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Campo-Caballero D, de la Riva P, de Arce A, Martínez-Zabaleta M, Rodríguez-Antigüedad J, Ekiza J, Iruzubieta P, Purroy F, Fuentes B, de Lera Alfonso M, Krupinski J, Mengual Chirife JJ, Palomeras E, Guisado-Alonso D, Rodríguez-Yáñez M, Ustrell X, Tejada García J, de Felipe Mimbrera A, Paré-Curell M, Tembl J, Cajaraville S, Garcés M, Serena J. Reperfusion therapy in acute ischaemic stroke due to cervical and cerebral artery dissection: Results from a Spanish multicentre study. Neurologia (Engl Ed) 2022:S2173-5808(22)00074-8. [PMID: 35842129 DOI: 10.1016/j.nrleng.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ischaemic stroke (IS) due to cervical and cerebral artery dissection (CAD) is a rare entity, and few data are available on the use of such reperfusion therapies as intravenous fibrinolysis and mechanical thrombectomy in these patients. We analysed the use of these treatments in patients with IS due to CAD and compared them against patients receiving reperfusion treatment for IS of other aetiologies. METHODS We conducted an observational, retrospective, multicentre study of patients with IS due to CAD recorded in the National Stroke Registry of the Spanish Society of Neurology during the period 2011-2019. Comparative analyses were performed between: a) patients with CAD treated and not treated with reperfusion therapies and b) patients treated with reperfusion for IS due to CAD and patients treated with reperfusion for IS due to other causes. Epidemiological data, stroke variables, and outcomes at discharge and at 3 months were included in the analysis. RESULTS The study included 21,037 patients with IS: 223 (1%) had IS due to CAD, of whom 68 (30%) received reperfusion treatment. Reperfusion treatments were used less frequently in cases of vertebral artery dissection and more frequently in patients with carotid artery occlusion. Compared to patients with IS due to other causes, patients with CAD were younger, more frequently underwent mechanical thrombectomy, and less frequently received intravenous fibrinolysis. Rates of haemorrhagic complications, mortality, and independence at 3 months were similar in both groups. CONCLUSIONS Reperfusion therapy is frequently used in patients with IS due to CAD. The outcomes of these patients demonstrate the efficacy and safety of reperfusion treatments, and are comparable to the outcomes of patients with IS due to other aetiologies.
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Affiliation(s)
- D Campo-Caballero
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain.
| | - P de la Riva
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain
| | - A de Arce
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain
| | | | - J Ekiza
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain
| | - P Iruzubieta
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, Spain
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova de Lleida, Lleida, Spain
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, Spain
| | - M de Lera Alfonso
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J Krupinski
- Servicio de Neurología, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | | | - E Palomeras
- Servicio de Neurología, Hospital de Mataró, Mataró, Spain
| | - D Guisado-Alonso
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - X Ustrell
- Servicio de Neurología, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | | | - M Paré-Curell
- Servicio de Neurología, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - J Tembl
- Servicio de Neurología, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - S Cajaraville
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M Garcés
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - J Serena
- Servicio de Neurología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
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Campo-Caballero D, de la Riva P, de Arce A, Martínez-Zabaleta M, Rodríguez-Antigüedad J, Ekiza J, Iruzubieta P, Purroy F, Fuentes B, de Lera Alfonso M, Krupinski J, Mengual Chirife JJ, Palomeras E, Guisado-Alonso D, Rodríguez-Yáñez M, Ustrell X, Tejada García J, de Felipe Mimbrera A, Paré-Curell M, Tembl J, Cajaraville S, Garcés M, Serena J. Reperfusion treatment in acute ischaemic stroke due to cervical and cerebral artery dissection: results of a Spanish national multicentre study. Neurologia 2020; 38:S0213-4853(20)30430-8. [PMID: 33358059 DOI: 10.1016/j.nrl.