Fibrilación auricular

Infarto cerebeloso bilateral simultáneo en un paciente con fibrilación auricular paroxística no valvular: una presentación atípica. Simultaneous bilateral cerebellar infarction in a patient with paroxysmal atrial fibrillation: an atypical presentation

Introduction: Cerebellar infarcts usually occur in the territory of the posterior inferior cerebellar artery (PICA) and tend to be unilateral. Simultaneous bilateral involvement is extremely rare.

Case report: We present the case of a 67-year-old male who developed an acute cerebellar syndrome secondary to acute infarction in the territory of both PICA confirmed by nuclear magnetic resonance imaging. Non-valvular paroxysmal atrial fibrillation was the most plausible etiology after digital cerebral angiography ruled out vascular abnormalities.

Conclusion: This case shows that bilateral infarction in the territory of both PICA can occur in the context of cardiac embolism, even in the absence of an anomalous common PICA.

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Palabras clave: arteriografía, cerebelo, embolia, Fibrilación auricular, infarto cerebral (DeCS),

Keywords: angiography, atrial fibrillation, cerebellum, cerebral infarction (MeSH), embolism,

Trombo Flotante en Arteria Carótida. Carotid Free-Floating Thrombus.

Carotid free-floating thrombus (FFT) is a rare cause of ischemic stroke, usually detected during etiologic vascular studies. There is no consensus regarding the management of carotid free-floating thrombi in those patients.

A 83-year-old male presented to the emergency department with right hemiparesis and dysarthria, consistent with finding of multiple left hemispheric brain infarcts on neuroimaging. Contrast CT showed a free-floating thrombus fixed to an atheroma plaque in left internal carotid artery (ICA). Holter monitorization registered a not previously noticed paroxystic atrial fibrillation. Due to findings, sodic heparinization was started and serial ecosonographic monitoring of the thrombus was performed. He was discharged home with a clot reduction >50% with oral anticoagulant therapy (rivaroxaban 20mg daily). At 2 months, ecographic control was realized without residual clot in left ICA.

Oral anticoagulation is currently the first therapeutic option that should be considered when a FFT is detected. In some reported case series, simple antiplatelet therapy was associated. Deferred surgical endarterectomy has a limited therapeutic gap in these patients when an ulcerated atheroma plaque or a significant stenosis carotid stenosis are detected. Surgical thrombectomy is reported only in few cases series. Endovascular therapies are steadily growing as an effective option when a FFT is detected, usually associated with distal protection devices to avoid distal embolization.

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Palabras clave: Arteria Carótida interna, Fibrilación auricular, Heparina sódica, Trombo flotante,

Keywords: atrial fibrillation, Free-floating thrombus, internal carotid artery, Sodic heparinization,

Riesgo de enfermedad cerebrovascular en la fibrilación auricular. Hospital Lenin Enero 2006 – Diciembre 2007.

A case-series was performed in the Emergency Service of the University Hospital V. I. Lenin. The universe of the study was 413 patients in Observation at the Emergency Service of Internal Medicine. Considered as an objective was to determine the behavior of the different clinical, epidemiological and therapeutic variables of the patients with atrial fibrillation and with risk to develop cerebrovascular disease. Of these patients, 165 were selected according to the inclusion criteria. The main results were that the most frequent clinical pattern of presentation was recent diagnosis followed by recurrent and permanent diagnosis and that after 60 years of age the highest risk to develop stroke was in patients with permanent clinical pattern which were not properly protected to prevent it. We concluded that if cerebrovascular disease is to be prevented, then it is necessary to give the patients the proper anticoagulants and antiplatelet medications. We recommend insisting in the application of the protocols of management.