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Arauz A, Barboza MA, Quintero LC, Cantu C, Chiquete E, Serrano F. Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy. Neurologia 2023; 38:617-624. [PMID: 37996212 DOI: 10.1016/j.nrleng.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/04/2021] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.
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Affiliation(s)
- A Arauz
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - M A Barboza
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico; Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, CCSS, San José, Costa Rica.
| | - L C Quintero
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - C Cantu
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - E Chiquete
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - F Serrano
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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Lindgren E, Krzywicka K, de Winter MA, Sánchez van Kammen M, Heldner MR, Hiltunen S, Aguiar de Sousa D, Mansour M, Canhão P, Ekizoglu E, Rodrigues M, Silva EM, Garcia-Esperon C, Arnao V, Aridon P, Simaan N, Silvis SM, Zuurbier SM, Scutelnic A, Sezgin M, Alasheev A, Smolkin A, Guisado-Alonso D, Yesilot N, Barboza MA, Ghiasian M, Leker RR, Arauz A, Arnold M, Putaala J, Tatlisumak T, Coutinho JM, Jood K. A scoring tool to predict mortality and dependency after cerebral venous thrombosis. Eur J Neurol 2023. [PMID: 37165521 DOI: 10.1111/ene.15844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND We developed a prognostic score to predict dependency and death after cerebral venous thrombosis (CVT) to identify patients for targeted therapy in future clinical trials.. METHODS We used data from the International CVT Consortium. We excluded patients with pre-existent functional dependency. We used logistic regression to predict poor outcome (modified Rankin Scale 3-6) at 6 months and Cox regression to predict 30-day and 1-year all-cause mortality. Potential predictors derived from previous studies were selected with backward stepwise selection. Coefficients were shrunken using Ridge regression to adjust for optimism in internal validation. RESULTS Of 1454 patients with CVT, the cumulative number of deaths was 44 (3%) and 70 (5%) for 30 days and 1 year, respectively. Of 1126 patients evaluated regarding functional outcome, 137 (12%) were dependent or dead at 6 months. From the retained predictors for both models, we derived the SI2 NCAL2 C score utilizing the following components: absence of female Sex-specific risk factor, Intracerebral hemorrhage, Infection of the central nervous system, Neurologic focal deficits, Coma, Age, lower Level of hemoglobin (g/L), higher Level of glucose (mmol/L) at admission, and Cancer. C-statistics were 0.80 (95%CI 0.75-0.84), 0.84 (95%CI 0.80-0.88) and 0.84 (95%CI 0.80-0.88) for the poor outcome, 30 days and 1 year mortality model, respectively. Calibration plots indicated good model fit between predicted and observed values. The SI2 NCAL2 C score calculator is freely available at www.cerebralvenousthrombosis.com. CONCLUSIONS The SI2 NCAL2 C score shows adequate performance for estimating individual risk of mortality and dependency after CVT but external validation of the score is warranted.
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Affiliation(s)
- E Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Krzywicka
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M A de Winter
- Department of Internal Medicine, UMC, Utrecht, Utrecht, the Netherlands
| | - M Sánchez van Kammen
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - S Hiltunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - D Aguiar de Sousa
- Stroke Centre, Centro Hospital Universitário Lisboa Central, Lisbon, Portugal
- CEEM and Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - M Mansour
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - P Canhão
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria/CHULN; University of Lisbon, Lisbon, Portugal
| | - E Ekizoglu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M Rodrigues
- Department of Neurology. Hospital Garcia de Orta, Almada, Portugal
| | - E M Silva
- Department of Neurology. Hospital Garcia de Orta, Almada, Portugal
| | - C Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - V Arnao
- U.O.C. Neurologia con Stroke Unit A.R.N.A.S. Civico, Palermo, Italy
| | - P Aridon
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D), University of Palermo, Palermo, Italy
| | - N Simaan
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S M Silvis
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S M Zuurbier
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - M Sezgin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Alasheev
- Department of Neurology, Sverdlovsk, Yekaterinburg, Russia
| | - A Smolkin
- Department of Neurology, Sverdlovsk, Yekaterinburg, Russia
| | - D Guisado-Alonso
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - N Yesilot
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M A Barboza
- Neurosciences Department, Hospital Dr. R.A. Calderón Guardia, CCSS, San José, Costa Rica
| | - M Ghiasian
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - R R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Arauz
- Instituto Nacional de Neurologia and Neurocirugia Manuel Velasco Suarez, Mexico-City, Mexico
| | - M Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - J Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - K Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Carrillo-Loza K, Baranchuk A, Serrano F, Hasseb S, Espinosa Lira F, Soriano E, Arauz A. Advanced interatrial block predicts recurrence of embolic stroke of undetermined source. Neurologia 2022; 37:647-652. [PMID: 31899017 DOI: 10.1016/j.nrl.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/19/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Advanced interatrial block (IAB) is an independent risk factor for ischaemic stroke. This study aimed to analyse whether advanced IAB predicts recurrence of embolic stroke of undetermined source (ESUS). METHODS 104 patients with a confirmed diagnosis of ESUS were followed up for a median period of 15 months (interquartile range, 10-48). We recorded data on clinical variables, P-wave characteristics, and presence of IAB on the electrocardiogram. Electrocardiogram findings were interpreted by a blinded, centralised rater at (XXXX2). ESUS recurrence was the primary outcome variable. RESULTS Median age was 47 years (range, 19-85); 50% of patients were women. IAB was detected in 36 patients (34.6%); IAB was partial in 29 cases (27.9%) and advanced in 7 (6.7%). Sixteen patients (15.4%) presented stroke recurrence; of these, 5 had partial and 4 had advanced IAB (P = .01; odds ratio [OR] = 9.44; 95% confidence interval [CI], 1.88-47.46; relative risk [RR] = 4.62; 95% CI, 2.01-10.61). Median P-wave duration was longer in patients with stroke recurrence (P = .009). The multivariate logistic regression analysis identified the following independent risk factors for stroke recurrence: advanced IAB (P < .001; OR = 10.86; 95% CI, 3.07-38.46), male sex (P = .028; OR = 4.6; 95% CI, 1.18-17.96), and age older than 50 years (P = .039; OR = 3.84; 95% CI, 1.06-13.88). In the Cox proportional hazards model, the risk variables identified were age older than 50 years (P = .002; hazard ratio, 7.04; 95% CI, 2.06-23.8) and P-wave duration (per ms) (P = .007; hazard ratio, 1.02; 95% CI, 1.01-1.04). CONCLUSIONS Advanced IAB and age older than 50 years predict ESUS recurrence.
