Mild hyperhomocysteinemia and low folate concentrations as risk factors for cervical arterial dissection.

BACKGROUND AND PURPOSE: Elevated homocysteine (Hcy) plasma levels are associated with an increased risk of spontaneous cervical artery dissection (sCAD). We examined the potential association between Hcy, folate, vitamin B(12) levels and 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphisms in patients with cerebral infarct caused by sCAD. PATIENTS AND METHODS: 39 patients who survived a cerebral infarct caused by sCAD [20 (51%) women; 24 (61.5%) vertebral and 15 (38.5%) internal carotid arteries], and 76 healthy control subjects were included. Hcy plasma levels (fasting and after methionine load), folate and vitamin B(12) levels were measured. We also performed polymorphisms of MTHFR. Hcy, vitamin B(12), folates and polymorphisms of MTHFR were assessed and any associations were analyzed using multivariate statistics. RESULTS: Mean plasma fasting Hcy level was 9.81 mumol/l for cases and 6.38 for controls (p = 0.001). The occurrence of sCAD was associated with elevated fasting Hcy levels (>95th percentile over the control group) with an adjusted odds ratio of 7.9 (95% CI 1.66-35). The association between low plasma folate values (<5th percentile) and the presence of CAD was 7.9 (95% CI 1.6-31) after adjusting for confounding variables. The distribution of the MTHFR genotype showed a higher TT mutant frequency among CAD patients (p = 0.034). CONCLUSIONS: High plasma concentrations of Hcy and low plasma levels of folate were associated with an increased risk of sCAD in the sample studied. We conclude that deficiencies in nutritional status may contribute to the relatively high incidence of CAD in Mexico.

Carotid plaque inflammation detected by 18F-fluorodeoxyglucose-positron emission tomography. Pilot study.

OBJECTIVES: Inflammation is important in both the pathogenesis and outcome of atherosclerosis. Current imaging techniques provide anatomic data but no indication of plaque inflammation. We tested the hypothesis that plaque inflammation could be assessed in vivo by (18)FDG-PET and that plaque inflammation could increase the risk of recurrent vascular events and poor response to treatment in a pilot study. PATIENTS AND METHODS: Thirteen patients (median age 66.1 years [55-82 years]) with recent carotid territory TIA or ischemic stroke and internal carotid artery (ICA) stenosis > or =50% were studied. Angiography and (18)F-fluorodeoxyglucose-positron emission tomography ((18)FDG-PET) imaging were carried out in all patients. Treatment for carotid stenosis in each patient was selected by the attending physician and consisted in medical treatment, endarterectomy or stent placement. During 6 months of follow-up, the specific end points assessed were the occurrence of any stroke, death, or re-stenosis. RESULTS: Patients with symptomatic carotid atherosclerosis were imaged using (18)FDG-PET. Strong (18)FDG uptake (SUV> or =2.7) was seen in 11 of 13 (85%) carotid lesions. Among these patients two died during follow-up, 3 had recurrent non-fatal ipsilateral ischemic stroke and 1 patient who had undergone stenting had non-symptomatic re-stenosis in control studies. There was a significant correlation between the (18)FDG uptake and degree of ICA stenosis detected by angiography. CONCLUSION: Carotid atherosclerotic plaques contain a variable degree of inflammation which can be assessed in vivo by means of FDG and PET. The prognostic value of this marker is, however, still unclear and needs further study.

Dissection of cervical arteries: Long-term follow-up study of 130 consecutive cases.

BACKGROUND AND PURPOSE: We describe the natural history, functional prognosis and long-term recurrences of patients with dissection of cervical arteries (DCA) in a sequential observational study. METHODS: We describe 130 patients with angiographically-proven DCA admitted to the Neurology Institute in Mexico City (Mexico), and analyzed clinical and neuroimaging data, treatment and outcome. Treatment with either anticoagulation or aspirin was decided by the primary physician. Primary outcome measures were recurrence (stroke and death) and clinical outcome at 6 months. Follow-up studies were performed to determine recanalization. RESULTS: Mean age was 35.4 years; 4 patients died (3%) and 126 were followed for 3,906 person/years; 17 patients (13%) had a heralding ischemic cerebral event (6 strokes, 11 TIAS) about 8 days before the diagnosis of DCA. After diagnosis, recurrent ischemic stroke occurred in 6 patients (4.8%) within the 2 first weeks (1.5 persons/1,000 follow-up years). No significant differences were found between aspirin and anticoagulation. Recanalization was more frequent in vertebral dissections. Complete recanalization of vertebral dissections was associated with a favorable prognosis [OR 3.2 (95% CI 1.1-8.8; p = 0.02)]. CONCLUSIONS: In Mexico, DCA affects young adults and may present with a heralding stroke or TIA. We found rare, early ischemic recurrences. Vertebral territory dissections had better prognosis than carotid ones, particularly in patients with demonstrated complete recanalization.

Exámen de la noción del volumen mediante procedimientos Piaget-Inhelder y Bovet y Cols / Analysis of volume notions by the method of Piage-Inhelder and Bovet et al

Por medio del procedimiento para evaluar la noción de conservación del volumen, instrumentada por Bovet y cols. Fueron examinados 48 niños. Igualmente, otro grupo de 48 niños fue evaluado con el procedimiento clásico de conservación de volumen, elaborado por Piaget e Inhelder. Las edades de los sujetos se encontraron dentro de los siguientes límites: 32 de 7(0)-8(11); 32 de 9(0)-10(11) y 32 de 11(0)-12(11) años de edad. Los resultados muestran diferencias cuantitativas y cualitativas entre un grupo y otro. El grupo que fué evaluado con el procedimiento de Bovet y cols. Mostró mayores logros a edad más temprana que el grupo examinado con el piagetano. Los datos anteriores confirman la importancia de la adecuación psicológica de los instrumentos de evaluación. Asimismo, se confirman las desparación del desfase entre las nociones de peso y volumen reportados por Bovet y cols