RESUMO
INTRODUCTION: In acute symptomatic vertebrobasilar artery stenosis, the use of mechanical recanalisation remains controversial. The complication rate of acute interventional recanalisation (aIR) has to be considered, as evidence from randomised trials is lacking. In a single centre retrospective case series, we here describe complications and outcome after aIR. METHODS: We retrospectively assessed aIR in a tertiary care centre and included the following parameters: indication for aIR, national institute of health stroke scale (NIHSS) score on admission, recanalisation by thrombolysis in myocardial infarction score (TIMI) grades, post-interventional complications, mortality, NIHSS and modified Rankin scale at follow-up and rate of restenosis. RESULTS: We identified 14 aIR (14 percutaneous transluminal angioplasty with or without stent implantation in 12 patients; 6/12 with thrombolysis; n = 6 vertebral artery, n = 8 basilar artery; 4 women, mean age 67 years). Mortality was 25 % (3/12) after 7 days and 42 % (5/12) after 12 months. In 12/14, interventions are complete (TIMI 3, 86 %), in 2/14, a partial recanalisation (TIMI 2, 14 %) was achieved. In one case, a peri-interventional fatal intracerebral haemorrhage occurred (1/12, 8 %). At late follow-up (mean 342 days), one re-occlusion (1/7, 14 %) and one recurrent stroke (1/12, 8 %) were observed. CONCLUSIONS: In our single centre series of vertebrobasilar aIR recanalisation rate was high. However, procedural safety and clinical outcome varied considerably. The results of aIR need to be assessed in multicentric registers to define the procedural risk and outcome in the clinical setting.
Assuntos
Angioplastia/efeitos adversos , Angioplastia/métodos , Revascularização Cerebral/efeitos adversos , Revascularização Cerebral/métodos , Complicações Pós-Operatórias/etiologia , Insuficiência Vertebrobasilar/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagemAssuntos
Malformações Vasculares do Sistema Nervoso Central/patologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/patologia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Artéria Vertebral/patologia , Idoso , Angiografia , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Diagnóstico Diferencial , Embolização Terapêutica , Evolução Fatal , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Nervo Frênico/lesões , Nervo Frênico/fisiopatologia , Pneumonia/etiologia , Pneumonia/patologia , Pneumonia/fisiopatologia , Quadriplegia/etiologia , Quadriplegia/patologia , Quadriplegia/fisiopatologia , Insuficiência Respiratória/diagnóstico por imagem , Compressão da Medula Espinal/fisiopatologia , Neoplasias da Coluna Vertebral/diagnóstico , Espaço Subdural/patologia , Espaço Subdural/fisiopatologia , Espaço Subdural/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Falha de Tratamento , Procedimentos Cirúrgicos Vasculares , Veias/patologia , Veias/fisiopatologia , Veias/cirurgia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgiaRESUMO
OBJECTIVE: To study the time course of immunoglobulin, B and plasma cells in the blood and cerebrospinal fluid (CSF) before and during rituximab treatment in a patient with severe relapsing-remitting multiple sclerosis (MS) in relation to clinical and MRI findings. METHODS: Immunoglobulins in the CSF were measured by nephelometry and detected by isoelectrical focussing. CSF and blood cell subtypes from seven time points were analysed by flow cytometry. RESULTS: Treatment with rituximab induced a dramatic and sustained improvement in clinical and MRI findings over a follow-up period of 20 months. By contrast, the initially completely suppressed B and plasma cells in both the blood and CSF reappeared after 5 and 10 months, CSF cells being the first to reappear. Interestingly, intrathecal IgG synthesis persisted throughout the study period. DISCUSSION: Although highly effective in this case, the clinical effect in larger series and the mechanism of rituximab in MS deserves further evaluation.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Linfócitos B/imunologia , Imunoglobulina G/biossíntese , Esclerose Múltipla/tratamento farmacológico , Adulto , Anticorpos Monoclonais Murinos , Formação de Anticorpos , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/líquido cefalorraquidiano , Imageamento por Ressonância Magnética , Masculino , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/imunologia , Plasmócitos/imunologia , Rituximab , Resultado do TratamentoRESUMO
OBJECTIVE: Celiac disease (CD), or gluten sensitivity, is considered to be a state of heightened immunologic responsiveness to ingested gluten proteins in genetically predisposed individuals. The gastrointestinal manifestation suggests a severe enteropathy of the small intestine with malabsorption, steatorrhea, and weight loss because of a deranged mucosal immune response. Neurologic complications occur, especially epilepsy, possibly associated with occipital calcifications or folate deficiency and cerebellar ataxia. There have been reports of brain white-matter lesions as an extraintestinal manifestation in Crohn disease and ulcerative colitis but not in CD. METHODS: In this study, 75 diet-treated mainly pediatric patients with biopsy-proven CD underwent prospectively clinical neurologic examinations, laboratory investigations, electroencephalography, computed tomography, and magnetic resonance imaging. The age range was 2.8 to 24.2 years with a mean of 11.6 years. The mean period of gluten exposure was 2.4 years. RESULTS: Ten patients had neurologic findings such as febrile seizures, single generalized seizures, mild ataxia, and muscular hypotonia with retarded motor development. No folate deficiency was found. The hippocampal regions showed no abnormalities. Computed tomography did not reveal any cerebral calcifications, but magnetic resonance imaging detected unilateral and bilateral T2-hyperintensive white-matter lesions in 15 patients (20%). There was no correlation between these lesions and dietary compliance or neurologic or electroencephalographic abnormalities. The mean gluten exposure time of these patients was slightly increased (not significant). CONCLUSIONS: Focal white-matter lesions in the brain may represent an extraintestinal manifestation of CD. They may be ischemic in origin as a result of a vasculitis or caused by inflammatory demyelination. They seem to be more typical of pediatric CD than cerebral calcifications. Their prognostic value is unclear and needs to be elucidated in additional studies. CD should be suggested as a differential diagnosis in children with unclear white-matter lesions even without intestinal symptoms.