Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study / Incidência e desfecho funcional de AVC cardioembólico com e sem fibrilação atrial em Joinville, Brazil: estudo de base populacional

ABSTRACT Among ischemic strokes, cardioembolic (CE) stroke has the worst outcome. We measured the incidence of atrial fibrillation (AF) and non-AF related CE strokes, previous anticoagulant use, and the 90-day functional outcome. Using multiple overlapping sources, we included all CE strokes that occurred in 2015 in Joinville, Brazil. Of the 374 ischemic strokes, 23% (84) were CE. The CE age-adjusted incidence, per 1,000 person-years, was 0.14 (0.11–0.17). Of the 26 patients with known prior AF, 73% (19) were not anticoagulated, 77% (20) had a CHA2DS2VASc score ≥ 3 and 81% (21) had a HAS-BLED score < 3. After three months, approximately one third of those 26 patients died or became disabled. The incidence of CE stroke in our sample was lower than in other population-based studies. The opportunity for anticoagulation was missed in one third of cases.

RESUMO Entre todos os subtipos de AVC isquêmico, os eventos cardioembólicos (CE) apresentam os piores prognósticos. Determinamos a incidência de AVC isquêmico CE, associada ou não à fibrilação atrial (FA), o uso prévio de anticoagulantes e os desfechos funcionais em Joinville, Brasil. Utilizando múltiplas e sobrepostas fontes de informação, registramos todos os primeiros eventos CE ocorridos em 2015. Entre 374 eventos isquêmicos, 23% (84) foram CE. A incidência ajustada, para qualquer fonte cardioembólica, foi 0.14 (0.11–0.17) por 1000 pessoas-ano. Entre 26 pacientes com FA previamente conhecida, 73% (19) não estavam anticoagulados, 77% (20) tinham ≥ 3 pontos na escala CHA2DS2VASc e 81 % (21) < 3 pontos na escala HAS-BLED. Após 3 meses, um terço destes 26 pacientes morreram ou ficaram dependentes. A incidência de AVC I CE em Joinville é menor do que em outros estudos de base populacional. Um terço dos casos de AVC I CE com FA previamente conhecida perderam a oportunidade de anticoagulação.

Complicação após tratamento percutâneo de comunicação interatrial: migração de dispositivo Amplatzer® para bifurcação aórtica – relato de caso / Complication after percutaneous treatment of inter-atrial communication: Amplatzer© device migration to the aortic bifurcation – a case report

Com o uso crescente do dispositivo Amplatzer® para diversos procedimentos endovasculares, dentre os quais a comunicação interatrial, complicações decorrentes de seu uso vêm sendo descritas. Relatamos um caso em que o dispositivo foi empregado para correção de comunicação interatrial e, seis meses depois, migrou para a bifurcação da aorta abdominal. A retirada do corpo estranho foi realizada por cirurgia convencional, após insucesso de tentativa por via endovascular.

Complications arising from use of the Amplatzer© device to correct endovascular conditions such as atrial septal defect have been described with increasingly frequency. We report on a case in which this device was used to correct an atrial septal defect, but 6 months later migrated to the abdominal aorta bifurcation. Removal of the foreign body was accomplished by conventional surgery after an endovascular attempt had failed.

La combinación de atorvastatina y meloxicam inhibe la neuroinflamación y atenúa el daño celular en la isquemia cerebral experimental por embolia arterial / Atorvastatin-meloxicam association inhibits neuroinflammation and attenuates the cellular damage in cerebral ischemia by arterial embolism.

