RESUMO
RESUMEN Presentamos el caso de un varón de 25 años con antecedentes de consumo de marihuana y tabaco, que durante viaje en vuelo comercial a Cusco presentó disnea, pérdida de conciencia y estado epiléptico. Arribó a esta ciudad presentando hipotensión arterial, murmullo pulmonar abolido, sin recuperación de conciencia. La tomografía de tórax reveló bullas pulmonares y la tomografía mostró neumoencéfalo, diagnosticándose embolia gaseosa cerebral. La hipoxemia asociada a convulsiones y pérdida de conciencia en una persona joven durante el vuelo no es un evento común. La pérdida de la presión en la cabina durante el ascenso parece ser el evento desencadenante en pacientes con enfermedad pulmonar.
ABSTRACT We present the case of a 25-year old man with a history of marijuana and tobacco consumption who, during a commercial flight to Cusco, presented dyspnea, loss of consciousness, and epileptic condition. He arrived in this city presenting arterial hypotension, abolished pulmonary murmur, with no recovery of consciousness. The thorax tomography revealed lung bullae and the tomography showed pneumocephalus. He was diagnosed with cerebral gas embolism. Hypoxemia associated with seizures and loss of consciousness in a young person during a flight is not a common event. Loss of cabin pressure during climb appears to be the triggering event in patients with lung disease.
Assuntos
Adulto , Humanos , Masculino , Inconsciência/etiologia , Embolia Intracraniana/diagnóstico , Dispneia/etiologia , Viagem Aérea , Convulsões/etiologia , Tomografia Computadorizada por Raios X , Embolia Intracraniana/etiologiaAssuntos
Anemia Falciforme/complicações , Encéfalo/patologia , Embolia Gordurosa/etiologia , Embolia Intracraniana/etiologia , Adolescente , Anemia Falciforme/diagnóstico , Diagnóstico Diferencial , Embolia Gordurosa/diagnóstico , Feminino , Humanos , Embolia Intracraniana/diagnóstico , Imageamento por Ressonância MagnéticaAssuntos
Doença de Chagas/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Embolia Intracraniana/diagnóstico , Imageamento por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico , Adulto , Brasil/epidemiologia , Feminino , Humanos , Embolia Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/epidemiologiaRESUMO
We present the case of a 25-year old man with a history of marijuana and tobacco consumption who, during a commercial flight to Cusco, presented dyspnea, loss of consciousness, and epileptic condition. He arrived in this city presenting arterial hypotension, abolished pulmonary murmur, with no recovery of consciousness. The thorax tomography revealed lung bullae and the tomography showed pneumocephalus. He was diagnosed with cerebral gas embolism. Hypoxemia associated with seizures and loss of consciousness in a young person during a flight is not a common event. Loss of cabin pressure during climb appears to be the triggering event in patients with lung disease.
Presentamos el caso de un varón de 25 años con antecedentes de consumo de marihuana y tabaco, que durante viaje en vuelo comercial a Cusco presentó disnea, pérdida de conciencia y estado epiléptico. Arribó a esta ciudad presentando hipotensión arterial, murmullo pulmonar abolido, sin recuperación de conciencia. La tomografía de tórax reveló bullas pulmonares y la tomografía mostró neumoencéfalo, diagnosticándose embolia gaseosa cerebral. La hipoxemia asociada a convulsiones y pérdida de conciencia en una persona joven durante el vuelo no es un evento común. La pérdida de la presión en la cabina durante el ascenso parece ser el evento desencadenante en pacientes con enfermedad pulmonar.
