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.

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.

Association between short-term outcomes and collateral circulation status in patients with acute ischemic stroke receiving thrombolysis therapy: a systematic review and meta-analysis / 中华全科医师杂志

Objective To evaluate the association between short-term outcomes and collateral circulation status in patients with acute ischemic stroke receiving thrombolysis therapy.Methods Full-text articles published from January 2000 to November 2016 in Cochrane Library,Medline,Embase and Web of Science electronic database were retrieved and their quality was assessed.The association between short-term outcomes and collateral circulation status were analyzed by random-effects models.Results Twenty three studies involving 2 849 patients were included in quantitative synthesis.The results showed that good collateral circulations had a beneficial effect on favorable outcomes at 3 or 6 months (RR =2.26,95％ CI:1.85-2.77,P =0.00),and were also associated with a lower rate of symptomatic intracranial hemorrhage (RR =0.56,95％ CI:0.47-0.67,P ＜ 0.01) and a lower rate of mortality (RR =0.30,95％ CI:0.22-0.40,P ＜ 0.01).Conclusion The baseline collateral cimulation status is associated with the short-term outcomes in patients with acute ischemic stroke receiving thrombolysis therapy.

The clinical efficacy of recombinant tissue plasminogen activator for the treatment of ischemic cerebrovascular disease caused by cerebral thrombosis / 天津医药

Objective To study the clinical efficacy of intra-arterial thrombolysis with recombinant tissue plasminogen activator (rt-PA) for the treatment of ischemic cerebrovascular disease caused by cerebral thrombosis. Methods A total of 245 patients accepted by our hospital during May 2013 and July 2015 were divided into the observation group (n=148) and the control group (n=97). All patients were given conventional process for controling blood pressure and blood lipids. Patients in observation group received intra-arterial thrombolysis with rt-PA, while patients in control group accepted conventional treatment. At the time of admission, the demographic characteristic, vascular influencing factors, baseline clinical findings, laboratory findings and neurological deficits were collected. The improvement of neurological function was evaluated by the modified Rankin scale 3 months after treatment. The levels of fibrinogen (FIB), D-Dimer, activated partial thromboplastin time (APTT) and thrombin time (PT) were measured before and 24 h after the treatment. Results There were no significant differences in demographic characteristic and general clinical data between the two groups ( P>0.05). The proportion of patients with improved neurological function was significantly higher in observation group than that of the control group (83.11％vs. 53.61％, P0.05). Twenty-four hours after the treatment, the levels of FIB, D-Dimer, APTT and PT were significantly improved in the observation group compared with those before treatment. The level of FIB was significantly decreased, D-Dimer was significantly increased, APTT and PT were significantly prolonged in observation group compared with those of control group (P<0.05). Conclusion The rt-PA can effectively dissolve thrombosis and correct the coagulation system and fibrinolytic system.

Dual Mechanical Thrombectomy for Recanalization of a Resistant Acute Posterior Circulation Stroke

A 71-year-old man with acute basilar artery occlusion was referred for endovascular treatment 6 hours after the onset of stroke with a Glasgow Coma Score of 3 and National Institutes of Health Stroke Scale of 27. A cerebral arteriogram revealed occlusion of the left vertebral artery proximally and thromboembolic occlusion of the basilar tip. Direct aspiration and mechanical thrombectomy with various stent retrievers failed to reconstitute arterial flow in the basilar artery. Thrombolysis in cerebral infarction 2b recanalization was achieved only after placement of double Catch Mini stent retrievers through 2 microcatheters, on both side branches of the basilar bifurcation in a kissing fashion and retrieving them simultaneously. It was possible to perform this maneuver through a single distal access catheter without any complications. On follow-up the patient awakened and was able to follow commands on his right side. To our knowledge, dual mechanical thrombectomy with stent retrievers has not been reported in the posterior circulation previously. This technique may be useful in retrieving thrombi located at major intracranial bifurcations of the posterior circulation which do not recanalize with standard mechanical thrombectomy procedures. Although bilateral access to the basilar artery through both vertebral arteries is an advantage in posterior circulation for this technique, dual mechanical thrombectomy can also be performed through a unilateral access.

