RESUMEN
UNLABELLED: Cerebral arteriovenous malformations (AVMs) are uncommon but can cause intracerebral hemorrhage with grave disability or death. AVMs can even cause focal neurological symptoms, seizures and headache. The treatment of AVMs is complex. The most common treatment forms are microsurgery, stereotactic radiotherapy and endovascular embolization. The best treatment in each case can include a combination of the mentioned treatment forms. New studies indicate that no intervention is the best option in unruptured AVMs. In this article we discuss the epidemiology, diagnosis and treatment of cerebral AVMs. KEY WORDS: cerebral arteriovenous malformations, intracerebral hemorrhage, seizures, headache, surgery, radiation, endovascular embolization. Correspondence: Olafur Sveinsson, olafur.sveinsson@karolinska.se.
Asunto(s)
Malformaciones Arteriovenosas Intracraneales , Angiografía Cerebral/métodos , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/epidemiología , Malformaciones Arteriovenosas Intracraneales/terapia , Valor Predictivo de las Pruebas , Resultado del TratamientoRESUMEN
Four hundred individuals suffer from ischemic stroke every year in Iceland, more than one daily. Cerebral ischemia is an emergency. Around two million brain cells die every minute after an occlusion of a cerebral artery. Therefore, it is of utmost importance that the patient is transported quickly to hospital, not least to receive thrombolytic treatment. Even though thrombolytic treatment can be given up to four and a half hours after the ictal event, time is brain and the effect of thombolysis reduces dramatically as times passes. For every two patients who are treated inside one hour, one recovers fully. When the treatment is administred between three and four and a half hours only one in 14 recovers fully. All patients with an acute stroke should be admitted to a stroke unit where a multidisciplinary focus on stroke causation and treatment is present, with emphasis on early rehabilitation. Secondary preventive treatment focusing on anti-thrombotic, hypertensive, diabetic, cholesterol lowering treatment, carotic endarterectomy and life style changes should be initiated as soon as possible.
Asunto(s)
Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Infarto Cerebral/diagnóstico , Infarto Cerebral/terapia , Terapia Trombolítica , Tiempo de Tratamiento , Isquemia Encefálica/epidemiología , Isquemia Encefálica/fisiopatología , Infarto Cerebral/epidemiología , Infarto Cerebral/fisiopatología , Humanos , Islandia/epidemiología , Recuperación de la Función , Factores de Riesgo , Conducta de Reducción del Riesgo , Prevención Secundaria/métodos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Eight of ten strokes are due to cerebral ischemia, two from cerebal hemorrhage. Stroke is the most common cause of disability, the second commonest cause of dementia and the fourth commonest cause of death in the developed world. The incidence of stroke is 150-200/100.000 individuals/ year. One of every seven individuals suffers from stroke in their lifetime. In this article the epidemiology, risk factors, pathophysiology and symptoms of cerebral ischemia will be reviewed.
Asunto(s)
Isquemia Encefálica/epidemiología , Infarto Cerebral/epidemiología , Accidente Cerebrovascular/epidemiología , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Isquemia Encefálica/fisiopatología , Angiografía Cerebral/métodos , Infarto Cerebral/diagnóstico , Infarto Cerebral/mortalidad , Infarto Cerebral/fisiopatología , Imagen de Difusión por Resonancia Magnética , Humanos , Incidencia , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatologíaRESUMEN
Spinal cord infarction is a rare disease. The disorder is well known as a result of aorta atherosclerosis or complication of aorta surgery. The disorder can mimic other diseases and be difficult to diagnose. We describe a special case of a patient with idiopathic spinal cord infarction. Symptoms and prognosis of the disorder will also be discussed. Key words: Spinal cord infarct, case report, MRI, spinal cord diseases.
Asunto(s)
Infarto , Médula Espinal/irrigación sanguínea , Humanos , Infarto/diagnóstico , Imagen por Resonancia MagnéticaRESUMEN
Spontaneous intracerebral hemorrhage occurs when a blood vessel within the brain parenchyma ruptures without a near related trauma. It is the second most common form of stroke, accounting for approximately 10% to 15% of new strokes. The 30 day mortality is very high (25-50%). Hypertension is the most common cause. Unfortunately, surgery has not proven to be helpful except in certain exceptions such as in large cerebellar hemorrhage. Nonetheless, it is very important that patients with ICH are admitted to an intensive care or a stroke unit with close surveillance of consciousness, focal neurologic symptoms, blood pressure and fluid balance.
