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González-Alvarez F, Estañol B, González-Hermosillo JA, Gómez-Pérez FJ, Tamez-Torres KM, Peña E, Cantú C, Chiquete E, Sifuentes-Osornio J, Alba-Lorenzo MDC, Celestino-Montelongo DA, Salazar-Calderón GE, Aceves Buendia JDJ. Complete remission with histamine blocker in a patient with intractable hyperadrenergic postural orthostatic tachycardia syndrome secondary to long coronavirus disease syndrome. J Hypertens 2024; 42:928-932. [PMID: 38526146 PMCID: PMC10990027 DOI: 10.1097/hjh.0000000000003669] [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: 11/22/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 03/26/2024]
Abstract
The COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), has emerged as a global public health concern and its sequels have barely started to outcrop. A good percentage of patients who suffered from COVID-19 are prone to develop long-COVID or post-COVID condition (PCC), a multisystemic, heterogeneous, chronic disorder. Patients with PCC may experience diverse manifestations, of which cardiovascular and neurological symptoms are among the most frequently reported. Indeed, dysautonomia presented as orthostatic intolerance has gained room following recent reports linking postural orthostatic tachycardia syndrome (POTS) with PCC. Disturbances in heart rate (HR) and blood pressure (BP) during postural changes are the cornerstones of orthostatic intolerance seen in patients suffering from PCC. A subtype of POTS, hyperadrenergic POTS, has been widely studied because of its association with mast cell activation syndrome (MCAS). Although a causative relationship between PCC, hyperadrenergic POTS, and MCAS remains unrevealed, these syndromes can overlap. We want to propose here a correlation produced by a close-loop mechanism with positive feedback established after SARS-CoV-2 infection in a previously healthy young patient.
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Affiliation(s)
- Felipe González-Alvarez
- Laboratory of Autonomic Nervous System, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Bruno Estañol
- Laboratory of Autonomic Nervous System, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | | | | | | | - Eduardo Peña
- Laboratory of Autonomic Nervous System, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Carlos Cantú
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Erwin Chiquete
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | | | | | | | | | - Jose de Jesus Aceves Buendia
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
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Weder-Cisneros ND, Téllez-Zenteno JF, Cardiel MH, Guibert-Toledano M, Cabiedes J, Velásquez-Paz AL, García-Ramos G, Cantú C. Prevalence and Factors Associated with Headache in Patients with Systemic Lupus Erythematosus. Cephalalgia 2016; 24:1031-44. [PMID: 15566417 DOI: 10.1111/j.1468-2982.2004.00822.x] [Citation(s) in RCA: 32] [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] [Indexed: 11/27/2022]
Abstract
Headache is common in systemic lupus erythematosus with reported prevalence as high as 70%. The aims of this study were: to estimate the prevalence and types of headache in a sample of patients with systemic lupus erythematosus comparing it with rheumatoid arthritis, to determine clinical and serological associations. Eighty-one systemic lupus erythematosus and 29 rheumatoid arthritis consecutive patients seen in our outpatient clinic were interviewed. Headache was evaluated using the diagnostic criteria proposed by the International Headache Society. Additional evaluations were carried out in the 81 systemic lupus erythematosus patients including depression, disease activity, lupus damage, function disability, quality of life, and severity degree using a validated scales. We analysed the following autoantibodies: anti-double stranded DNA, anti-nucleosomes, anti-histones, anti-ribosomal P, anti-cardiolipin antibodies, anti-β2-glycoprotein-I (GPI), and antinuclear antibodies. Forty-one per cent of systemic lupus erythematosus and 17% of rheumatoid arthritis patients suffered from headache ( P = 0.02). No significant difference for any primary headache type between the two groups was found. Frequency of headache types in systemic lupus erythematosus patients was: migraine 24%, tensional-type headache 11%, and mixed headache 5%. In systemic lupus erythematosus patients the risk factors associated with headaches were Raynaud's phenomenon (OR 3.6; 95% CI 1.3-9.5; P = 0.009) and β2GPI antibody positivity (OR 4.5; 95% CI 1.2-16.2; p = 0.016). We conclude that headache is more common in systemic lupus erythematosus than in rheumatoid arthritis patients and was independently associated with Raynaud's phenomenon and β2GP-I antibodies.
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Affiliation(s)
- N D Weder-Cisneros
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Immunology and Rheumatology, INCMNSZ
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3
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Claros M, Soto R, Rodríguez JJ, Cantú C, Contreras-Vidal JL. Novel compliant actuator for wearable robotics applications. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2013:2854-7. [PMID: 24110322 DOI: 10.1109/embc.2013.6610135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the growing fields of wearable robotics, rehabilitation robotics, prosthetics, and walking robots, variable impedance and force actuators are being designed and implemented because of their ability to dynamically modulate the intrinsic viscoelastic properties such as stiffness and damping. This modulation is crucial to achieve an efficient and safe human-robot interaction that could lead to electronically generate useful emergent dynamical behaviors. In this work we propose a novel actuation system in which is implemented a control scheme based on equilibrium forces for an active joint capable to provide assistance/resistance as needed and also achieve minimal mechanical impedance when tracking the movement of the user limbs. The actuation system comprises a DC motor with a built in speed reducer, two force-sensing resistors (FSR), a mechanism which transmits to the FSRs the torque developed in the joint and a controller which regulate the amount of energy that is delivered to the DC motor. The proposed system showed more impedance reduction, by the effect of the controlled contact forces, compared with the ones in the reviewed literature.
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Marquez-Romero JM, Arauz A, Góngora-Rivera F, Barinagarrementeria F, Cantú C. The burden of stroke in México. Int J Stroke 2013; 10:251-2. [PMID: 24206581 DOI: 10.1111/ijs.12189] [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: 05/02/2013] [Accepted: 07/04/2013] [Indexed: 12/01/2022]
Abstract
Regrettably, stroke has been scarcely studied in México, and the available data suffer from great variability in diagnostic testing, risk factor definitions, and poor generalizability. The current cumulative incidence of stroke in Mexico is 232.2 per 100,000, whereas prevalence among people aged 60 years or older is 18.2 per 1000. Hypertension and diabetes are the main risk factors. Ischemic stroke is the most frequent sub-type. Stroke mortality has been increasing during last years, and 30-day case fatality rate doubles at one-year follow-up. A remarkable finding of a hospital-based registry was that most of ischemic stroke cases are of undetermined etiology and even when a quarter of patients arrive on time for thrombolysis, less than 1% received this management.
