RESUMEN
OBJECTIVES: This study aimed to explore the correlation between Fibroblast Growth Factor-23 (FGF23) levels and Cerebral Infarction (CI), and to determine whether there is a significant relationship between FGF23 and the occurrence and severity of CI. METHODS: The study categorized Cerebral Infarction (CI) patients into severe and mild stenosis groups based on vertebrobasilar artery stenosis, using Digital Subtraction Angiography (DSA) and Magnetic Resonance Imaging (MRI). The study compared the levels of Fibroblast Growth Factor-23 (FGF23) in the serum of CI patients and healthy controls using a t-test and evaluated the diagnostic effectiveness of serum FGF23 using a Receiver Operating Characteristic (ROC) curve. Additionally, the study analyzed the correlation between FGF23 levels and CI severity after treatment using the National Institute of Health Stroke Scale score. RESULTS: The study found a significant increase in serum Fibroblast Growth Factor-23 (FGF23) levels in patients with Cerebral Infarction (CI) compared to healthy volunteers, (p < 0.001). A higher serum FGF23 level was observed in the severe stenosis group than in the mild stenosis group (p < 0.001). Furthermore, the study showed that a high FGF23 level at admission was significantly related to more severe symptoms of CI as indicated by the National Institute of Health Stroke Scale (NIHSS) score on the 7th day after treatment (p < 0.001). CONCLUSIONS: This study discovered a correlation between Fibroblast Growth Factor-23 (FGF23) levels, vertebrobasilar artery stenosis, and short-term prognosis in patients who had recently experienced acute Cerebral Infarction (CI).
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Infarto Cerebral , Factor-23 de Crecimiento de Fibroblastos , Factores de Crecimiento de Fibroblastos , Índice de Severidad de la Enfermedad , Insuficiencia Vertebrobasilar , Humanos , Insuficiencia Vertebrobasilar/sangre , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Infarto Cerebral/sangre , Infarto Cerebral/diagnóstico por imagen , Femenino , Masculino , Factores de Crecimiento de Fibroblastos/sangre , Persona de Mediana Edad , Anciano , Estudios de Casos y Controles , Imagen por Resonancia Magnética , Angiografía de Substracción Digital , Biomarcadores/sangre , Curva ROC , Adulto , Valores de ReferenciaRESUMEN
INTRODUCCIÓN: Las disecciones de arterias cervicales (DAC) son la primera causa de accidente cerebrovascular isquémico (ACVi) en personas jóvenes. Los factores asociados (FA) de ACVi y la relación temporal con la DAC no están bien caracterizados. Tampoco disponemos de una clasificación clínico-radio-lógica que permita conocer el riesgo de ACVi. OBJETIVO: Describir frecuencia y FA y temporalidad de los ACVi en pacientes con DAC. MÉTODOS: Estudio prospectivo de pacientes mayores de 18 años hospitalizados por una DAC carotidea y/o vertebral entre agosto de 2009 y junio de 2017. Las DAC se diagnosticaron clínico-radiológicamente y los ACVi con imagen con infarto. Se utilizo la Clasificación de Borgess para caracterizar radiológicamente las DAC. Se utilizaron análisis de regresión logística uni y multivariable para evaluar las características clínico-radiológicas y los FA. RESULTADOS: 163 pacientes con 182 DAC (60% vertebrales y 40% carotídeas). 73 pacientes (44,8%) tuvieron un ACVi 28 de 68 pacientes (41,2%) tuvieron simultáneamente síntomas de disección y de isquemia. 60 de 68 pacientes (88%) presentan síntomas de isquemia durante la primera semana. FR significativamente asociados a ACVi: Borgess tipo IB (p = 0,001; OR: 4,1; IC: 1,8-9,3), sexo masculino (p < 0,001; OR: 0,2; IC: 0,06-0,8) y anticonceptivos orales (p = 0,02; OR: 0,2; IC: 0,06-0,8). CONCLUSIÓN: Ocurre aproximadamente en la mitad de los pacientes, en su mayoría dentro de la primera semana, no es la forma habitual de presentación inicial y no se relaciona con el tipo de arteria disecada. El principal FA para desarrollar un ACVi fue la oclusión arterial (Borgess tipo IB).
