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Biomedical subjects

J A Egido

Publications and source records attributed to J A Egido.

At least 19 recordsLinked to original sources
PubMed2007

Risk of ischemic stroke and lifetime estrogen exposure.

BACKGROUND: Estrogen loss has been related to higher incidence of stroke in postmenopausal women, but randomized trials have demonstrated an increased risk of stroke in women receiving hormone replacement therapy (HRT). OBJECTIVE: To assess the relationship between exposure to endogenous ovarian hormones and the risk of noncardioembolic ischemic stroke. METHODS: We conducted a multicenter, age-matched, case-control study in postmenopausal women (case: nonembolic ischemic stroke; control: no stroke) comparing duration of ovarian activity or lifetime estrogen exposure, which was defined as age at menarche to age at menopause. Embolic cardiopathy and unreliable gynecologic data were exclusion criteria. Cardiovascular disease risk factors were recorded. The relationships of the principal variables to the risk of stroke were assessed using a conditional logistic regression analysis. RESULTS: There were 430 cases and 905 controls in the study. In the multivariate analysis, hypertension (odds ratio [OR]: 2.73; 95% CI: 2.09 to 3.58; p < 0.0001), diabetes (OR: 3.38; 95% CI: 2.53 to 4.52; p < 0.0001), hyperlipidemia (OR: 1.31; 95% CI: 1.01 to 1.7; p = 0.045), lifespan of ovarian activity <34 years (OR: 1.51; 95% CI: 1.13 to 2.03; p = 0.005), and menarche at <13 years of age (OR 1.49; 95% CI: 1.15 to 1.92; p = 0.002) were independently related to an increased risk of stroke. Obesity (OR: 0.73; 95% CI: 0.56 to 0.95; p = 0.021) was related to a lower risk of stroke. CONCLUSIONS: Longer lifetime exposure to ovarian estrogens may protect against noncardioembolic ischemic stroke. However, a very early age of exposure onset could be disadvantageous.

Age Factors↗
PubMed2001

Neurosonology in cerebral ischemia: future application of transcranial Doppler in acute stroke.

Transcranial Doppler (TCD) has become a general practice in recent years in the diagnostic study of patients with cerebral ischemia. This is due to the fact that it is a rapid, noninvasive, reproducible and dynamic examination of intracranial circulation. In the acute phase of cerebral infarction, it can detect MCA occlusion with a good correlation with angiographic findings and, what is even more important, the patients who will later suffer lacunar infarctions almost always show a normal Doppler examination. Acute abnormalities can also demonstrate the mechanism of the clinical signs; the examination informs us of the existence of collaterals and severe occlusions or stenoses of the extracranial arteries, and can change the priority in the search for the etiological diagnosis. The diagnosis of intracranial stenoses as a cause of clinical signs is another immediate application of TCD, right from the acute phase. If in the future anticoagulation is shown to be an optimum treatment for secondary prophylaxis in intracranial stenoses, TCD will probably become the diagnostic technique of choice. The ability to predict the prognosis based on parameters obtained by TCD opens up the possibility of using it as an auxiliary technique for the selection of patients for reperfusion treatment, having in its favor that it is quick and easy to perform, and therefore suitable for treatment monitoring. It seems clear that the data obtained by Doppler in the first 6 h are a good predictor of both spontaneous improvement and early impairment, which could help to avoid treatment in patients in whom a rapid improvement can be expected. Finally, the hemodynamic data of the TCD could be of inestimable value in the assessment and monitoring of intracranial hypertension treatments and for hemodynamic management of the patient, allowing the treatment margins of the acute phase of arterial hypertension to be reliably established without compromising the perfusion pressure. In conclusion, TCD will possibly be more widely used in the future in the acute phase of cerebral infarction as a guide to diagnostic procedures, for treatment selection and for monitoring of cerebral hemodynamics.

Acute Disease↗
PubMed2000

Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit.

