Embolic stroke of undetermined source: potential etiology and secondary prevention / 国际脑血管病杂志

The source of the emboli of embolic stroke of undetermined source (ESUS) is still unclear, and the effect of antithrombotic therapy is also different. The recurrence rate of stroke in patients with ESUS is higher, and antiplatelet therapy is still a commonly used secondary prevention scheme. This article reviews the potential causes, pathogenesis and secondary prevention of ESUS.

Early and late interventional embolization can improve neurological function, mental state and living ability of patients with intracranial aneurysm / 中国基层医药

Objective:To investigate the application value of early and late interventional embolization in intracranial aneurysms.Methods:Eighty-two patients with intracranial aneurysm who received treatment in Wenzhou People's Hospital from October 2015 to February 2020 were included in this study. These patients were divided into early (≤ 3 days) and late (> 3 days) groups, with 41 patients in each group, according to time from disease onset to surgery. The early group was subjected to early interventional embolization, and the late group was treated with late interventional embolization. The effects of embolization and National Institutes of Health Stroke Scale score pre- and post-treatment, as well as modified Barthel index, Mini-Mental State Exam score, matrix metalloproteinase-9 level, and soluble intercellular adhesion molecule-1 level post-treatment and prognosis were compared between the two groups.Results:The embolization effects in the early group were statistically superior to those in the late group ( P = 0.046). After treatment, National Institutes of Health Stroke Scale score in the early group was significantly lower than that in the late group [(4.02 ± 1.64) points vs. (6.81 ± 2.02) points, t = 6.86, P < 0.01]. Mini-Mental State Exam score and modified Barthel index in the early group were (28.09 ± 1.35) points and (81.12 ± 9.67) points, respectively, which were significantly higher than (26.01 ± 1.19) points and (73.02 ± 8.19) points in the late group ( t = 7.40, 4.09, both P < 0.001). After treatment, matrix metalloproteinase-9 and soluble intercellular adhesion molecule-1 levels in the early group were (420.33 ± 29.40) μg/L and (403.70 ± 23.28) ug/L, respectively, which were significantly lower than (491.30 ± 31.19) μg/mL and (496.37 ± 30.46) μg/L in the late group ( t = 10.60, 15.47, both P < 0.001). Prognosis in the early group was superior to that in the late group ( P = 0.049). Conclusion:Early interventional embolization has better efficacy than late interventional embolization in the treatment of intracranial aneurysm. The former can effectively improve neurological function and mental state, enhance living ability, and improve prognosis, which may be related to the regulation of matrix metalloproteinase-9 and soluble intercellular adhesion molecule-1 levels.

Embolic stroke of undetermined source: potential etiology and secondary prevention / 国际脑血管病杂志

The secondary prevention of embolic stroke of undetermined source (ESUS) is still mainly antiplatelet therapy, but the recurrence rate of stroke in this patient population is still very high. This article reviews the potential etiology of ESUS, its potential embolic mechanisms, and secondary prevention of ESUS.

Etiology of bilateral cerebral infarction and influencing factors of short-term clinical outcome / 国际脑血管病杂志

