Uklanjanje mikroembolijskih signala kombiniranom antikoagulantnom i bantitrombocitnom terapijom

The effect of antithrombotic treatment on cerebral microembolism detected by transcranial Doppler sonography (TCD) in a case of internal carotid artery siphon stenosis is reported. A 58-year-old man suffered acute visual impairment associated with acute transient right upper limb paresis and paresthesia. Ultrasound examination of the neck arteries, TCD and digital subtraction angiography showed stenosis of the siphon of the left internal carotid artery. The patient was administered aspirin as antiplatelet therapy for 40 days, followed by anticoagulant therapy. Subsequently, he experienced many recurrent cerebral ischemic events. TCD monitoring performed on 4 occasions revealed microembolic signals (MES) in the ipsilateral middle cerebral artery. Aspirin was added to anticoagulant therapy. Once the combined anticoagulant and antiplatelet therapy had been introduced, no recurrent events were recorded anymore and no MES were detected. In this case, the detected MES proved to be in close relationship with recurrent cerebral ischemia, and were eliminated by combined anticoagulant and antiplatelet therapy.U radu se izvještava o zapaženom utjecaju antitrombotskog liječenja na cerebralnu mikroemboliju, koji je otkriven transkranijskim Dopplerovim ultrazvukom (TCD) u slučaju stenoze sliva unutarnje karotidne arterije. U 58-godišnjeg muškarca nastupio je akutni poremećaj vida te akutna prolazna pareza i parestezija gornjeg desnog ekstremiteta. Ultrazvučni pregled vratnih arterija, TCD i digitalna subtrakcijska angiografija pokazali su stenozu sliva lijeve unutarnje karotidne arterije. Bolesniku je uvedena antitrombocitna terapija aspirinom kroz 40 dana, nakon čega je nastavio s antikoagulantnom terapijom. Naknadno je imao brojne opetovane moždane ishemijske ispade. Praćenje pomoću TCD provedeno u 4 navrata otkrilo je mikroembolijske signale (MES) u istostranoj središnjoj moždanoj arteriji. Antikoagulantnoj terapiji dodan je aspirin. Nakon što je uvedena kombinirana antikoagulantna i antitrombocitna terapija nisu više zabilježeni nikakvi opetovani ispadi niti su više otkriveni MES. U ovom slučaju se pokazalo da su otkriveni MES bili usko povezani s opetovanom moždanom ishemijom, a uklonjeni su kombiniranom antikoagulantnom i antitrombocitnom terapijom

Uklanjanje mikroembolijskih signala kombiniranom antikoagulantnom i bantitrombocitnom terapijom

The effect of antithrombotic treatment on cerebral microembolism detected by transcranial Doppler sonography (TCD) in a case of internal carotid artery siphon stenosis is reported. A 58-year-old man suffered acute visual impairment associated with acute transient right upper limb paresis and paresthesia. Ultrasound examination of the neck arteries, TCD and digital subtraction angiography showed stenosis of the siphon of the left internal carotid artery. The patient was administered aspirin as antiplatelet therapy for 40 days, followed by anticoagulant therapy. Subsequently, he experienced many recurrent cerebral ischemic events. TCD monitoring performed on 4 occasions revealed microembolic signals (MES) in the ipsilateral middle cerebral artery. Aspirin was added to anticoagulant therapy. Once the combined anticoagulant and antiplatelet therapy had been introduced, no recurrent events were recorded anymore and no MES were detected. In this case, the detected MES proved to be in close relationship with recurrent cerebral ischemia, and were eliminated by combined anticoagulant and antiplatelet therapy.U radu se izvještava o zapaženom utjecaju antitrombotskog liječenja na cerebralnu mikroemboliju, koji je otkriven transkranijskim Dopplerovim ultrazvukom (TCD) u slučaju stenoze sliva unutarnje karotidne arterije. U 58-godišnjeg muškarca nastupio je akutni poremećaj vida te akutna prolazna pareza i parestezija gornjeg desnog ekstremiteta. Ultrazvučni pregled vratnih arterija, TCD i digitalna subtrakcijska angiografija pokazali su stenozu sliva lijeve unutarnje karotidne arterije. Bolesniku je uvedena antitrombocitna terapija aspirinom kroz 40 dana, nakon čega je nastavio s antikoagulantnom terapijom. Naknadno je imao brojne opetovane moždane ishemijske ispade. Praćenje pomoću TCD provedeno u 4 navrata otkrilo je mikroembolijske signale (MES) u istostranoj središnjoj moždanoj arteriji. Antikoagulantnoj terapiji dodan je aspirin. Nakon što je uvedena kombinirana antikoagulantna i antitrombocitna terapija nisu više zabilježeni nikakvi opetovani ispadi niti su više otkriveni MES. U ovom slučaju se pokazalo da su otkriveni MES bili usko povezani s opetovanom moždanom ishemijom, a uklonjeni su kombiniranom antikoagulantnom i antitrombocitnom terapijom

High-dose intravenous immunoglobulin treatment and cerebral vasospasm : a possible mechanism of ischemic encephalopathy?

