Enfermedad cardioembólica cerebral a partir de un tumor primario de cavidades cardíacas izquierdas / Cerebral cardioembolic disease from a primary tumor of the left heart chambers

Introducción: De los tumores cardiacos primarios, el 75 por ciento son benignos y más de la mitad corresponde a mixomas. Pueden ser asintomáticos o generar manifestaciones cardíacas, sistémicas o embólicas, estas últimas frecuentes. Objetivo: Divulgar la importancia de tener presente el tumor primario cardiaco como causa de enfermedad embólica cerebral. Caso clínico: Hombre de 53 años de edad, con mareos, cefalea, malestar general, decaimiento, dolores articulares, palpitaciones, disnea y ortopnea. Sufrió pérdida de la conciencia y posteriormente pérdida de la fuerza muscular del hemicuerpo izquierdo debido a un accidente vascular encefálico de tipo embólico. Con el ecocardiograma transtorácico, se confirmó el diagnóstico de un tumor primario cardiaco. Después de la operación, se comprobó en anatomía patológica, que era un mixoma. Conclusiones: El mixoma es un tumor que puede producir fenómenos cardioembólicos y se debe tener presente en pacientes como el que se presenta(AU)

Introduction: Of the primary cardiac tumors, 75 percent are benign and more than half correspond to myxomas. They can be asymptomatic or generate cardiac, systemic or embolic manifestations, the latter frequent. Objective: To remark the importance of considering the primary cardiac tumor as a cause of cerebral embolic disease. Clinical case: 53-year-old man with dizziness, headache, general malaise, weakness, joint pain, palpitations, dyspnea and orthopnea. He suffered loss of consciousness and later loss of muscle strength in the left half of the body due to an embolic-type stroke. With the transthoracic echocardiogram, the diagnosis of a primary cardiac tumor was confirmed. After the operation, it was verified in pathological anatomy, that it was a myxoma. Conclusions: Myxoma is a tumor that can produce cardioembolic phenomena and must be taken into account in patients like the one presented(AU)

Uso de anticoagulantes em pacientes com fibrilação atrial em primeiro evento de AVC e em recidivas / Use of anticoagulants in patients with atrial fibrillation in the first event of AVC and in recidivas

Introdução: A fibrilação atrial (FA) é a causa mais comum de AVC cardioembólico. Esse artigo científico pretende quantificar o número total de pacientes com acidente vascular cerebral cardioembólico portadores de fibrilação atrial prévia, o seguimento do tratamento e a taxa de recorrência. Métodos: estudo retrospectivo (de abril de 2014 a abril de 2015) cujos dados foram extraídos da base JOINVASC e organizados em uma tabela no programa Excel®. Os dados registrados incluíram o total de pacientes que apresentaram AVC cardioembólico inicial ou recorrência de AVC que eram portadores de FA e o uso de medicação anticoagulante ou não. Resultados e conclusões: 49 pacientes com FA conhecida foram encontrados. Desses, 46 receberam anticoagulante após AVC e apenas 3 não receberam tratamento anticoagulante. Entre os pacientes que receberam anticoagulação, 27 usaram varfarina, 3 usaram apixabana, 3 rivaroxabana, 2 dabigatrana e 1 femprocumona. Durante 2 anos, o controle de seguimento foi realizado com os 49 pacientes com FA conhecida, os 3 que não receberam tratamento anticoagulante não sofreram recidiva de AVC ou apresentaram outra comorbidade associada a causas vasculares. Estudo com número maior de sujeitos faz-se necessário para esclarecer o achado de desfecho favorável nos pacientes que não receberam medicação anticoagulante.

Introduction: Atrial fibrillation is the most commonly cause of cardioembolic stroke. This article aim to quantify the total number of patients with cardioembolic stroke that had preview atrial fibrillation, the outcoming of the treatment and if had any recurrence. Methods: It's a retrospective study (April 2014 through April 2015), the data will be registered in a table in the Excel® program, extracted from the data collected from the JOINVASC study of patients who had an initial cardioembolic stroke or recurrence of stroke who had AF and data from the medical record, recording the use or not of anticoagulant and which class. Results and conclusions: In a total of 49 patients with known AF, 46 received anticoagulant after stroke, and only 3 did not receive anticoagulant treatment. Among patients who received anticoagulation, 27 used warfarin, 3 used apixaban, 3 rivaroxaban, 2 dabigatran and 1 phenprocoumon. For 2 years follow-up control was performed with the 49 patients with known AF, the 3 who chose not to receive anticoagulant treatment, after 2 years they had not relapsed or some comorbidity associated with vascular causes. The authors suggest a new study with a larger N, since it can not be affirmed that the non-use is positive.

Síndrome de Foix-Chavany-Marie por infarto biopercular con mecanismo cardioembólico / Foix-Chavany-Marie syndrome sue to biopercular infarction with cardioembolic mechanism

El síndrome de Foix-Chavany-Marie o síndrome biopercular fue descrito como una diplejía labio-facio-faringo-laringo-gloso-masticatoria, con disociación automática del movimiento. Los pacientes que padecen este síndrome presentan alteración del habla (disartria o anartria), disfagia y no pueden abrir la boca, cerrar los párpados o protruir la lengua por voluntad propia, pero pueden sonreír, llorar y bostezar automáticamente. La etiología más frecuente en la edad adulta es la isquémica, a nivel opercular bilateral. Se presenta el caso clínico de un paciente con enfermedad cerebrovascular isquémica de la arteria cerebral media derecha con parálisis pseudobulbar con conversión hemorrágica por mecanismo cardioembólico, con trastorno de la deglución. Tuvo una evolución favorable(AU)

Foix-Chavany-Marie syndrome or biopercular syndrome was described as a lip-facio-pharyngo-laryngeal-glosso-chewing diplegia, with automatic dissociation of movement. Patients with this syndrome have speech impairment (dysarthria or anarthria), dysphagia and cannot open their mouths, close their eyelids or protrude their tongue freely, but they can smile, cry and yawn spontaneously. The most frequent etiology in adulthood is ischemic, at the bilateral opercular level. We report a clinical case of a female patient with ischemic cerebrovascular disease of the right middle cerebral artery with pseudobulbar paralysis, hemorrhagic conversion by cardioembolic mechanism, and swallowing disorder. She evolved favorably(AU)

Cardiomiopatía periparto temprana complicada con accidente cerebrovascular cardioembólico: a propósito de un caso / Early peripartum cardiomyopathy complicated by cardioembolic stroke: a case report

Presentamos el caso de una paciente con cardiomiopatía periparto quien súbitamente presentó hemiplejia flácida, producido por un accidente cerebrovascular de origen cardioembólico con transformación hemorrágica en la evolución. El diagnóstico fue clínico, ecocardiográfico y tomográfico. La evolución del cuadro neurológico fue favorable, con recuperación parcial de la funcionalidad. Se presenta este caso debido a la presentación atípica de una nosología infrecuente: "la cardiomiopatía periparto", cuyas complicaciones suscitaron controversias en el manejo terapéutico.

We report a case of a patient with peripartum cardiomyopathy, who suddenly suffered left hemiplejia. The neurological status was the result of Cardioembolic Stroke which transformed from ischemic to hemorrhagic in evolution. The diagnosis was based on the clinical, echocardiographical and tomographical findings. The evolution of the neurological status improved, nevertheless the cardiac and neurologic disease recovery almost completely. We present this case due the atypical presentation of peripartum cardiomyopathy in this patient, and the neurological complication that generated controversies in its management.