Objective:To investigate the etiology of bilateral cerebral infarction (BCI) and influencing factors of short-term clinical outcome.Methods:Patients with BCI admitted to the Department of Neurology, Xiangyang Central Hospital from January to July 2020 were enrolled retrospectively. According to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria, the etiological classification was performed, including large artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined etiology (SOE), and stroke of undetermined etiology (SUE). According to the location of acute infarction showed on diffusion-weighted imaging, the patients were divided into anterior circulation group, posterior circulation group, and anterior + posterior circulation group. The demographic and baseline data of the three groups were compared. The short-term outcome was assessed by the modified Rankin Scale score at discharge. 0-2 was defined as good outcome, and >2 were defined as poor outcome. The clinical data of the good outcome group and the poor outcome group were compared. Multivariate logistic regression was used to analyze the independent influencing factor of short-term clinical outcome. Results:A total of 72 patients with BCI were enrolled, accounting for 9.4% of all acute cerebral infarction. Their age was 67.89±12.50 years. There were 41 males (56.9%). Twenty-three patient were in the anterior circulation group (32.0%), 25 were in the posterior circulation group (34.7%), and 24 were in the anterior + posterior circulation group (33.3%). The etiological types were SUE in 25 cases (34.7%), CE in 22 cases (30.6%), LAA in 14 cases (19.4%), SOE in 9 cases (12.5%), and SVO in 2 cases (2.8%). CE, SUE and SOE were the main etiologies in the anterior circulation group, and CE was the most common (43.5%). The proportion of CE was significantly higher than that in the posterior circulation group ( P=0.036), and there was no significant difference compared with the anterior + posterior circulation group. LAA, SUE and CE were the main etiologies in the posterior circulation group, and LAA was the most common (48.0%). The proportion of LAA was significantly higher than that in the anterior circulation group ( P<0.001) and the anterior + posterior circulation group ( P=0.002). SUE, CE and SOE were the main etiologies in the anterior + posterior circulation group, and SUE was most common (37.5%). However, there was no significant difference in the proportion of SUE between the anterior + posterior circulation group, the anterior circulation group and the posterior circulation group. Forty patients (55.6%) had poor short-term outcomes. The history of ischemic heart disease, fasting blood glucose, baseline National Institutes of Health Stroke Scale (NIHSS) score, large infarction (the largest infarct diameter >5 cm), the number of infarct distribution layers (6.6 mm/layer) and the proportion of LAA in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic analysis showed that higher baseline NIHSS score was an independent risk factor for poor outcome in patients with BCI (odds ratio 1.373, 95% confidence interval 1.014-1.859; P=0.041). Conclusions:BCI is not uncommon. Its main etiologies are SUE, CE and LAA. CE is the most common in the anterior circulation BCI, LAA is the most common in the posterior circulation BCI, and SUE is the most common in the anterior + posterior circulation BCI. The short-term poor outcome rate of BCI is higher, and the higher baseline NIHSS score is an independent risk factor for poor outcome of patients with BCI.

Paradoxical brain embolism and pulmonary embolism due to a deep femoral venous aneurysm and patent foramen ovale: a case report / 中华神经科杂志

The cases of paradoxical brain embolism (PBE) due to venous aneurysms and patent foramen ovale (PFO) are extremely scarce, with only 5 cases caused by popliteal venous aneurysm reported in the literature to date, while PBE caused by deep femoral venous aneurysm (DFVA) and PFO has not been reported. Herein, an unusual case of PBE in a 15-year-old girl with PFO who still had cerebral infarction and pulmonary embolism after transcatheter closure was present. She was finally diagnosed as PFO with DFVA by angiography. Furthermore, clinical characteristics of 6 cases were summarized to improve the clinicians′ recognition of the rare risk factor of stroke-venous aneurysms of the lower extremity deep veins.

Atrial fibrillation with low cardioembolic risk and ischemic cerebrovascular accidents / Fibrilación auricular con riesgo cardioembólico bajo y accidente cerebrovascular isquémico

Abstract Atrial fibrillation is the most prevalent disease in hypertensive patients over the age of 60. Although a large proportion of patients have symptoms related to this arrhythmia, some asymptomatic patients may experience cerebrovascular accidents as the only clinical manifestation. It is very important for clinicians to have a clear understanding of the tools, scales and specific information required for performing an appropriate assessment of patients with atrial fibrillation, in order to prevent its complications. We present the case of a male patient with atrial fibrillation and a low risk of ischemic cardiovascular accidents, whose implanted event monitor showed no evidence of arrhythmias for over one year, and who developed an ischemic CVA in multiple cerebral territories, with subsequent documentation of a thrombus in the left atrial appendage. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2006).

Resumen La fibrilación auricular es la enfermedad más prevalente en pacientes hipertensos mayores de 60 años. Si bien una gran proporción de pacientes tiene síntomas relacionados con esta arritmia, algunos pacientes asintomáticos pueden desarrollar accidentes cerebrovasculares como única manifestación clínica. Para el clínico es importante tener un conocimiento claro sobre las herramientas, escalas e información específica para realizar una correcta valoración del paciente con fibrilación auricular, con el objetivo de prevenir las complicaciones relacionadas con esta arritmia. Se presenta el caso de un paciente de sexo masculino con fibrilación auricular y riesgo bajo de accidente cerebrovascular isquémico, portador de monitor de eventos, sin evidencia de arritmia por más de un año, quien desarrolló un ACV isquémico en múltiples territorios cerebrales, con posterior documentación de trombo en la auriculilla izquierda. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2006).

