Takotsubo syndrome is characterized by predominantly medial-apical transient left ventricular dysfunction, which is typically triggered by physical or emotional stress. The present article reports the case of a 61-year-old female patient presenting with dizziness, excessive sweating, and sudden state of ill feeling following an episode involving intense emotional stress. The physical examination and electrocardiogram were normal upon admission, but the troponin I and creatine kinase-MB concentrations were increased. Acute myocardial infarction without ST segment elevation was suspected, and coronary angiography was immediately performed, which showed severe diffuse left ventricular hypokinesia, medial-apical systolic ballooning, and a lack of significant coronary injury. The patient was referred to the intensive care unit and was successfully treated with supportive therapy. As this case shows, Takotsubo syndrome might simulate the clinical manifestations of acute myocardial infarction, and coronary angiography is necessary to distinguish between both myocardial infarction and myocardial infarction in the acute stage. The present patient progressed with spontaneous resolution of the ventricular dysfunction without any sequelae.
A Síndrome Hepatorrenal (SHR) é uma complicação da cirrose hepática e da hipertensão portal, e uma das causas de lesão renal aguda (LRA) nesses pacientes. Trata-se de uma condição com elevada morbidade e mortalidade. Recentes modificações conceituais e no diagnóstico permitiram que essa condição fosse mais precocemente identificada com instituição de tratamento em tempo oportuno, e maior chance de sobrevida para os pacientes. O presente capítulo objetiva revisar o conceito, quadro clínico e critérios diagnósticos, tratamento e prevenção da SHR, com ênfase na SHR-lesão renal aguda (LRA). Para tal, foi realizada pesquisa de artigos de revisão literária em bancos de dados com uso do descritor Síndrome Hepatorrenal, com seleção, leitura e síntese a partir dos materiais lidos, visando auxiliar estudantes, médicos generalistas e clínicos no manejo dessa importante condição.
Context: The rostral midbrain and thalamomesencephalic junction are the supranuclear premotor control of vertical eye movements, and is supplied by the posterior thalamo-subthalamic paramedian artery originated from P1 segment of posterior cerebral artery. Case report: A 51-year-old man presented with sudden speech difficulties, dizziness and dyplopia, associated with moderate intensity headache. Neuroophthalmological examination revealed incomplete ptosis of the right eye, with mydriatic pupil, poorly reactive to light. No eye movements were present on attempted upward gaze. On attempted downward gaze, depression of the left eye was observed but with absent saccades. Lateral gaze to the right was intact, while attempted gaze deviation to the left revealed adduction deficit of the right eye with incomplete abduction of the left eye without nystagmus. Convergence was absent. He exhibited left hemiataxia with left hypoestesia. MRI showed acute right paramedian thalamic and mesencephalic stroke. Conclusions: About the vertical one and a half syndrome, it was suggested damage in the pathway to contralateral downgaze neurons before its decussation with the unilateral interstitial nucleus of Cajal. As for the contralateral lateral rectus palsy we infer that this patient’s abduction deficit was due to pseudo-abducens palsy, with several mechanisms that could explain abduction deficits associated with upgaze palsy. Claude’s syndrome is usually explained by a lesion of oculomotor nerve fascicle and the superior cerebellar peduncle, affecting cerebellothalamic connections.
Background and purposeSeveral risk factors of symptomatic intracerebral hemorrhage (SICH) following intravenous thrombolysis for acute ischaemic stroke have been established. However, potential predictors of good functional outcome post‐SICH have been less studied.MethodsPatient data registered in the Safe Implementation of Treatment in Stroke—International Stroke Thrombolysis Register (SITS‐ISTR) from 2005 to 2021 were used. Acute ischaemic stroke patients who developed post intravenous thrombolysis SICH according to the SITS Monitoring Study definition were analyzed to identify predictors of functional outcomes.ResultsA total of 1679 patients with reported SICH were included, out of which only 2.8% achieved good functional outcome (modified Rankin Scale scores of 0–2), whilst 80.9% died at 3 months. Higher baseline National Institutes of Health Stroke Scale (NIHSS) score and 24‐h ΔNIHSS score were independently associated with a lower likelihood of achieving both good and excellent functional outcomes at 3 months. Baseline NIHSS and hematoma location (presence of both SICHs, defined as remote and local SICH concurrently; n = 478) were predictors of early mortality within 24 h. Independent predictors of 3‐month mortality were age, baseline NIHSS, 24‐h ΔNIHSS, admission serum glucose values and hematoma location (both SICHs). Age, baseline NIHSS score, 24‐h ΔNIHSS, hyperlipidemia, prior stroke/transient ischaemic attack, antiplatelet treatment, diastolic blood pressure at admission, glucose values on admission and SICH location (both SICHs) were associated with reduced disability at 3 months (≥1‐point reduction across all modified Rankin Scale scores). Patients with remote SICH (n = 219) and local SICH (n = 964) had comparable clinical outcomes, both before and after propensity score matching.ConclusionsSymptomatic intracerebral hemorrhage presents an alarmingly high prevalence of adverse clinical outcomes, with no difference in clinical outcomes between remote and local SICH.
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