[Cerebrovascular disease: its relationship with cardiovascular and renal pathology in 134 clinical autopsies]. / Enfermedad cerebrovascular: su relación con cardiovasculopatías y nefropatías en 134 necropsias clínicas.

OBJECTIVE: To establish the relationship between cardiopathy and chronic nephropathy, and cerebral vascular pathology in clinical necropsies performed in adult patients. MATERIAL AND METHODS: The protocols of 861 clinical autopsies done during the lapse 1990-2000 were reviewed, of these, 134 cases with diagnosis of cerebrovascular disease (CVD) were selected. Analyzed features included: neuropathological study of CVD, renal and cardiovascular pathology, and cause of death. RESULTS: CVD represented 15.5% of all autopsies done during the study period. Ischemic CVD constituted 56.7% of the cases, whereas cases of hemorrhagic CVD accounted for 43.3% of the total. Causes included arterial hypertension (33%), atherosclerosis (19%), emboli and vascular malformations (13% each, respectively), coagulopathies (8%), angeiitis (4%), tumors (1%), and unknown origin (11%). Ischemic CVD was caused by atherosclerosis in 34.2% of the cases, lacunar infarcts in 32.8%, of embolic cause in 14.4% of the cases, angeiitis in 1.3%, and of unknown origin in 17.1% of the cases. Hemorrhagic CVD presented as intraparenchymal hematoma in 50% of the cases, as sub-arachnoid hemorrhage in 28%, as disseminated petechial hemorrhages in 19%, and intraventricular in 3% of the cases. Ischemic CVD was associated with hypertensive cardiopathy in 86.5% of the cases, and with nephrosclerosis in 51.3%, whereas hemorrhagic CVD was seen associated with the same pathological entities in 86.2% and 29.3% of the cases, respectively. Cerebral herniation was the cause of death in 2.6% of the patients with ischemic CVD, and in 74.1% of the patients with hemorrhagic CVD. CONCLUSIONS: CVD was associated with a high frequency of intercurrent pathological processes, namely hypertensive cardiopathy, atherosclerosis, nephroscleroisis, and other chronic nephropathies, that eventually interact, and constitute well known predisposing and/or concomitant factors to the cerebrovascular event

[Non neoplastic space occupying lesions mimicking central nervous system tumors]. / Lesiones ocupantes de espacio no neoplasicas que simulan tumores del sistema nervioso central.

OBJECTIVE: To establish the frequency and nature of space occupying lesions of the central nervous system (CNS) that mimic neoplastic growths. PATIENTS AND METHODS: We reviewed the clinical records, imaging and neuropathological studies of patients operated in different hospitals of Maracaibo, Venezuela during the period January 1 1996 July 31 2002. These patients had a pre operative diagnosis of CNS tumor, and their definitive diagnosis was non neoplastic disease. RESULTS: The 33 cases of expansive, non neoplastic growths represented 8% of 408 CNS lesions diagnosed during the study period. Approximately two thirds of the cases (63,36%) consisted of either inflammatory or vascular lesions, whereas the rest of the cases grouped miscellaneous conditions. CONCLUSIONS: Even though it is not frequent that non neoplastic lesions of the CNS mimic expansive growths of neoplastic nature, on occasions the clinical and neuroimaging features of both groups of entities are remarkably similar.

[Clinical and tomographic aspects of hemorrhagic cerebrovascular disease associated with hypertensive crisis in adults under 50 years of age]. / Aspectos clínicos y tomográficos de la enfermedad cerebrovascular hemorrágica asociada con crisis hipertensiva en adultos menores de 50 años.

The purpose of this study was to analyze both the clinical and tomographic aspects of the hemorrhagic cerebrovascular disease (HCd), associated with hypertensive crisis in adults under 50 years of age. Forty six patients, who were not under anticoagulant therapy, were not using illegal drugs, who had not a cerebral tumor disease, and who had neither arteriovenous malformations nor past traumatic episodes, were studied. Seventy eight percent of the patients had preexisted arterial hypertension, 30% of them had at least a previous emergency for a hypertensive crisis. Mortality for intracerebral hematoma (ICH) and for subarachnoid hemorrhage (SAH) was 21% and 23% respectively. In 68% of the cases, ICH was located in the deep structures of the brain. Asymmetric ventricular system, compression or the absence of mesencephalic cisterna were significantly associated (p > 0.01; p > 0.001 respectively) with higher mortality. There was not a significant difference between the deceased and the survivors in relation with their systolic and diastolic arterial pressure on admission to the emergency unit. A significant positive relation was found between the severity of the injury (percentage of patients with an Scale Coma Glasgow < or = 8 points) and the mortality percentage for the type of HCd (r = 0.81 for ICH; p < 0.001, r = 0.98 for SAH; p < 0.001). Age and a low Scale Coma Glasgow score on the admission, represent unfavorable prognostic factors. Due to the different criteria used to evaluate the tomographic characteristics of intracerebral hematomas, comparisons of the present results with other findings can be difficult.

[Lupus anticoagulant in preeclampsia and non-proteinuria gestational hypertension in primiparous women]. / Anticoagulante lúpico en preeclampsia e hipertensión gestacional no proteinúrica en primigestas.

The purpose of this study was to determine the relationship between the lupus anticoagulant and the proteinuric and non-proteinuric Gestational Hypertension in primigravids without subjacent pathology. Sixty- five patients with a single gestation of twenty or more weeks long were studied. Thirty four patients (Group A) were pregnant women with a normal blood pressure. Hypertensive disease developed during pregnancy (according to Davey and MacGillivray, classification) affected 31 patients (Group B). A test to determine the presence of the lupus anticoagulant was performed on all of them, according to the method of the diluted Russel viper venom. None of the patients developed any other symptomatic subjacent pathology. Fifty-five percent of the Group B patients developed proteinuric gestational hypertension (preeclampsia) and forty-five percent of them non-proteinuric gestational hypertension. The test to determine the lupus anticoagulant was negative in all the patients from both groups. The results suggest that the presence of a lupus anticoagulant is unlikely in the proteinuric and non-proteinuric gestational hypertension in primigravidas without subjacent pathology, therefore it remains as a controversial study issue.