Cardioembolic stroke: risk factors, clinical features, and early outcome in 956 consecutive patients

ABSTRACT Background: There is little information about the early clinical features of cardioembolic stroke before complementary examinations. Objective: The aim of this study was to identify risk factors, clinical features, and early outcomes of cardioembolic stroke. Methods: Retrospective study based on prospectively collected data available from a university medical center hospital-based stroke registry. Consecutive patients diagnosed with cardioembolic infarction were selected and compared to those diagnosed with an atherothrombotic stroke. Predictors of cardioembolic infarction were assessed by multivariate analysis. Results: From a cohort of 4597 consecutive patients, we studied 956 patients diagnosed with cardioembolic infarction (80 years [standard deviation (SD) 9.14]; 63% women) and 945 with atherothrombotic infarction (77.01 years [SD 9.75]; 49.8% women). The univariate comparative analysis reported that advanced age (≥ 85 years), female gender, atrial fibrillation (AF), ischemic heart disease, and congestive heart failure were significantly more frequent in the cardioembolic group, whereas hypertension, diabetes, peripheral vascular disease, heavy smoking, hyperlipidemia, and previous transient ischemic attack were significant in the atherothrombotic group. In the logistic regression model, AF (odds ratio [OR] 15.75, 95% confidence interval [CI]: 12.14-20.42), ischemic heart disease (OR 3.12, 95% CI: 2.16-4.5), female gender (OR 1.56, 95% CI: 1.22-2.00), and sudden-onset (OR 1.97, 95% CI: 1.54-2.51), were independent significant predictors of cardioembolic stroke. Conclusions: Potential cardioembolic stroke requires a comprehensive evaluation, since early classification and identification through predictors would improve effective management. (REV INVEST CLIN. 2021;73(1):23-30)

Accidente cerebrovascular de la arteria basilar: cannabis como factor de riesgo en jóvenes / Cerebrovascular accident of basilar artery: Cannabis as a risk factor in young people / Acidente Vascular Cerebral (AVC) da artéria basilar: cannabis como fator de risco em jovens

Introducción. La arteria basilar se forma de las arterias vertebrales, cursa sobre el puente y se bifurca originando las arterias cerebrales posteriores. Irriga parte del tronco encefálico, cerebelo, tálamo y los lóbulos occipitales y temporales cerebrales. Su obstrucción es rara (1% de los accidentes isquémicos), puede ocurrir en cualquier parte de su trayecto, con cuadro clínico diverso. En jóvenes se añaden otros factores de riesgo distintos a los cardiovasculares, se incluye el consumo de sustancias psicoactivas. El objetivo de este artículo es presentar el caso de un adulto joven, su evolución posterior a la intervención endovascular y la asociación, pasada por alto, al consumo de cannabinoides. Caso clínico. Individuo de 23 años con 14 horas de parálisis facial periférica derecha, diplopía, disartria, hemiparesia e hiperreflexia izquierda, disfagia, náuseas y emesis. Tomografía Axial Computarizada de cráneo simple sin alteraciones. Posteriormente, al realizarse resonancia magnética nuclear, se evidencia isquemia pontomesencefálica y focos isquémicos agudos lacunares en lóbulos cerebelosos. Se consideró comprometido el territorio de la arteria basilar, por lo que se realizó angiotomografía que evidenció una obstrucción crítica de dicho vaso a nivel del tercio distal. Se realizó trombectomía con stent-retriever con recanalización total de la arteria basilar con flujo en toda su extensión. Al egreso fue clasificado como TOAST idiopático. Conclusiones. Las escalas etiológicas para stroke creadas para adultos mayores sobreestiman la etiología idiopática en pacientes jóvenes, lo cual puede ocasionar que el consumo de cannabis sea pasado por alto como causante pese a la asociación reportada por la literatura.

