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Sanchez-Boluarte SS, Barrientos-Iman DM, Ramirez-Quiñones J, Bustos J, Ecos R, Gonzales I, Saavedra H, Garcia HH. Transcranial Doppler ultrasonography to evaluate cerebral hemodynamic changes in neurocysticercosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-7. [PMID: 39074913 DOI: 10.1055/s-0044-1788584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Arteritis is a complication of neurocysticercosis (NCC), which is not well known and could trigger strokes. The transcranial Doppler ultrasound (TCD) is a noninvasive method for detecting, staging, and monitoring cerebrovascular diseases. Nonetheless, the utility of TCD to evaluate cerebral hemodynamic changes, suggesting vasculitis associated with NCC remains uncertain. OBJECTIVE To evaluate cerebral hemodynamic changes using TCD in patients with subarachnoid and parenchymal NCC. METHODS There were 53 patients with NCC evaluated at a reference hospital for neurological diseases included (29 with subarachnoid and 24 with parenchymal). Participants underwent a clinical interview and serology for cysticercosis and underwent TCD performed within 2 weeks of enrollment. Mean flow velocity, peak systolic velocity, end diastolic velocity, and pulsatility index were recorded. RESULTS Among the participants, there were 23 (43.4%) women, with a median age of 37 years (IQR: 29-48). Cerebral hemodynamic changes suggesting vasculitis were detected in 12 patients (22.64%); the most compromised vessel was the middle cerebral artery in 11 (91.67%) patients. There were more females in the group with sonographic signs of vasculitis (10/12, 83.33% vs. 13/41, 31.71%; p = 0.002), and this was more frequent in the subarachnoid NCC group (9/29, 31.03% vs. 3/24, 12.5%; p = 0.187), although this difference did not reach statistical significance. CONCLUSION Cerebral hemodynamic changes suggestive of vasculitis are frequent in patients with NCC and can be evaluated using TCD.
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Affiliation(s)
- Sofia S Sanchez-Boluarte
- Universidad César Vallejo, Health Sciences Faculty, Trujillo, Peru
- Instituto Nacional de Ciencias Neurológicas, Epilepsy Department, Lima, Peru
| | | | | | - Javier Bustos
- Universidad Peruana Cayetano Heredia, Center for Global Health, Lima, Peru
| | - Rosa Ecos
- Instituto Nacional de Ciencias Neurológicas, Neurovascular Department, Lima, Peru
| | - Isidro Gonzales
- Instituto Nacional de Ciencias Neurológicas, Unidad de Investigación, Lima, Peru
| | - Herbert Saavedra
- Instituto Nacional de Ciencias Neurológicas, Neuroinfectology Department, Lima, Peru
| | - Hector H Garcia
- Universidad Peruana Cayetano Heredia, Center for Global Health, Lima, Peru
- Instituto Nacional de Ciencias Neurológicas, Cysticercosis Unit, Lima, Peru
- Asociación Benéfica PRISMA, Lima, Peru
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Cagna-Castillo D, Salcedo-Carrillo AL, Carrillo-Larco RM, Bernabé-Ortiz A. Prevalence and incidence of stroke in Latin America and the Caribbean: a systematic review and meta-analysis. Sci Rep 2023; 13:6809. [PMID: 37100856 PMCID: PMC10133252 DOI: 10.1038/s41598-023-33182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/08/2023] [Indexed: 04/28/2023] Open
Abstract
Stroke is a recurrent and well-known cardiovascular event and a leading cause of death worldwide. We identified reliable epidemiological evidence of stroke in Latin America and the Caribbean (LAC) and estimated the prevalence and incidence of stroke, overall and by sex, in that region. A systematic search in OVID (Medline, Embase and Global Health) and in the Latin America and Caribbean Health Sciences Literature (LILACS) until the end of 2020 was made for all cross-sectional or longitudinal studies estimating (or allowing the estimation of) the prevalence or incidence of stroke among individuals of the general population ≥ 18 years from LAC countries. No language restriction was applied. Studies were assessed for methodological quality and risk of bias. Pooled estimates were calculated using random effect meta-analysis as high heterogeneity was expected. A total of 31 papers for prevalence and 11 papers for incidence were included in the review for analysis. The overall pooled stroke prevalence was 32 (95% CI 26-38) per 1000 subjects and were similar among men (21; 95% CI 17-25) and women (20; 95% CI 16-23) per 1000 subjects. The overall pooled stroke incidence was 255 (95% CI 217-293) per 100 000 person-years, being higher in men (261; 95% CI 221-301) compared to women (217; 95% CI 184-250) per 100 000 person-years. Our results highlight the relevance of the prevalence and incidence of stroke in the LAC region. The estimates were similar in stroke prevalence by sex, but with higher incidence rates among males than females. Subgroup analyses highlight the need for standardized methodologies to obtain appropriate prevalence and incidence estimates at the population level in a region with a great burden of cardiovascular events.
