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1.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 70(2): e20231001, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1535081

ABSTRACT

SUMMARY OBJECTIVE: The objective of this study was to investigate whether the measurement of mean optic nerve sheath diameter in patients with transient ischemic attack could be used to distinguish between control groups, the acute ischemic stroke group, and subgroups within the acute ischemic stroke category. METHODS: Retrospectively, the mean optic nerve sheath diameters of patients aged 18 years and older belonging to control, transient ischemic attack, acute ischemic stroke, and subgroups within the acute ischemic stroke category were measured with initial computed tomography conducted in the emergency department. RESULTS: Out of the 773 patients included in the study, 318 (41.1%) were in the control group, 77 (10%) had transient ischemic attack, and 378 (49%) were categorized as stroke patients. The average mean optic nerve sheath diameter was significantly higher in both the stroke and transient ischemic attack groups compared with the control group (p<0.001 for both comparisons). Furthermore, the mean optic nerve sheath diameter in the stroke subgroups was significantly higher than in both the transient ischemic attack and control groups (p<0.001 for all comparisons). In transient ischemic attack patients, the mean optic nerve sheath diameter showed a significant ability to predict transient ischemic attack (AUC=0.913, p<0.001), with a calculated optimal cutoff value of 4.72, sensitivity of 94.8%, and specificity of 73.9%. CONCLUSION: The mean optic nerve sheath diameter of patients in the transient ischemic attack group was lower compared with those in the stroke subgroups but higher compared with the control group.

2.
International Journal of Cerebrovascular Diseases ; (12): 220-224, 2023.
Article in Chinese | WPRIM | ID: wpr-989216

ABSTRACT

Intracranial atherosclerotic stenosis (ICAS) is the main cause of ischemic stroke. Endovascular therapy (EVT) is a method of treating symptomatic ICAS, and in-stent restenosis (ISR) is an important factor affecting the efficacy of EVT. This article summarizes the influencing factors of ISR in patients with ICAS receiving EVT treatment.

3.
International Journal of Cerebrovascular Diseases ; (12): 187-191, 2023.
Article in Chinese | WPRIM | ID: wpr-989210

ABSTRACT

Objective:To investigate the efficacy and safety of encephalo-duro-arterio-synangiosis (EDAS) for intracranial atherosclerotic steno-occlusive disease (ICASD).Methods:Patients with symptomatic ICASD received EDAS treatment in the Department of Neurosurgery, the PLA General Hospital from January 2018 to January 2019 were retrospectively included. The baseline information, perioperative complications, primary endpoint events, and changes in modified Rankin Scale (mRS) scores before and after surgery were collected. The primary endpoint event was any stroke/death that occurred within 30 d after enrollment. The secondary endpoint events were any stroke/death, non-stroke bleeding (subdural or epidural bleeding), and clinical functional improvement after 30 d. The clinical functional improvement was defined as a decrease of ≥1 in the mRS score compared to before surgery.Results:A total of 40 patients were included, including 30 males and 10 females, aged 53.9±8.6 years old. The clinical symptoms were mainly limb weakness and dizziness. One case of ischemic stroke and one case of hemorrhagic stroke occurred during the perioperative period. The primary endpoint event incidence was 2.5%. The patients were followed up for 49.75±2.99 months after surgery. One patient died of cerebral hemorrhage 31 months after surgery, and one patient developed acute ischemic stroke 35 months after surgery. The postoperative mRS scores of 34 patients decreased compared to before surgery, and the clinical function improvement rate was 85%. The mRS score increased in 2 cases after surgery compared to before surgery and 4 cases had no change.Conclusion:EDAS can improve the clinical function of patients with symptomatic ICASD and reduce the incidence of long-term stroke.