Introduction. The basilar artery is formed from the vertebral arteries, runs over the pons and bifurcates, originating the posterior cerebral arteries. It irrigates part of the brainstem, cerebellum, thalamus, and the occipital and temporal lobes of the brain. Its obstruction is rare (1% of ischemic accidents), it can occur in any part of its path, with a diverse clinical condition. In young people, other risk factors other than cardiovascular ones are added; psychoactive substance use is included. The objective of this article is to present the case of a young adult, his evolution after endovascular intervention and the association, overlooked, to the consumption of cannabinoids. Clinical case. 23-year-old man with 14 hours of right peripheral facial paralysis, diplopia, dysarthria, left hyperreflexia and hemiparesis, dysphagia, nausea and emesis. Simple skull Computerized Axial Tomography without alterations. Subsequently, when a nuclear magnetic resonance was performed, pontomesencephalic ischemia and acute lacunar ischemic foci in the cerebellar lobes were evidenced. The basilar artery territory was considered compromised, so a CT angiography was performed, which revealed a critical obstruction of said artery at the level of the distal third. A stent-retriever thrombectomy was performed with total recanalization of the basilar artery with flow in its entirety. Upon discharge, he was classified as "idiopathic" according to the TOAST classification. Conclusions. The etiological scales for stroke created for older adults overestimate idiopathic etiology in young patients, which may cause cannabis use to be overlooked as a cause despite the association reported in the literature.

Introdução. A artéria basilar é formada pelas artérias vertebrais, passa pela ponte e se bifurca, originando as artérias cerebrais posteriores. Irriga parte do tronco cerebral, cerebelo, tálamo e os lobos occipital e temporal do cérebro. Sua obstrução é rara (1% dos acidentes isquêmicos), podendo ocorrer em qualquer parte de seu trajeto, com quadro clínico diverso. Nos jovens, são adicionados outros fatores de risco além dos cardiovasculares, incluindo o consumo de substâncias psicoativas. O objetivo deste artigo é apresentar o caso de um adulto jovem, sua evolução após a intervenção endovascular e a associação, despercebida, ao consumo de canabinoides. Caso clínico. Indivíduo de 23 anos com 14 horas de paralisia facial periférica direita, diplopia, disartria, hemiparesia e hiperreflexia esquerda, disfagia, náuseas e vômitos. Tomografia axial computadorizada de crânio simples sem alterações. Posteriormente, quando foi realizada a ressonância magnética nuclear, foram evidenciados isquemia pontomesencefálica e focos agudos de isquemia lacunar nos lobos cerebelares. O território da artéria basilar foi considerado comprometido, por isso foi realizada uma angiotomografia, que revelou uma obstrução crítica do referido vaso no terço distal. Foi realizada trombectomia stent-retriever com recanalização total da artéria basilar com fluxo em sua totalidade. No momento da alta, foi classificado como TOAST idiopática. Conclusões.As escalas etiológicas para AVC criadas para idosos superestimam a etiologia idiopática em pacientes jovens, o que pode fazer com que o uso de cannabis seja negligenciado como causa, apesar da associação relatada na literatura.

Application of echocardiography in evaluating cardioembolic sources in patients with ischemic stroke / 国际脑血管病杂志

For patients with ischemic stroke,accurate identification of the etiology and mechanism of stroke are important for guiding treatment and prevention.The long-term recurrence rate and mortality rate of cardioembolic stroke are high.Echocardiography is a powerful diagnostic tool for evaluating cardioembolic sources.This article reviews the application of echocardiography in evaluating cardioernbolic sources in patients with ischemic stroke.

Brain natriuretic peptide and cardioembolic stroke / 国际脑血管病杂志

Cardioembolic stroke (CES) is the most severe type of ischemic stroke, accounting for 14％ to 30％ of all ischemic strokes, tends to early recurrence, and has a high long-term recurrence rate and mortality. Therefore, early diagnosis of CES in patients with ischemic stroke is of great significance. Some studies have shown that brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are associated with CES. This article reviews the roles of BNP and NT-proBNP in early diagnosis and recurrence risk prediction of CES.

