Rubens José Gagliardi

Estudo das freqüências dos principais fatores de risco para acidente vascular cerebral isquêmico em idosos

Foram estudados retrospectivamente 262 pacientes com diagnostico clinico de acidente vascular cerebral isquemico (AVCi) permanente, com idade igual ou superior a 60 anos, selecionados dos 1015 registros da Liga de Aterosclerose da Clinica Neurologica da ISCMSP, de 1990 a 2002. O estudo focalizou as frequencias dos fatores de risco modificaveis para AVCi nesta populacao idosa, considerando-se sexo e faixa etaria dos pacientes. Os resultados evidenciaram que a hipertencao arterial sistemica e significativamente frequente (87,8%) entre pacientes idosos com AVCi, independentemente do sexo e da faixa etaria. Tabagismo (46,9%) e etilismo (35,1%) revelaram-se fatores de riscos modificaveis frequentes especialmente entre os homens. As cardiopatias (27,0%), o Diabete Melito (19,9%) e as dislipidemias (15,6%) tambem se revelaram fatores de risco modificaveis frequentes em pacientes idosos com AVCi, em ambos os sexos e em ambas as faixas etarias estudadas (60 a 70 anos e mais que 71 anos). Foi relativamente baixa a frequencia de hiperuricemia nesta amostra.

Neuroprotection, excitotoxicicity and nmda antagonists

PURPOSE To analyze the main aspects of neuroprotection and excitotoxicity. DISCUSSION This is a significant theory on the pathophysiology of cerebral ischemia; it is based on the release of excitatory aminoacid (EAA), mainly glutamate. The sequence starts with a decrease of the blood flow and ends in neuronal death. The main stages of this reaction are herein presented and discussed. An in depth study of the effects of the excessive intracellular calcium is undertaken. Neuroprotectors (NP) are a group of drugs that reduce the excitotoxicity, opposing the excessive release of EAA and its intracellular effects. Neuroprotectors represent a rational approach to stroke treatment and offer a number of potential advantages. They prevent or limit ischemia-induced damage. CONCLUSION There are many experimental and clinical NP trials. A minimum of 800 trials are currently under study worldwide. The most important NP subgroups are: N-methyl D-aspartate (NMDA) antagonists, gamma-amino butyric acid (GABA) agonists, amino-hydroxy-methyl-isoxalone propionic acid (AMPA) antagonists, reducers of intracellular Ca++ inhibitors of nitric oxide modulation pathway free radicals scavengers, sodium channel antagonists, glutamate release inhibitor, growth factors, hypothermia and potassium channel activators.

Guidelines for acute ischemic stroke treatment - Part I

Executive Committee: Charles André, Aroldo Luiz Bacellar, Daniel da Cruz Bezerra, Roberto Campos, João José Freitas de Carvalho, Gabriel Rodrigues de Freitas, Roberto de Magalhães Carneiro de Oliveira, Sebastião Eurico Melo de Souza, Soraia Ramos Cabette Fábio, Eli Faria Evaristo, Jefferson Gomes Fernandes, Maurício Friedrich, Marcia Maiumi Fukujima, Rubens José Gagliardi, Sérgio Roberto Haussen, Maria Clinete Sampaio Lacativa, Bernardo Liberato, Alexandre L. Longo, Sheila Cristina Ouriques Martins, Ayrton Roberto Massaro, Cesar Minelli, Carla Heloísa Cabral Moro, Jorge El-Kadum Noujaim, Edison Matos Nóvak, Jamary Oliveira-Filho, Octávio Marques Pontes-Neto, César Noronha Raffin, Bruno Castelo Branco Rodrigues, José Ibiapina Siqueira-Neto, Elza Dias Tosta, Raul Valiente, Leonardo Vedolim, Marcelo Gabriel Veja, Leonardo Vedolin, Fábio Iuji Yamamoto, Viviane Flumignan Zétola. Correspondence: Jamary Oliveira-Filho; Rua Reitor Miguel Calmon s/n; Instituto de Ciências da Saúde / sala 455; 40110-100 Salvador BA Brasil; E-mail: jamaryof@ufba.br Conflict of interest: There is no conflict of interest to declare. Received 18 February 2012; Received in final form 22 February 2012; Accepted 29 February 2012 Guidelines for acute ischemic stroke treatment – Part I

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br).

Interleukin-10 may protect against progressing injury during the acute phase of ischemic stroke

UNLABELLED Atherosclerosis is an inflammatory disease, and ischemic stroke is one of its most common and devastating manifestations. Proinflammatory cytokines play a key role in the progression of the irreversible ischemic lesions. The presence of anti-inflammatory mediators may prevent secondary ischemic injury. OBJECTIVES 1) To assess the relationship between stroke severity and the serum levels of IL-1β, IL-2, and IL-10; and 2) To analyze the neurological outcome after 72 h of ischemic stroke onset and expression of interleukins. METHOD We measured the serum levels of IL-1β, IL-2, and IL-10 in 26 patients with acute stroke. Neurological impairment was scored using the National Institute of Health Stroke Scale within the first 72 h after stroke onset. Thirty healthy subjects were analyzed as controls. RESULTS Patients with IL-10 <925.0 pg/mL presented with neurological deterioration within the first 72 h. CONCLUSION IL-10 may protect against ischemic injury during the acute phase of stroke.