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Affiliation(s)
- Juan M Marquez-Romero
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico City, México
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Arauz A, Alonso E, Rodríguez-Saldaña J, Reynoso-Marenco M, Benitez IT, Mayorga AM, Rodríguez-Agudelo Y, Romero AV, Cantú C. Cognitive impairment and mortality in older healthy Mexican subjects: a population-based 10-year follow-up study. Neurol Res 2013; 27:882-6. [PMID: 16354550 DOI: 10.1179/016164105x49427] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 10/31/2022]
Abstract
OBJECTIVES To estimate the incidence of cognitive impairment (CI) among cognitively healthy, Mexican subjects, and to evaluate the impact of demographic and vascular factors on the conversion to CI and mortality. METHODS 734 eligible subjects (aged 55 to >90 years) from a population-based sample were examined. The cognitive function of participants was assessed using the Mini-Mental State Examination (MMSE) every 2 years. The subjects were followed for an average of 3.2 years. The CI was defined using two sets of criteria: (i) moderate CI, as a drop to 25-21 on the MMSE at 2-year follow-up or a decrease of at least four points and (ii) severe CI, defined as a drop of 21 or less in MMES at follow-up. The incidence density and period prevalence were determined as epidemiological measures as well as the cumulative incidence as a risk measure. Kaplan-Meier survival curves were used to analyse the main points of interest: CI, dementia and mortality. RESULTS The period prevalence of moderate CI was 20%, and 10% for severe CI. During 1959 person-years of follow-up, severe CI developed in 33 of the 361 participants. While during 2096 person-years of follow-up; 80 of 361 participants developed moderate CI. The rate of progression to severe CI in moderate CI subjects gradually increases with follow-up. Both, moderate and severe CI were associated with low educational level, higher age and higher mortality. CONCLUSIONS Elderly people with moderate CI have an increased risk of severe CI. Moderate and severe CI are both predictive of higher mortality in Mexican subjects.
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Affiliation(s)
- Antonio Arauz
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez; México City, Mexico.
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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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Arauz A, Murillo L, Márquez JM, Tamayo A, Cantú C, Roldan FJ, Vargas-Barrón J, Barinagarrementeria F. Long-Term Risk of Recurrent Stroke in Young Cryptogenic Stroke Patients with and without Patent Foramen Ovale. Int J Stroke 2011; 7:631-4. [DOI: 10.1111/j.1747-4949.2011.00641.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Among patients with a patent foramen ovale and cryptogenic ischemic stroke, the long-term prognosis is unclear. Aims This study aims to estimate the recurrence rate in young cryptogenic stroke patients with and without patent foramen ovale. Patients and methods One hundred eighty-six cryptogenic stroke patients (aged 18–45 years) were prospectively followed for up to five-years. They were divided into two groups according to the echocardiographic presence of patent foramen ovale. All patients received aspirin (100mg/day) for secondary prevention. Results Mean age was 32·3 (standard deviation 7·9) years. During the mean follow-up of 66 months five patients with patent foramen ovale had recurrent strokes compared with 11 patients without patent foramen ovale. The average annual rate of recurrent cerebral ischemia was 1·1% and 1·6% for patients with and without patent foramen ovale, respectively. The recurrence rate did not increase with the presence of patent foramen ovale, atrial septal aneurysm or other variables. More than 60% of the reported cases achieved a good functional outcome. Conclusions Young patients with cryptogenic ischemic stroke with and without patent foramen ovale have a low recurrence rate in a long-term follow-up and most present a favorable outcome. Patent foramen ovale with or without atrial septal aneurysm did not increase the risk of recurrence.
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Affiliation(s)
- Antonio Arauz
- Stroke Clinic, National Institute of Neurology and Neurosurgery, ‘Manuel Velasco Suárez,’ Mexico City (DF)
| | - Luis Murillo
- Facultad de Medicina de la Universidad Autónoma de Guadalajara
| | - Juan Manuel Márquez
- Stroke Clinic, National Institute of Neurology and Neurosurgery, ‘Manuel Velasco Suárez,’ Mexico City (DF)
| | - Arturo Tamayo
- Stroke Prevention Clinic, Brandon Regional Health Centre, Brandon Manitoba, Canada and Neurology Service, Department of Medicine, University of Manitoba
| | - Carlos Cantú
- Servicio de Neurologia, National Institute of Nutrition and Medical Sciences ‘Salvador Zubiran,’ Mexico City, Mexico
| | - Francisco-Javier Roldan
- Department of Echocardiography, National Institute of Cardiology ‘Ignacio Chavez,’ Mexico City, Mexico
| | - Jesús Vargas-Barrón
- Department of Echocardiography, National Institute of Cardiology ‘Ignacio Chavez,’ Mexico City, Mexico
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Mimenza A, Juarez S, Aguilar S, Ávila A, Cantú C, Reyes J. P3‐089: Neuropsychological profiles in mild cognitive impairment and correlation with subcortical vascular lesions in Mexican elderly: A retrospective study. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.1529] [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] [Indexed: 11/26/2022]
Affiliation(s)
- Alberto Mimenza
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMéxicoMexico
| | - Sandra Juarez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMéxicoMexico
| | - Sara Aguilar
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMéxicoMexico
| | - Alberto Ávila
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMéxicoMexico
| | - Carlos Cantú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMéxicoMexico
| | - Jorge Reyes
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMéxicoMexico
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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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Villarreal-Careaga J, Murillo-Bonilla L, Góngora-Rivera F, Leyva-Rendón A, Barinagarrementeria F, Cantú C, Ruiz-Sandoval JL, Romano J, Merino JG, Arauz A, Márquez J. [Guideline for surgical treatment (endarterectomy) and endovascular (angioplasty with distal protection and stenting) for secondary prevention treatment of ischemic stroke secondary to carotid atheroesclerotic disease]. Rev Invest Clin 2010; 62:170-180. [PMID: 20597397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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11
