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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. NEUROLOGÍA (ENGLISH EDITION) 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] [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] [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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Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like Episodes (MELAS) Syndrome: Frequency, Clinical Features, Imaging, Histopathologic, and Molecular Genetic Findings in a Third-level Health Care Center in Mexico. Neurologist 2021; 26:143-148. [PMID: 34190208 DOI: 10.1097/nrl.0000000000000331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome, is a multisystemic entity of mitochondrial inheritance. To date, there is no epidemiological information on MELAS syndrome in Mexico. CASE SERIES A retrospective, cross-sectional design was employed to collect and analyze the data. The clinical records of patients with mitochondrial cytopathies in the period ranging from January 2018 to March 2020 were reviewed. Patients who met definitive Yatsuga diagnostic criteria for MELAS syndrome were included to describe frequency, clinical, imaging, histopathologic, and molecular studies. Of 56 patients diagnosed with mitochondrial cytopathy, 6 patients met definitive Yatsuga criterion for MELAS (10.7%). The median age at diagnosis was 34 years (30 to 34 y), 2 females and the median time from onset of symptoms at diagnosis 3.5 years (1 to 10 y). The median of the number of stroke-like episodes before the diagnosis was 3 (range, 2 to 3). The main findings in computed tomography were basal ganglia calcifications (33%), whereas in magnetic resonance imaging were a lactate peak in the spectroscopy sequence in 2 patients. Five patients (84%) had red-ragged fibers and phantom fibers in the Cox stain in the muscle biopsy. Four patients (67%) had presence of 3243A>G mutation in the mitochondrial MT-TL1 gene. One patient died because of status epilepticus. CONCLUSIONS MELAS syndrome represents a common diagnostic challenge for clinicians, often delaying definitive diagnosis. It should be suspected in young patients with stroke of undetermined etiology associated with other systemic and neurological features.
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Divišová P, Šaňák D, Král M, Bártková A, Hutyra M, Zapletalová J, Dorňák T, Špaček M, Franc D, Polidar P, Veverka T, Kaňovský P. Young cryptogenic ischemic stroke: A descriptive analysis of clinical and laboratory characteristics, outcomes and stroke recurrence. J Stroke Cerebrovasc Dis 2020; 29:105046. [PMID: 32807456 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic strokes (IS) occur also in young adults and despite an extensive work-up the cause of IS remains very often cryptogenic. Thus, effectiveness of secondary prevention may be unclear. We aimed to analyze a relationship among vascular risk factors (VRF), clinical and laboratory parameters, outcomes and recurrent IS (RIS) in young cryptogenic IS (CIS) patients. SUBJECTS AND METHODS The study set consisted of young acute IS patients < 50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). All analyzed patients underwent transesophageal echocardiography, 24-h and 3-week ECG-Holter to assess cause of IS according to the ASCOD classification. Recurrent IS (RIS) was recorded during a follow-up (FUP). RESULTS Out of 294 young enrolled patients, 208 (70.7%, 113 males, mean age 41.6 ± 7.2 years) were identified as cryptogenic. Hyperlipidemia (43.3%), smoking (40.6%) and arterial hypertension (37.0%) were the most frequent VRF. RIS occurred in 7 (3.4%) patients during a mean time of FUP 19 ± 23 months. One-year risk of RIS was 3.4% (95%CI: 1.4-6.8%). Patients with RIS were older (47.4 vs. 41.1 years, p = 0.007) and more often obese (71.4 vs. 19.7%, p = 0.006), and did not differ in any of other analyzed parameters and VRF. Multivariate logistic regression analysis showed obesity (OR: 9.527; 95%CI: 1.777-51.1) and the previous use of antiplatelets (OR: 15.68; 95%CI: 2.430-101.2) as predictors of recurrent IS. CONCLUSION Despite a higher presence of VRF in young CIS patients, the risk of RIS was very low. Obesity and previous use of antiplatelet therapy were found the only predictors of RIS.