INTRODUCTION: Cervical artery dissections (CAD) are the leading cause of ischemic stroke (CVA) in young people. The risk factors for stroke and the temporal relationship with CAD are not well characterized. Nor do we have a clinical-radiological classification that allows knowing the risk of stroke. OBJECTIVE: To describe the associated factors and temporality of ACVi in patients with CAD. METHODS: We performed a prospective study that included patients over 18 years of age, hospitalized for carotid and/or vertebral CAD between August 2009 and June 2017. CAD cases were diagnosed clinically and radiologically; ACVi was diagnosed when the imaging study demonstrated infarction. The Borgess Classification was used to characterize the CAD radiologically. For correlation studies, we used univariate and multivariate logistic regression analyses. RESULTS: We analyzed 163 patients with 182 CAD (60% vertebral and 40% carotid). 28 of 68 patients (41.2%) simultaneously had symptoms of dissection and ischemia. 60 of 68 patients (88%) presented symptoms of ischemia during the first week. CAD: Borgess type IB (p = 0.001; OR: 4.1; CI: 1.8-9.3), male (p < 0.001; OR: 0.2; CI: 0.06- 0.8) were significantly associated with ischemic strokes and oral contraceptives (p = 0.02; OR: 0.2; CI: 0.06-0.8). CONCLUSION: Stroke associated with CAD has a relatively low frequency. It is not related to the type of dissected artery. It mainly occurs not simultaneously with CAD and within the first week. The main associated factor for developing a stroke is arterial occlusion (Borgess type IB).1,8-9,3), male sex (p < 0.001; OR: 0.2; CI: 0.06-0.8) and oral contraceptives (p = 0.02; OR: 0.2; CI: 0.06-0.8).
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Infarto Cerebral/etiología , Infarto Cerebral/diagnóstico por imagen , Disección de la Arteria Carótida Interna/complicaciones , Disección de la Arteria Carótida Interna/diagnóstico por imagen , Disección de la Arteria Vertebral/complicaciones , Disección de la Arteria Vertebral/diagnóstico por imagen , Factores de Tiempo , Factores Sexuales , Estudios Prospectivos , Factores de RiesgoRESUMEN
INTRODUCTION: Cervical artery dissections (CAD) are the leading cause of ischemic stroke (CVA) in young people. The risk factors for stroke and the temporal relationship with CAD are not well characterized. Nor do we have a clinical-radiological classification that allows knowing the risk of stroke. OBJECTIVE: To describe the associated factors and temporality of ACVi in patients with CAD. METHODS: We performed a prospective study that included patients over 18 years of age, hospitalized for carotid and/or vertebral CAD between August 2009 and June 2017. CAD cases were diagnosed clinically and radiologically; ACVi was diagnosed when the imaging study demonstrated infarction. The Borgess Classification was used to characterize the CAD radiologically. For correlation studies, we used univariate and multivariate logistic regression analyses. RESULTS: We analyzed 163 patients with 182 CAD (60% vertebral and 40% carotid). 28 of 68 patients (41.2%) simultaneously had symptoms of dissection and ischemia. 60 of 68 patients (88%) presented symptoms of ischemia during the first week. CAD: Borgess type IB (p = 0.001; OR: 4.1; CI: 1.8-9.3), male (p < 0.001; OR: 0.2; CI: 0.06- 0.8) were significantly associated with ischemic strokes and oral contraceptives (p = 0.02; OR: 0.2; CI: 0.06-0.8). CONCLUSION: Stroke associated with CAD has a relatively low frequency. It is not related to the type of dissected artery. It mainly occurs not simultaneously with CAD and within the first week. The main associated factor for developing a stroke is arterial occlusion (Borgess type IB).1,8-9,3), male sex (p < 0.001; OR: 0.2; CI: 0.06-0.8) and oral contraceptives (p = 0.02; OR: 0.2; CI: 0.06-0.8).