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Barinagarrementeria F, Arauz A, Ruiz-Sandoval JL, Cantú C, Leyva A, Murillo L, Villarreal J, Vargas RD, Alegría MA, Merino JG, Romano J. [Antiplatelet treatment for secondary prevention of ischemic stroke or transient ischemic attack]. Rev Invest Clin 2010; 62:135-140. [PMID: 20597393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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12
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Alegría MA, Arauz A, Roa LF, Márquez J, Calleja J, Leyva A, Cantú C, Barinagarrementeria F, Ruiz-Sandoval JL, Villarreal J, Romano J, Merino JG, Murillo L, Escamilla JM. [Antiocoagulation for the secondary prevention of ischemic stroke]. Rev Invest Clin 2010; 62:141-151. [PMID: 20597394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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13
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Cantú C, Villarreal J, Barinagarrementeria F, Ruiz-Sandoval JL, Arauz A, Leyva A, Murillo L, Fernández-Vera JA, Amaya LE, Venegas A, Merino JG, Romano J. [Statins for the secondary prevention of ischemic stroke]. Rev Invest Clin 2010; 62:162-169. [PMID: 20597396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Carlos Cantú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
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Ruiz-Sandoval JL, León-Jiménez C, Chiquete-Anaya E, Sosa-Hernández JL, Espinosa-Casillas CA, Cantú C, Villarreal J, Barinagarrementeria F, Ruiz-Sandoval JL, Arauz A, Leyva A, Murillo L, Alegría MA, Merino J, Romano J, González-Vargas O. [Lifestye and primary and secondary prevention for cerebrovascular disease]. Rev Invest Clin 2010; 62:181-191. [PMID: 20597398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Murillo-Bonilla L, Lepe-Cameros L, Espinoza-Casillas C, Leyva-Rendón A, López M, León-Jiménez C, Enríquez-Coronel G, Arauz A, Cantú C, Lizola-Hernández J, Méndez-González C, Ruíz-Sandoval JL, Merino JG, Romano J, Barinagarrementeria F, Villarreal-Careaga J. [Guideline for hypertension treatment in patients with cerebrovascular diseases after acute phase]. Rev Invest Clin 2010; 62:152-161. [PMID: 20597395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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16
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Arauz A, Murillo-Bonilla L, Leyva A, Barinagarrementeria F, Alegria MA, Villarreal-Careaga J, León C, Cantú C, Ruíz-Sandoval JL. [Guideline for secondary prevention treatment in cerebrovascular diseases after acute phase]. Rev Invest Clin 2010; 62:130-134. [PMID: 20597392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Antonio Arauz
- Instituto Nacional de Neurología y Neurocirugia Manuel Velasco Suárez.
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Abstract
BACKGROUND AND PURPOSE Little is known about the gender-specific manifestations of cerebral venous and sinus thrombosis, a disease that is much more common in women than men. METHODS We used data of the International Study on Cerebral Vein and Dural sinus Thrombosis (ISCVT), a multicenter prospective observational study, to analyze gender-specific differences in clinical presentation, etiology, and outcome of cerebral venous thrombosis. RESULTS Four hundred sixty-five of a total of 624 patients were women (75%). Women were significantly younger, had less often a chronic onset of symptoms, and had more often headache at presentation. There were no gender differences in ancillary investigations or treatment. A gender-specific risk factor (oral contraceptives, pregnancy, puerperium, and hormonal replacement therapy) was present in 65% of women. Women had a better prognosis than men (complete recovery 81% versus 71%l P=0.01), which was entirely due to a better outcome in female patients with gender-specific risk factors. Women without gender-specific risk factors are similar to men in clinical presentation, risk factor profile, and outcome. Logistic regression analysis confirmed that the absence of gender-specific risk factors is a strong and independent predictor of poor outcome in women with sinus thrombosis (OR, 3.7; CI, 1.9 to 7.4). CONCLUSIONS Our study identified important differences between women and men in presentation, course, and risk factors of cerebral venous and sinus thrombosis and showed that women with a gender-specific risk factor have a much better prognosis than other patients.
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Affiliation(s)
- Jonathan M Coutinho
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Ruiz-Sandoval JL, Cantú C, Chiquete E, León-Jiménez C, Arauz A, Murillo-Bonilla LM, Villarreal-Careaga J, Barinagarrementería F. Aneurysmal Subarachnoid Hemorrhage in a Mexican Multicenter Registry of Cerebrovascular Disease: The RENAMEVASC Study. J Stroke Cerebrovasc Dis 2009; 18:48-55. [DOI: 10.1016/j.jstrokecerebrovasdis.2008.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 09/01/2008] [Accepted: 09/11/2008] [Indexed: 10/21/2022] Open
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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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Arauz A, Hoyos L, Cantú C, Jara A, Martínez L, García I, Fernández MDLA, Alonso E. Mild Hyperhomocysteinemia and Low Folate Concentrations as Risk Factors for Cervical Arterial Dissection. Cerebrovasc Dis 2007; 24:210-4. [PMID: 17596690 DOI: 10.1159/000104479] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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: 10/23/2006] [Accepted: 02/22/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Elevated homocysteine (Hcy) plasma levels are associated with an increased risk of spontaneous cervical artery dissection (sCAD). We examined the potential association between Hcy, folate, vitamin B(12) levels and 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphisms in patients with cerebral infarct caused by sCAD. PATIENTS AND METHODS 39 patients who survived a cerebral infarct caused by sCAD [20 (51%) women; 24 (61.5%) vertebral and 15 (38.5%) internal carotid arteries], and 76 healthy control subjects were included. Hcy plasma levels (fasting and after methionine load), folate and vitamin B(12) levels were measured. We also performed polymorphisms of MTHFR. Hcy, vitamin B(12), folates and polymorphisms of MTHFR were assessed and any associations were analyzed using multivariate statistics. RESULTS Mean plasma fasting Hcy level was 9.81 mumol/l for cases and 6.38 for controls (p = 0.001). The occurrence of sCAD was associated with elevated fasting Hcy levels (>95th percentile over the control group) with an adjusted odds ratio of 7.9 (95% CI 1.66-35). The association between low plasma folate values (<5th percentile) and the presence of CAD was 7.9 (95% CI 1.6-31) after adjusting for confounding variables. The distribution of the MTHFR genotype showed a higher TT mutant frequency among CAD patients (p = 0.034). CONCLUSIONS High plasma concentrations of Hcy and low plasma levels of folate were associated with an increased risk of sCAD in the sample studied. We conclude that deficiencies in nutritional status may contribute to the relatively high incidence of CAD in Mexico.
