RESUMO
INTRODUCTION: In our metropolitan area, the Stroke Code (SC) system allows immediate transfer of patients with acute stroke to a stroke center. It may be activated by community hospitals (A), emergency medical services (EMS, B), or the emergency department of the stroke center (C). Our aim was to analyze whether the SC activation source influences the access to thrombolytic therapy and outcome of patients with ischemic stroke. METHODS: We prospectively registered patients with ischemic stroke admitted to the acute stroke unit who arrived through the SC system. The primary outcome variable was good outcome at discharge (Rankin Scale
Assuntos
Sistemas de Comunicação entre Serviços de Emergência/normas , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Avaliação de Resultados em Cuidados de Saúde , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/enfermagem , Centros Médicos Acadêmicos/normas , Centros Médicos Acadêmicos/estatística & dados numéricos , Centros Médicos Acadêmicos/tendências , Doença Aguda/enfermagem , Doença Aguda/terapia , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/enfermagem , Grupos Diagnósticos Relacionados , Diagnóstico Precoce , Sistemas de Comunicação entre Serviços de Emergência/estatística & dados numéricos , Sistemas de Comunicação entre Serviços de Emergência/tendências , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/tendências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Feminino , Hospitais Comunitários/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/tendências , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes/normas , Transferência de Pacientes/estatística & dados numéricos , Transferência de Pacientes/tendências , Estudos Prospectivos , Espanha , Acidente Vascular Cerebral/diagnóstico , Terapia Trombolítica/normas , Terapia Trombolítica/estatística & dados numéricos , Terapia Trombolítica/tendências , Fatores de Tempo , Transporte de Pacientes/normas , Transporte de Pacientes/estatística & dados numéricos , Transporte de Pacientes/tendênciasRESUMO
INTRODUCTION: Percutaneous transluminal angioplastia has in recent years become an alternative to surgery and increasingly used for revascularization of the extracranial arteries in patients with cerebral ischemia. However, intracranial angioplasty is a technique which is still not widely used since it is technically more difficult and until now endoprotheses (stents) have not been available specifically designed for intracranial territory. CLINICAL CASE: A 73 year old patient with extensive extracranial and intracranial atheromatous lesions, multiple vascular risk factors and cardiac ischemia which contraindicated surgical treatment which was treated consecutively by angioplasty and angioplasty with implantation of stents in both carotid bifurcations. Subsequently, he was treated by angioplasty for a stenosing lesion of 90% of the right carotid siphon with clinical and hemodynamic repercussions. Following the procedure, which was well-tolerated by the patient, there was clinical and angiographic improvement and return to normal of the hemodynamic parameters measured by transcranial Doppler. CONCLUSIONS: Angioplasty is a technique which may be used in intracranial stenosing atheromatous lesions. Even without perfect angiographic correction, adequate blood flow is established in the hemodynamically affected lesions. As far as we know this is the first case of intracranial angioplasty of a lesion of the carotid siphon reported in Spain.
Assuntos
Angioplastia com Balão/métodos , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/etiologia , Angiografia Cerebral , Circulação Cerebrovascular/fisiologia , Humanos , Arteriosclerose Intracraniana/complicações , MasculinoRESUMO
A 57-year-old woman with SLE and subarachnoid haemorrhage is described. The aetiology of the haemorrhage was a saccular aneurysm. The literature is reviewed.
Assuntos
Aneurisma Intracraniano/complicações , Lúpus Eritematoso Sistêmico/complicações , Hemorragia Subaracnóidea/etiologia , Angiografia , Evolução Fatal , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgiaRESUMO
INTRODUCTION: Continuous use of oral anticontraceptive agents has been related to adverse vascular changes in the form of venous or arterial thromboses and cerebrovascular accidents (CVA). In our case, we describe a CVA due to occlusion of the common carotid artery after an acute massive overdose of estrogens due to error of dosage when using Yuzpe's system or emergency post-coital therapy. CLINICAL CASE: We describe a 26 year old woman with no previous clinical history, who smoked 20 cigarettes per day, did not take oral contraceptive pills and suffered an acute left facial-brachial-crural hemiplegia together with reduced level of consciousness. Imaging tests showed acute occlusion of the right common carotid artery. Etiological study of the patient's cerebral vascular accident was negative. The only etiopathogenic factor to be related was having taken oral contraceptive agents for three days after coitus as emergency post-coital treatment. This treatment was incorrect, since the dose of estrogens was four times that recommended. CONCLUSIONS: The continued use of estrogens, especially at doses over 30 micrograms per day, was considered responsible for approximately 10% of CVAs in young people. The risk of cerebral vascular accident is greater when there is associated migraine and/or smoking. We describe a patient who showed that the acute use of high doses of estrogens may also cause arterial occlusion, in this case in the common carotid artery.