Letter to the Editor
Safe thrombolysis in astrocytoma of middle cranial fossa
Trombólisis segura en astrocitoma de fosa craneal media
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B) TC craneal con contraste a las 24<span class="elsevierStyleHsp" style=""></span>h, se identifica una hiperdensidad en el lóbulo temporal izquierdo, apagando la cisura de Silvio ipsilateral, sin realce de la lesión. Resonancia magnética cerebral: C) Imagen axial T1. Se observa lesión hiperintensa en el lóbulo temporal izquierdo. D) Imagen coronal T1con contraste. Se identifica una lesión irregular de baja intensidad central (realce en anillo). E) Imagen axial T1con contraste. Área irregular con bajo realce, con componente de apariencia quística y necrosis central que ejerce efecto de masa con apagamiento del asta temporal izquierda. F) Imagen axial T2. Se identifica una lesión hiperintensa temporal izquierda (edema). RM global: tumor de la serie glial en el lóbulo temporal izquierdo que se extiende al uncus e hipocampo con apariencia quística y necrosis central con patrón de crecimiento infiltrativo/expansivo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. 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"apellidos" => "Cardoso" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580818300063" "doi" => "10.1016/j.nrleng.2016.02.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580818300063?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485316000566?idApp=UINPBA00004N" "url" => "/02134853/0000003300000003/v1_201803271020/S0213485316000566/v1_201803271020/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2173580818300099" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2016.02.016" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "875" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2018;33:201-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 587 "formatos" => array:3 [ "EPUB" => 38 "HTML" => 376 "PDF" => 173 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Late-onset meningeal lymphomatosis in mantle cell lymphoma controlled with chemotherapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "201" "paginaFinal" => "202" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfomatosis meníngea tardía en linfoma del manto controlada con quimioterapia" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.J. Alonso, A. Cánovas, M.M. Riñón" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J.J." "apellidos" => "Alonso" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Cánovas" ] 2 => array:2 [ "nombre" => "M.M." "apellidos" => "Riñón" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485316300019" "doi" => "10.1016/j.nrl.2016.02.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485316300019?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580818300099?idApp=UINPBA00004N" "url" => "/21735808/0000003300000003/v1_201804060407/S2173580818300099/v1_201804060407/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2173580816300086" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2016.02.001" "estado" => "S300" "fechaPublicacion" => "2018-04-01" "aid" => "865" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2018;33:196-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 925 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 609 "PDF" => 264 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "An exceptional cause of sudden neurological deterioration and coma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "196" "paginaFinal" => "199" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Una causa excepcional de deterioro neurológico repentino y coma" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1455 "Ancho" => 832 "Tamanyo" => 151992 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Brain CT (A and B) and FLAIR MRI (C–F) images. (A) Predominant presence of diffuse white matter hypodensity in both frontal lobes and involvement of the corpus callosum indicating vasogenic oedema. Convexity sulci effacement is seen. (B) Image was taken after the administration of contrast, showing no focal enhancement. (C) Signs of intracranial hypertension involving both frontal lobes and the corpus callosum are present. (D) Brain herniation persists despite extensive bilateral frontal craniectomy. (E and F) Infratentorial diffuse involvement is also present.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.J. Vargas López, J.M. Garbizu Vidorreta, E. Salinero Paniagua, C. Fernández Carballal" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A.J." "apellidos" => "Vargas López" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Garbizu Vidorreta" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Salinero Paniagua" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Fernández Carballal" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485316000578" "doi" => "10.1016/j.nrl.2016.02.