Assuntos
Viagem Aérea , Dispneia/etiologia , Embolia Intracraniana/diagnóstico , Inconsciência/etiologia , Adulto , Humanos , Embolia Intracraniana/etiologia , Masculino , Convulsões/etiologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The objective of this study was to identify and describe the comorbidities, clinical features, and prognostic implications of cancer patients with cerebrovascular disease. MATERIALS AND METHODS: All patients with cerebrovascular disease (CVD) seen in the neuro-oncology unit at a cancer referral center from April 2010 to November 2016 were included; demographic, oncologic diagnosis, risk factors, and prognostic considerations were presented as well. RESULTS: We report on 256 patients with CVD and cancer, of whom 66% were women. The mean age at the time CVD occurred was 56 years. The most frequently associated malignancies were gynecologic (including breast cancer), hematologic, head and neck, and urologic. The men had more smoking and alcohol consumption history, hemorrhagic CVD, and urologic and hematologic malignancies. The women, besides gynecologic cancer, had more ischemic CVD. Thrombotic CVD, followed by embolic and hemorrhagic CVDs, was more frequent. A comorbid condition besides cancer was found in 71% of the patients. The most frequent clinical presentation was focal motor weakness, altered mental status, and aphasia. The 10-year mortality was 59%; higher rates were found in men, in those with hemorrhagic CVD, in tobacco users, and in those with altered mental status. CONCLUSIONS: Cancer is a well-known risk factor for stroke, which has been associated with a higher frequency in cancer. We found that ischemic stroke due to thrombosis and cardioembolism was more common, and gender, comorbidities, clinical presentation, and type of CVD, but not cancer type, were elements associated with prognosis.
Assuntos
Embolia Intracraniana/epidemiologia , Trombose Intracraniana/epidemiologia , Neoplasias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Afasia/epidemiologia , Afasia/psicologia , Comorbidade , Bases de Dados Factuais , Feminino , Nível de Saúde , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/fisiopatologia , Embolia Intracraniana/psicologia , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/fisiopatologia , Trombose Intracraniana/psicologia , Masculino , Saúde Mental , México/epidemiologia , Pessoa de Meia-Idade , Atividade Motora , Debilidade Muscular/epidemiologia , Debilidade Muscular/fisiopatologia , Neoplasias/diagnóstico , Prognóstico , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Adulto JovemRESUMO
Fat embolism syndrome (FES) is a rare syndrome caused by embolization of fat particles into multiple organs including the brain. It typically manifests with petechial rash, deteriorating mental status, and progressive respiratory insufficiency, usually occurring within 24-48 h of trauma with long-bone fractures or an orthopedic surgery. The diagnosis of FES is based on clinical and imaging findings, but requires exclusion of alternative diagnoses. Although there is no specific treatment for FES, prompt recognition is important because it can avoid unnecessary interventions and clarify prognosis. Patients with severe FES can become critically ill, but even comatose patients with respiratory failure may recover favorably. Prophylactic measures, such as early stabilization of fractures and certain intraoperative techniques, may help decrease the incidence and severity of FES.
Assuntos
Embolia Gordurosa , Embolia Intracraniana , Adulto , Embolia Gordurosa/complicações , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/etiologia , Embolia Gordurosa/terapia , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Masculino , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Prognostic factors related to mortality rates after stroke have been reported; however, most studies included different treatments and did not focus solely on ischemic stroke. The study aimed to report the short- and long-term survival and predictors of death in patients with first-ever ischemic stroke in the middle cerebral artery (MCA) territory, submitted to intravenous thrombolysis (IVT). METHODS: A prospective observational cohort study of patients with first-ever ischemic stroke in the MCA territory treated with IVT from March 2010 to February 2015 was conducted, and patients were followed up until May 2015. The Kaplan-Meier method was used to estimate the cumulative case fatality rates. The potential prognostic factors were identified using Cox proportional hazards regression analysis. RESULTS: A total of 169 patients, 51% women of mean age of 64.1 ± 12.9 years were followed up for a median time of 23.6 (8.1-36.2) months. At the end of the study, 53 (31.4%) patients had died. The estimated cumulative case fatality rate was 41.8% for 5 years. Chronic heart failure (hazards ratio [HR] 2.89, 95% CI 1.43-5.84, p = 0.003), atrial fibrillation (HR 3.88, 95% CI 1.30-11.57, p = 0.015), and symptomatic intracerebral hemorrhage (SICH; HR 7.83, 95% CI 3.43-17.92, p < 0.001) were significant unfavorable independent outcome predictors. The most frequent cause of death was infection (46%). CONCLUSIONS: Stroke in the MCA territory has a high mortality rate, even in patients treated with IVT. SICH, atrial fibrillation, and chronic heart failure are modifiable factors related to cardioembolism that need to be aggressively targeted for improved outcomes after stroke.
