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Biomedical subjects

A Arboix

Publications and source records attributed to A Arboix.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Predictive clinical factors of in-hospital mortality in 231 consecutive patients with cardioembolic cerebral infarction.

Cardioembolic cerebral infarction is a subtype of stroke with a high mortality. The purpose of this study was to determine predictors of in-hospital mortality in 231 consecutive patients with cardioembolic stroke by means of a multivariate analysis. Three predictive models were constructed. A first model was based on demographic, anamnestic and clinical variables collected at the bedside examination (total 8 variables). A second model was based on clinical and neuroimaging variables (total 10 variables). A third model was based on the aforementioned clinical and neuroimaging variables and the presence of early recurrent embolism (total 11 variables). Deteriorated level of consciousness, limb weakness, presence of congestive heart failure, male gender, and age appeared to be independent prognostic factors of in-hospital mortality in the predictive model based on clinical variables and in the predictive model based on clinical and neuroimaging variables. In addition to these variables, early recurrent embolization was selected in the third predictive model. In the first two models, setting a cut-off point of 0.50 for predicting vital status at hospital discharge resulted in a sensitivity of 60%, a specificity of 89% and a total correct classification of 81%. The corresponding values of the third model were 62, 89 and 81%, respectively. These data may help clinicians to establish an early prognosis of this stroke subtype more accurately as well as to allocate patients with cardioembolic stroke in clinical trials correctly.

Cerebral Infarction↗
PubMedDate not supplied

Clinical predictors of early embolic recurrence in presumed cardioembolic stroke.

BACKGROUND: We determined clinical predictive factors of in-hospital embolic recurrence in presumed cardioembolic stroke patients by means of multivariate analysis based on clinical and neuroimaging prognostic variables assessed within 48 h of stroke onset. METHODS: Data of 347 consecutive patients with presumed cardioembolic stroke included in a prospective stroke registry were collected. Demographic characteristics, clinical events, and outcome in the recurrent and nonrecurrent embolization group were compared. The independent predictive value of each variable on the development of early embolic recurrence was analyzed in two multiple liner regression models - one based on eight demographic, anamnestic, and clinical variables and another based on 10 clinical, neuroimaging, and outcome variables. RESULTS: In-hospital recurrent embolization was diagnosed in 25 (6.9%) patients. The latency period was 12.1 days. The overall in-hospital mortality was 70.8% in the recurrent embolization group and 24.4% in the nonrecurrent embolization group (p < 0.001). Alcohol abuse, the combination of hypertension, valvular heart disease, and atrial fibrillation, nausea and vomiting, and previous cerebral infarction were predictors of recurrent embolization in the model based on clinical variables. In addition to these four variables, cardiac events were selected in the model based on clinical, neuroimaging, and outcome variables. CONCLUSIONS: A small number of clinical features that can be easily obtained on the patient's initial assessment may help clinicians to identify a subgroup of patients with cardioembolic stroke at the highest risk of developing early recurrent brain or systemic embolization.

Acute Disease↗
PubMedDate not supplied

Hemorrhagic lacunar stroke.

A total of 17 patients with lacunar syndromes due to intracerebral hemorrhage or hemorrhagic lacunar stroke (pure motor hemiparesis 9, sensorimotor stroke 5, pure sensory stroke 3) are reported. Data from these patients were obtained from consecutive stroke patients included in the prospective Hospital Sagrat Cor-Aliança Stroke Registry. Hemorrhagic lacunar stroke accounted for 3.8% of all cases of lacunar syndrome (n = 439) and 7.4% of all cases of intracerebral hemorrhage (n = 229) entered in the database. Demographic, anamnestic, clinical and neuroimaging variables in patients with hemorrhagic lacunar stroke, non-lacunar intracerebral hemorrhage and non-hemorrhagic lacunar stroke were compared. Predictors of hemorrhagic lacunar stroke were assessed by logistic regression analysis. Hypertension, cigarette smoking and involvement of the internal capsule were significantly more frequent in patients with hemorrhagic lacunar stroke than in those with non-lacunar intracerebral hemorrhage, whereas nausea and vomiting, altered consciousness, speech disturbances, hemianopia, and ventricular hemorrhage were significantly less frequent. As compared with non-hemorrhagic lacunar stroke, patients with hemorrhagic lacunar stroke were more likely to have hypertension, sudden stroke onset (minutes), head injury, headache, and basal ganglia involvement and less likely to have diabetes, gradual stroke onset (hours), and dysarthria. After multivariate analysis, only headache (OR 10.14), sudden onset (OR 9.89), and dysarthria (OR 0.10) were independent predictors of hemorrhagic lacunar stroke. Accordingly, the presence of headache and sudden onset of symptoms and absence of dysarthria may be useful signs for distinguishing hemorrhagic lacunar stroke from other causes of lacunar stroke.

