RESUMO
Matrix metalloproteinase-9 (MMP-9) is a possible marker for acute ischemic stroke (AIS). In animal models of cerebral ischemia, MMP expression was significantly increased and was related to blood-brain barrier disruption, vasogenic edema formation, and hemorrhagic transformation. The definition of the exact role of MMPs after ischemic stroke will have important diagnostic implications for stroke and for the development of therapeutic strategies aimed at modulating MMPs. The objectives of the present study were to determine (1) whether MMP-9 is a possible marker for AIS; (2) whether MMP-9 levels correlate with infarct volume, stroke severity, or functional outcome; and (3) whether MMP-9 levels correlate with the development of hemorrhagic transformation after tissue plasminogen activator (t-PA) administration. The literature was searched using MEDLINE and EMBASE with no year restriction. All relevant reports were included. A total of 22 studies (3,289 patients) satisfied the inclusion criteria. Our review revealed that higher MMP-9 values were significantly correlated with larger infarct volume, severity of stroke, and worse functional outcome. There were significant differences in MMP-9 levels between patients with AIS and healthy control subjects. Moreover, MMP-9 was a predictor of the development of intracerebral hemorrhage in patients treated with thrombolytic therapy. MMP-9 level was significantly increased after stroke onset, with the level correlating with infarct volume, stroke severity, and functional outcome. MMP-9 is a possible marker for ongoing brain ischemia, as well as a predictor of hemorrhage in patients treated with t-PA.
Assuntos
Biomarcadores/sangue , Isquemia Encefálica/sangue , Metaloproteinase 9 da Matriz/sangue , Acidente Vascular Cerebral/sangue , Isquemia Encefálica/complicações , Estudos de Casos e Controles , Hemorragia Cerebral/epidemiologia , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática , Humanos , Ativadores de Plasminogênio/efeitos adversos , Ativadores de Plasminogênio/uso terapêutico , Valor Preditivo dos Testes , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Acidente Vascular Cerebral/etiologia , Resultado do TratamentoRESUMO
El manejo de los pacientes con accidente isquémico transitorio (AIT) en los servicios de urgencia es muy variable, en algunas instituciones todos los pacientes son admitidos al hospital para su evaluación y tratamiento, y en otras se recomienda efectuar la evaluación en el ámbito ambulatorio. Definir el pronóstico a corto plazo y los factores de riesgo para desarrollar un accidente vascular encefálico después de un episodio de AIT nos permite identificar a los grupos de riesgo que necesitan ser admitidos al hospital porque requieren monitorización y evaluación inmediata. En la última década, el manejo de los pacientes con AIT ha sufrido cambios significativos que los médicos de los servicios de urgencia deben conocer e incorporar en sus protocolos de atención. En esta revisión se han actualizado algunos conceptos sobre tópicos específicos relacionados con el manejo de urgencia de pacientes con AIT: 1) La definición de AIT ha sido modificada, 2) Criterios diagnósticos de AIT, 3) Evaluación diagnóstica y tratamiento recomendado para el paciente con AIT, 4) Evaluación de los factores de riesgo que permiten orientar el lugar de manejo y el estudio de los enfermos. Para ilustrar el problema, se presenta el caso clínico de un paciente que consultó en el servicio de urgencia por síntomas neurológicos transitorios que no estaban presentes en el momento de la consulta.
Management of patients with acute transient ischemic attack (TIA) varies widely, with some institutions admitting all patients and others proceeding with outpatient evaluations. Defining the short-term prognosis and risk factors for stroke after TIA may provide guidance in determining which patients need rapid evaluation. In the past few years, the approach to patients with transient ischemic attacks has undergone a transformation. To care for these patients, emergency physicians must understand these changes. They must be comfortable with the diagnosis and treatment of transient ischemic attacks in their emergency department. To this end, we ask and answer the following important questions in this up-to-date review of transient ischemic attacks: 1) How is a transient ischemic attack defined?, 2) Does this patient have a transient ischemic attack?, 3) Once diagnosed, what diagnostic evaluation should be done (and when)?, 4) What treatment should be instituted (and when)? and 5) What is the correct disposition? We submit a case report of a patient who presented to the emergency physician completely asymptomatic with complaints of transient neurologic symptoms.