Assuntos
Fibrinolíticos/administração & dosagem , Cardiopatias/mortalidade , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/mortalidade , Embolia Intracraniana/tratamento farmacológico , Embolia Intracraniana/mortalidade , Terapia Trombolítica/mortalidade , Idoso , Fibrilação Atrial/mortalidade , Brasil/epidemiologia , Causas de Morte , Hemorragia Cerebral/mortalidade , Doença Crônica , Feminino , Fibrinolíticos/efeitos adversos , Cardiopatias/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Infarto da Artéria Cerebral Média/diagnóstico , Infusões Intravenosas , Embolia Intracraniana/diagnóstico , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
AIMS: This study aimed to evaluate the safety and performance of the TriGuard™ Embolic Deflection Device (EDD), a nitinol mesh filter positioned in the aortic arch across all three major cerebral artery take-offs to deflect emboli away from the cerebral circulation, in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: The prospective, multicentre DEFLECT I study (NCT01448421) enrolled 37 consecutive subjects undergoing TAVR with the TriGuard EDD. Subjects underwent clinical and cognitive follow-up to 30 days; cerebral diffusion-weighted magnetic resonance imaging (DW-MRI) was performed pre-procedure and at 4±2 days post procedure. The device performed as intended with successful cerebral coverage in 80% (28/35) of cases. The primary safety endpoint (in-hospital EDD device- or EDD procedure-related cardiovascular mortality, major stroke disability, life-threatening bleeding, distal embolisation, major vascular complications, or need for acute cardiac surgery) occurred in 8.1% of subjects (VARC-defined two life-threatening bleeds and one vascular complication). The presence of new cerebral ischaemic lesions on post-procedure DW-MRI (n=28) was similar to historical controls (82% vs. 76%, p=NS). However, an exploratory analysis found that per-patient total lesion volume was 34% lower than reported historical data (0.2 vs. 0.3 cm3), and 89% lower in patients with complete (n=17) versus incomplete (n=10) cerebral vessel coverage (0.05 vs. 0.45 cm3, p=0.016). CONCLUSIONS: Use of the first-generation TriGuard EDD during TAVR is safe, and device performance was successful in 80% of cases during the highest embolic-risk portions of the TAVR procedure. The potential of the TriGuard EDD to reduce total cerebral ischaemic burden merits further randomised investigation.
Assuntos
Estenose da Valva Aórtica/terapia , Valva Aórtica , Cateterismo Cardíaco/instrumentação , Dispositivos de Proteção Embólica , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Embolia Intracraniana/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Ligas , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/prevenção & controle , Brasil , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/mortalidade , Cognição , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/prevenção & controle , Imagem de Difusão por Ressonância Magnética , Europa (Continente) , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Embolia Intracraniana/mortalidade , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Desenho de Prótese , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler TranscranianaRESUMO
OBJECTIVES: This study was designed to assess the role of left atrial (LA) shape in predicting embolic cerebrovascular events (ECE) in patients with mitral stenosis (MS). BACKGROUND: Patients with rheumatic MS are at increased risk for ECE. LA remodeling in response to MS involves not only chamber dilation but also changes in the shape. We hypothesized that a more spherical LA shape may be associated with increased embolic events due to predisposition to thrombus formation or to atrial arrhythmias compared with an elliptical-shaped LA of comparable volume. METHODS: A total of 212 patients with MS and 20 control subjects were enrolled. LA volume, LA emptying fraction, and cross-sectional area were measured by 3-dimensional (3D) transthoracic echocardiography. LA shape was expressed as the ratio of measured LA end-systolic volume to hypothetical sphere volume ([4/3π r(3)] where r was obtained from 3D cross-sectional area). The lower the LA shape index, the more spherical the shape. RESULTS: A total of 41 patients presented with ECE at the time of enrollment or during follow-up. On multivariate analysis, LA 3D emptying fraction (adjusted odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92 to 0.99; p = 0.028) and LA shape index (OR: 0.73; 95% CI: 0.61 to 0.87; p < 0.001) emerged as important factors associated with ECE, after adjustment for age and anticoagulation therapy. In patients in sinus rhythm, LA shape index remained associated with ECE (OR: 0.79; 95% CI: 0.67 to 0.94; p = 0.007), independent of age and LA function. An in vitro phantom atrial model demonstrated more stagnant flow profiles in spherical compared with ellipsoidal chamber. CONCLUSIONS: In rheumatic MS patients, differential LA remodeling affects ECE risk. A more spherical LA shape was independently associated with an increased risk for ECE, adding incremental value in predicting events beyond that provided by age and LA function.