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J Alvarez-Sabín

Publications and source records attributed to J Alvarez-Sabín.

At least 37 records · Page 2Linked to original sources
PubMed2001

Matrix metalloproteinase expression after human cardioembolic stroke: temporal profile and relation to neurological impairment.

BACKGROUND AND PURPOSE: Uncontrolled expression of matrix metalloproteinases (MMPs) can result in tissue injury and inflammation. In animal models of cerebral ischemia, the expression of MMP-2 and MMP-9 was significantly increased. However, their role in human stroke in vivo remains unknown. Therefore, we sought to determine the temporal profile of MMP expression in patients with acute ischemic stroke and to investigate its relationship to stroke severity, location of arterial occlusion, and total infarct volume. METHODS: Serial MMP-2 and MMP-9 determinations were made in 39 patients with cardioembolic strokes that involved the middle cerebral artery territory by means of enzyme-linked immunosorbent assay. Blood samples, transcranial Doppler recordings, and National Institutes of Health Stroke Scale (NIHSS) scores were obtained at baseline and at 12, 24, and 48 hours after stroke onset. Infarct volume was measured with CT scanning at 48 hours. RESULTS: No correlation was found between MMP-2 and NIHSS score at any time point, although a close relation appeared between mean MMP-9 and final NIHSS score (r=0.486, P=0.002). MMP-9 value was the only factor associated with the final NIHSS score in the multiple logistic regression model (OR 4.54, 95% CI 1.5 to 13.75). A cut-point of MMP-9 142.18 ng/mL had a positive predictive value of 94.4% to assess a patient's NIHSS (<8 or >/=8) by the end of the study. Final MMP-2 and MMP-9 levels were significantly lower when recanalization occurred (528+/-144.3 versus 681.4+/-239.2 ng/mL, P=0.031 for MMP-2; 110.2+/-100.9 versus 244.8+/-130 ng/mL, P=0.004 for MMP-9). A positive correlation was found between mean MMP-9 and infarct volume (r=0.385, P=0.022). CONCLUSIONS: MMPs are involved in the acute phase of human ischemic stroke. MMP-9 levels are associated with neurological deficit, middle cerebral artery occlusion, and infarct volume.

Acute Disease↗
PubMed2000

Cerebral microembolism in acute spontaneous internal carotid artery dissection.

The rate and risk factors for early ischemic recurrence in patients with internal carotid artery dissection (ICAD) are largely unknown. Serial transcranial Doppler (TCD) monitoring of microembolic signals (MES) was performed in 28 consecutive patients with acute ICAD. MES were identified in 13 patients, and early ischemic recurrence occurred in 7. Six of 13 patients with MES and 1 of 15 without MES experienced early ischemic recurrence (p = 0.029). MES detection on serial TCD monitoring may be associated with an increased risk of early ischemic recurrence in patients with acute ICAD.

Acute Disease↗
PubMed2000

Mitral papillary fibroelastoma as a cause of cardiogenic embolic stroke: report of two cases and review of the literature.

UNLABELLED: Papillary fibroelastoma (PFE) is a rare benign tumour that attaches to the endocardial surface, mostly on cardiac valves. Though usually asymptomatic, it can be the source of several complications. To date, 49 cases have been reported of embolic stroke with a PFE as the probable origin. CASE REPORTS: (i) a 39-year-old male presented with ischemic embolic stroke; the presence of a PFE was assessed by means of transoesophageal echocardiography and confirmed by pathological findings; (ii) a 32-year-old woman presented with sudden onset of left hemiparesis; a cardiogenic embolic stroke was suspected, and a diagnosis of PFE was made based on echocardiographic and pathological findings. In both cases, surgical excision of the tumours was performed with no recurrences at follow-up. Two mechanisms can explain the formation of emboli in PFE: dislodgement of the tumour leaves or fibrin-platelet aggregation on the endocardial surface of these leaves. Transthoracic echocardiography may lead to the suspicion of a PFE, but transoesophageal echocardiography is required for confirmation. Prompt surgical excision is indicated in most cases. Anticoagulation is only recommended in situations of high surgical risk and during the wait for surgery.

Adult↗
PubMed1999

[Neuroimaging in cerebral ischemia].

A critical review about different neuroimaging techniques and its contribution to the field of cerebrovascular diseases is presented. The advances of neuroradiology have revolutionized stroke diagnosis. The inminence use of specific treatment for acute brain ischemia (neuroprotective and thrombolytic drugs) make neurologists become familiar with several imaging techniques that will also change stroke management. Nowadays, computed tomography is the mostly available technique for spanish neurologists in the acute phase, because of that, a suitable knowledge of early CT signs of acute infarction make possible use it in peak condition. Perfusion-and-diffusion-weighted magnetic resonance give such a lot of information for acute stroke, that at the near future, therapeutic decisions will be based on these findings. The role of other functional an angiography techniques is discussed.

Acute Disease↗
PubMed1998

[Value of cranial MRI in the follow-up of dural sinus thrombosis].

