Sandra Lepera - Academia.edu (original) (raw)
Papers by Sandra Lepera
Journal of Stroke and Cerebrovascular Diseases
Journal of Stroke and Cerebrovascular Diseases, 2001
Background: Activated C protein resistance (APC-R) has recently been reported to be a common caus... more Background: Activated C protein resistance (APC-R) has recently been reported to be a common cause of thrombophilia; it may be acquired or caused by a genetic defect (factor V Leiden mutation). It is clear that there is an association between APC-R and venous thrombosis. It has been suggested that there is a possible relationship of APC-R with arterial ischemic stroke (IS), but case-control studies have not given enough clues for considering APC-R as a main risk factor. Objectives: To assess the incidence of APC-R in patients with IS of several ethiologies in Buenos Aires. Patients and methods: Seventy-two patients with IS were assessed for signs or symptoms of previous clinical thrombophilia and the presence of vascular risk factors (RF). They were searched for APC-R (COATEST, APC resistance-V, with a predilution of the samples) test. Determinations were carried out between 1 to 4 months after the ischemic episode. The plasma of 50 healthy control subjects (blood donors) was used as controls. Results: None of the patients had signs of previous thrombophilia; 57 (79.2%) had RF for IS, and 3 (4.2%) had APC-R (all of them with RF). One subject in the control group (2%) showed a low APC response (1/50). The ocurrence of APC-R among patients with stroke was not significantly higher when compared with the ocurrence of APC-R among the control subjects. Conclusions: In the present series, the incidence of factor V Leiden related APC-R in the group with IS was similar to the healthy population. Other risk factors were associated in patients showing APC-R.
Journal of the Neurological Sciences, 1997
Neurología Argentina, 2010
BackgroudStroke is a major cause of disability and death. Stroke Units (SU) have improved the tre... more BackgroudStroke is a major cause of disability and death. Stroke Units (SU) have improved the treatment of cerebrovascular disease.
Neurología Argentina, 2015
n e u r o l a r g . 2 0 1 5;7(2):117-119 w w w.elsevier.es/neurolar g
Archives of Neurology, 2001
The simultaneous occurrence of intracerebral hemorrhages in different arterial territories is an ... more The simultaneous occurrence of intracerebral hemorrhages in different arterial territories is an uncommon clinical event. Its predisposing factors and pathophysiological mechanisms are not clearly defined. To analyze the frequency, risk factors, clinical features, neuroimaging findings, and outcome of multiple simultaneous intracerebral hemorrhages (SIHs). We studied all patients with acute stroke admitted to our hospital from July 18, 1997, through December 18, 1999. Multiple SIHs were defined as the presence of 2 or more intracerebral hemorrhages affecting different arterial territories with identical computed tomographic density profiles. Patients with a history of traumatic brain injury were excluded from this study. Diagnostic investigation included routine blood and urine tests, coagulation studies, a chest radiograph, electrocardiogram, 2-dimensional transthoracic echocardiography, and computed tomography of the head without contrast medium. Disability was assessed using the National Institutes of Health Stroke Scale and Modified Rankin Scale. Among 142 patients with hemorrhagic stroke, we found 4 (2.8%) with SIHs. All 4 patients had a history of uncontrolled arterial hypertension. We excluded other potential causes of multiple SIHs by using appropriate diagnostic tests. The most common clinical manifestations were headache and weakness. Localization of hematomas was supratentorial, except for one patient who had both infratentorial and supratentorial hemorrhages. The mean National Institutes of Health score on admission was 15 and the Modified Rankin Scale score was higher than 4 at 3 months. In our study, all patients with multiple SIHs had arterial hypertension and a poor outcome. Additional analytic studies, including new imaging techniques, can help to elucidate the association between arterial hypertension and multiple SIHs, risk factors, and underlying mechanisms of this clinical condition.
Journal of the Neurological Sciences, 1997
in carotid arteries effects the prevalence of stroke highly and it is one of the most important r... more in carotid arteries effects the prevalence of stroke highly and it is one of the most important risk factors of stroke. In this study, age, sex and the cetvical bruits were assessed with relation to the degree of stenosis in ischaemic cerebrovascular accidents. We prospectively investigated the degree of stenosis in the carotid arteries using duplex ultrasound in a total of 104 patients. of these, 70 patients had ischaemic strokes (IS) and 34 patients had transient ischaemic attacks (TIA). The results were compared with those of 30 control subjects. We classified carotid stenosis as follows: mild, 0% to 35%; moderate, 35% to 75%; and significant 75%. We could not find any relationship between sex and the degree of stenosis. The incidence of carotid stenosis was much more common in IS group compared with that in TIA group. Moderate stenosis was higher in patients with TIA, over 65 years of age. Bilateral carotid stenosis was statistically significant in the patients with IS (x = 3.81, p = 0.005). We found significant correlations between the cervical bruits and the degree of stenosis in patient subgroups with moderate and significant stenosis (x = 8.99, p = 0.0082). Detection of carotid stenosis is essential for the prevention and the treatment of IS, and duplex ultrasound can be employed in patients with IS.