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Affiliation(s)
- K Carrillo-Loza
- Servicio de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - A Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canadá
| | - F Serrano
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - S Hasseb
- Division of Cardiology, Queen's University, Kingston, Ontario, Canadá
| | - F Espinosa Lira
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - E Soriano
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - A Arauz
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México.
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Arauz A, Arteaga C, Zapata-Gómez C, Ramos-Ventura C, Méndez B, Otiniano-Sifuentes R, Haseeb S, González-Oscoy R, Baranchuk A. Embolic stroke of undetermined source: beyond atrial fibrillation. Neurologia (Engl Ed) 2022; 37:362-370. [PMID: 35672123 DOI: 10.1016/j.nrleng.2019.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/03/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Embolic stroke of undetermined source (ESUS) accounts for 25% of all cerebral infarcts; only 30% are associated with paroxysmal atrial fibrillation (AF). Various biochemical, electrocardiographic, and echocardiographic findings may suggest left atrial damage and increased risk of embolism in the absence of clinically documented AF or atrial flutter. In this review, we analyse the available evidence on atrial cardiopathy or atrial disease, its involvement in ESUS, and its identification through electrocardiographic, echocardiographic, and serum markers and its possible therapeutic implications. DEVELOPMENT A systematic search was conducted on MEDLINE (PubMed) using the following MeSH terms: MeSH [ESUS]+[atrial cardiopathy]+[atrial fibrillation]+[interatrial block]+[treatment]. We selected what we considered to be the most useful original prospective or retrospective studies and systematic reviews. We then read the full texts of the articles and checked the references cited in each article. We analyse epidemiological and demographic variables of patients with ESUS, as well as recent evidence related to presentation and prognosis and factors associated with recurrence and mortality. We review the contribution of atrial cardiopathy diagnosis prior to the detection of AF and the clinical, electrocardiographic, and echocardiographic variables and the biochemical markers associated with its development and its potential contribution to cerebral embolism. CONCLUSIONS The systematic search of biochemical and electrocardiographic, and echocardiographic alterations can be useful to identify ESUS patients at higher risk of recurrence.
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Affiliation(s)
- A Arauz
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico; Queen's University, Kingston, Ontario, Canada.
| | - C Arteaga
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - C Zapata-Gómez
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - C Ramos-Ventura
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - B Méndez
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - R Otiniano-Sifuentes
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - S Haseeb
- Queen's University, Kingston, Ontario, Canada
| | - R González-Oscoy
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - A Baranchuk
- Queen's University, Kingston, Ontario, Canada
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Arauz A, Arteaga C, Zapata-Gómez C, Ramos-Ventura C, Méndez B, Otiniano-Sifuentes R, Haseeb S, González-Oscoy R, Baranchuk A. Embolic stroke of undetermined source: Beyond atrial fibrillation. Neurologia 2022; 37:362-370. [PMID: 31060753 DOI: 10.1016/j.nrl.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/31/2019] [Accepted: 03/03/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Embolic stroke of undetermined source (ESUS) accounts for 25% of all cerebral infarcts; only 30% are associated with paroxysmal atrial fibrillation (AF). Various biochemical, electrocardiographic, and echocardiographic findings may suggest left atrial damage and increased risk of embolism in the absence of clinically documented AF or atrial flutter. In this review, we analyse the available evidence on atrial cardiopathy or atrial disease, its involvement in ESUS, and its identification through electrocardiographic, echocardiographic, and serum markers and its possible therapeutic implications. DEVELOPMENT A systematic search was conducted on MEDLINE (PubMed) using the following MeSH terms: MeSH [ESUS]+[atrial cardiopathy]+[atrial fibrillation]+[interatrial block]+[treatment]. We selected what we considered to be the most useful original prospective or retrospective studies and systematic reviews. We then read the full texts of the articles and checked the references cited in each article. We analyse epidemiological and demographic variables of patients with ESUS, as well as recent evidence related to presentation and prognosis and factors associated with recurrence and mortality. We review the contribution of atrial cardiopathy diagnosis prior to the detection of AF and the clinical, electrocardiographic, and echocardiographic variables and the biochemical markers associated with its development and its potential contribution to cerebral embolism. CONCLUSIONS The systematic search of biochemical and electrocardiographic, and echocardiographic alterations can be useful to identify ESUS patients at higher risk of recurrence.
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Affiliation(s)
- A Arauz
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México; Queen̿s University, Kingston, Ontario, Canadá.
| | - C Arteaga
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - C Zapata-Gómez
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - C Ramos-Ventura
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - B Méndez
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - R Otiniano-Sifuentes
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - S Haseeb
- Queen̿s University, Kingston, Ontario, Canadá
| | - R González-Oscoy
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - A Baranchuk
- Queen̿s University, Kingston, Ontario, Canadá
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Nathal E, Serrano-Rubio A, Maciel E, Arauz A. Moyamoya disease in Mexico: our experience. Neurologia (Engl Ed) 2021; 36:603-610. [PMID: 34654535 DOI: 10.1016/j.nrleng.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/13/2018] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Moyamoya disease (MD) is a progressive, occlusive disease of the arteries of the anterior cerebral circulation that may cause ischaemia or haemorrhage. Patient management aims to prevent new cerebrovascular events through surgical revascularisation and/or pharmacological treatment. MATERIALS AND METHODS We studied a series of 17 patients with MD (n = 14) or moyamoya syndrome (MS; n = 3), who were evaluated between January 1989 and December 2016; 11 patients were women and 6 were men. Thirteen patients had definitive MD (76%), one had unilateral MD (5.2%), and 3 had MS (18%). The condition manifested as intraparenchymal haemorrhage (in 35.2% of patients), brain ischaemia (29.4%), subarachnoid haemorrhage (17.6%), seizures (11.7%), and headache with no associated haemorrhage (1 patient). RESULTS Ten patients (58.8%) underwent revascularisation and 7 (41.2%) received pharmacological treatment. All patients were evaluated with the modified Rankin Scale (mRs) at admission and at the last consultation; mRs scores were significantly lower in the group undergoing surgery (P < .04). During follow-up, none of the patients undergoing revascularisation experienced recurrences, whereas 2 patients receiving pharmacological treatment did experience a new vascular event (one ischaemic and one haemorrhagic) (P < .05). No significant differences were observed between the treatment outcomes of different revascularisation techniques. CONCLUSIONS Although our population has different demographic characteristics from those of other non-Asian populations, ours is the largest published series of Hispanic individuals with MD. Our results support the use of revascularisation procedures to improve these patients' neurological status and to prevent new cerebrovascular events.