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Disección de la Arteria Carótida Interna , Infarto Cerebral , Disección de la Arteria Vertebral , Humanos , Masculino , Femenino , Factores de Riesgo , Estudios Prospectivos , Disección de la Arteria Vertebral/complicaciones , Disección de la Arteria Vertebral/diagnóstico por imagen , Persona de Mediana Edad , Adulto , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/etiología , Disección de la Arteria Carótida Interna/complicaciones , Disección de la Arteria Carótida Interna/diagnóstico por imagen , Factores de Tiempo , Factores Sexuales , AncianoAsunto(s)
Corea , Accidente Cerebrovascular , Infarto Cerebral/complicaciones , Infarto Cerebral/diagnóstico por imagen , Corea/diagnóstico por imagen , Corea/etiología , Humanos , Imagen por Resonancia Magnética , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagenRESUMEN
INTRODUCTION: Pseudobulbar palsy (PBP) is characterized by supranuclear lesions in the corticobulbar pathway. Neoplasia, inflammatory, demyelinating, and stroke are possible etiologies of this disorder. CASE REPORT: We report an elderly female who presented with dysarthria. She was dysarthric with a hypernasal voice, no apraxia or aphasia was observed. Tongue movements were slow with limited amplitude. Her soft palate dropped bilaterally; gag reflex was present. Also, she reported swallowing difficulty and choking with her saliva. Bilateral vertical and horizontal gaze were intact to either voluntary or oculocephalic movements. A cranial CT scan was suggestive of artery of Percheron (AOP) infarction. Brain magnetic resonance imaging showed hypersignal on diffusion-weighted and T2-weighted images and hyposignal on apparent diffusion coefficient in both thalami. CT angiography scan revealed an AOP originating from the left posterior cerebral artery. The swallowing study with a videofluoroscopic demonstrated oral and pharyngeal phases with severe dysfunction. CONCLUSION: To the authors' knowledge, there are two cases of individuals with artery of Percheron infarction who developed PBP associated with other clinical syndromes. Still, isolated PBP following infarction of Percheron's artery was not reported. We hypothesized that the PBP may have occurred because of the existence of vascular territory variations in the perforating arteries that arise from the AOP.
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Encéfalo/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética/métodos , Disartria/etiología , Infarto/diagnóstico por imagen , Parálisis Seudobulbar/complicaciones , Tálamo/diagnóstico por imagen , Anciano , Arterias/patología , Infarto Cerebral/complicaciones , Angiografía por Tomografía Computarizada , Femenino , Humanos , Infarto/complicaciones , Imagen por Resonancia Magnética , Neuroimagen/efectos adversos , Tálamo/irrigación sanguínea , Tálamo/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
Background: Movement disorders are an infrequent presentation to stroke, and in this context, negative myoclonus is not among the most common movement disorders, hence we present a case of negative myoclonus secondary to thalamic stroke. Case: A 75 year old male presented with left central facial palsy and negative myoclonus on his left upper limb. He was submitted to a diagnostic workup, with evidence of a right thalamic stroke. He was started on Phenobarbital 50 mg and the movement disorder resolved. Conclusion: Given the relevance of cerebrovascular disease as a cause of morbidity and mortality, it is important to the clinician to be aware of the less typical presentations such as the observed in our case, in order to provide adequate care to the patient.
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Trastornos del Movimiento , Mioclonía , Accidente Cerebrovascular , Anciano , Brazo , Infarto Cerebral/complicaciones , Infarto Cerebral/diagnóstico por imagen , Humanos , Masculino , Mioclonía/complicaciones , Mioclonía/tratamiento farmacológico , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagenAsunto(s)
Infecciones Relacionadas con Catéteres , Cardiopatías , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Diálisis Renal/efectos adversos , Trombosis , Ultrasonografía/métodos , Trombosis de la Vena , Adulto , Encéfalo/diagnóstico por imagen , Procedimientos Quirúrgicos Cardiovasculares/métodos , Infecciones Relacionadas con Catéteres/complicaciones , Infecciones Relacionadas con Catéteres/etiología , Infecciones Relacionadas con Catéteres/microbiología , Infarto Cerebral/diagnóstico por imagen , Drenaje/métodos , Femenino , Cardiopatías/diagnóstico , Cardiopatías/etiología , Humanos , Fallo Renal Crónico/terapia , Pruebas en el Punto de Atención , Diálisis Renal/instrumentación , Supuración , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Trombosis/fisiopatología , Trombosis/cirugía , Resultado del Tratamiento , Trombosis de la Vena/complicaciones , Trombosis de la Vena/etiologíaRESUMEN
Introducción: El método clínico por sí solo no es definitivo para diagnosticar una enfermedad cerebrovascular, por lo que es importante el uso de medios de diagnóstico imagenológicos como la tomografía axial computarizada, que permite investigar los aspectos morfológicos y funcionales del cerebro. Objetivo: Describir las características clínicas y tomográficas de pacientes con infarto cerebral. Métodos: Se efectuó un estudio descriptivo y transversal de 269 pacientes con infarto cerebral, atendidos en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero hasta diciembre de 2019. Resultados: Predominaron el sexo masculino (54,6 %), el grupo etario de 70-79 años, las afectaciones motoras (76,5 %), la alteración de la conciencia (51,3 %) y el trastorno del lenguaje (50,5 %). En 38 pacientes los resultados de la tomografía fueron negativos antes de las 24 horas de evolución y 64,0 % se consideraron mejorados con secuelas. Conclusiones: La tomografía antes de las 24 horas demuestra una baja positividad y los hallazgos evolucionan con el tiempo, aunque es posible reconocer varios signos precoces de ictus agudo en menos de 4-6 horas.