A 46-year-old woman with a severe polyradiculoneuropathy treated with high-dose intravenous immunoglobulin (IVIg) presented an encephalopathy with increased blood flow velocities of the middle cerebral arteries (MCAs) detected by transcranial Doppler (TCD) studies. The similitude between this observation and another case recently reported of a patient suffering from Guillain-Barré syndrome (GBS) and cerebral blood flow abnormalities after IVIg treatment prompted us to investigate the responsibility of the IVIg therapy in the genesis of these blood flow alterations. We studied therefore by TCD 10 consecutive patients who underwent this treatment for different reasons. In 1 case we observed an asymptomatic, spontaneously reversible increase in the blood flow velocities of the MCAs consistent with a vasospasm and occurring 3-10 days after completion of the therapy. Stroke and ischemic encephalopathy have been reported as possible complications of IVIg treatment. In the case under discussion, clinical events appeared shortly after the administration of the IVIg therapy and responded favorably to a treatment with nimodipine. Other etiopathogenic mechanisms, in particular a CNS vasculopathic process related to the GBS itself, have to be considered as well. Further studies, with a larger number of patients, are therefore needed to evaluate the underlying mechanisms of blood flow abnormalities occurring sometimes in GBS patients after IVIg treatment

Migraine : fini le casse-tête ?

Une meilleure compréhension de la physiopathogénie de la migraine a permis le développement de nouveaux médicaments. Les triptans, agonistes des récepteurs 5 HT1, sont devenus les médicaments les plus efficaces dans les crises migraineuses sévères. Ces nouvelles substances ne sont cependant pas efficaces chez l'ensemble des migraineux. Il est aussi difficile de faire un choix parmi les nombreux médicaments à disposition. En ce qui concerne les médicaments de fond de la migraine, les progrès ont été moins spectaculaires. De nouveaux médicaments anti-migraineux préventifs seraient nécessaires pour permettre une meilleure prise en charge des patients souffrant de crises migraineuses très fréquentes

EEG dans 19 cas de SIDA avec atteinte de l'encéphale

Between 1983 and 1987, 19 patients presenting with encephalic involvement of AIDS had an EEG recording during the early neurological examination. In 8 patients, EEGs were repeated 1 to 11 times during the course of the disease. All recordings were abnormal. A good EEG correlation existed with clinical, virological and bacteriological (SF), radiological, and histological data (10 cases). EEG recordings are useful to study the encephalic pathology of AIDS, not only for its secondary, but even more for its primary involvement

Fatty acid binding protein as a serum marker for the early diagnosis of stroke: a pilot study

No biological marker is currently available for the routine diagnosis of stroke. The aim of this pilot study was to determine whether heart-fatty acid binding protein (H-FABP) could be used as a valid diagnostic biomarker for stroke, as compared with neuron-specific enolase (NSE) and S100B proteins. Using two-dimensional gel electrophoresis separation of cerebrospinal fluid proteins and mass spectrometry techniques, FABP was found elevated in the cerebrospinal fluid of deceased patients, used as a model of massive brain damage. Because H-FABP, a FABP form present in many organs, is also localized in the brain, an enzyme-linked immunosorbant assay was developed to detect H-FABP in stroke versus control plasma samples. However, H-FABP being also a marker of acute myocardial infarction (AMI), troponin-I and creatine kinase-MB levels were assayed at the same time in order to exclude any concomitant heart damage. NSE and S100B levels were assayed simultaneously. These assays were assessed in serial plasma samples from 22 control patients with no AMI or stroke, 20 patients with AMI but no stroke, and 22 patients with an acute stroke but no AMI. Twenty-two out of the 22 control patients and 15 out of the 22 stroke patients were correctly classified, figures much better than those obtained with NSE or S100B, in the same study's population. H-FABP appears to be a valid serum biomarker for the early diagnosis of stroke. Further studies on large cohorts of patients are warranted