P-wave dispersion parameters predict paroxysmal atrial fibrillation in patients with embolic stroke of undetermined source / 国际脑血管病杂志

Objective To investigate the possibility of P-wave dispersion parameters of 12-lead ECG in predicting paroxysmal atrial fibrillation (PAF) in patients with embolic stroke of undetermined source (ESUS).Methods Patients with ESUS admitted to the Department of Neurology,the Affiliated Hospital of Yangzhou University from January 2017 to December 2018 were enrolled.According to the findings of 24 h dynamic ECG monitoring,they were divided into PAF group and non-PAF group.The maximum P-wave duration (Pmax),minimum P-wave duration (Pmm) and P-wave dispersion (Pd) in the conventional 12-1ead ECG were documented.Multivariate logistic regression analysis was used to determine the independent correlation between different P-wave dispersion parameters and PAF in patients with ESUS.Results A total of 87 patients with ESUS were enrolled,including 40 females and 47 males,with an average age of 68.53 ± 10.68 years.PAF was detected in 17 patients (19.54％).There were significant differences in age,baseline NIHSS score,Pmax,Pd,and left atrial diameter (LAD) between the PAF group and the non-PAF group (all P ＜0.05).Multivariate logistic regression analysis showed that Pd Was the only independent predictor of PAF in patients with ESUS (odds ratio,1.279,95％ confidence interval 1.048-1.561,P =0.015).Conclusion Pd is an independent predictor of PAF in patients with ESUS.

Paradoxical cerebral embolism caused by pulmonary arteriovenous fistula: a case report / 中华神经科杂志

A young female patient with paradoxical cerebral embolism caused by pulmonary arteriovenous fistula,mainly presented the right limbs asthenia,and brain magnetic resonance imaging examination showed multiple acute cerebral infarctions in the left hemisphere,which belongs to left middle cerebral artery and left posterior cerebral artery blood areas.After excluding the common risk factors of cerebrovascular disease,foaming test suggested the right-to-left shunt.The esophageal ultrasound examination excluded the patent foramen ovala.The lung CT angiography examination confirmed the intracranial embolism caused by pulmonary arteriovenous fistula.There was no recurrence of ischemic stroke after the patient was treated with pulmonary arteriovenous fistula embolization.

Cerebral Air Embolism: a Case Report with an Emphasis of its Pathophysiology and MRI Findings

Cerebral air embolism (CAE) is a rare complication of various medical procedures. It manifests with symptoms similar to those of typical acute cerebral infarction, however the treatment is quite different. We present a case of arterial CAE that was associated with a disconnected central venous catheter and appeared as punctate dark signal intensities with aliasing artifacts on the susceptibility-weighted filtered phase magnetic resonance image. The susceptibility-weighted filtered phase image can be helpful for diagnosing CAE and the magnetic resonance imaging reflects the pathophysiology of CAE.

Hemodynamic changes during heart displacement in aorta no-touch off-pump coronary artery bypass surgery: a pilot study

Abstract Objective: To evaluate the sequential changes of hemodynamic and metabolic parameters in patients who underwent aorta no-touch off-pump coronary artery bypass surgery (OPCAB). Methods: Prospective study involving twenty-seven consecutive patients who underwent aorta no-touch OPCAB. The FloTrac/PreSep/Vigileo™ system (Edwards Lifesciences) was used to continuously record heart rate (HR), mean arterial blood pressure (MABP), central venous pressure (CVP), continuous cardiac index (FCI), stroke volume (SV), stroke volume variation (SVV), and central venous oxygen saturation (ScvO2). The parameters were assessed 5 min before, during and 5 min after each anastomosis (left anterior descending [LAD], posterior descending [PD], obtuse marginal [OM] and diagonal [Dg]). Postoperative lactate was also evaluated. Results: There was no significant change in HR and MABP for all anastomoses, except for MABP during PD grafting (-10.1±2.7 mmHg, P=0.03). There was a significant decrease in ScvO2 only during PD and OM anastomoses (-9.4±0.4, P=0.03; -4.4±0.4, P=0.02; respectively). CVP drop after PD manipulation was strongly associated with a higher lactate during the first hours after surgery (r=-0.82; P=0.001). These hemodynamic changes were transient and entirely recovered after the heart was returned to its anatomical position. No significant differences were observed in FCI, SVV, or the systemic vascular resistance index (SVRI) during all anastomoses, except for a drop in SVRI during PD grafting (-8.03±2.3, P=0.007). SV tended to decrease during the procedure in all territories, but with statistically significant drop only in PD and OM grafting (-10.4±1.2, P=0.02; -13.6±5.1, P=0.007; respectively). Conclusion: Heart displacement for performing aorta no-touch OPCAB is well tolerated, with transient and endurable hemodynamic variations.