Introduction: The clinical method by itself is not definitive to diagnose a cerebrovascular disease, reason why the use of imaging diagnostic means, as the computerized axial tomography is important, as it allows to investigate the morphological and functional aspects of the brain. Objective: To describe the clinical and tomographic characteristics of patients with complete stroke. Methods: A descriptive and cross-sectional study of 269 patients with complete stroke, assisted in Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January to December, 2019. Results: There was a prevalence of the male sex (54.6 %), 70-79 age group, motor disorders (76.5 %), alteration of the conscience (51.3 %) and language disorder (50.5 %). In 38 patients the results of the tomography were negative before the 24 hours of clinical course and 64.0 % were better with aftereffects of the disease. Conclusions: Tomography before the 24 hours demonstrates a low positivity and findings have a favorable clinical course as time goes by, although it is possible to recognize several early signs of acute ictus in less than 4-6 hours.
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Encefalopatías , Infarto Cerebral/diagnóstico por imagen , Isquemia Encefálica/diagnóstico por imagen , Tomografía Computarizada EspiralRESUMEN
INTRODUCTION: Magnetic resonance diffusion tensor imaging through the fraction of anisotropy allows evaluation of the integrity of the motor pathways after cerebral infarction. AIMS: To correlate the fraction of anisotropy with the clinical scales and the prognosis of cerebral infarction. SUBJECTS AND METHODS: Prospective study of patients with cerebral infarction to compare the fraction of anisotropy in different regions of interest with functional evaluations and with controls free of infarction. A subgroup of subjects with rehabilitation underwent an initial MRI scan and another at three months, with clinical follow-up for six months. RESULTS: Thirty-eight consecutive patients with middle cerebral artery infarction were included. The fraction of anisotropy values were lower in the ipsilateral corticospinal pathway than the fraction of anisotropy of the corticospinal pathway of the controls. The values of the fraction of anisotropy in the ipsilateral corticospinal pathway were associated with the value of the functional scale on admission. Changes in the fraction of anisotropy values between the initial MRI and the scan performed at three months correlated with the score on the functional scale and the modified Rankin scale at three and six months. CONCLUSIONS: The value of the fraction of anisotropy in the ipsilateral internal capsule is associated with the presence of a lesion and with its presenting symptoms. Changes in the fraction of anisotropy at three months suggest long-term clinical recovery.
TITLE: Imagen del tensor de difusión de la vía corticoespinal y su asociación con el pronóstico del infarto cerebral agudo: experiencia de una cohorte en México.Introducción. La imagen del tensor de difusión por resonancia magnética a través de la fracción de anisotropía permite evaluar la integridad de las vías motoras después de un infarto cerebral. Objetivo. Correlacionar la fracción de anisotropía con las escalas clínicas y el pronóstico del infarto cerebral. Sujetos y métodos. Estudio prospectivo de pacientes con infarto cerebral para comparar la fracción de anisotropía en diferentes regiones de interés con evaluaciones funcionales y con controles sin infarto. En un subgrupo con rehabilitación, se realizó una resonancia magnética inicial y a los tres meses, con un seguimiento clínico durante seis meses. Resultados. Se incluyó a 38 pacientes consecutivos con infarto cerebral de la arteria cerebral media. Los valores de la fracción de anisotropía fueron menores en la vía corticoespinal ipsilateral que en la vía corticoespinal de los controles. Los valores de la fracción de anisotropía en la vía corticoespinal ipsilateral se asociaron con el valor de la escala funcional en el momento de su admisión. Los cambios en los valores de la fracción de anisotropía entre la resonancia magnética inicial y a los tres meses se correlacionaron con la puntuación en la escala funcional y en la escala de Rankin modificada a los tres y a los seis meses. Conclusiones. El valor de la fracción de anisotropía en la cápsula interna ipsilateral se asocia a la presencia de lesión y a su presentación clínica. Los cambios en la fracción de anisotropía a los tres meses sugieren la recuperación clínica a largo plazo.
