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Biomedical subjects

A Arboix

Publications and source records attributed to A Arboix.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Early recurrence of spectacular shrinking deficit as a form of presentation in a cardio-embolic infarct].

INTRODUCTION: Spectacular shrinking deficit (SSD) is a little known neurovascular syndrome with a monophasic clinical course. It was observed in 4.8% (11 of 231 patients) with cardio-embolic cerebral infarcts in the records of patients with cerebrovascular disease at our hospital. CLINICAL CASE: We present the only patient in our records (0.04% of the cardio-embolic infarcts and 0.06% of the patients in the series, which consists of 1,500 consecutive patients with stroke studied over a period of 8 years) with recurrent SSD, which was the form of presentation of rheumatic mitral valve disease with atrial fibrillation. DISCUSSION: As far as we know, the recurrent clinical course of SSD has not previously been described. The clinical case presented shows that early recurrence is possible in SSD. CONCLUSIONS: The possibility of the presentation of a cerebral infarct of cardioembolic origin in the form of recurrent SSD should be borne in mind. Early recurrence of SSD should also be taken into account to avoid bias in selecting patients for clinical trials to be carried out during the acute phase of cerebrovascular disease.

Aged↗
PubMed1997

Cardioembolic infarction in the Sagrat Cor-Alianza Hospital of Barcelona Stroke Registry.

OBJECTIVES: To describe the clinical features of cardioembolic infarcts. MATERIAL & METHODS: Cardioembolic infarct was diagnosed in 231 (15.4%) of 1500 consecutive stroke patients included in a prospective stroke registry over an 8-year period. RESULTS: Cardiac sources of emboli included isolated atrial dysrhythmia (57.1%), valvular heart disease (20.3%), and coronary artery disease (18.2%). Patients with cardioembolic stroke showed a significantly higher (P < 0.00001) frequency of sudden onset of neurological deficit (79.7%) and altered consciousness (31.2%) than patients with lacunar infarct (38% and 1.9%) and atherothrombotic infarction (46% and 24%). Eleven patients had a spectacular shrinking deficit and 6 a presumed cardioembolic lacunar infarct. Early recurrent embolisms occurred in 6.5% of patients mostly (60%) within 7 days of initial embolism. In-hospital mortality was 27.3% (0.8% in lacunar infarcts, 21.7% in atherothrombotic infarction, P < 0.00001). CONCLUSION: Cardioembolic infarction is a severe subtype of stroke with a high risk of early death. Clinical features at stroke onset may help clinicians to differentiate cerebral infarction subtypes and to establish prognosis more accurately.

Adult↗
PubMed1997

Cerebrovascular disease as the initial clinical presentation of haematological disorders.

We describe 14 patients (mean age 57 years) in whom stroke or TIA was the presenting manifestation of a haematologic disorder. Twelve patients had an ischaemic stroke and 2 a haemorrhagic stroke. This group represented 1.27% (14/1,099) of the total number of patients with first-ever stroke diagnosed from 1986 to 1992 at our institution, accounted for 1.32% (12/906) of all brain infarcts and 1.03% (2/193) of all haemorrhagic strokes, and was the most common aetiology (25%) of ischaemic stroke of unusual cause. Haematological disorders included essential thrombocythaemia (6), polycythaemia vera (1), smoker's polycythaemia (1), thrombotic thrombocytopenic purpura (1), IgA lambda myeloma (1), acute lymphoblastic leukaemia (1), Waldenström's macroglobulinaemia (1), chronic granulocytic leukaemia (1) and IgG lambda myeloma (1). Stroke subtypes included definitive cerebral infarct (10), TIA (2), parenchymal haemorrhage (1) and spontaneous subdural haematoma (1). Vascular territories in ischaemic stroke were the carotid in 7 patients, the vertebrobasilar in 1 and undetermined in 4. Mean follow-up was 40 months (range, 1-96 months). The mortality rate was 18.7%.

Adult↗
PubMed1997

Predictive factors of early seizures after acute cerebrovascular disease.