4.
Chinese Journal of Neurology ; (12): 365-373, 2023.
Article in Chinese | WPRIM | ID: wpr-994841

ABSTRACT

Objective:To explore the efficacy and safety of different anti-platelet regimens in the treatment of high-risk non-disabling ischemic cerebrovascular events (HR-NICE) guided by point-of-care testing of CYP2C19 gene. Methods:A single-centre, prospective, randomised, open-label, and blinded endpoint design was uesd in the study. From July 2020 to January 2022, HR-NICE patients were enrolled in the Stroke Green Channel and Department of Neurology of Xuzhou Central Hospital, and all patients were scraped the buccal mucosa for screening for CYP2C19 loss-of-function allele carriers by point-of-care testing . Patients with intermediate metabolism were defined as those who carried 1 loss-of-function allele and patients with poor metabolism were those who carried 2 loss-of-function alleles. This study reduced the test turnaround time to 1 hour by using a fully automated medical polymerase chain reaction analyzer for a point-of-care test of CYP2C19 genotype. CYP2C19 loss-of-function allele carriers were divided according to the random number table method into the conventional treatment group (clopidogrel 75 mg, once a day), the ticagrelor group (ticagrelor 90 mg, twice a day) and the intensive dose group (clopidogrel 150 mg, once a day) separately combined with aspirin (100 mg, once a day) dual antiplatelet for 21 days. Baseline information, Acute Stroke Org 10172 Treatment Trial staging, 90-day modified Rankin Scale score, occurrence of adverse events and severe adverse events were collected for all the 3 groups. The primary efficacy outcome was new stroke within 90 days, and the primary safety outcome was severe or moderate bleeding within 90 days. Results:A total of 716 patients were included: 240 in the conventional treatment group, 240 in the ticagrelor group and 236 in the intensive dose group. There was no statistically significant difference between the 3 groups at baseline (all P>0.05). There were 26 cases (10.8%) with new stroke events in the conventional treatment group, 11 cases (4.6%) in the ticagrelor group and 4 cases (1.7%) in the intensive dose group, with statistically significant differences among the 3 groups (χ 2=19.28, P<0.05), and the differences between the conventional treatment group and the ticagrelor group (χ 2=6.59, P=0.010) and between the conventional treatment group and the intensive dose group (χ 2=16.83, P<0.001) were statistically significant, whereas the difference between the ticagrelor group and the intensive dose group was not statistically significant ( P>0.05). In the 3 groups, there was 1 case (0.4%) of severe bleeding in the conventional treatment group, 6 cases (2.5%) in the ticagrelor group and none in the intensive dose group, which showed statistically significant differences (χ 2=7.23, P<0.05), and there was statistically significant difference between the ticagrelor group and the intensive dose group ( P=0.030). Among the patients with intermediate CYP2C19 metabolism, there were 13 cases (13/158, 8.2%) with 90-day recurrent stroke in the conventional treatment group, 4 cases (4/153, 2.6%) in the ticagrelor group, and 0 case (0/159) in the intensive dose group, with statistically significant difference (χ 2=16.04, P<0.001), and the differences between the intensive dose group and the conventional treatment group were statistically significant (χ 2=13.64, P<0.001), whereas there was no statistically significant difference between the intensive dose group and the ticagrelor group ( P>0.05). In the patients with 90-day recurrent stroke in the intensive dose group, there was 0 case (0/159) with intermediate metabolism and 4 cases (4/77,5.2%) with poor metabolism, with statistically significant differences ( P=0.011), whereas there were no statistically significant differences in the conventional treatment group and the ticagrelor group ( P>0.05). Conclusions:Screening carriers of CYP2C19 loss-of-function alleles by point-of-care testing can quickly and precisely guide the treatment of patients with non-cardiogenic HR-NICE. An intensive clopidogrel dose of 150 mg, once a day combined with aspirin was effective in reducing stroke recurrence with less occurrence of any bleeding and adverse events, and patients with intermediate CYP2C19 metabolism may be the best population to benefit.

5.
Chinese Journal of General Surgery ; (12): 341-345, 2023.
Article in Chinese | WPRIM | ID: wpr-994578

ABSTRACT

Objective:To investigate the effect of carotid endarterectomy(CEA) in the treatment of symptomatic carotid artery near-occlusion(CNO).Methods:Clinical symptoms, imaging examination, treatment and prognosis of 122 symptomatic CNO patients admitted to China-Japan Friendship Hospital from Jan 2014 to Jan 2020 undergoing CEA were retrospectively analyzed. Patients were divided into two groups based on the collapse condition,full collapse group(54 cases) and non-full collapse group(68 cases).Results:The difference was insignificant between the two groups at the 30-day and 12-month occurrence rate of primary endpoints(1.85% vs. 4.41%, P=0.629;7.41% vs. 4.41%, P=0.698).Postoperative re-stenosis occurred in one case in the non-full collapse group 8 months after CEA. Conclusions:CEA can achieve good curative effect for patients with CNO with recurrent symptoms, irrelevant to the existence of distal full collapse. The shunt can prevent intraoperative hypoperfusion and postoperative hyperperfusion.