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Infarto Cerebral/diagnóstico por imagen , Imagen de Difusión Tensora , Tractos Piramidales/diagnóstico por imagen , Enfermedad Aguda , Anciano , Anisotropía , Femenino , Humanos , Infarto de la Arteria Cerebral Media , Masculino , México , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
O infarto da artéria de Percheron é uma apresentação rara de acidente vascular cerebral, caracterizado principalmente por isquemia talâmica bilateral. A apresentação clinica desse infarto se apresenta de maneira inesperada e variável. Relata-se um caso de um paciente masculino, idoso, acometido por diversas comorbidades, admitido na emergência em coma e hemiplégico a direita, demonstrando acometimento neurológico. A condição clínica do paciente variou durante a hospitalização, apresentando melhora do quadro neurológico focal e midríase fixa à direita, levando a um diagnóstico tardio. Paciente evoluiu ao óbito devido a causas não neurológicas.
The artery of Percheron infarct is a rare presentation of stroke, featured mainly by thalamic bilateral ischemia. The clinical presentation of this infarct is unexpected and variable. It's reported a case of a male patient, elderly, affected with several comorbidities, admitted to the emergency in comatose state and right hemiplegic, proving neurological involvement. The patient's clinical condition has fluctuated throughout the hospitalization presenting improvement of the focal neurologic implication and right mydriasis, culminating in a lagged diagnosis. Patient's death due to non neurologic causes.
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Humanos , Masculino , Anciano , Infarto Cerebral/diagnóstico por imagen , Tálamo/irrigación sanguínea , Tálamo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Comorbilidad , Factores de Riesgo , Resultado FatalAsunto(s)
Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/etiología , Infecciones por Coronavirus/complicaciones , Coronavirus/aislamiento & purificación , Tos/etiología , Pandemias , Neumonía Viral/complicaciones , Tórax/diagnóstico por imagen , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Betacoronavirus , COVID-19 , Infarto Cerebral/tratamiento farmacológico , Imagen de Difusión por Resonancia Magnética , Enoxaparina/uso terapéutico , Humanos , Masculino , SARS-CoV-2 , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Objetivo: Caracterizar el comportamiento intrahospitalario del infarto cerebral cardioembólico.Métodos: Se realizó un estudio observacional, descriptivo, prospectivo, en el Hospital Militar Central Dr. Carlos J. Finlay, de enero de 2016 a diciembre de 2017, con 63 pacientes que padecían de infarto cerebral cardioembólico. Las variables analizadas fueron la edad, sexo, factores de riesgo vasculares, latencia al ingreso, gravedad del ictus,territorio vascular afectado, tamaño imagenológico del infarto cerebral, manejo terapéutico, complicaciones, estado al egreso, estadía hospitalaria y la escala de Barthel al egreso. Seempleó la estadística descriptiva; se obtuvieron las frecuencias absolutas y relativas de cada variable.Resultados: Predominó entre los factores de riesgo vascular el sexo masculino (52,4 Por ciento), los mayores de 70 años (63,8 Por ciento), la hipertensión arterial (87,3 Por ciento) y la fibrilación auricular no valvular (71,5 Por ciento). Fue más frecuente la atención tardía, la afectación del territorio carotideo, el tamaño mediano del infarto en la neuroimagen, el ictus leve, la estadíahospitalaria corta y las complicaciones no neurológicas. Más de la mitad recibió un tratamiento de inicio tardío con doble antiagregación y un 41 Por ciento no se anticoaguló al egreso hospitalario.Conclusiones: Predominaron los pacientes masculinos, mayores de 70 años, con fibrilación auricular no valvular, tanto crónica como aislada, y con insuficiencia cardiaca congestiva.La mayor parte de estos pacientes recibieron una atención hospitalaria tardía, por lo que se decidió una doble antiagregación plaquetaria en la fase aguda y la no anticoagulación almomento del egreso hospitalario(AU)
Objective: To characterize the in-hospital occurrence of cardioembolic cerebral infarction.Methods: An observational, descriptive, prospective study was carried out at Dr. Carlos J. Finlay Central Military Hospital from January 2016 to December 2017. Sixty-three patients suffering from cardioembolic stroke. The variables analyzed were age, sex, vascular riskfactors, latency at admission, stroke severity, affected vascular territory, imaging size of cerebral infarction, therapeutic management, complications, state at discharge, hospital stay and Barthel scale at discharge. Descriptive statistics was used and absolute and relative frequencies of each variable were obtained.Results: Among the vascular risk factors, the male sex (52.4 Per cent), those older than 70 years (63.8Per cent), hypertension (87.3 Per cent) and nonvalvular atrial fibrillation (71.5 Per cent) predominated. Late care, involvement of the carotid territory, median infarct size on neuroimaging, mild stroke, short in-hospital stay, and non-neurological complications were more frequent. More than half received late-onset dual antiplatelet therapy and 41 Per cent did not anticoagulate ondischarge from hospital.Conclusions: Male patients, older than 70 years, with non-valvular atrial fibrillation, both chronic and isolated, and with congestive heart failure predominated. Most of these patientsreceived late hospital care, so dual platelet antiaggregation was decided in the acute phase and non-anticoagulation at the time of hospital discharge(AU)