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Ischaemic stroke (IS) due to cervical and cerebral artery dissection (CAD) is a rare entity, and few data are available on the use of such reperfusion therapies as intravenous fibrinolysis and mechanical thrombectomy in these patients. We analysed the use of these treatments in patients with IS due to CAD and compared them against patients receiving reperfusion treatment for IS of other aetiologies. METHOD We conducted an observational, retrospective, multicentre study of patients with IS due to CAD recorded in the National Stroke Registry of the Spanish Society of Neurology during the period 2011-2019. Comparative analyses were performed between: a) patients with CAD treated and not treated with reperfusion therapies and b) patients treated with reperfusion for IS due to CAD and patients treated with reperfusion for IS due to other causes. Epidemiological data, stroke variables, and outcomes at discharge and at 3 months were included in the analysis. RESULTS The study included 21,037 patients with IS: 223 (1%) had IS due to CAD, of whom 68 (30%) received reperfusion treatment. Reperfusion treatments were used less frequently in cases of vertebral artery dissection and more frequently in patients with carotid artery occlusion. Compared to patients with IS due to other causes, patients with CAD were younger, more frequently underwent mechanical thrombectomy, and less frequently received intravenous fibrinolysis. Rates of haemorrhagic complications, mortality, and independence at 3 months were similar in both groups. CONCLUSIONS Reperfusion therapy is frequently used in patients with IS due to CAD. The outcomes of these patients demonstrate the efficacy and safety of reperfusion treatments, and are comparable to the outcomes of patients with IS due to other aetiologies.
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Affiliation(s)
- D Campo-Caballero
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España.
| | - P de la Riva
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España
| | - A de Arce
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España
| | | | - J Ekiza
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España
| | - P Iruzubieta
- Servicio de Neurología, Hospital Universitario Donostia, Sant Sebastián, España
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova de Lleida, Lleida, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, España
| | - M de Lera Alfonso
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J Krupinski
- Servicio de Neurología, Hospital Universitari Mútua de Terrassa, Terrassa, España
| | | | - E Palomeras
- Servicio de Neurología, Hospital de Mataró, Mataró, España
| | - D Guisado-Alonso
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - X Ustrell
- Servicio de Neurología, Hospital Universitari Joan XXIII, Tarragona, España
| | | | | | - M Paré-Curell
- Servicio de Neurología, Hospital Universitari Germans Trias i Pujol, Badalona, España
| | - J Tembl
- Servicio de Neurología, Hospital Universitari i Politécnic La Fe, Valencia, España
| | - S Cajaraville
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - M Garcés
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | - J Serena
- Servicio de Neurología, Hospital Universitari Dr. Josep Trueta, Girona, España
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Abstract
BACKGROUND The pathogenic role of hyperhomocysteinemia in cryptogenic stroke is not well established. We aimed to determine homocysteine levels in patients with cryptogenic stroke considering the possible variables that may act as confounders and analyze the influence of obesity on this association. PATIENTS AND METHODS We conducted a case-control study in 123 patients with cryptogenic stroke aged 42 ± 12 years and in 153 control subjects aged 42 ± 13 years. Serum homocysteine was determined by fluorescence polarization immunoassay. RESULTS Patients showed statistically higher levels of homocysteine, creatinine and higher BMI than controls (p = 0.045, p = 0.014, p = 0.013), respectively. After multivariate adjustment the differences in homocysteine levels disappeared (p = 0.774). When subjects were classified according to the presence or absence of obesity, the differences in the prevalence of hyperhomocysteinemia (homocysteine >15 μM) were highly significant, being higher in patients than in controls (p = 0.009). Likewise, mean values of homocysteine in obese were higher in cases than in controls (16.9 ± 9.5 μM vs. 10.12 ± 2.5 μM; p = 0.020), remaining significant after adjusting for the above mentioned confounders. CONCLUSION Although in general, hyperhomocysteinemia does not seem to constitute an independent risk factor for cryptogenic stroke, it significantly increases the risk in obese subjects; therefore it is convenient to decrease its levels in this sub-group to minimize the risk.
