Cytotoxic Lesions of the Corpus Callosum Caused by Thermogenic Dietary Supplements.

Consumption of over-the-counter dietary supplements to reduce body weight is common among the population. Thermogenics are herbal combinations that claim to produce a fat-burning process through an increase in the cellular metabolic rate and greater cellular energy consumption, having a high risk for patients developing toxic leukoencephalopathy. We present a series of 6 patients with acute neurologic symptoms and MR imaging showing restricted diffusion and decreased apparent diffusion coefficient values (mean value, 400 mm2/s × 10-6) in the entire corpus callosum compatible with a cytotoxic lesion of the corpus callosum. Although patients responded favorably to the product discontinuation with rapid recovery of neurologic symptoms, there was a more prolonged resolution on imaging alterations. Because of the widespread availability and unregulated nature of thermogenic dietary supplements, physicians must be aware of the clinical and radiologic characteristics of these potential complications of their use.

[The neurological complications of infectious endocarditis]. / Complicaciones neurológicas de la endocarditis infecciosa.

We review the neurologic complications of 131 episodes of infective endocarditis, and the influences of some factors that are considered risk factors at its presentation, like the presence of vegetations detected by echocardiography, type and location of involved valve, or bacterial culture. Neurologic complications occurred in 28 patients (21.4%), 4 of them were excluded because of the absence of neuroimaging studies. In 21 patients the underlying cardiac pathology was valve disease and in the remaining 3 patients was congenital heart disease. 11 patients had native valve endocarditis and 10 prosthetic valve endocarditis. The cultured bacteria were Streptococcus viridans in 8 cases and Staphylococcus aureus in 7. The most frequent complication was cerebrovascular with incidence of cerebral embolism, and intracerebral hemorrhage of 62.5% and 8.3% respectively. Echocardiographic evidence of vegetation was seen in 18 patients, and cerebral embolism were noted in 12. Death occurred in 29% of patients with neurologic complications and 27% without. Two of nine patients who underwent open-heat surgery died. We conclude that there is no difference in the incidence of neurologic complications between mitral and aortic valve groups, neither when comparing native and prosthetic valve groups. Open-heart surgery does not increase mortality in this group of patients.

[Cerebral ischemia secondary to embolism of an aorto-coronary graft. Angiographic findings]. / Isquemia cerebral secundaria a embolia de un injerto aorto-coronario. Evidencia angiográfica.

Ischemic stroke during or following cardiac catheterization may be secondary to diverses mechanisms. Formation and detachment of clots in the catheter wall and embolization of a breaked atheromatous lesion are most frequently. The visualization of clots free in the interior of bypass aortocoronary graft is extremely rare and poorly documented. With angiographic evidence we present a case of cerebral acute ischemia secondary to migration of an embolus from a saphenous vein aortocoronary bypass graft. This case shows a different mechanism of cerebral ischemia.

[Cerebral ischemia: a complication in heart catheterization. An assessment in 2178 catheterizations]. / Isquemia cerebral: una complicación del cateterismo cardiáco. Evaluación en 2,178 cateterismos.

Cardiac catheterization is highly recognized as the more definitive test in several cardiac diseases. However it has a small but definite risk. Cerebral ischemia is an unusual complication of this procedure; the main recognized physiopathological mechanism is thromboembolism. We present the analysis of 7 cases observed in 2178 consecutive cardiac catheterizations. In all cases the neurological dysfunction developed during the procedure or in the few minutes after it. One patient had a complete cerebral infarct. All cases of cerebral infarct were confirmed with computed tomography scan or magnetic resonance imaging. The clinical profile supported an embolic mechanism. The early recognition and management of this complication can influence the prognosis of these patients and therefore emphasize the importance of the monitoring of the neurological function in the hemodynamic department.