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Detección Doppler transcraneal de embolias cerebrales de grasa y su relación con la embolia paradójica: un estudio
Alejandro M Forteza1, Sebastian Koch, Iszet Campo-Bustillo
1Cardiac and Stroke Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, FL, USA. aforteza@med.miami.edu
Circulation
|April 27, 2011
Resumen
El síndrome de embolia grasa, caracterizado por problemas neurológicos después de fracturas óseas largas, está relacionado con derivaciones de derecha a izquierda (RLS). El Doppler transcraneal detecta señales microembólicas, lo que predice síntomas neurológicos en pacientes con fracturas con SLR.
Área de la Ciencia:
- Neurología Neurología.
- Cirugía vascular Cirugía vascular.
- Trauma Cirugía cirugía cirugía.
Sus antecedentes:
- El síndrome de embolia grasa (FES) se presenta con disnea, petequias y disfunción neurológica.
- La FES está relacionada principalmente con las fracturas óseas largas y la circulación sistémica de la grasa de la médula ósea.
- Las derivaciones intracardiacas de derecha a izquierda (RLS) pueden facilitar el paso de partículas de grasa más grandes a la circulación sistémica.
Objetivo del estudio:
- Investigar la relación entre el SLR y las señales microembólicas detectadas por Doppler transcraneal (TCD) en pacientes con fracturas del eje femoral.
- Evaluar el valor predictivo de RLS y señales microembólicas para el desarrollo de síntomas neurológicos en FES.
Principales métodos:
- Estudio prospectivo de 42 pacientes con fracturas del eje del fémur.
- Evaluación de RLS usando ecocardiografía y TCD diario con detección de embolia.
- Exámenes neurológicos para evaluar los síntomas de FES.
Principales resultados:
- 14 de 42 pacientes tenían un RLS detectado.
- Siete pacientes desarrollaron síntomas neurológicos, todos con un RLS positivo (P<0,001).
- Los pacientes con RLS mostraron recuentos e intensidades de señales microembólicas significativamente más altos (P<0.05, P<0.01).
- Los altos recuentos/intensidades de señales microembólicas en pacientes con RLS+ predijeron fuertemente síntomas neurológicos (OR 204, P<0.001).
Conclusiones:
- La presencia de RLS en pacientes con fracturas óseas largas se asocia con un aumento y mayor de las señales microembólicas cerebrales.
- La detección transcraneal Doppler de señales microembólicas en pacientes con RLS+ puede predecir el desarrollo de síntomas neurológicos.
- La RLS es un factor crítico en la patogénesis de la FES neurológica después de fracturas óseas largas.
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