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Affiliation(s)
- A Vayá
- Hemorheology and Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain. vaya
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Santos MT, Valles J, Lago A, Tembl J, Sánchez E, Moscardo A, Cosin J. Residual platelet thromboxane A2 and prothrombotic effects of erythrocytes are important determinants of aspirin resistance in patients with vascular disease. J Thromb Haemost 2008; 6:615-21. [PMID: 18221358 DOI: 10.1111/j.1538-7836.2008.02915.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Permanent inactivation of cyclooxygenase-1 and inhibition of platelet thromboxane A(2) (TxA(2)) constitute the main mechanisms underlying the prevention of vascular disease by aspirin. METHODS AND RESULTS We studied platelet TxA(2) synthesis and its impact on platelet reactivity and platelet-erythrocyte [platelet-rich plasma (PRP)-RBC] interactions in 533 aspirin-treated patients with vascular disease. Seventy aspirin-free and 16 aspirin-treated normal subjects were evaluated as controls. Collagen (1 mug mL(-1))-induced platelet activation ((14)C-5HT release) and recruitment (proaggregatory activity of cell-free releasates from activated platelets) were assessed in PRP, PRP + RBC, and whole blood (WB). TxA(2) was quantified in releasates from WB. Aspirin inhibited TxA(2) synthesis and platelet function in all patients, but to different degrees. Forty-two patients (8%) displayed partial (<95%) inhibition of TxA(2) relative to that of aspirin-free controls. They produced >3.5 ng mL(-1) TxA(2) and had higher platelet reactivity than 491 patients who had undetectable TxA(2) or produced residual TxA(2) (R-TxA(2); =3.5 ng mL(-1)). Patients with R-TxA(2) were distributed into TxA(2) quartiles. Patients in the third and fourth quartiles had significantly elevated (14)C-5HT release in PRP, which was markedly amplified in PRP + RBC and WB. TxA(2) in the fourth quartile translated into increased platelet aggregation and recruitment. Significant correlations were found between R-TxA(2) and platelet hyperfunction. CONCLUSION Biochemical markers (TxA(2) synthesis, (14)C-5HT release) and biological assays (platelet aggregation and recruitment) used to monitor the aspirin effect in a large population of patients presenting with vascular disease have evidenced the importance of R-TxA(2) and the prothrombotic effects of RBC in aspirin resistance.
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Affiliation(s)
- M T Santos
- Research Center, University Hospital La Fe, Valencia, Spain.
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Geffner D, Lago A, Tembl J, Vilar C. [Delayed hospitalization of the patient with acute stroke]. Rev Neurol 1998; 27:947-51. [PMID: 9951010] [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: 02/10/2023]
Abstract
INTRODUCTION AND OBJECTIVE We analyze the main factors influencing the time delay between onset and admission to the hospital in acute stroke. PATIENTS AND METHODS Consecutive series of 1,344 patients with acute stroke or transient ischemic attack admitted at two reference hospitals of Valencia and included at the same stroke register. Factors assessed were age, sex, vascular risk factors, stroke onset and arrival at hospital, stroke severity and stroke subtype. RESULTS In 30% of patients the stroke onset time was unknown. 70.7% of patients with acute stroke, and known onset, arrived to the hospital in the first six hours. The median time from onset to admission was: TIA, 2 hours; cerebral infarct, 3 hours (lacunar infarcts 5 hours, non-lacunar infarcts 2 hours) and intracerebral hemorrhage, 2 hours. Patients with severe stroke arrive earlier at the hospital (p < 0.001). Neither sex, age, nor vascular risk factors influence the delay time. CONCLUSIONS The arrival time varies with stroke subtype: patients with intracerebral hemorrhage or TIA arrive earlier than those with cerebral infarct, and non-lacunar infarcts earlier than lacunar ones. Furthermore, patients with severe stroke are admitted sooner at the hospital.