Application of susceptibility-weighted imaging in patients with acute ischemic stroke / 国际脑血管病杂志

Susceptibility-weighted imaging (SWI) is a high spatial resolution,three-dimensional,and gradient echo magnetic resonance technique.Recent studies have shown that SWI can be used to detect the intra-arterial thrombi,assess the viability of the ischemic brain tissue,and predict the short-and long-term outcomes in patients with acute ischemic stroke.This article reviews the application of SWI in these fields.

Primary stent retrieval for acute intracranial large artery occlusion due to atherosclerotic disease / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: The goal of stent retriever-based thrombectomy is removal of embolic clots in patients with intracranial large artery occlusion. However, outcomes of stent retrieval may differ between acute arterial occlusions due to intracranial atherosclerotic disease (IAD) and those due to embolism. This case series describes the outcomes of stent retriever-based thrombectomy and rescue treatments in 9 patients with IAD-related occlusion. METHODS: Among patients who underwent endovascular treatment for acute intracranial large artery occlusion, those in whom stent retrieval was attempted as first-line treatment were included in this review. IAD was defined as significant fixed focal stenosis at the occlusion site, which was evident on final angiographic assessment or observed during endovascular treatment. RESULTS: Median number of stent retriever passes was 2 (range, 1-3), and temporary bypass was seen in all patients. Immediate partial recanalization (arterial occlusive lesion grade 2-3) was observed in 7 patients. Immediate modified thrombolysis in cerebral infarction grade 2b-3 was seen in 6 patients, but the lesions often required rescue treatment due to reocclusion or flow insufficiency. In terms of rescue treatments, angioplasty and intra-arterial tirofiban infusion seemed to be effective. CONCLUSIONS: Our findings suggest that stent retrieval can effectively remove thrombi from stenotic lesions and achieve partial recanalization despite the tendency toward reocclusion in most patients with IAD-related occlusion. Further research into the use of rescue treatments, such as tirofiban infusion and angioplasty, is warranted.

Primary stent retrieval for acute intracranial large artery occlusion due to atherosclerotic disease / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: The goal of stent retriever-based thrombectomy is removal of embolic clots in patients with intracranial large artery occlusion. However, outcomes of stent retrieval may differ between acute arterial occlusions due to intracranial atherosclerotic disease (IAD) and those due to embolism. This case series describes the outcomes of stent retriever-based thrombectomy and rescue treatments in 9 patients with IAD-related occlusion. METHODS: Among patients who underwent endovascular treatment for acute intracranial large artery occlusion, those in whom stent retrieval was attempted as first-line treatment were included in this review. IAD was defined as significant fixed focal stenosis at the occlusion site, which was evident on final angiographic assessment or observed during endovascular treatment. RESULTS: Median number of stent retriever passes was 2 (range, 1-3), and temporary bypass was seen in all patients. Immediate partial recanalization (arterial occlusive lesion grade 2-3) was observed in 7 patients. Immediate modified thrombolysis in cerebral infarction grade 2b-3 was seen in 6 patients, but the lesions often required rescue treatment due to reocclusion or flow insufficiency. In terms of rescue treatments, angioplasty and intra-arterial tirofiban infusion seemed to be effective. CONCLUSIONS: Our findings suggest that stent retrieval can effectively remove thrombi from stenotic lesions and achieve partial recanalization despite the tendency toward reocclusion in most patients with IAD-related occlusion. Further research into the use of rescue treatments, such as tirofiban infusion and angioplasty, is warranted.

Complete spontaneous thrombosis and parent artery occlusion of a giant vertebral artery aneurysm: a case report and literature review / 国际脑血管病杂志

Spontaneous complete thrombosis with parent artery occlusion of giant intracranial aneurysms is rare.We report a patient with a rare giant vertebral artery aneurysm with spontaneous complete thrombosis and parent artery occlusion,and review the related literature,discuss its incidence,clinical presentation,pathogenesis,diagnosis,and treatment.

