Hemicorea-hemibalismo asociado a hiperglucemia no cetósica con hiperintensidad estriatal / Hemichorea-hemiballism associated to non-ketonic hyperglycemia with striatal hyperintensity

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Epidemiological characteristics of pregnancy, delivery, and birth outcome in women with multiple sclerosis in Argentina (EMEMAR study).

BACKGROUND: The influence of pregnancy on Multiple Sclerosis (MS) has been extensively studied but such influence on Latin American women with MS has not been characterized. Our objective was to describe the course of pregnancy and birth outcome in Argentinean MS patients and the evolution of MS during pregnancy and after delivery. METHOD: We used a retrospective design in eight MS centers in Argentina and administered a survey to women with definite MS (Mc Donald) with pregnancies during or after MS onset. We contacted 355 women of which 81 met inclusion criteria. We recorded 141 pregnancies. RESULTS: Involuntary abortion was observed in 16% of pregnancies (95% CI = 10-23). Thirty five women received immunomodulatory therapy (IMT) before 42 pregnancies. Twenty three (55%) out of 42 pregnancies were exposed to IMT. The mean time of IMT discontinuation before conception in 19 (45.2%) pregnancies without exposure, was 104 days (95% CI = 61.0-147.0). There were 103 deliveries: 79% full term. Birth defects were detected in 19% of pregnancies exposed to IMT (95% CI = 4-46) and in 2% of non-exposed (95% CI = 0.3-8.0). The mean relapse rate was: pre-pregnancy year: 0.22 (95% CI = 0.12-0.32); pregnancy: 0.31 in 1st (95% CI = 0.10-0.52), 0.19 (95% CI = 0.03-0.36) in 2nd, and 0.04 in 3rd trimester (95% CI = -0.04-0.12); 1st trimester post delivery: 0.82 (95% CI = 0.42-1.22). CONCLUSION: We observed a higher rate of birth defects among infants exposed to immunomodulators in utero than those not exposed. The reduction in MS relapses during 2nd and 3rd trimester of pregnancy and its increase during postpartum is consistent with previous reports.

Encefalopatía hipereosinofílica con múltiples infartos cerebrales en los territorios vasculares limítrofes, asociada a cáncer de próstata / Hypereosinophilic encephalopathy with multiple cerebral infarctions in neighbouring vascular territories associated to prostate cancer

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Triflusal vs aspirin for prevention of cerebral infarction: a randomized stroke study.

BACKGROUND: Triflusal is an antiplatelet agent that has shown clinical advantages when compared with aspirin in the secondary prevention of vascular events. TAPIRSS (Triflusal versus Aspirin for Prevention of Infarction: a Randomized Stroke Study) explored the efficacy and safety of triflusal in the secondary prevention of stroke in a Latin American homogeneous population with the ultimate aim of preparing for a larger trial in the same setting. METHODS: A double-blind, multicenter, randomized, pilot trial was conducted in Buenos Aires, Argentina, from October 1996 to November 1999. The study sample was 431 patients, randomized to receive aspirin 325 mg daily or triflusal 600 mg daily for a mean of 586 days. All patients had experienced either an ischemic stroke or TIA within 6 months from enrollment. Data from 429 patients were analyzed. RESULTS: No differences were observed in the primary endpoint that combined the incidence of vascular death, cerebral ischemic infarction, nonfatal myocardial infarction, or major hemorrhage (aspirin 13.9%, triflusal 12.7%; odds ratio [OR] 1.11, 95% CI 0.64 to 1.94) or in the individual analysis of each component of the primary endpoint. In a post hoc analysis, the overall incidence of major and minor hemorrhagic events was significantly lower in triflusal-treated patients (aspirin 8.3%, triflusal 2.8%; OR 3.13, 95% CI 1.22 to 8.06). CONCLUSIONS: This pilot trial has not found differences between triflusal and aspirin in the prevention of vascular complications after TIA or ischemic stroke, although given the wide CI, potentially important group differences could not be ruled out. Triflusal may be associated with a lower risk of hemorrhagic complications. A larger, prospective clinical trial is necessary to verify these results.

[Aortic debris in cerebrovascular ischemic disease]. / Debris aórtico en la enfermedad cerebrovascular isquémica.

