- Mexico
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Objetivo. Determinar la frecuencia de acidosis metabolica y sus factores relacionados en pacientes tratados con topiramato solo o como adyuvante para el tratamiento de epilepsia. Pacientes y metodos. Analisis transversal de la gasometria... more
Objetivo. Determinar la frecuencia de acidosis metabolica y sus factores relacionados en pacientes tratados con topiramato solo o como adyuvante para el tratamiento de epilepsia. Pacientes y metodos. Analisis transversal de la gasometria arterial de pacientes epilepticos que recibieron topiramato durante 2010 en la clinica de epilepsia del Centro Medico Nacional 20 de Noviembre en Mexico. Se registraron datos clinicos concernientes a la epilepsia y su tratamiento, asi como de los sintomas comunes de acidosis metabolica. Resultados. Se estudiaron 32 adultos con epilepsia, quienes recibieron topiramato en monoterapia o en combinacion por lo menos durante un mes. Se encontro acidosis metabolica en todos los pacientes (HCO3 < 22 Eq/L); nueve tomaron solo topiramato y 23 tomaron por lo menos dos farmacos antiepilepticos (FAE). Todos los pacientes fueron asintomaticos. No se encontro correlacion entre los niveles de bicarbonato y la dosis del medicamento o la duracion del tratamiento. La dosis fue significativamente mayor en el grupo de monoterapia y el nivel de bicarbonato fue mas bajo en los pacientes que tomaban mas de un FAE. Conclusiones. El uso concomitante de FAE incrementa los efectos conocidos del topiramato sobre los niveles sericos de bicarbonato y la presencia de acidosis metabolica; estos efectos parecen ser independientes del numero de FAE utilizados.
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Background: Given the high contribution of stroke to the global burden of disease, there is a need for good-quality information on Web platforms such as Wikipedia. Aims: This study aimed to describe the quality of the Wikipedia articles... more
Background: Given the high contribution of stroke to the global burden of disease, there is a need for good-quality information on Web platforms such as Wikipedia. Aims: This study aimed to describe the quality of the Wikipedia articles on stroke written in different languages. Methods: We studied the world’s 30 most spoken languages. With the DISCERN score, we evaluated the quality of the information within the Wikipedia articles. Three investigators assessed each of the texts translated to English. We also registered the word count, the number of references, and if the text referred to the emergency status of stroke, cues to suspect a stroke, and allusions to endovascular treatment. Results: There is a Wikipedia article for stroke in 23 out of the 30 languages. The mean DISCERN score was 35 29.9 ± 9.2. Overall quality ranged from 3/5 in 26.1% to 1/5 in 17.4%. Word count had a mean of 36 3,145.8 ± 3,048.9 words, and the texts included a mean of 43.1 ± 57.3 references; 69.6% of the articles referred to stroke as a medical emergency, 52.2% included awareness symptoms, and 34.8% included endovascular management among the stroke treatments. Three pages included steroids as part of the stroke treatment. The DISCERN score was not correlated with the number of speakers, but it was positively correlated with the number of references (r = 0.90, p &lt; 0.001) and the number of words (r = 0.78, p &lt; 0.001) in the articles. Conclusion: The analyzed Wikipedia articles do not contain relevant and up-to-date information to the general population. Further, the content varies widely across the different languages and is missing for some of them. The missing versions disproportionally affect millions of potential information seekers in undeveloped countries.
