The intervention effects of fluoxetine hydrochloride on hypothalamic-pituitary-thyroid axis function deficiency in patients with poststrok depression / 中华行为医学与脑科学杂志

ObjectiveTo investigate the intervention effects of fluoxetine on hypothalamic-pituitary-thyroid (HPT) axis function changes in post-stroke depression (PSD) patients.MethodsMild to moderate stroke patients were enrolled and blood T3,T4,FT3,FT4 and TSH were measured at day 0,1,7,14,21 and 3 months.At day 7,thyroid hormone releasing hormone (TRH) stimulation test were performed.After evaluated with the anxiety scale screening using the HAMD scale assessment at day 21,the subjects were divided into simple stroke subgroup ( ＜8 points,25 cases) and PSD sub-group ( ≥ 8 points,18 cases),with 16 healthy age and sex matched individuals as control group.In the 2nd stage,TRH stimulation test were performed in PSD patients before and after 7 days of fluoxetine administration.ResultsCompared with control group,stroke patients presented lower FT3 (P ＜0.05 ) and higher serum TSH (P ＜ 0.05) at day 0,1,7,14.Furthermore,PSD patients presented lower FT3,TSH levels and higher FT4 levels than simple stroke patients did(P＜0.05).At day 21 and month 3,T3,T4,FT3,FT4 and TSH levels in stroke patients were not different from those in control group(P ＞ 0.05).TRH test showed that the responses in PSD patients were lower than those in simple stroke patients( (2.65 ±0.42)μIU/ml vs (5.31 ±0.68 ) μIU/ml,P ＜ 0.05 ).Correlation analysis showed HAMD scores correlated with TSH level changes and TSH0 ～30 in PSD subgroup closely( r=0.35,0.25,P＜0.01 ).In the 2nd stage,TRH test showed that PSD patients who took fluoxetine presented a lower TSH level change than PSD patients who did not( (4.61 ± 2.02) μIU/ml vs (7.05 ± 2.12) μIU/ml,P ＜ 0.05 ).ConclusionPSD patients present a long and severe HPT axis function inhibition,which may due to TRH deficiency,and fluoxetine may improve this abnormality.

Acidente vascular encefálico em adultos jovens: análise de 44 casos / Stroke in young adults: analysis of 44 cases

Objetivo: estudar as características epidemiológicas, clínicas e laboratoriais dos pacientes jovens com diagnóstico de acidente vascular encefálico isquêmico em acompanhamento no Ambulatório de Neurovascular do Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil. Métodos: entre os 106 pacientes em acompanhamento, identificaram-se 44 com idades abaixo de 50 anos à época do evento isquêmico encefálico. Coletaram-se dados relativos à idade de ocorrência, exposição a fatores de risco, número de eventos isquêmicos, região encefálica acometida, exames complementares realizados na investigação etiológica, drogas utilizadas na prevenção secundária e medidas de reabilitação instituídas. Resultados: dos 44 pacientes, 63,1% eram do sexo feminino e 20,4% sofreram recorrência do evento isquêmico. A topografia mais acometida foi o território da artéria encefálica média (49,9%). Observou-se pelo menos um fator de risco cardiovascular em 84,8% dos pacientes. A hipertensão arterial sistêmica predominou em mais da metade dos casos. Causas cardioembólicas foram associadas ao acidente vascular encefálico em 22,7% dos pacientes. Realizou-se arteriografia em 16 pacientes, sendo que 50% destes apresentaram alterações. Para a prevenção secundária, observou--se o uso de ácido acetilsalicílico em 81,7% dos casos, warfarina em 22,7% e estatinas em 36,3%. Elevada proporção de pacientes (45%) está em tratamento de reabilitação, principalmente fisioterapia. Conclusão: fatores de risco cardiovasculares são freqüentes mesmo em pacientes jovens que sofreram acidente vascular encefálico isquêmico, portanto, as medidas de prevenção secundária não podem ser negligenciadas nessa faixa etária. Extensa propedêutica é indispensável para o diagnóstico topográfico e etiológico do evento cerebral, o que requer infraestrutura hospitalar sofisticada.

