Asociación de marcadores inflamatorios y de disfunción endotelial con la depresión en la enfermedad cerebrovascular isquémica

Fundamento: la depresión es una de las complicaciones no neurológicas más frecuentes en la enfermedad cerebrovascular isquémica. Objetivo: determinar la asociación de marcadores inflamatorios y de disfunción endotelial con la depresión en pacientes con enfermedad cerebrovascular isquémica. Métodos: se realizó un estudio analítico, prospectivo de corte transversal en pacientes con enfermedad cerebrovascular isquémica en fase aguda (N=22) y no aguda (N=37); atendidos en el Instituto de Neurología y Neurocirugía y el Hospital Manuel Fajardo, de La Habana, Cuba. Se recogieron variables demográficas, factores de riesgo, etiología y localización del infarto, deficiencia neurológica, discapacidad para las actividades de la vida diaria (índice de Barthel), neuropsicológicas (depresión por inventario de Beck y test de Hamilton). Se determinó proteína C-reactiva, alfa-1-antitripsina, complementos C3 y C4 y microalbuminuria. Resultados: las puntuaciones de las pruebas neuropsicológicas no tuvieron diferencias significativas entre la fase aguda y no aguda, pero hubo un aumento estadístico de la frecuencia de pacientes sin depresión y con ligera depresión en la fase no aguda. En la fase aguda, el complemento C4 y en la fase no aguda el complemento C3, la proteína C-reactiva y el alfa-1-antitripsina se correlacionaron directamente con la puntuación del inventario de Beck. La proteína C-reactiva y C3 se correlacionaron estadísticamente con la puntuación del test de Hamilton. En el análisis multivariado, la proteína C-reactiva mostró asociación independiente con el grado de depresión por el test de Hamilton. Conclusiones: la proteína C-reactiva pudiera estar relacionada con la severidad de la depresión, quizás por asociación con la discapacidad para las actividades de vida diaria.

Foundation: depression in ischemic cerebrovascular disease is one of the most frequent non-neurological complications. Objective: to determine the association of inflammatory markers and endothelial dysfunction with depression in patients with ischemic cerebrovascular disease. Methods: an analytical, prospective, cross-sectional study was carried out in patients with acute (N=22) and non-acute (N=37) ischemic cerebrovascular disease; treated at the Institute of Neurology and Neurosurgery; and the Manuel Fajardo Hospital, in Havana, Cuba. Demographic variables, risk factors, etiology and location of the infarction, neurological deficiency, disability for activities of daily living (Barthel index), neuropsychological (depression by Beck inventory and Hamilton test) were collected. C-reactive protein, alpha-1-antitrypsin, C3 and C4 complements, and microalbuminuria were determined. Results: the scores of the neuropsychological tests did not have significant differences between the acute and non-acute phase, but there was a statistical increase in the frequency of patients without depression and with slight depression in the non-acute phase. In the acute phase, C4, and in the non-acute phase, C3, C-reactive protein and alpha-1-antitrypsin were directly correlated with the Beck inventory score. C-reactive protein and C3 were statistically correlated with the Hamilton test score. In the multivariate analysis, C-reactive protein showed an independent association with the degree of depression by the Hamilton test. Conclusions: C-reactive protein could be related to the severity of depression, perhaps by association with the disability for activities of daily living.

Asymptomatic cerebral small vessel disease in adults with low cardiovascular risk.

