RESUMEN
INTRODUCTION: Ischaemic stroke (IS) due to cervical and cerebral artery dissection (CAD) is a rare entity, and few data are available on the use of such reperfusion therapies as intravenous fibrinolysis and mechanical thrombectomy in these patients. We analysed the use of these treatments in patients with IS due to CAD and compared them against patients receiving reperfusion treatment for IS of other aetiologies. METHODS: We conducted an observational, retrospective, multicentre study of patients with IS due to CAD recorded in the National Stroke Registry of the Spanish Society of Neurology during the period 2011-2019. Comparative analyses were performed between: a) patients with CAD treated and not treated with reperfusion therapies and b) patients treated with reperfusion for IS due to CAD and patients treated with reperfusion for IS due to other causes. Epidemiological data, stroke variables, and outcomes at discharge and at 3 months were included in the analysis. RESULTS: The study included 21,037 patients with IS: 223 (1%) had IS due to CAD, of whom 68 (30%) received reperfusion treatment. Reperfusion treatments were used less frequently in cases of vertebral artery dissection and more frequently in patients with carotid artery occlusion. Compared to patients with IS due to other causes, patients with CAD were younger, more frequently underwent mechanical thrombectomy, and less frequently received intravenous fibrinolysis. Rates of haemorrhagic complications, mortality, and independence at 3 months were similar in both groups. CONCLUSIONS: Reperfusion therapy is frequently used in patients with IS due to CAD. The outcomes of these patients demonstrate the efficacy and safety of reperfusion treatments, and are comparable to the outcomes of patients with IS due to other aetiologies.
Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular/etiología , Isquemia Encefálica/terapia , Isquemia Encefálica/complicaciones , Estudios Retrospectivos , Resultado del Tratamiento , Accidente Cerebrovascular Isquémico/complicaciones , Reperfusión/métodos , Arterias CerebralesRESUMEN
INTRODUCTION: Ischaemic stroke (IS) due to cervical and cerebral artery dissection (CAD) is a rare entity, and few data are available on the use of such reperfusion therapies as intravenous fibrinolysis and mechanical thrombectomy in these patients. We analysed the use of these treatments in patients with IS due to CAD and compared them against patients receiving reperfusion treatment for IS of other aetiologies. METHOD: We conducted an observational, retrospective, multicentre study of patients with IS due to CAD recorded in the National Stroke Registry of the Spanish Society of Neurology during the period 2011-2019. Comparative analyses were performed between: a) patients with CAD treated and not treated with reperfusion therapies and b) patients treated with reperfusion for IS due to CAD and patients treated with reperfusion for IS due to other causes. Epidemiological data, stroke variables, and outcomes at discharge and at 3 months were included in the analysis. RESULTS: The study included 21,037 patients with IS: 223 (1%) had IS due to CAD, of whom 68 (30%) received reperfusion treatment. Reperfusion treatments were used less frequently in cases of vertebral artery dissection and more frequently in patients with carotid artery occlusion. Compared to patients with IS due to other causes, patients with CAD were younger, more frequently underwent mechanical thrombectomy, and less frequently received intravenous fibrinolysis. Rates of haemorrhagic complications, mortality, and independence at 3 months were similar in both groups. CONCLUSIONS: Reperfusion therapy is frequently used in patients with IS due to CAD. The outcomes of these patients demonstrate the efficacy and safety of reperfusion treatments, and are comparable to the outcomes of patients with IS due to other aetiologies.
RESUMEN
No disponible
Asunto(s)
Humanos , Accidente Cerebrovascular/fisiopatología , Ataque Isquémico Transitorio/fisiopatología , Fibrinolíticos/farmacocinética , Código Sanitario , Terapia TrombolíticaAsunto(s)
Isquemia Encefálica/tratamiento farmacológico , Calidad de Vida , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Anciano , Isquemia Encefálica/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta , Estudios Retrospectivos , España , Accidente Cerebrovascular/etiologíaRESUMEN
No disponible
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Humanos , Masculino , Anciano , Embolia Aérea/complicaciones , Accidente Cerebrovascular/etiología , /efectos adversos , /efectos adversos , NeuroimagenAsunto(s)
Isquemia Encefálica/etiología , Cateterismo Venoso Central/efectos adversos , Embolia Aérea/complicaciones , Embolia Intracraneal/complicaciones , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Anciano , Anafilaxia/complicaciones , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/fisiopatología , Seno Cavernoso/diagnóstico por imagen , Venas Cerebrales/diagnóstico por imagen , Venas Cerebrales/fisiopatología , Embolia Aérea/diagnóstico por imagen , Embolia Aérea/fisiopatología , Humanos , Embolia Intracraneal/diagnóstico por imagen , Embolia Intracraneal/fisiopatología , Venas Yugulares/diagnóstico por imagen , Venas Yugulares/fisiopatología , Imagen por Resonancia Magnética , Masculino , Cuadriplejía/etiología , Diálisis Renal/métodos , Tomografía Computarizada por Rayos XRESUMEN
We report the case of a young patient with an ischemic stroke due to a paradoxical embolism through a giant isolated pulmonary arterio-venous fistula and review the literature of similar cases. We argue that the use of contrast transcranial Doppler (c-TCD) may well help in redressing the likely situation of underdiagnosis of this condition. C-TCD is reliable and sensitive in the diagnosis of right-to-left shunt and allows us to suspect pulmonary arterio-venous fistula as the underlying mechanism. Furthermore, the qualities of non-invasiveness, ease of use, precision, reliability and inexpensiveness of c-TCD make it the ideal tool for checking the success of surgical or endovascular treatment and subsequent follow-ups.