6.
Rev. bras. cir. cardiovasc ; 37(5): 648-653, Sept.-Oct. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1407283

ABSTRACT

ABSTRACT Introduction: There is no complete consensus on the three surgical methods and long-term consequences for coexisting coronary and carotid artery disease. We retrospectively evaluated the surgical results in this high-risk group in our clinic for a decade. Methods: Between 2005 and 2015, 196 patients were treated for combined carotid and coronary artery disease. A total of 50 patients were operated on with the staged method, 40 of which had carotid endarterectomy (CEA) priority, and 10 had coronary artery bypass grafting (CABG) priority. CABG and CEA were simultaneously performed in 82 patients; and in 64 asymptomatic patients with unilateral carotid artery lesions and stenosis over 70%, only CABG was done (64 patients). Results were evaluated by uni-/multivariate analyses for perioperative, early, and late postoperative data. Results: In the staged group, interval between the operations was 2.82±0.74 months. Perioperative and early postoperative (30 days) parameters did not differ between groups (P-value < 0.05). Postoperative follow-up time was averaged 94.9±38.3 months. Postoperative events were examined in three groups as (A) deaths (all cause), (B) cardiovascular events (non-fatal myocardial infarction, recurrent angina, congestive heart failure, palpitation), and (C) fatal neurological events (amaurosis fugax, transient ischemic attack, and stroke). When group C events were excluded, event-free actuarial survival rates were similar in all three methods (P=0.740). Actuarial survival rate was significantly different when all events were included (P=0.027). Neurological events increased markedly between months 34 and 66 (P=0.004). Conclusion: Perioperative and early postoperative event-free survival rates were similar in all three methods. By the beginning of the 34th month, the only CABG group has been negatively separated due to neurological events. In the choice of methodology, "most threatened organ priority'' was considered as clinical parameter.

7.
Article | IMSEAR | ID: sea-222189

ABSTRACT

Transient ischemic attack (TIA) is a diagnostic challenge for all physicians due to the temporariness of symptoms and the absence of any definitive diagnostic test. There is a very high risk of TIA being followed by an ischemic stroke, hence require urgent investigation and preventive strategies. At the same time, it is also important to distinguish TIA from other close differentials, to avoid wrong diagnoses leading to harmful, misdirected medical management. In this report, we will discuss the case of a middle-aged male patient with stable pre-operative vitals who was posted for total parotidectomy and suddenly developed jerky movement of the upper limb and transient aphasia on the operation theater table along with raised blood pressure. This is a very rare presentation of TIA that needs to be differentiated from other close differentials as this form is mostly associated with severe carotid occlusive disease and, hence, carries a high risk of stroke.

8.
Article | IMSEAR | ID: sea-222177

ABSTRACT

Magnetic resonance imaging (MRI) is often seen as the gold standard when dealing with an acute ischemic stroke. Despite its unique ability to quickly diagnose acute stroke with diffusion-weighted imaging, there is enough evidence to suggest that MRI has failed to diagnose acute ischemic stroke in a minority of patients. We, hereby, present a case of a 55-year-old gentleman who presented with symptoms consistent with an acute ischemic event, but concurrent computed tomography and MRI were normal. However, the treatment regime for stroke was commenced despite normal imaging. It was only on the 3rd day of admission when the MRI revealed a significant finding which consolidated our diagnosis of ischemic stroke.Through this case report, we aim to help clinicians avoid misdiagnosis or delay in the treatment strategies, especially intravenous thrombolysis in patients with a clinical diagnosis of acute stroke with normal neuroradiological imaging. This is a testament to the fact that clinical assessment still retains priority until a diagnostic tool offers 100% sensitivity and specificity

9.
Chinese Journal of Neurology ; (12): 1061-1064, 2022.
Article in Chinese | WPRIM | ID: wpr-958004

ABSTRACT

Ischemic stroke and transient ischemic attack (TIA) are the most common subtypes of cerebrovascular diseases. Effective secondary prevention is an important approach to reduce the risk of stroke recurrence, disability, and mortality. With the development of international and domestic clinical research on the secondary prevention of ischemic stroke and TIA, new evidence-based medical evidence has been present, especially evidence in risk factor control, antithrombotic therapy, and other treatments. Based on these findings, the guidelines were updated in a timely and systematic manner to provide new standard of secondary prevention for stroke patients.