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Affiliation(s)
- Antonio Arauz
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
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Ruiz-Sandoval JL, Romero-Vargas S, Chiquete E, Padilla-Martínez JJ, Villarreal-Careaga J, Cantú C, Arauz A, Barinagarrementería F. Hypertensive intracerebral hemorrhage in young people: previously unnoticed age-related clinical differences. Stroke 2006; 37:2946-50. [PMID: 17095739 DOI: 10.1161/01.str.0000248766.22741.4b] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Hypertensive intracerebral hemorrhage (ICH) in young people has been the object of only succinct analyses. Therefore, it is unclear whether extrapolation of the information obtained from older patients is also valid for the young. Here we describe young persons with hypertensive ICH and compare them with their older counterparts to determine whether age-related clinical differences exist. METHODS From 1988 to 2004, we studied 35 consecutive young patients with ICH (60% men; mean age, 33 years; range, 15 to 40 years) for whom the etiology of the brain hemorrhage was hypertension. For clinical comparisons, sex-matched persons with hypertensive ICH, aged >40 years, were randomly selected by a factor of 3:1 (n=105). RESULTS Essential hypertension was present in 26 (74%) young patients and secondary hypertension in 9 (26%), with renovascular hypertension being the most common cause (n=5, 55%). Compared with older patients, the young had higher blood pressures, smaller hemorrhage volumes, lower rates of ventricular extensions (for all, P<0.05), and different distribution pattern of ICHs (P=0.05), without cerebellar and lobar locations. Thirty-day mortality was markedly lower in the young than in older persons (P=0.001), nevertheless at the expense of more incapacitating disabilities. CONCLUSIONS Young people presenting with hypertensive ICH differ in clinical characteristics and have a different prognosis when compared with their older counterparts. These findings suggest underlying age-related differences in disease pathogenesis.
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Affiliation(s)
- José L Ruiz-Sandoval
- Servicio de Neurología y Neurocirugía, Hospital Civil de Guadalajara Fray Antonio Alcalde, Hospital 278, Guadalajara, Jalisco, México CP44280.
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Arauz A, Cantú C, Ruiz-Sandoval JL, Villarreal-Careaga J, Barinagarrementeria F, Murillo-Bonilla L, Fernández JA, Torres B, León C, Rodríguez-Leyva I, Rangel-Guerra R. [Short-term prognosis of transient ischemic attacks. Mexican multicenter stroke registry]. Rev Invest Clin 2006; 58:530-9. [PMID: 17432283] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND There are no data on Mexican population referring to frequency and prognosis of transient ischemic attacks (TIA). The purpose of the present study was to: (1) estimate the prevalence, vascular risk factors and short-term outcome in patients with TIA included in the first Mexican registry of cerebrovascular disease, and (2) analyze the acute care provided in these patients. PATIENTS AND METHODS This national registry of cerebrovascular diseases is a multicenter, observational, and hospital-based registry that was conducted from November 2002 to October 2004. The registry was developed to improve our knowledge in Mexico regarding risk factors profile, outcome, current diagnostic and treatment strategies, and short-term follow-up in patients with acute cerebral ischemia. Standardized data assessment was used by all centers which included information on demographics, pre-hospital events (including stroke onset and arrival to hospital), emergency department triage and workup. Short-term outcome was evaluated at day 30. Of this registry, TIA cases were selected and associated risk factors, clinical characteristics, diagnosis and treatment were analyzed. RESULTS During the study time period, 2,000 patients were enrolled; 97 (5%) with diagnosis of TIA; 51 women and 46 men, mean age 69.3 +/- 11.4 years. Among these 97 patients; 51 (52.6%) were admitted to the hospital for evaluation. The main risk factors were; age > or = 65 years in 74%, hypertension in 64%, diabetes in 45%, and dislipidemia in 36% and obesity in 31%. The affected arterial territory was carotid TIA in 74% and vertebrobasilar in 26%. TIA was attributed to atherosclerosis in 63% of the patients, cardioembolism in 17%, and small vessels disease in 5%. At 30 days follow-up; three patients died during the initial evaluation (two secondary to cardiac arrhythmia, and one secondary to pneumonia). Among 14 of the 94 survivors (14.9%) we documented an early stroke recurrence, including cerebral infarction in nine patients (9.6%) and new TIA in five cases (5.3%). Considering death and cerebral infarction, the frequency of unfavorable major events was 12.4%. There were only three cases treated with carotid endarterectomy. CONCLUSIONS The short-term risk of ischemic stroke, death or recurrent in TIA patients is high. These findings emphasize that all patients with TIA should undergo rapid investigation and management to prevent a major stroke and other vascular events.
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Affiliation(s)
- Antonio Arauz
- Clínica de Enfermedad Cerebral, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, México, DF.
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Arauz A, Hoyos L, Espinoza C, Cantú C, Barinagarrementeria F, Román G. Dissection of Cervical Arteries: Long-Term Follow-Up Study of 130 Consecutive Cases. Cerebrovasc Dis 2006; 22:150-4. [PMID: 16691024 DOI: 10.1159/000093244] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [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: 08/22/2005] [Accepted: 01/30/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE We describe the natural history, functional prognosis and long-term recurrences of patients with dissection of cervical arteries (DCA) in a sequential observational study. METHODS We describe 130 patients with angiographically-proven DCA admitted to the Neurology Institute in Mexico City (Mexico), and analyzed clinical and neuroimaging data, treatment and outcome. Treatment with either anticoagulation or aspirin was decided by the primary physician. Primary outcome measures were recurrence (stroke and death) and clinical outcome at 6 months. Follow-up studies were performed to determine recanalization. RESULTS Mean age was 35.4 years; 4 patients died (3%) and 126 were followed for 3,906 person/years; 17 patients (13%) had a heralding ischemic cerebral event (6 strokes, 11 TIAS) about 8 days before the diagnosis of DCA. After diagnosis, recurrent ischemic stroke occurred in 6 patients (4.8%) within the 2 first weeks (1.5 persons/1,000 follow-up years). No significant differences were found between aspirin and anticoagulation. Recanalization was more frequent in vertebral dissections. Complete recanalization of vertebral dissections was associated with a favorable prognosis [OR 3.2 (95% CI 1.1-8.8; p = 0.02)]. CONCLUSIONS In Mexico, DCA affects young adults and may present with a heralding stroke or TIA. We found rare, early ischemic recurrences. Vertebral territory dissections had better prognosis than carotid ones, particularly in patients with demonstrated complete recanalization.