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Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Cuba/epidemiología , Infarto Cerebral/complicaciones , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/tratamiento farmacológico , Infarto Cerebral/etiología , Accidente Cerebrovascular/epidemiología , Factores de RiesgoRESUMEN
OBJECTIVE: Cerebral small vessel disease (cSVD) and large artery atherosclerosis (LAA) are related to different pathogenetic mechanisms. However, relationships between single biomarkers of cSVD and LAA affecting isolated vascular beds have been reported. Using the Atahualpa Project cohort, we aimed to assess the association between cSVD score categories and LAA burden in community-dwelling older adults. PATIENTS AND METHODS: Atahualpa individuals aged ≥60 years undergoing assessment of the cSVD score and LAA in the peripheral, carotid extracranial, and intracranial vascular beds (n = 333) were included. Multivariate models were fitted to assess independent associations between the cSVD score and LAA burden. RESULTS: The cSVD score was 0 points in 62 % individuals, 1 point in 19 %, 2 points in 13 %, and 3-4 points in 7 %. LAA involved the extracranial carotid bed in 43 % individuals, the intracranial bed in 36 %, and the peripheral bed in 20 %. One vascular bed was involved in 111 (33 %) individuals, two beds in 75 (23 %), and three beds in 23 (7 %). The remaining 124 (37 %) had no atherosclerosis. Ordinal logistic regression models showed progressively greater associations between higher categories of cSVD score and the odds of having more beds involved with LAA. Multinomial logistic regression models showed associations between categories of cSVD score and LAA burden, but only when two or three vascular beds were involved. CONCLUSION: This study demonstrates robust associations between the cSVD score and LAA, which become evident at the upper end of the spectrum of cSVD score (3-4 points) and LAA burden (2-3 vascular beds involved).
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Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico por imagen , Enfermedades de los Pequeños Vasos Cerebrales/epidemiología , Arteriosclerosis Intracraneal/diagnóstico por imagen , Arteriosclerosis Intracraneal/epidemiología , Anciano , Anciano de 80 o más Años , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/epidemiología , Circulación Cerebrovascular , Estudios de Cohortes , Costo de Enfermedad , Ecuador/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Vida Independiente , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Factores de Riesgo , UltrasonografíaRESUMEN
OBJECTIVES: Cerebral ischemia seriously threatens human health and is characterized by high rates of incidence, disability and death. Developing an ideal animal model of cerebral ischemia that reflects the human clinical features is critical for pathological studies and clinical research. The goal of this study is to establish a local cerebral ischemia model in rhesus macaque, thereby providing an optimal animal model to study cerebral ischemia. METHODS: Eight healthy rhesus monkeys were selected for this study. CT scans were performed before the operation to exclude cerebral vascular and intracranial lesions. Under guidance and monitoring with digital subtraction angiography (DSA), a microcatheter was inserted into the M1 segment of the middle cerebral artery (MCA) via the femoral artery. Then, autologous white thrombi were introduced to block blood flow. Immediately following embolization, multisequence MRI was used to monitor cerebrovascular and brain parenchymal conditions. Twenty-four hours after embolization, 2 monkeys were sacrificed and subjected to perfusion, fixation and pathological examination. RESULTS: The cerebral ischemia model was established in 7 rhesus monkeys; one animal died during intubation. DSA and magnetic resonance angiography (MRA) indicated the presence of an arterial occlusion. MRI showed acute local cerebral ischemia. HE staining revealed infarct lesions formed in the brain tissues, and thrombi were present in the cerebral artery. CONCLUSION: We established a rhesus macaque model of local cerebral ischemia by autologous thrombus placement. This model has important implications for basic and clinical research on cerebral ischemia. MRI and DSA can evaluate the models to ensure accuracy and effectiveness.