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Background and Purpose: Sphenopalatine ganglion (SPG) electrical stimulation has been studied in the setting of acute ischemic stroke to enhance collateral flow. Capsaicin poses an alternative to chemically stimulate the sphenopalatine... more
Background and Purpose: Sphenopalatine ganglion (SPG) electrical stimulation has been studied in the setting of acute ischemic stroke to enhance collateral flow. Capsaicin poses an alternative to chemically stimulate the sphenopalatine ganglion. Therefore, the objective of this study was to determine the safety and effect of increasing doses of capsaicin upon serial transcranial Doppler markers of cerebral blood flow. Methods: We performed serial transcranial Doppler testing in 30 healthy volunteers divided into 5 equal groups. Capsaicin doses ranged from 33 to 165 μMol. We recorded peak systolic and end-diastolic velocities in the middle cerebral artery, arterial pressure, and perceived pungency in 5-minute intervals up to 20 minutes. We then calculated the mean velocity, the pulsatility index, and the cerebral blood flow index. Results: The participants’ median age was 21 years (range, 5 years); all reported consumption of capsaicin in their diets. After and during the study, none reported side effects. Perceived pungency peaked at 5 minutes, and by the 20-minute mark, none perceived any pungency. All the tested doses produced the same pattern, consisting of augmentation of the middle cerebral artery mean velocity with the pulsatility index’s diminution. The effects peaked between the 5- and the 10-minute measurements and then returned to basal levels except for the 66-μMol doses, which produced a sustained effect. We found no correlation between perceived pungency and dose, but the middle cerebral artery mean velocity was strongly correlated with the dose administered. Conclusions: This study provides evidence supporting the safety and tolerability of oral capsaicin in a population of healthy volunteers. Capsaicin appears to produce effects similar to those of sphenopalatine ganglion electrical stimulation. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04545892.
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To describe the differences in the serum levels of MMP-2 and MMP-9 of patients with vertebrobasilar dolichoectasia (VBD) with and without acute stroke. Case–control study. From an outpatient clinic, we recruited 14 controls and 19... more
To describe the differences in the serum levels of MMP-2 and MMP-9 of patients with vertebrobasilar dolichoectasia (VBD) with and without acute stroke. Case–control study. From an outpatient clinic, we recruited 14 controls and 19 patients with VBD. We also recruited 33 patients with stroke from two emergency departments, 14 without VBD (S/-VBD) and 19 with VBD (S/ + VBD). All the patients underwent serum MMP-2 and MMP-9 measurements and a non-contrast CT scan. Two investigators assessed the intracranial vertebral arteries (VA) and the basilar artery (BA) at the mid-pons. Diagnosis of VBD was made if the BA diameter was ≥ 4.5 mm. The mean age of the 66 patients studied was 57.6 + 16.0 years, 41% female. In the 33 patients with stroke, the median NIHSS was 8 (range 15); there were no differences in the NIHSS scores between both groups with stroke. Median MMP-2 levels were lower in the S/-VBD when compared to controls. Median MMP-9 serum levels were higher in both groups with VBD when compared to controls and the S/-VDB group. Both groups with stroke exhibited higher MMP-9 serum levels than controls but were not statistically different from those found in patients with VBD. Serum levels of MMP-9 were significantly correlated with the diameters of the BA (r = 0.344, p = 0.01) and the left VA (r = 0.305, p = 0.05). This study found that high serum levels of MMP-9 are associated with VBD independently of stroke and correlated with the degree of VBD.
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The actual investigation of the body of a patient by the clinician in search for the signs of the disease beginning with the primary vital signs and continues with the careful and attentive observation of the patient. This article reviews... more
The actual investigation of the body of a patient by the clinician in search for the signs of the disease beginning with the primary vital signs and continues with the careful and attentive observation of the patient. This article reviews the key findings in the physical examination of patients with ischemic stroke that have the potential to indicate the etiology of the infarct and to help to choose the use of ancillary tests. Through a systematic search of articles published in English related to the physical examination of patients with stroke, we identified key findings in the vital signs and classic components of the physical exam (appearance of the patient, auscultation, and eye examination) that have shown clinical significance when determining ischemic stroke etiology. We further suggest that the prompt identification of such findings can translate into better use of diagnostic tools and selection of ancillary confirmatory tests, thus, reducing the time to etiology based treatment and secondary prevention of ischemic stroke. in this manuscript, we aim to show that even though nowadays the clinical skills tend to be overlooked due to the overreliance on technology, the physical exam continues to be a valuable tool in the clinician armamentarium when facing the challenge of a patient with ischemic stroke.