Asunto(s)
Hemorragia Cerebral , Accidente Cerebrovascular , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiología , Hemorragia Cerebral/mortalidad , Hemorragia Cerebral/terapia , Humanos , Hipertensión/complicaciones , Pronóstico , Factores de Riesgo , Rotura Espontánea , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Factores de TiempoRESUMEN
Thrombosis of the cerebral veins and sinuses is an unusual but important cause of increased intracranial pressure and stroke, especially in the young and middle aged. Pregnant women, especially during the puerperium, and individuals with thrombophilia are a special risk group. What makes the diagnosis difficult is the vast range of symptoms including: headache, nausea, vomiting, blurry vision, reduction of consciousness, aphasia and motor and sensory disturbances. We present four cases which reflect the diverse clinical presentation of the disease.
Asunto(s)
Cefalea/etiología , Convulsiones/etiología , Trombosis de los Senos Intracraneales/diagnóstico , Accidente Cerebrovascular/etiología , Angiografía Cerebral/métodos , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/terapiaRESUMEN
Spontaneous subarachnoid hemorrhage is a bleeding in to the subarachnoid space without trauma. Aneurysms are the underlying cause in 80% of the cases. Among other causes are: arteriovenous malformations, anticoagulation, vasculitis or brain tumor. Spontaneous subarachnoid hemorrhage is a serious disease, where up to half of the patients die. Of those who survive, only half return to work and many have a reduced quality of life. To prevent rebleeding the aneurysm is closed either with endovascular coiling or neurosurgical clipping.
Asunto(s)
Hemorragia Subaracnoidea , Angiografía Cerebral , Embolización Terapéutica , Procedimientos Endovasculares , Humanos , Imagen por Resonancia Magnética , Procedimientos Neuroquirúrgicos , Calidad de Vida , Recurrencia , Factores de Riesgo , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/mortalidad , Hemorragia Subaracnoidea/cirugía , Resultado del TratamientoRESUMEN
In recent years carotid and vertebral artery dissections have been diagnosed more frequently, probably because new imaging techniques are more reliable and they are certainly less invasive. The cause of cervical artery dissections is largely unexplained but probably involves a combination of genetic and environmental factors such as trauma or infection. Most authors recommend intravenous heparin or low molecular weight heparin followed by oral warfarin to maintain INR between 2-3 for 3-6 months. If the artery has healed after 3-6 months of anti-coagulation all treatment can be stopped but if there is a remaining stenosis the patient can be put on aspirin 75-100 mg a day. The long-term prognosis of cervical artery dissection is favourable in the majority of patients. New dissections are uncommon.
Asunto(s)
Vértebras Cervicales/irrigación sanguínea , Disección de la Arteria Vertebral , Anticoagulantes/administración & dosificación , Esquema de Medicación , Humanos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Disección de la Arteria Vertebral/diagnóstico , Disección de la Arteria Vertebral/tratamiento farmacológico , Disección de la Arteria Vertebral/etiologíaRESUMEN
OBJECTIVE: To find sequence variants that associate with the risk for ischemic stroke (IS), we performed a genome-wide association study. METHODS: We genotyped 1,661 Icelandic IS patients and 10,815 control subjects using the Infinium HumanHap300 chip (Illumina, San Diego, CA). A total of 310,881 single nucleotide polymorphisms (SNPs) were tested for association with IS, and the most significant signals were replicated in two large European IS sample sets (2,224 cases/2,583 control subjects). Two SNPs, rs2200733 and rs10033464, were tested further in additional European IS samples (2,327 patients and 16,760 control subjects). RESULTS: In the Icelandic samples and the two replication sets combined, rs2200733 associated significantly with cardioembolic stroke (CES) (odds ratio [OR], 1.54; p = 8.05 x 10(-9)). No other variants associated with IS or any of its subtypes. rs2200733 associated significantly with IS in all sample sets combined (OR, 1.26; p = 2.18 x 10(-10)), and both rs2200733 and its neighbour, rs10033464 associated strongly with CES (rs2200733: OR, 1.52; p = 5.8 x 10(-12); rs10033464: OR, 1.27; p = 6.1 x 10(-4)). Interestingly, rs2200733 also showed significant association to IS not classified as CES. INTERPRETATION: We discovered that variants previously shown to associate with atrial fibrillation (AF), rs2200733 and rs10033464, significantly associated with IS, with the strongest risk for CES. The association with noncardiogenic stroke is intriguing and suggests that atrial fibrillation may be underdiagnosed in patients presenting with stroke. This discovery may have implications for workup and treatment of IS.