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485316000578?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580816300086?idApp=UINPBA00004N" "url" => "/21735808/0000003300000003/v1_201804060407/S2173580816300086/v1_201804060407/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Safe thrombolysis in astrocytoma of middle cranial fossa" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "199" "paginaFinal" => "201" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F.J. Ros Forteza, I. Pantazi, A. Cardoso" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Ros Forteza" "email" => array:1 [ 0 => "javierros40@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Pantazi" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Cardoso" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidade de AVC, Unidade Local de Saúde da Guarda, EPE, Guarda, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Ciências Médicas, Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trombólisis segura en astrocitoma de fosa craneal media" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1149 "Ancho" => 1600 "Tamanyo" => 229069 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Brain CT: (A) Findings from the initial non-contrast cranial CT scan were normal. (B) Contrast brain CT image at 24<span class="elsevierStyleHsp" style=""></span>hours revealing a hyperdense area in the left temporal lobe, infiltrating the ipsilateral Sylvian fissure with no contrast uptake. Brain MRI: (C) Axial T1-weighted sequence. A hyperintense lesion was observed in the left temporal lobe. (D) Coronal contrast T1-weighted sequence. An irregular lesion with a hypointense centre (ring enhancement) was identified. (E) Axial contrast T1-weighted sequence. The scan revealed an irregular area with low contrast with a cyst-like component and central necrosis exerting a mass effect with left temporal horn effacement. F) Axial T2-weighted sequence. A left temporal hyperintense lesion (oedema) was observed. MRI results: glial tumour in the left temporal lobe expanding into the uncus and hippocampus with a cyst-like appearance and central necrosis with an infiltrative/expansive growth pattern.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Some patients with acute ischaemic stroke occasionally present seizures at stroke onset.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Non-contrast brain computed tomography (CT) has some limitations in this context, and early signs of ischaemia are frequently subtle.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> An epileptic seizure at stroke onset is considered a relative contraindication for intravenous recombinant tissue plasminogen activator (rt-PA) administration. The 2011 SEN stroke management guidelines<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> acknowledge that this should not justify ruling out thrombolytic treatment when cerebral infarction is confirmed by neuroimaging techniques. The 2013 American Heart Association/American Stroke Association guidelines deem intravenous thrombolysis appropriate given evidence that the residual deficits are secondary to ischaemia and not to a postictal event.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 46-year old man with a history of hypercholesterolaemia and moderate alcohol consumption, who attended our emergency department due to speech disturbances and right-sided motor deficit of sudden onset. He arrived 45<span class="elsevierStyleHsp" style=""></span>minutes after symptom onset, presenting an arterial pressure of 168/92<span class="elsevierStyleHsp" style=""></span>mm Hg and a heart rate of 109<span class="elsevierStyleHsp" style=""></span>bpm. Auscultation was normal and the echocardiogram showed sinus rhythm. Neurological examination revealed global aphasia, right-sided hemiparesis of faciobrachial predominance, and right hemihypaesthesia. The National Institute of Health Stroke Scale (NIHSS) score was 15:2 in level of consciousness (LOC) questions, 2 in LOC commands, 1 in facial palsy, 4 in right motor arm, 2 in right motor leg, 1 in sensory, and 3 in language. One hour and 30<span class="elsevierStyleHsp" style=""></span>minutes after symptom onset, the patient experienced a generalised tonic-clonic seizure which resolved in 20<span class="elsevierStyleHsp" style=""></span>seconds after the intravenous administration of 10<span class="elsevierStyleHsp" style=""></span>mg diazepam. A non-contrast brain CT scan performed with a Siemens Somatom<span