Neurología Argentina, 2010
... Por Corina Christie a, Sandra Lepera a, Alejandro Giacchino a, Raúl Carlos Rey a. a. ... 2008... more ... Por Corina Christie a, Sandra Lepera a, Alejandro Giacchino a, Raúl Carlos Rey a. a. ... 2008;19(2):143-5. [Medline] 16. Bou-Haidar P, Peduto AJ, Karunaratne N. Differential diagnosis of T2 hyperintense spinal cord lesions: Part A. J Med Imaging Radiat Oncol. 2009;52:535-43. ...
Acta Neurologica Scandinavica, 2001
Journal of the Neurological Sciences, 1997
of the sinocarotid reflexogenic zone plays important role in hypertensive cerebrovascular patholo... more of the sinocarotid reflexogenic zone plays important role in hypertensive cerebrovascular pathology. The purpose of this study was to evaluate the results of the application of ethylchloride spray (ECS) on the projection of the sinocarotid zones in hypertensive patients with headaches. The effect of ECS was studied in 252 hypertensive patients with headaches just after ECS and 30,60, 120 min later, after full cessation of hypotensive and other vasoactive medication. After ECS marked analgesic effect -diminution or dissaperance of headaches -was observed in 76.3% of patients. ECS definitely lowered retinal (from 96 + 2.7/70 + 2.1 to 65 + 2.6/62 + 2.0 mmHg), temporal (from 116 + 2.5'52 + 1.7 to 100 + 2.5/46 + 1.7 mmHg) and brachial (from 163 + 3.0196 + 1.5 to 152 + 2.7/92 + 1.3 mmHg) arterial pressure.
Journal of the Neurological Sciences, 1997
Journal of Stroke and Cerebrovascular Diseases, 2001
Background: Activated C protein resistance (APC-R) has recently been reported to be a common caus... more Background: Activated C protein resistance (APC-R) has recently been reported to be a common cause of thrombophilia; it may be acquired or caused by a genetic defect (factor V Leiden mutation). It is clear that there is an association between APC-R and venous thrombosis. It has been suggested that there is a possible relationship of APC-R with arterial ischemic stroke (IS), but case-control studies have not given enough clues for considering APC-R as a main risk factor. Objectives: To assess the incidence of APC-R in patients with IS of several ethiologies in Buenos Aires. Patients and methods: Seventy-two patients with IS were assessed for signs or symptoms of previous clinical thrombophilia and the presence of vascular risk factors (RF). They were searched for APC-R (COATEST, APC resistance-V, with a predilution of the samples) test. Determinations were carried out between 1 to 4 months after the ischemic episode. The plasma of 50 healthy control subjects (blood donors) was used as controls. Results: None of the patients had signs of previous thrombophilia; 57 (79.2%) had RF for IS, and 3 (4.2%) had APC-R (all of them with RF). One subject in the control group (2%) showed a low APC response (1/50). The ocurrence of APC-R among patients with stroke was not significantly higher when compared with the ocurrence of APC-R among the control subjects. Conclusions: In the present series, the incidence of factor V Leiden related APC-R in the group with IS was similar to the healthy population. Other risk factors were associated in patients showing APC-R.
Neurología Argentina, 2015
Revista de neurologia
Bilateral paramedian thalamic infarcts are uncommon. The most frequent clinical manifestations ar... more Bilateral paramedian thalamic infarcts are uncommon. The most frequent clinical manifestations are acute impairment of consciousness, oculomotor abnormalities and cognitive disturbances. A fluctuating course has not been previously reported. A 66 year-old woman with a past history of arterial hypertension and diabetes was admitted to our hospital presenting four episodes of decreased consciousness and vertical gaze paresis. Neurological examination between episodes was unremarkable. Diffusion-weighted magnetic resonance imaging revealed high-signal lesions in both paramedian thalamic areas. Fluctuating impairment of consciousness may be a clinical presentation of bilateral paramedian thalamic infarction. Atheromatous occlusion of the mouth of the paramedian thalamic penetrating artery is the most common cause. Neurological findings and diffusion-weighted images may help to define the extension and the underlying pathophysiological mechanism.
