RESUMO
La aterosclerosis ocupa la primera causa de muerte en Cuba y la enfermedad cerebro-vascular la tercera. Para valorar su comportamiento como causa básica de muerte y precisar calidad de diagnósticos premortem, se realizó un estudio descriptivo y retrospectivo de 2 868 autopsias con diagnóstico de aterosclerosis cerebral en el Hospital Militar Central Dr Carlos J Finlay, desde enero de 1999 hasta diciembre de 2002. Se estudiaron 206 casos en los que la aterosclerosis cerebral fue causa básica de muerte (53,9 por ciento del sexo femenino). El grupo de 65 a 84 años de edad fue mayoritario y el 81,1 por ciento falleció en salas de medicina intensiva. Infecciones, tumores malignos y daño multiorgánico constituyeron la principal morbilidad asociada. La discrepancia diagnóstica premortem y postmortem fue 28,3 por ciento en la causa directa de muerte y 27,4 por ciento en la básica. Se destacó la importancia del estudio multicausal de la muerte.
Atherosclerosis is the first cause of death in Cuba, whereas the cerebrovascular disease is the third. To assess its behaviour as a basic cause of death in Cuba, and to determine the quality of premortem diagnosis, a descriptive and retrospective study of 2 868 autopsies with diagnosis of cerebral atherosclerosis performed at Dr Carlos J. Finlay Military Central Hospital from January 1999 to December 2002, was conducted. 206 cases were studied in whom cerebral atherosclerosis was the main cause of death (53.9 percent were females). The age group 65-84 was the greatest. 81.1 percent died in intensive medicine wards. Infections, malignant tumors and multiple organ damage were the main associated morbidity. Premortem and postmortem diagnostic discrepancy was 28.3 percent in the direct cause of death, and 27.4 percent in the basic. The importance of the multicausal study of death was stressed.
Assuntos
Humanos , Adulto , Arteriosclerose Intracraniana/diagnóstico , Arteriosclerose Intracraniana/etiologia , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
BACKGROUND: Ethnic differences and vascular risk factors are the major determinants of stroke subtypes. Nevertheless, specific data from undeveloped countries is difficult to obtain. Natives from South America may have a higher frequency of penetrating small vessel disease and hemorrhagic stroke. However, there are few studies in South America supporting these findings. OBJECTIVE: We analyze demographic, ethnic, risk factors, clinical characteristics, and stroke subtypes in all patients with acute stroke admitted to our hospital. METHODS: We studied all consecutive acute stroke patients admitted to the Ramos Mejia Hospital in Buenos Aires from 1997 to 1999. Our hospital serves a determined population of Southern Buenos Aires. Data were collected prospectively on patients' admission in a form especially designed for this study including vascular risk factors, clinical features, epidemiological characteristics, and neuroradiological findings. Stroke subtypes were determined according to the TOAST classification. RESULTS: Among 361 acute stroke patients, 31% had hemorrhagic stroke. It was more frequent among Natives (34%) than Caucasians (27%) (P<0.002). Ischemic stroke subtypes were as follows: 105 (42%) patients had lacunar, 31 (12%) atherosclerotic stroke, 53 (21%) cardioembolic infarction, and 16 (6%) other causes of stroke. Forty-five (18%) patients were classified as undetermined. Small vessel disease was higher among Caucasians (35%) than Natives (24%). CONCLUSIONS: Penetrating artery disease (42%) and intracranial hemorrhage (31%) were the most common stroke subtypes, being more frequent than reported in the literature. Natives had significantly higher frequency of hemorrhagic stroke than Caucasians.
Assuntos
Países em Desenvolvimento , Acidente Vascular Cerebral/etnologia , População Urbana/estatística & dados numéricos , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Ásia/etnologia , Hemorragia Cerebral/etnologia , Hemorragia Cerebral/etiologia , Infarto Cerebral/etnologia , Infarto Cerebral/etiologia , Comparação Transcultural , Estudos Transversais , Feminino , Hospitais Comunitários , Humanos , Indígenas Sul-Americanos , Arteriosclerose Intracraniana/etnologia , Arteriosclerose Intracraniana/etiologia , Embolia Intracraniana/etnologia , Embolia Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/etiologia , População BrancaRESUMO
LP(a) lipoprotein, discovered by Berg, appears as an independent risk factor for atherogenesis with a weight similar to that of the total to HDL cholesterol ratio. It is probably synthesized in the liver and its metabolism is similar to that of LDL; however degradation is preferential mediated by monocytes and macrophages. It is structurally related to plasminogen and may interfere with fibrinolysis. In vitro, its atherogenic power surpasses that of LDL. Elevated levels of LP(a) are inherited as an autosomic codominant trait. Increased atherogenic risk, both at coronary and cerebrovascular sites, is associated to plasma LP(a) levels in excess of 20 mg/dl. Its plasma level increases during pregnancy, after menopause, with renal failure and in decompensated insulin dependent diabetes. Plasma levels are decreased by stanozolol and chronic alcoholism. Diet therapy is of no value for control of high LP(a) levels; only neomycin associated to nicotinic acid has proven effective.
