RESUMEN
Calcitonin gene-related peptide (CGRP) is involved in nociception and neurogenic inflammation in migraine, but also serves as a potent vasodilator acting on intracranial arteries. This latter effect raises concern about the possibility of drugs inhibiting CGRP precipitating cerebral ischemia. We describe a 41-year-old woman with migraine without aura who developed a right thalamic infarction following a first dose of erenumab, a CGRP-receptor blocker. Stroke onset occurred during a typical migraine. Imaging demonsrated right posterior cerebral artery near-occlusion initially with normalization of the vessel at follow-up imaging 2 months later, suggesting vasospasm as a possible mechanism. Extensive evaluation revealed no other specific cause of stroke or vascular risk factors aside from long-term use of oral contraceptive pills. CGRP inhibitors might be associated with ischemic stroke due to blockade of normal cerebral vasodilatory regulatory function.
Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antagonistas del Receptor Peptídico Relacionado con el Gen de la Calcitonina/efectos adversos , Infarto de la Arteria Cerebral Posterior/inducido químicamente , Migraña sin Aura/tratamiento farmacológico , Arteria Cerebral Posterior/efectos de los fármacos , Vasoespasmo Intracraneal/inducido químicamente , Adulto , Femenino , Humanos , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Infarto de la Arteria Cerebral Posterior/tratamiento farmacológico , Infarto de la Arteria Cerebral Posterior/fisiopatología , Migraña sin Aura/diagnóstico , Arteria Cerebral Posterior/diagnóstico por imagen , Arteria Cerebral Posterior/fisiopatología , Terapia Trombolítica , Resultado del Tratamiento , Grado de Desobstrucción Vascular/efectos de los fármacos , Vasoespasmo Intracraneal/diagnóstico por imagen , Vasoespasmo Intracraneal/tratamiento farmacológico , Vasoespasmo Intracraneal/fisiopatologíaRESUMEN
Models of ischemic brain injury in the nonhuman primate (NHP) are advantageous for investigating mechanisms of central nervous system (CNS) injuries and testing of new therapeutic strategies. However, issues of reproducibility and survivability persist in NHP models of CNS injuries. Furthermore, there are currently no pediatric NHP models of ischemic brain injury. Therefore, we have developed a NHP model of cortical focal ischemia that is highly reproducible throughout life to enable better understanding of downstream consequences of injury. Posterior cerebral arterial occlusion was induced through intracortical injections of endothelin-1 in adult (n = 5) and neonatal (n = 3) marmosets, followed by magnetic resonance imaging (MRI), histology and immunohistochemistry. MRI revealed tissue hyperintensity at the lesion site at 1-7 days followed by isointensity at 14-21 days. Peripheral macrophage and serum albumin infiltration was detected at 1 day, persisting at 21 days. The proportional loss of total V1 as a result of infarction was consistent in adults and neonates. Minor hemorrhagic transformation was detected at 21 days at the lesion core, while neovascularization was detected in neonates, but not in adults. We have developed a highly reproducible and survivable model of focal ischemia in the adult and neonatal marmoset primary visual cortex, demonstrating similar downstream anatomical and cellular pathology to those observed in post-ischemic humans.
Asunto(s)
Modelos Animales de Enfermedad , Infarto de la Arteria Cerebral Posterior/patología , Corteza Visual/patología , Factores de Edad , Animales , Animales Recién Nacidos , Barrera Hematoencefálica/metabolismo , Barrera Hematoencefálica/patología , Callithrix , Endotelina-1/toxicidad , Infarto de la Arteria Cerebral Posterior/inducido químicamente , Reproducibilidad de los ResultadosRESUMEN
El uso del cannabis es un hábito muy extendido entre los jóvenes de las sociedades desarrolladas, y sin embargo sólo se han documentando 20 casos de ictus por consumo de cannabis. Las dificultades diagnósticas derivadas del uso de otras drogas y de la falta de especificidad clínica justifican el estudio de nuevos casos control. Un varón de 19 años acude a Urgencias por cefalea holocraneal y pérdida de fuerza en el hemicuerpo izquierdo después del consumo de cannabis. El TAC cerebral fue normal, y la RNM cerebral evidenció un infarto isquémico en la arteria cerebral posterior. En sangre y orina se detectó cannabis. A los catorce días se le dio el alta sin déficits neurológicos. Las características más relevantes de este caso incluyen: 1) diagnóstico etiológico nítido, por el consumo exclusivo de cannabis, 2) clínica inicial de migraña acompañada con TAC cerebral normal y 3) recuperación clínica total (AU)
Cannabis use is a widespread habit among the youth from well developed societies, however only 20 cases dealing with cannabis and stroke have been reported. Due to diagnostic difficulties linked to concomitant drug abuses and the lack of specific symptoms new cases should be studied. A 19-year-old male came to the Emergency Service reporting severe cephalgia and impairment in the left hemibody strenght after cannabis use. Brain CT was normal and the MRI revealed an ischemic infarct in the porterior cerebral artery. Cannabis was detected in the blood and in the urine analysis. After 14 days no neurologic deficits were found in the examination and the patient left the hospital. The most relevant issues in this case are: 1) clear etiologic diagnosis related to cannabis use, 2) initial migraine presentation with normal findings in the CT and 3) complete recovery (AU)