Neurología Argentina, 2012
Neurología Argentina, 2015
Journal of Stroke and Cerebrovascular Diseases
Journal of Stroke and Cerebrovascular Diseases, 2001
Background: Activated C protein resistance (APC-R) has recently been reported to be a common caus... more Background: Activated C protein resistance (APC-R) has recently been reported to be a common cause of thrombophilia; it may be acquired or caused by a genetic defect (factor V Leiden mutation). It is clear that there is an association between APC-R and venous thrombosis. It has been suggested that there is a possible relationship of APC-R with arterial ischemic stroke (IS), but case-control studies have not given enough clues for considering APC-R as a main risk factor. Objectives: To assess the incidence of APC-R in patients with IS of several ethiologies in Buenos Aires. Patients and methods: Seventy-two patients with IS were assessed for signs or symptoms of previous clinical thrombophilia and the presence of vascular risk factors (RF). They were searched for APC-R (COATEST, APC resistance-V, with a predilution of the samples) test. Determinations were carried out between 1 to 4 months after the ischemic episode. The plasma of 50 healthy control subjects (blood donors) was used as controls. Results: None of the patients had signs of previous thrombophilia; 57 (79.2%) had RF for IS, and 3 (4.2%) had APC-R (all of them with RF). One subject in the control group (2%) showed a low APC response (1/50). The ocurrence of APC-R among patients with stroke was not significantly higher when compared with the ocurrence of APC-R among the control subjects. Conclusions: In the present series, the incidence of factor V Leiden related APC-R in the group with IS was similar to the healthy population. Other risk factors were associated in patients showing APC-R.
Journal of the Neurological Sciences, 1997
Neurología Argentina, 2010
BackgroudStroke is a major cause of disability and death. Stroke Units (SU) have improved the tre... more BackgroudStroke is a major cause of disability and death. Stroke Units (SU) have improved the treatment of cerebrovascular disease.
Neurología Argentina, 2015
n e u r o l a r g . 2 0 1 5;7(2):117-119 w w w.elsevier.es/neurolar g
Archives of Neurology, 2001
The simultaneous occurrence of intracerebral hemorrhages in different arterial territories is an ... more The simultaneous occurrence of intracerebral hemorrhages in different arterial territories is an uncommon clinical event. Its predisposing factors and pathophysiological mechanisms are not clearly defined. To analyze the frequency, risk factors, clinical features, neuroimaging findings, and outcome of multiple simultaneous intracerebral hemorrhages (SIHs). We studied all patients with acute stroke admitted to our hospital from July 18, 1997, through December 18, 1999. Multiple SIHs were defined as the presence of 2 or more intracerebral hemorrhages affecting different arterial territories with identical computed tomographic density profiles. Patients with a history of traumatic brain injury were excluded from this study. Diagnostic investigation included routine blood and urine tests, coagulation studies, a chest radiograph, electrocardiogram, 2-dimensional transthoracic echocardiography, and computed tomography of the head without contrast medium. Disability was assessed using the National Institutes of Health Stroke Scale and Modified Rankin Scale. Among 142 patients with hemorrhagic stroke, we found 4 (2.8%) with SIHs. All 4 patients had a history of uncontrolled arterial hypertension. We excluded other potential causes of multiple SIHs by using appropriate diagnostic tests. The most common clinical manifestations were headache and weakness. Localization of hematomas was supratentorial, except for one patient who had both infratentorial and supratentorial hemorrhages. The mean National Institutes of Health score on admission was 15 and the Modified Rankin Scale score was higher than 4 at 3 months. In our study, all patients with multiple SIHs had arterial hypertension and a poor outcome. Additional analytic studies, including new imaging techniques, can help to elucidate the association between arterial hypertension and multiple SIHs, risk factors, and underlying mechanisms of this clinical condition.
Journal of the Neurological Sciences, 1997
in carotid arteries effects the prevalence of stroke highly and it is one of the most important r... more in carotid arteries effects the prevalence of stroke highly and it is one of the most important risk factors of stroke. In this study, age, sex and the cetvical bruits were assessed with relation to the degree of stenosis in ischaemic cerebrovascular accidents. We prospectively investigated the degree of stenosis in the carotid arteries using duplex ultrasound in a total of 104 patients. of these, 70 patients had ischaemic strokes (IS) and 34 patients had transient ischaemic attacks (TIA). The results were compared with those of 30 control subjects. We classified carotid stenosis as follows: mild, 0% to 35%; moderate, 35% to 75%; and significant 75%. We could not find any relationship between sex and the degree of stenosis. The incidence of carotid stenosis was much more common in IS group compared with that in TIA group. Moderate stenosis was higher in patients with TIA, over 65 years of age. Bilateral carotid stenosis was statistically significant in the patients with IS (x = 3.81, p = 0.005). We found significant correlations between the cervical bruits and the degree of stenosis in patient subgroups with moderate and significant stenosis (x = 8.99, p = 0.0082). Detection of carotid stenosis is essential for the prevention and the treatment of IS, and duplex ultrasound can be employed in patients with IS.