Inflammatory bowel disease and cerebrovascular disease / 国际脑血管病杂志

Clinical and epidemiological studies have shown that inflammatory bowel diseases (IBD) can increase the risks of cerebral artery and venous thrombosis.The pathogenesis of cerebrovascular disease in IBD remains unclear.IBD itself and its accompanying hypercoagulable state may be the main reasons.Clinicians familiar with neurological manifestations of IBD,early initiation of risk assessment for thromboembolism,and timely multidisciplinary consultation are very important for early diagnosis.The inpatients with IBD should receive the active measures of thromboprophylaxis.Usually,the preventive use of low-molecular-weight heparin is safe for patients at high risk of thrombosis.The treatment scheme for IBD patients with cerebral infarction and cerebral venous thrombosis is the same as other cerebrovascular diseases,but the most critical is that the treatment and remission of IBD itself.In case of emergency,intraarterial local thrombolysis or mechanical thrombectomy can be used;however,any benefits should be weighed against the high risk of intestinal bleeding.

Afasia post acv de acm unilateral por embolia infecciosa en endocarditis bacteriana / Aphasia post unilateral cerebral media stroke associated to infectious embolism in acute bacterial endocarditis

Se reporta el caso de un paciente con endocarditis infecciosa que sufre un accidente cerebro vascular (ACV) isquémico a nivel parieto-occipital e ínsula posterior izquierda, con manifestaciones afásicas de rasgos mixtos, donde prima la fluidez y los problemas de repetición, agresividad, agrafia y dificultades de lectura. Es un caso llamativo por la singularidad de los hallazgos y la mejoría funcional posterior al evento. Son escasos reportes en la literatura que muestren una complicación afásica por una endocarditis infecciosa con vegetaciones aórticas por Streptococo mitis versus S. oralis. El origen de la endocarditis infecciosa fue atribuido a procedimiento de endodoncia, y justificado en hallazgos de RMN, punción lumbar y ECO-TE. En la actualidad, el paciente posee un lenguaje funcional, con ciertas dificultades a nivel del lenguaje expresivo y de la comprensión.

We present a clinical report of a patient with infective endocarditis who suffered an ischemic stroke at the parietal occipital and posterior insula, with aphasic demonstrations including mixed features, primordially exhibiting fluency and repetition problems, aggression, dysgraphia, and reading difficulties. It is a striking case because of the uniqueness of the findings and the functional improvement after the event. There are few previous reports describing an association between these bacteria and this injury and the patient's improvement. The cause of the endocarditis was attributed to an endodontic procedure because other paraclinical tests made during medical care showed no other apparent cause. Currently the patient only has difficulty with expressive language and understanding certain commands.

Trombosis venosa cerebral, descripción clínica de una serie de casos en adultos de Bogotá-Colombia: a case series from Bogotá / Cerebral venous thrombosis

INTRODUCCIÓN: aunque la trombosis venosa cerebral representa una pequeña proporción de la enfermedad cere-brovascular, su incidencia y prevalencia se han incrementado en los últimos años. Este fenómeno se puede explicar por la mejoría en los métodos diagnósticos no invasivos y por el desarrollo de técnicas especializadas de resonancia magnética. Por las razones anteriores es necesario conocer las características demográficas y el comportamiento clínico de esta entidad en nuestro medio. OBJETIVO: describir las características clínicas y demográficas de pacientes con trombosis venosa cerebral y sus complicaciones en una población clínica de un hospital de IV nivel de Bogotá, Colombia y determinar los de factores de riesgo para complicaciones en la fase aguda. MATERIALES Y MÉTODOS: se analizaron historias clínicas de pacientes con trombosis venosa cerebral y se obtuvieron datos sobre aspectos demográficos, condición clínica y complicaciones. RESULTADOS: se encontraron 38 historias clínicas, 29 mujeres, 60,4% de ellas menores de 40 años. La trombofilia fue el factor de riesgo más común, con el síndrome antifosfolípido como causa principal, otras causas importantes fueron el embarazo y el puerperio. CONCLUSIÓN: la trombosis venosa cerebral es una enfermedad frecuente en la práctica clínica que afecta más a mujeres en edad fértil. Aunque no se encontró una relación estadísticamente significativa, las mujeres con síndrome antifosfolípido representaron el grupo con mayor riesgo de complicaciones. Se necesitan más estudios a futuro con una muestra de mayor tamaño.