10.
Chinese Journal of Primary Medicine and Pharmacy ; (12): 1441-1446, 2022.
Article in Chinese | WPRIM | ID: wpr-955858

ABSTRACT

Objective:To investigate the changes and clinical significance of plasma S100A1 protein, nuclear factor-κB p65 (NF-κB p65) and interleukin-6 (IL-6) levels in patients with acute ischemic cerebrovascular diseases.Methods:A total of 141 patients with acute ischemic cerebral infarction (AICI; AICI group) and 20 patients with transient ischemic attack (TIA; TIA group) who received treatment in Northern Jiangsu People's Hospital from April to November 2020 were included in this study. According to the volume of cerebral infarct, the AICI group was subdivided into small-volume cerebral infarct (SCI group, n = 78), moderate-volume cerebral infarct (MCI group, n = 32) and large-volume cerebral infract (LCI group, n = 31) groups. An additional 31 healthy controls who concurrently received physical examination were included as controls (HC group). S100A1, NF-κB p65, and IL-6 levels were compared between AICI, TIA and HC groups and between SCI, MCI and LCI groups. S100A1, NF-κB p65, and IL-6 levels were correlated with the National Institutes of Health Stroke Scale score and the volume of cerebral infarct. The receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic value of S100A1, NF-κB p65, and IL-6 levels for AICI. Results:S100A1, NF-κB p65, and IL-6 levels in the AICI group were (230.96 ± 39.37) ng/L, (3.99 ± 0.65) mg/L, (13.32 ± 1.57) ng/L, respectively, which were significantly higher than (185.85 ± 43.24) ng/L, (3.58 ± 0.74) mg/L, (11.61 ± 1.67) ng/L in the TIA group ( t = 4.95, 2.39, 4.14, all P < 0.05) and (181.47 ± 27.39) ng/L, (3.51 ± 0.99) mg/L, (11.42 ± 2.34) ng/L in the HC group ( t = 6.54, 3.32, 5.55, all P < 0.05). There were no significant differences in S100A1, NF-κB p65, and IL-6 levels between TIA and HC groups (all P > 0.05). S100A1, NF-κB p65, and IL-6 levels in the LCI group were (254.25 ± 37.07) ng/L, (4.41 ± 0.45) mg/L, and (14.00 ± 1.40) ng/L, respectively, which were significantly higher than (225.42 ± 30.92) ng/L, (3.85 ± 0.64) mg/L, (12.77 ± 1.31) ng/L in the MCI group ( t = 3.04, 3.60, 3.20, all P < 0.05) and (223.98 ± 40.21) ng/L, (3.88 ± 0.66) mg/L, (13.27 ± 1.65) ng/L in the SCI group ( t = 3.79, 4.01, 2.25, all P < 0.05). There were no significant differences in S100A1, NF-κB p65, and IL-6 levels between MCI and SCI groups (all P > 0.05). S100A1 and NF-κB p65 levels in patients with AICI were positively correlated with the volume of cerebral infarct ( r = 0.24, 0.27, both P < 0.05). S100A1 and IL-6 levels in patients with AICI were positively correlated with the National Institutes of Health Stroke Scale score ( r = 0.24, 0.28, both P < 0.05). The areas under the curves plotting S100A1, NF-κB p65, and IL-6 levels against AICI diagnosis were 0.818, 0.667 and 0.754, respectively. The optimal cutoff values were 181.03, 3.50 and 10.79, respectively. The corresponding sensitivities were 95.0%, 76.6% and 97.2%, respectively, and the specificities were 37.3%, 45.1% and 49.0%, respectively. Conclusion:Increased S100A1, NF-κB p65, and IL-6 levels in patients with AICI are closely related to the severity of AICI.

