RESUMEN
Intracerebral hemorrhage (ICH), defined as bleeding into the brain parenchyma, is a significant public health issue. Although it accounts for only 10 to 15% of strokes, it is associated with the highest morbidity and mortality rates. Despite advances in the field of stroke and neurocritical care, the principles of acute management have fundamentally remained the same over many years. The main treatment strategies include aggressive blood pressure control, early hemostasis, reversal of coagulopathies, clot evacuation through open surgical or minimally invasive surgical techniques, and the management of raised intracranial pressure.
Asunto(s)
Hemorragia Cerebral , Accidente Cerebrovascular , Presión Sanguínea/fisiología , Encéfalo , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
ABSTRACT Intracerebral hemorrhage (ICH), defined as bleeding into the brain parenchyma, is a significant public health issue. Although it accounts for only 10 to 15% of strokes, it is associated with the highest morbidity and mortality rates. Despite advances in the field of stroke and neurocritical care, the principles of acute management have fundamentally remained the same over many years. The main treatment strategies include aggressive blood pressure control, early hemostasis, reversal of coagulopathies, clot evacuation through open surgical or minimally invasive surgical techniques, and the management of raised intracranial pressure.
RESUMO A hemorragia cerebral é definida como um sangramento no parênquima cerebral e representa um importante problema de saúde pública. Ela corresponde a 10 a 15% das causas de AVC e está associada a altas taxas de morbimortalidade. Apesar dos avanços no campo do AVC e dos cuidados neurocríticos, os princípios do manejo agudo permaneceram fundamentalmente os mesmos por muitos anos. As principais estratégias de tratamento incluem controle agressivo da pressão arterial, hemostasia precoce, reversão de coagulopatias, evacuação do coágulo por meio de técnicas cirúrgicas abertas ou cirúrgicas minimamente invasivas e gerenciamento da pressão intracraniana elevada.
Asunto(s)
Humanos , Hemorragia Cerebral , Accidente Cerebrovascular , Presión Sanguínea/fisiología , Encéfalo , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
Cervical arterial dissection accounts for only a small proportion of ischemic stroke but arouses scientific interest due to its wide clinical variability. OBJECTIVE This study aimed to evaluate its risk factors, outline its clinical characteristics, compare treatment with antiaggregation or anticoagulation, and explore the prognosis of patients with cervical arterial dissection. METHODS An observational, retrospective study using data from medical records on patients with cervical arterial dissection between January 2010 and August 2015. RESULTS The total number of patients was 41. The patients' ages ranged from 19 to 75 years, with an average of 44.5 years. The most common risk factor was smoking. Antiaggregation was used in the majority of patients (65.5%); 43% of all patients recanalized in six months, more frequently in patients who had received anticoagulation (p = 0.04). CONCLUSION The presence of atherosclerotic disease is considered rare in patients with cervical arterial dissection; however, our study found a high frequency of hypertension, smoking and dyslipidemia. The choice of antithrombotic remains controversial and will depend on the judgment of the medical professional; the clinical results with anticoagulation or antiaggregation were similar but there was more recanalization in the group treated with anticoagulation; its course was favorable in both situations. The recurrence of cervical arterial dissection and stroke is considered a rare event and its course is favorable.
Asunto(s)
Disección de la Arteria Vertebral/tratamiento farmacológico , Disección de la Arteria Vertebral/etiología , Adulto , Anciano , Anticoagulantes/uso terapéutico , Aterosclerosis/etiología , Brasil/epidemiología , Enfermedades de las Arterias Carótidas/tratamiento farmacológico , Enfermedades de las Arterias Carótidas/epidemiología , Enfermedades de las Arterias Carótidas/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Fumar/efectos adversos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Factores de Tiempo , Resultado del Tratamiento , Disección de la Arteria Vertebral/epidemiología , Adulto JovenRESUMEN
ABSTRACT Cervical arterial dissection accounts for only a small proportion of ischemic stroke but arouses scientific interest due to its wide clinical variability. Objective: This study aimed to evaluate its risk factors, outline its clinical characteristics, compare treatment with antiaggregation or anticoagulation, and explore the prognosis of patients with cervical arterial dissection. Methods: An observational, retrospective study using data from medical records on patients with cervical arterial dissection between January 2010 and August 2015. Results: The total number of patients was 41. The patients' ages ranged from 19 to 75 years, with an average of 44.5 years. The most common risk factor was smoking. Antiaggregation was used in the majority of patients (65.5%); 43% of all patients recanalized in six months, more frequently in patients who had received anticoagulation (p = 0.04). Conclusion: The presence of atherosclerotic disease is considered rare in patients with cervical arterial dissection; however, our study found a high frequency of hypertension, smoking and dyslipidemia. The choice of antithrombotic remains controversial and will depend on the judgment of the medical professional; the clinical results with anticoagulation or antiaggregation were similar but there was more recanalization in the group treated with anticoagulation; its course was favorable in both situations. The recurrence of cervical arterial dissection and stroke is considered a rare event and its course is favorable.
