Ictus (Ictus) es una publicación periódica con revisión por pares, y es el órgano oficial de la Asociación Mexicana de Enfermedad Vascular Cerebral, A.C. Ictus recibe y publica artículos originales, así como cartas editoriales, casos clínicos, artículos de revisión e introspección de expertos , de las diferentes areas de la medicina. Ictus tiene todos los Derechos Reservados (C) Asociación Mexicana de Enfermedad Vascular Cerebral, A.C. y sus artículos son Open Access bajo licencia CC BY-NC-ND (Creative Commons — Attribution-NonCommercial-NoDerivatives 4.0 International — CC BY-NC-ND 4.0).
Intestinal Microbiota in Ischemic and Hemorrhagic Stroke
Letter to the editor about "Intestinal Microbiota in Ischemic and Hemorrhagic Stroke" published in volume 5, issue 3 of ICTUS.
Copyright (c) 2025 Paulina Elizabeth Bombón-Albán, Johanna Vanessa Suárez-Salazar https://creativecommons.org/licenses/by-nc-nd/4.0
Pseudoephedrine and Risk of Posterior Reversible Encephalopathy Syndrome (PRES): Case Report in an Adult Patient
Clinical Image on 'Pseudoephedrine and the Risk of Posterior Reversible Encephalopathy Syndrome (PRES): Case Report in an Adult Patient' presented in volume 5, Issue 1 of Ictus.
Posterior Reversible Encephalopathy Syndrome
Copyright (c) 2025 Jorge Andrés Hernández-Navas; Diego Andrés Torres-Ardila (Autor); Luis Andres Dulcey-Sarmiento, Juan Sebastian Theran, Jaime Gómez-Ayala, Víctor Barbosa-Navarro https://creativecommons.org/licenses/by-nc-nd/4.0
Boston 2.0 Criteria for Cerebral Amyloid Angiopathy
Copyright (c) 2025 Juan Antonio Sotelo-Ramirez (Autor); Amado Jiménez-Ruiz, Ivan Roque-Sánchez, Juan Carlos Ayala-Alvarez, José Luis Ruiz-Sandoval https://creativecommons.org/licenses/by-nc-nd/4.0
Alteplase-induced Facial Orolingual Angioedema
Clinical snapshot on "Alteplase-induced Facial Orolingual Angioedema" presented in volume 5 issue 1 of ICTUS.
Copyright (c) 2025 Amado Jiménez-Ruiz (Autor); Ricardo Gabriel Ascencio-Tene; Juan Carlos Ayala-Alvarez (Autor); Iván Roque-Sánchez; Santiago Alba-Valencia, Jose Luis Ruiz-Sandoval (Autor) https://creativecommons.org/licenses/by-nc-nd/4.0
Update on the Management of Acute Ischemic Stroke
Stroke is the second cause of morbidity and mortality in Chile. Mechanical thrombectomy (MT) is a time-dependent therapy that is effective in reducing the probability of functional dependence in cases with arterial ischemic stroke due to large vessel occlusion and non-extensive infarcted tissue volume. With this approach, treatment can only be indicated for around 9% of total acute ischemic stroke (AIS) cases, so assessing additional situations that were not included in the pivotal trials has been the emphasis of multiple recently published studies. We, therefore conducted a systematic review of the literature published between January 2015 and May 2023, prioritizing clinical trials and meta-analyses of individual patients. Evidence on situations that to this day are controversial, such as intravenous thrombolytic bridging therapy, occlusion of medium caliber vessels, extensive ischemic core, low NIHSS, acute stent placement, and use of antiplatelet agents in the first 24 hours, intra-arterial adjuvant thrombolysis, TM in basilar artery occlusion and the radial approach in complex aortic arches. Expanding the indication for MT under new selection criteria, dispensing the use of advanced neuroimaging, and using adjuvant fibrinolytic or antiaggregant therapies in selected cases, seems to be the path to a paradigm shift that allows expanding the number of patients eligible for reperfusion therapy, without significantly increasing the complications associated with the intervention.
Copyright (c) 2023 Andrés Gallardo, Pablo Cox https://creativecommons.org/licenses/by-nc-nd/4.0
Air Pollution-related Stroke in Guadalajara. A Call to Action
Editorial on "Air Pollution-related Stroke in Guadalajara. A Call to Action" presented in volume 5 number 1 of 2024 of ICTUS.