Introduction: Cerebral small vessel disease (CSVD) frequently occurs in individuals with vascular risk factors. This condition might go unrecognised or result in only mild functional deficits. Objective: To evaluate the relationship between cardiovascular (CV) risk calculated with the HEARTS app and CSVD burden in a population without cardio-cerebrovascular diseases, and to estimate the prevalence of CSVD in low risk (LR) individuals. Methods: Asymptomatic subjects with vascular risk factors were included from primary health areas in Havana. The WHO's revised CV disease risk prediction chart (HEARTS app) was applied to all individuals, who were classified into two groups: LR and moderate/high risk (M/HR). Brain MRI was performed in all subjects. Results: 170 patients were included: 43 (25.3%) classified as low CV risk and 127 (74.7%) had M/HR CV risk. Half of the neurologically healthy individuals included displayed cerebral small vessel involvement (51.2%). White matter hyperintensities (WMH) and enlarged perivascular spaces were the most frequent lesions observed in both groups. WMH were more severe and more severe global score for CSVD were more frequent in the M/HR group (57.5%). It was noteworthy that 32.6% of LR-patients also exhibited more severe CSVD. The multivariate regression analysis revealed an independent association of arterial hypertension and age with the severity of CSVD. Conclusions: CV risk stratification through the HEARTS app has limited utility for predicting brain health in individuals with low CV risk. Identifying silent CSVD in individuals with apparently low CV risk is important, especially if they suffer from arterial hypertension.

Increased C-reactive protein in acute ischemic stroke patients is age dependent / El incremento de la proteína C reactiva en pacientes con ictus isquémico agudo varía con la edad

Introduction: Several studies investigating blood biomarkers such as C-reactive protein (CRP) in the prognosis and mortality of stroke have not been conclusive. This may be related to the fact that age has not been taken into account for these analyses. Objective: In the present study, we evaluated the possible relationship of blood markers with the age and clinical characteristics of ischemic stroke patients. Methods: Two groups of acute ischemic stroke patients (≤ 55 years and > 55 years of age) who were paired with a control group were included. CRP, alpha 1 antitrypsin (AAT), complements C3 and C4, microalbuminura, ceruloplasmin, glucose, cholesterol, triglycerides, glutamic-piruvic transaminase (GPT), glutamic-oxalacetic transaminase (GOT), gamma glutamiltranspeptidase (GGT), creatinine, and uric acid were determined. Other clinical information, including NIH stroke scale was collected. Results: AAT, ceruloplasmin, microalbuminuria, GPT, GOT and GGT were significantly increased with respect to control subjects in both age groups. Nevertheless, CRP was increased only in patients older than 55 years. CRP and age were directly correlated in stroke patients, but not in the control group joint analysis of age and NIHSS revealed a tendency towards even higher CRP values in older patients with more severe neurological impairment. Levels of CRP increased significantly with age according to NIH score. Conclusions: Age should be considered when evaluating the usefulness of CRP and other blood biomarkers as clinical tools for predicting long or short-term neurological outcome or stroke recurrence events in ischemic stroke patients(AU)

Introducción: Los estudios sobre marcadores sanguíneos incluido la proteína C reactiva (PCR) en el pronóstico y mortalidad del ictus no han sido concluyentes, quizás porque en sus análisis no se ha tenido en cuenta la edad los pacientes. Objetivo: Evaluar la relación de los marcadores sanguíneos con la edad y características clínicas de pacientes con ictus isquémico. Métodos: Se incluyeron en el estudio 2 grupos de pacientes con ictus isquémico (( y > 55 años) quienes fueron pareados con grupos controles. Fueron determinados: PCR, alfa 1 antitripsina (AAT), complementos C3 y C4, microalbuminuria, ceruloplasmina, glucosa, colesterol, triglicéridos, transaminasa glutámico-pirúvico (TGP), transaminasa glutámico-oxalacético (TGO), gamma glutamiltranspeptidasa (GGT), creatinina, y ácido úrico. También, se recogió información clínica (escala neurológica, etiología y localización del ictus). Resultados: La AAT, ceruloplasmina, microalbuminuria, TGP, TGO y GGT aumentaron significativamente respecto al grupo control de ambos grupos de estudio. Sin embargo, la PCR se incrementó solamente en pacientes mayores de 55 años. La PCR se correlacionó directamente con la edad de los pacientes, pero no en el grupo control. A su vez, se observó una tendencia hacia el aumento de la PCR en pacientes mayores de 55 años con mayor la severidad neurológica. Los valores de PCR se incrementaron estadísticamente con la edad de acuerdo al déficit neurológico. Conclusiones: La edad debiera ser considerada en la evaluación de la utilidad de la PCR y de otros marcadores como herramientas clínicas para predecir un desenlace neurológico fatal o recurrencia de nuevos eventos en pacientes con ictus isquémico(AU)

Spontaneous Subdural Hematoma and Behavioral Changes Due to a Dural Arteriovenous Fistula. A Case Report and Literature Review.