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Research Interests: Adolescent, Medicine, Humans, Male, Tramadol, and 3 moreNeurologia, Status Epilepticus, and Neurología
Research Interests: Adolescent, Medicine, Humans, Male, Tramadol, and 3 moreNeurologia, Status Epilepticus, and Neurología
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Background: Ischemic stroke has been reported to occur in approximately 5% of COVID-19 patients, although some reports are contradictory. Proposed mechanisms of this association are hypercoagulable state, vasculitis and cardiomyopathy,... more
Background: Ischemic stroke has been reported to occur in approximately 5% of COVID-19 patients, although some reports are contradictory. Proposed mechanisms of this association are hypercoagulable state, vasculitis and cardiomyopathy, together with traditional vascular risk factors. We analyzed the frequency and clinical characteristics of COVID-19 positive stroke cases during the first months of the pandemic in Latin America. Methods: A multinational study (7 countries, 18 centers) of patients admitted during the pandemic outbreak (March - June 2020). We assessed acute stroke cases associated to COVID-19 infection. Clinical characteristics, stroke etiology and severity, acute care and functional outcomes, were compared between non-COVID-19 and COVID-19 cases. Results: There were a total of 1037 stroke cases; sixty-two of them (6.0%) were diagnosed with COVID-19 infection. This group consisted of 38 men [61.3%], with a median age of 68 years [IQR 59-79 years]. From these cases, 80....
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Background: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially acute admissions and ancillary tests availability. We assessed the impact of the pandemic and the... more
Background: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially acute admissions and ancillary tests availability. We assessed the impact of the pandemic and the lockdowns imposed in stroke admissions in Latin America. Methods: A multinational study (7 countries, 18 centers) of patients admitted since the pandemic outbreak (January - June 2020). These cases were compared with the same period in 2019. We also assessed patterns during the strictest lockdown period (March-June 2020). Number of cases, stroke etiology and severity, acute care and functional outcomes were compared per periods, months, centers and countries. Results: There were 1863 stroke cases in 2019 and 1781 cases in 2020 (p=0.02). We found a significant increase in strokes of undetermined etiology due to incomplete studies in 2020 [16.8% vs 27.6%, p<0.001]). Most countries reported decreases in all-type stroke admissions, except México and Bra...
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OBJECTIVES COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially during peak periods. We assessed the impact of the pandemic and lockdowns in stroke admissions and... more
OBJECTIVES COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially during peak periods. We assessed the impact of the pandemic and lockdowns in stroke admissions and care in Latin America. MATERIALS AND METHODS A multinational study (7 countries, 18 centers) of patients admitted during the pandemic outbreak (March-June 2020). Comparisons were made with the same period in 2019. Numbers of cases, stroke etiology and severity, acute care and hospitalization outcomes were assessed. RESULTS Most countries reported mild decreases in stroke admissions compared to the same period of 2019 (1187 vs. 1166, p = 0.03). Among stroke subtypes, there was a reduction in ischemic strokes (IS) admissions (78.3% vs. 73.9%, p = 0.01) compared with 2019, especially in IS with NIHSS 0-5 (50.1% vs. 44.9%, p = 0.03). A substantial increase in the proportion of stroke admissions beyond 48 h from symptoms onset was observed (13.8% vs. 20.5%, p < 0.001). Nevertheless, no differences in total reperfusion treatment rates were observed, with similar door-to-needle, door-to-CT, and door-to-groin times in both periods. Other stroke outcomes, as all-type mortality during hospitalization (4.9% vs. 9.7%, p < 0.001), length of stay (IQR 1-5 days vs. 0-9 days, p < 0.001), and likelihood to be discharged home (91.6% vs. 83.0%, p < 0.001), were compromised during COVID-19 lockdown period. CONCLUSIONS In this Latin America survey, there was a mild decrease in admissions of IS during the COVID-19 lockdown period, with a significant delay in time to consultations and worse hospitalization outcomes.
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Background Reports on sex differences in stroke outcome and risk factors are scarce in Latin America. Our objective was to analyze clinical and prognostic differences according to sex among participants in the LASE (Latin American Stroke... more
Background Reports on sex differences in stroke outcome and risk factors are scarce in Latin America. Our objective was to analyze clinical and prognostic differences according to sex among participants in the LASE (Latin American Stroke Registry). Methods and Results Nineteen centers across Central and South America compiled data on demographics, vascular risk factors, clinical stroke description, ancillary tests, and functional outcomes at short‐term follow‐up of patients included from January 2012 to January 2017. For the present study, all these variables were analyzed according to sex at hospital discharge. We included 4788 patients with a median in‐hospital stay of 8 days (interquartile range, 5–8); 2677 were male (median age, 66 years) and 2111 female (median age, 60 years). Ischemic stroke occurred in 4293: 3686 as cerebral infarction (77%) and 607 as transient ischemic attack cases (12.7%); 495 patients (10.3%) corresponded to intracerebral hemorrhage. Poor functional outco...
