16 research outputs found

    Wallenberg's syndrome as the presenting symptom of a cavernous angioma

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    Introducci贸n: los angiomas cavernosos representan el 5-13% del total de malformaciones vasculares. En el 75% de los casos se encuentran en la fosa posterior, y hasta en el 30%, asociado a un drenaje venoso an贸malo. La principal complicaci贸n son las hemorragias; es excepcional la presencia de focalidad neurol贸gica sin evidencia radiol贸gica de sangrado. Caso cl铆nico: presentamos un caso de un var贸n de 54 a帽os con factores de riesgo cardiovascular, que muestra un cuadro progresivo en 72 horas de duraci贸n de afectaci贸n de los pares craneales bajos izquierdos, d茅ficit sensitivo y alteraci贸n de la coordinaci贸n compatible con un s铆ndrome de Wallenberg. Con la tomograf铆a axial computarizada craneal en dos ocasiones normal, se realiz贸 la orientaci贸n diagn贸stica de ictus vertebrobasilar en progresi贸n. Cinco d铆as despu茅s, la resonancia magn茅tica (RM) demostr贸 la presencia de un angioma venoso y un drenaje venoso an贸malo asociado. Conclusi贸n: los angiomas cavernosos presentan un equilibrio din谩mico de sangrado y trombosis de intracavernoma, con un flujo venoso muy lento. Una rotura en este equilibrio supone un aumento de la presi贸n de intracavernoma y la afectaci贸n del tejido circundante, sin expresi贸n radiol贸gica de sangrado. La RM ayuda en estos casos a diferenciar una malformaci贸n vascular de flujo lento de un cuadro ictal isqu茅mico de origen arterial

    Comparison of Plasma Lipoprotein Composition and Function in Cerebral Amyloid Angiopathy and Alzheimer鈥檚 Disease

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    Cerebral amyloid angiopathy (CAA) refers to beta-amyloid (A尾) deposition in brain vessels and is clinically the main cause of lobar intracerebral hemorrhage (ICH). A尾 can also accumulate in brain parenchyma forming neuritic plaques in Alzheimer's disease (AD). Our study aimed to determine whether the peripheral lipid profile and lipoprotein composition are associated with cerebral beta-amyloidosis pathology and may reflect biological differences in AD and CAA. For this purpose, lipid and apolipoproteins levels were analyzed in plasma from 51 ICH-CAA patients (collected during the chronic phase of the disease), 60 AD patients, and 60 control subjects. Lipoproteins (VLDL, LDL, and HDL) were isolated and their composition and pro/antioxidant ability were determined. We observed that alterations in the lipid profile and lipoprotein composition were remarkable in the ICH-CAA group compared to control subjects, whereas the AD group presented no specific alterations compared with controls. ICH-CAA patients presented an atheroprotective profile, which consisted of lower total and LDL cholesterol levels. Plasma from chronic ICH-CAA patients also showed a redistribution of ApoC-III from HDL to VLDL and a higher ApoE/ApoC-III ratio in HDL. Whether these alterations reflect a protective response or have a causative effect on the pathology requires further investigation

    Circulating AQP4 Levels in Patients with Cerebral Amyloid Angiopathy-Associated Intracerebral Hemorrhage

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    Cerebral amyloid angiopathy (CAA) is a major cause of lobar intracerebral hemorrhage (ICH) in elderly patients. Growing evidence suggests a potential role of aquaporin 4 (AQP4) in amyloid-beta-associated diseases, including CAA pathology. Our aim was to investigate the circulating levels of AQP4 in a cohort of patients who had suffered a lobar ICH with a clinical diagnosis of CAA. AQP4 levels were analyzed in the serum of 60 CAA-related ICH patients and 19 non-stroke subjects by enzyme-linked immunosorbent assay (ELISA). The CAA-ICH cohort was divided according to the time point of the functional outcome evaluation: mid-term (12 +/- 18.6 months) and long-term (38.5 +/- 32.9 months) after the last ICH. Although no differences were found in AQP4 serum levels between cases and controls, lower levels were found in CAA patients presenting specific hemorrhagic features such as >= 2 lobar ICHs and >= 5 lobar microbleeds detected by magnetic resonance imaging (MRI). In addition, CAA-related ICH patients who presented a long-term good functional outcome had higher circulating AQP4 levels than subjects with a poor outcome or controls. Our data suggest that AQP4 could potentially predict a long-term functional outcome and may play a protective role after a lobar ICH