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Affiliation(s)
- D Geffner
- Sección de Neurología, Hospital General, Castellón, España
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Tembl J, Serena J, Segura T, Penarroja G, Dávalos A, Ay H, Buonanno FS, Philip Kistler J, Koroshetz WJ, Abraham SA. Electrocardiographic diagnosis of patent foramen ovale associated with ischemic stroke. Stroke 1998; 29:2665-6. [PMID: 9836784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Abstract
BACKGROUND AND PURPOSE We investigated circadian rhythm in ischemic stroke onset and its subtypes, differentiating between first-ever stroke and recurrent stroke. METHODS A consecutive series of 1223 patients with ischemic stroke was admitted at 2 reference hospitals; the time of onset of symptoms was obtained, differentiating between onset while asleep and awake. We compared circadian rhythm between stroke types and between first-ever and recurrent stroke. RESULTS The onset time was known in 914 patients; 25.6% experienced onset on awakening [higher incidence in thrombotic and lacunar stroke (28.9% and 28.4%, respectively) than in embolic stroke (18.8%)]. For all stroke subtypes, there was a significant diurnal variation, with a morning peak between 6 AM and noon; after redistributing the hour of onset of patients awakening with stroke, the morning peak was minimal in all types of stroke. There were no differences in circadian rhythm between patients with first-ever and recurrent stroke. CONCLUSIONS Only hospitalized patients were studied. There is a circadian rhythm in all types of stroke, with higher frequency during the day and lower frequency in the last hours in the evening. The highest incidence in the early hours of the morning can be overestimated, due to patients who awaken with stroke. There is no difference in circadian rhythm between first-ever stroke and recurrent stroke.
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Affiliation(s)
- A Lago
- Department of Neurology, Hospital Universitari La Fe, Valencia, Spain.
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Guerrero AL, Benito-León J, Tembl J, Ramos A. [Simultaneous supra- and infra-tentorial brain hemorrhage probably caused by hypertension]. Neurologia 1997; 12:320-22. [PMID: 9432205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Lago A, Beltrán I, Ferrer JM, Tembl J, Deyá E. [Transitory episode of laughter as the initial symptom of an ischemic stroke]. Rev Neurol 1997; 25:239-41. [PMID: 9147746] [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: 02/04/2023]
Abstract
INTRODUCTION Pathological laughter occurs in pseudobulbar paralysis, in psychiatric disorders and as a sign of convulsions (gelastic crisis). An extremely rare form is the "fou rire prodromique' a pathological episode of laughter preceding a stroke. The pathogenesis is unknown and classically differentiated from gelastic crises. "Fou rire prodromique' has been described in subcortical ischaemic or haemorrhagic strokes, not in cortical strokes. CLINICAL CASE We describe a patient with an ischaemic cerebrovascular accident due to embolism of the left Sylvian artery. The clinical picture started with a short episode of pathological laughter which preceded sensitive aphasia and weakness of the right limbs. CONCLUSIONS We suggest that in the case described it is impossible to differentiate between the "fou rire prodromique' and a gelastic crisis as a first sign of an embolic cerebrovascular accident.
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Affiliation(s)
- A Lago
- Servicio de Neurologia, Hospital Universitari La Fe, Valencia, España
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Tembl J, Lago A, Baquero M, Blasco R. [Primary intraventricular hemorrhage: an analysis of eight cases]. Rev Neurol 1997; 25:215-8. [PMID: 9147739] [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: 02/04/2023]
Abstract
OBJECTIVE Primary intraventricular haemorrhage (HIVP) is a rare condition, of diverse aetiology and variable course. We present a series of eight cases of HIVP diagnosed by CT and analyze the different aetiologies. MATERIALS AND METHODS A retrospective series of 8 cases diagnosed by CT, the risk factors, clinical behaviour, complications and prognosis are evaluated. Neuroimaging findings (CT, MR and/or DIVAS) are described. RESULTS The most commonly associated factor is arterial hypertension (75%). Clinically, presentation was uniform as evidence of sudden intracranial hypertension with signs of meningeal irritation with little or no neurological focal signs. The commonest complication was hydrocephalus (25%) and the chances of survival in most cases were good. Three causes of bleeding were found: an arteriovenous malformation, an aneurysm and a blood coagulation disorder. Three hypertensive patients with no obvious cause of bleeding had periependimary laguna infarcts. CONCLUSIONS HIVP is an unusual condition of diverse aetiology, uniform clinical presentation and has a good short term prognosis. We suggest that pathology of the small vessels, induced by hypertension, may play a part in the aetiology of a subgroup of patients with no obvious cause of bleeding.
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Affiliation(s)
- J Tembl
- Servicio de Neurología, Hospital Universitario La Fe, Valencia, España
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