Aged↗
PubMedDate not supplied

[Intravascular lymphomatosis: a rare etiology of recurrent cerebral ischemia].

INTRODUCTION: Intravascular lymphomatosis is a rarely seen clinicopathological condition. OBJECTIVE: To review the literature on cerebral ischemia and intravascular lymphomatosis. DEVELOPMENT: Intravascular lymphomatosis is usually caused by an uncommon type of non-Hodgkin lymphoma, usually of B cells, characterized by the localization of predominantly neoplastic cells within the small calibre blood vessels (arterioles, venules and capillaries). Therefore, it tends to cause multifocal vascular occlusions, with symptoms generally limited to the central nervous system, in the form of recurrent, multifocal cerebral infarcts--one in every 5,000 consecutive cases is usually of this aetiology--or rapidly progressive encephalopathy. Cerebral or meningeal biopsy, or biopsy of peripheral nerve, muscle, adrenal or lymphoid tissue, prostate or lung is usually diagnostic. The differential diagnosis is with vasculitis, multi-infarct dementia, occult neoplasia or infections. In spite of starting suitable treatment with chemotherapy or radiotherapy, the average survival from onset of symptoms is usually four months. CONCLUSION: Intravascular lymphomatosis should be taken into account in the differential diagnosis of repeated cerebral ischaemia of unusual aetiology.

Brain Ischemia↗
PubMedDate not supplied

[Cerebrovascular disease in the cancer patient].

OBJECTIVE: To make an up-to-date review of the literature on cerebrovascular disease of the patient with cancer. DEVELOPMENT: Approximately 15% of the patients with cancer have cerebrovascular disease. The frequency of cerebral infarcts is similar to that of cerebral hemorrhage. The commonest mechanisms of cerebral ischemia are atherosclerosis, non-bacterial thrombotic endocarditis, disseminated intravascular coagulation, infection, tumour embolism and thrombosis of the longitudinal venous sinuses. The most usual mechanisms of cerebral hemorrhage are intratumoural hemorrhage, hypertensive hemorrhage and the coagulopathies. In the Stroke Register of the Hospital del Sagrat Cor in Barcelona, of a total of 1,099 patients with their first cerebrovascular episode, in 14 patients the stroke (12 infarcts and two intracerebral hemorrhages) were the form of onset of a previously unrecognised hematological disorder. The hematological neoplasias were the commonest form of hematological disorders, mainly essential thrombocythemia, which was diagnosed in six patients. CONCLUSIONS: The clinical management and care of patients with stroke and cancer differ from that of patients with stroke alone, since the cause is different from that of non-neoplastic patients.

Brain Ischemia↗
PubMedDate not supplied

[Modifiable risk factors for non-cardioembolic transient ischemic attacks. Case control studies in the general population].