    Thrombectomy within 8 hours after symptom onset in ischemic stroke

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    BACKGROUND: We aimed to assess the safety and efficacy of thrombectomy for the treatment of stroke in a trial embedded within a population-based stroke reperfusion registry. METHODS: During a 2-year period at four centers in Catalonia, Spain, we randomly assigned 206 patients who could be treated within 8 hours after the onset of symptoms of acute ischemic stroke to receive either medical therapy (including intravenous alteplase when eligible) and endovascular therapy with the Solitaire stent retriever (thrombectomy group) or medical therapy alone (control group). All patients had confirmed proximal anterior circulation occlusion and the absence of a large infarct on neuroimaging. In all study patients, the use of alteplase either did not achieve revascularization or was contraindicated. The primary outcome was the severity of global disability at 90 days, as measured on the modified Rankin scale (ranging from 0 [no symptoms] to 6 [death]). Although the maximum planned sample size was 690, enrollment was halted early because of loss of equipoise after positive results for thrombectomy were reported from other similar trials. RESULTS Thrombectomy reduced the severity of disability over the range of the modified Rankin scale (adjusted odds ratio for improvement of 1 point, 1.7; 95% confidence interval [CI], 1.05 to 2.8) and led to higher rates of functional independence (a score of 0 to 2) at 90 days (43.7% vs. 28.2%; adjusted odds ratio, 2.1; 95% CI, 1.1 to 4.0). At 90 days, the rates of symptomatic intracranial hemorrhage were 1.9% in both the thrombectomy group and the control group (P = 1.00), and rates of death were 18.4% and 15.5%, respectively (P = 0.60). Registry data indicated that only eight patients who met the eligibility criteria were treated outside the trial at participating hospitals. CONCLUSIONS: Among patients with anterior circulation stroke who could be treated within 8 hours after symptom onset, stent retriever thrombectomy reduced the severity of post-stroke disability and increased the rate of functional independence

    Wallenberg's syndrome as the presenting symptom of a cavernous angioma

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    Introducci贸n: los angiomas cavernosos representan el 5-13% del total de malformaciones vasculares. En el 75% de los casos se encuentran en la fosa posterior, y hasta en el 30%, asociado a un drenaje venoso an贸malo. La principal complicaci贸n son las hemorragias; es excepcional la presencia de focalidad neurol贸gica sin evidencia radiol贸gica de sangrado. Caso cl铆nico: presentamos un caso de un var贸n de 54 a帽os con factores de riesgo cardiovascular, que muestra un cuadro progresivo en 72 horas de duraci贸n de afectaci贸n de los pares craneales bajos izquierdos, d茅ficit sensitivo y alteraci贸n de la coordinaci贸n compatible con un s铆ndrome de Wallenberg. Con la tomograf铆a axial computarizada craneal en dos ocasiones normal, se realiz贸 la orientaci贸n diagn贸stica de ictus vertebrobasilar en progresi贸n. Cinco d铆as despu茅s, la resonancia magn茅tica (RM) demostr贸 la presencia de un angioma venoso y un drenaje venoso an贸malo asociado. Conclusi贸n: los angiomas cavernosos presentan un equilibrio din谩mico de sangrado y trombosis de intracavernoma, con un flujo venoso muy lento. Una rotura en este equilibrio supone un aumento de la presi贸n de intracavernoma y la afectaci贸n del tejido circundante, sin expresi贸n radiol贸gica de sangrado. La RM ayuda en estos casos a diferenciar una malformaci贸n vascular de flujo lento de un cuadro ictal isqu茅mico de origen arterial