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Affiliation(s)
- E Nathal
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico.
| | - A Serrano-Rubio
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - E Maciel
- Escuela de Medicina, Instituto Tecnológico de Monterrey Campus Guadalajara, Guadalajara, Mexico
| | - A Arauz
- Departamento de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudadde México, Mexico
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Carrillo-Loza K, Baranchuk A, Serrano F, Hasseb S, Espinosa Lira F, Soriano E, Arauz A. Advanced interatrial block predicts recurrence of embolic stroke of undetermined source. Neurologia (Engl Ed) 2021; 37:647-652. [PMID: 34656503 DOI: 10.1016/j.nrleng.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 10/13/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Advanced interatrial block (IAB) is an independent risk factor for ischaemic stroke. This study aimed to analyse whether advanced IAB predicts recurrence of embolic stroke of undetermined source (ESUS). METHODS 104 patients with a confirmed diagnosis of ESUS were followed up for a median period of 15 months (interquartile range, 10-48). We recorded data on clinical variables, P-wave characteristics, and presence of IAB on the electrocardiogram (ECG). ECG findings were interpreted by a blinded, centralised rater at (XXXX2). ESUS recurrence was the primary outcome variable. RESULTS Median age was 47 years (range, 19-85); 50% of patients were women. IAB was detected in 36 patients (34.6%); IAB was partial in 29 cases (27.9%) and advanced in 7 (6.7%). Sixteen patients (15.4%) presented stroke recurrence; of these, 5 had partial and 4 had advanced IAB (P = .01; odds ratio [OR] = 9.44; 95% confidence interval [CI], 1.88-47.46; relative risk [RR] = 4.62; 95% CI, 2.01-10.61). Median P-wave duration was longer in patients with stroke recurrence (P = .009). The multivariate logistic regression analysis identified the following independent risk factors for stroke recurrence: advanced IAB (P < .001; OR = 10.86; 95% CI, 3.07-38.46), male sex (P = .028; OR = 4.6; 95% CI, 1.18-17.96), and age older than 50 years (P = .039; OR = 3.84; 95% CI, 1.06-13.88). In the Cox proportional hazards model, the risk variables identified were age older than 50 years (P = .002; hazard ratio, 7.04; 95% CI, 2.06-23.8) and P-wave duration (per ms) (P = .007; hazard ratio, 1.02; 95% CI, 1.01-1.04). CONCLUSIONS Advanced IAB and age older than 50 years predict ESUS recurrence.
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Affiliation(s)
- K Carrillo-Loza
- Servicio de Neurología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - A Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - F Serrano
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - S Hasseb
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - F Espinosa Lira
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - E Soriano
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico
| | - A Arauz
- Clínica de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico.
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Arauz A, Barboza MA, Quintero LC, Cantu C, Chiquete E, Serrano F. Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy. Neurologia 2021; 38:S0213-4853(21)00072-4. [PMID: 34253412 DOI: 10.1016/j.nrl.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.
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Affiliation(s)
- A Arauz
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - M A Barboza
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico; Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, CCSS, San José, Costa Rica.
| | - L C Quintero
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - C Cantu
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - E Chiquete
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - F Serrano
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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9
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Afifi K, Bellanger G, Buyck PJ, Zuurbier SM, Garcia-Esperon C, Barboza MA, Costa P, Escudero I, Renard D, Lemmens R, Hinteregger N, Fazekas F, Jimenez-Conde J, Giralt-Steinhauer E, Hiltunen S, Arauz A, Pezzini A, Montaner J, Putaala J, Weimar C, Schlamann M, Gattringer T, Tatlisumak T, Coutinho JM, Demaerel P, Thijs V. Correction to: Features of intracranial hemorrhage in cerebral venous thrombosis. J Neurol 2020; 267:3299-3300. [PMID: 32785839 DOI: 10.1007/s00415-020-10082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The original version of this article unfortunately contained mistakes. The correct information is given below.
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Affiliation(s)
- K Afifi
- Department of Neurology, Menoufia University, Al Minufya, Menoufia, Egypt.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia
| | - G Bellanger
- Department of Neuroradiology, Purpan University Hospital, Toulouse, France.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia
| | - P J Buyck
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - S M Zuurbier
- Department of Neurology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - C Garcia-Esperon
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia
| | - M A Barboza
- Stroke Department, Instituto Nacional de Neurología Y Neurocirugía Dr. Manuel Velasco Suárez, México City, México
| | - P Costa
- Department of Head and Neck, Neurology Clinic, University of Brescia, Brescia, Italy
| | - I Escudero
- Neurology Department, University Hospital Virgen del Rocio, Sevilla, Spain.,Neurovascular Lab, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - D Renard
- Department of Neurology, Nîmes University Hospital, Nîmes, France
| | - R Lemmens
- Department of Neurosciences, Experimental Neurology and Leuven Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Center for Brain and Disease Research, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - N Hinteregger
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - F Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - J Jimenez-Conde
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona, Spain.,Universitat Autònoma de Barcelon, Barcelona, Spain
| | - E Giralt-Steinhauer
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona, Spain.,Universitat Autònoma de Barcelon, Barcelona, Spain
| | - S Hiltunen
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - A Arauz
- Stroke Department, Instituto Nacional de Neurología Y Neurocirugía Dr. Manuel Velasco Suárez, México City, México
| | - A Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic University of Brescia, Brescia, Italy
| | - J Montaner
- Neurovascular Lab, Instituto de Biomedicina de Sevilla, Sevilla, Spain.,Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - J Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - C Weimar
- Institute of Medical Informatics, Biometry and Epidemiology and Department of Neurology, University Hospital Essen, Essen, Germany
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany
| | - T Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Tatlisumak
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - P Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - V Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia. .,Department of Neurology, Austin Health, Heidelberg, VIC, Australia.
