Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Hemorragia intracerebral

 

Riesgo Cardiovascular en el Uso de Anticoagulación Oral Posterior a Hemorragia Intracerebral: ¿Qué Desenlaces Considerar?

To the Editor:

The use of oral anticoagulation in patients with atrial fibrillation has been shown to significantly reduce thromboembolic events, including ischemic stroke. However, this therapeutic strategy poses significant clinical dilemmas in survivors of intracerebral hemorrhage (ICH), where the risk of rebleeding is weighed against the potential benefit of preventing new ischemic events. Despite the advancement of direct oral anticoagulants (DOACs), a critical gap in evidence remains to guide optimal management in this high-risk subgroup, particularly regarding the selection of neurological outcomes of greatest interest.

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Palabras clave: anticoagulación oral, Hemorragia intracerebral, riesgo cardiovascular,

Keywords: cardiovascular risk, Intracerebral hemorrhage, oral anticoagulation,

Hemorragia en área dependiente de circulación cerebral posterior por síndrome de hiperperfusión tras stenting en arteria carótida interna. Hemorrhage on a dependent area of posterior cerebral circulation due to hyperperfusion syndrome after stenting in internal carotid artery.

Cerebral hyperperfusion syndrome (CHS) after stent placement has a low incidence, between 0.37- 1.9% (1,2). We present a case of CHS due to recanalization in right internal carotid artery (ICA) which, contrary to expectations, produces a hematoma on a dependent area of the posterior cerebral circulation. Through the clinical case, we proceed to delve into the CHS and the characteristics that give the patient a higher risk. In addition, we expose the potential usefulness of the neurosonological study of inter-individual variability for better perioperative management. In this way, we can ensure a good therapeutic approach that minimizes morbidity and mortality as much as possible.

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Palabras clave: Hemorragia intracerebral, Neurorradiología, Síndrome de hiperp erfusión cerebral, Stent, Tálamo,

Keywords: Cerebral hyperperfusion syndrome, Intracerebral hemorrhage, Neuroradiology, Stent, Thalamus,

Hemorragia en área dependiente de circulación cerebral posterior por síndrome de hiperperfusión tras stenting en arteria carótida interna. Hemorrhage on a dependent area of posterior cerebral circulation due to hyperperfusion syndrome after stenting in internal carotid artery

Cerebral hyperperfusion syndrome (CHS) after stent placement has a low incidence, between 0.37- 1.9% (1,2). We present a case of CHS due to recanalization in right internal carotid artery (ICA) which, contrary to expectations, produces a hematoma on a dependent area of the posterior cerebral circulation. Through the clinical case, we proceed to delve into the CHS and the characteristics that give the patient a higher risk. In addition, we expose the potential usefulness of the neurosonological study of inter-individual variability for better perioperative management. In this way, we can ensure a good therapeutic approach that minimizes morbidity and mortality as much as possible.

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Palabras clave: Hemorragia intracerebral, Neurorradiología, Síndrome de hiperperfusión cerebral, Stent, Tálamo,

Keywords: Cerebral hyperperfusion syndrome, Intracerebral hemorrhage, Neuroradiology, Stent, Thalamus,

Niveles altos de hemoglobina glicosilada se asocian a hemorragia intracerebral espontánea: Estudio de casos y controles. High levels of glycated hemoglobin are associated with spontaneous intracerebral hemorrhage: A case control study

Introduction: Evidence shows that glycosylated hemoglobin (HbA1C) is associated with spontaneous intracerebral hemorrhage (ICH). However, reports in Latin-American patients are scarce.

Objective: To determine if HbA1C is a risk factor for ICH.

Methods: A case-control study was carried out. Cases were hospitalized patients with ICH, whereas the controls were diabetic patients within the same age range. Logistics regression was calculated to identify risk factors associated with ICH.

Results: A total of 45 cases and 45 controls were included. HbA1C values were higher in the ICH group (median 6.8%, IQR=5.8– 7.5) compared to the control group (median 5.8%, IQR=5.5–6.2%; P<0.001). High HbA1C values were identified as a risk factor for ICH (OR=2.75, 95% CI=1.41-5.41). Among the ICH patients, barely 29% had a confirmed previous diagnosis of diabetes. The hospital mortality rate in the ICH patients was 37.8%, while mortality was 15% in the patients with diabetes and 46% in those without a previous diabetes diagnosis. 

Conclusions: High HbA1C levels were associated with the development of ICH. It is paramount to improve public policies for early detection of diabetes due to the potential to reduce the impact of spontaneous intracerebral hemorrhage in the general population.

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Palabras clave: diabetes, evento cerebrovascular, Factores de riesgo, hemoglobina glicosilada, Hemorragia intracerebral, hiperglicemia,

Keywords: cerebrovascular event, diabetes, glycosylated hemoglobin, hyperglycemia, Intracerebral hemorrhage, Risk factors,
 
 
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