Neurología Argentina, 2010
... Por Corina Christie a, Sandra Lepera a, Alejandro Giacchino a, Raúl Carlos Rey a. a. ... 2008... more ... Por Corina Christie a, Sandra Lepera a, Alejandro Giacchino a, Raúl Carlos Rey a. a. ... 2008;19(2):143-5. [Medline] 16. Bou-Haidar P, Peduto AJ, Karunaratne N. Differential diagnosis of T2 hyperintense spinal cord lesions: Part A. J Med Imaging Radiat Oncol. 2009;52:535-43. ...
Acta Neurologica Scandinavica, 2001
Journal of the Neurological Sciences, 1997
of the sinocarotid reflexogenic zone plays important role in hypertensive cerebrovascular patholo... more of the sinocarotid reflexogenic zone plays important role in hypertensive cerebrovascular pathology. The purpose of this study was to evaluate the results of the application of ethylchloride spray (ECS) on the projection of the sinocarotid zones in hypertensive patients with headaches. The effect of ECS was studied in 252 hypertensive patients with headaches just after ECS and 30,60, 120 min later, after full cessation of hypotensive and other vasoactive medication. After ECS marked analgesic effect -diminution or dissaperance of headaches -was observed in 76.3% of patients. ECS definitely lowered retinal (from 96 + 2.7/70 + 2.1 to 65 + 2.6/62 + 2.0 mmHg), temporal (from 116 + 2.5'52 + 1.7 to 100 + 2.5/46 + 1.7 mmHg) and brachial (from 163 + 3.0196 + 1.5 to 152 + 2.7/92 + 1.3 mmHg) arterial pressure.
Journal of the Neurological Sciences, 1997
Journal of Stroke and Cerebrovascular Diseases, 2001
Background: Activated C protein resistance (APC-R) has recently been reported to be a common caus... more Background: Activated C protein resistance (APC-R) has recently been reported to be a common cause of thrombophilia; it may be acquired or caused by a genetic defect (factor V Leiden mutation). It is clear that there is an association between APC-R and venous thrombosis. It has been suggested that there is a possible relationship of APC-R with arterial ischemic stroke (IS), but case-control studies have not given enough clues for considering APC-R as a main risk factor. Objectives: To assess the incidence of APC-R in patients with IS of several ethiologies in Buenos Aires. Patients and methods: Seventy-two patients with IS were assessed for signs or symptoms of previous clinical thrombophilia and the presence of vascular risk factors (RF). They were searched for APC-R (COATEST, APC resistance-V, with a predilution of the samples) test. Determinations were carried out between 1 to 4 months after the ischemic episode. The plasma of 50 healthy control subjects (blood donors) was used as controls. Results: None of the patients had signs of previous thrombophilia; 57 (79.2%) had RF for IS, and 3 (4.2%) had APC-R (all of them with RF). One subject in the control group (2%) showed a low APC response (1/50). The ocurrence of APC-R among patients with stroke was not significantly higher when compared with the ocurrence of APC-R among the control subjects. Conclusions: In the present series, the incidence of factor V Leiden related APC-R in the group with IS was similar to the healthy population. Other risk factors were associated in patients showing APC-R.
Neurología Argentina, 2015
Revista de neurologia
Bilateral paramedian thalamic infarcts are uncommon. The most frequent clinical manifestations ar... more Bilateral paramedian thalamic infarcts are uncommon. The most frequent clinical manifestations are acute impairment of consciousness, oculomotor abnormalities and cognitive disturbances. A fluctuating course has not been previously reported. A 66 year-old woman with a past history of arterial hypertension and diabetes was admitted to our hospital presenting four episodes of decreased consciousness and vertical gaze paresis. Neurological examination between episodes was unremarkable. Diffusion-weighted magnetic resonance imaging revealed high-signal lesions in both paramedian thalamic areas. Fluctuating impairment of consciousness may be a clinical presentation of bilateral paramedian thalamic infarction. Atheromatous occlusion of the mouth of the paramedian thalamic penetrating artery is the most common cause. Neurological findings and diffusion-weighted images may help to define the extension and the underlying pathophysiological mechanism.
Neurología Argentina, 2012
Neurología Argentina, 2015