11.
Journal of the Japan Society of Acupuncture and Moxibustion ; : 255-260, 2022.
Article in Japanese | WPRIM | ID: wpr-986373

ABSTRACT

[Objective] We report a case in which we unexpectedly encountered a patient with a transient ischemic attack (TIA) caused by severe stenosis of the left middle cerebral artery (MCA) during the course of acupuncture treatment.Patient: A 79-year-old man suffered from bilateral shoulder pain. He was diagnosed with a frozen shoulder at the orthopedic department and was referred to the acupuncture department.[Results] During the course of acupuncture treatment, the subject occasionally exhibited subtle behavioral features, such as difficulty in speech, holding incoherent conversations, and forgetting where he put things. The symptoms were observed repeatedly during treatment, so the acupuncturist referred the patient to the neurosurgical department for a consultation. Magnetic resonance imaging (MRI) of the brain showed an old cerebral infarction in the watershed area in the left paraventricular region, and MR angiography (MRA) revealed left middle cerebral artery stenosis. Single photon emission computed tomography showed decreased blood flow in the left MCA area. The symptoms could be considered TIA with motor and sensory aphasia. The administration of aspirin was started, and the symptoms disappeared.[Discussion and Conclusion] The acupuncturist has more opportunities to obtain information about the patient due to the longer time spent in acupuncture therapy compared to general outpatient treatment. Acupuncture can play an important role in medical partnership. It is also important that the acupuncturist has sufficient medical knowledge.

12.
Rev. Col. Bras. Cir ; 49: e20223400, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1406733

ABSTRACT

ABSTRACT Objective: stroke etiology is ischemia in 85%, and in circa 25% of these, the source is the extracranial carotid. Recurrence is frequent and usually more severe. Carotid revascularization prevents new ischemic strokes. The sooner the treatment is undertaken, complete recovery chances are greater with less recurrences. But, historically, intervention in the acute setting was catastrophic. Objective: Identify determinants of success when carotid revascularization after a recent cerebral ischemic event is performed. Materials and Methods: A cohort of 50 subjects underwent carotid revascularization after ischemic symptoms, within a period of 71 months. The currently diagnostic tools were used, and the symptoms stratified by the Rankin scale. The extension of the cerebral lesion and the source location the source of the event was analyzed. Results: indications were based on the Rankin Scale (R0: 35.4%; R1: 45.8%; R2:18.8% and R3: zero), on the location of the source and the absence of ischemic areas greater than 15mm. An early surgical approach was adopted in all patients. Extreme care was applied to control arterial pressure. At discharge, no additional deficits were observed. Conclusions: carotid revascularization after ischemic events can be achieved without additional morbidity and no recurrences, using the most appropriate therapy in the shortest time, in patients with Rankin Scale up to 2, absence of intracranial hemorrhage and single or multiple ischemic intracerebral areas, with 15mm or less in their greater dimension.


RESUMO Introdução: isquemia é a etiologia do acidente vascular cerebral em 85% dos casos e em cerca de 25% destes, a fonte é a carótida extracraniana. Recorrência é frequente e usualmente mais grave que a inicial. A revascularização carotídea previne novos acidentes. Quanto mais cedo for realizado o tratamento, maiores as chances de recuperação e menor o risco de recorrência. Mas, historicamente, os resultados das intervenções precoces eram catastróficos. Objetivos: identificar determinantes de sucesso da revascularização carotídea após um evento isquêmico cerebral recente. Materiais e Métodos: uma coorte de 50 pacientes foi submetida à revascularização carotídea após sintomas isquêmicos, em um período de 71 meses. Foram empregados os métodos de investigação atuais e os sintomas estratificados pela Escala de Rankin. A extensão das lesões cerebrais e a fonte do evento foram estudados e analisados. Resultados: as indicações foram baseadas na escala de Rankin (R0: 35.4%; R1: 45.8%; R2: 18.8% e R3: zero), na localização da fonte e na ausência de áreas isquêmicas com menos de 15mm. Uma abordagem cirúrgica precoce foi empregada em todos os pacientes. Cuidados extremos com a pressão arterial foram aplicados. Na alta hospitalar, nenhum déficit adicional foi observado. Conclusões: a revascularização carotídea após eventos isquêmicos pode ser realizada sem morbidade adicional ou recorrências, empregando a terapêutica mais apropriada no período de tempo mais curto, em pacientes classificados como Rankin até 2, na ausência de hemorragia intracraniana e com áreas isquêmicas intracerebrais únicas ou múltiplas, com menos de 15mm em sua maior dimensão.

