Trombosis venosa cerebral en una paciente puérpera con preeclampsia con datos de severidad / Cerebral venous thrombosis in a post-partum patient with preeclampsia with signs of severity

Resumen ANTECEDENTES: la trombosis venosa cerebral es infrecuente, pero con mayor incidencia durante la gestación y el puerperio. OBJETIVO: revisar la bibliografía más reciente y proponer una opción de tratamiento de la paciente con trombosis venosa cerebral durante el puerperio. CASO CLÍNICO: paciente de 30 años de edad, con antecedente de dos embarazos y dos cesáreas. En el séptimo día de puerperio tuvo edema de miembros inferiores, cifras tensionales elevadas, cefalea y alteraciones visuales. Con el tratamiento antihipertensivo con nifedipino y neuroprotección con sulfato de magnesio se logró el control de la hipertensión, aunque persistieron la cefalea y los síntomas de visión borrosa y diplopía. La resonancia magnética reportó: trombosis venosa de seno transverso lateral izquierdo. Con el tratamiento anticoagulante hubo disminución importante de los síntomas neurológicos. CONCLUSIONES: puesto que la preeclampsia y la eclampsia pueden ocultar los síntomas de la trombosis venosa cerebral, es importante tener siempre en mente ambos padecimientos para el diagnóstico y tratamiento oportuno de uno y otro.

Abstract BACKGROUND: cerebral venous thrombosis is infrequent, but with the highest incidence during pregnancy and puerperium. OBJECTIVE: to review the most recent bibliography and propose a treatment option for the patient with cerebral venous thrombosis during puerperium. CLINICAL CASE: a 30 year old patient with a history of two pregnancies and two Cesarean sections. On the seventh day of puerperium she presented edema of the lower limbs, high blood pressure, headache and visual disorders. Antihypertensive treatment with nifedipine and neuroprotection with magnesium sulfate, hypertension was controlled although the headache and blurry vision and double vision symptoms persisted. The MRI results reported: venous thrombosis of the left lateral transverse sinus. With anticoagulant treatment there was significant decrease of neurological symptoms. CONCLUSIONS: since preeclampsia and eclampsia can hide symptoms of cerebral venous thrombosis, it is important to always consider both conditions for the timely diagnosis and treatment of both.

[Non-valvular atrial fibrillation and completed stroke: factors determining mortality, recurrence and prognosis after a first event in the Mexican population]. / Fibrilación auricular no valvular e infarto cerebral: determinantes de mortalidad, recurrencia y pronóstico después de un primer evento en población mexicana.

AIMS: Non-valvular atrial fibrillation (NVAF) accounts for 25% of completed strokes (CS) of a cardioembolic origin in patients over 60 years old. Our aim was to define the predictors of a good and poor prognosis after a CS secondary to an NVAF in our milieu. PATIENTS AND METHODS: We evaluated the risk factors (RF) and severity of CS in relation to death, functionality and recurrence at 5 years. 81 patients between the ages of 49 and 88 were followed up consecutively for 1 to 90 months; 38 (46.9%) of them were males. Multivariate analysis was performed with the following independent variables: age, gender, smoking, hypertension, heart disease, diabetes mellitus and characteristics of the stroke. The severity of the CS was assessed by means of the modified Rankin scale, which was dichotomised into a good prognosis (0-2) and a poor prognosis (> or = 3), both basal and at the end of the clinical control. We also evaluated the secondary preventive treatment used and its relation with recurrence, prognosis, death and complications. RESULTS: No RF was linked to a poor prognosis or recurrence; 88% had a poor prognosis. Antiplatelet drugs were used in 42% of cases and 39% received anticoagulants. A good final progression was observed in 9.5% of the patients treated with antiplatelet drugs versus 35% of those receiving anticoagulation therapy (p = 0.004). Severity of the CS on admission was worse in the aspirin group, with no differences in recurrence and mortality. A better prognosis was observed in patients from urban areas. CONCLUSIONS: Use of antiplatelet drugs, living in a rural area and a Rankin score of > or = 3 on admission are factors suggesting a poor prognosis in the clinical control at 5 years.

Fibrilación auricular no valvular e infarto cerebral: determinantes de mortalidad, recurrencia y pronóstico después de un primer evento en población mexicana / Non-valvular atrial fibrillation and completed stroke: factors determining mortality, recurrence and prognosis after a first event in the Mexican population