RESUMO As dissecções arterais cervicais correspondem somente a uma pequena proporção dos casos de acidente vascular cerebral (AVC) isquêmico, mas despertam interesse científico devido à sua alta variabilidade clínica. Objetivos: Este estudo destina-se a avaliar os fatores de risco, desfechos clínicos, comparar o tratamento com anticoagulação e antiagregação, e avaliar o prognóstico desses pacientes. Métodos: Estudo observacional, retrospectivo utilizando dados de prontuários de pacientes com dissecção arterial cervical entre os períodos de janeiro de 2010 e agosto de 2015. Resultados: O número de pacientes foi 41. A idade foi de 19 a 75 anos, com idade média de 44,5 anos. O fator de risco mais comum encontrado foi o tabagismo. Antiagregação foi utilizada na maioria dos pacientes (65,5%); 43% dos pacientes apresentaram recanalização em seis meses, sendo esta mais frequentemente observada nos pacientes que receberam anticoagulação (p = 0,04). Conclusão: A presença de doença aterosclerótica é considerada rara em pacientes com dissecção arterial cervical. Entretanto, nosso estudo encontrou alta frequência de hipertensão arterial, tabagismo e dislipidemia. A escolha pela terapia antitrombótica permanece controversa e dependerá do julgamento clínico do médico; os resultados clínicos com anticoagulação ou antiagregação foram similares, mas houve maior taxa de recanalização no grupo tratado com anticoagulação. A recorrência de dissecação arterial cervical e AVC foi considerada rara e o curso, favorável.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Disección de la Arteria Vertebral/etiología , Disección de la Arteria Vertebral/tratamiento farmacológico , Pronóstico , Factores de Tiempo , Índice de Severidad de la Enfermedad , Brasil/epidemiología , Inhibidores de Agregación Plaquetaria/uso terapéutico , Enfermedades de las Arterias Carótidas/etiología , Enfermedades de las Arterias Carótidas/tratamiento farmacológico , Enfermedades de las Arterias Carótidas/epidemiología , Fumar/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/epidemiología , Disección de la Arteria Vertebral/epidemiología , Aterosclerosis/etiología , Anticoagulantes/uso terapéuticoRESUMEN
Spinal cord injury (SCI) affects 1.3 million North Americans, with more than half occurring after trauma. In Brazil, few studies have evaluated the epidemiology of SCI with an estimated incidence of 16 to 26 per million per year. The final extent of the spinal cord damage results from primary and secondary mechanisms that start at the moment of the injury and go on for days, and even weeks, after the event. There is convincing evidence that hypotension contributes to secondary injury after acute SCI. Surgical decompression aims at relieving mechanical pressure on the microvascular circulation, therefore reducing hypoxia and ischemia. The role of methylprednisolone as a therapeutic option is still a matter of debate, however most guidelines do not recommend its regular use. Neuroprotective therapies aiming to reduce further injury have been studied and many others are underway. Neuroregenerative therapies are being extensively investigated, with cell based therapy being very promising.
Asunto(s)
Traumatismos de la Médula Espinal , Descompresión Quirúrgica , Humanos , Metilprednisolona/uso terapéutico , Fármacos Neuroprotectores/uso terapéutico , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/terapia , Índices de Gravedad del TraumaRESUMEN
ABSTRACT Spinal cord injury (SCI) affects 1.3 million North Americans, with more than half occurring after trauma. In Brazil, few studies have evaluated the epidemiology of SCI with an estimated incidence of 16 to 26 per million per year. The final extent of the spinal cord damage results from primary and secondary mechanisms that start at the moment of the injury and go on for days, and even weeks, after the event. There is convincing evidence that hypotension contributes to secondary injury after acute SCI. Surgical decompression aims at relieving mechanical pressure on the microvascular circulation, therefore reducing hypoxia and ischemia. The role of methylprednisolone as a therapeutic option is still a matter of debate, however most guidelines do not recommend its regular use. Neuroprotective therapies aiming to reduce further injury have been studied and many others are underway. Neuroregenerative therapies are being extensively investigated, with cell based therapy being very promising.
RESUMO O traumatismo raquimedular (TRM) afeta 1.3 milhão de norte americanos, sendo mais da metade secundário a trauma.No Brasil, pouco estudos avaliaram sistematicamente a epidemiologia do TRM, mas estima-se uma incidência de 16 a 26 por milhão por ano. A extensão final do dano medular é resultante de mecanismos primários e secundários, que começam no momento do evento e prosseguem por dias e até semanas seguintes. Há fortes evidências de que a hipotensão contribua para danos secundários pós TRM. A cirurgia descompressiva visa a aliviar a compressão mecânica sobre a microcirculação, assim reduzindo isquemia e hipóxia. O papel da metilprednisolona no tratamento de pacientes com TRM é controverso, não sendo recomandada pela maior parte das diretrizes atuais. Terapias neuroprotetoras visando a reduzir injúria adicional foram e vêm sendo estudadas. Terapias neurorregenerativas estão sob investigação ampla, sendo a terapia celular uma forte promessa.
Asunto(s)
Humanos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/terapia , Metilprednisolona/uso terapéutico , Índices de Gravedad del Trauma , Fármacos Neuroprotectores/uso terapéutico , Descompresión QuirúrgicaRESUMEN
BACKGROUND: Man in the barrel syndrome (MBS) is a condition of brachial diplegia initially described after a bilateral watershed cerebral infarct between the anterior and the middle cerebral artery territories. OBJECTIVE: To report a case of MBS as a consequence of anterior spinal artery infarct due to vertebral artery dissection. DISCUSSION: More recently, nonischemic lesions in brain and brain stem have also been described as etiologies of MBS. There are few reports describing spinal cord infarction leading to MBS. The anterior spinal artery syndrome with only brachial diplegia also represents a rare and atypical pattern. CONCLUSION: The conventional neurological consideration that MBS provides a precise anatomical localization is now challenged. The finding of a brachial diplegia leads to the need to investigate the brain, the spinal cord, and the peripheral nervous system.