Objective: to study epidemiological, clinical and laboratorial characteristics of young patients with diagnosis of ischemic brain stroke followed at the UFMG Hospital das Clinicas Neurovascular Outpatient Department ( Ambulatório de Neurovascular do Hospital das Clínicas da Universidade Federal de Minas Gerais), Brazil. Methods: Among the 106 patients under treatment, 44 were identified with ages below 50 years old at the time of the ischemic brain stroke event. Data related to the age at the occurrence, exposure to risk factors, number of ischemic events, brain region affected, complementary examinations performed at the etiologic investigation, drugs used in the secondary prevention and rehabilitation measures introduced were collected. Results: of the 44 patients, 63.1% were female and 20.4% suffered ischemic events. The most affected topography of the victims was the middle cerebral artery (49.9%). There was at least one cardiovascular risk factor in 84.8% of patients. Systemic Arterial Hypertension prevailed in more than half of cases. Cardioembolic causes were associated with brain stroke in 22.7% of patients. Arteriography was performed in 16 patients, 50% of these showed alterations. For secondary prevention, aspirin was used in 81.7% of cases, warfarin in 22.7% and statins in 36.3%. High proportion of patients (45%) is in rehabilitation treatment, especially physiotherapy. Conclusions: cardiovascular risk factors are common even in young patients who suffered ischemic brain stroke, so the secondary prevention measures cannot be overlooked in this age group. Extensive workup is essential for topographic and etiologic diagnosis of the cerebral event, which requires sophisticated hospital infrastructure.

Effect of GLEDI and alteplase on acute ischemic stroke / 国际中医中药杂志

Objective To compare effect of GLEDI and alteplase on acute ischemic stroke. Methods 120 patients were randomly recruited into a GLEDI group and a alteplase group, and treated with the corresponding medicine respectively.The changes of NIHSS and hemorheology were observed. Results NISS and hemorheology in both groups were declined.There was statistic difference (P＜0.05). The GLEDI group had a greater decline in ESR than the alteplase group, showing statistic difference (P＜0.05). Conclusion Both GLEDI and alteplase were effective in treating acute ischemic stroke. They have relatively same effects ifthey were used to a full therapeutic course.

Acidente vascular cerebral hemorrágico decorrente de ofidismo por bothrops sp: relato de caso / Hemorrhagic stroke due to bothrops sp snakebite: case report

Objetivo: relatar um caso de hemorragia cerebral consequente a ofidismo por serpente Bothrops sp. Relato do caso: mulher de 62 anos vítima de acidente ofídico por serpente do gênero Bothrops, evoluiu com quadro de hemorragias sistêmicas, déficit neurológico focal e rebaixamento do nível de consciência. Tomografia de crânio revelou hematomas cerebrais intraparenquimatosos. Recebeu soroterapia antibotrópica e suporte clínico, apresentando boa recuperação. Considerações Finais: distúrbios hemorrágicos decorrente de ofidismo são causas potenciais de acidente vascular cerebral.

Purpose: to report a case of cerebral hemorrhage resulting from ophidism by Bothrops sp snake. Case report: a 62-year-old woman, victim of snakebite by Bothrops sp, evolved with systemic hemorrhage, focal neurologic deficit and declining level of consciousness. Tomography of the brain revealed cerebral intraparenchymal hematoma. The victim received bothropic antivenom and clinical support, presenting good recovery. Final considerations: bleeding disorders caused by snakebite are potential causes of stroke.

A study on the expression of anti-mitochondriai antibody in the brain of patients with MELAS syndrome / 中华内科杂志

Objective To investigate the pathological changes and pathogenesis of the MELAS syndrome (mitochondrial encephalopathy lactic acidosis strok-like episodes ) by using the method of immunohistochemical staining in the brain biopsy specimens with anti-mitochondrial antibody (AMA).Methods We performed immunohistochemical staining in 3 confirmed MELAS patients' paraffin-imbed brain biopsy specimens.Results Small vessel proliferation and the uneven thickness of the wall were found in the 3 MELAS patients.A lot of brown deposits was shown in the wall of small vessels and also noted in neurons.Conclusions The main pathological change in the MELAS brain biopsy immunohistochemical staining with AMA was the small vessel proliferation,indicating that abnormal mitochondria accumulated in the vascular smooth muscle,endothelial cell and neurons of the lesion sites.This finding was consistent with the electron microscopic discovery and valuable for the diagnosis of MELAS.