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Stroke has been scarcely studied in Latin America (LA). The Mexican Institute of Neurology Stroke Registry was established in 1990 as a prospective computer-based database to register data obtained from patients admitted with stroke.... more
Stroke has been scarcely studied in Latin America (LA). The Mexican Institute of Neurology Stroke Registry was established in 1990 as a prospective computer-based database to register data obtained from patients admitted with stroke. Using this data, we attempted to define the profile of risk factors and outcomes. The demographic data, stroke description, ancillary tests, vascular risk factors, and modified Rankin scale (mRs) were registered. Ischemic stroke subtyping was based on the Trial of Org 10,172 of the Acute Stroke Treatment classification. We followed-up patients using multiple overlapping methods. Primary outcomes included mRs, recurrence, and death at 30 days and at the end of follow-up. We included 4,481 patients with a median follow-up of 27 months, (17,281 person-years follow-up). The mean age was 52.8 ± 18 years. There were 2,229 males (50%) included in the study. CI was present in 64.9%, intracerebral hemorrhage (ICH) in 25.6%, and cerebral venous thrombosis (CVT) i...
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Introduction: As acute stroke therapies expand to less well-resourced regions, it is imperative to study real-world data to assess outcomes and the quality of stroke care. The present study analyzes clinical, and imaging outcomes after... more
Introduction: As acute stroke therapies expand to less well-resourced regions, it is imperative to study real-world data to assess outcomes and the quality of stroke care. The present study analyzes clinical, and imaging outcomes after acute IV thrombolysis (IV-tPA) compared to mechanical thrombectomy (MT) or combined therapy in the LASE. Methods: A retrospective analysis of consecutive acute ischemic stroke cases in 17 centers from 9 Latin American (LA) countries since 2012 was performed using weighted Euclidean matching of nearest neighbors in 3-D space of baseline NIHSS, age, and glucose. Results: 950 patients receiving only IV-tPA were matched to 127 treated with MT+IV-tPA. Matching resulted in 97 pairs well balanced for age (69.1 vs. 69.3), baseline NIHSS (17 vs. 17), and glucose (124.3 vs. 124.5), all p>0.2. 3-month mRS 0-1 (38.3% vs 29.8%, p=0.23) and mRS 0-2 (46.8% vs 41.5%, p=0.54) were non-significantly higher in the MT+IV-tPA group, with higher hemorrhage (26.6% vs 15....
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Endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) remains an off-label procedure seldom utilized in the pediatric population; this holds especially true for patients presenting outside the standard 6-hour... more
Endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) remains an off-label procedure seldom utilized in the pediatric population; this holds especially true for patients presenting outside the standard 6-hour time window. In this review we describe the published literature regarding usage of the extended time window EVT in pediatric stroke. We searched PubMed for all pediatric AIS cases and case series that included patients treated with extended time window EVT. We found data from 38 cases found in 27 publications (15 case reports and 12 case series). The median age was 10 years; 60.5% males. The median NIHSS before EVT was 13 with a median time-to-treatment of 11 hours. The posterior circulation was involved in 50.0%. Stent retrievers were used in 68.5%, and aspiration in 13.2%. Angiographic outcome TICI ≥2B was achieved in 84.2%, whereas TICI˂2B was reported in 10.6%. A favorable clinical outcome (NIHSS score ≤4, modified Rankin score ≤1, or Pediatric S...
