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Introducción: Si bien la primera causa de crisis epilépticas en la población adulta mayor es el accidente cerebrovascular, un importante diagnóstico diferencial corresponde al limb shaking syndrome, una manifestación clínica particular de un accidente isquémico transitorio. Caso clínico: Se describe entonces el caso de un hombre chileno de 62 años de edad que sufre una crisis focal motora sin alteración de conciencia con evidencia imagenológica de injuria isquémica de unos 10 días de antigüedad y de estenosis carotídea significativa, la cual es manejada quirúrgicamente. Discusión: Existen diferentes elementos que pueden distinguir una crisis epiléptica de un limb shaking sryndrome. La fisiopatología de la primera corresponde un fenómeno irritativo post isquémico con una clara manifestación electroencefalográfica, mientras que la segunda es producida por hipoperfusión relativa gatillada por ortostatismo en el contexto de una enfermedad carotídea oclusiva. El cuadro clínico del paciente se consideró más compatible con una crisis epiléptica que con un limb shaking syndrome.

Introduction: Although the leading cause of seizures in the older adult population is cerebrovascular accident, limb shaking syndrome is an important differential diagnosis, being a particular clinical manifestation of a transient ischemic attack. Clinical case: We thus describe a clinical case of a 62-year-old Chilean man who suffers a simple focal motor epileptic seizure, with imaging evidence of ischemic injury about 10 days old and significant carotid stenosis which is managed surgically. Discussion: There are different elements that can distinguish an epileptic seizure from a limb shaking syndrome. The pathophysiology of the first corresponds to a post-ischemic irritative phenomenon with a clear electroencephalographic manifestation, while the second is produced by relative hypoperfusion triggered by orthostatism in the context of carotid occlusive disease. The patient's clinical picture was considered more compatible with an epileptic seizure than with a limb shaking syndrome syndrome.

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Baroreflex and chemoreflex act through the autonomic nervous system, which is involved with the neural regulation of inflammation. The present study reports the effects of reflex physiological sympathetic activation in endotoxemic rats using bilateral carotid occlusion (BCO), a physiological approach involving the baroreflex and chemoreflex mechanisms and the influence of the baroreceptors and peripheral chemoreceptors in the cardiovascular and systemic inflammatory responses. After lipopolysaccharide (LPS) administration, the arterial pressure was recorded during 360 min in unanesthetized rats, and serial blood samples were collected to analyze the plasma cytokine levels. BCO elicited the reflex activation of the sympathetic nervous system, providing the following outcomes: (I) increased the power of the low-frequency band in the spectrum of the systolic arterial pressure during the BCO period; (II) reduced the levels of pro-inflammatory cytokines in plasma, including the tumor necrosis factor (TNF) and the interleukin (IL)-1ß; (III) increased the plasma levels of anti-inflammatory cytokine IL-10, 90 min after LPS administration. Moreover, selective baroreceptor or chemoreceptor denervation deactivated mechanosensitive and chemical sensors, respectively, and decreased the release of the LPS-induced cytokine but did not alter the BCO modulatory effects. These results show, for the first time, that physiological reflex activation of the sympathetic circuit decreases the inflammatory response in endotoxemic rats and suggest a novel function for the baroreceptors as immunosensors during the systemic inflammation.

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The goal of this work is to assess the impact of vascular anatomy definition degree in the predictions of blood flow models of the arterial network. To this end, results obtained with an anatomically detailed network containing over 2000 vessels are systematically compared with those obtained with an anatomically simplified network containing the main 86 vessels, the latter being a truncated version of the former one. The comparison is performed quantitatively and qualitatively in terms of pressure and flow rate waveforms, wave intensity analysis and impedance analysis. Comparisons are performed under physiological conditions and for the case of common carotid artery occlusion. Mechanisms of blood flow delivery to the brain, as well as different blood flow steal phenomena, are unveiled in light of model predictions. Results show that detailed and simplified models are in reasonable agreement regarding the hemodynamics in larger vessels and in healthy scenarios. The anatomically detailed arterial network features improved predictive capabilities at peripheral vessels. Moreover, discrepancies between models are substantially accentuated in the case of anatomical variations or abnormal hemodynamic conditions. We conclude that physiologically meaningful agreement between models is obtained for normal hemodynamic conditions. This agreement rapidly deteriorates for abnormal blood flow conditions such as those caused by total arterial occlusion. Differences are even larger when modifications of the vascular anatomy are considered. This rational comparison allows us to gain insight into the need for anatomically detailed arterial networks when addressing complex hemodynamic interactions.

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Abstract Trichilia catigua A. Juss., Meliaceae, known as "catuaba" in Brazil, has been popularly used as a tonic for fatigue, impotence and memory deficits. Previously, we have demonstrated that T. catigua ethyl-acetate fraction exerted antidepressive-like effects in mice. Affective-like symptoms are also well recognized outcome of cerebral ischemia in clinical and preclinical settings. Therefore, here we evaluated the effects of ethyl-acetate fraction on the emotional outcomes and its relation with hippocampal neurogenesis in ischemic mice. Male Swiss mice were subject to the bilateral common carotid occlusion during 20 min. The animals received ethyl-acetate fraction (400 mg/kg, orally) 30 min before and once per day during 7 days after reperfusion. Emotional outcomes were assessed using the open field test, elevated zero maze, and the tail suspension test. After the behavioral testing, the animals were sacrificed and their brains were processed to immunohistochemistry and Nissl staining. Ischemic mice exhibited anxiogenic-like behaviors in the elevated zero maze, hippocampal neurodegeneration and decreased hippocampal neurogenesis. The anxiogenic-like effect was counteracted by ethyl-acetate fraction administration. Furthermore, ethyl-acetate fraction restored the number of newborn neurons in the dentate gyrus of hippocampus of ischemic mice. In conclusion, T. catigua ethyl-acetate fraction promoted functional recovery and restored hippocampal neurogenesis in ischemic mice.