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10
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Silvis SM, Reinstra E, Hiltunen S, Lindgren E, Heldner MR, Mansour M, Ghiasian M, Jood K, Zuurbier SM, Groot AE, Arnold M, Barboza MA, Arauz A, Putaala J, Tatlisumak T, Coutinho JM. Anaemia at admission is associated with poor clinical outcome in cerebral venous thrombosis. Eur J Neurol 2020; 27:716-722. [PMID: 31883169 PMCID: PMC7155011 DOI: 10.1111/ene.14148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/22/2019] [Indexed: 01/28/2023]
Abstract
Background and purpose Anaemia is associated with poor clinical outcome after ischaemic and haemorrhagic stroke. The association between anaemia and outcome in patients with cerebral venous thrombosis (CVT) was examined. Methods Consecutive adult patients with CVT were included from seven centres. Anaemia at admission was scored according to World Health Organization definitions. Poor clinical outcome was defined as a modified Rankin Scale score 3–6 at last follow‐up. A multiple imputation procedure was applied for handling missing data in the multivariable analysis. Using binary logistic regression analysis, adjustments were made for age, sex, cancer and centre of recruitment (model 1). In a secondary analysis, adjustments were additionally made for coma, intracerebral haemorrhage, non‐haemorrhagic lesion and deep venous system thrombosis (model 2). In a sensitivity analysis, patients with cancer were excluded. Results Data for 952 patients with CVT were included, 22% of whom had anaemia at admission. Patients with anaemia more often had a history of cancer (17% vs. 7%, P < 0.001) than patients without anaemia. Poor clinical outcome (21% vs. 11%, P < 0.001) and mortality (11% vs. 6%, P = 0.07) were more common amongst patients with anaemia. After adjustment, anaemia at admission increased the risk of poor outcome [adjusted odds ratio (aOR) 2.4, 95% confidence interval (CI) 1.5–3.7, model 1]. Model 2 revealed comparable results (aOR 1.9, 95% CI 1.2–3.2), as did the sensitivity analysis excluding patients with cancer (aOR 2.3, 95% CI 1.3–3.8, model 1). Conclusion The risk of poor clinical outcome is doubled in CVT patients presenting with anaemia at admission.
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Affiliation(s)
- S M Silvis
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E Reinstra
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Hiltunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M Mansour
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - M Ghiasian
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - K Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S M Zuurbier
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A E Groot
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M A Barboza
- Neurosciences Department, Hospital Dr R.A. Calderón Guardia, CCSS, San José, Costa Rica
| | - A Arauz
- National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - J Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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11
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Nathal E, Serrano-Rubio A, Maciel E, Arauz A. Moyamoya disease in Mexico: Our experience. Neurologia 2018; 36:S0213-4853(18)30179-8. [PMID: 30076039 DOI: 10.1016/j.nrl.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 05/06/2018] [Accepted: 05/13/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Moyamoya disease (MD) is a progressive, occlusive disease of the arteries of the anterior cerebral circulation that may cause ischaemia or haemorrhage. Patient management aims to prevent new cerebrovascular events through surgical revascularisation and/or pharmacological treatment. METHODS We studied a series of 17 patients with MD (n = 14) or moyamoya syndrome (n = 3), who were evaluated between January 1989 and December 2016; 11 patients were women and 6 were men. Thirteen patients had definitive MD (76%), one had unilateral MD (5.2%), and 3 had moyamoya syndrome (18%). The condition manifested as intraparenchymal haemorrhage (in 35.2% of patients), brain ischaemia (29.4%), subarachnoid haemorrhage (17.6%), seizures (11.7%), and headache with no associated haemorrhage (one patient). RESULTS Ten patients (58.8%) underwent revascularisation and 7 (41.2%) received pharmacological treatment. All patients were evaluated with the modified Rankin Scale (mRs) at admission and at the last consultation; mRs scores were significantly lower in the group undergoing surgery (P < .04). During follow-up, none of the patients undergoing revascularisation experienced recurrences, whereas 2 patients receiving pharmacological treatment did experience a new vascular event (one ischaemic and one haemorrhagic) (P < .05). No significant differences were observed between the treatment outcomes of different revascularisation techniques. CONCLUSIONS Although our population has different demographic characteristics from those of other non-Asian populations, ours is the largest published series of Hispanic individuals with MD. Our results support the use of revascularisation procedures to improve these patients' neurological status and to prevent new cerebrovascular events.
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Affiliation(s)
- E Nathal
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México.
| | - A Serrano-Rubio
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - E Maciel
- Escuela de Medicina, Instituto Tecnológico de Monterrey Campus Guadalajara, Guadalajara, México
| | - A Arauz
- Departamento de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
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12
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Merayo-Chalico J, Barrera-Vargas A, Juárez-Vega G, Alcocer-Varela J, Arauz A, Gómez-Martín D. Differential serum cytokine profile in patients with systemic lupus erythematosus and posterior reversible encephalopathy syndrome. Clin Exp Immunol 2018; 192:165-170. [PMID: 29271478 DOI: 10.1111/cei.13095] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 11/29/2022] Open
Abstract
Systemic lupus erythematosus (SLE) patients are susceptible to the development of posterior reversible encephalopathy syndrome (PRES). The main theory concerning the physiopathology of PRES suggests that there is brain-blood barrier damage, which is associated with endothelial dysfunction, and characterized by vasogenic oedema. However, current evidence regarding its physiopathogenic mechanisms is quite scant. The aim of this study was to analyse the expression of different serum cytokines, as well as vascular endothelial growth factor (VEGF) and soluble CD40 ligand (sCD40L), in patients with PRES/systemic lupus erythematosus (SLE) and to compare them with levels in SLE patients without PRES and in healthy controls. We performed a transversal study in a tertiary care centre in México City. We included 32 subjects (healthy controls, n = 6; remission SLE, n = 6; active SLE, n = 6 and PRES/SLE patients, n = 14). PRES was defined as reversible neurological manifestations (seizures, visual abnormalities, acute confusional state), associated with compatible changes by magnetic resonance imaging (MRI). Serum samples were obtained during the first 36 h after the PRES episode and were analysed by cytometric bead array, Luminex multiplex assay or enzyme-linked immunosorbent assay (ELISA). Interleukin (IL)-6 and IL-10 levels were significantly higher in PRES/SLE patients (P = 0·013 and 0·025, respectively) when compared to the other groups. Furthermore, IL-6 and IL-10 levels displayed a positive correlation (r = 0·686, P = 0·007). There were no differences among groups regarding other cytokines, sCD40L or VEGF levels. A differential serum cytokine profile was found in PRES/SLE patients, with increased IL-6 and IL-10 levels. Our findings, which are similar to those described in other neurological manifestations of SLE, support the fact that PRES should be considered among the SLE-associated neuropsychiatric syndromes.