13.
Neuroscience Bulletin ; (6): 753-768, 2022.
Article in English | WPRIM | ID: wpr-939840

ABSTRACT

A transient ischemic attack (TIA) can cause reversible and delayed impairment of cognition, but the specific mechanisms are still unclear. Annexin a1 (ANXA1) is a phospholipid-binding protein. Here, we confirmed that cognition and hippocampal synapses were impaired in TIA-treated mice, and this could be rescued by multiple mild stimulations (MMS). TIA promoted the interaction of ANXA1 and CX3CR1, increased the membrane distribution of CX3CR1 in microglia, and thus enhanced the CX3CR1 and CX3CL1 interaction. These phenomena induced by TIA could be reversed by MMS. Meanwhile, the CX3CR1 membrane distribution and CX3CR1-CX3CL1 interaction were upregulated in primary cultured microglia overexpressing ANXA1, and the spine density was significantly reduced in co-cultured microglia overexpressing ANXA1 and neurons. Moreover, ANXA1 overexpression in microglia abolished the protection of MMS after TIA. Collectively, our study provides a potential strategy for treating the delayed synaptic injury caused by TIA.


Subject(s)
Animals , Mice , Annexin A1/metabolism , CX3C Chemokine Receptor 1/metabolism , Chemokine CX3CL1 , Cognition , Dendritic Spines/metabolism , Ischemic Attack, Transient , Microglia/metabolism
14.
Acta neurol. colomb ; 37(3): 139-144, jul.-set. 2021. graf
Article in Spanish | LILACS | ID: biblio-1345053

ABSTRACT

RESUMEN Se presenta un caso de ataque isquémico transitorio con sintomatología compatible con lesión de la circulación cerebral posterior, secundario a embolia aérea iatrogénica. Se describe la evolución clínica y las consideraciones más relevantes de la atención y el diagnóstico del ataque cerebrovascular de la circulación posterior. En cuanto a la embolia gaseosa, se describen los métodos diagnósticos, las intervenciones clínicas y las opciones de tratamiento disponibles.


SUMMARY Here ia a case of transient ischemic attack with symptoms compatible with injury to the posterior cerebral circulation, secondary to iatrogenic air embolism. Clinical evolution and the most relevant aspects for the care and diagnosis of cerebrovascular stroke of the posterior circulation are described. Regarding air embolism, the diagnostic methods, clinical interventions, and available treatment options are described.


Subject(s)
Minor Surgical Procedures , Ischemic Attack, Transient , Embolism, Air
15.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1390250

ABSTRACT

RESUMEN Presentamos caso de un varón de 39 años con antecedentes de varios accidentes isquémicos transitorios que siempre resolvieron rápida y espontáneamente. Fue sometido a varios estudios cardiovasculares, neurovasculares y de neuro y angioimagen que resultaron normales. El paciente se presentó a consulta con una paresia facio-braquial derecha y disartria. Sin embargo, el cuadro cedió en el transcurso de horas a pesar de manifestarse una isquemia en los estudios neurovasculares. Por todo lo anterior se decidió estudiar trombofilias presentándose el resultado de una mutación del gen G20210A de la protrombina. Al alta, en tratamiento con anticoagulantes orales, el paciente se presenta asintomático con monitoreo mensual continuo.


ABSTRACT We present the case of a 39-year-old man with a history of several transient ischemic attacks that always resolved quickly and spontaneously. He underwent several cardiovascular, neurovascular, and neuro and angioimaging studies that were normal. The patient presented for consultation with a right faciobrachial paresis and dysarthria. However, the condition subsided within hours despite ischemia manifested in neurovascular studies. For all the above, it was decided to study thrombophilias, finding the prothrombin G20210A mutation. Upon discharge, on treatment with oral anticoagulants, the patient is asymptomatic with continuous monthly monitoring.