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It is well established that several infectious diseases can directly lead to ischemic or hemorrhagic stroke. Neurocysticercosis (NCC), caused by infection of the human central nervous system with the parasite Taenia solium, is recognized... more
It is well established that several infectious diseases can directly lead to ischemic or hemorrhagic stroke. Neurocysticercosis (NCC), caused by infection of the human central nervous system with the parasite Taenia solium, is recognized as an important public health problem in developing countries. The clinical manifestations of NCC are nonspecific and varied depending on the number and topography of lesions. Cerebrovascular disease is a relatively common but underrecognized complication of NCC; published data indicate that the incidence of stroke is between 4% and 12% in patients with NCC, depicting a clear relationship among these 2 pathologies. We review the cerebrovascular complications of NCC including the possible role of NCC as a cerebrovascular risk factor, including epidemiology, pathogenesis, diagnosis, and management of the cerebrovascular complications derived from cysticercal infarction and those associated with the use of anticysticercal drugs. Common and uncommon clinical manifestations, localization of stroke, and associated syndromes are discussed along with their prognostic significance. Although an underrecognized cause of stroke, present preponderantly in undeveloped countries, NCC still causes significant incapacity and even death in young patients suffering from stroke in the absence of cerebrovascular risk factors; hence, neurologists should become familiar with this potential complication.
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Research Interests: Health Sciences, Medicine, Mexico, Humans, Placebo, and 15 moreFemale, Male, Clinical Sciences, Randomized Controlled Trial, FLUOXETINE, Intracerebral Hemorrhage, MEXICO, Clinical Protocols, Cerebral Hemorrhage, Neurosciences, Motor Recovery, Motor activity, Recovery of Function, Disability Evaluation, and Cardiovascular medicine and haematology
Background Among patients with a patent foramen ovale and cryptogenic ischemic stroke, the long-term prognosis is unclear. Aims This study aims to estimate the recurrence rate in young cryptogenic stroke patients with and without patent... more
Background Among patients with a patent foramen ovale and cryptogenic ischemic stroke, the long-term prognosis is unclear. Aims This study aims to estimate the recurrence rate in young cryptogenic stroke patients with and without patent foramen ovale. Patients and methods One hundred eighty-six cryptogenic stroke patients (aged 18–45 years) were prospectively followed for up to five-years. They were divided into two groups according to the echocardiographic presence of patent foramen ovale. All patients received aspirin (100mg/day) for secondary prevention. Results Mean age was 32·3 (standard deviation 7·9) years. During the mean follow-up of 66 months five patients with patent foramen ovale had recurrent strokes compared with 11 patients without patent foramen ovale. The average annual rate of recurrent cerebral ischemia was 1·1% and 1·6% for patients with and without patent foramen ovale, respectively. The recurrence rate did not increase with the presence of patent foramen ovale,...
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Background and Purpose— We investigated the predictors and time course for recanalization after vertebral artery dissection. Methods— We prospectively studied 61 consecutive patients with confirmed diagnoses of vertebral artery dissection... more
Background and Purpose— We investigated the predictors and time course for recanalization after vertebral artery dissection. Methods— We prospectively studied 61 consecutive patients with confirmed diagnoses of vertebral artery dissection without intracerebral hemorrhage. Neuroimaging and clinical follow-up were performed at presentation and at 3, 6, and 12 months. Results— We included 61 patients with confirmed vertebral artery dissection; 19 were evaluated and followed up with conventional angiography, 24 with MR angiography, and 18 with CT angiography. Fifty-one patients had a stenotic dissection, 7 had an occlusive dissection, one had a double-lumen image, and 2 had a pseudoaneurysm. The estimated rate of complete recanalization after vertebral artery dissection was 45.9% at 3 months, 62.3% at 6 months, and 63.9% at 12 months. We found no association between outcome and complete or partial recanalization nor did we find any factors associated with recanalization. Conclusions— Th...
Research Interests: Medicine, Stroke, Prospective studies, Humans, Outcome, and 13 moreMale, Young Adult, Clinical Sciences, Middle Aged, Adult, Time Factors, Prognosis, Neurosciences, Vertebral artery, Cerebral Angiography, Cervical Artery Dissection, Vertebral Artery Dissection, and Cardiovascular medicine and haematology
Cerebral vasospasm (CV) accounts significant morbimortality after aneurysmal subarachnoid hemorrhage. The objective of this study was to compare the clinical outcome of patients with CV treated by 2 endovascular procedures: intra-arterial... more
Cerebral vasospasm (CV) accounts significant morbimortality after aneurysmal subarachnoid hemorrhage. The objective of this study was to compare the clinical outcome of patients with CV treated by 2 endovascular procedures: intra-arterial nimodipine angioplasty (IANA) and balloon angioplasty (BA). Between 2008 and June 2011, we performed 22 IANA and 8 BA in 30 patients. The mean age was 44 years and 60 % was female. In 17 patients, the treatment was clipping, whereas 13 underwent coil treatment. The CV was severe in 63%, moderate in 30%, and mild in 7%. Good outcome between 2 groups was similar (P .36). The clinical outcome according to the subgroups of CV severity and modality treatment was equivalent (P .22). Mortality at 3 months was 16 % and 20 % at 1 year. We did not find differences in the clinical outcome despite the fact that both techniques produce adequate angiographic resolution of CV.