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Affiliation(s)
- Antonio Arauz
- Stroke Clinic of the Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
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Abstract
OBJECTIVES To analyze the causes and long-term clinical outcome of internuclear ophthalmoplegia (INO) in a consecutive series of 65 patients. PATIENTS AND METHODS From a clinical registry of a neuroophthalmological department, patients with diagnosis of INO were retrospectively identified. Patients were classified into three groups: unilateral INO, bilateral INO, and one-and-a-half syndrome. RESULTS AND CONCLUSIONS Thirty-three men (50.8%) and 32 women (49.2%), with a mean age of 38.4 years were included in the study. INO was unilateral in 36 patients (55.4%), bilateral in 22 (33.8%) and one-and-a-half syndrome in seven (10.8%). The most common causes were vascular (36.9%), multiple sclerosis (32.3%), and infectious diseases (13.8%). Resolution of INO was documented in 32 patients (49.2%): 15 patients showed INO resolution during the first 3 months and 17 patients in 3-9 months. INO persisted in 33 patients (50.8%) even after a follow-up longer than 12 months.
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Affiliation(s)
- I Bolaños
- Department of Neuroophthalmology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, México City, México
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Abstract
BACKGROUND AND PURPOSE We investigated whether lacunar infarct (LI) patients with >1 lacune have different vascular risk factors, a different prognosis, and poorer functional outcome than those with a single lacune. METHODS The study included 175 first-ever LI patients. The group was divided according to the presence of multiple (n=136) or single (n=39) LI. The association of single or multiple LI with the principal vascular risk factors, leukoaraiosis, outcome, and recurrence was investigated with logistic regression models that included age, sex, and cardiac disease. RESULTS No significant differences were found between single and multiple LI with respect to age, hypertension, hyperlipidemia, smoking, and heavy alcohol drinking. Diabetes mellitus (odds ratio [OR], 2.43; 95% CI, 1.09 to 5.4), high levels of hematocrit (>0.47) (OR, 1.09; 95% CI, 1.04 to 1.21), and leukoaraiosis (OR, 3.58; 95% CI, 1.77 to 7.51) were significantly related to multiple but not to single LI. Stroke recurrence rate was 7.7% in patients with single LI and 24.3% in the multiple LI group (OR, 3.84; 95% CI, 1.1 to 13.3). During a median follow-up of 12 months (range, 6 to 156 months), 94% of the single LI patients and 77.2% of the multiple LI patients had favorable outcomes (Rankin Scale score 0 to 2) (OR, 5.4; 95% CI, 1.25 to 23.9). CONCLUSIONS Diabetes mellitus, leukoaraiosis, and high levels of hematocrit are important risk factors in patients with >1 LI. The presence of multiple LI may be an important prognostic indicator not only for functional recovery but also for a higher rate of recurrence.
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Affiliation(s)
- Antonio Arauz
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Tlalpan, México City, México.
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Tellez-Zenteno JF, Negrete-Pulido O, Cantú C, Márquez C, Vega-Boada F, García Ramos G. [Hemorrhagic stroke associated to neurocysticercosis]. Neurologia 2003; 18:272-5. [PMID: 12768515] [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: 03/02/2023] Open
Abstract
A well-known complication of neurocysticercosis is cerebral arteritis, which is usually manifested by cerebral ischemia. Only anecdotal cases of hemorrhagic stroke associated to this parasitosis have been described. Previously there are only two reported cases of this association. One of these cases had an intracystic hemorrhage confirmed by autopsy without cerebrovascular risk factors. Autopsy revealed an inflammatory arteriopathy adjacent to the cyst intracystic hemorrhage. The second case had a subarachnoidal hemorrhage secondary to the rupture of an aneurysm in the right anteroinferior cerebellar artery. At surgery, the aneurysm was found to be surrounded by a thickened-leptomeninges, which histologically showed the presence of cysticercous with dense inflammation. Our first patient was a 32 year-old female developed a lenticulo-capsular hemorrhage around a cysticercotic lesion. The second patient was a 34 year-old male developed an intracystic hemorrhage. As cerebral angiography was normal in both patients, cerebral hemorrhages were considered to be related to cysticercotic arteritis of small penetrating vessels. We conclude that cysticercosis is associated with differenttypes of intracranial hemorrhage, as documented the present cases. In neurocysticercosis endemic areas, cysticercotic arteritis should be added to the list of causes of intracranial hemorrhage in young people.
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Affiliation(s)
- J F Tellez-Zenteno
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City.
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Arauz A, Velásquez L, Cantú C, Nader J, López M, Murillo L, Aburto Y. Phenylpropanolamine and intracranial hemorrhage risk in a Mexican population. Cerebrovasc Dis 2003; 15:210-4. [PMID: 12646782 DOI: 10.1159/000068830] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/20/2001] [Accepted: 06/27/2002] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Phenylpropanolamine (PPA) has been associated with an increased risk of intracranial hemorrhage (ICH). The aim of this study was to assess the association between PPA intake and ICH in a Mexican population. METHODS We included all patients with ICH aged 18 to 51 years, with no known structural etiology, diagnosed from January 1991 to December 2000. Three to 4 controls per patient matched by sex, age (within 5 years) and place of residence were included. Patients and controls were asked about use of cold medication or appetite suppressant medications within the previous year before the interview. We considered a PPA related hemorrhage when there was a temporal relationship between the use of medication and the development of the hemorrhage, and when other causes could be ruled out. Associated risks for PPA use and other possibly related variables were estimated. RESULTS 177 patients (mean age 39 +/- 12 years) were included; 58 (33%) were diagnosed with subarachnoid hemorrhage (SAH) and 119 (67%) with ICH. 41.2% (73 of 177) of patients had documented use of PPA within the past year and 10 (5.7%) of them had a temporal relationship between ingestion of PPA and ICH. In control subjects 42.4% (422 of 996) had been exposed to PPA and none of them developed hemorrhage. The time from PPA exposure to the onset of ICH varied from 30 minutes to 24 hours. The risk of PPA exposure for hemorrhage was not significant in cases or controls, OR 0.95 (95% CI, 0.68 to 1.34; p = 0.77). No subjects (cases or controls) reported use of PPA as an appetite suppressant. CONCLUSIONS We found no association between ingestion of PPA and cerebral hemorrhage with respect to ingestion of PPA in the previous year. When recent use was looked at an apparent risk was evident.
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Affiliation(s)
- Antonio Arauz
- National Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez', México, México.