Objetivo. La fibrilación auricular no valvular (FANV) representa el 25% de los infartos cerebrales (IC) de origen cardioembólico en mayores de 60 años. Nuestro propósito fue definir los factores de buen y mal pronósticos después de un IC secundario a FANV en nuestro medio. Pacientes y métodos. Evaluamos los factores de riesgo (FR) y la gravedad del IC en relación con muerte, funcionalidad y recurrencia a cinco años. Se siguieron 81 pacientes consecutivos de entre 49 y 88 años, durante 1-90 meses; 38 (46,9%) fueron hombres. Se realizó un análisis multivariado con las siguientes variables independientes: edad, sexo, tabaquismo, hipertensión, cardiopatía, diabetes mellitus y características del infarto. La gravedad del IC se evaluó mediante la escala modificada de Rankin, dicotomizada en buen pronóstico (0-2) y mal pronóstico 3), basal y al final del control clínico. Evaluamos también el tratamiento de prevención secundaria utilizado y su relación con recurrencia, pronóstico, muerte y complicaciones. Resultados. Ningún FR se asoció con mal pronóstico o recurrencia; el 88% tuvo mal pronóstico. En el 42% se utilizaron antiagregantes, y en el 39% anticoagulantes. Se observó una buena evolución final en un 9,5% de los pacientes con antiagregantes frente a un 35% con anticoagulación (p 0,004). La gravedad del IC al ingreso fue peor en el grupo de aspirina, sin diferencias en recurrencia y mortalidad. Se observó mejor pronóstico en los pacientes provenientes de áreas urbanas. Conclusión. El uso de antiagregantes, vivir en área rural y un Rankin 3 al ingreso son factores de mal pronóstico en el control clínico a los cinco años

Aims. Non-valvular atrial fibrillation (NVAF) accounts for 25% of completed strokes (CS) of a cardioembolic origin in patients over 60 years old. Our aim was to define the predictors of a good and poor prognosis after a CS secondary to an NVAF in our milieu. Patients and methods. We evaluated the risk factors (RF) and severity of CS in relation to death, functionality and recurrence at 5 years. 81 patients between the ages of 49 and 88 were followed up consecutively for 1 to 90 months; 38 (46.9%) of them were males. Multivariate analysis was performed with the following independent variables: age, gender, smoking, hypertension, heart disease, diabetes mellitus and characteristics of the stroke. The severity of the CS was assessed by means of the modified Rankin scale, which was dichotomised into a good prognosis (0-2) and a poor prognosis 3), both basal and at the end of the clinical control. We also evaluated the secondary preventive treatment used and its relation with recurrence, prognosis, death and complications. Results. No RF was linked to a poor prognosis or recurrence; 88% had a poor prognosis. Antiplatelet drugs were used in 42% of cases and 39% received anticoagulants. A good final progression was observed in 9.5% of the patients treated with antiplatelet drugs versus 35% of those receiving anticoagulation therapy (p = 0.004). Severity of the CS on admission was worse in the aspirin group, with no differences in recurrence and mortality. A better prognosis was observed in patients from urban areas. Conclusions. Use of antiplatelet drugs, living in a rural area and a Rankin score of 3 on admission are factors suggesting a poor prognosis in the clinical control at 5 years

[Transesophageal echocardiographic findings in patients under 40 years of age with cerebrovascular event]. / Hallazgos ecocardiográficos transesofágicos en pacientes menores de 40 años con evento vascular cerebral.

UNLABELLED: The potential cardioembolic sources for ischemic stroke in patients younger than 40 years could be asymptomatic. The purpose of this study is to justify routine implementation of transesophageal echocardiography (TEE) in the study of young patients with ischemic stroke. MATERIAL AND METHODS: 34 patients younger than 40 years with ischemic stroke were studied with TEE complemented with contrast study, looking for potential cardioembolic sources or intracardiac shunts. RESULTS: 19 patients were male and 15 female with ages between 18-40 years (average 31 years). None had cardiac signs or symptoms. Eleven anomalies were detected in 20 patients (58.8%); of these, only 3 were considered as probably coursing with cardioembolic sources: patent foramen ovale (PFO), mitral valve prolapse, and ventricular enlargement, which were found in 12 patients (35.29%). In patients with cardiovascular anomalies, we found a hypercoagulable state, associated in eight patients with PFO (four patients), two with valvular thickening, and two with valvular nodules. CONCLUSIONS: In patients younger than 40 years with ischemic stroke, TEE is useful in detecting direct and indirect cardiac sources of embolism, even in those patients with unsuspected cardiac disease.

[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.

[Sonographic patterns by transcranial Doppler in acute cerebral infarction]. / Patrones sonográficos por Doppler transcraneal en el infarto cerebral agudo.

AIM: To evaluate the correlations between the patterns of Transcranial Doppler (TCD) and the extent and pathophysiologic mechanism of the ischemia as well as the prognosis of patients with acute ischemic stroke. METHODS: 37 patients with ischemic stroke within the first 24 hours of evolution were examined using TCD, neuroimaging, and neurologic state at admission and disarcharge. The TCDs were grouped into four categories: normal, stenotic, hemispheric asymmetry and trunk occlusion of the middle cerebral artery (MCA); they were correlated with the extent of brain damage, pathophysiologic mechanism of the stroke and prognosis. RESULTS: Normal TCD was highly predictive of lacunar infarction secondary to small vassels disease (p = 0.01) and good recovery (p < 0.02). The stenotic and hemispheric asymmetry patterns correlated highly with a cortical infarctions (p < 0.05) and a cardioembolic mechanism. The occlusion of the MCA was highly correlated with a large infarction (p < 0.01) and with poor outcome and death (p = 0.004). CONCLUSIONS: Our data show that TCD has a value in predicting the prognosis and the severity, location and pathophysiologic mechanism of cerebral strokes.