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La oclusión de la arteria carotidea interna no es infrecuente, típicamente su evolución impide la endarterectomía debido a que el trombo se extiende hasta el origen de la arteria oftálmica y hace inadecuada su reconstrucción. La carótida interna solo emite ramas intracraneales, pero extraordinariamente, existe una rama extracraneal de la carótida interna que mantiene el flujo distal a la oclusión y hace viable la revascularización como en el caso que se describe a continuación. Se trata de un paciente masculino, blanco, de 67 años de edad, fumador inveterado con antecedentes de dislipidemia. Acude por presentar disminución de la visión del ojo izquierdo acompañado de cuadros vertiginosos. Con el ultrasonido vascular y la angiotomografía computarizada se comprobó la oclusión de la emergencia de la carótida interna izquierda, con recanalización distal y presencia de vaso colateral anómalo. Se realizó endarterectomía carotidea y restitución del flujo a la carótida interna con preservación del vaso anómalo. El paciente evolucionó de forma satisfactoria. El conocimiento de las variantes anatómicas y una técnica cuidadosa permiten alcanzar buenos resultados en la cirugía de la oclusión carotidea(AU)

Occlusion of internal carotid artery is not uncommon; its progression frequently hinders endarterectomy because the thrombus extends into the origin of the ophthalmic artery, making the carotid artery inadequate for reconstruction. The internal carotid only emits intracranial branches, but exceptionally, there is an extracranial branch of the internal carotid that keeps the distal flow to the occlusion and makes the revascularization viable as it occurs in the case described here. This is a 67 years old Caucasian male patient, heavy smoker with a history of dyslipidemia. He went to the doctors because of decreased vision in his left eye and dizzy changes. Vascular US and angiotomography showed occlusion of left internal carotid artery, with distal recanalization and presence of collateral anomalous vessel. The treatment consisted of carotid endarterectomy and reestablishment of the flow to the left internal carotid with preservation of the anomalous collateral vessel with satisfactory recovery. The knowledge of the anatomical variations and a careful surgical technique allow reaching good results in carotid occlusion surgery(AU)

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La oclusión de la arteria carotidea interna no es infrecuente, típicamente su evolución impide la endarterectomía debido a que el trombo se extiende hasta el origen de la arteria oftálmica y hace inadecuada su reconstrucción. La carótida interna solo emite ramas intracraneales, pero extraordinariamente, existe una rama extracraneal de la carótida interna que mantiene el flujo distal a la oclusión y hace viable la revascularización como en el caso que se describe a continuación. Se trata de un paciente masculino, blanco, de 67 años de edad, fumador inveterado con antecedentes de dislipidemia. Acude por presentar disminución de la visión del ojo izquierdo acompañado de cuadros vertiginosos. Con el ultrasonido vascular y la angiotomografía computarizada se comprobó la oclusión de la emergencia de la carótida interna izquierda, con recanalización distal y presencia de vaso colateral anómalo. Se realizó endarterectomía carotidea y restitución del flujo a la carótida interna con preservación del vaso anómalo. El paciente evolucionó de forma satisfactoria. El conocimiento de las variantes anatómicas y una técnica cuidadosa permiten alcanzar buenos resultados en la cirugía de la oclusión carotidea(AU)

Occlusion of internal carotid artery is not uncommon; its progression frequently hinders endarterectomy because the thrombus extends into the origin of the ophthalmic artery, making the carotid artery inadequate for reconstruction. The internal carotid only emits intracranial branches, but exceptionally, there is an extracranial branch of the internal carotid that keeps the distal flow to the occlusion and makes the revascularization viable as it occurs in the case described here. This is a 67 years old Caucasian male patient, heavy smoker with a history of dyslipidemia. He went to the doctors because of decreased vision in his left eye and dizzy changes. Vascular US and angiotomography showed occlusion of left internal carotid artery, with distal recanalization and presence of collateral anomalous vessel. The treatment consisted of carotid endarterectomy and reestablishment of the flow to the left internal carotid with preservation of the anomalous collateral vessel with satisfactory recovery. The knowledge of the anatomical variations and a careful surgical technique allow reaching good results in carotid occlusion surgery(AU)

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ETHNOPHARMACOLOGICAL RELEVANCE: Trichilia catigua preparations have antinociceptive, antiinflammatory, and neuroprotective activity. Recently, a neuroprotective role for T. catigua was proposed using an in vitro model of ischemia-reperfusion in rat hippocampal slices. The aim of the present study was to evaluate the effects of an ethyl-acetate fraction (EAF) of T. catigua, which has potent antioxidant activity, in mice subjected to an in vivo model of cerebral ischemia. MATERIAL AND METHODS: Male Swiss mice were subject to the bilateral common carotid occlusion (BCCAO) model of cerebral ischemia. The animals were orally administered the T. catigua EAF (200, 400, or 800 mg/kg) 30 min before and once per day for 7 days after BCCAO. Histological and behavioral outcomes were assessed using Nissl staining and the Morris water maze test of cognition, respectively. RESULTS: Mice that were subjected to BCCAO exhibited cognitive impairments in the Morris water maze. The spatial cognitive deficits were counteracted by T. catigua EAF administration (200-800 mg/kg). The T. catigua EAF significantly increased the number of intact-appearing Nissl-stained cells in the hippocampus in BCCAO mice. CONCLUSIONS: These results show that the T. catigua EAF promoted functional recovery, decreased the delayed hippocampal cell loss, and mitigated the ongoing neurodegenerative processes induced by BCCAO in mice.

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