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Affiliation(s)
- J Merayo-Chalico
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A Barrera-Vargas
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - G Juárez-Vega
- Red de Apoyo a la Investigación, CIC- UNAM, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J Alcocer-Varela
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A Arauz
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco, Mexico City, Mexico
| | - D Gómez-Martín
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Red de Apoyo a la Investigación, CIC- UNAM, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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13
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Perera KS, Vanassche T, Bosch J, Swaminathan B, Mundl H, Giruparajah M, Barboza MA, O’Donnell MJ, Gomez-Schneider M, Hankey GJ, Yoon BW, Roxas A, Lavallee P, Sargento-Freitas J, Shamalov N, Brouns R, Gagliardi RJ, Kasner SE, Pieroni A, Vermehren P, Kitagawa K, Wang Y, Muir K, Coutinho JM, Connolly SJ, Hart RG, Czeto K, Kahn M, Mattina K, Ameriso S, Pujol-Lereis V, Hawkes M, Pertierra L, Perera N, De Smedt A, Van Dyck R, Van Hooff R, Yperzeele L, Gagliardi V, Cerqueir L, Yang X, Chen W, Amarenco P, Guidoux C, Ringleb P, Bereczki D, Vastagh I, Canavan M, Toni D, Anzini A, Colosimo C, De Michele M, Di Mascio M, Durastanti L, Falcou A, Fausti S, Mancini A, Mizumo S, Uchiyama S, Kim C, Jung S, Kim Y, Kim J, Jo J, Arauz A, Quiroz-Compean A, Colin J, Nederkoorn P, Marianito V, Cunha L, Santo G, Silva F, Coelho J, Kustova M, Meshkova K, Williams G, Siegler J, Zhang C, Gallatti N, Kruszewski M. Global Survey of the Frequency of Atrial Fibrillation–Associated Stroke. Stroke 2016; 47:2197-202. [DOI: 10.1161/strokeaha.116.013378] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/27/2016] [Indexed: 12/22/2022]
Abstract
Background and Purpose—
Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features.
Methods—
Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels.
Results—
Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4;
P
<0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF (
r
=0.76;
P
=0.0002).
Conclusions—
This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women.
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Affiliation(s)
- Kanjana S. Perera
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Thomas Vanassche
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Jackie Bosch
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Balakumar Swaminathan
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Hardi Mundl
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Mohana Giruparajah
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Miguel A. Barboza
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Martin J. O’Donnell
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Maia Gomez-Schneider
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Graeme J. Hankey
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Byung-Woo Yoon
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Artemio Roxas
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Philippa Lavallee
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Joao Sargento-Freitas
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Nikolay Shamalov
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Raf Brouns
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Rubens J. Gagliardi
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Scott E. Kasner
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Alessio Pieroni
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Philipp Vermehren
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Kazuo Kitagawa
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Yongjun Wang
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Keith Muir
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Jonathan M. Coutinho
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Stuart J. Connolly
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Robert G. Hart
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - K. Czeto
- Population Health Research Institute (Coordinating Center), Hamilton, Ontario, Canada
| | - M. Kahn
- Population Health Research Institute (Coordinating Center), Hamilton, Ontario, Canada
| | - K.R. Mattina
- Population Health Research Institute (Coordinating Center), Hamilton, Ontario, Canada
| | - S.F. Ameriso
- Institute for Neurological Research, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - V. Pujol-Lereis
- Institute for Neurological Research, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - M. Hawkes
- Institute for Neurological Research, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - L. Pertierra
- Institute for Neurological Research, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - N. Perera
- School of Medicine & Pharmacology, University of Western Australia and Sir Charles Gairdner Hospital, Perth, Australia
| | - A. De Smedt
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - R. Van Dyck
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - L. Yperzeele
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - L.G. Cerqueir
- Santa Casa de São Paulo, Medical School, Sao Paulo, Brazil
| | - X. Yang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - W. Chen
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | | | - P.A. Ringleb
- University Hospital Heidelberg, Heidelberg, Germany
| | | | - I. Vastagh
- Semmelweis University, Budapest, Hungary
| | - M. Canavan
- Galway University Hospitals, Galway, Ireland
| | - D. Toni
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - A. Anzini
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - C. Colosimo
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - M. De Michele
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - M.T. Di Mascio
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - L. Durastanti
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - A. Falcou
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - S. Fausti
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - A. Mancini
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - S. Mizumo
- Tokyo Women’s Medical University, Tokyo, Japan
| | - S. Uchiyama
- Tokyo Women’s Medical University, Tokyo, Japan
| | - C.K. Kim
- Seoul National University Hospital, Seoul, Korea
| | - S. Jung
- Seoul National University Hospital, Seoul, Korea
| | - Y. Kim
- Seoul National University Hospital, Seoul, Korea
| | - J.A. Kim
- Seoul National University Hospital, Seoul, Korea
| | - J.Y. Jo
- Seoul National University Hospital, Seoul, Korea
| | - A. Arauz
- Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico
| | - A. Quiroz-Compean
- Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico
| | - J. Colin
- Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico
| | | | | | - L. Cunha
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - G. Santo
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F. Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J. Coelho
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M. Kustova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K. Meshkova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - G. Williams
- Institute of Neuroscience and Physiology, University of Glasgow, Queen Elizabeth Hospital, Glasgow, United Kingdom
| | - J. Siegler
- Hospital of the University of Pennslyvania, Philadelphia
| | - C. Zhang
- Hospital of the University of Pennslyvania, Philadelphia
| | - N. Gallatti
- Hospital of the University of Pennslyvania, Philadelphia
| | - M. Kruszewski
- Hospital of the University of Pennslyvania, Philadelphia
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Ameriso S, Lavados P, Arauz A, Gagliardi R, Shoamanesh A, Pater C, Mundl H, Berkowitz S, Connolly S, Hart R. NAVIGATE ESUS: Phase-III RCT assessing prevention of stroke and systemic embolism in patients with embolic stroke of undetermined source. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Marquez-Romero JM, Capristo F, Arauz A. [Ischaemic stroke secondary to unilateral focal cerebral arteriopathy]. An Pediatr (Barc) 2014; 82:370-1. [PMID: 25446796 DOI: 10.1016/j.anpedi.2014.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/05/2014] [Accepted: 09/12/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- J M Marquez-Romero
- Neurología Vascular, HGZ #2 IMSS Aguascalientes, Aguascalientes, México.
