones , Isquemia Encefálica/tratamiento farmacológico , Estudios de Casos y Controles , Hemorragia Cerebral/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Riesgo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/tratamiento farmacológico , Resultado del TratamientoRESUMEN
PURPOSE: To describe an important symptom of bilateral amaurosis precipitated by exposure to bright light. METHODS: Case report. Clinical analysis of transient, painless, asymmetrical visual loss occurring in bright light in a 54-year-old man. RESULTS: Carotid ultrasound showed bilateral carotid disease. Carotid angiography demonstrated occlusion of the left internal carotid artery and severe stenosis of the right internal carotid artery and both external carotid arteries. Visual symptoms and an abnormal photostress test completely remitted after a right carotid endarterectomy. CONCLUSION: Light-induced amaurosis is an unfamiliar manifestation of ocular ischemic syndrome occurring with severe, often bilateral, carotid artery disease. Its recognition is important because the complaint is associated with severe carotid occlusive disease and recognition is necessary for timely surgical intervention because of the major risk for stroke.