Copyright (c) 2024 Fatima Gabriela Macias-Ortiz; Victor Aguilar-Fuentes (Autor); Amado Jimenez-Ruiz; Jose Luis Ruiz-Sandoval (Revisor IPAO) https://creativecommons.org/licenses/by-nc-nd/4.0
Atrial Fibrillation and Multi-infarct dementia
Clinical snapshot on "Atrial Fibrillation and Multi-infarct Dementia" presented in volume 4 number 3 of 2023 of ICTUS.
Copyright (c) 2024 Amado Jimenez-Ruiz; Victor Aguilar-Fuentes, Jose Luis Ruiz-Sandoval (Autor) https://creativecommons.org/licenses/by-nc-nd/4.0
Cryptogenic Stroke, Review of the Mechanisms and Clinical Therapeutic Implications of a Complex Clinical Problem
Cryptogenic stroke represents a heterogenous but clinically important collection of stroke etiologies for which our understanding continues to grow. Here, we review our current knowledge and most recent recommendations on secondary prevention for common causes of cryptogenic stroke including paroxysmal atrial fibrillation, atrial cardiopathy, patent foramen ovale, and substenotic atherosclerotic disease as well as the under-recognized mechanisms of occult malignancy, heart failure, and, most recently, infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The results from recent observational studies and randomized clinical trials have provided greater insight into the causal relationship and attributable risk of these suspected etiologies and have identified potential strategies to reduce the rates of recurrence. However, further clinical trials are needed to confirm the benefits of specific stroke prevention strategies, including the patient populations most likely to benefit from anticoagulation. There is ongoing research aimed at both reducing the proportion of ischemic strokes classified as cryptogenic and resolving much of the clinical equipoise that still exists. The results of these studies have the potential to provide us with a better understanding of these occult mechanisms and allow for more targeted interventions.
Copyright (c) 2023 Luis Andrés Dulcey-Sarmiento, Juan Sebastián Theran-Leon, Valentina Cabrera-Peña, Rafael Guillermo Parales-Strauch, Raimondo Caltagirone https://creativecommons.org/licenses/by-nc-nd/4.0
Global Cerebral Infarction After In-hospital Cardiac Arrest
Clinical Image on "Global Cerebral Infarction After Hospital Cardiac Arrest" presented in volume 4 issue 1 of 2023 of Ictus.
Copyright (c) 2023 Amado Jiménez-Ruiz, Fernando Benavides-Gómez, Omar Cardenas-Saenz, Enrique Gomez-Figueroa, José Luis Ruiz-Sandoval (Autor) https://creativecommons.org/licenses/by-nc-nd/4.0
Could Treating Atrial Fibrillation Reduce the Risk of Cognitive Decline and Dementia?
Letter to the Editor on "Could Treating Atrial Fibrillation Reduce the Risk of Cognitive Decline and Dementia?" presented in Volume 4 Issue 1 of 2023 of ICTUS.
Copyright (c) 2023 Paulina Elizabeth Bombon-Alban https://creativecommons.org/licenses/by-nc-nd/4.0
Cerebrovascular disease in COVID-19, Review of its Pathological Mechanisms, Diagnostic Imaging and Therapeutic Implications
Acute cerebrovascular disease, particularly ischemic stroke, has emerged as a serious complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The accumulation of data on stroke patients associated with COVID-19 has shed light on specificities related to clinical presentation, neuroimaging findings, and their outcomes. Such specificities include a propensity for large-vessel occlusion, multiterritorial stroke, and involvement of otherwise uncommonly affected vessels. In contrast, cerebral small vessel disease, cerebral venous thrombosis, and intracerebral hemorrhage appear to be less common. Cases presenting with encephalopathy or encephalitis with seizures presaging stroke were particularly challenging. The pathogenesis and optimal management of ischemic stroke associated with COVID-19 remain uncertain, but emerging evidence suggests that cytokine storm-triggered coagulopathy and endotheliopathy represent possible target mechanisms. Some specific management issues in this population include the difficulty in identifying clinical signs of stroke in critically ill patients in the intensive care unit, as well as the need for a protected pathway for brain imaging, intravenous thrombolysis, and mechanical thrombectomy, considering that "time is brain" also for patients with COVID-19.
