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Biomedical subjects

J M Ferro

Publications and source records attributed to J M Ferro.

100 records · Page 6Linked to original sources
PubMedDate not supplied

The detection of microembolic signals in patients at risk of recurrent cardioembolic stroke: possible therapeutic relevance.

The clinical predictors and potential therapeutic implications of microembolic signals (MES) were investigated in 104 patients with ischemic stroke or transient ischemic attack associated with high-risk (n = 60) or low-risk (n = 44) cardiac emboligenic conditions. Patients with artificial valves and carotid stenosis were excluded. MES counts were based on 30-min bilateral middle cerebral artery transcranial Doppler (TCD) monitoring recordings. MES were detected in 15 subjects (14%). The mean number of MES per hour was 1.9. MES prevalence and counts were influenced neither by age, gender or type of cerebral event, nor by cardiac disease. MES were more frequently detected and greater in number in patients with multiple cerebral ischemic events and in subjects monitored within 1 month of the last event. By multiple logistic regression, TCD recording within 1 month of the last event [Odds ratio (OD) = 13.5; 95% confidence intervals (CI) = 3.3-54.3] and multiple cerebral events (OD = 4.7; 95% CI = 1.3-17.3) were the best MES predictors. MES were detected in 40% (4/10) of patients on heparin, 5% (2/4) of untreated subjects and 13% (5/39) of those on antiplatelet drugs. For patients on warfarin, MES counts and prevalence were similar in subjects with international normalized ratios (INR) below and within/above the therapeutic range. MES were detected in only 2 out of 16 subjects with INR <2 and in 1 with INR >2. MES detection can be potentially relevant to the selection of antithrombotic treatment in acute stroke associated with cardioembolic disease, but further studies are necessary to assess its effectiveness as an additional guide to monitor oral anticoagulant intensity.

Administration, Oral↗
PubMedDate not supplied

[Multiple vertebro-basilar infarcts and cardio-embolism].

INTRODUCTION: Stroke characteristics do not inform much about its etiology, even if they can suggest a specific mechanism. We thought that multiple vertebrobasilar infarcts could be related with embolism, namely cardioembolism. PATIENTS AND METHODS: From a hospital prospective registry of stroke we retrieved 73 cases of acute non-lacunar vertebrobasilar infarcts, without previous episodes of stroke in any territory or vertebrobasilar transient ischemic accidents (TIA). Two groups were compared: patients with single cerebral posterior artery infarct (49) and patients with multiple vertebrobasilar infarcts (24), in respect to conventional risk factors for cerebrovascular disease, ancillary procedures performed, and associated pathologic conditions, as possible infarct pathogenesis. RESULTS: Proportions of risk factors and ancillary procedures performed were similar in both groups, except for hypercholesterolemia, which was more frequent in multiple infarcts, and for transcranial Doppler, which was performed more frequently in multiple infarcts. In multiple infarct group, cardioemboligenic pathology was more frequent, as were medium-high emboligenic risk cardiac diseases and atrial fibrillation, although the difference did not reach statistical significance. CONCLUSIONS: Our results support the hypothesis that multiple non-lacunar vertebrobasilar infarcts, from a first ever stroke event, suggest cardioembolic etiology, and recommend performing an exhaustive cardiac investigation.

Aged↗
PubMedDate not supplied

[Diabetes mellitus and intracranial stenosis].

INTRODUCTION: The risk of having a cerebrovascular accident (CVA) is approximately 3 to 5 times greater in the diabetic population than in non-diabetics. The physiopathological mechanisms of CVAs in patients with diabetes mellitus are not well-known, since few studies of this have been done. OBJECTIVES: To verify the hypothesis that intracranial arteriosclerosis, interpreted from findings of stenosis on intracranial Doppler studies, is greater in diabetics than in non-diabetics, independently of other vascular risk factors. PATIENTS AND METHODS: Patients were selected from the Register of Cerebrovascular Diseases of the Neurology Department of the Hospital de Santa Maria as having had an ischemic cerebrovascular accident (CVA)/transient ischemic accident (TIA), assessed by a colour codified vertebral carotid eco-Doppler and transcranial Doppler. Intracranial changes in the diabetic and non-diabetic groups of patients were compared with relation to the presence of risks such as hypercolestrolaemia, arterial hypertension and smoking. RESULTS: 384 patients were included, 71 were diabetic and 313 non-diabetic. The two groups were comparable with regard to average age and sex. Intracranial stenosis was approximately 3.13 (95% CI = 1.69-5.79) times more frequent in the diabetic population than in non-diabetics. This difference persisted independently of the presence or absence of other vascular risk factors. CONCLUSIONS: Diabetes mellitus is an important independent risk factor of alterations in the intracranial blood vessels and therefore of CVA. The intracranial circulation should be studied in these patients in view of the great frequency of intracranial stenoses and possible future improvements with therapeutic intervention.