| | - F Capristo
- Neurología Pediátrica, Hospital Miguel Hidalgo, Aguascalientes, México
| | - A Arauz
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía «MVS», México DF, México
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Marquez-Romero J, Morales-Ramírez M, Arauz A. Non-breathing-related sleep disorders following stroke. Neurología (English Edition) 2014. [DOI: 10.1016/j.nrleng.2013.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Marquez-Romero J, Morales-Ramírez M, Arauz A. Trastornos del sueño no respiratorios en relación con ictus. Neurologia 2014; 29:511-6. [DOI: 10.1016/j.nrl.2013.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 04/01/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022] Open
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León-Jiménez C, Ruiz-Sandoval J, Chiquete E, Vega-Arroyo M, Arauz A, Murillo-Bonilla L, Ochoa-Guzmán A, Carrillo-Loza K, Ramos-Moreno A, Barinagarrementeria F, Cantú-Brito C. Tiempo de llegada hospitalaria y pronóstico funcional después de un infarto cerebral: resultados del estudio PREMIER. Neurologia 2014; 29:200-9. [DOI: 10.1016/j.nrl.2013.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/02/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022] Open
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León-Jiménez C, Ruiz-Sandoval J, Chiquete E, Vega-Arroyo M, Arauz A, Murillo-Bonilla L, Ochoa-Guzmán A, Carrillo-Loza K, Ramos-Moreno A, Barinagarrementeria F, Cantú-Brito C. Hospital arrival time and functional outcome after acute ischaemic stroke: Results from the PREMIER study. Neurología (English Edition) 2014. [DOI: 10.1016/j.nrleng.2013.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Arauz A, Ruiz-Navarro F, Silos H, Vargas-González J, Arguelles-Morales N, Reyes M, Ruiz-Franco A, Rivera A, Fleury A. Response to Letter: Aneurysm, ischemic stroke and cysticercosis. Clin Neurol Neurosurg 2014; 119:136. [DOI: 10.1016/j.clineuro.2013.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/25/2013] [Indexed: 10/25/2022]
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Silva MG, Sala-Blanch X, Marín R, Espinoza X, Arauz A, Morros C. [Ultrasound-guided axillary block: anatomical variations of terminal branches of the brachial plexus in relation to the brachial artery]. Rev Esp Anestesiol Reanim 2014; 61:15-20. [PMID: 24161518 DOI: 10.1016/j.redar.2013.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 07/11/2013] [Accepted: 07/24/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe the distribution of the terminal branches of the brachial plexus at the axillary level and define distribution patterns after ultrasound evaluation. MATERIAL AND METHOD Fifty volunteers underwent ultrasound bilateral axillary brachial plexus scanning exploration. Nerve distribution around the humeral artery was described and the distance between each nerve and the center of the artery was measured. The distance and relationship between the ulnar nerve and the humeral vein were also recorded. RESULTS The median nerve was located in the anterolateral quadrant (-29±40°) and at a mean distance of 2.1±0.9mm from the artery (85%). The ulnar nerve was found at 53±26° and at 4.2±2.1mm from the artery in the anteromedial quadrant (90%), anterolateral to the vein in 46% of cases, and deep to it in 54%. The radial nerve was at 122±38° and at 3.3±1.7mm from the artery in the posteromedial quadrant (86%). The musculocutaneous nerve was found at -103±22° and 9.3±5.6mm from the artery in the posterolateral quadrant (90%) and in the anterolateral quadrant (-55±16°) at 4.8±2.7mm (10%). There were no differences regarding laterality, gender or overweight patients. CONCLUSIONS Our results allow defining four different anatomical patterns, two based in the position of the musculocutaneous nerve and two based on the disposition of the ulnar nerve with respect to the humeral vein. These patterns were not related to laterality, gender or body weight.
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Affiliation(s)
- M G Silva
- Fellow en Anestesia Regional, Universitat de Barcelona, Barcelona, España
| | - X Sala-Blanch
- Servicio de Anestesiología, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
| | - R Marín
- Fellow en Anestesia Regional, Universitat de Barcelona, Barcelona, España
| | - X Espinoza
- Fellow en Anestesia Regional, Universitat de Barcelona, Barcelona, España
| | - A Arauz
- Unidad de Cirugía Mayor Ambulatoria, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - C Morros
- Servicio de Anestesiología, Clínica Diagonal, Barcelona, España
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Arauz A, Romano JG, Ruiz-Franco A, Shang T, Dong C, Rundek T, Koch S, Hernández-Curiel B, Pacheco J, Rojas P, Ruiz-Navarro F, Katsnelson M, Sacco RL. Differences in lipid profiles in two Hispanic ischemic stroke populations. Int J Stroke 2013; 9:394-9. [PMID: 24898282 DOI: 10.1111/ijs.12239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/29/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE The study aims to compare lipid profiles among ischemic stroke patients in a predominantly Caribbean-Hispanic population in Miami and a Mestizo Hispanic population in Mexico City. METHODS We analyzed ischemic stroke Hispanic patients with complete baseline fasting lipid profile enrolled contemporaneously in the prospective registries of two tertiary care teaching hospitals in Mexico City and Miami. Demographic characteristics, risk factors, medications, ischemic stroke subtype, and first fasting lipid profile were compared. Vascular risk factor definitions were standardized. Multiple linear regression analysis was performed to compare lipid fractions. RESULTS A total of 324 patients from Mexico and 236 from Miami were analyzed. Mexicans were significantly younger (58 · 1 vs. 67 · 4 years), had a lower frequency of hypertension (53 · 4% vs. 79 · 7%), and lower body mass index (27 vs. 28 · 5). There was a trend toward greater prevalence of diabetes in Mexicans (31 · 5 vs. 24 · 6%, P = 0 · 07). Statin use at the time of ischemic stroke was more common in Miami Hispanics (18 · 6 vs. 9 · 4%). Mexicans had lower total cholesterol levels (169 · 9 ± 46 · 1 vs. 179 · 9 ± 48 · 4 mg/dl), lower low-density lipoprotein (92 · 3 ± 37 · 1 vs. 108 · 2 ± 40 · 8 mg/dl), and higher triglyceride levels (166 · 9 ± 123 · 9 vs. 149 · 2 ± 115 · 2 mg/dl). These differences remained significant after adjusting for age, gender, hypertension, diabetes, body mass index, smoking, ischemic stroke subtype, and statin use. CONCLUSION We found significant differences in lipid fractions in Hispanic ischemic stroke patients, with lower total cholesterol and low-density lipoprotein, and higher triglyceride levels in Mexicans. These findings highlight the heterogeneity of dyslipidemia among the Hispanic race-ethnic group and may lead to different secondary prevention strategies.