Late Coil Migration after Embolization of Cerebral Aneurysms ­ Case Series

Background Coil migration after cerebral aneurysm embolization is a very rare complication. It can take place early or late in the postoperative period, evolving asymptomatic and causing severe neurological deficits. Ruptured aneurysms of anterior communicant artery were the most frequent reported examples in the literature. Case Report We report three cases of patients with unruptured aneurysms treated with coils and remodeling balloon technique. The first case was that of a left posterior communicating artery aneurysm with coil migration to a distal cortical branch of ipsilateral middle cerebral artery (MCA). The patient had mild paresthesia in the arm for a few days. The second one was a fenestrated basilar artery aneurysm with coil migration to the P2 segment of the left posterior cerebral artery. The patient was fully asymptomatic. The third case was a MCA aneurysm with coil migration to the M3 segment. There were no ischemic complications, and all patients underwent a new endovascular procedure. Conclusions Coil migration is a rare but not always severe complication. Antiplatelet agents are recommended even if the coil migration is asymptomatic.

Introdução A migração de coil após embolização de aneurisma cerebral é uma complicação muito rara. Ela pode ocorrer no período pós-operatório tanto precoce quanto tardio, evoluindo assintomático ou causando graves déficits neurológicos. Aneurismas rotos da artéria comunicador anterior foram os exemplos mais frequentes relatados na literatura. Relato de Caso Relatamos três casos de pacientes com aneurismas não rotos tratados com coils e técnica de remodelagem com balão. O primeiro caso foi de um aneurisma de artéria comunicante posterior com migração do coil para um ramo cortical distal da artéria cerebral média (ACM) ipsilateral. A paciente apresentou parestesia leve no braço por alguns dias. O segundo foi um aneurisma de artéria basilar fenestrada com migração de coil para o segmento P2 da artéria cerebral posterior esquerda. O paciente ficou totalmente assintomático. O terceiro caso foi de um aneurisma de ACM com migração do coil para o segmento M3. Não houve complicações isquêmicas, e todos os pacientes foram submetidos a novo procedimento endovascular. Conclusões Migração de coil é uma complicação rara, mas nem sempre grave. Antiagregantes plaquetários são recomendados mesmo se a migração do coil for assintomática.

Factores de riesgo asociados a ictus cardioembólico en pacientes con fibrilación auricular no valvular / Risk Factors Associated with Cardioembolic Stroke in Patients with non Valvular Atrial Fibrillation

Fundamento: la fibrilación auricular es la arritmia más frecuente que se trata en la práctica clínica y la que motiva hasta el 33 % de las hospitalizaciones. Provoca una morbimortalidad significativa al aumentar el riesgo de ictus e insuficiencia cardiaca. Objetivo: identificar factores de riesgo asociados a la aparición del ictus cardioembólico en pacientes con fibrilación auricular en Cienfuegos. Métodos: estudio descriptivo correlacional de dos series de casos, Grupo A (pacientes con diagnóstico de fibrilación auricular más ictus cardioembólico y Grupo B (pacientes con diagnóstico de fibrilación auricular sin ictus cardioembólico) los cuales acudieron a consulta externa de arritmias o estaban ingresados en la unidad de ictus, en el Hospital Dr. Gustavo Aldereguía Lima de Cienfuegos, de noviembre 2014 a julio 2016. Se estudiaron 103 pacientes, 50 con fibrilación auricular e ictus cardioembólico y 53 con fibrilación auricular sin ictus cardioembólico. Se analizaron como variables demográficas: edad y sexo; variables clínicas: hábitos tóxicos, comorbilidades, manejo terapéutico con anticoagulantes; y variables ecocardiográficas. Resultados: el porcentaje de pacientes con fibrilación auricular sin ictus cardioembólico aumentó en relación con la progresión de la edad. La comorbilidad más importante fue la hipertensión arterial, hubo una baja frecuencia de pacientes con tratamiento anticoagulante antes del ictus y asociación estadística de la cantidad de factores de riesgo con la aparición del ictus. Conclusiones: se identificaron como factores de riesgo asociados al ictus cardioembólico en pacientes con fibrilación auricular: la edad, la hipertensión arterial, la ausencia de tratamiento anticoagulante previo al ictus y la coexistencia de más de 2 factores de riesgo conocidos.