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INTRODUCTION The objective of the study was to analyse the correlation between extracorporeal life support (ECLS) and aortic cross-clamp times and optic nerve sheath diameter (ONSD). PATIENTS AND METHODS Study in a cohort of patients aged... more
INTRODUCTION The objective of the study was to analyse the correlation between extracorporeal life support (ECLS) and aortic cross-clamp times and optic nerve sheath diameter (ONSD). PATIENTS AND METHODS Study in a cohort of patients aged 0 to 15 years that underwent ECLS for cardiac surgery after obtention of signed informed consent. We calculated a sample size of 23 participants. First, we obtained 3 vertical and 3 horizontal measurements of the ONSD for each eye and calculated the mean of both eyes for each measurement to be used in the analysis. The measurements were made at admission and at 6 and 24hours post surgery. We retrieved the ECLS time and the aortic cross-clamp time were from the operative report. RESULTS We analysed data for 23 participants, 52.2% female, with a median age of 14 months. The median ECLS time was 60minutes; the median aortic cross-clamp time was 32minutes. The median baseline ONSD was 3.1mm. ONSD values had increased a median of 0.015mm at 6hours post ...
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ABSTRACT
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En la actualidad, la anticoagulación re-presenta una de las estrategias más impor-tantes para la prevención primaria y secundaria de la enfermedad vascular cere-bral (EVC) isquémica. El embolismo cerebral derivado de alteraciones... more
En la actualidad, la anticoagulación re-presenta una de las estrategias más impor-tantes para la prevención primaria y secundaria de la enfermedad vascular cere-bral (EVC) isquémica. El embolismo cerebral derivado de alteraciones cardiacas, es el res-ponsable de ...
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ABSTRACT
In the clinical study of migraine and cephalalgia it is clear that there are psychological co-morbidities associated with the development of the disease. So, the aim of this study was to compare the mood and personality traits of migraine... more
In the clinical study of migraine and cephalalgia it is clear that there are psychological co-morbidities associated with the development of the disease. So, the aim of this study was to compare the mood and personality traits of migraine female patients (MFP) with those of control healthy subjects (CS). In this epidemiological study, 103 patients with clinical and neurological diagnosis of migraine (International Headache Society, criteria), and 86 control female subjects from 18 to 50 years participated. Methodology. Psychological aspects evaluated were: Mayor depression (DSMIVTR), anxiety (Hamilton test: Br J Med Psychol, 1959), selfesteem (Coopersmith test, J Reprod Med, 2002), personality (Eysenck & LaraCantu, Salud Mental, 1989); and the social adaptation (SASS scale, Boscm et al, Eur Neuropsyc, 1997). Results. MPF had significatively higher score of psychotic traits than control subjects. The mean and standar deviation (X±SD) results were: 13.1±5.2 vs. 10.3±5.1, for MPF an...
Background: Stroke has been scarcely studied in Latin America (LA). The Mexican Institute of Neurology Stroke Registry was established in 1988 as a prospective computer-based database to register data from patients admitted with stroke.... more
Background: Stroke has been scarcely studied in Latin America (LA). The Mexican Institute of Neurology Stroke Registry was established in 1988 as a prospective computer-based database to register data from patients admitted with stroke. Using this data, we attempted to estimate the subtype and define the profile of risk factors and outcomes. Methods: The National Institute of Neurology is tertiary neurologic hospital in Mexico City. The standard protocol included demographic data, stroke description, vascular risk factors, mortality rate at 30-day and at the end of individual follow-up. We followed-up patients in the ambulatory stroke clinic and by telephone for those that did not return to clinic; we also reviewed possible readmissions to our institution. Primary outcome were outcome, stroke recurrence and death. Results: We included 4,491 patients with median follow-up of 27 months, giving 17,281 person-years follow-up time. There were 2,229 men (mean 53.4 years) and 2,262 women (me...