Asunto(s)
Fístula Arteriovenosa/diagnóstico , Medios de Contraste/uso terapéutico , Ultrasonografía Doppler Transcraneal , Adulto , Fístula Arteriovenosa/patología , Fístula Arteriovenosa/terapia , Femenino , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Presentamos el caso de un paciente con ictus isquémico producido por una embolia paradójica por una fístula arteriovenosa pulmonar (FAVP) gigante. La revisión de la literatura sugiere que la FAVP como causa de ictus es una patología infradiagnosticada. El doppler transcraneal con contraste salino es una técnica sensible y fiable para la detección de una comunicación derecha-izquierda producida por una FAVP. Dado que es una técnica inocua, sencilla y eficaz no sólo es útil para el diagnóstico, sino también para su control evolutivo postratamiento
We report the case of a young patient with an ischemic stroke due to a paradoxical embolism through a giant isolated pulmonary arterio-venous fistula and review the literature of similar cases. We argue that the use of contrast transeranial doppler (c-TCD) may well help in redressing the likely situation of underdiagnosis of this condition. C-TCD is reliable and sensitive in the diagnosis of right-to-left shunt and allows us to suspect pulmonary arterio-venous fistula as the underlying mechanism. Furthermore, the qualities of non-invasiveness, case of use, precision, reliability and inexpensiveness of c-TCD make it the ideal tool for cheeking the success of surgical or endovascular treatment and subsequent follow-ups
Asunto(s)
Adulto , Persona de Mediana Edad , Humanos , Fístula Arteriovenosa/diagnóstico , Medios de Contraste/uso terapéutico , Ultrasonografía Doppler Transcraneal , Angiografía por Resonancia Magnética , Resultado del Tratamiento , Fístula Arteriovenosa/patología , Fístula Arteriovenosa/terapiaRESUMEN
We report 4 clinical cases of hyperammonemic encephalopathy (HE) associated with valproate acid (VPA) and review the literature on its pathophysiology. In all four cases, hepatic function was normal and valproic levels were within the therapeutic range. Elevated ammonium levels were found as the only biochemical abnormality. Patients showed decreased level of consciousness, confusion, ataxia and seizures. In 1 case the EEG showed diffused triphasic waves with frontal predominance. After suppression of treatment with VPA there was remission of clinical manifestations, and ammonium levels returned to normal. In order to obtain the correct diagnosis of HE, in all patients treated with either VPA mono or polytherapy, ammonium levels should be considered.
Asunto(s)
Amoníaco/sangre , Anticonvulsivantes/efectos adversos , Encefalopatías/sangre , Encefalopatías/inducido químicamente , Ácido Valproico/efectos adversos , Adulto , Anciano , Anticonvulsivantes/uso terapéutico , Electroencefalografía , Epilepsia/complicaciones , Epilepsia/tratamiento farmacológico , Femenino , Humanos , Masculino , Ácido Valproico/uso terapéuticoRESUMEN
Se describen 4 casos clínicos de encefalopatía hiperamoniémica (EH) asociada al uso de valproato sódico y se revisa la literatura respecto a los mecanismos fisiopatológicos implicados. En todos los casos la función hepática fue normal y los niveles de valproato se encontraron dentro del rango terapéutico, hallándose solamente niveles elevados de amonio. Los pacientes presentaron clínica de disminución del nivel de conciencia, cuadro confusional, ataxia y, en 1 caso, aumento del número de crisis. Uno de los casos presentó un registro electroencefalográfico con ondas trifásicas difusas de predominio frontal bilateral. Tras la supresión del tratamiento con valproato sódico se normalizó la clínica y los niveles de amonio volvieron a la normalidad. Para el correcto diagnóstico de la EH, ante todo paciente que esté en tratamiento con valproato sódico, en mono o politerapia y que presente clínica compatible con encefalopatía, se aconseja determinar los niveles de amonio. (AU)