Trombolisis endovenosa post reversión de acenocumarol con complejo de protrombina: caso clínico / Intravenous thrombolysis after reversion of acenocoumarol anticoagulation: report of one case

We report an 89-year-old male under oral anticoagulant therapy with a therapeutic international normalized ratio, presenting at the emergency room with right side hemiparesis and aphasia. Neuroimaging was compatible with an acute middle cerebral artery ischemic stroke. Anticoagulation was reverted with the use of four factor prothrombin complex, followed by thrombolysis with alteplase, with a favorable evolution, returning to his basal functional status.

Accidente cerebrovascular embólico secundario a fibroelastoma papilar de válvula mitral / Embolic stroke secondary to a mitral valve fibroelastoma: case report

Embolic stroke secondary to cardiac tumors is uncommon. However, 25-30% of cardiac tumors may cause systemic emboli. We report a 29-year-old male consulting for a sudden episode of aphasia and right hemiparesis, compatible with infarct of the left middle cerebral artery territory. Transthoracic echocardiography reported an ovoid tumor of 8 × 7 × 7 mm in relation to the sub valvular apparatus of the mitral valve. After neurologic stabilization, surgical treatment was performed. Approached by median sternotomy and in cardiopulmonary bypass, the mitral valve was explored. A macroscopic tumor consistent with a papillary fibroelastoma curled in sub valvular chordae was found. It was deployed and resected from its base, while the anterior mitral leaflet was preserved intact. Histopathological examination confirmed the intraoperative macroscopic diagnosis. The patient recovered uneventfully postoperatively and was discharged on the fifth day after surgery. He currently is in functional capacity I without cardiovascular symptoms at five years follow-up.

La enfermedad periodontal, ¿un factor de riesgo más para el infarto cerebral isquémico aterotrombótico? / Periodontal disease, is it one more risk factor for atherothrombotic ischemic stroke?

De forma compactada se explica la relación biológicamente plausible que existe entre la aparición de accidentes cerebrovasculares, particularmente de infarto cerebral isquémico aterotrombótico y la precedencia de enfermedad periodontal inmuno-inflamatoria crónica. Se sugiere la necesidad de estudios que vinculen ambas entidades para conciliar los resultados de las investigaciones internacionales con las realizadas en nuestro medio. Se propone el análisis del estado periodontal en los pacientes pertenecientes a grupos de riesgo o víctimas de enfermedades cerebrovasculares. La consideración de la enfermedad periodontal inmuno-inflamatoria crónica como un factor de riesgo más para el infarto cerebral isquémico aterotrombótico, debe pasar de una interrogante a una estrategia(AU)

The biologically plausible relation existing between the occurrence of cerebrovascular accidents, particularly of atherothrombotic ischemic stroke, and the presence of chronic immunoinflammatory periodontal disease is explained in a compacted way. The need for studies linking both entities is suggested for conciliating the results of the international researches with those carried out in our environment. The analysis of the periodontal state in patients from risk groups of victims on cerebrovascular disease is proposed. Considering the chronic immunoinflammatory periodontal disease as a risk factor for atherothrombotic ischemic stroke should pass from a question to a strategy(AU)

Stroke associated with left atrial mass: Association of cerebral aneurysm with left atrial myxoma.

Association of LA myxoma with cerebral aneurysm is rare. We describe a patient who had LA mass and cerebral aneurysm and developed stroke. The patient underwent clipping of the cerebral aneurysm. We discuss the pathology of the association and the anesthetic management.

Infarto maligno cerebral e craniectomia descompressiva: revisão da literatura / Massive cerebral infarction and decompressive craniectomy: literature review

O infarto maligno da artéria cerebral média é definido como a ocorrência de edema cerebral intenso, circunjacente à área de um infarto extenso.O edema pode causar deterioração da consciência, aumentar a pressão intracraniana,provocar desvio das estruturas da linha média e, finalmente,herniação cerebral e morte.Indivíduos que desenvolvem acidente vascular cerebral isquêmico maligno representam de 1 por cento a 10 por cento dos casos de isquemia cerebral supratentorial. A história natural dessa doença segue um curso previsível na maior parte dos casos,chegando a apresentar uma mortalidade de até 80 por cento quando tratados clinicamente. Os sobreviventes são incapacitados e afligidos por graves seqüelas neurológicas,tornando-se dependentes de cuidados e acamados.A craniectomia descompressiva tem evidenciado resultados animadores, com redução na mortalidade para níveis que variam de 16 por cento a 42 por cento e uma melhor qualidade de vida aos sobreviventes.A presente revisão da literatura tem como principal objetivo caracterizar, de forma prática, o acidente vascular cerebral maligno - epidemiologia,etiologia,apresentação clínica,história natural da doença,medidas terapêuticase prognóstico- bem como buscar embasamento científico à indicação de hemicraniectomia descompressiva.

Aneurisma micótico abdominal e embolia cerebral associados à endocardite infecciosa em paciente com doença valvar reumática crônica / Abdominal mycotic aneurysm and cerebral embolic event associated with infective endocarditis in a patient with chronic rheumatic valvar disease

Relatamos o caso de uma menina com doença valvar crônica devido à febre reumática que apresentou endocardite infecciosa e duas complicações: acidente vascular cerebral devido à embolia e aneurisma micótico da artéria mesentérica superior.