Introducción. El accidente cerebrovascular es la segunda causa de muerte y la primera de discapacidad en el mundo, y más de 85 % es de origen isquémico. Objetivo. Evaluar en un modelo de infarto cerebral por embolia arterial el efecto de la atorvastatina y el meloxicam, administrados por separado y de forma conjunta, sobre la respuesta neuronal, los astrocitos y la microglia. Materiales y métodos. Se sometieron ratas Wistar a embolia de la arteria carótida y a tratamiento con meloxicam y atorvastatina, administrados por separado y conjuntamente, a las 6, 24, 48 y 72 horas. Se evaluó la reacción de las proteínas COX-2, GFAP y OX-42 en las neuronas, los astrocitos y la microglia mediante inmunohistoquímica y estudios morfológicos y de densitometría. Los datos obtenidos se evaluaron por medio de un análisis de varianza y de pruebas no paramétricas de comparación múltiple. Resultados. La isquemia cerebral por embolia arterial incrementó significativamente (p<0,001) la reacción de los astrocitos y la microglia, en tanto que la atorvastatina y el meloxicam, administrados por separado y de forma conjunta, la redujeron. La isquemia produjo acortamiento de las proyecciones de los astrocitos, engrosamiento celular, ruptura de las expansiones protoplásmicas (clasmatodendrosis) y cambios morfológicos en la microglia propios de diversas etapas de actividad. En las zonas circundantes del foco se incrementó la reacción inmunológica de la COX-2 y se redujo en el foco isquémico, en tanto que el meloxicam y la atorvastatina redujeron significativamente (p<0,001) la reacción inmunológica en la zona circundante del foco, restableciendo la marcación de la ciclooxigenasa en el foco isquémico. Conclusión. La combinación de meloxicam y atorvastatina atenúa la respuesta de los astrocitos y la microglia en el proceso inflamatorio posterior a la isquemia cerebral por embolia arterial, reduciendo la degeneración neuronal y restableciendo el equilibrio morfológico y funcional del tejido nervioso.

Introduction: Stroke is the second leading cause of death and the first cause of disability in the world, with more than 85% of the cases having ischemic origin. Objective: To evaluate in an embolism model of stroke the effect of atorvastatin and meloxicam on neurons, astrocytes and microglia. This evaluation was done administering each medication individually and in association. Materials and methods: Wistar rats were subjected to carotid arterial embolism and treatment with meloxicam and atorvastatin at 6, 24, 48 and 72 hours. Using immunohistochemistry, we evaluated the immunoreactivity of COX-2 protein, GFAP and OX-42 in neurons, astrocytes and microglia by densitometric and morphological studies. Data were evaluated by variance analysis and non-parametric multiple comparison. Results: Cerebral ischemia by arterial embolism increased significantly the reactivity of microglia and astrocytes (p<0.001), whereas it was reduced by atorvastatin, meloxicam and their association. Ischemia produced astrocytic shortening, cellular thickening, protoplasmic rupture expansions (clasmatodendrosis) and microglial morphological changes characteristic of various activity stages. In perifocal areas, immunoreactivity of COX-2 was increased and in the ischemic focus it was reduced, while meloxicam and atorvastatin significantly reduced (p<0.001) perifocal immunoreactivity, restoring the marking of cyclooxygenase in the ischemic focus. Conclusion: These results suggest that the meloxicam-atorvastatin association attenuates astrocytic and microglial response in the inflammatory process after cerebral ischemia by arterial embolism, reducing neurodegeneration and restoring the morphological and functional balance of nervous tissue .

Perfil clínico epidemiológico de pacientes con accidente cerebrovascular en el Instituto Hondureño de Seguridad Social / Clinical and epidemiological profile of patients with stroke at The Honduran Social Security Institute

Introducción: En Honduras los accidentes cerebro vasculares (ACV) son la octava causa de muerte a nivel nacional y cuarta causa de muerte en hospitales estatales. Es la primera causa neurológica de ingresos en el Hospital Escuela. El objetivo del estudio fue determinar el perfil clínico epidemiológico de los pacientes con ACV atendidos en el Instituto Hondureño de Seguridad Social (IHSS) en Tegucigalpa. Pacientes y métodos: Se realizó un estudio transversal descriptivo incluyendo a 56 pacientes con diagnóstico de ACV durante el período enero a diciembre del año 2006. Resultados. Predominó el ACV isquémico (68%). Los hombres sufrieron ACV de tipo hemorrágico más que las mujeres (34% vs. 25% respectivamente). La hipertensión arterial fue el antecedente de riesgo predominante (66%, 37/56), seguido de la diabetes mellitus (26.7%, 15/56). El 55% de las mujeres y el 36% de los hombres habían presentado un ACV previo. Discusión. Los resultados muestran que el principal factor de riesgo para ACV en pacientes del IHSS continúa siendo la hipertensión arterial, predominando el ECV Isquémico. Los pacientes requirieron ser atendidos en diversas unidades de tratamiento hospitalario...