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Affiliation(s)
- A Arauz
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
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Alonso de Leciñana M, Gutiérrez-Fernández M, Romano M, Cantú-Brito C, Arauz A, Olmos LE, Ameriso SF, Díez-Tejedor E. Strategies to improve recovery in acute ischemic stroke patients: Iberoamerican Stroke Group Consensus. Int J Stroke 2013; 9:503-13. [PMID: 23802573 DOI: 10.1111/ijs.12070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/31/2012] [Indexed: 12/20/2022]
Abstract
Stroke is not only a leading cause of death worldwide but also a main cause of disability. In developing countries, its burden is increasing as a consequence of a higher life expectancy. Whereas stroke mortality has decreased in developed countries, in Latin America, stroke mortality rates continue to rise as well as its socioeconomic dramatic consequences. Therefore, it is necessary to implement stroke care and surveillance programs to better describe the epidemiology of stroke in these countries in order to improve therapeutic strategies. Advances in the understanding of the pathogenic processes of brain ischemia have resulted in development of effective therapies during the acute phase. These include reperfusion therapies (both intravenous thrombolysis and interventional endovascular approaches) and treatment in stroke units that, through application of management protocols directed to maintain homeostasis and avoid complications, helps to exert effective brain protection that decreases further cerebral damage. Some drugs may enhance protection, and besides, there is increasing knowledge about brain plasticity and repair mechanisms that take place for longer periods beyond the acute phase. These mechanisms are responsible for recovery in certain patients and are the focus of basic and clinical research at present. This paper discusses recovery strategies that have demonstrated clinical effect, or that are promising and need further study. This rapidly evolving field needs to be carefully and critically evaluated so that investment in patient care is grounded on well-proven strategies.
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Affiliation(s)
- M Alonso de Leciñana
- Stroke Unit, Deparment of Neurology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
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Arauz A, Ruiz A, Pacheco G, Rojas P, Rodríguez-Armida M, Cantú C, Murillo-Bonilla L, Ruiz-Sandoval JL, Barinagarrementeria F. Aspirin versus anticoagulation in intra- and extracranial vertebral artery dissection. Eur J Neurol 2012; 20:167-72. [DOI: 10.1111/j.1468-1331.2012.03825.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 06/12/2012] [Indexed: 12/01/2022]
Affiliation(s)
- A. Arauz
- Stroke Clinic; National Institute of Neurology and Neurosurgery Manuel Velasco Suárez; México City (DF) México
| | - A. Ruiz
- Stroke Clinic; National Institute of Neurology and Neurosurgery Manuel Velasco Suárez; México City (DF) México
| | - G. Pacheco
- Stroke Clinic; National Institute of Neurology and Neurosurgery Manuel Velasco Suárez; México City (DF) México
| | - P. Rojas
- Stroke Clinic; National Institute of Neurology and Neurosurgery Manuel Velasco Suárez; México City (DF) México
| | - M. Rodríguez-Armida
- Stroke Clinic; National Institute of Neurology and Neurosurgery Manuel Velasco Suárez; México City (DF) México
| | - C. Cantú
- National Institute of Nutrition and Medical Sciences “Salvador Zubiran”; México City México
| | - L. Murillo-Bonilla
- Facultad de Medicina of the Universidad Autónoma de Guadalajara, Guadalajara; México
| | - J. L. Ruiz-Sandoval
- Department of Neurology and Neurosurgery; Hospital civil de Guadalajara Fray Antonio Alcalde; México
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Guenther G, Arauz A. Cerebral venous thrombosis: A diagnostic and treatment update. Neurología (English Edition) 2011. [DOI: 10.1016/j.nrleng.2010.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Arauz A, Merlos-Benítez M, Roa L, Hernández-Curiel B, Cantú C, Murillo L, Roldán J, Vargas-Barrón J, Barinagarrementeria F. Infarto cerebral criptogénico en pacientes jóvenes. Pronóstico y recurrencia a largo plazo. Neurologia 2011; 26:279-84. [DOI: 10.1016/j.nrl.2010.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 09/30/2010] [Accepted: 10/12/2010] [Indexed: 10/18/2022] Open
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Cantu-Brito C, Arauz A, Aburto Y, Barinagarrementeria F, Ruiz-Sandoval JL, Baizabal-Carvallo JF. Cerebrovascular complications during pregnancy and postpartum: clinical and prognosis observations in 240 Hispanic women. Eur J Neurol 2010; 18:819-25. [DOI: 10.1111/j.1468-1331.2010.03259.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Guenther G, Arauz A. Cerebral venous thrombosis: a diagnostic and treatment update. Neurologia 2010; 26:488-98. [PMID: 21163216 DOI: 10.1016/j.nrl.2010.09.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 08/03/2010] [Accepted: 09/05/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is still a significant diagnostic and therapeutic challenge, due to its high variability of clinical manifestations and its lack of a clear therapeutic consensus. SOURCES A search of the medical literature was made through PubMed using the conjoined terms of CVT and epidemiology (428 results), pathophysiology (504 results), aetiology (2714 results), diagnosis (2802 results), treatment (2173 results) and outcome (648 results). Original and review publications deemed to be useful for this review were selected. Classical and historical works on CVT were also included. DEVELOPMENT The present paper reviews the fundamental aspects of the epidemiology, pathophysiology and aetiology of CVT. There is a comparison of the most common initial clinical manifestations along with a description of the most important neuroradiological studies needed to establish a diagnosis, all based on multiple published series. Moreover, in order to serve as an important tool in both clinical practice and continuing research, there is also an analysis of recent evidence on treatment and prognosis. CONCLUSIONS CVT represents approximately 0.5% of all stroke cases worldwide. Headache, focal deficits and seizures are the most frequent initial clinical manifestations, representing 89%, 50%, and 35% of appearances, respectively. Magnetic resonance imaging (MRI) in combination with magnetic resonance venography has proved to have the highest sensitivity and specificity in establishing a diagnosis. An equal alternative to MRI is computed tomography venography due to similar diagnostic results. Pharmacological treatment with heparin is widely accepted today. Recurrence and mortality rates of CVT are 2.8 per 100 cases and 10%, respectively, despite of anticoagulation treatment.
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Affiliation(s)
- G Guenther
- Departamento de Medicina Interna-Neurología, Hospital Ángeles del Pedregal (GG), México DF, México.