INTRODUCTION: Transient ischemic attacks (TIA) often precede a stroke. AIMS: The purpose of this study is to examine the modifiable cardiovascular risk factors for non-cardioembolic TIA. PATIENTS AND METHODS: A population based case control study was conducted in a district within the city of Barcelona. The cases were 103 patients with non-cardioembolic TIA, who had been diagnosed by a neurologist, and with normal CAT or MRI scans. Subjects were paired by age and sex with 193 controls without TIA or stroke, who were selected by simple random sampling from the clinical records file at the centre. The risk factors were studied using a standardized questionnaire that included the following factors which were codified in a dichotomous manner: smoking, arterial hypertension (AHT), hypercholesterolemia, hypertriglyceridemia, obesity, impaired fasting glucose and diabetes mellitus (DM). RESULTS: The average age was 74.6 years and 52.3% of the subjects were females. All the modifiable cardiovascular risk factors were associated to a higher risk of TIA, although only AHT (OR: 1.9; CI 95%: 1.1-3.3) and obesity (OR: 2.1; CI 95%: 1.2-3.6) were associated in a significant way in the univariate analysis. In the multivariate analysis by logistic regression, the modifiable cardiovascular risk factors that were associated in a significant manner were AHT (OR: 1.9; CI 95%: 1.0-3.6), obesity (OR: 2.8; CI 95%: 1.4-12.3) and DM (OR: 1.7; CI 95%: 1.0-2.9). CONCLUSIONS: In the present study, AHT, obesity and DM were seen to be modifiable risk factors for non-cardioembolic TIA.

Case-Control Studies↗
PubMedDate not supplied

[Changes in the Q-Tc interval in the acute phase of cerebral ischemic infarction].

A clinical prospective study was carried out in 100 patients with stroke (S) (56 with lacunar infarctions [LI] and 44 with nonlacunar infarctions [NLI]) and in a control group without organic cerebral disease (n = 100) to compare the abnormalities in the Q-Tc interval of the electrocardiogram. An abnormal Q-Tc interval (greater than 0.44 sec) was found in 18% of S and in 8% of the control subjects (p less than 0.05). These abnormalities in S were more common at the onset of the disease (18%) than from 3 weeks after the development of focal signs (9%). An abnormal Q-Tc interval was found in 18% of NLI (8 of 44 cases) and in 18% of NLI (10 of 56 cases). Regarding the topography of the lesions, an abnormal Q-Tc interval was found in 20% (3 of 15 cases) of the brainstem infarctions; in 19% of the infarctions of basal ganglia (9 of 47 cases) and in 13% (4 of 30 cases) of hemispheral strokes. Our results show that the abnormalities of Q-Tc interval in strokes are not uncommon. They may be reversible and in some cases they are related with the topography of the cerebral lesion.

Acute Disease↗
PubMedDate not supplied

[Cerebral infarctions of the lacunar type in young adults].

From a total number of 227 patients with lacunar infarcts of the brain assisted during a period of 7 consecutive years, 18 (8%) had an age equal or below 45 years. This group of patients represent 1.1% of strokes and 1.6 of the ischemic cerebral infarcts treated in a Neurology Service during the study period. Eleven patients (64%) were male. The most relevant cerebrovascular risk factors are: arterial hypertension (55%), cardiopathy (26%), and diabetes mellitus (11%). The most common syndrome was pure motor hemiparesis (61%), pure sensitive syndrome (22%), and atypical lacunar syndrome (17%). Computerized axial tomography of the brain was positive in 44.5% of cases. The mean systolic arterial pressure during the first 24 hours of the illness was significantly lower (p less than 0.03) in the young patients. Our results indicate that lacunar cerebral infarcts in young patients: a) are uncommon, and b) constitute a group with some differential clinical characteristics and with a better immediate prognosis with respect to the remaining patients with lacunar infarcts.

Adult↗
PubMedDate not supplied

Transient global amnesia and antiphospholipid antibodies.

The patient, a 55 year-old man, developed an episode of transient global amnesia. He was a smoker and had hypercholesterolemia. He was found to have a positive rapid plasma reagin test and high levels of anticardiolipin antibodies. Other investigations were negative. The presence in this patient of antiphospholipid antibodies suggests a vascular mechanism for transient global amnesia.

Amnesia↗