BACKGROUND AND PURPOSE: We sought to study overall and domain-specific quality of life in stroke survivors 1 year after stroke and to identify variables that could predict quality of life after stroke. METHODS: We followed up for 1 year a cohort of 118 patients consecutively admitted to our stroke unit at San Carlos University Hospital in Madrid, Spain. The final series at 1-year follow-up consisted of 90 survivors (41 women and 49 men; mean age, 68 years; range, 32 to 90 years). A cross-sectional, descriptive design was developed. Patients completed a questionnaire that included socioeconomic variables, Hamilton Rating Scale for Depression, Sickness Impact Profile (SIP), Short Form 36, Frenchay Index, Barthel Index, Rankin Scale, and Scandinavian Stroke Scale. Independent variables were sex, age, functional status, motor impairment, and depression. We developed an ANOVA model for statistical analysis. RESULTS: We interviewed 79 patients with ischemic and 11 with hemorrhagic stroke. Thirty-eight percent of patients scored in the depressed range. Variables related to depression were status as a housewife, female sex, inability to work because of disability, and diminished social activity (P:<0.0001). Mean total SIP (24.3), SIP psychosocial dimension (27.5), and SIP physical dimension (21.2) were correlated with disability, female sex, motor impairment, and depression (P:<0.0001). CONCLUSIONS: Functional status and depression were identified as predictors of quality of life. Patients independent in their activities of daily living suffered from a deterioration of the psychosocial dimension of the SIP.

Activities of Daily Living↗
PubMed1998

[The one and a half vertical syndrome as the only evidence of bilateral thalamo-subthalamic infarction].

INTRODUCTION: The one and a half vertical syndrome consists of paralysis of upward vertical conjugated gaze and monocular paralysis of downward gaze or vice-versa. It occurs as a consequence of a mesencephalodiencephalic lesion, either unilaterally or bilaterally, due to effects on structures such as the interstitial nucleus of Cajal, posterior commissure and rostral interstitial nucleus of the medial longitudinal bundle. The arterial supply of the structures involved in the supranuclear control of vertical gaze depends on the paramedian thalamic arteries (or posterior thalamo-subthalamic arteries) and the paramedian peduncular arteries. CLINICAL CASE: We present the case of a 58 year old woman with non-insulin dependent diabetes mellitus who presented with sudden onset of diplopia of vertical gaze. On examination there was paralysis of superior vertical conjugated gaze and monocular paralysis of ocular infraversion (one and a half syndrome) with no other pathological findings. Cerebral angioresonance and Doppler studies of the territory supplied by the posterior cerebral artery were normal. CONCLUSIONS: Both unilateral and bilateral mesencephalodiencephalic infarcts usually present clinically as disorders of consciousness and of conduct (the almost universal form of presentation), involvement of the pyramidal tract, the third cranial nerves and a supranuclear disorder of vertical gaze. The unusual feature of the case we present is a bilateral thalamo-subthalamic infarct which presented solely as a one and a half vertical syndrome with no clinically apparent effect on anatomically adjacent structures. We have not found any similar cases in the literature.

Cerebral Infarction↗
PubMed1998

[Right sensory-motor syndrome as the presentation of a spontaneous cervico-thoracic epidural hematoma].

INTRODUCTION: A spontaneous cervical epidural hematoma is an infrequent cause of cord compression. The commonest clinical presentations are with paraparesia and tetraparesia. Transient hemiparesia is very rare and a sensory-motor syndrome is exceptional. CLINICAL CASE: A 38 year old man had sudden onset of spontaneous interscapular vertebral pain with bilateral root radiation. A few minutes later he started to have weakness and sensory loss in his right limbs. On clinical examination there was pain on pressure over the spinal apophyses of the T4 and T5 vertebrae, hemiparesia and hemi-hypoalgesia of the right limbs. After ten hours this had all returned to normal. MRI of the cord showed an epidural hematoma extending from C6 to T2. Coagulation studies and spinal arteriography were normal. CONCLUSIONS: The sensory motor syndrome is an unusual form of presentation of a spontaneous cervico-thoracic epidural hematoma. Root pain is a symptom of great value for orientation of a syndrome which would otherwise seem to be of central origin. The explanation for this clinical findings may be compression of both lateral cord pathways due to their particular blood distribution. Regarding therapeutic approach, this should be conservative, with close observation to see whether it will resolve spontaneously in a short period of time.