Foundation: atrial fibrillation is the most frequent arrhythmia treated in the clinical practice and the one which causes 33 % of hospital admissions. Morbimortality increases significantly with the risk of stroke and cardiac failure. Objective: to identify the risk factors associated to the onset of cardioembolic stroke in patients with atrial fibrillation and cardiac failure. Methods: descriptive correlational study of two series of cases, Group A (patients with diagnosis of atrial fibrillation and cardioembolic stroke and Group B (patients with diagnosis atrial fibrillation without cardioembolic stroke). These cases came to outpatient consultation of arrhythmias or were admitted to the stroke unit at the Cienfuegos Dr. Gustavo Aldereguía Lima from November 2014 to July 2016. A number of 103 patients were studied, 50 with atrial fibrillation and cardioembolic stroke and 53 with atrial fibrillation without cardioembolic stroke. Demographic variables as age and sex and clinical variables; toxic habits, comorbidities, therapeutic management with anticoagulants and ecocardiographic variables were analyzed. Results: patients with atrial fibrillation without cardioembolic stroke increased in relation to aging. The most important co/morbidity was arterial hypertension; there was a low number of patients treated with anticoagulants before stroke and statistic association of the number of risk factors with the onset of stroke. Conclusion: the identified risk factors for cardioembolic stroke in patients with atrial fibrillation were age, arterial hypertension and stroke previous anticoagulant treatment and the coexistance of more than two known risk factors.

Role of Computed Tomography in Evaluation of Cerebrovascular Accidents in a Tertiary Care Centre in Northern Kerala

Background: Cerebrovascular accident is one of the leading causes of death and disability throughout the world. It is the third most common cause of death after heart disease and cancer in India. Early diagnosis can improve the morbidity and mortality rates, as more advanced therapies are currently being instituted. Computed tomography imaging having wider availability, being cost effective and less time consuming, plays the role of first-line imaging modality. Many studies have been done all over the world to demonstrate the usefulness of computed tomography in management of cerebrovascular accident. Our study is aimed to establish the role of computed tomography in clinically suspected cases of cerebrovascular accident. The purpose of this study is to document the presence or absence of hemorrhage or infarcts, to find the location and reasonably assess the blood vessels involved and to spot the incidence of negative cases of clinically suspected stroke. Methods: A prospective study of 250 cases admitted to Academy of medical sciences, Pariyaram, Kannur with the clinical diagnosis of acute stroke were taken up for the study. Results: Out of 250 patients clinically suspected of CVA submitted for CT scan study of the brain. 150 patients i.e., 60% had infarcts. 70 patients i.e., 28% had haemorrhage,5 patients i.e., 2% had S.D.H.,5 patients i.e., 2% had C.V.T., 5 patients i.e., 2% had tumor and 15 patients i.e.,6% had normal scans. Infarcts formed the major group of the CVA cases i.e., 60%, involving most commonly the R.M.C.A. territory in patients i.e., 33.34%. Hemorrhage formed the second major group of the CVA cases i.e., 28.5%, involving most commonly the R.M.C.A. territory in patients i.e., 28.5%. Conclusions: The study showed that there is a preponderance of ischemic over hemorrhagic CVA. There is also a male preponderance in the occurrence of both hemorrhagic and ischemic CVA. C.T. Scanning is the “Gold Standard” technique for the diagnosis of acute stroke. And management of stroke depends upon “accurate diagnosis”. Hence, CT scan should be ideally done in all cases.