class="elsevierStyleSup">®</span> Emotion eco (16-slice configuration) 15<span class="elsevierStyleHsp" style=""></span>minutes after the seizure yielded normal results (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). As we did not consider the patient's symptoms to be due to postictal changes, no change to the neurological deficits after the seizure was observed, and an advanced imaging scan could not be scheduled (time- and space-limited accessibility), we discussed the case and started treatment with intravenous alteplase, 2<span class="elsevierStyleHsp" style=""></span>hours and 15<span class="elsevierStyleHsp" style=""></span>minutes after symptom onset. Neurological improvement was observed (NIHSS 9:1 in LOC questions, 1 in LOC commands, 1 in facial palsy, 2 in right motor arm, 1 in right motor leg, 1 in sensory, and 2 in language). At 24<span class="elsevierStyleHsp" style=""></span>hours, we observed mild aphasia with no motor or sensory deficit (NIHSS 2); the contrast brain CT scan (indicated after the epileptic seizure at onset) performed at 24<span class="elsevierStyleHsp" style=""></span>hours showed a hyperdense area in the left temporal lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The echocardiogram and the carotid and vertebral echo-Doppler study yielded normal results. The brain MRI study (T1-, contrast T1-, T2-, T2*-, and diffusion-weighted, FLAIR sequences and apparent diffusion coefficient [ADC] maps) performed at 3 days revealed a glial tumour with cyst-like appearance in the left temporal lobe, extending to the uncus and hippocampus. It also revealed central necrosis with an infiltrative/expansive growth pattern (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C-F). No haemorrhagic transformation or intratumoural bleeding was observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C-F). Diffusion-weighted sequences and ADC maps did not show changes suggestive of cerebral ischaemia. At day 5 (with no previous corticosteroids or surgery), deficits resolved completely (NIHSS 0).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was transferred to the neurosurgery department for tumour resection. Histological findings were compatible with grade III anaplastic astrocytoma.</p><p id="par0020" class="elsevierStylePara elsevierViewall">There is limited scientific information on the use of alteplase in patients with astrocytomas mimicking stroke.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> To our knowledge, there are only 2 published cases of patients treated with rt-PA due to suspected acute ischaemic stroke; both were finally diagnosed with glioblastoma multiforme.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Our patient was symptomatic for more than 24<span class="elsevierStyleHsp" style=""></span>hours; however, no signs of lesions caused by cerebrovascular disease were observed. We believe that the stroke-like symptoms were caused by infiltration of the tumour into the Sylvian fissure, surrounding the left middle cerebral artery as in the case reported by García et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> However, we cannot definitively rule out an ischaemia associated with the brain tumour and resolved by thrombolysis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Few cases of patients with epileptic seizures manifesting at stroke onset and safe use of rt-PA have been published,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,8</span></a> and cases of patients with stroke-like conditions treated with thrombolysis and finally diagnosed as brain tumour are rare.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The Copenhagen Stroke Study suggests that an epileptic seizure at stroke onset may involve a large area of hypoperfused but potentially salvageable brain tissue.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">We would like to highlight that: (1) thrombolysis in a patient with astrocytoma was safe, (2) a patient with an epileptic seizure at onset of a stroke-like event may present a tumour; (3) non-contrast brain CT is not sufficient to detect neoplasms, particularly in the middle cranial fossa (artefacts are frequent in this location), potentially causing an astrocytoma to go unnoticed; and (4) brain MRI is useful since it displays the middle cranial fossa better than brain CT, helping to rule out tumour vs ischaemic lesion. Likewise, an astrocytoma may go unnoticed in non-contrast brain CT images.</p><p id="par0040" class="elsevierStylePara elsevierViewall">As far as we are aware, this is the first case of safe use of alteplase in a patient with grade III anaplastic astrocytoma mimicking stroke with no haemorrhagic transformation.