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Jara-Prado A, Alonso M, Ruano LM, Camacho JG, Leyva A, López M, Gutierrez-Castrellon P, Arauz A. MTHFR C677T, FII G20210A, FV Leiden G1691A, NOS3 Intron 4 Vntr, and APOE ε4 Gene Polymorphisms are Not Associated with Spontaneous Cervical Artery Dissection. Int J Stroke 2010; 5:80-5. [DOI: 10.1111/j.1747-4949.2010.00412.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims The pathogenesis of spontaneous cervical artery dissection remains unknown. We examined the association between different polymorphisms frequently found in young patients with cryptogenic stroke [methylenetetrahydrofolate reductase ( MTHFR) C677T, factor II (prothrombin) G20210A, factor V G1691A (Leiden), nitric oxide synthase 3 ( NOS3) intron 4 VNTR, and apolipoprotein E ( APOE) ε4 gene] in patients with a cerebral infarct caused by spontaneous cervical artery dissection. Methods Forty-eight patients (27 males) and 96 matching control subjects were recruited. Clinical history, including cardiovascular risk factors, was assessed in all subjects. Genotypes were determined by a polymerase chain reaction with and without a restriction fragment length polymorphism. The genotypes and allele frequencies of the five genetic variants studied were compared between spontaneous cervical artery dissection cases and controls. We also incorporated our data into a meta-analysis of the MTHFR/C677T variant. Results Of 48 patients with spontaneous cervical artery dissection (28 vertebral and 20 carotid), the mean age of the patients was 36·6 ± SD 9·9 years. There were no significant associations between the alleles of the five genetic polymorphisms studied and spontaneous cervical artery dissection. In the meta-analysis of the MTHFR/C677T variant, a total of 564 individuals (231 cases and 333 controls) were analysed; no significant association was observed. Conclusions The results from this exploratory case-control study show the lack of an association between MTHFR, factor II G20210A, factor V G1691A, NOS3, intron 4 VNTR, and APOE ε4 gene polymorphisms and the development of spontaneous cervical artery dissection. Our findings contribute towards a better understanding of the genetic risk factors associated with spontaneous cervical artery dissection.
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Affiliation(s)
- A. Jara-Prado
- Department of Neurogenetics, National Institute of Neurogenetics and Neurosurgery, Manuel Velasco Suárez of Mexico, Mexico City, Mexico
| | - M.E. Alonso
- Department of Neurogenetics, National Institute of Neurogenetics and Neurosurgery, Manuel Velasco Suárez of Mexico, Mexico City, Mexico
| | - L. Martínez Ruano
- Department of Neurogenetics, National Institute of Neurogenetics and Neurosurgery, Manuel Velasco Suárez of Mexico, Mexico City, Mexico
| | - J. Guerrero Camacho
- Department of Neurogenetics, National Institute of Neurogenetics and Neurosurgery, Manuel Velasco Suárez of Mexico, Mexico City, Mexico
| | - A. Leyva
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez of Mexico, Mexico City, Mexico
| | - M. López
- Department of Biological Systems, Metropolitan Autonomous University, Mexico City, Mexico
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Arauz A, López M, Cantú C, Barinagarrementeria F. [Nonaneurysmal subarachnoid hemorrhage. Study of long-term follow-up]. Neurologia 2007; 22:502-6. [PMID: 17641987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION Nonaneurysmal subarachnoid hemorrhage (SAH) accounts for 15% to 20% of all the cases of SAH. Its prognosis may vary from complete recovery to different and serious complications. We describe a series of cases with nonaneurysmal SAHs, their clinical and tomographic characteristics and causes as well as long term prognosis. PATIENTS AND METHODS 50 patients diagnosed of SAH and two negative brain angiographies for aneurysm were followed-up for an average period of 62 months. The demographic data of importance, vascular risk factors, were recorded. They were evaluated during the acute phase with the Hunt and Hess clinical scale and Fisher topographic scale. The distribution of the hemorrhage was listed as absent, perimesencephalic, focal, ventricular or diffuse. Presence of rebleeding, death and the functional course, measured by the Rankin modified scale, were recorded during the follow-up. According to this scale, Rankin of 0 to 2 was considered as a favorable prognosis. RESULTS This series represents 8.6 of all the SAH cases in our hospital. In 6 cases (12%), there was a causal relationship between the use of sympathicomimetic drugs and the development of SAH. In 80% of them, it was not possible to document the cause of the hemorrhage, while difference causes )cerebral venous thrombosis in 4 [8%], spontaneous dissection of the vertebral artery in 2 [4%], vasculitis secondary to neurocystecerosis in 2 [4%], cavernous angioma in 1 [2%] and spinal arteriovenous malformation in 1) were found. Rebleeding did not occur in any of the cases and only one patient died. In 45 patients (90%), the final functional prognosis was good (Rankin 0-2). We found no significant differences between the tomographic pattern of the hemorrhage, initial clinical condition and long term prognosis. CONCLUSIONS Our findings show a low frequency of nonaneurysmal SAH in our population and a diversity of causes greater than those reported by other series. The good functional prognosis in these cases was confirmed.
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Affiliation(s)
- A Arauz
- Clinica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez, Mexico.
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Becker S, Wang ZJ, Massey H, Arauz A, Labosky P, Hammerschmidt M, St-Jacques B, Bumcrot D, McMahon A, Grabel L. A role for Indian hedgehog in extraembryonic endoderm differentiation in F9 cells and the early mouse embryo. Dev Biol 1997; 187:298-310. [PMID: 9242425 DOI: 10.1006/dbio.1997.8616] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hedgehog genes in Drosophila and vertebrates control patterning of a number of different structures during embryogenesis. They code for secreted signaling proteins that are cleaved into an active aminopeptide and a carboxypeptide. The aminopeptide can mediate local and long range events and can act as a morphogen, inducing differentiation of distinct cell types in a concentration-dependent manner. We demonstrate here that the expression of Indian hedgehog mRNA and protein is upregulated dramatically as F9 cells differentiate in response to retinoic acid, into either parietal endoderm or embryoid bodies, containing an outer visceral endoderm layer. The ES cell line D3 forms embryoid bodies in suspension culture without addition of retinoic acid and also upregulates Indian hedgehog expression. RT-PCR analysis of blastocyst outgrowth cultures demonstrates that whereas little or no Indian hedgehog message is present in blastocysts, significant levels appear upon subsequent days of culture, coincident with the emergence of parietal endoderm cells. In situ hybridization analysis for Indian hedgehog mRNA expression demonstrates the presence of elevated levels of message in the outer visceral endoderm cells relative to the core cells in mature embryoid bodies and in the visceral endoderm of Day 6.5 embryos. Whole-mount in situ hybridization analysis of Day 7.5 and 8.5 embryos indicates that Indian hedgehog expression is highest in the visceral yolk sac at this stage. F9 cell lines expressing a full length Indian hedgehog cDNA express a number of characteristics of differentiated cells, in the absence of retinoic acid. Taken together, these data suggest that Indian hedgehog is involved in mediating differentiation of extraembryonic endoderm during early mouse embryogenesis.
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Affiliation(s)
- S Becker
- Department of Biology, Wesleyan University, Middletown, Connecticut 06559-0170, USA
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