    Trombose venosa cerebral como apresenta莽茫o de l煤pus eritematoso sist茅mico

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    Introducci贸n: la trombosis venosa cerebral (TVC) es una proceso inhabitual en el lupus eritematosos sist茅mico. Presentamos una paciente cuya manifestaci贸n inicial del lupus fue una TVC. Caso cl铆nico: paciente de 30 a帽os de edad que presenta cefalea y disminuci贸n de la agudeza visual; en la exploraci贸n destaca papiledema bilateral. La resonancia magn茅tica realizada demuestra la presencia de una trombosis venosa en el seno longitudinal superior y transverso. Las exploraciones complementarias mostraron unos niveles elevados de anticuerpos antinucleares con leucopenia y proteinuria. Los anticuerpos antifosfol铆pidos fueron negativos. Tras tratamiento anticoagulante, mejor贸 cl铆nica y radiol贸gicamente. Meses m谩s tarde se realiz贸 biopsia, que demostr贸 una glomerulonefritis difusa grado IV. Conclusi贸n: en el lupus eritematosos sist茅mico, fen贸menos como la TVC pueden ser la forma de manifestaci贸n inicial de la enfermedad. La presencia de anticuerpos antifosfol铆pidos participa de forma parcial en la TVC; deber铆an considerarse otros fen贸menos, como los inflamatorios

    Cerebral venous thrombosis as the presenting symptom of systemic lupus erythematosus

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    Introducci贸n: la trombosis venosa cerebral (TVC) es una proceso inhabitual en el lupus eritematosos sist茅mico. Presentamos una paciente cuya manifestaci贸n inicial del lupus fue una TVC. Caso cl铆nico: paciente de 30 a帽os de edad que presenta cefalea y disminuci贸n de la agudeza visual; en la exploraci贸n destaca papiledema bilateral. La resonancia magn茅tica realizada demuestra la presencia de una trombosis venosa en el seno longitudinal superior y transverso. Las exploraciones complementarias mostraron unos niveles elevados de anticuerpos antinucleares con leucopenia y proteinuria. Los anticuerpos antifosfol铆pidos fueron negativos. Tras tratamiento anticoagulante, mejor贸 cl铆nica y radiol贸gicamente. Meses m谩s tarde se realiz贸 biopsia, que demostr贸 una glomerulonefritis difusa grado IV. Conclusi贸n: en el lupus eritematosos sist茅mico, fen贸menos como la TVC pueden ser la forma de manifestaci贸n inicial de la enfermedad. La presencia de anticuerpos antifosfol铆pidos participa de forma parcial en la TVC; deber铆an considerarse otros fen贸menos, como los inflamatorios

    Inhibidores de la proprote铆na convertasa subtilisina/kexina tipo 9 (iPCSK9) en la prevenci贸n secundaria de episodios vasculares en pacientes con ictus isqu茅mico: Documento de consenso y aplicaciones pr谩cticas

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    Introducci贸n Los pacientes, tras un ictus o un ataque isqu茅mico transitorio, presentan un riesgo muy elevado de sufrir nuevos episodios vasculares. La reducci贸n del nivel de colesterol unido a lipoprote铆nas de baja densidad (cLDL) reduce la incidencia de nuevos episodios, si bien una proporci贸n importante de pacientes no alcanza los objetivos terap茅uticos recomendados con los tratamientos hipolipemiantes actuales. El objetivo de este documento de consenso es actualizar el papel de los inhibidores de la proprote铆na convertasa subtilisina/kexina tipo 9 (iPCSK9; alirocumab y evolocumab) en la prevenci贸n secundaria de episodios vasculares en pacientes con ictus isqu茅mico previo. M茅todos Se realiz贸 una revisi贸n bibliogr谩fica para identificar las principales evidencias sobre el uso de iPCSK9 en estos pacientes y los objetivos terap茅uticos recomendados de cLDL. Los resultados se discutieron en 2 reuniones de consenso, que constituyeron la base para la elaboraci贸n del documento. Conclusiones Los iPSCSK9 son eficaces en la reducci贸n del riesgo vascular en prevenci贸n secundaria y, espec铆ficamente, evolocumab ha demostrado esta reducci贸n en pacientes con ictus isqu茅mico previo. Ambos f谩rmacos han demostrado un buen perfil de seguridad, incluso en pacientes que alcanzaron un nivel de cLDL < 20 mg/dL. En este sentido, en el subestudio de episodios neurocognitivos con evolocumab no se observ贸 ninguna se帽al de empeoramiento de la funci贸n cognitiva en pacientes con nivel muy bajo de cLDL. Con base en estas evidencias, en el documento se presentan recomendaciones pr谩cticas sobre el uso de iPCSK9 para la prevenci贸n secundaria y seguimiento de episodios vasculares en pacientes con ictus isqu茅mico previo