Curative effect of warfarin therapy on atrial fibrillation complicated with cerebral embolism and its influence on D-dimer / 中国基层医药

Objective To observe the clinical curative effect of warfarin therapy on atrial fibrillation complicated with cerebral embolism,and its influence on D－dimer.Methods From January 2013 to March 2016,80 cases of atrial fibrillation complicated with cerebral embolism in Shanxi Cardiovascular Disease Hospital were selected in the study.By using the random number table method,the patients were divided into two groups,with 40 cases in each group.The control group was given aspirin therapy,the observation group was given warfarin treatment.The treatment effect,D －dimer level,blood coagulation function index,cerebral embolism recurrence rate and mortality were compared between the two groups.Results The total effective rate of the observation group was 95.0%,which of the control group was 90.0%,there was no statistically significant difference between the two groups (χ2＝0.721,P＞0.721).After treatment,the D－dimer,prothrombin time (PT),activated partial clotting enzyme live time (APTT), thrombin time (TT)in the observation group were (162.85 ±60.53)μg/L,(20.54 ±4.03)s,(42.84 ±8.47 )s, (22.59 ±4.84)s,respectively,which in the control group 1were (245.41±83.24)μg/L,(16.39 ±3.41)s,(34.23 ± 7.59 )s,(17.98 ±4.27 )s,respectively,the differences between the two groups were statistically significant (t ＝5.073,4.972,4.788,4.972,all P ＜0.05 ).The recurrence rate of cerebral embolism in the observation group (7.5%)was significantly lower than that in the control group (25.0%)(χ2＝4.501,P＜0.05 ).The mortality of the observation group (2.5%)was slightly lower than that of the control group (5.0%),but there was no statistically significant difference (χ2＝0.346,P＞0.346).Conclusion Warfarin therapy in the treatment of atrial fibrillation complicated with cerebral embolism has significant clinical effect,it has anticoagulant effect,and can reduce the D－dimer level,improve patients'anticoagulant function,effectively prevent the cerebral embolism happen again,and improve the prognosis.

Mechanical thrombectomy with Solitaire AB stent for acute ischemic stroke: comparison between cardioembolic and large artery atherosclerotic stroke / 国际脑血管病杂志

Objective To compare the outcomes of Solitaire AB stent mechanical thrombectomy for the treatment of large-artery atherosclerotic stroke (LAA) and cardioembolic stroke (CES).Methods Acute ischemic stroke patients treated with Solitaire stent retriever device were enrolled retrospectively. They were divided into either a LAA group or a CES group according to the etiology. The outcomes in both groups were compared. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcome (defined as the modified Rankin Scale score > 2) at 90 d after onset. Results A total of 39 patients were enrolled in the study. There were 18 patients in the LAA group (49. 2％), 6 (33. 3％) had good outcome at 90 days; there were 21 patients (50. 8％) in the CES group, 9 (42. 9％) had good outcome at 90 days. There was no significant difference in the the good outcome rate at 90 days in both groups (P = 0. 223). Multivariate logistic regression analysis showed that only age was independently associated with poor outcome (odds ratio 1. 107, 95％ confidence interval 1. 016-1. 206; P = 0. 047), and stroke etiology subtype was not independently associated with poor outcome (odds ratio 0. 671, 95％ confidence interval 0. 078- 5. 743; P = 0. 716). Conclusions There was no significant difference in the clinical outcome between the patents with LAA and CES who received mechanical thrombectomy with Solitaire AB stent.

Etiology and secondary prevention of embolic stroke of undetermined source / 国际脑血管病杂志

Cryptogenic stroke refers to ischemic stroke that is not clear to the cause of the disease through routine examinations. With the development of medical technology, studies have found that most cryptogenic stroke is caused by embolism.Therefore,the concept of embolic stroke of undetermined source (ESUS) is proposed. The main causes of ESUS include subclinical atrial fibrillation, patent foramen ovale, aortic arch atherosclerotic plaque, non-stenotic complex carotid atherosclerotic plaques, and tumor-related embolism, etc. This article reviews the etiology and secondary prevention of ESUS.