Influência do etanol das bebidas alcoólicas na aterosclerose em artérias carótidas extracranianas

Existem fortes evidencias de menor incidencia de doenca cerebrovascular oclusiva, de aterosclerose coronariana e de outros vasos em individuos com consumo leve ou moderado de alcool. Este estudo procura analisar o efeito do etanol, em diferentes doses no comportamento da aterosclerose carotidea extracraniana. Atraves do ultrassom Doppler colorido, foram investigadas 328 arterias carotidas extracranianas, de homens e mulheres brancos, com mais de 35 anos de idade, normotensos, nao tabagistas e sem as principais doencas que constituam fatores de risco para doencas cardiovasculares. Foram divididos de acordo com o consumo de alcool por semana (em mililitros) em abstemios, etilistas leves (1 a 100), moderados (101 a 300) e pesados (301 ou mais). Houve menor incidencia de placas de aterosclerose e de estenose naqueles que ingeriram moderada quantidade. CONCLUSAO: O estudo sugere uma acao protetora do alcool etilico para aterosclerose carotidea, quando ingerido em moderada quantidade.

Chlamydia pneumoniae and symptomatic carotid atherosclerotic plaque: a prospective study

OBJECTIVE To investigate the possible link between symptomatic carotid atherosclerotic plaque and Chlamydia pneumoniae. BACKGROUND Recently, several studies have demonstrated that there may be a possible link between Chlamydia pneumonia and carotid atherosclerosis, however the real role of Chlamydia pneumoniae is not completely understood. METHOD This is a prospective study with a total of 52 patients analyzed. All patients had been submitted to endarterectomy, and had suffered thrombotic ischemic stroke or transient ischemic attack up to 60 days prior to the surgery. Every patient presented carotid stenosis over 70%. The plaque was removed during the surgery and the laboratory exams were immediately done. Evaluation of Chlamydia pneumoniae DNA was done using polymerase chain reaction (PCR). RESULTS The PCR analyses of all 52 patients were negative for Chlamydia pneumoniae. CONCLUSION These initial results do not show a relationship between Chlamydia pneumoniae and symptomatic carotid atherosclerotic plaque.

Active extravasation of contrast within the hemorrhage (spot sign): a multidetector computed tomography finding that predicts growth and a worse prognosis in non-traumatic intracerebral hemorrhage

Intracerebral hemorrhage (ICH) causes high rates of disability and neurological sequelae Objective To evaluate spot signs as predictors of expansion and worse prognosis in non-traumatic ICH in a Brazilian cohort. Method We used multidetector computed tomography angiography to study 65 consecutive patients (40 men, 61.5%), with ages varying from 33 to 89 years (median age 55 years). Clinical and imaging findings were correlated with the findings based on the initial imaging. Results Of the individuals who presented a spot sign, 73.7% died (in-hospital mortality), whereas in the absence of a spot sign the mortality rate was 43.0%. Although expansion of ICH was detected in 75% of the patients with a spot sign, expansion was observed in only 9.0% of the patients who did not present a spot sign. Conclusions The spot sign strongly predicted expansion in non-traumatic ICH and an increased risk of in-hospital mortality.

Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

OBJECTIVE The potential of computed tomography angiography (CTA) was assessed for early determination of stroke subtypes in a Brazilian cohort of patients with stroke. METHOD From July 2011 to July 2013, we selected patients with suspected hyperacute stroke (< 6 hours). Intracranial and cervical arteries were scrutinized on CTA and their imaging features were correlated with concurrent subtype of stroke. RESULTS Stroke was documented in 50/106 selected patients (47.2%) based on both clinical grounds and imaging follow-up (stroke group), with statistically significant arterial stenosis and vulnerable plaques on CTA. Intracranial large artery disease was demonstrated in 34% of patients in the stroke group. Partial territorial infarct prevailed (86%) while artery-to-artery embolization was the most common stroke mechanism (52%). CONCLUSION Multidetector CTA was useful for the etiologic work-up of hyperacute ischemic stroke and facilitated the knowledge about the topographic pattern of brain infarct in accordance with its causative mechanism.

PAPEL DA CURVA DE AGREGAÇÃO PLAQUETÁRIA NO CONTROLE DA ANTIAGREGAÇÃO NA PREVENÇÃO SECUNDÁRIA DO ACIDENTE VASCULAR CEREBRAL ISQUÊMICO

INTRODUCTION: Stroke is the leading cause of death in Brazil. The risk of suffering a recurrent stroke is around 30% in 5 years. Antiplatelet therapy has been frequently used to prevent recurrent strokes without laboratory control. OBJECTIVE: To determine the value of the platelet aggregation test in the control of antiplatelet aggregation in the secondary stroke prevention. METHOD: Retrospective study from January 1990 to January 2001 with 189 patients with stroke that were followed up during this period with platelet aggregation curve. Patients with cardioembolic disease were excluded. Low aggregation rates of platelet aggregation activated by ADP and/or epinephrine lower or equal to 50% were considered. Patients were followed up for a period from one to six years to verify differences in stroke recurrence. RESULTS: Nine patients had had a recurrent stroke; 2,6% of the strokes occurred among the group with low aggregaton and 15,1% among the group with normal aggregation (0,03<OR<0,69, p<0,05). Most of the cases occurred in the second year after the first stroke. CONCLUSION: Platelet aggregation curve is a valid and a helpful laboratory test to therapeutic control of antiplatelet aggregation in secondary stroke prevention.