Comportamiento intrahospitalario del infarto cerebral cardioembólico / In-hospital cardioembolic stroke

Objetivo: Caracterizar el comportamiento intrahospitalario del infarto cerebral cardioembólico.Métodos: Se realizó un estudio observacional, descriptivo, prospectivo, en el Hospital Militar Central “Dr. Carlos J. Finlay”, de enero de 2016 a diciembre de 2017, con 63 pacientes que padecían de infarto cerebral cardioembólico. Las variables analizadas fueron la edad, sexo, factores de riesgo vasculares, latencia al ingreso, gravedad del ictus,territorio vascular afectado, tamaño imagenológico del infarto cerebral, manejo terapéutico, complicaciones, estado al egreso, estadía hospitalaria y la escala de Barthel al egreso. Seempleó la estadística descriptiva; se obtuvieron las frecuencias absolutas y relativas de cada variable.Resultados: Predominó entre los factores de riesgo vascular el sexo masculino (52,4 Por ciento), los mayores de 70 años (63,8 Por ciento), la hipertensión arterial (87,3 Por ciento) y la fibrilación auricular no valvular (71,5 Por ciento). Fue más frecuente la atención tardía, la afectación del territorio carotideo, el tamaño mediano del infarto en la neuroimagen, el ictus leve, la estadíahospitalaria corta y las complicaciones no neurológicas. Más de la mitad recibió un tratamiento de inicio tardío con doble antiagregación y un 41 Por ciento no se anticoaguló al egreso hospitalario.Conclusiones: Predominaron los pacientes masculinos, mayores de 70 años, con fibrilación auricular no valvular, tanto crónica como aislada, y con insuficiencia cardiaca congestiva.La mayor parte de estos pacientes recibieron una atención hospitalaria tardía, por lo que se decidió una doble antiagregación plaquetaria en la fase aguda y la no anticoagulación almomento del egreso hospitalario(AU)

Objective: To characterize the in-hospital occurrence of cardioembolic cerebral infarction.Methods: An observational, descriptive, prospective study was carried out at Dr. Carlos J. Finlay Central Military Hospital from January 2016 to December 2017. Sixty-three patients suffering from cardioembolic stroke. The variables analyzed were age, sex, vascular riskfactors, latency at admission, stroke severity, affected vascular territory, imaging size of cerebral infarction, therapeutic management, complications, state at discharge, hospital stay and Barthel scale at discharge. Descriptive statistics was used and absolute and relative frequencies of each variable were obtained.Results: Among the vascular risk factors, the male sex (52.4 Per cent), those older than 70 years (63.8Per cent), hypertension (87.3 Per cent) and nonvalvular atrial fibrillation (71.5 Per cent) predominated. Late care, involvement of the carotid territory, median infarct size on neuroimaging, mild stroke, short in-hospital stay, and non-neurological complications were more frequent. More than half received late-onset dual antiplatelet therapy and 41 Per cent did not anticoagulate ondischarge from hospital.Conclusions: Male patients, older than 70 years, with non-valvular atrial fibrillation, both chronic and isolated, and with congestive heart failure predominated. Most of these patientsreceived late hospital care, so dual platelet antiaggregation was decided in the acute phase and non-anticoagulation at the time of hospital discharge(AU)

Intravenous thrombolysis is more effective in ischemic cardioembolic strokes than in non-cardioembolic? / A trombólise endovenosa é mais eficaz nos acidentes vasculares cerebrais isquêmicos cardioembólicos do que nos não cardioembólicos?

It was suggested that intravenous thrombolysis (IT) leads to larger extent recanalization in cardioembolic stroke. In this work we assess if this has beneficial clinical traduction. METHOD: We evaluated 177 patients undergoing IT, which were categorized into cardioembolic (CE) and non-cardioembolic (NCE). National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale were compared. RESULTS: The mean age was 67.4±12.01 and 53.8 percent were male. The mean NIHSS was: 14 (admission), 9 (24 h) and 6 (discharge), similar in subgroups. The difference between NIHSS at admission and 24 hours was 4.17±4.92 (CE: 4.08±4.71; NCE: 4.27±5.17, p=0.900) and at admission and discharge there was an average difference of 6.74±5.58 (CE: 6.97±5.68; NCE: 6.49±5.49, p=0.622). The mRS at discharge and 3 months was not significantly different by subtype, although individuals whose event was NCE are more independent at 3 months. CONCLUSION: Ours findings argue against a specific paper of IT in CE. It can result from heterogeneity of NCE group.

Alguns estudos sugerem que a trombólise endovenosa (TE) conduz a melhor recanalização nos acidentes vasculares cerebrais isquêmicos (AVCI) cardioembólicos. Neste trabalho questionamos se isto terá tradução em benefício clínico. MÉTODO: Avaliamos 177 doentes submetidos a TE, os quais foram categorizados como cardioembólicos (CE) e não cardioembólicos (NCE). Compararam-se a National Institutes of Health Stroke Scale (NIHSS) e escala de Rankin modificada. RESULTADOS: A idade média foi 67,4±12,01 e 53,8 por cento eram homens. NIHSS média foi: 14 (admissão), 9 (24 h), 6 (alta), semelhante nos subgrupos. A diferença entre NIHSS à admissão e 24 h foi de 4,17±4,92 (CE: 4,08±4,71; NCE: 4,27±5,17, p=0,900) e entre a admissão e a alta de 6,74±5,58 (CE: 6,97±5,68; NCE: 6,49±5,49, p=0,622). A classificação na mRS não foi significativamente diferente nos subgrupos (alta e 3 meses), mas os doentes com eventos NCE estavam mais independentes aos 3 meses. CONCLUSÃO: Os nossos resultados não documentam um papel específico da TE nos CE, o que pode resultar da heterogeneidade do grupo NCE.

Trombo mural gigante como causa de cardioembolismo. Presentación de un caso / Gigantic mural thrombus causing thromboembolism. Report of one case

Se presenta el caso de un hombre de setenta y un años de edad quien presenta en forma súbita síntomas y signos isquémicos cerebrales. Tiene antecedente de fibrilación auricular crónica, prótesis valvular en posición aórtica y mitral, insuficiencia cardiaca y complicaciones hemorrágicas relacionadas con la anticoagulación. Como parte del estudio se realizó ecocardiograma transesofágico que demostró trombo mural gigante en la aurícula izquierda, el cual desapareció luego de nueve meses de tratamiento anticoagulante.

The case of a 71 years old male that suddenly presents ischemic brain signs and symptoms is presented. He had a previous history of chronic atrial fibrillation, mitral and aortic valve protheses, heart failure and bleeding related to anticoagulation. A transesophageal echocardiogram was performed as part of the assessment, showing a gigantic left atrial mural thrombus that disappeared after 9 months of anticoagulation therapy.