INTRODUCTION: although cerebral venous thrombosis represents a small proportion of cerebrovascular disease, its incidence and prevalence has increased in recent years. This phenomenon can be explained by the improved access to noninvasive diagnostic methods and the development of more specialized techniques in magnetic resonance image (MRI). Also, it is convenient to know demographic and clinical aspects of this entity in our environment. OBJECTIVE: the aim of this study was to describe demographic and clinical features in patients with cerebral venous thrombosis and its complications in a cases series from a high complexity hospital in Bogotá, Colombia, and determine the association between risk factors and clinical complications in the acute phase. MATERIALS AND METHODS: clinical records belonging to patients with cerebral venous thrombosis were analyzed in order to obtain data regarding to demographic information, clinical condition and complications. RESULTS: 38 clinical records were analyzed, among which 76.3% were of female patients, 60.5% of which were under 40. Thrombophilia was the most frequent risk factor in which antiphospolipid syndrome represented the most common condition. Other important conditions were pregnancy and post partum period. CONCLUSION: cerebral venous thrombosis is frequent in clinical practice. In this cases series: female gender at childbearing age was the most affected group. Although we did not find statistical correlation, women with anti-phospolipid syndrome represented the group with most chance of complications. Further studies with a larger sample or big population are necessary.

Microembolic signals and outcome in patients with acute ischemic stroke: a prospective case series study / 国际脑血管病杂志

Objective To investigate the correlation of microembolic signals (MES) and outcome in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled in the study.The MES of middle cerebral artery was monitored dynamically using transcranial color Doppler ultrasound.The early lesions of ischemic stroke were evaluated by MRI.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological deficits.The modified Rankin scale was used to evaluate the outcome,and the stroke recurrence was recorded.Results A total of 135 patients with acute ischemic stroke were enrolled,in which,33 were cardiogenic cerebral embolism,49 were large artery atherosclerotic stroke,24 were small arterial occlusive stroke,and 29 were other clear causes or cryptogenic stroke.Multivariate logistic regression analysis showed that coronary heart disease (odds ratio [OR],5.862,95％ confidence interval [CI] 2.008-17.114; P =0.000) was the independent risk factor for positive MES within 48 hours after stroke onset,while the history of antithrombotic treatment (OR 0.376,95％ CI 0.141-0.998; P =0.045) was its independent protective factor.In addition,coronary heart disease (OR 4.879,95％ CI 1.257-18.939; P =0.033),hypertension (OR 4.958,95％ CI 1.029-23.882; P =0.030),and diabetes (OR 3.659,95％ CI 1.027-13.034; P =0.050) were the independent risk factors for positive MES within 1 week after stroke onset.The NIHSS scores of the patients of the positive MES at baseline and 1 week and the clinical outcome at 3 months had no significant differences with the patients of negative MES,however,stroke recurrence and deaths increased significantly (P =0.019).Conclusions MES within 48 hours of onset was not associated with the outcome in patients with acute ischemic stroke at 3 months,however,the incidence of endpoint events such as recurrence and death was significantly higher in patients of positive MES within 3 months.

Ischemic stroke following acute myocardial infarction / 国际脑血管病杂志

Myocardial infarction and ischemic stroke share many common risk factors.Their pathophysiological processes are also similar and the 2 diseases often occur at the same time.Coronary artery disease is one of the important causes of embolic stroke in the elderly population.However,there are a few reported stroke events available after myocardial infarction.This article reviews ischenic stroke following acute myocardial infarction.