Terapia de recanalização endovascular de oclusão da artéria carótida em paciente com acidente vascular cerebral agudo / Percutaneous recanalization of carotid artery occlusion in patient with and acute stroke

Relatamos o caso de uma paciente de 69 anos, que, após a realização de arteriografia carotídea apresentou trombose sintomática da bifurcação carotídea. A paciente foi submetida imediatamente a reperfusão endovascular mecânica, com implante bem-sucedido de stent carotídeo, obtendo reversão completa do déficit neurológivo.

A 69 year-old woman developed symptomatic internal carotid artery thrombosis after carotid angiography. She was immediately submitted to mechanical endovascular reperfusion with successful carotid stent implantation and complete neurological recovery.

Cognitive dysfunction in congestive heart failure: transcranial Doppler evidence of microembolic etiology

Sintomas cognitivos são comuns em pacientes com insuficiência cardíaca congestiva (ICC) e são geralmente atribuídos a um regime de baixo fluxo sanguíneo cerebral. Neste estudo, objetivamos avaliar a função cognitiva global (Mini Exame do Estado Mental MEEM) em pacientes com ICC e sua relação com o grau de disfunção cardíaca (avaliada pelo ecocardiograma) e a hemodinâmica cerebral (avaliada pelo Doppler transcraniano DTC). Em 83 pacientes estudados, nenhuma correlação foi encontrada entre a pontuação no MEEM e parâmetros ecocardiográficos. Em contraste, uma correlação significativa foi encontrada entre a velocidade média na artéria cerebral média direita (ACMD) e a pontuação no MEEM (r=0,231 p=0,039), assim como entre o índice de pulsatilidade na ACMD e a pontuação no MEEM (rs=–0,292 p=0,015). Após excluir pacientes com histórico prévio de acidente vascular encefálico, somente o índice de pulsatilidade na ACMD manteve uma correlação com a pontuação no MEEM (rs=–0,314 p=0,007). A relação entre maior resistência vascular cerebral e pior desempenho cognitivo sugere que microembolia pode ser responsável por uma proporção significativa de sintomas cognitivos em pacientes com ICC.

Percutaneous transluminal angioplasty in an embolic middle cerebral artery occlusion.

A young lady developed left middle cerebral artery embolism after percutaneous transseptal mitral commissurotomy. She was successfully treated with immediate percutaneous transluminal angioplasty. There was complete recovery of neurological deficit.

Endocarditis infecciosa: complicaciones neurológicas / Infectious endocarditis: neurologic complications

A pesar de los diferentes cambios que ha experimentado la Endocarditis Infecciosa (EI) con los años, los adelantos tecnológicos y la antibioterapia, las complicaciones neurológicas han continuado más o menos igual en el tiempo. Ellas se revisan extensamente en esta publicación, enfatizando la clínica, métodos de exploración y terapéutica actualizada.

The isoprenoid pathway in lone atrial fibrillation with embolic stroke.

BACKGROUND: The isoprenoid pathway was assessed and compared in patients of lone atrial fibrillation with embolic stroke as well as in patients with right hemispheric, left hemispheric and bihemispheric dominance to determine the role of hemispheric dominance in its pathogenesis. METHODS AND RESULTS: The activities of hydroxyl methyl glutaryl-CoA reductase and RBC sodium-potasium ATPase as well as serum levels of plasma magnesium, digoxin, dolichol and ubiquinone were measured. The tyrosine/tryptophan catabolic patterns, glycoconjugate metabolism, free radical metabolism and RBC membrane composition were also assessed. In patients with lone atrial fibrillation with embolic stroke, there was elevated digoxin synthesis, increased dolichol and glycoconjugate levels, and low ubiquinone and elevated free radical levels. There was also an increase in tryptophan catabolites and a reduction in tyrosine catabolites: and an increase in the cholesterol: phospholipid ratio with a reduction in the glycoconjugate levels of the RBC membrane. The same biochemical patterns were obtained in individuals with right hemispheric dominance whereas the patterns were reversed in patients with left hemispheric dominance. CONCLUSIONS: Lone atrial fibrillation with embolic stroke is associated with an upregulated isoprenoid pathway and elevated digoxin secretion from the hypothalamus. This occurs in right hemisphere-dominant individuals.

Mumps hemiplegia.

Neurological involvement of mumps is commonly restricted to aseptic meningitis. However, rarely mumps is associated with more severe encephalitic illness; other known associations described with mumps are cases of transverse myelitis and Gullain Barre like illness. We report a case of hemiplegia due to mumps parotitis probably caused by involvement of carotid artery.