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "xack341549" "titulo" => "Acknowledgement" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ros Forteza FJ, Pantazi I, Cardoso A. Trombólisis segura en astrocitoma de fosa craneal media. Neurología. 2018;33:199–201.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1149 "Ancho" => 1600 "Tamanyo" => 229069 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Brain CT: (A) Findings from the initial non-contrast cranial CT scan were normal. (B) Contrast brain CT image at 24<span class="elsevierStyleHsp" style=""></span>hours revealing a hyperdense area in the left temporal lobe, infiltrating the ipsilateral Sylvian fissure with no contrast uptake. Brain MRI: (C) Axial T1-weighted sequence. A hyperintense lesion was observed in the left temporal lobe. (D) Coronal contrast T1-weighted sequence. An irregular lesion with a hypointense centre (ring enhancement) was identified. (E) Axial contrast T1-weighted sequence. The scan revealed an irregular area with low contrast with a cyst-like component and central necrosis exerting a mass effect with left temporal horn effacement. F) Axial T2-weighted sequence. A left temporal hyperintense lesion (oedema) was observed. MRI results: glial tumour in the left temporal lobe expanding into the uncus and hippocampus with a cyst-like appearance and central necrosis with an infiltrative/expansive growth pattern.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The incidence of seizures after acute stroke: a preliminary report (abstract)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.P. Szaflarski" 1 => "D. Woo" 2 => "B.M. Kissela" 3 => "W.T. Cahill" 4 => "R. Miller" 5 => "J. Khoury" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "125th Annual Meeting of the American Neurological Association, Boston" "serieFecha" => "2000" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Agreement and variability in interpretation of early CT changes is stroke patients qualifying for intravenous rtPA therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Grotta" 1 => "D. Chiu" 2 => "M. Lu" 3 => "S. Patel" 4 => "S.R. Levine" 5 => "B.C. Tilley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "1999" "volumen" => "30" "paginaInicial" => "1528" "paginaFinal" => "1533" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10436095" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía para el tratamiento del infarto cerebral agudo" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Alonso de Leciñana" 1 => "J.A. Egido" 2 => "I. Casado" 3 => "M. Ribó" 4 => "A. Dávalos" 5 => "J. Masjuan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nrl.2011.09.012" "Revista" => array:6 [ "tituloSerie" => "Neurologia" "fecha" => "2014" "volumen" => "29" "paginaInicial" => "102" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22152803" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology" "etal" => true "autores" => array:6 [ 0 => "E.C. Jauch" 1 => "J.L. Saver" 2 => "H.P. Adams Jr." 3 => "A. Bruno" 4 => "J.J. Connors" 5 => "B.M. Demaerschalk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/STR.0b013e318284056a" "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2013" "volumen" => "44" "paginaInicial" => "870" "paginaFinal" => "947" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23370205" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombolysis for ischemic stroke in patients with brain tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Etgen" 1 => "I. Steinich" 2 => "L. Gsottschneider" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jstrokecerebrovasdis.2013.05.004" "Revista" => array:6 [ "tituloSerie" => "J Stroke Cerebrovasc Dis" "fecha" => "2014" "volumen" => "23" "paginaInicial" => "361" "paginaFinal" => "366" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23763899" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "bcr06.2008.0268" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombolysis for ischaemic stroke and glioblastoma multiforme: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.M. García" 1 => "J.A. Egido" 2 => "M.E. García" 3 => "P. Simal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2009" "volumen" => "2009" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intratumoral hemorrhage after thrombolysis in a patient with glioblastoma multiforme" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.A. Grimm" 1 => "L.M. DeAngelis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/01.wnl.0000265392.03231.ac" "Revista" => array:5 [ "tituloSerie" => "Neurology" "fecha" => "2007" "volumen" => "69" "paginaInicial" => "936" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17724301" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seizure at stroke onset: should it be an absolute contraindication to thrombolysis?