BACKGROUND: The aortic atherosclerotic debris is considered a high risk embolic source, being an independent predictor for cerebrovascular ischemia. The incidence is higher in the elderly and in patients with coronary artery disease. Transesophageal echocardiogram (TEE) is an important diagnostic tool that allows its detection. OBJECTIVE: To describe characteristics of patients with ischemic stroke and echocardiographic diagnosis of aortic debris. PATIENTS AND METHODS: We analyzed the group of patients with debris diagnosis in 209 TEE performed between 01/01/99 and 31/05/02, in 835 consecutive ischemic events. The information was collected from the Stroke Database of the Neurology Department of Policlinica Bancaria. RESULTS: TEE was accomplished in 25% of all assisted events. The mean age was 66.56 years (SD 11.22). In 30 studies (14%) aortic debris was detected. In this group of patients, 26 men and 4 women, was also found: plaques grade IV 60%, left atrial dilatation 40% and spontaneous echo contrast 20%. The most frequent risk factors were hypertension, dislipemia and smoking, with no significative difference compared to the group without debris. 40% had a prior cerebrovascular event. They presented with clinical subtype LACI 53%, PACI 27%, POCI 17%. 63% of patients had lacunar infarct (53% anterior and 10% posterior). CONCLUSION: The contribution of TTE for detection of embolic sources is relevant. A high percentage of the population with echocardiographic diagnosis of aortic debris, had a lacunar infarct, defined radiologically and by clinical features.

Debris aórtico en la enfermedad cerebrovascular isquémica / Aortic debris in cerebrovascular ischemic disease

Introducción. El debris aórtico (DA) aterosclerótico se considera una fuente de elevado potencial embólico, y es un predictor independiente para el accidente cerebrovascular (ACV). La incidencia es mayor en pacientes ancianos y con enfermedad arterial coronaria. El ecocardiograma transesofágico (ETE) es un método diagnóstico importante que permite su detección. Objetivo. Describir las características de los pacientes con ACV isquémico y diagnóstico de DA por ETE. Pacientes y métodos.En209ETErealizados entre el 01/01/99 y 31/05/02 sobre 835 eventos isquémicos consecutivos, se analizaron los pacientes con hallazgo de debris. La información se obtuvo de la Base de Datos de ACV del Servicio de Neurología de la Policlínica Bancaria. Resultados. Se realizó ETE en el 25 por ciento del total de eventos asistidos. La edad media de la población estudiada fue de 66,56 años (DE: 11,22). En 30 casos (14 por ciento) se encontró DA. En este grupo de pacientes -26 hombres y cuatro mujeres-se hallaron, además, placas de grado IV (60 por ciento), dilatación auricular izquierda (40 por ciento) y contraste espontáneo (20 por ciento). Los factores de riesgo más frecuentes fueron la hipertensión arterial, la dislipemia y el tabaquismo, y no se evidenciaron diferencias significativas respecto a los pacientes sin debris. El 40 por ciento presentaba antecedente de evento cerebrovascular previo. Se presentaron con subtipo clínico LACI (53 por ciento), PACI (27 por ciento), POCI (17 por ciento). El 63 por ciento de los pacientes tuvo infarto lacunar (53 por ciento territorio anterior y 10 por ciento posterior). Conclusión. La aportación del ETE en la detección de fuentes embolígenas es relevante. Un alto porcentaje de la población con diagnóstico ecocardiográfico de DA se presentó con clínica y radiología definida de infarto lacunar (AU)

[Ischemic stroke: transesophageal echocardiographic findings]. / Accidente cerebrovascular isquémico: hallazgos en ecocardiograma transesofágico.

INTRODUCTION: Since its initial application in 1976, the transesophageal echocardiogram (TEE) has improved the detection of cardiovascular emboligenic sources. Even though its indication in patients with stroke is still controversial, its use has contributed to the identification of potential embolic stroke sources. OBJECTIVE: To describe the transesophageal echocardiographic findings in ischemic stroke patients. PATIENTS AND METHODS: We analyzed case series of 162 TEE performed on a total of 576 ischemic events dated between 01/01/99 to 01/05/01. The required information was collected prospectively in the Stroke Data Bank of the Neurology Department at Policl nico Bancario in Buenos Aires. RESULTS: TEE was carried out in 162 (28.1%) cases. Of theses cases 13% belonged to the clinical subtype TACI, 37% to PACI, 17% to POCI, and 37% to LACI subtype. Pathologic findings corresponded to cardiac level: spontaneous contrast in 29% of the cases, and to aortic level: plaques grade IV in 34% and debris in 13% of the cases. According to the etiology of ischemic stroke, 67 patients had been registered under the diagnosis of lacunar infarct (60 in the anterior region and 7 in the posterior region), 93 had been diagnosed medium and grand artery infarct (73 in the anterior region and 29 in the posterior region), and 2 had remained unclassified. Emboligenic sources were found in 69.5% of TACI, 65% of PACI, 52% of POCI, and 53% of LACI. CONCLUSIONS: A high percentage of aortic artheroembolic pathology was detected in the population under study. However, spontaneous contrast was the echocardiographic phenomenon more frequently reported. It is to be pointed out the presence of potential cardiac and/or aortic emboligenic sources in 48% of the population with lacunar infarct

