Consenso sobre accidente cerebrovascular isquémico agudo / Consensus on acute ischemic stroke

El accidente cerebrovascular es la tercera causa de muerte y la primera de discapacidad en la Argentina. Los eventos isquémicos constituyen el 80% de los casos. Los accidentes vasculares cerebrales requieren la implementación de protocolos sistematizados que permitan reducir los tiempos en la atención, la morbilidad y mortalidad. En el consenso participaron especialistas de nueve sociedades médicas relacionadas con la atención de pacientes con enfermedad cerebrovascular. Se consensuó un temario separado en capítulos y para la redacción de los mismos se conformaron grupos de trabajo con miembros de diferentes especialidades médicas. Se discutió y acordó para cada tema el nivel de recomendación en base a la mejor evidencia clínica disponible para cada tópico. Se realizó una adaptación al ámbito local de las recomendaciones cuando se consideró necesario. El sistema de la American Heart Association se utilizó para redactar las recomendaciones y su grado de evidencia. La corrección y edición fue realizada por cinco revisores externos, que no participaron en la redacción y con amplia experiencia en enfermedad vascular. Finalizado el documento preliminar, se organizó una reunión general con todos los integrantes de los grupos de trabajo y los revisores para redactar las recomendaciones definitivas. El consenso abarca la atención del paciente con accidente cerebrovascular isquémico en la fase pre-hospitalaria, evaluación inicial en la central de emergencias, terapias de recanalización (trombolisis y/o trombectomía mecánica), craniectomía descompresiva, neuroimágenes y cuidados clínicos en la internación.

Stroke is the third cause of death and the first cause of disability in Argentina. Ischemic events constitute 80% of cases. It requires the implementation of systematized protocols that allow reducing the time of care, morbidity and mortality. Specialists from nine medical societies related to the care of patients with cerebrovascular disease participated in the consensus. A separate agenda was agreed upon in chapters and for the writing of them, work groups were formed with members of different medical specialties. The level of recommendation was discussed and agreed upon for each topic based on the best clinical evidence available for each of them. An adaptation to the local scope of the recommendations was made when it was considered necessary.The American Heart Association system was used to draft the recommendations and their level of evidence. The correction and editing were done by five external reviewers, who did not participate in the writing and with extensive experience in vascular pathology. Once the preliminary document was finalized, a general meeting was held with all the members of the working groups and the reviewers to reach final recommendations. The consensus covers the management of ischemic stroke in the pre-hospital phase, initial evaluation in the emergency center, recanalization therapies (thrombolysis and/ or mechanical thrombectomy), decompressive craniectomy, neuroimaging and clinical care in the hospital.

Association between homocysteine and cerebral infarction / 中国康复理论与实践

@#ObjectiveTo investigate the association between homocysteine and cerebral infarction, as well as between different subtypes of cerebral infarction.Methods105 cases with cerebral infarction were divided into two subgroups, according to TOAST criteria, large-artery disease and small-artery disease.In addition,50 normal persons were selected as control group.Fasting blood samples were drawn from antecubital vein for measurement of plasma total homocysteine,glucose and lipids.Enzyme conversion immunoassay was applied to detect plasma total homocysteine (tHcy) levels.ResultsThe mean tHcy of cerebral infarction, which was (24.85±24.56) μmol/L, was significantly higher than that of control group, which was (16.18±6.97) μmol/L(P<0.05).There was a significant difference of homocysteine between large-artery disease,which was (30.46±31.16) μmol/L, and small-artery disease,which was (18.43±10.73) μmol/L,or the control group(P<0.05),but there was no significant difference between small-artery disease and the control group. ConclusionThe mean tHcy significantly elevated in large-artery disease,which indicated that elevated plasma homocysteine levels is an independent risk factor for atherosclerotic vascular disease.

Fibromuscular Dysplasia with Cerebral Infarction in a Child: Case Report

An 11-year-old child presented with left hemiparesis and a seizure caused by fibromuscular dysplasia of the right internal carotid artery with cerebral infarction is presented. On conventional angiography, the authors found the classical `beaded' lesions. These pathognomic changes were most important to diagnosis. On brain single-photon emission computed tomography, we found the impaired vascular reserve of right basal ganglia, frontal and temporal area. We tried an antiplatelet agent and an encephaloduroarterio-synangiosis on the right hemisphere.

Changes of adhesion molecules in peripheral blood in patients with recurrent cerebral infarction / 第二军医大学学报

Objective: To investigate the changes of adhesion molecules in peripheral blood in patients with recurrent cerebral infarction. Methods: By cytometry and enzyme-linked immunosorbent assay, the expression of integrin Mac-1 ?-sub-unit(CD18) ,intercellular adhesion molecule-3(CD50) intercellular adhesion molecule-1 (CD54) ,very late antigen-4 ?-subunit and p-subunit(CD49d and CD29),CD44 and L-selectin(CD62L) in lymphocyte,the expression of platelet membrane glycopro-tein I b- I a complex a-subunit (CD41), P-selectin (CI)62p) ,the serum level of soluble P-selectin(sP-selectin) and soluble intercellular adhesion molecule-1 (sICAM-1) were measured in 33 recurrent cerebral infarction patients and 44 patients with previous ever-single cerebral infarction history. Results: Compared with previous ever-single cerebral infarction history patients, the positive percentage of CD18,CD50,CD54 ,CD49d,CD29,CD44 and CD62L in lymphocytes ,CD41 on platelet did not significantly change,while the positive percentage of CD62p on platelet and the level sP-selectin,sICAM-1 were significantly higher (P