Assuntos
Arteriosclerose/etiologia , Lipoproteínas/metabolismo , Doença da Artéria Coronariana/etiologia , Humanos , Arteriosclerose Intracraniana/etiologia , Lipoproteína(a) , Lipoproteínas/sangue , Fatores de RiscoRESUMO
Los estudios de prevalencia de Macroangiopatía en los diabéticos dan cifras diferentes y lo mismo los factores de riesgo que pudieran tener relación con ella. Se estudian ambos aspectos en 204 pacientes cuyas características son: Edad: x 58,4 ñ 12,7 años, son mujeres el 67,2%; la duración es de 11,7 ñ 6,3 años, son tipo 2 el 89,2%, se tratan con Hipoglicemiantes orales el 53,9% con Insulina el 42,7% y con regimen el 3,4%. En estas condiciones fueron la Glicemia: x de 194,8 ñ 51,3 mg.; el Colesterol: x 208 ñ 52 mg. y los Triglicéridos: x 113 mg. Son Hipertensos el 40,7%. Son portadores de Macroangiopatía 63 pacientes (30,9%), con ATE coronaria 50 pacientes (24,5%), ATE de extremidades inferiores 23 pacientes (11,3%) y ATE vascular encefálica 7 pacientes (3,4%). Los factores de riesgo que tienen relación significativa con la Macroangiopatía fueron la edad, el tipo de Diabetes, estando esta complicación prácticamente sólo en pacientes Tipo 2, el Colesterol sérico y la Hipertensión. Las cifras obtenidad se comparan con las de la literatura estudiada y son similares. Con respecto a los factores de riesgo son los mismos y no se evidencia relaciones con la Glicemia ni la duración de la Diabetes
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Angiopatias Diabéticas/epidemiologia , Arteriosclerose Obliterante/etiologia , Doença da Artéria Coronariana/etiologia , Arteriosclerose Intracraniana/etiologia , Colesterol , Fatores de Risco , Diabetes Mellitus/complicações , Hiperlipidemias , Perna (Membro)/fisiopatologia , Hipertensão/diagnóstico , Triglicerídeos/sangueRESUMO
A encefalopatia subcortical arteriosclerótica de Binswanger constitui forma especial de demência associada à hipertensäo arterial sistêmica, caracterizada por processo arterosclerótico pronunciado nos vasos da substância branca subcortical, poupando o córtex. Com a devida valorizaçäo do quadro clínico e sobretudo a utilizaçäo da tomografia computadorizada cerebral, é possível o diagnóstico em vida. Relatamos três casos que apresentavam, como características principais: presença de hipertensäo arterial sistêmica, início de instalaçäo da doença entre 50 e 70 anos, evoluçäo subaguda, comprometimendo mental predominante, com probreza de sinais neurológicos e sobretudo tomografia computadorizada cerebral característica, com hipodensidade subcortical bilateral e simétrica. Em um dos pacientes, que faleceu, foi realizada arteriografia cerebral. Esta evidenciou trombose na artéria carótida interna e probreza de circulaçäo no território das artérias tálamo-estriadas bilateralmente, principalmente à direita. Os outros dois pacientes, encontram-se sob acompanhamento ambulatorial, fazendo uso de anti-hipertensivos, evoluindo aparentemente com estabilizaçäo do quadro neurológico. Apesar de se conseguir identificaçäo bem definida desta doença com características clínicas, tomográficas e etiopatogênicas próprias, ainda ela continua a ser pouco relatada. Seu diagnóstico deve ser considerado com maior freqüência porque, apesar de näo existir tratamento efetivo até o momento, é possível tentar sua prevençäo mediante controle adequado de hipertensäo arterial sistêmica, fator este que parece estar intimamente ligado à sua gênese