Copyright (c) 2023 Ictus https://creativecommons.org/licenses/by/4.0
Heparin-induced thrombocytopenia, review of mechanisms involved, diagnosis and management of a complex adverse event
Heparin induced thrombocytopenia (HIT) is an immune mediated disorder caused by antibodies that recognize complexes of platelet factor 4 and heparin. Thrombosis is a central and unpredictable feature of this syndrome. Despite optimal management, disease morbidity and mortality from thrombosis remain high. The hypercoagulable state in HIT is biologically distinct from other thrombophilic disorders in that clinical complications are directly attributable to circulating ultra-large immune complexes (ULIC). In some individuals, ULIC elicit unchecked cellular procoagulant responses that culminate in thrombosis. To date, the clinical and biologic risk factors associated with thrombotic risk in HIT remain elusive. This review will summarize our current understanding of thrombosis in HIT with attention to its clinical features, cellular mechanisms, and its management.
Pseudotumoral Posterior Fossa Infarction
Clinical Image of "Pseudotumoral Posterior Fossa Infarction" presented in volume 4 issue 1 of 2023 of ICTUS.
Copyright (c) 2023 Amado Jiménez-Ruiz, Juan Carlos Ayala-Alvarez, Rebeca Soledad Gamboa-Gauna, Naomi Nazareth Becerra-Aguiar, José Luis Ruiz-Sandoval (Autor) https://creativecommons.org/licenses/by-nc-nd/4.0
Neuroanatomic Basis of Language and Aphasia Secondary to Stroke
The functional neuroanatomy of language processing has not been fully elucidated. The known anatomical basis of speech have been proposed by various researchers, who have integrated different models of the brain regions involved. In this work, we address: historical aspects of the study of language (from Paul Broca until Hickok and Poeppel); some of the regions of the cerebral cortex that participate in the processing of speech, connected through the white matter; the proposed language models (Charcot, Grasset, Wernicke, Geschwind and dual model for auditory language processing); generalities of aphasias (causes and types); post-stroke aphasia and its treatment; and impact of neuronal plasticity in the treatment of aphasia.
Copyright (c) 2022 Ictus https://creativecommons.org/licenses/by/4.0
Seven Memos for the future of the Mexican Stroke Association
Editorial presented by the President of AMEVASC Dr. Juan Manuel Calleja-Castillo for issue 3 number 3 of ICTUS, Journal of the Mexican Stroke Association.
Editorial on basilar artery thrombectomy in acute ischemic stroke presented in volume 3 issue 2 of Ictus, Journal of the Mexican Association of Cerebral Vascular Disease.
Woven Endobridge Device for Ruptured Aneurysm Within Middle Cerebral Artery Bifurcation
Introduction: Intracranial aneurysms represent an abnormal dilatation on the arterial wall of the cerebral vessels. There is a controversy about the best treatment for ruptured aneurysms located at the middle cerebral artery bifurcation. Case Report: 63-year-old male, presented with left facial paralysis and ipsilateral paresthesia associated with right palpebral ptosis. CT Angiography revealed bleeding in the subarachnoid space, Fisher grade I and the presence of a ruptured, wide neck saccular aneurysm in right middle cerebral artery. Given the size and shape of this wide neck aneurysm (5 mm neck dimension, 7.4 mm height/neck aspect radio and dome/neck radio of 7.43mm.) added to its location, we considered the usage of Woven Endobridge device for endovascular embolization. The device was suitable because of its preferred wide-neck indication (mayor/igual 4mm). Conclusions. Mexico´s experience with intracranial WEB device remains scarce, therefore, pointing out different therapeutic options but neurosurgical clipping highly benefits patients in our country.
Cerebral Arterial Circle ¿The Circle of Willis?
The Circle fo Willis is a particular formation of vessels located at the base of the brain. At some point it was named after Thomas Willis, an eminent English scientist who in his work, Cerebri Anatome, details the anatomy of the nervous system as no one before had done, particularly with regard to its vasculature. However, the historical path of descriptions of the circle of Willis until before Willis, is quite long. Many anatomists, doctors and other scientists had already made an approximation to this network of arteries, years or even centuries before Willis. So, behind the polygon name of Willis, there are many other names that deserve to be recognized.