Brain↗
PubMedDate not supplied

[Cerebral venous thrombosis and familial prothrombin gene G20210a mutation].

INTRODUCTION: The prothrombin gene variant G20210A was first described as a risk factor for deep vein thrombosis, and recently for cerebral venous thrombosis, although reported cases had other concomitant risk factors. CLINICAL CASES: A 33 years old woman, with no previous vascular nor thrombotic risk factors, was admitted with thrombosis of superior longitudinal, lateral and sigmoid right sinus. The father had deep venous thrombosis 3 years before. One year later, the 29 year old sister of the proband, developed massive deep venous thrombosis, when she was 8 months pregnant. Laboratory investigations showed elevated anticardiolipin antibodies titer in the proband. Prothrombin activity was in the normal range in the 3 patients. Prothrombin gene mutation G 20210A was detected in the 3 patients. CONCLUSION: As the presence of more than one thrombophilic factor (in the reported case, prothrombin G20210A mutation and anticardiolipin antibodies) increases the likehood of a thrombotic event, it is useful to screen for thrombotic genetic conditions, even when other vascular risks are present, and vice versa.

Adult↗
PubMedDate not supplied

[Nimodipine in subarachnoid hemorrhage].

The efficacy of nimodipine in decreasing mortality and morbidity of subarachnoid haemorrhage (HSA) is evaluated in 51 patients admitted to the Neurological and Neurosurgery Departments of the Santa Maria Hospital. Reductions of 2 x (0.65, 6.39) of the incidence of ischemia in the total group and of 2.1 x (0.58, 7.79) of mortality in the sub-group with initial severity of less than 4 points of the Hunt score were observed relatively to a comparable group of patients previously admitted who did not receive nimodipine. Randomized clinical trials that tested the effect of nimodipine in the context of HSA are reviewed.

Adolescent↗
PubMedDate not supplied

Lacunar stroke associated headache is not related to intracranial large vessel disease.

It was recently suggested that lacunar strokes presenting with headache may be due to large intracranial artery disease. From the stroke database of the Neurology department, Hospital Sta Maria, we retrieved all lacunar strokes who had investigations of the intracranial circulation. Forty seven of the 208 lacunar strokes registered had either angiography (5 cases) or transcranial doppler (42 cases). Twelve subjects noticed headache during stroke onset, but all had normal investigations of the intracranial circulation. In five patients transcranial Doppler showed ipsilesional increased peak systolic velocities and another subject had a middle cerebral artery branch occlusion. None of them reported headache. Headache associated with lacunar strokes is not related to intracranial artery disease.

Cerebrovascular Disorders↗
PubMedDate not supplied

[Therapeutic recommendations. Secondary prevention of cerebral vascular accident].

The guidelines for secondary stroke prevention, graded following available scientific evidence, are presented. Stroke and TIA are defined and the indications for referral established. Basic assessment of stroke patients should include laboratory evaluation, ECG, brain CT, ultrasound examination of the extracranial vessels for events in the carotid distribution, and transthoracic or transesophageal echocardiogram if cardioembolism is suspected. The pharmacological and non-pharmacological reduction of blood pressure and serum cholesterol, stopping smoking and reducing alcohol intake are general measures recommended for secondary stroke prevention, together with healthier life-style changes (eating a Mediterranean type diet and performing regular moderate physical exercise). Concerning antithrombotic therapy, oral anticoagulants are recommended for patients with atrial fibrillation and other high to medium emboligenic cardiac risk conditions. Antiplatelet drugs are recommended for all other survivors of an ischemic cerebral event. Aspirin (75-325 mg/day) is the drug of choice. Alternative antiplatelet agents are clopidrogrel, ticlopidine, dipiridamol or triflusal. They can be used in patients with intolerance or contraindication to aspirin or in high-risk subjects. Endarterectomy of the symptomatic carotid is an additional procedure recommended for patients with ischemic stroke or TIA and carotid stenosis > 80% on the side of the symptomatic cerebral hemisphere.

Antihypertensive Agents↗