[Assessing the prevalence of intra-and-extra cranial arteries stenosis in diabetic patients with hypertension by transcranial doppler sonography]

Stroke is one of the most common causes of mortality and morbidity worldwide. In addition to the effects of some risk factors like old age, hypertension, hyperlipidemia and smoking, the prevalence of this disorder is twice as high in diabetic as compared to nondiabetic patients. The purpose of this survey to detect asymptomatic intracranial stenosis and to determine its risk factors in hypertensive diabetic patients aged over 50 years using Transcranial Doppler Sonography[TCD]. Diabetic patients aged over 50 years with hypertension and no previous history of cerebrovascular problems were invited, and initially a questionnaire on demographic information, smoking, history of hyperlipidemia, duration of diabetes and hypertension and physical exams was completed. Then evaluation of peak systolic flow velocity [PSV] in middle cerebral [MCA] internal carotid [ICA] and vertebral arteries [VA] was done by TCD, PSV >/= 120 cm/sec for MCA and ICA and PSV >/= 100 cm/sec for VA over 50% stenosis of arterial wall diameter was classified [defined] as significant stenosis,. Student t test, analyze of variance and non parametric tests were used for data analysis. Overall 108 patients with mean age 62.51 +/- 7.90 years were studied, of which 22 [20.3%] patients [11male, 11 female] had stenosis and 34 [31.4%] stenotic arteries were also detected; 7 out of 22 patients [32%] had multiple stenosis. Mean durations of hypertension in these two groups were 5.36 +/- 1/7and 3.07 +/- 0.39 years respectively [P = NS], and mean durations of diabetes were 14.09 +/- 1/8 and 8.15 +/- 0/72 years respectively [P< 0.01]. Of 22 [41%], 9 had hyperlipidemia, with 6 of them having multiple involvement, whereas only 1 out of 13 patients without hyperlipidemia had multiple stenosis. [P<0/003]. More than 20% of our patients had significant but asymptomatic cerebral artery stenosis; 30% of patients had multiple artery Involvement. There was no relation between occurence of stenosis and age, sex or duration of hypertension, but there was a significant relation between prevalence and multiplicity of stenoses and the duration of diabetes and also the presence of hyperlipidemia. Periodic evaluation of cranial vessels hence, in aged diabetic patients with risk factors of atherosclerosis using TCD is recommended

Meta-análisis neuroepidemiológico sobre síndromes agudos vasculares encefálicos (S.A.V.E.) del circuito posterior de un hospital general de la ciudad de Córdoba / Acute vasculoencephalic syndrome of the posterior circuit: neuroepidemiological metha-analysis in a General Hospital of Córdoba city

Este trabajo neuroepidemiológico se llevó a cabo en un grupo de pacientes diagnosticados en forma fehaciente como afecciones vasculares del encéfalo y del circuito Vértebro Basilar Cerebral Posterior. nuestro pacientes nos han permitido construir una visión ampliada del perfil clínico en relación a la topografía lesional y a los mecanismos fisiopatogénicos. Y no nos ajustamos sólo a lo prescripto en 1975 por el comité Ad Hoc. Nuestra propuesta ampliatoria se basa en considerar al circuito posterior sobre un eje que comprenda a las arterias Vertebral - Basilar - Cerebral posterior y bajo el concepto de las manifestaciones clínicas fundadas en las definiciones del Comité Ad Hoc para Stroke y los datos que se agregaron al integrar a la arteria Cerebral Posterior. La estrategia del Meta-análisis nos ha permitido desarrollar la idea de la importancia que poseen signos o síntomas CENTINELAS o de SOSPECHA en un grupo etareo de alto riesgo por ser gerontes y portadores de cardiopatías embolígenas, hipertensión arterial, dislipemias y/o diabetes. Descubrir a sospechosos con datos subclínicos o pausisintomáticos, dentro del perfil de sindromes vasculares agudos o crónicos y enmarcados en una filosofía que priorice el diagnóstico temprano para evitar la lesión estructural incapacitante, redundará en una más alta calidad de vida para el geronte y un mejor control sanitario para la tercera edad