Transverse Cerebral Venous Sinus Thrombosis Secondary to ChAdOx1-S Vaccine (Recombinant). First Report in Northestern Colombia
Introduction: Adverse events related to vaccines are reactions that can lead to serious complications, in the present that we live at the publication of this article with the need to generate high rates of vaccination have been presented in the case of vaccine agents against COVID-19 adverse events, with thrombotic events being the most important. Case Report: This is a 37-year-old female patient who presents 11 days after ChAdOx1-S vaccination against COVID-19 presents with intense headache associated with symptoms of intracranial hypertension, she was initially taken to simple cranial tomography showing presence of cerebral edema and indirect signs of cerebral venous thrombosis, it is proposed to carry out cerebral angiography which showed the presence of thrombosis of both transverse venous sinuses, no hypercoagulability states were found in the laboratories, the immunological tests carried out for antiphospholipid syndrome were negative, the thrombotic event was associated with the ChAdOx1-S vaccine, later the patient was taken to thrombectomy by Neuroradiology, achieving complete channeling of both transverse venous sinuses. Conclusions. Adverse events associated with vaccination have been described with multiple vaccine agents, this component against COVID-19 is also an event to consider, knowing the pathophysiology of these events is essential to be able to reduce these risks and select the least risky agent. Despite this risk, vaccination remains the only cost-effective measure to reduce the morbidity and mortality associated with COVID-19.
The quality of stroke care begins with the standardization of hospital processes. We present a visually accessible resource for the complex-care process of acute ischemic stroke. The purpose of this tool is to facilitate decision-making in the management of acute ischemic stroke in any emergency room and to generate a significant impact on the quality of care, reducing median delay times and promoting efficiency and safety in each of its steps.
Top of the Basilar Syndrome, Clinical Case Presentation and Literature Review
Cerebral vascular disease includes hemorrhagic and ischemic pathologies, because of the risk factors that prevail in our population, the ischemic spectrum is the most common. Of the ischemic-type, only 20% compromise the posterior circulation, the behavior of this events is usually benign, however, occlusion of the basilar artery has serious neurological repercussions, hence the importance of making an early diagnosis and an early therapeutic intervention that improves the prognosis and recovery of these patients. We present the clinical report of top basilar syndrome, a rare entity, and a review of the literature. There are no studies that report the incidence of this syndrome in Mexico, which is probably the result of underdiagnosis in our country.
Oral Anticoagulants After Ischemic Stroke in Older Adults with Atrial Fibrillation
Letter to the editor about Oral Anticoagulants After Ischemic Stroke in Older Adults with Atrial Fibrillation, published in Ictus volume 3 issue 2.
Abstracts of the First Joint Meeting AMEVASC/SIECV ictus2021
Abstracts of the first joint annual meeting "ictus2021" of the "Asociación Mexicana de Enfermedad Vascular Cerebral (AMEVASC)" and the " Sociedad Iberoamericana de Enfermedades Cerebrovasculares (SIECV)" in October 2021.
Popcorn Brain: Familial Multiple Cerebral Cavernomatosis
Introduction. Cerebral vascular malformations are a heterogeneous group of disorders with several clinical manifestations. Cerebral Cavernous Malformations (CCM) are defined by dilated vascular spaces, with a single layer of endothelium, no mature vessel wall, and no intervening brain parenchyma. CCM may be sporadic or have an autosomal dominant hereditary pattern. Case Report. Here we present the case of a 31-year-old male with a medical history of multiple vascular malformations, difficult to treat epilepsy, and multiple hemorrhagic strokes. At initial evaluation the patient revealed mild dysarthria, left hemiparesis 4/5, hyperreflexia, left dysdiadochokinesia and dysmetria with a modified Rankin scale (mRS) score of 1. Magnetic Resonance Imaging (MRI) of the brain showed multiple supra and infratentorial parenchymal lesions with heterogeneous components on T1-weighted and T2-weighted sequences, surrounded by a rim of signal loss, demonstrating a “popcorn” appearance on Susceptibility-Weighted Angiography (SWAN) MRI. Molecular testing reported a heterozygous KRIT1 c.1099dup (p. His367Profs*3). Screening of fist degree relatives was performed, and antiepileptic treatment was adjusted. As of today, our patient has a mRS of 3, with refractary epileptic seizures. Conclusion. Symptomatic CCM must receive targeted medical treatment with a multidisciplinary approach. If a patient presents with more than one lesion, a familial case should be suspected, molecular testing and a screening head computed tomography should be done in first degree relatives. It is important to follow-up any patient with CCM with an annual MRI to monitor the size and number of lesions, symptomatic medical treatment is indicated, and surgical treatment should also be assessed.