ABSTRACT Objective: Our purpose was to construct a simple and reliable prognostic scale for neurocysticercosis. Background: Infection of the human nervous system by T.solium larvae (neurocysticercosis) is a very common event in endemic... more
ABSTRACT Objective: Our purpose was to construct a simple and reliable prognostic scale for neurocysticercosis. Background: Infection of the human nervous system by T.solium larvae (neurocysticercosis) is a very common event in endemic regions, where symptomatic NCC accounts for approximately one third of seizure disorders and contributes to other neurological sequelae that result from the immunological reaction of the host against cysticerci, such reaction is largely unpredictable and accounts for the therapeutic and prognostic uncertainty that still remains around this disease. Design/Methods: The scale was obtained in 293 consecutive patients fulfilling criteria for neurocysticercosis evaluated at our center. Outcome was assessed at 3 months as the number of patients with neurological deficit due to the parasitosis. By a preliminary univariate analysis, 14 of 42 baseline variables were found to be associated with the development of neurological sequelae. Subsequent multivariable analyses led to a ¿nal model of six dichotomous factors. Results: Each of the found factors was assigned a score based on their beta coefficient: Seizures (-1 point) or headache (1 point) as initial manifestation of neurocysticercosis, leukocyte count above 12x109/L (-1 point), presence of six to ten parasites (-1 point), subarachnoid localization of parasites (-1 point) and the use of anti-helminthic drugs (1 point). Among 113 patients with scores -4 to -1, 79.6% developed neurological deficits. With 1-2 scores, 64.6% of the patients recovered completely, overall accuracy of prediction 74.7%, area under ROC curve = 0.722 (95% Confidence Interval, 0.664-0.780, p&lt;0.0001). Conclusions: In patients with neurocysticercosis, the presence of seizures, headache, leukocytosis and a moderate number of parasites with subarachnoid localization allow a simple and accurate prediction of the development of neurological sequelae due to this highly prevalent disease.
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... Yolanda Aburto-Murrieta, 1,2 Dulce Bonifacio-Delgadillo, 1 and Juan Marquez 1. ... 95% CI 0.70–0.97) and of ischemic strokes (OR 0.76; 95% CI 0.63–0.93) and was associated with a nonsignificant increase in hemorrhagic strokes, without... more
... Yolanda Aburto-Murrieta, 1,2 Dulce Bonifacio-Delgadillo, 1 and Juan Marquez 1. ... 95% CI 0.70–0.97) and of ischemic strokes (OR 0.76; 95% CI 0.63–0.93) and was associated with a nonsignificant increase in hemorrhagic strokes, without reduction in the risk of fatal or nonfatal ...
BACKGROUND AND PURPOSE: We investigated the predictors and time course for recanalization after vertebral artery dissection. METHODS: We prospectively studied 61 consecutive patients with confirmed diagnoses of vertebral artery dissection... more
BACKGROUND AND PURPOSE:
We investigated the predictors and time course for recanalization after vertebral artery dissection.
METHODS:
We prospectively studied 61 consecutive patients with confirmed diagnoses of vertebral artery dissection without intracerebral hemorrhage. Neuroimaging and clinical follow-up were performed at presentation and at 3, 6, and 12 months.
RESULTS:
We included 61 patients with confirmed vertebral artery dissection; 19 were evaluated and followed up with conventional angiography, 24 with MR angiography, and 18 with CT angiography. Fifty-one patients had a stenotic dissection, 7 had an occlusive dissection, one had a double-lumen image, and 2 had a pseudoaneurysm. The estimated rate of complete recanalization after vertebral artery dissection was 45.9% at 3 months, 62.3% at 6 months, and 63.9% at 12 months. We found no association between outcome and complete or partial recanalization nor did we find any factors associated with recanalization.
CONCLUSIONS:
These results suggest that recanalization of vertebral artery dissection occurs mainly within the first 6 months after the onset of symptoms regardless of the location or pattern of the dissection.
We investigated the predictors and time course for recanalization after vertebral artery dissection.