BACKGROUND AND PURPOSE: Seizures within the first 48 hours of a first stroke or transient ischemic attack (TIA) are an independent prognostic factor for in-hospital mortality. The aim of this study was to determine predictive factors of early seizures in first-ever stroke patients. METHODS: Data of 1220 first-ever stroke patients admitted consecutively to an acute stroke unit of a 450-bed teaching hospital between January 1986 and December 1993 were collected from a stroke registry. Demographic, anamnestic, clinical, neurological, and neuroimaging variables in the seizure and nonseizure group were compared using the t test and the chi 2 test. The independent predictive value of each variable on the development of early seizures was assessed with a logistic regression analysis. RESULTS: Early epileptic seizures were diagnosed in 29 patients (2.4%). Seizures were significantly more frequent in patients with hemorrhagic stroke (4.3%) than in those with ischemic stroke (2%). Patients with seizures were significantly younger and significantly more likely to have acute confusional state, cortical involvement, large stroke, and involvement of the parietal, frontal, occipital, and temporal lobes than patients without seizures. The in-hospital mortality rate was 37.9% in the seizure group and 14.4% in the nonseizure group (P < .0005). After multivariate analysis, only cortical involvement (odds ratio of 6.01) and acute agitated confusional state (odds ratio of 4.44) were independent clinical factors for developing epileptic seizures. CONCLUSIONS: Cortical involvement in the neuroimaging studies and agitated acute confusional state at the onset of stroke were independent predictive factors of early seizures in first-ever stroke patients. The efficacy of anticonvulsant drugs in the prophylactic control of seizures should be assessed in prospective, randomized, double-blind clinical trials conducted in the subgroup of patients with the highest risk of developing epileptic seizures.

Acute Disease↗
PubMed1997

[Circadian rhythm and lacunar syndromes].

BACKGROUND: There is scarce knowledge on the mode of onset of disease related to circadian rhythm in lacunar syndromes. METHODS: A prospective clinical analysis was conducted in 181 patients with lacunar infarcts (LI) and 47 patients with lacunar syndromes not due to lacunar infarcts. In every patient the onset of the disease was recorded for each of the four 6-hour equal periods of the day. The injure volume of the LI was measured by means of a computer and image analyzer. A descriptive analysis of the hour of onset of the disease and a comparative analysis of clinical differences and injure size for each day period, relating to circadian rhythm were made. RESULTS: For LI, the onset occurred during nocturnal sleep in 32.5% and during wakening hours in 67.5%. The morning onset of the disease was significantly more frequent in lacunar syndromes by cerebral hemorrhage (55.5%) than in LI (24.5%) (p < 0.001). For LI, the mean injure volume was significantly larger when associated with a morning onset (2,574 mm3), during the afternoon (1,678 mm3) or during the night (1,328 mm3) (p < 0.04). At discharge, no significant differences were documented between hospital stay length and also between functional disability, when compared with disease onset and circadian rhythm. CONCLUSIONS: A third of patients with LI had their onset of symptoms during nocturnal sleep. The morning onset of the disease regarding circadian rhythm in LI is associated with a larger injure volume.

Adult↗
PubMed1996

Pentosan polysulfate-induced thrombocytopenia: a case diagnosed with an ELISA test used for heparin-induced thrombocytopenia.

We report a patient who developed severe thrombocytopenia and ischemic stroke following pentosan polysulfate treatment. An ELISA test employed in type-II heparin-induced thrombocytopenia was highly positive. To our knowledge, this is the first case in which this test has been performed in a pentosan polysulfate-induced thrombocytopenia (PIT). Our data suggest that the antibody against pentosan polysulfate-platelet complex also cross-reacts with heparin-platelet factor 4 complex. Due to its greater sensitivity and wider availability, this ELISA test should be used in cases where PIT is suspected.

Cross Reactions↗
PubMed1996

Relevance of early seizures for in-hospital mortality in acute cerebrovascular disease.

BACKGROUND: We studied the influence of early poststroke seizures (within the first 48 hours of onset of a first stroke or transient ischemic attack) on in-hospital mortality in 1,099 consecutive patients collected in a prospective stroke registry. METHODS: Differences in the frequency of demographic characteristics, clinical events, and outcome between patients with and those without epileptic seizures were assessed. To determine the independent predictive value of early seizures on in-hospital mortality, variables related to vital status at discharge (alive, dead) in the univariate analysis, plus age, were studied in two multiple linear regression models. The first predictive model was based on demographic, anamnestic, and clinical variables with a total of 13 variables, and the second model was based on clinical and neuroimaging variables with a total of 16 variables. RESULTS: A total of 27 patients (2.5%) had epileptic seizures during the first 48 hours of stroke. Advanced age, confusional syndrome, hemorrhagic stroke, large lesions, involvement of parietal and temporal lobes, and occurrence of neurologic and medical complications were significantly more frequent in seizure patients than in nonseizure patients. Overall in-hospital mortality rate was 33.3% in the seizure group and 14.2% in the nonseizure group (p = 0.02). The presence of early seizures was a significant predictive variable both in the model based on clinical variables (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.81 to 16.72) and in the model based on clinical and neuroimaging variables (OR, 6.1; 95% CI, 2.13 to 17.93). CONCLUSIONS: Seizures at the onset of a first-ever stroke is an independent prognostic factor for in-hospital mortality. Patients with the highest risk of developing epileptic seizures-aged persons with a large hemorrhagic infarction of a parietal lobe-may be candidates to be treated prophylactically against seizures for a few days.

Acute Disease↗