Dural arteriovenous fistulas (DAVFs) represent 10-15% of intracranial arteriovenous malformations. Of these, only 12-29% cause intracranial hemorrhage. The presentation of DAVF as a subdural hematoma (SDH) and intraparenchymal hemorrhage (IPH) is infrequent; additionally, behavioral changes are not common among these patients. We report, for the first time in our country, the case of a 23-year-old man with no history of head injury, in which a brain computed tomography (CT) scan revealed SDH and IPH with behavioral disturbances. The angiotomography showed ecstatic venous vessels, indicating the presence of a DAVF, which was later confirmed by cerebral angiography. Endovascular therapy, which followed the clinical diagnosis, resulted in satisfactory evolution two years after treatment. A review of the literature concerning cases with DAVF and behavioral disturbances is presented. DAVF may lead to cognitive impairment, behavioral changes, and dementia as a result of diffuse white matter and thalamus modifications related to venous ischemia, and it should be considered as a reversible cause of vascular dementia.

Short-term prognostic value of serum neuron specific enolase and S100B in acute stroke patients.

OBJECTIVE: To explore the value of blood markers for brain injury as outcome predictors in acute stroke. DESIGN AND METHODS: The study included 61 patients with acute stroke (44 ischemic and 17 hemorrhagic) and a high risk control group (79 individuals with no known history of neurological disease). Serum neuron specific enolase (NSE) and S100B were determined by immunoassay (CanAg Diagnostics, Sweden). Outcome at 60 days was evaluated with clinical scales. RESULTS: Higher concentrations of NSE and S100B were measured in patients compared to high risk controls, but they were not related to stroke severity on admission. NSE was associated with functional neurological outcome at 60 days and to the degree of recovery, whereas S100B exhibited a strong correlation with depression symptoms at 60 days. CONCLUSIONS: The measurements of serum concentrations of NSE and S100B after acute stroke may be clinically relevant for predicting functional neurological outcome and post-stroke depression, respectively.

Neuroimaginología: bases bioquímicas y su aplicación en la enfermedad cerebrovascular isquémica / Neuroimaging: biochemical principles and its application in the cerebrovascular ischemic disease

El conocimiento de las bases neurobioquímicas ha permitido comprender la cascada isquémica que se desencadena después de la caída del flujo sanguíneo cerebral y los hallazgos que se visualizan en los estudios neuroimaginológicos en la enfermedad cerebrovascular isquémica. La búsqueda de alternativas para diagnosticar cada vez más precozmente los eventos agudos y restablecer el flujo sanguíneo cerebral, para disminuir las secuelas neurológicas, ha dado lugar al desarrollo de técnicas imaginológicas más avanzadas, las cuales permiten seguir los cambios histoquímicos y morfológicos que ocurren dentro del cerebro in vivo de forma no invasiva, así como su evolución, extensión del daño cerebral y estructuras cerebrales dañadas. La presente revisión bibliográfica tiene como objetivo fundamentar la importancia de los estudios neuroimaginológicos en el diagnóstico de la isquemia cerebral aguda(AU)

The knowledge of neurobiochemical principles has allowed understanding the ischemic cascade that takes place after the decrease of cerebral blood flow and the findings that are visualized in neuroimaging studies in cerebrovascular ischemic disease. The need for early diagnosis of acute events to reestablish the cerebral blood flow to reduce neurological sequels, has led to the development of advanced imaging techniques, which allows following the histochemical and morphologicalchanges that take place within the brain in vivo, in a non-invasive way, as well as its development, extent of thecerebral damage and damaged cerebral structures. The present bibliographic review has the objective of supporting the importance of neuroimaging studies in the diagnosis of acute cerebral ischemia(AU)