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Mercado R, López S, Cantú C, Sanchez A, Revuelta R, Gómez-Llata S, Bouffard JA, Pineda C. Intracranial aneurysms associated with unsuspected aortic coarctation. J Neurosurg 2002; 97:1221-5. [PMID: 12450049 DOI: 10.3171/jns.2002.97.5.1221] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial aneurysms (IAs) are found more often in patients with aortic coarctation (AC) than in the general population and aneurysm rupture occurs much earlier in the lives of these patients when there is coexistent AC. The diagnosis of AC is frequently made only after a serious cerebrovascular complication has developed. The aim of this paper is to call attention to AC in patients presenting with aneurysmal subarachnoid hemorrhage. The literature is reviewed, the key clinical features are highlighted, and the proposed pathogenesis of this association is discussed. The authors present clinical information and imaging data obtained in three young patients with ruptured IAs that were associated with initially unnoticed AC. Abnormal results of cardiovascular examinations led the authors to consider an underlying AC, which was later confirmed by aortography. These aneurysms were successfully treated prior to correction of the ACs. The diagnosis of AC should be considered in adolescent and young adult patients presenting with IAs.
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Affiliation(s)
- Rodrigo Mercado
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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29
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Ruiz JL, Colorado H, Loy MDC, Millán R, Talamás O, Torres B, Vargas R, Cantú C, Araúz A, Barinagarrementeria F. [Diagnosis and treatment of intracerebral hemorrhage]. Rev Invest Clin 2002; 54:275-80. [PMID: 12183899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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30
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Alegría MA, Araúz A, Azcanio G, Escamilla JM, Flores F, Ruiz JL, Torres B, Cantú C, Barinagarrementeria F. [General measures and intensive care of acute cerebrovascular accident]]. Rev Invest Clin 2002; 54:262-5. [PMID: 12183896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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31
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Barinagarrementeria F, Amaya L, Guzmán JL, Ibarra O, Loy MDC, Millán R, Neri G, Villarreal J, Araúz A, Cantú C. [Secondary prevention of cerebral ischemia. AMEVASC. Mexican Association of Cerebrovascular Disease]. Rev Invest Clin 2002; 54:257-61. [PMID: 12183895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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32
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Villarreal J, Cantú C, Aguayo G, Amaya L, Guzmán JL, Barinagarrementeria F, Araúz A. [Atherosclerotic carotid disease and endarterectomy]. Rev Invest Clin 2002; 54:271-4. [PMID: 12183898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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33
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Cantú C, Talamás O, Mejía A, Rodríguez J, Murillo LM, Osorno M, Miranda L, Araúz A, Barinagarrementeria F. [Primary prevention of cerebrovascular disease]. Rev Invest Clin 2002; 54:247-56. [PMID: 12183894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Carlos Cantú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F
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34
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Araúz A, Barinagarrementeria F, Navarrete H, Ascanio G, Osorno M, Miranda L, Alegría MA, Escamilla JM, Cantú C. [Acute management of cerebral infarction]. Rev Invest Clin 2002; 54:266-70. [PMID: 12183897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Antonio Araúz
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, México, D.F
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35
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Nader J, Flores F, Ibarra O, Mejía A, Neri G, Rangel R, Rodríguez J, Araúz A, Cantú C, Barinagarrementeria F. [Diagnosis and treatment of subarachnoid hemorrhage]. Rev Invest Clin 2002; 54:281-4. [PMID: 12183900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Juan Nader
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, México, D.F
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Cantú C, Pineda C, Barinagarrementeria F, Salgado P, Gurza A, Espinosa R, Martínez-Lavín M. Noninvasive cerebrovascular assessment of Takayasu arteritis. Stroke 2000; 31:2197-202. [PMID: 10978051 DOI: 10.1161/01.str.31.9.2197] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Despite prominent neurological symptoms reported in Takayasu arteritis (TA), a complete evaluation of the cerebral circulation has not been consistently performed. The purpose of this study is to describe MR angiography (MRA), color Doppler flow imaging, and transcranial Doppler (TCD) findings in the extracranial and intracranial cerebral arteries in TA. METHODS MRA, color Doppler flow imaging, and TCD were performed in 21 patients with TA. Intima-media thickness was measured in the common carotid artery. The correlation between noninvasive studies and panaorto-arteriography was examined for supraortic vessels. Cerebral angiography findings were compared with the noninvasive methods in 7 patients. Intracranial hemodynamic changes detected by TCD were compared with extracranial circulation lesions assessed by panaorto-arteriography. RESULTS Noninvasive vascular techniques showed at least 1 abnormality in the extracranial and/or intracranial cerebral arteries in 20 of 21 patients (95%). Both MRA and color Doppler flow imaging showed a substantial correlation in the ability to detect obstructive lesions in supra-aortic vessels compared with panaorto-arteriography. High-resolution ultrasonography displayed common carotid artery wall thickening in 5 vessels that were considered normal by arteriography. In 24% of patients, MRA and TCD showed abnormalities consistent with stenosis of the basal cerebral arteries. In 10 patients with severe extracranial circulation involvement (detected by arteriography), TCD displayed intracranial hemodynamic changes consisting of dampened or blunted waveforms with low pulsatility. CONCLUSIONS The comprehensive assessment of cerebral circulation in TA patients by noninvasive methods allowed the detection of a high rate of diverse vascular abnormalities in both extracranial and intracranial circulation.
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Affiliation(s)
- C Cantú
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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Abstract
BACKGROUND AND PURPOSE The frequency of intracerebral hemorrhages (ICHs) in people aged </=40 years has been poorly studied. We investigated the incidence, causes, locations, and prognosis of ICH in young patients. METHODS We evaluated all consecutive patients with neuroimaging evidence or pathological confirmation of symptomatic ICH. We excluded patients with primary subarachnoid or traumatic hemorrhage, past evidence of vascular malformation, or brain tumor. We analyzed the risk factors, number, locations, and causes of ICH, and final outcome measured by the modified Glasgow Outcome Scale. RESULTS We retrospectively evaluated 200 patients (mean age, 27 years; range, 15 to 40 years). The most frequent risk factors were tobacco use (20%), hypocholesterolemia (35%), hypertension, (13%), and alcohol use (10%). The locations of ICH were lobar (55%), basal ganglia/internal capsule (22%), and others (24%). The most common causes of ICH were vascular malformations (49%), including cavernous angioma, and hypertension (11%). Cryptogenic ICH was considered in 15%. Other causes included cerebral venous thrombosis (5%) and sympathomimetic drug use (4%). The majority of patients with ICH that resulted from hypertension were aged >31 years (odds ratio, 3.48), and those with ICH that resulted from arteriovenous malformations were aged <20 years (odds ratio, 2.80). The final outcome was considered favorable in 60%. CONCLUSIONS ICHs in young people are mainly lobar in location and result from vascular malformation. Hypertension causes most cases in which the ICH is located in the basal ganglia. Mortality and morbidity in the acute phase are low and are related to hypertension as the cause of ICH.