16.
Rev. baiana saúde pública ; 45(1): 153-165, 20210101.
Article in Portuguese | LILACS | ID: biblio-1369742

ABSTRACT

Acidentes vasculares cerebrais ou isquêmicos transitórios são eventos raros em pacientes jovens sem fatores de risco clássicos, correspondendo muitas vezes a eventos não definidos etiologicamente e caracterizados como fenômenos tromboembólicos criptogênicos. A doença de Chagas é um fator de risco que deve ser considerado como potencial causa etiológica quando especificamos áreas endêmicas, tanto pelo conhecido mecanismo cardioembólico de acometimento cardíaco como pelas demais formas sem acometimento cardíaco, uma vez que já é descrita como fator de risco independente para doenças cerebrovasculares. Este estudo demonstra, por meio de um relato de caso, o desfecho de uma paciente portadora da doença de Chagas crônica, na forma indeterminada, sem fatores de risco clássicos. A paciente foi acometida por um ataque isquêmico transitório, tendo como etiologia presumida a doença de Chagas, que pode determinar um perfil pró-inflamatório e pró-coagulante, de modo a corroborar a tese de que o prognóstico da forma indeterminada pode não ser benigno. A associação entre a forma indeterminada e as doenças cerebrovasculares incorre na necessidade de anexar ao protocolo de investigação de acidente vascular encefálico (AVE) criptogênicos da doença de Chagas, quando se refere a áreas endêmicas, bem como em alertar as áreas da saúde para essa forma da doença, como forma de ajudar em medidas de prevenção de fenômenos tromboembólicos encefálicos.


Transient strokes or ischemic attacks are rare events in young patients without classic risk factors, often corresponding to events not defined etiologically and characterized as cryptogenic thromboembolic phenomena. Chagas disease is a risk factor that should be considered as a potential etiological cause when specifying endemic areas, both for the cardioembolic mechanism and for other forms without cardiac involvement, since it is described as an independent risk factor for cerebrovascular diseases. This study shows, by means of a case report, the outcome of a patient with chronic indeterminate Chagas disease without classic risk factors. The patient was affected by a transient ischemic attack, with the presumed etiology being Chagas disease, which can determinate a pro-inflammatory and pro-coagulant profile, thus corroborating that the prognosis of the indeterminate form may not be benign. The association between the indeterminate form and stroke incurs in the need to attach to the investigation protocol for cryptogenic stroke of Chagas disease, when referring to endemic areas, as well as to take a better look at this form to help in prevention measures for encephalic thromboembolic phenomena.


Los accidentes cerebrovasculares o accidentes isquémicos transitorios son eventos raros en pacientes jóvenes sin factores de riesgo clásicos, que a menudo corresponden a eventos no definidos etiológicamente caracterizándose como fenómenos tromboembólicos criptogénicos. La enfermedad de Chagas es un factor de riesgo que debe ser considerado como una posible causa etiológica cuando especificamos áreas endémicas, tanto por el conocido mecanismo cardioembólico de afectación cardíaca como por otras formas sin afectación cardíaca, puesto que la enfermedad ya está descrita como factor de riesgo independiente de enfermedades cerebrovasculares. Este estudio demuestra, a partir de un reporte de caso, el desenlace de un paciente con enfermedad de Chagas crónica en forma indeterminada sin factores de riesgo clásicos. La paciente sufrió un ataque isquémico transitorio, con la enfermedad de Chagas como presunta etiología, lo que puede determinar un perfil proinflamatorio y procoagulante, por lo que corroboró con la tesis de que el pronóstico de la forma indeterminada puede no ser tan benigno. La asociación entre la forma indeterminada y las enfermedades cerebrovasculares incurre en la necesidad de adjuntar la enfermedad de Chagas al protocolo de investigación de accidente cerebrovascular (ACV) criptogénico cuando se habla de áreas endémicas, así como de incrementar la visión de las áreas de salud a esta forma de enfermedad, para así contribuir con las medidas preventivas de los fenómenos tromboembólicos cerebrales.