    Association of Endovascular Thrombectomy vs Medical Management With Functional and Safety Outcomes in Patients Treated Beyond 24 Hours of Last Known Well: The SELECT Late Study

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    Importance: The role of endovascular thrombectomy is uncertain for patients presenting beyond 24 hours of the time they were last known well. Objective: To evaluate functional and safety outcomes for endovascular thrombectomy (EVT) vs medical management in patients with large-vessel occlusion beyond 24 hours of last known well. Design, setting, and participants: This retrospective observational cohort study enrolled patients between July 2012 and December 2021 at 17 centers across the United States, Spain, Australia, and New Zealand. Eligible patients had occlusions in the internal carotid artery or middle cerebral artery (M1 or M2 segment) and were treated with EVT or medical management beyond 24 hours of last known well. Interventions: Endovascular thrombectomy or medical management (control). Main outcomes and measures: Primary outcome was functional independence (modified Rankin Scale score 0-2). Mortality and symptomatic intracranial hemorrhage (sICH) were safety outcomes. Propensity score (PS)-weighted multivariable logistic regression analyses were adjusted for prespecified clinical characteristics, perfusion parameters, and/or Alberta Stroke Program Early CT Score (ASPECTS) and were repeated in subsequent 1:1 PS-matched cohorts. Results: Of 301 patients (median [IQR] age, 69 years [59-81]; 149 female), 185 patients (61%) received EVT and 116 (39%) received medical management. In adjusted analyses, EVT was associated with better functional independence (38% vs control, 10%; inverse probability treatment weighting adjusted odds ratio [IPTW aOR], 4.56; 95% CI, 2.28-9.09; P \u3c .001) despite increased odds of sICH (10.1% for EVT vs 1.7% for control; IPTW aOR, 10.65; 95% CI, 2.19-51.69; P = .003). This association persisted after PS-based matching on (1) clinical characteristics and ASPECTS (EVT, 35%, vs control, 19%; aOR, 3.14; 95% CI, 1.02-9.72; P = .047); (2) clinical characteristics and perfusion parameters (EVT, 35%, vs control, 17%; aOR, 4.17; 95% CI, 1.15-15.17; P = .03); and (3) clinical characteristics, ASPECTS, and perfusion parameters (EVT, 45%, vs control, 21%; aOR, 4.39; 95% CI, 1.04-18.53; P = .04). Patients receiving EVT had lower odds of mortality (26%) compared with those in the control group (41%; IPTW aOR, 0.49; 95% CI, 0.27-0.89; P = .02). Conclusions and relevance: In this study of treatment beyond 24 hours of last known well, EVT was associated with higher odds of functional independence compared with medical management, with consistent results obtained in PS-matched subpopulations and patients with presence of mismatch, despite increased odds of sICH. Our findings support EVT feasibility in selected patients beyond 24 hours. Prospective studies are warranted for confirmation

    Comparison of plasma lipoprotein composition and function in cerebral amyloid angiopathy and Alzheimer's disease

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    Cerebral amyloid angiopathy (CAA) refers to beta-amyloid (A尾) deposition in brain vessels and is clinically the main cause of lobar intracerebral hemorrhage (ICH). A尾 can also accumulate in brain parenchyma forming neuritic plaques in Alzheimer's disease (AD). Our study aimed to determine whether the peripheral lipid profile and lipoprotein composition are associated with cerebral beta-amyloidosis pathology and may reflect biological differences in AD and CAA. For this purpose, lipid and apolipoproteins levels were analyzed in plasma from 51 ICH-CAA patients (collected during the chronic phase of the disease), 60 AD patients, and 60 control subjects. Lipoproteins (VLDL, LDL, and HDL) were isolated and their composition and pro/antioxidant ability were determined. We observed that alterations in the lipid profile and lipoprotein composition were remarkable in the ICH-CAA group compared to control subjects, whereas the AD group presented no specific alterations compared with controls. ICH-CAA patients presented an atheroprotective profile, which consisted of lower total and LDL cholesterol levels. Plasma from chronic ICH-CAA patients also showed a redistribution of ApoC-III from HDL to VLDL and a higher ApoE/ApoC-III ratio in HDL. Whether these alterations reflect a protective response or have a causative effect on the pathology requires further investigation
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