INTRODUCTION: At the present time it is well established that cranial magnetic resonance (MR) is the imaging technique of choice for diagnosis of thrombosis of the dural sinuses. However, few studies have been done to evaluate its role in follow-up in this cerebrovascular disorder. OBJECTIVE: To assess the alterations in resonance signal in follow-up of patients with thrombosis of the dural sinuses and the clinical correlation of this. MATERIAL AND METHODS: We reviewed the clinical histories of 12 patients diagnosed on cranial MR as having thrombosis of the dural sinuses; 8 cases were also seen again six months later. The cranial MR study was done using a 1.5 or 1.0 T superconductive apparatus to do measured spin-echo sequences (SE) in T1 and T2 in sagittal, transverse and coronal planes. The time elapsed between diagnosis on MR and clinical diagnosis was between 24 hours and 6 months. RESULTS: All patients had stronger resonance signals in T1 and T2 indicating a subacute phase of the thrombosis (oxidative conversion of deoxyhaemoglobin to methoxyhaemoglobin) and complete absence of blood flow in the sinuses. The eight patients seen again after six months were found to be normal on neurological. On cranial MR partial recanalization was seen in 5 of these (62%). CONCLUSION: Changes in the resonance signal persist for a long time both with and without signs of recanalization. This finding does not affect the medium term clinical course.

Adult↗
PubMed1998

[Stroke: a stranger among the people].

INTRODUCTION: Lack of awareness of warning signs of stroke is a factor that contribute to late patient arrival to the emergency department. OBJECTIVE: The goal of this pilot study was to determine the baseline knowledge of stroke among the population (terminology, signs-symptoms, risk factors and attitude) prior to educational campaigns. PATIENTS AND METHODS: A population-based interview using closed-ended questions was conducted by neurologists among 100 users of the Vall d'Hebron's Primary Health Center, randomly sampled. RESULTS: In our population a 9% unknowns totally the disease, of the remainder, 42% has a good knowledge of signs-symptoms and 46% of risk factors. Only 22% of the sample has good global knowledge of the disease. If suffering a stroke this population should seek medical attention through 911 (46.2%) or come directly to the emergency department (50.5%). If symptoms were gone away, transient ischemic attack (TIA), appears a trend to contact primary physicians (59.3%). Respondents aged > 65 years were less likely to recognize symptoms (p = 0.001) and to consider stroke as an emergency. Respondents with an affected relative (50.5%) tend to locate more exactly the disease at the brain (p = 0.05) and to arrive earlier to the emergency department (p = 0.045), than those with non-affected relatives. CONCLUSIONS: Less than a quarter of our population have a good knowledge of the disease. Stroke is considered an emergency unlike TIA. The information about stroke is theoretically associated with early presentation to the emergency department. These results permit a redesign of the questionnaire to conduct a second phase of the study and generalize them for the Spanish population.

Adolescent↗
PubMed1997

[Reversible leukoencephalopathy related to cyclosporin treatment].

INTRODUCTION: At the present time cyclosporin is the most commonly used immunodepressive drug for the prevention of transplant rejection. Although the mechanism by which cerebral dysfunction occurs is not well understood, it has been noted that the clinical and radiological characteristics of cyclosporin neurotoxicity, which may occur even when the blood levels of the drugs are within the therapeutic range, are very similar to those of hypertensive encephalopathy and also resolve when the blood pressure drops. CASE CLINIC: A 35 year old woman, treated with high doses of cyclosporin for a bone marrow transplant, presented with progressive headache, drowsiness, blurred vision and convulsions which coincided with a rapid rise in blood pressure. After antihypertensive treatment full recovery (of all symptoms) was seen. Neuro-radiological studies showed extensive changes in the white matter, mainly in the posterior cerebral regions that were not enhanced after contrast. The changes were compatible with oedema. A magnetic resonance study done two years later was completely normal. CONCLUSIONS: In this clinical report the aetiology and the clinical and radiological characteristics of the neurotoxicity due to cyclosporin are discussed.

Adult↗
PubMed1997

[Secondary prevention of ischemic strokes: effect of dosage of aspirin].

INTRODUCTION AND OBJECTIVE: The value of acetylsalicylic acid (ASS) in the secondary prevention of ischemic stroke is well established. However, the optimum dose of AAS for stroke-threatened patients remains unsettled. This paper reviews the pattern of adverse reactions to AAS and their relationship to the dosage of ASS evaluated. METHOD: All the clinical trials in which AAS was used as the sole antiaggregant in the secondary prevention of ischemic stroke were reviewed. The crude odds ratio for the different adverse reactions was calculated using three sub tests: AAS versus placebo; AAS < 330 mg/d versus AAS > 330 mg/d; and each dosage level versus a placebo. RESULTS: There is an increased risk associated with the use of AAS as compared to a placebo with respect to gastrointestinal bleeding (OR 2.3, IC 95% (1.6-4.1)), peptic ulcer (10.1 (2.5-85.2)), intracerebral hemorrhage (2.2 (1.3-4)) and other hemorrhagic phenomena (2.6 (2-3.3)). CONCLUSIONS: There seems to be a direct relationship between the dosage of AAS and the frequency with which adverse reactions occur, except in the case of intracerebral hemorrhage. In the latter case there was no relationship with the dose given (0.8 (0.5-1.4)).

