viernes, 28 de marzo de 2014

AVC isquémico/ischemic strokes

Tiempos críticos de trombólisis en pacientes con evento vascular cerebral isquémico en el Hospital Regional Ciudad Madero, PEMEX 

Sánchez MR, Cruz LC, Trejo GJF
Rev Med Cri Ter Int 2010 

Isquemia cerebral leve: Seguridad y resultados en los pacientes que recibieron trombolisis. 
Mild stroke: safety and outcome in patients receiving thrombolysis.
Logallo N, Kvistad CE, Naess H, Waje-Andreassen U, Thomassen L.
Acta Neurol Scand Suppl. 2014 Apr;(198):37-40. doi: 10.1111/ane.12235.
OBJECTIVES: The aim of this study was to compare the short-term clinical outcome of patients with acute cerebral ischemia and mild symptoms receiving rt-PA with that of patients with acute cerebral ischemia and mild symptoms not treated with rt-PA, and to investigate the frequency of symptomatic intracranial hemorrhage (sICH) in these patients. MATERIALS AND METHODS: All patients with confirmed ischemic stroke/TIA and mild symptoms were included. Mild symptoms were defined as NIHSS score ≤5 on admission. Functional outcome was assessed with modified Rankin Scale (mRS) at day 7 or at earlier discharge. Excellent outcome was defined as mRS = 0. sICH was defined according to both NINDS and ECASS III criteria. RESULTS: Of 2753 patients with confirmed ischemic stroke/TIA admitted between February 2006 and February 2013, 966 (35.3%) were excluded because of having admission NIHSS >5. A total of 1791 patients presented with mild symptoms on admission (NIHSS ≤5), of which 158 (8.8%) patients received rt-PA. Treatment with rt-PA and early admission were independently associated with excellent outcome. Higher NIHSS score on admission and prior ischemic stroke were independently associated with poor outcome. Three (1.9%) sICH were diagnosed in rt-PA-treated patients and one (0.1%) in patients not receiving rt-PA. CONCLUSIONS: This study highlights the efficacy of rt-PA in patients with acute cerebral ischemia presenting with mild symptoms and confirms the low-risk profile of this treatment.

Impacto de un centro terciario de ictus en la atención de pacientes con ictus isquémico agudo por disección de arterias cervicales 
Impact of a comprehensive stroke center on the care of patients with acute ischemic stroke due to cervical artery dissection.
Almendrote M, Millán M, Prats LA, Pérez de la Ossa N2, López-Cancio E, Gomis M, Dorado L, Hernández-Pérez M, Hidalgo C, García-Bermejo P,Castaño C, Domenech S, Dávalos A.
Neurologia. 2014 Feb 20. pii: S0213-4853(14)00015-2. doi: 10.1016/j.nrl.2014.01.006
INTRODUCTION:Cervical artery dissection (CAD) is the cause of 2-3% of ischemic strokes and 10-25% of the ischemic strokes in young people. Our objective is to evaluate whether the implementation of a comprehensive stroke center (CSC) improves the diagnosis and modifies the prognosis of patients with acute stroke due to CAD.PATIENTS AND METHODS: Retrospective study of a registry of consecutive patients with acute stroke due to CAD. They were classified according to the period of care at our center: pre-CSC (October 2004-March 2008, 42 months) or post-CSC (April 2008-June 2012, 51 months). We compared baseline characteristics, methods of diagnosis, treatment and outcome of these patients in both periods.
RESULTS:Nine patients were diagnosed with CAD in the pre-CSC and 26 in the post-CSC, representing 0.8% and 2.1% of all ischemic strokes treated in each period, respectively. The diagnosis of CAD was made within the first 24hours in 42.3% of the patients in the post-CSC versus 0% in the pre-CSC, through the use of urgent cerebral angiography as a diagnostic test in 46.2% of cases in the second period compared to 0% in the first. The severity of stroke (median NIHSS score 11 vs. 3, P=.014) and time to neurological care (265min vs 148, P=.056) were higher in the post-CSC period. Endovascular treatment was performed in 34.3%, all in the post-CSC. The functional outcome was comparable in both periods. CONCLUSIONS: The implementation of a CSC increases the frequency of the diagnosis of CAD, as well as the treatment options for these patients in the acute phase of stroke. 

Cambios metabólicos en infarto cerebral agudo: Los hallazgos de imágenes espectroscópicas de resonancia magnética de protones. 

Metabolic changes in acute cerebral infarction: Findings from proton magnetic resonance spectroscopic imaging.
Lin AQ, Shou JX, Li XY, Ma L, Zhu XH.
Exp Ther Med. 2014 Feb;7(2):451-455. Epub 2013 Nov 19.
The purpose of this study was to investigate the clinical role of proton magnetic resonance spectroscopy (1H-MRS) in the diagnosis of acute cerebralinfarction. Using databases available at the Fifth Affiliated Hospital of Zhengzhou University (Zhengzhou, China), the medical records of 47 patients with acute cerebral infarction treated between April 2010 and March 2012 were retrospectively reviewed. The patients underwent routine magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI) and multiple-voxel 1H-MRS examination within 12 h after the onset of stroke. The patients then received normal medical treatment for 2 weeks and underwent follow-up 1H-MRS examination at 1-2 months after stroke. The concentrations of the main metabolites [N-acetylaspartic acid (NAA), creatine (Cr), choline (Cho) and lactate (Lac)] in the infarct center, the infarction border region and the contralateral brain areas (control) were analyzed. The 47 patients experienced changes in NAA, Cho and Lac levels at different stages after stroke. In the infarction center, the NAA/Cr and NAA/Cho ratios decreased, while the Lac/Cr ratio increased within 12 h compared with those in the contralateral side. Within 6-12 h after stroke, the Lac/Cr ratio increased and the NAA/Cho ratio decreased compared with those <6 h after stroke. During the 1-2 months post-stroke, significant reductions in the NAA/Cr, NAA/Cho, Cho/Cr and Lac/Cr ratios were observed in the infarction center. In the infarction border region, the Lac/Cr ratio increased significantly at 12 h and decreased during the 1-2 months after stroke. The NAA/Cr, NAA/Cho and Cho/Cr ratios were significantly increased in the infarction border regions of patients who received thrombolytic therapy for 1-2 months compared with those in patients who did not undergo thrombolysis. Our results highlight the usefulness of 1H-MRS-based metabolomics as a feasible and efficient prognostic tool for assessing the treatment effect of acute cerebral infarction.
KEYWORDS:N-acetylaspartate, acute cerebral infarction, diagnosis, lactate, magnetic resonance spectroscopy

Anestesiología y Medicina del Dolor
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