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Isquemia Encefálica/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Angiografía de Substracción Digital , Animales , China , Humanos , Macaca mulatta , Masculino , Modelos Biológicos , Modelos CardiovascularesRESUMEN
OBJECTIVE: To describe the sonographic characteristics of periventricular hemorrhagic infarction (PVHI) and their association with mortality and neurodevelopmental disability in very preterm infants born in 2008-2013. STUDY DESIGN: Retrospective multicenter observational cohort study. Diagonal PVHI size was measured and severity score assessed. PVHI characteristics were scored and temporal trends were assessed. Neurodevelopmental outcome at 2 years of corrected age was assessed using either the Bayley Scales of Infant and Toddler Development, Third Edition or the Griffiths Mental Development Scales. Multigroup analyses were applied as appropriate. RESULTS: We enrolled 160 infants with median gestational age of 26.6 weeks. PVHI was mostly unilateral (90%), associated with an ipsilateral grade III intraventricular hemorrhage (84%), and located in the parietal lobe (51%). Sixty-four (40%) infants with PVHI died in the neonatal period. Of the survivors assessed at 2 years of corrected age, 65% had normal cognitive and 69% had normal motor outcomes. The cerebral palsy rate was 42%. The composite outcome of death or severe neurodevelopmental disability was observed in 58%, with no trends over the study period (P = .6). Increasing PVHI severity score was associated with death (P < .001). Increasing PVHI size and severity score were negatively associated with gross motor scores (P = .01 and .03, respectively). Trigone involvement was associated with cerebral palsy (41% vs 14%; P = .004). Associated posthemorrhagic ventricular dilation (36%) was an independent risk factor for poorer cognitive and motor outcomes (P < .001 for both). CONCLUSIONS: Increasing PVHI size and severity score were predictive of less optimal gross motor outcome and death in very preterm infants.
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Hemorragia Cerebral/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Ventrículos Cerebrales/diagnóstico por imagen , Enfermedades del Prematuro/diagnóstico por imagen , Hemorragia Cerebral/mortalidad , Hemorragia Cerebral/patología , Infarto Cerebral/mortalidad , Infarto Cerebral/patología , Parálisis Cerebral/complicaciones , Ventrículos Cerebrales/patología , Preescolar , Discapacidades del Desarrollo/complicaciones , Discapacidades del Desarrollo/diagnóstico por imagen , Femenino , Edad Gestacional , Humanos , Lactante , Recien Nacido Extremadamente Prematuro , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/mortalidad , Enfermedades del Prematuro/patología , Masculino , Estudios Retrospectivos , UltrasonografíaRESUMEN
OBJECTIVES: Cerebral ischemia seriously threatens human health and is characterized by high rates of incidence, disability and death. Developing an ideal animal model of cerebral ischemia that reflects the human clinical features is critical for pathological studies and clinical research. The goal of this study is to establish a local cerebral ischemia model in rhesus macaque, thereby providing an optimal animal model to study cerebral ischemia. METHODS: Eight healthy rhesus monkeys were selected for this study. CT scans were performed before the operation to exclude cerebral vascular and intracranial lesions. Under guidance and monitoring with digital subtraction angiography (DSA), a microcatheter was inserted into the M1 segment of the middle cerebral artery (MCA) via the femoral artery. Then, autologous white thrombi were introduced to block blood flow. Immediately following embolization, multisequence MRI was used to monitor cerebrovascular and brain parenchymal conditions. Twenty-four hours after embolization, 2 monkeys were sacrificed and subjected to perfusion, fixation and pathological examination. RESULTS: The cerebral ischemia model was established in 7 rhesus monkeys; one animal died during intubation. DSA and magnetic resonance angiography (MRA) indicated the presence of an arterial occlusion. MRI showed acute local cerebral ischemia. HE staining revealed infarct lesions formed in the brain tissues, and thrombi were present in the cerebral artery. CONCLUSION: We established a rhesus macaque model of local cerebral ischemia by autologous thrombus placement. This model has important implications for basic and clinical research on cerebral ischemia. MRI and DSA can evaluate the models to ensure accuracy and effectiveness.
