La asterixis y la disartria-mano torpe son signos neurológicos poco frecuentes que pertenecen a los trastornos del movimiento después de un accidente cerebrovascular. Clínicamente ellos son clasificados como parte del infarto lacunar y la mayoría de los casos se resuelven espontáneamente en un periodo entre 10 semanas y un mes. El objetivo de este estudio fue reportar seis casos de pacientes masculinos con infarto lacunar y describir los síntomas, localización y tamaño de las lesiones. Se describen casos de infarto lacunar y síntomas motores leves (disartria y asterixis) sin ningún indicio de demencia. En conclusión, nuestros casos presentan movimientos neurológicos anormales como asterixis y disartria-mano torpe en pacientes con hipertensión y / o diabetes mellitus tipo 2. Debido a la transitoriedad de esos movimientos, el diagnóstico en el tiempo adecuado es importante, a partir de eso los médicos pueden solicitar los exámenes de imagen, tratar al paciente y luego acompañarlo previniendo futuros ictus con consecuencias aún más graves. Así, estudios como el nuestro pueden contribuir al correcto diagnóstico de los infartos lacunares.
infarto lacunar
Índice de Pulsatilidad Cerebral en Adultos Mayores con Infarto Lacunar Silente (Proyecto Atahualpa). Cerebral Pulsatility Index In Older Adults With Silent Lacunar Strokes (The Atahualpa Project).
Background: Diagnosis of silent lacunar infarcts is complicated in remote rural areas where MRI is not available. Hospital series have suggested an association between the pulsatility index of intracranial arteries –as assessed by transcranial Doppler –and some neuroimaging signatures of cerebral small vessel disease. We aimed to assess the reliability of cerebral pulsatility indices to identify candidates for MRI screening in population-based studies assessing prevalence of silent lacunar infarctions.
Methods: A random sample of stroke-free Atahualpa residents aged ≥60 years investigated with MRI underwent transcranial Doppler for calculating the pulsatility index (PI) of the middle cerebral artery (MCA). For each person, mean PI was obtained by averaging both MCAs. Using conditional logistic regression for matched pairs data, we evaluated whether the pulsatility index of both MCAs correlate with silent lacunar infarcts.
Results: Silent lacunar infarcts were noticed in 28 (12%) of 234 scanned persons. Six of them were excluded due to poor insonation through transtemporal windows. The remaining 22 participants were considered case-patients and were matched 1:1 with individuals free of infarcts (controls). Moderate-to-severe white matter hyperintensities were noticed in 12 (55%) case-patients and 7 (32%) controls (p=0.228). The mean MCA PI value in the 44 participants was 1.15 ± 0.21, with no difference found across case-patients and controls, after adjustment for white matter hyperintensities (β coefficient: 3.361, 95% C.I.: -0.693 to 7.417, p=0.104).
Conclusions: Cerebral PI should not be used to identify candidates for MRI screening in population-based studies assessing the burden of silent lacunar infarcts.
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Disappearing Cerebral Microbleed After A Lacunar Infarct
Both, lacunar infarcts and deep cerebral microbleeds are recognized markers of cerebral small vessel disease. However, the “de novo” appearance of an infarct at the site of a previously documented microbleeds has not been described. Here, we report a patient who suffered a lacunar infarct at the site of a microbleed, associated with its disappearing on MRI. This case illustrate a previously unrecognized progression of a cerebral microbleed, which may help to elucidate pathogenetic mechanisms involved in this uncommon evolution.