Clinical Imagen presented in issue 3 number 1 of Ictus, Journal of the Mexican Stroke Association.
Lateral Medullary Syndrome in Patients with Vertebral Artery Dissection: Case Series Illustration and Review of the Neuroanatomical Correlates
Introduction: Lateral medullary syndrome (LMS) is the most common of the crossed brainstem syndromes involving the posterior circulation. There are several patterns of sensory dysfunction according to the site of lesion. Although some sources still cite cardioembolism or atherothrombosis as the main causes of lateral medullary infarctions, it is increasingly recognized vertebral artery dissection (VAD) as the chief etiology. Methods: We report on nine patients presenting with LMS due to confirmed VAD in predominantly young individuals (6 men, age range 23-54 years). Results: Most patients presented with sudden headache or neck pain, ataxia and nystagmus (n=7). On neurological examination the majority (n=7) had crossed sensory loss of the classical Wallenberg pattern and all but two had Horner syndrome. At 6-month follow-up no deaths or recurrences were observed: five patients were completely asymptomatic, three patients persisted with mild or moderate deficits and one was unable to walk without assistance. Seven patients had dysphagia that evolved unevenly within the 6-month follow-up period. We also discuss on the clinical and neuroanatomical correlates behind the LMS variants. Conclusions: VAD should be suspected in patients presenting with LMS and headache or neck pain. Given the intricacy of the medulla anatomy and the serendipitous nature of ischemia after VAD, a missing sign from the original Wallenberg’s description is not incompatible with a lateral medullary infarction.
Mechanism of hemorrhagic stroke in the old patiens with COVID-19
Letter to de editor received for volume 2 number 3 of ICTUS, official organ of the Mexican Association of Cerebral Vascular Disease.
Copyright (c) 2021 Ictus https://creativecommons.org/licenses/by/4.0
Covid-19: Physiopathology and cerebrovascular complications
Since the outbreak of COVID-19 pandemic, multiple associated symptoms have been described, pointing out the neurological symptoms contributing to increase in mortality, amongst them, the stroke; therefore we carried out a bibliographic review to understand the physiopathology of COVID-19 that may trigger a stroke, either ischemic or haemorrhagic; it is stated that it is associated to a hypercoagulability status due to the interaction of the virus with its main pathway of entry, this being the Angiotensin Converting Enzyme-2. A conclusion has been reached that the presence of COVID-19 in conjunction with comorbidities and cardiovascular risk factors of the patient, lead to develop it in a more catastrophic way. In regards to the management of stroke secondary to COVID-19 infection, the usual treatment both acute as well as for secondary prevention has been used, however, a high rate of morbidity and mortality has been detected, particularly with cases of haemorrhagic stroke; it is currently recommended the use of anticoagulants in an individualized way. Despite the studies obtained on its pathophysiology, it is not clear what events trigger an stroke whilst infected with COVID-19, however, they are all aimed at the condition of hypercoagulability, endothelial dysfunction and microthrombosis, derived from the binding of viral glycoprotein S (spike) to angiotensine converting enzyme 2 (ACE2) causing alteration in the renin-angiotensin-aldosterone system (RAAS), so it is necessary to wait for more studies and results to know fully the relationship of COVID-19 with the presence of stroke.
The thalamic hemorrhage and the wooden fan
Editorial published in volume 2 issue 3 of ICTUS, Official Organ of scientific dissemination of the Mexican Stroke Association "AMEVASC".
Vladimir Hachinski - On the Shoulders of A Giant
We present the life and work of Dr. Vladimir Hachinski, one of the pioneers and top contributors in the field of vascular neurology.