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Humanos , Animales , Masculino , Infarto Cerebral/diagnóstico por imagen , Isquemia Encefálica/diagnóstico por imagen , Angiografía de Substracción Digital , China , Macaca mulatta , Modelos Biológicos , Modelos CardiovascularesAsunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Trombectomía/métodos , Accidente Cerebrovascular/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto , Infarto Cerebral/complicaciones , Infarto Cerebral/diagnóstico por imagen , Estudios Multicéntricos como Asunto , Teorema de Bayes , Terapia Combinada , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/mortalidad , Hemorragias Intracraneales/etiología , Evaluación de la Discapacidad , Procedimientos Endovasculares , Fibrinolíticos/uso terapéutico , Tiempo de TratamientoRESUMEN
BACKGROUND: Cerebral autoregulation (CA) impairment after aneurysmal subarachnoid hemorrhage (SAH) has been associated with delayed cerebral ischemia and an unfavorable outcome. We investigated whether the early transient hyperemic response test (THRT), a transcranial Doppler (TCD)-based CA evaluation method, can predict functional outcome 6 months after aneurysmal SAH. METHODS: This is a prospective observational study of all aneurysmal SAH patients consecutively admitted to a single center between January 2016 and February 2017. CA was evaluated within 72 h of hemorrhage by THRT, which describes the changes in cerebral blood flow velocity after a brief compression of the ipsilateral common carotid artery. CA was considered to be preserved when an increase ≥ 9% of baseline systolic velocity was present. According to the modified Rankin Scale (mRS: 4-6), the primary outcome was unfavorable 6 months after hemorrhage. Secondary outcomes included cerebral infarction, vasospasm on TCD, and an unfavorable outcome at hospital discharge. RESULTS: Forty patients were included (mean age = 54 ± 12 years, 70% females). CA was impaired in 19 patients (47.5%) and preserved in 21 (52.5%). Impaired CA patients were older (59 ± 13 vs. 50 ± 9, p = 0.012), showed worse neurological conditions (Hunt&Hess 4 or 5-47.4% vs. 9.5%, p = 0.012), and clinical initial condition (APACHE II physiological score-12 [5.57-13] vs. 3.5 [3-5], p = 0.001). Fourteen patients in the impaired CA group and one patient in the preserved CA group progressed to an unfavorable outcome (73.7% vs. 4.7%, p = 0.0001). The impaired CA group more frequently developed cerebral infarction than the preserved CA group (36.8% vs. 0%, p = 0.003, respectively). After multivariate analysis, impaired CA (OR 5.15 95% CI 1.43-51.99, p = 0.033) and the APACHE II physiological score (OR 1.67, 95% CI 1.01-2.76, p = 0.046) were independently associated with an unfavorable outcome. CONCLUSIONS: Early CA impairment detected by TCD and admission APACHE II physiological score independently predicted an unfavorable outcome after SAH.
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Velocidad del Flujo Sanguíneo , Infarto Cerebral/epidemiología , Circulación Cerebrovascular , Hiperemia/diagnóstico por imagen , Arteria Cerebral Media/diagnóstico por imagen , Hemorragia Subaracnoidea/diagnóstico por imagen , APACHE , Adulto , Anciano , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/epidemiología , Infarto Cerebral/diagnóstico por imagen , Femenino , Homeostasis , Sistemas de Distribución en Hospital , Humanos , Modelos Logísticos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mortalidad , Análisis Multivariante , Rendimiento Físico Funcional , Pronóstico , Estudios Prospectivos , Hemorragia Subaracnoidea/epidemiología , Hemorragia Subaracnoidea/fisiopatología , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler Transcraneal , Vasoespasmo Intracraneal/diagnóstico por imagen , Vasoespasmo Intracraneal/epidemiologíaRESUMEN
BACKGROUND: Cerebral ptosis is understood as the bilateral paralysis of eyelid elevation linked to a stroke or hemorrhage of the middle cerebral artery (MCA). It is a transient condition, independent of the evolution of the lesion. AIM: To analyze six patients with the condition. PATIENTS AND METHODS: Report of five women and one male aged 42 to 72 years. RESULTS: All suffered an infarction or hemorrhage in the territory of the middle cerebral artery of the non-dominant hemisphere and developed a bilateral palpebral ptosis. The recovery started after the fourth day. At the tenth day, eye opening was effortless and did not require frontal help, despite the persistence of hemiplegia. CONCLUSIONS: Cerebral ptosis is a mimetic dysfunction of a specific non-injured area of the cerebral cortex, originated from a nearby parenchymal damage such as the middle cerebral artery of the same hemisphere. Cerebral ptosis expresses the inhibition of the voluntary eyelid elevation center, of prefrontal location in the non-dominant hemisphere.