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Affiliation(s)
- J L Ruíz-Sandoval
- Stroke Clinic, Stroke Program, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
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Abstract
UNLABELLED The aim of this study was to determine the risk factors and mechanism of cerebral infarction in young women. METHODS We evaluated 130 consecutive women younger than 41 years of age with cerebral infarction and compared the risk factors with a control group of 122 healthy, age-matched women. RESULTS The leading risk factors in patients with cerebral infarction were migraine (15%), tobacco use (15%), and oral contraceptive (OC) use (12%). Cerebral arteriograms were abnormal in 59% of patients (57 of 96). The causes of cerebral infarction were cardiac embolism in 36%, nonatherosclerotic vasculopathy in 25%, hematologic disorders in 8%, and migraine in 8%. The etiology could not be determined in 23% of patients. CONCLUSION Migraine and OCs are independent risk factors for cerebral infarction in young women. The leading etiologies were rheumatic valve disease and nonatherosclerotic vasculopathy, hematologic disturbances, and migraine were responsible for a few cases.
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Affiliation(s)
- F Barinagarrementeria
- Stroke Clinic, Stroke Program, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez, Tlalpan, Mexico City, Mexico.
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Abstract
BACKGROUND AND PURPOSE The frequency of recurrent primary cerebral hemorrhage (RPCH), mainly in cases related to hypertension, has been considered low. This study investigated the frequency, mechanisms, and prognosis of RPCH. METHODS We evaluated 359 patients with neuroimaging evidence of cerebral hemorrhage and selected 22 with RPCH. RESULTS Five patients (23%) were older than 70 years at the first cerebral hemorrhage. Mean ages at the first and second hemorrhages were 60 and 63 years, respectively. Risk factors included hypertension (86%), diabetes (27%), and tobacco and alcohol use (each 14%). Hypocholesterolemia was demonstrated in 35% of the patients. The most common pattern of recurrent bleeding was ganglionic-ganglionic, mainly related to hypertension. Overall mortality was 32%. Forty-one percent and 27% of patients, respectively, had incapacitating and nonincapacitating sequelae; 2 of the latter had RPCH with a lobar location. Ganglionic-ganglionic hemorrhage was associated with a poor prognosis; otherwise, this pattern was uncommon in patients with nonincapacitating sequelae. Analysis of the control of risk factors, primarily hypertension after the first cerebral hemorrhage, disclosed that 56% of patients did not gain subsequent control. CONCLUSIONS Rebleeding after a first primary intracerebral hemorrhage is not uncommon. The main topographic pattern of bleeding, ganglionic-ganglionic, is likely the result of hypertension; the less common lobar-lobar pattern probably results from amyloid angiopathy.
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Affiliation(s)
- A González-Duarte
- Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
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Yamamoto-Furusho JK, Cantú C, Vargas-Alarcón G, Andrade F, Zúñiga J, Rodriguez J, Boom R, Granados J. Complotype SC30 is associated with susceptibility to develop ulcerative colitis in Mexicans. J Clin Gastroenterol 1998; 27:178-9. [PMID: 9754788 DOI: 10.1097/00004836-199809000-00020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Cantú C, Villarreal J, Soto JL, Barinagarrementeria F. Cerebral cysticercotic arteritis: detection and follow-up by transcranial Doppler. Cerebrovasc Dis 1998; 8:2-7. [PMID: 9645974 DOI: 10.1159/000015808] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 11/19/2022] Open
Abstract
Intracranial arteritis is a well-known complication of cerebral cysticercosis. The aim of this study was to explore the possible role of transcranial Doppler (TCD) in the evaluation of cysticercotic arteritis in 9 patients with subarachnoid cysticercosis and stroke. Arteritis of main basal vessels was detected by TCD in 7 of 10 arterial lesions that were demonstrated by cerebral angiography. The Doppler pattern was occlusive in 2 cases and stenotic in 5. In the 3 patients with lacunar infarcts, both cerebral angiography and TCD were normal. In 6 arterial lesions followed serially with TCD a stenotic pattern resolved within 4 and 6 months in 3 cases and remained in the stenotic range at 12 months in 1 case, whereas an occlusive pattern persisted at 6 and 18 months in the other 2 cases. In conclusion, TCD may be useful to detect and follow up cerebral vasculitis due to chronic cysticercotic arachnoiditis.
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Affiliation(s)
- C Cantú
- Stroke Clinic, Instituto Nacional de Neurología, Mexico City, Mexico
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Abstract
BACKGROUND AND PURPOSE Subarachnoid cysticercosis is a well-recognized cause of cerebral infarction. However, few patients with this infection develop cerebral infarction, and the reason for this is not known. The aim of this study was to determine the frequency of cerebral arteritis in these patients. METHODS Using cerebral arteriography, we studied 28 patients with subarachnoid cysticercosis admitted to our hospital from July 1993 to February 1996. All patients underwent MRI to detect the presence of basal arachnoiditis. We analyzed demographic data, time to cysticercosis since the first symptom onset, mode of onset, stroke syndromes, neuroimaging features of cysticercosis and cerebral infarction, and arteriographic findings for each patient. RESULTS Of the 28 patients (mean age, 37 years), 15 patients had angiographic evidence of cerebral arteritis (53%); 12 of the 15 had a stroke syndrome (P=.02). Eight of the 15 patients (53%) with cerebral arteritis had evidence of cerebral infarction on MRI, whereas only one patient without cerebral arteritis had cerebral infarction (P=.05). The most commonly involved vessels were the middle cerebral artery and the posterior cerebral artery. CONCLUSIONS The frequency of cerebral arteritis in subarachnoid cysticercosis is higher than previously reported, and middle-size vessel involvement is a common finding, even in those patients without clinical evidence of cerebral ischemia.