Adult↗
PubMed1998

[Oculocerebral syndrome: an infrequent pathological manifestation of carotid occlusion].

INTRODUCTION: The simultaneous occurrence of impaired visual and ipsilateral hemisphere symptoms is uncommon. It is associated with carotid pathology. CLINICAL CASES: We present three cases under the name of oculocerebral syndrome, in which there were symptoms of monocular ischemia and ipsilateral cerebral ischemia. In two of these cases the monocular vision loss was transient, and in the third case it was permanent due to occlusion of the central retinal artery. In all three cases there was evidence of obstruction of the internal carotid artery. CONCLUSION: The pathological process involved may be mixed, embolic-hemodynamic.

Aged↗
PubMed1997

[Dolichoectasia of multiple cranial arteries. Findings on neuroimaging and transcranial Doppler].

INTRODUCTION: Dolichoectasia of the intracranial arteries may give rise to ischaemic or haemorragic pathology and to compression phenomena. Joint dolichoectasia of the whole circle of Willis, in both the anterior and basilar portions extending to the main basal arteries is an unusual finding. CLINICAL CASE: We describe a 76 year old man who presented with vertigo with vertically downward nystagmus. On neuroimaging studies there was aneurysmal dilation of the left vertebral, basilar and both carotid arteries (in their supra-clinoid portion) and of both medial cerebral arteries. Transcraneal Doppler showed marked reduction in flow rate with normal morphology and pulsation. CONCLUSION: The combination of non-invasive techniques allows full, reliable evaluation of the swollen arteries and possible complications.

Aged↗
PubMed1996

[Paramedian thalamo-mesencephalic infarct con triphasic waves].

Triphasic waves are usually associated with metabolic encephalopathies but have been reported in patients with other etiologies. The pathophysiology of this EEG pattern remains poorly understood, although they have been attributed to lesion in the connections between the thalamus and cortex. We report a case of top-of-the-basilar artery occlusion with selective paramedian thalamic-mesencephalic infarct in which triphasic waves were evident on the EEG during clinical hypersomnia. To our knowledge this is the first reported case of triphasic waves with selective paramedian thalamomesencephalic infarct. We conclude that triphasic waves are a nonspecific manifestation of diencephalic dysfunction, probably of the paramedian thalamomesencephalic reticular system.

Aged↗
PubMed1996

Takayasu's arteritis: transcranial Doppler findings and follow-up.

Takayasu's arteritis is an inflammatory disease that produces a narrowing of the aorta and its major branches. The transcranial doppler findings and its value have not been clearly determined. We describe a patient with a history of orthostatic syncopal attacks, and transitory ischemic attacks. Arteriography showed severe narrowings and occlusions of multiple large branches of the aortic arch. Transcranial doppler showed a low flow velocity in both middle cerebral arteries, low pulsatility index and damping in the waveform. After surgery, transcranial doppler ipsilateral to the graft became almost normal and the collateralization pattern had changed. This case provides further evidence that the Takayasu's arteritis leads to relevant changes in the transcranial doppler waveform and that this technique can help in the follow-up of these patients.

Adult↗
PubMed1994

False positive of ADA determination in cerebrospinal fluid.

The elevation of ADA in CSF is useful as a diagnostic means for detecting tuberculous meningitis, and in other etiologies such as lymphoma, neurosarcoidosis, fulminant bacterial meningitis, cryptococcal meningitis, neurobrucellosis and AIDS. We report an increase of ADA in CSF in association with SHA. In our case the total activity of ADA was the same as that obtained in serum, which can be interpreted among the false positives of the determination.

Adenosine Deaminase↗