Subject(s)
Ischemic Attack, Transient , Risk Factors , Chagas Disease , Stroke
17.
International Journal of Cerebrovascular Diseases ; (12): 666-670, 2021.
Article in Chinese | WPRIM | ID: wpr-907378

ABSTRACT

Objective:To investigate the correlation between metabolic syndrome (MetS) and early neurological deterioration (END) in patients with acute minor ischemic stroke (MIS) and high-risk transient ischemic attack (TIA).Methods:Consecutive patients with acute MIS or high-risk TIA admitted to the Second Affiliated Hospital of Xuzhou Medical University between May 2018 and June 2020 were enrolled prospectively. MIS was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤3, high-risk TIA was defined as ABCD 2 score ≥4, and END was defined as the highest score of NIHSS within 72 h after admission increased by ≥1 compared with the baseline. Multivariate logistic regression analysis was used to determine the correlation between MetS or its component and END. Results:A total of 145 patients with acute MIS or high-risk TIA were enrolled, including 66 males (45.5%), aged 68.28±9.71 years. Fifty-two patients (35.9%) met the diagnostic criteria of MetS, and 46 (31.7%) developed END. Univariate analysis showed that there were significant differences in age, sex, atrial fibrillation, elevated blood glucose, MetS, fasting blood glucose and C-reactive protein between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that MetS (odds ratio 2.637, 95% confidence interval 1.127-6.169) and high blood glucose (odds ratio 2.672, 95% confidence interval 1.052-6.789) were the independent risk factors for END within 72 h of admission in patients with acute MIS or high-risk TIA. Conclusion:MetS is significantly associated with END in patients with acute MIS or high-risk TIA.

18.
International Journal of Cerebrovascular Diseases ; (12): 514-520, 2021.
Article in Chinese | WPRIM | ID: wpr-907357

ABSTRACT

Patients with mild stroke and transient ischemic attack (TIA) have a high risk of early recurrence or deterioration. Antiplatelet therapy has been recognized to reduce the risk of ischemic vascular events. All guidelines recommend antiplatelet therapy for patients with ischemic stroke. Dual antiplatelet therapy (DAPT) refers to the application of two drugs with different mechanisms to block platelet aggregation and prevent thrombosis. There are many combinations of DAPT, and its safety and effectiveness are still uncertain. This article reviews the efficacy and safety of DAPT in patients with mild stroke and TIA.

19.
International Journal of Cerebrovascular Diseases ; (12): 426-431, 2021.
Article in Chinese | WPRIM | ID: wpr-907342

ABSTRACT

Objective:To investigate the clinical safety and efficacy of tirofiban in the treatment of hemiplegic stroke warning syndrome.Methods:Patients with hemiplegic stroke warning syndrome admitted to Jining First People's Hospital without receiving intravenous thrombolysis from January 2018 to May 2020 were enrolled retrospectively. Some patients were given tirofiban intravenous infusion for at least 24 h in acute phase, then received oral antiplatelet therapy (tirofiban group); some only received aspirin+ clopidogrel dual antiplatelet therapy (control group). The primary endpoint was muscle strength at the paralytic side and National Institutes of Health Stroke Scale (NIHSS) score at day 7 after onset. The secondary endpoint was the modified Rankin Scale (mRS) score at 3 months after onset, and ≤2 was defined as good clinical outcome. The safety endpoint was the bleeding events during treatment. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 30 patients with hemiplegic stroke warning syndrome were enrolled, including 19 (63.3%) in the tirofiban group and 11 (36.7%) in the control group. There was no significant difference in baseline clinical data between the two groups, and no drug-related bleeding complications occurred during treatment. The muscle strength at paralytic side and NIHSS score at day 7 after onset, NIHSS score at discharge and good clinical outcome rate at 3 months in the tirofiban group were significantly better than those in the control group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that tirofiban was an independent protective factor for good outcome after adjusting the NIHSS score at the beginning of treatment (odds ratio 0.040, 95% confidence interval 0.040-0.449; P=0.009). Conclusions:Tirofiban is safe and effective in the treatment of patients with hemiplegic stroke warning syndrome in acute phase. It can effectively block the progress of the disease, improve the outcome of patients, and will not increase the risk of bleeding.

20.
International Journal of Cerebrovascular Diseases ; (12): 926-930, 2021.
Article in Chinese | WPRIM | ID: wpr-929868

ABSTRACT

Capsule warning syndrome (CWS) is a special clinical subtype of transient ischemic attack involving internal capsule, no cortical involvement and showing stereotyped attack. Although CWS is rare in clinical practice, most patients have poor outcomes. Therefore, a comprehensive and in-depth understanding of CWS is helpful to improve the outcomes and quality of life of patients. This article reviews the recent research progress of CWS.

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