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Affiliation(s)
| | | | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Antonio Bernabé-Ortiz
- Universidad Cientifica del Sur, Lima, Peru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw FE, Tuladhar AM. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry 2020; 91:411-417. [PMID: 32015089 DOI: 10.1136/jnnp-2019-322424] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/04/2022]
Abstract
Ischaemic stroke at young age is an increasing problem in both developing and developed countries due to rising incidence, high morbidity and mortality and long-term psychological, physical and social consequences. Compared with stroke in older adults, stroke in young adults is more heterogeneous due to the wide variety of possible underlying risk factors and aetiologies. In this review, we will provide an overview of the global variation in the epidemiology of stroke in young adults, with special attention to differences in geography, ethnicity/race and sex, as well as traditional and novel risk factors for early-onset ischaemic stroke, such as air pollution. Understanding global differences is an important prerequisite for better region-specific prevention and treatment of this devastating condition.
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Affiliation(s)
- Esther Boot
- Department of Neurology, Radboud Univerisity Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Merel Sanne Ekker
- Department of Neurology, Radboud Univerisity Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Steven Kittner
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Frank-Erik De Leeuw
- Department of Neurology, Radboud Univerisity Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Radboud Univerisity Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
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Gonzales I, Rivera JT, Garcia HH. Pathogenesis of Taenia solium taeniasis and cysticercosis. Parasite Immunol 2016; 38:136-46. [PMID: 26824681 DOI: 10.1111/pim.12307] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/25/2016] [Indexed: 12/22/2022]
Abstract
Taenia solium infections (taeniasis/cysticercosis) are a major scourge to most developing countries. Neurocysticercosis, the infection of the human nervous system by the cystic larvae of this parasite, has a protean array of clinical manifestations varying from entirely asymptomatic infections to aggressive, lethal courses. The diversity of clinical manifestations reflects a series of contributing factors which include the number, size and location of the invading parasites, and particularly the inflammatory response of the host. This manuscript reviews the different presentations of T. solium infections in the human host with a focus on the mechanisms or processes responsible for their clinical expression.
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Affiliation(s)
- I Gonzales
- Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - J T Rivera
- Department of Microbiology and Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H H Garcia
- Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.,Department of Microbiology and Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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Del Brutto OH, Salgado P, Lama J, Del Brutto VJ, Campos X, Zambrano M, García HH. Calcified neurocysticercosis associates with hippocampal atrophy: a population-based study. Am J Trop Med Hyg 2014; 92:64-8. [PMID: 25349375 DOI: 10.4269/ajtmh.14-0453] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Calcified neurocysticercosis has been associated with hippocampal atrophy in patients with refractory epilepsy, but the relevance of this association in the population at large is unknown. We assessed calcified cysticerci and its association with hippocampal atrophy in elderly persons living in Atahualpa, an Ecuadorian village endemic for neurocysticercosis. All Atahualpa residents ≥ 60 years of age were invited to undergo computed tomography/magnetic resonance imaging for neurocysticercosis detection. Twenty-eight (11%) out of 248 enrolled persons had calcified cysticerci (case-patients) and were matched 1:1 by age, sex, and years of education to individuals without neurocysticercosis on computed tomography/magnetic resonance imaging (controls). Four case-patients and none of the controls had epilepsy (P = 0.134). Cognitive performance was similar across both groups. The Scheltens' medial temporal atrophy scale was used for hippocampal rating in case-patients and matched controls without neurocysticercosis. Mean score in the Scheltens' scale was higher in case-patients than in controls (P < 0.001). Atrophic hippocampi were noticed in 19 case-patients and five controls (P = 0.003). Atrophy was bilateral in 11 case-patients and unilateral in eight. All case-patients with unilateral hippocampal atrophy had at least one ipsilateral calcification. This study shows an association between calcified cysticerci and hippocampal atrophy and raises the possibility of an inflammation-mediated hippocampal damage as the responsible mechanism for these findings.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico; Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Community Center of the Atahualpa Project, Atahualpa, Ecuador; Outpatient Center North, Ecuadorian Institute of Social Security, Guayaquil, Ecuador; Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Perú; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Perla Salgado
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico; Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Community Center of the Atahualpa Project, Atahualpa, Ecuador; Outpatient Center North, Ecuadorian Institute of Social Security, Guayaquil, Ecuador; Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Perú; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Julio Lama
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico; Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Community Center of the Atahualpa Project, Atahualpa, Ecuador; Outpatient Center North, Ecuadorian Institute of Social Security, Guayaquil, Ecuador; Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Perú; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Victor J Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico; Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Community Center of the Atahualpa Project, Atahualpa, Ecuador; Outpatient Center North, Ecuadorian Institute of Social Security, Guayaquil, Ecuador; Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Perú; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Xavier Campos
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico; Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Community Center of the Atahualpa Project, Atahualpa, Ecuador; Outpatient Center North, Ecuadorian Institute of Social Security, Guayaquil, Ecuador; Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Perú; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Mauricio Zambrano
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico; Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Community Center of the Atahualpa Project, Atahualpa, Ecuador; Outpatient Center North, Ecuadorian Institute of Social Security, Guayaquil, Ecuador; Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Perú; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Héctor H García
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Neuroimaging Unit, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico; Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador; Community Center of the Atahualpa Project, Atahualpa, Ecuador; Outpatient Center North, Ecuadorian Institute of Social Security, Guayaquil, Ecuador; Center for Global Health, Tumbes and the Department of Microbiology, School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Perú; Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
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