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Revista Médica Sinergia

2023, Number 09

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Revista Médica Sinergia 2023; 8 (09)

What we should know and master about ischemic cerebrovascular disease at the first level of care

Mojica FRG

Language: Spanish
References: 17
Page:
PDF size: 183.10 Kb.


ABSTRACT

Cerebrovascular disease is a sudden neurological impairment attributable to a focal vascular cause. The definition of ischemic is oriented when it is due to an obstruction that causes a decrease or absence of blood flow, generally due to a thrombus in the vasculature in situ or an embolization from another place, causing a neuronal energy deficit with subsequent death of the affected neurons. Age is the most important demographic risk factor and although the incidence of cerebrovascular disease has decreased in recent years, the lifetime risk of stroke has increased due to the aging of the population. The clinical manifestations will correspond to the location of the ischemia, but are generally absent or decreased sensory, motor function or both in one half of the body, loss of speech or understanding, vision changes, gait disturbance, and sudden severe headache. The most common etiologies are cardioembolic, arterioarterial embolism and stenosis that limits the flow of a large extracranial vessel. Within the diagnostic tools, the first study of choice is still computed tomography without contrast, basically to show or not a bleeding process to rule out hemorrhagic cerebrovascular disease that may explain the patient's presentation. Lastly, seek the continuous education of our patients, guiding them towards a healthy lifestyle and be attentive in our consultations to see the clinical evolution of these patients.


REFERENCES

  1. Rhoades RA, Bell DR. Potencial de acción, transmisión sináptica y función nerviosa. En: Rhoades RA, Bell DR, editores. Fisiología Médica: Fundamentos de Medicina Clínica. Barcelona, España: Wolters Kluwer; 2018. p. 90-125.

  2. Smith WS, Johnston SC, Hemphill JC, III. Introducción a las enfermedades cerebrovasculares. En: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, et al., editores. Harrison´s Principles of Internal Medicine. New York: McGraw Hill; 2022. p. 12090-12123.

  3. Caplan L. Overview of the evaluation of stroke. UpToDate [Internet]. 2022 [citado el 03 enero 2023]. Disponible en: https://www.uptodate.com/contents/overview-of-the-evaluation-of-stroke?search=enfermedad%20cerebrovascular%20isquémica&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2

  4. Feske SK. Ischemic Stroke. Am J Med [Internet]. Diciembre 2021 [citado el 26 diciembre 2022];134(12):1457-1464. DOI. 10.1016/j.amjmed.2021.07.027 Disponible en: https://doi.org/10.1016/j.amjmed.2021.07.027

  5. Douglas VC, Aminoff MJ. Stroke. In: Papadakis MA, McPhee SJ, editors. CurrentMedical Diagnosis & Treatment. New York: McGraw-Hill; 2021. p. 2550 - 2562.

  6. García C, Martínez Reyes A, García V, Fajardo AR, Torres I, et al. Actualización en diagnóstico y tratamiento del ataque cerebrovascular isquémico agudo. Univ. Med. [Internet]. Setiembre 2019 [citado el 07 enero 2023];60(3):1-17. DOI: 10.11144/Javeriana.umed60-3.actu. Disponible en: https://doi.org/10.11144/Javeriana.umed60-3.actu

  7. inec.gob.pa. Defunciones y tasa de mortalidad de las principales causas de muerte en la república, por sexo, según causa: Año 2020 [Internet]. 2022 [citado el 07 enero 2022]. Disponible en: https://www.inec.gob.pa/archivos/P0774740120220127100641Cuadro%2013.pdf

  8. Goldstein LB. Enfermedad Cerebrovascular Isquémica. En: Goldman L, Schafer AI, editores. Goldman-Cecil Tratado de Medicina Interna. Barcelona, España: Elsevier; 2021. p. 2398–2410.

  9. Diener HC, Hankey GJ. Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage. JACC [Internet]. Abril 2020 [citado el 24 mayo 2023];75(15):1804–1818. DOI: 10.1016/j.jacc.2019.12.072. Disponible en: https://doi.org/10.1016/j.jacc.2019.12.072

  10. Khan SU, Khan MU, Riaz H, Valavoor S, Zhao Di, et al. Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map. Ann Intern Med [Internet]. Agosto 2019 [citado el 25 mayo 2023];171(3):190–198. DOI: 10.7326/M19-0341. Disponible en: https://doi.org/10.7326/M19-0341

  11. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomized trials in the context of expectations from prospective epidemiological studies. BMJ [Internet]. Mayo 2009 [citado el 25 mayo 2023];338:1-19. DOI: 10.1136/bmj.b1665. Disponible en: https://doi.org/10.1136/bmj.b1665

  12. Zheng SL, Roddick AJ. Association of Aspirin Use for Primary Prevention with Cardiovascular Events and Bleeding Events: a systematic review and meta-analysis. JAMA [Internet]. Enero 2019 [citado el 27 mayo 2023];321(3):277–287. DOI: 10.1001/jama.2018.20578. Disponible en: https://doi.org/10.1001/jama.2018.20578

  13. Armitage J, Baigent C, Barnes E, Betteridge DJ, Blackwell L, et al. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomized controlled trials. Lancet [Internet]. Febrero 2019 [citado el 27 mayo 2023];393(10170):407–415. DOI: 10.1016/S0140-6736(18)31942-1. Disponible en: https://doi.org/10.1016/S0140-6736(18)31942-1

  14. Yebyo HG, Aschmann HE, Kaufmann M, Puhan MA. Comparative effectiveness and safety of statins as a class and of specific statins for primary prevention of cardiovascular disease: A systematic review, meta-analysis, and network meta-analysis of randomized trials with 94,283 participants. Am Heart J [Internet]. Abril 2019 [citado el 28 mayo 2023];210:18–28. DOI: 10.1016/j.ahj.2018.12.007. Disponible en: https://doi.org/10.1016/j.ahj.2018.12.007

  15. Kitagawa K, Yamamoto Y, Arima H, Maeda T, Sunami N, et al. Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent Stroke: A Randomized Clinical Trial and Meta-analysis. JAMA Neurol [Internet]. Julio 2019 [citado el mayo 28, 2023];76(11):1309-1318. DOI: 10.1001/jamaneurol.2019.2167. Disponible en: https://doi.org/10.1001/jamaneurol.2019.2167

  16. Collins R, Reith C, Emberson J, Armitage J, Baigent C, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet [Internet]. Noviembre 2016 [citado el mayo 30, 2023];388(10059):2532–2561. DOI: 10.1016/S0140-6736(16)31357-5. Disponible en: https://doi.org/10.1016/S0140-6736(16)31357-5

  17. Rerkasem A, Orrapin S, Howard D, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev [Internet]. Septiembre 2020 [citado el 01 junio 2023];9:1-47. DOI: 10.1002%2F14651858.CD001081.pub4. Disponible en: https://doi.org/10.1002%2F14651858.CD001081.pub4




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