Mechanical embolectomy with the Solitaire AB device after acute basilar artery thrombosis: A report of 6 cases / 中国脑血管病杂志

Objective: To evaluate the efficacy and safety of arterial embolectomy with the Solitaire AB stent after acute basilar artery thrombosis. Methods: Six patients performed arterial embolectomy with the Solitaire AB stent after acute basilar artery thrombosis in the Encephalopathy Center, Guangdong Province Hospital of Traditional Chinese Medicine from May to November 2010 were analyzed retrospectively. Stent angioplasty was performed for patients with residual stenosis ≥50%. Their immediate effect of thrombectomy and postoperative bleeding were analyzed. The National Institutes of Health Stroke Scale (NIHSS) scores and the prognosis were compared before and after the treatment. Results: Circled digit oneAfter 1 to 2 embolectomies, the basilar arteries of the 6 patients were revascularized, in 5 patients with residual stenosis were treated in combination with balloon angioplasty and stenting. Circled digit twoOne patient had acute in-stent thrombosis after the release of stent. The angioplasty re-examination showed that the basilar artery was patent after the treatment. Circled digit three5 patients were re-examined by MRI 3 to 7 days after procedure. There were no significant expansion of cerebral infarction, and their basilar arteries were patent. One patient had cerebral hemorrhage 1 day after procedure, and he died after 7 days. Circled digit fourThe NIHSS scores were lowered 2-15 at dischange than at admission in 5 patients. The modified Rankin Scale (mRS) scores in 5 patients were 0(1 patient), 1(2 patients) , and 2(2 patients) at discharge. Conclusion: Using Solitaire AB stent and embolectomy are relatively safe and effective in patients with acute basilar artery thrombosis, and the prognosis of patients is good.

Comparisons of clinical and imaging characteristics in acute thrombotic and embolic middle cerebral artery occlusion A retrospective diffusion-weighted imaging-based study / 国际脑血管病杂志

Objective To investigate the clinical and imaging differences in acute thrombotic and embolic middle cerebral artery occlusion.Methods The cerebral infarction patients with acute middle cerebral artery trtmk occlusion confirmed by diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) within 24 hours of onset were divided into large artery atherosclerosis (LAA) group and the cardioembolism (CE) group according to the TOAST classification criteria.Under the circumstances of not receiving thrombolytic therapy,the infarct volume on DWI,morphological characteristics and the changes of the National Institutes of Health Stroke Scale (NIHSS) scores both at admission and day 14 were compared.Results A total of 102 cerebral infarction patients with acute middle cerebral artery trunk occlusion were included.The age of the CE group was significantly older than that of the LAA group (67.60 ± 9.62 years vs.62.57 ± 10.18 years,P =0.017),and more patients with coronary heart disease (27.27％ vs.2.90％,P=0.001 ).The infarct volume (31.96 ±39.20 ml vs.65.66 ±84.74 ml,P =0.005),the NIHSS score at admission (6.42 ± 3.38 vs.11.67 ±8.50,P=0.007),and the improvement of the disease (i.e.the difference of NIHSS scores between admission and day 14) (1.55 ± 6.43 vs.5.75 ± 9.28,P =0.027) in LAA group were significantly lower than those in the CE group.However,there was no significant difference in the NIHSS score between the 2 groups at day 14 (4.87 ± 6.61 vs.5.97 ± 3.60,P =0.324).The infarct volume was significantly correlated with the NIHSS scores at day 14 (CE group:r=0.625,P=0.001; LAA group:r=0.295,P=0.014).The LAA group was mostly the multiple lesions (71.01％),and the CE group was mostly the single lesions (54.55％) (P =0.016).Conclusion There were differences in morphology of cerebral lesion between the LAA and CE groups.In the early stage after onset,CE caused middle cerebral artery trunk occlusion was more serious and had larger infarct volume,but some patients could naturally significantly improve within a short time after onset.

Transcranial Doppler monitoring during carotid endarterectomy / 国际脑血管病杂志

Carotid endarterectomy (CEA) can effectively treat symptomatic carotid stenosis, however, perioperative stroke is the most important complication of CEA. The microemboli generated before and after the operation are the most important reason for causing perioperative stroke. In addition, the hypoperfusion and postoperative hyperperfusion syndrome caused by intraoperative clipping of carotid artery, as well as carotid restenosis or occlusion after CEA are all the causes of perioperative stroke. As a non-invasive, real-time monitoring tool, transcranial Doppler (TCD) can be widely used in intraoperative monitoring of CEA, It is able to detect a variety of perioperative blood flow changes and the production of microemboli, and thus effectively predicts the occurrence of perioperative stroke, and decreases the risks of perioperative stroke.