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Selim" 1 => "S. Kumar" 2 => "J. Fink" 3 => "G. Schlaug" 4 => "L.R. Caplan" 5 => "I. Linfante" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000063724" "Revista" => array:6 [ "tituloSerie" => "Cerebrovasc Dis" "fecha" => "2002" "volumen" => "14" "paginaInicial" => "54" "paginaFinal" => "57" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12097852" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemorrhagic complications after off-label thrombolysis for ischemic stroke" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Aleu" 1 => "P. Mellado" 2 => "C. Lichy" 3 => "M. Köhrmann" 4 => "P.D. Schellinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.STR.0000254504.71955.05" "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2007" "volumen" => "38" "paginaInicial" => "417" "paginaFinal" => "422" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17185641" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seizures in acute stroke: predictors and prognostic significance. The Copenhagen Stroke Study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "The Copenhagen Stroke Study" "etal" => false "autores" => array:5 [ 0 => "J. Reith" 1 => "H.S. Jorgensen" 2 => "H. Nakayama" 3 => "H.O. Raaschou" 4 => "T.S. Olsen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "1997" "volumen" => "28" "paginaInicial" => "1585" "paginaFinal" => "1589" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9259753" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack341549" "titulo" => "Acknowledgement" "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">We would like to thank Prof. Pablo Vivanco for his help in drafting this manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003300000003/v1_201804060407/S2173580818300063/v1_201804060407/en/main.assets" "Apartado" => array:4 [ "identificador" => "9409" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003300000003/v1_201804060407/S2173580818300063/v1_201804060407/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580818300063?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 0 | 7 |
| 2024 October | 16 | 4 | 20 |
| 2024 September | 18 | 3 | 21 |
| 2024 August | 19 | 5 | 24 |
| 2024 July | 25 | 3 | 28 |
| 2024 June | 14 | 2 | 16 |
| 2024 May | 14 | 5 | 19 |
| 2024 April | 22 | 41 | 63 |
| 2024 March | 24 | 6 | 30 |
| 2024 February | 36 | 2 | 38 |
| 2024 January | 47 | 7 | 54 |
| 2023 December | 23 | 5 | 28 |
| 2023 November | 33 | 5 | 38 |
| 2023 October | 46 | 3 | 49 |
| 2023 September | 29 | 4 | 33 |
| 2023 August | 23 | 3 | 26 |
| 2023 July | 47 | 4 | 51 |
| 2023 June | 37 | 3 | 40 |
| 2023 May | 78 | 9 | 87 |
| 2023 April | 59 | 0 | 59 |
| 2023 March | 44 | 2 | 46 |
| 2023 February | 57 | 6 | 63 |
| 2023 January | 65 | 2 | 67 |
| 2022 December | 46 | 7 | 53 |
| 2022 November | 57 | 9 | 66 |
| 2022 October | 42 | 6 | 48 |
| 2022 September | 66 | 7 | 73 |
| 2022 August | 64 | 8 | 72 |
| 2022 July | 40 | 7 | 47 |
| 2022 June | 33 | 6 | 39 |
| 2022 May | 41 | 7 | 48 |
| 2022 April | 31 | 4 | 35 |
| 2022 March | 37 | 6 | 43 |
| 2022 February | 22 | 3 | 25 |
| 2022 January | 37 | 7 | 44 |
| 2021 December | 38 | 10 | 48 |
| 2021 November | 48 | 10 | 58 |
| 2021 October | 59 | 10 | 69 |
| 2021 September | 55 | 12 | 67 |
| 2021 August | 53 | 6 | 59 |
| 2021 July | 33 | 8 | 41 |
| 2021 June | 30 | 7 | 37 |
| 2021 May | 29 | 10 | 39 |
| 2021 April | 47 | 14 | 61 |
| 2021 March | 97 | 11 | 108 |
| 2021 February | 38 | 6 | 44 |
| 2021 January | 32 | 12 | 44 |
| 2020 December | 47 | 13 | 60 |
| 2020 November | 51 | 8 | 59 |
| 2020 October | 38 | 6 | 44 |
| 2020 September | 18 | 10 | 28 |
| 2020 August | 36 | 7 | 43 |
| 2020 July | 16 | 15 | 31 |
| 2020 June | 30 | 8 | 38 |
| 2020 May | 20 | 10 | 30 |
| 2020 April | 22 | 3 | 25 |
| 2020 March | 24 | 4 | 28 |
| 2020 February | 20 | 4 | 24 |
| 2020 January | 28 | 3 | 31 |
| 2019 December | 25 | 13 | 38 |
| 2019 November | 20 | 10 | 30 |
| 2019 October | 23 | 6 | 29 |
| 2019 September | 33 | 4 | 37 |
| 2019 August | 17 | 1 | 18 |
| 2019 July | 19 | 9 | 28 |
| 2019 June | 59 | 9 | 68 |
| 2019 May | 173 | 9 | 182 |
| 2019 April | 61 | 14 | 75 |
| 2019 March | 13 | 6 | 19 |
| 2019 February | 16 | 3 | 19 |
| 2019 January | 6 | 3 | 9 |
| 2018 December | 5 | 5 | 10 |
| 2018 November | 26 | 3 | 29 |
| 2018 October | 51 | 15 | 66 |
| 2018 September | 35 | 5 | 40 |
| 2018 August | 12 | 1 | 13 |
| 2018 July | 9 | 1 | 10 |
| 2018 June | 11 | 2 | 13 |
| 2018 May | 11 | 1 | 12 |
| 2018 April | 10 | 3 | 13 |
| 2018 March | 2 | 0 | 2 |
| 2018 February | 0 | 1 | 1 |
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