We report the case of a girl with chronic rheumatic valvar heart disease who developed infeccious endocarditis and two complications, ischemic stroke due to cerebral embolic event and mycotic aneurysm of the superior mesenteric artery.

Disección traumática de la arteria carótida interna extracraneal con infarto en el territorio de la arteria cerebral media: diagnóstico por imagen / Traumatic dissection of extracranial internal carotid artery with middle cerebral artery stroke: imaging diagnosis

La disección de la arteria carótida interna (DACI) en su porción extracraneal es más común en adultos jóvenes, con edad de presentación promedio de 44 años y representa hasta 20% de los accidentes vasculares cerebrales en menores de 30. Algunos casos de DACI son de difícil diagnóstico, si se basan únicamente en la clínica y la exploración física; aunado a este hecho, los métodos de imagen como la tomografía computada (TC) helicoidal o multicorte así como la resonancia magnética (RM) pueden no ser suficientes para delinear la patología en cuestión. Presentamos el caso de un paciente masculino de 18 años, quien sufrió accidente automovilístico, sin pérdida del estado de alerta, 18 horas después del accidente presenta deterioro súbito del estado de conciencia, fue trasladado al hospital. La TC identificó una lesión hipodensa en el territorio de la arteria cerebral media izquierda, e hiperdensidad de esta arteria en la fase simple. Se realizó una angiografía cerebral diagnóstica, que mostró DACI izquierda en su segmento C1. Desde el punto de vista clínico-quirúrgico es importante sospechar esta patología en un paciente “asintomático” en las primeras horas postraumatismo y que posteriormente desarrolla déficit neurológico. La sospecha clínica y su comprobación radiológica permiten un tratamiento neuroquirúrgico-vascular para intentar el rescate del tejido cerebral viable en las primeras horas de establecido el daño.

Cervical carotid artery dissections (CCAD) are common in young adults with a mean age of 44 years and may account for as many as 20% of strokes in patients younger than 30 years. Trauma and primary diseases of the arterial wall such as fibromuscular dysplasia are the main predisposing factors. Some CCAD cases are diagnosed solely on clinical history and physical examination, and even imaging tools such as helical/multi-slice computed tomography (CT) and magnetic resonance imaging (MRI) sometimes are not sufficient to reach a diagnosis. We describe the case of an 18-year-old male who presented to our emergency department due to loss of consciousness 18 hours after a car accident. Previously he had been in no acute distress, with fluent speech, and able to follow 3-step commands. Helical CT showed a hypodense lesion in the left-middle cerebral artery territory, as well as hyperdensity of the M1 segment of the middle cerebral artery. Cerebral angiography depicted the left carotid artery dissection in the C1 segment. Physicians should consider this entity in [quot ]asymptomatic[quot ] patients during their first hours after head injury, among patients who later develop focal neurological symptoms and clinical deficits. Clinical suspicion followed by radiological findings allows early neurovascular treatment, trying to save viable brain tissue in the first hours post injury.

Hemiconvulsion, hemiplegia, epilepsy syndrome and inherited protein S deficiency.

A nine-year-old Nepalese girl developed hemiconvulsion, hemiplegia, epilepsy syndrome (HHE syndrome) after an episode of right-sided focal status epilepticus following acute gastroenteritis. She had left middle cerebral artery (MCA) territory infracts due to inherited protein S deficiency.

Infarto maligno de la arteria cerebral media en una paciente con meningitis bacteriana / Malignant infarct of the middle cerebral artery in a patient with bacterial meningitis

The mortality of acute bacterial meningitis (BM) has remained stable in the last decades in spite of the use of new antibiotics, probably due to vascular complications. We report a 68-year-old woman with BM who had a malignant infarction of left middle cerebral artery territory 72 hours after admission to the hospital. The patient experienced a bad evolution and died four days after admission. The arterial involvement in patients with BM is explained by vasospasm of large arteries and vasculitis of small arteries. The medical treatment of a malignant middle cerebral artery infarct has a high mortality.

A Case of Cerebral Infarct in Combined Antiphospholipid Antibody and Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome is a serious complication of ovulation induction and has a diverse clinical spectrum from edema to thromboembolism. Antiphospholipid antibody syndrome, one of the well known hypercoagulable states, can be also manifested as an arterial or venous thrombosis and recurrent spontaneous abortion. Sometimes a patient with antiphospholipid antibodies might not notice a miscarriage and seek for assisted reproduction treatment, which harbors a chance of developing ovarian hyperstimulation syndrome. If this happens, the ovarian hyperstimulation syndrome can exacerbate the thrombotic complication of underlying antiphospholipid antibody syndrome, resulting in a catastrophic vascular event. The authors experienced a case of middle cerebral artery infarct, which developed during ovarian hyperstimulation syndrome in a 33-yr-old woman with a previous history of fetal loss. An elevated titer of anticardiolipin antibodies was noticed and persisted thereafter. The authors suggest screening tests for the presence of antiphospholipid antibodies before controlled ovarian hyperstimulation.