METHODS:
We prospectively studied 61 consecutive patients with confirmed diagnoses of vertebral artery dissection without intracerebral hemorrhage. Neuroimaging and clinical follow-up were performed at presentation and at 3, 6, and 12 months.
RESULTS:
We included 61 patients with confirmed vertebral artery dissection; 19 were evaluated and followed up with conventional angiography, 24 with MR angiography, and 18 with CT angiography. Fifty-one patients had a stenotic dissection, 7 had an occlusive dissection, one had a double-lumen image, and 2 had a pseudoaneurysm. The estimated rate of complete recanalization after vertebral artery dissection was 45.9% at 3 months, 62.3% at 6 months, and 63.9% at 12 months. We found no association between outcome and complete or partial recanalization nor did we find any factors associated with recanalization.
CONCLUSIONS:
These results suggest that recanalization of vertebral artery dissection occurs mainly within the first 6 months after the onset of symptoms regardless of the location or pattern of the dissection.
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INTRODUCTION: The primary antiphospholipid syndrome (PAS) is an independent risk factor for cerebral infarction. AIM. To evaluate the risk of recurrence, to compare different treatments and determine the risk factors associated with... more
INTRODUCTION:
The primary antiphospholipid syndrome (PAS) is an independent risk factor for cerebral infarction. AIM. To evaluate the risk of recurrence, to compare different treatments and determine the risk factors associated with recurrence and hemorrhagic complications in patients with cerebral infarction and PAS.
PATIENTS AND METHODS:
Prospectively collected data from 92 patients under 45 years (71% female, mean age 33.8 ± 8.9 years) with confirmed diagnoses of cerebral infarction and PAS, treated with anticoagulants (n = 54) or aspirin (n = 38) were retrospectively analyzed. Clinical follow-up was obtained by neurological examination every 6 to 12 months. Outcome measures were: recurrence of CI, symptomatic intracerebral hemorrhage, and minor bleeding.
RESULTS:
During a median follow-up of 54 months (range: 12-240 months), there were 8 (9%) recurrent cerebral infarctions, with no difference between treatment with aspirin (n = 0) or anticoagulants (n = 8). The annual rate of recurrence was 0,014 person-years of follow-up. The history of previous thrombosis and spontaneous abortions were more frequent in patients with recurrence. Aspirin-treated patients more frequently came from rural areas. Four anticoagulated patients developed bleeding complications, two minor bleeding and two subdural hematomas. 76% of the cases evolved with good outcome (modified Rankin scale: 0-2).
CONCLUSION:
With the limitations of a nonrandomized study, our data suggest that the risk of recurrent arterial cerebral infarction in young patients with cerebral infarction secondary to PAS is low, probably non-uniform and independent of the type of antithrombotic.
The primary antiphospholipid syndrome (PAS) is an independent risk factor for cerebral infarction. AIM. To evaluate the risk of recurrence, to compare different treatments and determine the risk factors associated with recurrence and hemorrhagic complications in patients with cerebral infarction and PAS.
PATIENTS AND METHODS:
Prospectively collected data from 92 patients under 45 years (71% female, mean age 33.8 ± 8.9 years) with confirmed diagnoses of cerebral infarction and PAS, treated with anticoagulants (n = 54) or aspirin (n = 38) were retrospectively analyzed. Clinical follow-up was obtained by neurological examination every 6 to 12 months. Outcome measures were: recurrence of CI, symptomatic intracerebral hemorrhage, and minor bleeding.
RESULTS:
During a median follow-up of 54 months (range: 12-240 months), there were 8 (9%) recurrent cerebral infarctions, with no difference between treatment with aspirin (n = 0) or anticoagulants (n = 8). The annual rate of recurrence was 0,014 person-years of follow-up. The history of previous thrombosis and spontaneous abortions were more frequent in patients with recurrence. Aspirin-treated patients more frequently came from rural areas. Four anticoagulated patients developed bleeding complications, two minor bleeding and two subdural hematomas. 76% of the cases evolved with good outcome (modified Rankin scale: 0-2).
CONCLUSION:
With the limitations of a nonrandomized study, our data suggest that the risk of recurrent arterial cerebral infarction in young patients with cerebral infarction secondary to PAS is low, probably non-uniform and independent of the type of antithrombotic.