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Affiliation(s)
- Petra Divišová
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Daniel Šaňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic.
| | - Michal Král
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Andrea Bártková
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Cardiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Jana Zapletalová
- Department of Biophysics and Statistics, Palacký University Medical School, Olomouc, Czech Republic
| | - Tomáš Dorňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Miloslav Špaček
- Department of Cardiology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - David Franc
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Petr Polidar
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Tomáš Veverka
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
| | - Petr Kaňovský
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic
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Wu C, Qin Y, Lin Z, Yi X, Wei X, Ruan Y, He J. Prevalence and Impact of Aphasia among Patients Admitted with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104764. [PMID: 32173230 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104764] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/13/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Aphasia is one of the most severe symptoms in stroke patients, affecting one-third of acute stroke patients. We aimed to investigate the prevalence and outcomes of aphasia in patients with acute ischemic stroke (AIS). METHODS We computed the weighted prevalence of aphasia in AIS patients using the 2003 to 2014 National Inpatient Sample databases. Crude regression model, multivariable regression model, and propensity score matching were used to evaluate the impact of aphasia on the clinical outcomes in AIS patients. We performed the Subpopulation Treatment Effect Pattern Plot (STEPP) analyses in propensity score matching cohort to visually display the effect of interaction between aphasia and age on the clinical outcomes. RESULTS A total of 16.93% of 4,339,156 AIS patients identified were with aphasia. The proportion of patients with comorbid aphasia increased from 13.34% in 2003 to 21.94% in 2014 (P < .0001). The results of both multivariable regression model and propensity score matching analyses indicated aphasia in AIS as a risk factor for in-hospital deaths. Aphasia was linked to prolonged length of stay (0.66 day, P < .0001) and high hospitalization cost ($971.35, P < .0001). In the STEPP analyses, in-hospital mortality rate increased with age, and the rate was higher in patients with aphasia, but the ratios decreased with an increase in age. CONCLUSIONS Prevalence of comorbid aphasia with AIS is increasing, and it has a significant impact on clinical outcomes. Additionally, aphasia shows a greater impact on survival and medical burden among young patients with AIS.
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Affiliation(s)
- Cheng Wu
- Department of Health Statistics, Second Military Medical University, Shanghai, China, Shanghai, China
| | - Yingyi Qin
- Department of Health Statistics, Second Military Medical University, Shanghai, China, Shanghai, China
| | - Zhen Lin
- Department of Health Statistics, Second Military Medical University, Shanghai, China, Shanghai, China
| | - Xiyan Yi
- Department of Neurology, University of South Florida, Tampa, Florida
| | - Xin Wei
- Department of cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Yiming Ruan
- Department of Health Statistics, Second Military Medical University, Shanghai, China, Shanghai, China
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai, China, Shanghai, China; Tongji University School of Medicine, Shanghai, China.
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Camargo LC, Sánchez KP. [Thalamic Stroke and Associated Behavior Disorders. Possibilities for Integral Management: Case Report]. REVISTA COLOMBIANA DE PSIQUIATRIA 2012; 41:436-443. [PMID: 26573506 DOI: 10.1016/s0034-7450(14)60017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/29/2012] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Since ancient Greece, cerebrovascular accidents have been described with no variation. Even today, they are still a catastrophic event in the lives of patients with a high risk of disabling sequelae. METHODOLOGY Case report of a 56-year male patient with thalamic ischemia. RESULTS The intervention with integral strategies involving pharmacological management and cognitive interventions was decisive for the satisfactory evolution of the patient. CONCLUSIONS The management of patients with cerebrovascular accidents cannot be limited to the emergency room. Pharmacological advances in programs and cognitive intervention methods provide intervention tools from the very beginning of the stroke thus reducing the impact of long-term sequelae, and consequently enabling a better reintegration of the patient to his family.
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Affiliation(s)
- Loida Camargo Camargo
- Neuróloga, servicio de Neurología, Hospital Universitario Clínica San Rafael-OHSJD, Bogotá, Colombia.
| | - Katherine Parra Sánchez
- Residente de Psiquiatría tercer año, Fundación Universitaria Juan N. Corpas, Hospital Universitario Clínica San Rafael-OHSJD, Bogotá, Colombia
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