Aspirin↗
PubMed1997

[Stroke in teenagers].

Between 3.7% and 8.5% of all strokes occur before the age of 45 years old. In the population under 15 years of age, the annual incidence of strokes is 2.7 per 100,000 children, with ischaemic strokes making up 1.2 and haemorrhagic strokes 1.5 of this total. The main characteristic of ischaemic strokes in childhood is the wide variety of diagnoses involved. Some of these, such as congenital cardiopathy, are rare in adults, as are dissections and arterial dysplasias, arteritis, hereditary connective tissue disorders and disorders of metabolism. Similarly, the aetiology of haemorrhagic stroke is also very varied, with bursting of a vascular malformation or aneurysm being the commonest. Other aetiologies are disorders of haemostasis, arteritis, migraine, retarded post-traumatic phenomena and the use of drugs and sympathomimetic agents. The personal, family and social repercussions are considerable, since both ischaemic and haemorrhagic strokes have an appreciable mortality and morbidity.

Adolescent↗
PubMed1997

[Is a transitory ischemic accident diagnosed during inpatient or outpatient care?].

Both transient ischemic attacks (AIT) and minor strokes are common clinical findings in cerebro-vascular disease. They are warnings of the presence of a high risk that a more serious ictus may subsequently occur and cause irreversible lesions. Although only 40% of all strokes are preceded by AIT, and a first ictus may itself be serious, there are now available effective methods of treatment which can reduce the risk of a serious ictus in patients who have had AIT. There is also a higher death rate and greater risk of ischaemic cardiopathy in these patients. Since this risk is higher during the first month, all patients with recent AIT should be treated as emergency cases. If delay in diagnosis and treatment of cerebro-vascular disease may be costly for both the patient and the health system, in AIT this is particularly so.

Ambulatory Care↗
PubMed1997

[Jugular megabulb as a cause of pulsatile tinnitus].

INTRODUCTION: Pulsatile tinnitus (AP), possibly of vascular origin, may be a sign of various vascular and non-vascular pathological processes. Arteriovenous fistulas and malformations are, perhaps, the commonest cause of AP. CLINICAL CASE: A 64 year-old woman presented with AP of the right ear for the past 14 years. It was continuous all day and could be observed externally by the examiner. The intensity of the tinnitus diminished on right later-cervical compression and on turning her head to the left. There was bilateral transmission deafness. Neurological examination was normal. Complementary explorations (MR, CT of the base of the skull and cerebral arteriography) showed the presence of a jugular megabulb of the right side. CONCLUSIONS: The presence of AP may be for many years the only sign of subjacent vascular pathology, such as a megabulb of the jugular vein.

Female↗
PubMed1997

[Comparative study of the effect of low-dosage acetylsalicylic acid and triflusal in the prevention of cardiovascular events among young adults with ischemic cerebrovascular disease].

INTRODUCTION: The effectiveness of the low doses AAS in the prevention of the cerebral infarction has not been clearly still verified. OBJECTIVE: To compare the long term effectiveness of the treatment with low doses AAS in front of triflusal in the reduction of the stroke, ischemic cardiopathy, and cardiovascular death risks. MATERIAL AND METHODS: Of 386 patients with a first ischemic stroke, 217 were selected (106 triflusal, 111 AAS) that completed the approaches of atheromatous infarct (161 males, 72.2% and 58 female, 25.8%). The mean age was 43 years (standard deviation, SD 6.4, 95% CL 20-50). The patients received one of theses treatments: a) AAS (Sedergine) 330 mg/day (once a day); b) Triflusal (Disgren), 900 mg/day (300 mg 3 times a day). The mean time of follow-up for the group triflusal was of 48.3 months (20-94), while for the group AAS was of 46.3 months (2-84). RESULTS: The combined incidence of cerebral infarcts, ischemic cardiopathy and vascular death was 19.8% in the patients treated with triflusal, and 28.8% in the patients treated with AAS what supposes a reduction of the risk of the 39% (OR 0.61; CL 0.30-2.01). In the subgroup of patients with carotid stenoses of more than 70% demonstrated by angiography, triflusal produces a significant reduction of risk (OR 0.30; CL 0.10-0.90). Also, triflusal reduced in 76% the risk of hemorrhagic complications in comparison of the AAS (OR 0.24; IC 0.06-0.94). CONCLUSIONS: The study adds new doubts about the effectiveness of the low doses of AAS in the secondary prevention of the cerebral infarct. The triflusal shows effectiveness in subgroup of high risk and a significative reduction of the hemorrhagic complications that would be confirmed in controlled clinical trials with a greater number of patients.

Adult↗