Accidente cerebrovascular isquémico: hallazgos en ecocardiograma transesofágico / Ischemic stroke: transesophageal echocardiographic findings

Introducción. Desde su aplicación inicial en 1976, el ecocardiograma transesofágico (ETE) ha mejorado la detección de fuentes embolígenas (FE) cardiovasculares. Si bien su indicación en pacientes con accidente cerebrovascular (ACV) es todavía controvertida, su utilización ha contribuido a la identificación de fuentes potenciales de ACV embólico. Objetivo. Describir hallazgos por ETE en pacientes con ACV isquémico. Pacientes y métodos. Se analizaron en un diseño de casos en serie, 162 ETE realizados sobre un total de 576 eventos isquémicos ocurridos entre 01/01/99 y 01/05/01. La información se recolectó en forma prospectiva en la Base de Datos de ACV del Servicio de Neurología del Policlínico Bancario de Buenos Aires. Resultados. Se realizó ETE en 162 (28,1 por ciento) casos del total de eventos asistidos. Se presentaron con subtipo clínico TACI (13 por ciento), PACI (37 por ciento), POCI (17 por ciento), LACI (37 por ciento). Los hallazgos patológicos fueron: cardíacos, contraste espontáneo (29 por ciento); aórticos, placas grado IV (34 por ciento), debris (13 por ciento). De acuerdo con la etiología del ACV, 67 pacientes se habían registrado con el diagnóstico de infarto lacunar (60 del territorio anterior y siete del posterior), 93 como infartos de mediana y gran arteria (73 del territorio anterior y 20 del posterior), y dos no clasificables. Se encontró FE en TACI (69,5 por ciento), PACI (65 por ciento), POCI (52 por ciento), LACI (53 por ciento). Conclusión. En la población estudiada se identificó un alto porcentaje de patología ateroembólica aórtica. Sin embargo, el contraste espontáneo fue el fenómeno ecocardiográfico más frecuentemente informado. Hay que resaltar la presencia de potenciales FE, cardíaca o aórtica, en el 48 por ciento de la población con infarto lacunar (AU)

Introduction. Since its initial application in 1976, the transesophageal echocardiogram (TEE) has improved the detection of cardiovascular emboligenic sources. Even though its indication in patients with stroke is still controversial, its use has contributed to the identification of potential embolic stroke sources. Objective. To describe the transesophageal echocardiographic findings in ischemic stroke patients. Patients and methods. We analyzed case-series of 162 TEE performed on a total of 576 ischemic events dated between 01/01/99 to 01/05/01. The required information was collected prospectively in the Stroke Data Bank of the Neurology Department at Policlínico Bancario in Buenos Aires. Results. TEE was carried out in 162 (28.1%) cases. Of theses cases 13% belonged to the clinical subtype TACI, 37% to PACI, 17% to POCI, and 37% to LACI subtype. Pathologic findings corresponded to cardiac level: spontaneous contrast in 29% of the cases, and to aortic level: plaques grade IV in 34% and debris in 13% of the cases. According to the etiology of ischemic stroke, 67 patients had been registered under the diagnosis of lacunar infarct (60 in the anterior region and 7 in the posterior region), 93 had been diagnosed medium and grand artery infarct (73 in the anterior region and 29 in the posterior region), and 2 had remained unclassified. Emboligenic sources were found in 69.5% of TACI, 65% of PACI, 52% of POCI, and 53% of LACI. Conclusions. A high percentage of aortic artheroembolic pathology was detected in the population under study. However, spontaneous contrast was the echocardiographic phenomenon more frequently reported. It is to be pointed out the presence of potential cardiac and/or aortic emboligenic sources in 48% of the population with lacunar infarct (AU)