RESUMO
BACKGROUND: The only effective therapy for the treatment of acute ischemic stroke is the infusion of tissue plasminogen activator in the first three hours after the onset of symptoms. AIM: To report the experience with tissue plasminogen activator infusion in the treatment of acute ischemic stroke. PATIENTS AND METHODS: Ten males and 10 females, aged 52 to 85 years old with an acute ischemic stroke, admitted within 89 min after the onset of symptoms were studied. Tissue plasminogen activator was infused following the guidelines designed by the National Institute of Neurological Disorders and Stroke (NINDS). Patients were assessed according to Rankin scale after three months of follow up. RESULTS: All patients had normal CAT scans. The delay between the onset of symptoms and the infusion ranged from 75 to 180 min. One patient had a gastrointestinal bleeding due to a gastric ulcer and one patient had a fatal intracranial hemorrhage. After three months of follow up, 38% of patients had a good recuperation (Rankin 0 to 1), 33% had a mild to moderate disability (Rankin 2 or 3) and 14% had a moderate to severe disability (Rankin 4). There was a 15% mortality. CONCLUSIONS: This series show that treatment of acute ischemic stroke with tissue plasminogen activator is feasible and safe. The obtained results are similar to those reported abroad.
Assuntos
Infarto Cerebral/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Ativador de Plasminogênio Tecidual/uso terapêutico , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: It has been postulated that in Chile, transient ischemic attacks (TIA) are much less frequent than in Caucasian populations. A lesser frequency of these attacks would be due to a higher frequency of intracranial atheromas, whereas an abundance of TIA would be a result of a higher prevalence of extracranial atheromas. AIM: To study the history of TIA in a group of Chilean patients with an acute episode of cerebrovascular disease. PATIENTS AND METHODS: One hundred forty nine patients admitted to a Neurology service of a public hospital in Santiago, with an acute stroke, were studied. Patients and close relatives were interrogated about previous symptoms of TIA using a structured questionnaire. RESULTS: One hundred nine patients had an ischemic and 40 patients a hemorrhagic stroke. Twenty patients with ischemic stroke had a history of TIA (18%). Fifteen out of 74 patients without a cardiac source of emboli (20%) and five out of 35 cases with an embolic source (14%) had a TIA preceding their stroke. Three out of 40 patients (8%) with hemorrhagic stroke had a history of TIA. CONCLUSIONS: This study does not support nor reject the hypothesis of a Chilean pattern of cerebrovascular disease unlike that found in Northern Caucasians.
Assuntos
Transtornos Cerebrovasculares/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
The level of knowledge of clinical and legal aspects of brain death criteria was tested in 25 neurologists and 15 neurosurgeons. The answers were wrong or the questionnaire had not been responded in 36.9% of the cases. The highest percentage of mistakes concerned the apnea test and what Chilean law said regarding brain death. No differences were found between neurologists and neurosurgeons. Physicians with less than 10 years were better informed than those with more than 10 years of medical practice (p < 0.005). Although brain death as a criterion of death is accepted by Chilean law in order to donate organs for transplantation, a considerable percentage of physicians (30%) rejected this concept. The significant lack of knowledge found in this study may suggest that brain death diagnosis is being inadequately performed in many cases. This fact raises important medical, ethical and legal considerations.
Assuntos
Morte Encefálica/diagnóstico , Competência Profissional , Morte Encefálica/legislação & jurisprudência , Chile , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Neurologia/legislação & jurisprudência , Neurocirurgia/legislação & jurisprudência , Inquéritos e QuestionáriosRESUMO
A 49 year old woman with a fluctuating painful ophthalmoplegia and a history of polyarthralgia is reported. On examination, additional findings included a maxillary subcutaneous infiltration, sphenoidal sinusitis and pulmonary nodes. Lung and sinus biopsy demonstrated findings compatible with lymphomatoid granulomatosis. The patient was treated with prednisone and cyclophosphamide, with good response of neurological and dermatological findings.