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Abstract
BACKGROUND AND PURPOSE The incidence of cerebellar infarction in a series of patients with stroke is approximately 1.5%. The average patient age in most reported series is 62 years. The most common etiologies in this age group are atherosclerosis and cardiac embolism. The aim of this study was to determine the causes and mechanisms of cerebellar infarction in patients younger than 40 years. METHODS We analyzed retrospectively the clinical and radiological data from 21 men and 16 women with cerebellar infarction admitted to our hospital from January 1986 to December 1996. The patients had been studied extensively to determine the etiology of the cerebellar infarction. RESULTS In the 37 patients (mean age, 30 years), 29 infarcts were limited to one territory (15 in the posteroinferior cerebellar artery [PICA]; 14 in the superior cerebellar artery); 8 had nonterritorial infarctions. The most common stroke mechanisms in each territory were as follows: PICA: nonatherosclerotic vasculopathic (67%), cardioembolic (20%), and hematologic and cryptogenic (each 7%); superior cerebellar artery: cardioembolic (42%), cryptogenic (31%), migrainous (21%), and nonatherosclerotic vasculopathic and hematologic (each 7%); and mixed territory: nonatherosclerotic vasculopathic (50%), cryptogenic (25%), cardioembolic (12%), and hematologic (12%). CONCLUSIONS The most common mechanism of cerebellar infarctions was arterial occlusion as a result of intracranial vertebral artery dissection (40%), mainly with PICA involvement. Embolism from a cardiac source resulted primarily from patent foramen ovale and rheumatic valvular disease. Hematologic disturbances and migraine were responsible for a few cases.
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Affiliation(s)
- F Barinagarrementeria
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugía, Manuel Velasco Suárez, Mexico City, Mexico
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Abstract
OBJECTIVE To describe the clinical and neuroimaging spectrum of cerebral Cysticercus arteritis to clarify the mechanisms of a stroke that is associated with neurocysticercosis. DESIGN Case series. SETTING Tertiary care center. PATIENTS Sixty-five patients with strokes that were associated with neurocysticercosis. Based on the extension of cysticercosis, the study group was divided into patients with focal or diffuse cysticercal disease. Patients with focal affection were subdivided into those with small- and large-vessel angiitis. MEASURES For each group. stroke syndromes, mode of onset, associated neurologic syndromes, neuroimaging features of cysticercosis and cerebral infarcts, angiographic and cerebrospinal fluid findings, and outcome were analyzed. RESULTS Thirty-five patients had focal cysticercosis (13 with small-and 22 with large-vessel angiitis), and 30 had diffuse disease with either small-or large-vessel involvement. A high frequency of subarachnoidal cysts was found, neighboring the ischemic area. Patients with focal cysticercosis has a vascular onset in 80% compared with 20% in those with diffuse cysticercosis (P<.001). Distinctive findings in diffuse cysticercosis were hydrocephalus (80%), multiple cerebral infarcts (64%), and mental disorders (43%) (P<.001). There was a close parallelism between the type of cysticercosis and the degree of cerebrospinal fluid inflammatory changes, reflecting in the outcome. Death or incapacitating sequelae were associated with diffuse cysticercosis, and total recovery was common in patients with focal disease and small-vessel angiitis, whereas intermediate morbimortality occurred with focal cysticercosis and large-vessel vasculitis. CONCLUSION Based on the distribution of cysticercal disease and the severity of concomitant chronic arachnoiditis, it is possible to identify a wide spectrum of cerebrovascular involvement caused by neurocysticercosis.
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Affiliation(s)
- C Cantú
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
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Abstract
BACKGROUND Primary medullary hemorrhage is uncommon. Its clinical profile and prognosis are not well known. We report four cases of medullary hemorrhage and a review of the English and French literature since 1964 to analyze the clinical presentation and prognosis. CASE DESCRIPTIONS Of sixteen case reports of medullary hemorrhage reviewed from the literature, sixteen contained sufficient information for review and are included in this report. The age distribution of the patients was between 13 and 72 years, and 10 of these patients were men. The most frequent symptoms at onset were vertigo, sensory symptoms, and dysphagia. Presenting signs included palatal weakness, nystagmus, hypoglossal palsy, cerebellar ataxia, and limb weakness. The diagnosis was made at autopsy in 3 patients, at surgery in 3, by computed tomography in 4, and more recently by magnetic resonance imaging in 6. In nine instances the etiology of hemorrhage was undetermined; a ruptured vascular malformation was the cause in 3 patients, 1 was attributed to the use of anticoagulants, and hypertension was the suspected cause in the other 3 patients. Mortality rate was 19%; however, survivors generally had nonincapacitating sequelaes. CONCLUSIONS These findings indicate that primary medullary hemorrhage presents with a characteristic syndrome of sudden onset of headache and vertigo with neurological signs that correspond to various combinations of medial and lateral medullary involvement. In those patients who survive, prognosis usually is good.
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Affiliation(s)
- F Barinagarrementeria
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez, Mexico City, Mexico
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Abstract
BACKGROUND AND PURPOSE Cerebral venous thrombosis is characterized by its clinical pleomorphism and pathogenetic variability. We studied 67 patients with cerebral venous thrombosis associated with pregnancy and puerperium and compared them with 46 other cases unrelated to obstetric causes to disclose differences in their clinical presentation, neuroradiological findings, clinical course, and prognosis. METHODS In this retrospective study, we analyzed the clinical, laboratory, and neuroimaging findings of 113 patients collected consecutively at our institute. The diagnosis of cerebral venous thrombosis was confirmed by angiography, magnetic resonance imaging, or neuropathological study. RESULTS Patients with cerebral venous thrombosis associated with pregnancy and puerperium were younger (average age, 26 versus 36 years), and in most, the onset of symptoms was acute (82% versus 54%; P = .003). The evolution of symptoms reached a plateau within 10 days in 70% of patients with thrombosis from obstetric causes, compared with only 45% in those from other causes (P = .01). Anemia was more frequent in the obstetric group (64% versus 26%; P = .00001). There were no differences regarding neurological and neuroradiological findings. Although the initial severity of illness was similar in both groups, the final outcome was considered good in 80% of patients with obstetric causes, compared with 58% of patients with other causes (P = .01); mortality rates were 9% and 33%, respectively (P = .002). CONCLUSIONS Cerebral venous thrombosis associated with pregnancy and puerperium has a more acute onset and a better prognosis than thrombosis due to other causes. These findings might be helpful in the diagnostic and therapeutic strategies for patients with cerebral venous thrombosis.
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Affiliation(s)
- C Cantú
- Stroke Clinic, National Institute of Neurology and Neurosurgery, Mexico City, DF, Mexico
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Abstract
BACKGROUND AND PURPOSE Earlier cases of stroke due to postpartum cerebral angiopathy have been reported. The mechanism of this angiopathy has not been explained. CASE DESCRIPTION We present a case of cerebral infarction with evidence of occlusive change in the vertebrobasilar system as a complication of intravenous ergonovine use after cesarean section delivery. CONCLUSIONS Ergonovine therapy is a likely cause of so-called postpartum cerebral angiopathy and stroke.
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