Características de la enfermedad cerebrovascular en un Servicio de Cuidados Intermedios Neurológicos, en Chile. Análisis de 459 pacientes consecutivos / Cerebrovascular disease in a Neurologic Intermediate Care Unit in Chile. Analysis of 459 consecutive patients

Background: Stroke is the second cause of mortality and the first cause of morbidity in Chile and worldwide. Nowadays there is a major interest in introducing new therapies applying evidence based medicine for these patients. Aim: To describe the clinical profile of patients attended after a stroke, to determine stroke subtypes and their risk factors. Material and methods: Retrospective review of clinical records of 459 patients (mean age 65±48 years, 238 female) that were admitted to our unit during a period of 37 months. Results: Sixty three percent of patients had an ischemic stroke, 14% had an hemorrhagic stroke, 15% had a transient ischemic attack, 2% had a cerebral venous thrombosis and 6% a subarachnoidal hemorrhage. The global mortality was 1%. Seventy percent of patients had a history of high blood pressure. Conclusions: The most common type of stroke is ischemic and high blood pressure is the main risk factor.

Estudio multidisciplinario de los accidentes vasculares encefálicos: II perfil cardiovascular de los accidentes vasculares oclusivos / Multidisciplinary study of encephalic vascular accidents: II cardiovascular profile of occlusive vascular accidents

Ischemic stroke constitute a major cause of morbidity and mortality in the adult population, particulary in the elderly. Heart disease may predispose to ischemic stroke, especially in the presence of transient or permanent precipitating factors such as atrial fibrillation. To elucidate the role of heart disease in predisposing to ischemic stroke we studied the clinical and non invasive cardiac profile (EKG, 2D-Echo, Holter) of 186 consecutive patients, 91 of them embolic (Gl) and 96 non embolic (lacunar, atherotrombotic, others) (Gll), as determided by brain CT scan and through clinical evaluation. Age and male/female ratio were significantly different (71 + 13 vs 65 + 12 years, 40/60 vs 65/35, p <0.003). Hypertension was equally common in both groups (38 and 40 percent). Patients in Gl had higher prevalence of valvular heart disease (23 vs 1 percent), and atrial fibrillation (67 vs 10 percent), 2D Echo left atrial enlargement (45 vs 16 percent) and supraventricular ectopy in Holter (59 vs 32 percent) p< 0,001. By contrast absence of heart disease (45 vs 19 percent), ST-T changes in EKG (28 vs 14 percent), left ventricular hypertrophy in 2D Echo (28 vs 9 percent) and ventricular ectopy in Holter (54 vs 23 percent) were more prevalent in Gll patients, p<0.001. Multiple stepwise logistic regression analysis showed that age> 70years (relative risk (RR) 1.67), valvular heart disease (RR 2.25), chronic AF (RR 2.44) and paroxysmal AF (RR 1.89) were significant independient predictors of embolic stroke, whereas the presence of left ventricular hypertrophy in 2D-Echo (RR 0.76) and frequent ventricular premature beats in Holter (RR 0.47) were predictors of occlusive non embolic stroke. Thus, the clinical and non invasive cardiac profile of embolic and non embolic ischemic stroke is significantly different, which is relevant to preventive strategies

Manifestaciones neurológicas de la infección por el virus de la inmunodeficiencia humana (HIV) / Neurological manifestations in HIV infection

Las alteraciones neurológicas en la infección por el VIH son muy frecuentes. En un 10 a 20%es la primera manifestación de la infección y un 40 a 60%la presenta durante la evolución. El compromiso del sistema nervioso es diverso pudiendo afectarse desde la corteza cerebral hasta el músculo esquelético incluyendo las leptomeninges en formas aisladas, combinadas o sucesivas. Este daño principalmente se debe a la acción directa del virus o por infecciónes oportunistas o tumores. La frecuencia relativa y tipo de compromiso varía según el estado virológico y de inmunosupresión. En la etapa I prevalece la meningitis viral, en la etapa II y III la polineuropatía desmielinizante y en la etapa IV el complejo demencia, la mielopatía, la polineuropatía sensitivo-motora, las infecciones por agentes oportunistas y tumores. Frente a estos cuadros neurológicos se debe tener presente en el diagnóstico diferencial la infección por VIH. El paciente VIH (+) con manifestaciones neurológicas aunque sean leves, debe estudiarse agresivamente dado que algunas tienen tratamiento específico satisfactorio. Los exámenes de mayor utilidad son la tomografía computada y el estudio de líquido céfalo raquídeo

Valor de la biopsia cerebral en pacientes con SIDA y lesiones expansivas cerebrales / Cerebral biopsy in patients with AIDS

We performjed cerebral biopsy in 4 patients with AIDS and evidence of expanding intracerebral lesionhs. Three patients had cerebral toxoplasmosis and the fuourth had Chagas encephalitis. No patient developed complications. We feel that cerebral biopsy is warranted and safe in patients with AIDS and intracerebral lesion of uncertain origin