4 research outputs found
Infarto medular: etiolog铆a, hallazgos radiol贸gicos y factores pron贸sticos en una serie de 41 pacientes
Resumen: Introducci贸n: El infarto medular es una entidad infrecuente y con elevada morbilidad. El diagn贸stico puede resultar dif铆cil y el tratamiento 贸ptimo sigue siendo controvertido. Existen pocas series de casos publicadas. M茅todos: Estudio retrospectivo de infarto medular en un hospital terciario desde 1999 a 2020. Se evaluaron la etiolog铆a, las caracter铆sticas cl铆nicas, radiol贸gicas, terap茅uticas y pron贸sticas. Resultados: Se incluyeron 41 pacientes (58,5% varones, edad media 61聽卤17 a帽os). Treinta y un pacientes (75,6%) presentaban factores de riesgo vascular (FRV). Presentaron d茅ficit motor (39, 95,1%), dolor (20, 48,8%), d茅ficit sensitivo (33, 80,4%) y alteraci贸n auton贸mica (24, 58,5%). Se realiz贸 resonancia magn茅tica (RM) en 37 pacientes (90,2%). En los 12 pacientes con secuencias de difusi贸n, esta estaba alterada en 10. La localizaci贸n m谩s afectada fue la dorsal (68,2%). Se realiz贸 estudio vascular en 33 pacientes (80,4%). Las etiolog铆as m谩s frecuentes fueron disecci贸n a贸rtica en 6, ateroesclerosis demostrada en estudio vascular en 6, embolia fibrocartilaginosa en 6, posquir煤rgico en 5 e hipotensi贸n en 4. El mecanismo etiol贸gico qued贸 sin filiar en 12 pacientes (29,3%), 9 presentaban FRV. Al final del periodo de seguimiento (mediana 24 meses, rango intercuart铆lico 3-70), 12 pacientes (29,2%) presentaban deambulaci贸n aut贸noma. La presencia de FRV y la paraparesia se asociaron significativamente a peor pron贸stico (p聽<聽0,05). Discusi贸n: El infarto medular es una patolog铆a con una etiolog铆a variada, que en muchos de los pacientes queda sin resolver. El pron贸stico funcional a largo plazo es malo y depende de las caracter铆sticas basales del paciente y de la forma de presentaci贸n cl铆nica. La RM, especialmente las secuencias de difusi贸n, es 煤til en el diagn贸stico precoz. Abstract: Introduction: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. Methods: We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. Results: Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P聽<聽.05). Discussion: Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis
Mechanical thrombectomy beyond 6聽hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: experience at a tertiary hospital
Introduction: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. Methods: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. Results: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. Conclusion: In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study. Resumen: Introducci贸n: La eficacia de la trombectom铆a mec谩nica en territorio carot铆deo en las primeras 24 horas se ha probado con trabajos publicados recientemente. M茅todos: Revisi贸n retrospectiva a partir de un registro prospectivo en nuestro centro de referencia de ictus para valorar la eficacia y seguridad del tratamiento endovascular realizado m谩s all谩 de las 6 horas de evoluci贸n de los s铆ntomas en pacientes con ictus isqu茅mico agudo y oclusi贸n de gran vaso en territorio carot铆deo, entre noviembre de 2016 y abril de 2019. Resultados: Se recopilaron datos de 59 pacientes (55,9% mujeres, mediana de edad 71 a帽os). Treinta y tres pacientes fueron detectados al despertar. El 57,6% de los casos fueron traslados secundarios. La mediana de NIHSS basal fue 16. La mediana del ASPECTS fue 8 y el 94,9% de los pacientes present贸 > 50% de tejido salvable. El 88,1% de los pacientes logr贸 una recanalizaci贸n satisfactoria, en 5 pacientes despu茅s de 24 horas de evoluci贸n. El 67,8% de los casos logr贸 la independencia funcional a los 90 d铆as de seguimiento. Los pacientes que no lograron la independencia funcional presentaban mayor edad, mayor proporci贸n de fibrilaci贸n auricular, mayor tiempo punci贸n-recanalizaci贸n y mayor puntuaci贸n NIHSS, tanto basal como al alta. Conclusi贸n: En nuestra experiencia la trombectom铆a mec谩nica despu茅s de las 6 horas se asoci贸 con buenos resultados de funcionalidad a los 90 d铆as. La edad, la puntuaci贸n NIHSS, el tiempo punci贸n-recanalizaci贸n y la prevalencia de fibrilaci贸n auricular fueron factores determinantes en el pron贸stico funcional. La eficacia de este tratamiento por encima de las 24 horas merece ser estudiada