Infarto cerebeloso en el puerperio inmediato / Cerebella infarction in the immediate puerperium

La enfermedad cerebrovascular durante la gestación es rara. El presente trabajo tiene como objetivo describir las características clínicas de una paciente con embolismos de la arteria humeral derecha y tallo encefálico en el periodo expulsivo de un parto eutócico sin foco embolígeno causante de dicho accidente cerebrovascular. Se presenta el caso de una parturienta de 29 años con 40,2 semanas de edad gestacional que durante el periodo expulsivo de un parto eutócico comenzó a presentar dolor intenso en el miembro superior derecho con cambios de coloración y temperatura e impotencia funcional, imposibilidad para la apertura palpebral bilateral, vómitos sin náuseas, disartria y dificultad en los movimientos oculares...

The cerebrovascular disease during pregnancy is uncommon. The objective of present paper is to describe the clinical features of a patient with embolisms of the right humeral artery and of the brainstem at expulsion period of a spontaneous labor without emboligen focus causing this cerebrovascular accident...

Puerperal cerebral venous thrombosis: therapeutic benefit of low dose heparin.

Advances in imageology have improved the diagnostic yield of cerebral venous/sinus thrombosis (CVT). However, its management remains a challenge. The present study was carried out to study the role of heparin in CVT. Therapeutic outcome of 150 patients of puerperal CVT manifesting within one month of delivery or abortion, was analyzed. The diagnosis was supported by cranial computed tomography and/or angiography whenever required. Seventy three patients, 46 with non-haemorrhagic infarction and 27 with haemorrhagic infarction, received 2500 units of subcutaneous heparin, three times a day within 24 hours of hospitalization till 30th post partum day or symptomatic relief. Seventy seven patients during the same period, 50 with non-haemorrhagic infarction and 27 with haemorrhagic infarction, who did not receive heparin formed the control group. Repeat CT scans were done when indicated. Among the heparin group, 34 patients made full recovery. There were eight deaths, all among the patients with haemorrhagic lesion. In control group, only 14 patients recovered completely (P=<0.001) and 18 died (P=<0.001). There were no adverse effects of heparin. Low dose heparin is safe and efficacious in puerperal CVT, even in patients with haemorrhagic infarction.

Tratamiento trombolítico del accidente cerebrovascular isquémico / Thrombolytic treatment in acute ischemic strocke

Se presenta un caso de accidente cerebrovascular isquémico agudo, rápidamente progresivo, con afectación neurológica muy severa que mejora dramáticamente luego de la infusión de Estreptoquinasa sistémica. Nueve días más tarde repite accidente cerebrovascular en territorio similar al amenazado originalmente y luego fallece. Hay evidencia experimental y clínica sobre la utilidad de los trombolíticos en el accidente cerebrovascular. Se están desarrollando en este momento numerosos estudios para corroborarlo. Se discute la posible utilización de trombolíticos en un restringido grupo de Stroke grave progresivo

The thrombolytic effect of lumbrokinase is not as potent as urokinase in a rabbit cerebral embolism model

The purpose of the present study is to determine whether lumbrokinase has an in vivo thrombolytic effect in a rabbit cerebral embolism model. In our previous studies, we found that lumbrokinase, an extract from Korean earth worms, has a strong in vitro fibrinolytic effect without the presence of plasminogen and significant in vivo thrombolytic effects of lumbrokinase in a rat human-clot-induced cerebral embolism model. We established the cerebral embolism model in rabbits by injecting a piece of human clot into the internal carotid artery via the external carotid artery and confirmed the occlusion with angiography. Twenty one rabbits were divided into three groups and 5cc of saline, urokinase of 50,000 u/ml, and equipotent LK were injected intraarterially for 30 minutes into each group of 7 animals. Ten minutes after the end of infusion, an angiogram was performed to confirm the recanalization. Clot lysis occurred in one, six, and one animals in the saline, urokinase and lumbrokinase treated groups respectively. With regard to its in vitro effect, lumbrokinase is not as potent in vivo. Further investigation should be performed to determine the cause of its weakened in vivo effect and to develop a method to potentiate it.

Prostaglandins in thrombotic hemiplegia

Prostaglandins may act as local mediators of cellular action in initiating arterial thrombosis, leading to a wide variety of functional changes. This work was carried out to estimate PGE levels in noncomplicated thrombotic hemiplegic patients. There were 15 patients and 20 healthy adults as controls. For each case, clinical examination was carried out together with CT brain, blood cholesterol, triglycerides, total lipids and serum PGE estimated by radioimmunoassay. PGE was shown to be significantly higher in thrombotic hemiplegic group than in the control group, with no statistical significant difference in serum cholesterol triglycerides and total lipids between the two groups. This denotes that PGE acts as a mediator in the thrombotic process in these patients

Low dose aspirin and its antithrombotic effect in ischaemic stroke patient.

The investigators conducted a study of low dose aspirin and antithrombotic effectiveness in ischaemic strokes at Siriraj hospital Medical School, Mahidol University from July 1986 to June 1987. Thirty-six patients, 27 males and 9 females were enrolled in the study. The ages of the patients ranged from 33 to 80 years with a mean age of 55 +/- 12 years. Forty-seven per cent of patients had hyperfunction of platelet before treatment which fell to 3 and 0 per cent 24 hours and 7 days after low dose aspirin treatment (75 mg/d). The platelet count was significantly increased to compensate its hypofunction after seven days of treatment. There was no change in euglobulin lysis time, serotonin level in platelet after low dose aspirin treatment. Plasma prostacyclin in ischaemic stroke patients was statistically significantly reduced in comparison to normal subjects (223.8 pg/ml); but there was no further suppression of plasma prostacyclin after low dose aspirin therapy. Thus, we conclude that low dose aspirin (75 mg/d) is effective for antithrombotic effect in ischaemic stroke patients without any suppression of prostacyclin. We do recommend low dose aspirin for recurrent ischaemic stroke prophylaxis as it has fewer side effects, is cheap, easily administered and effective.

Lys-plasminógeno / Lys-plasminogen

Los fibrinolíticos (Estreptoquinasa y Uroquinasa) transforman el plasminógeno circulante en plasmina pero actúan poco sobre la fibrina de los trombos. El lys-plasminógeno de origen placentario se fija a la fibrina de los trombos, de modo que al ser activado por los fibrinolíticos promueve la trombólisis y la disolución de los coágulos. con ello se abren nuevas perspectivas a la terapia fibrinolítica en la enfermedad tromboembólica; las obstrucciones arteriales agudas de las extremidades inferiores y en las trombosis coronarias y cerebrales