Abstract Alcohol drinking may exercise both beneficial and untoward effects on the haemostatic and fibrinolytic systems. It may also predispose individuals to arterial thrombosis and trigger embolism in the brain. The aim here is to examine these problems. Methods used for evaluating platelet function were platelet aggregation and associated thromboxane B2 release, shear-induced platelet aggregation, and measurement of urinary prostaglandins. Changes in fibrinolytic system were evaluated by measuring plasminogen activator inhibitor type 1. The combined effects of alcohol drinking, physical exercise, eating a meal and circadian rhythms in healthy volunteers were examined in three experimental studies. Case-control studies were used for assessing the mechanism and etiology of ischaemic brain infarction triggered during alcohol intoxication. Alcohol drinking did not potentiate the effects of physical exercise on platelet function. Sleeping while under acute intoxication resulted in a significant activation of platelets, as shown by increased urinary excretion of a thromboxane metabolite. On the other hand, ingestion of a moderate dose of red wine seemed to attenuate platelet aggregation measured ex vivo, irrespective of whether the wine was consumed with a meal or alone. However, both red wine and a larger acute dose of alcohol in fruit juice inhibited fibrinolytic activity. In a case-control study, platelet count and function were evaluated in 426 consecutive patients hospitalized on account of acute brain infarction. Compared with the hospital-based controls, a higher than normal platelet count was observed immediately after admission. Heavy drinkers showed both higher and lower than normal platelet counts more often than the other patients with brain infarction. The changes in platelet function among the heavy drinkers reflected their recent drinking habits. Another case-control study indicated that recent heavy drinking of alcohol was an independent risk factor for cardiogenic embolism to the brain. Recent heavy drinking also seemed to predispose subjects to some other types of ischaemic brain infarction such as artery to artery embolism due to large-artery atherosclerosis and cryptogenic stroke, but these observations need to be confirmed in larger studies. In conclusion, the results show some untoward effects of acute heavy drinking of alcohol, which could contribute to the onset of brain infarction either as triggering or as predisposing factors. On the other hand, drinking of a moderate dose of red wine did not have any clear untoward effect on healthy human volunteers.

Introdução:embora seja mundialmente conhecida a correlação entre os escores tomográficos de avaliação isquêmica cerebral com achados e desfechos clínicos em pacientes com acidente vascular cerebral (AVC) isquêmico, são limitadas as evidencias em pacientes do subtipo cardioembólico. Objetivo: avaliar e correlacionar o perfil e desfechos clínicos de pacientes com AVC isquêmico do subtipo cardioembólico com os achados tomográficos de isquemia, segundo escores tomográficos. Métodos:estudo retrospectivo de um grupo de pacientes com AVC do tipo cardioembólico segundo a classificação TOAST, selecionados através de uma amostra de conveniência dos pacientes que foram atendidos em um centro de referência de emergências cerebrovasculares (março de 2014 a março de 2015). Os exames tomográficos destes pacientes foram avaliados por dois observadores (um radiologista com 10 anos e outro com 2 anos de experiência em exames tomográficos) treinados na avaliação de escores tomográficos relacionados a alterações isquêmicas encefálicas e cegados para os dados clínicos e laboratoriais dos pacientes. A análise estatística correlacionou os achados clínicos que incuíram fatores e preditores de risco, bem como transformação hemorrágica com os escores tomográficos que avaliam a isquemia cerebral. Resultados:o grupo com escore ASPECTS ≤7 apresentou significativamente maior uso de antiarrítmico, exclusão de trombólise, maior NIHSS, escala Rankin em 24h mais elevada e mais dias de internação quando comparado ao ASPECTS >7. Os pacientes com transformação hemorrágica apresentaram proporção significativamente maior de escore ASPECTS ≤ 7, mais do que um terço de acometimento do território da artéria cerebral média e AVC maior considerado pelo escore BASIS. Conclusão:os pacientes avaliados com AVC isquêmico cardioembólico que apresentaram transformação hemorrágica têm valores piores nos escores tomográficos de isquemia, com NHISS mais elevado e maior número de dias de internação. Houve uma correlação positiva entre o escore ASPECTS e os escores tomográficos regra de um terço e BASIS. / Introduction: although known worldwide, the correlation between tomographic cerebral ischemia evaluation scores and clinical outcome in patients with ischemic cerebral vascular accident (CVA), the evidences on patients with cardioembolic subtype are limited. Objective: evaluate and correlate the profile and clinical outcomes of patients with embolic subtype ischemic CVA with ischemia tomographic findings, according to tomographic scores. Methods: retrospective study of a patients group with cardioembolic subtype CVA according to TOAST classification, selected through a convenience sample from the patients that were treated at the cerebral vascular disease reference center emergency, (March 2014 to March 2015). These patients tomographic exams were evaluated by two observers (a radiologist with 10 years of expertise and another with 2 years of expertise in tomographic exams) trained in the assessment of tomographic scores related to encephalic ischemia alterations and blinded for the patients clinical and laboratorial data. The statistical analysis correlated the clinical findings, which included risk factors and predictors, as well as hemorrhagic transformation with the tomographic scores that evaluate cerebral ischemia. Results: groups with ASPECTS score ≤7 presented significantly higher use of antiarrhythmics, thrombolysis exclusion, higher NIHSS, higher 24 hours Rankin scale and more days of hospitalization when compared to ASPECTS >7. Patients with hemorrhagic transformation presented a significantly higher proportion of ASPECTS score ≤7. Conclusion: evaluated patients with cardioembolic ischemic CVA that had hemorrhagic transformation have worse tomographic ASPECTS score for ischemia, with higher NHISS and more hospitalization days. There was positive correlation between ASPECTS score and one third rule and BASIS tomographic scores.

Introdução:embora seja mundialmente conhecida a correlação entre os escores tomográficos de avaliação isquêmica cerebral com achados e desfechos clínicos em pacientes com acidente vascular cerebral (AVC) isquêmico, são limitadas as evidencias em pacientes do subtipo cardioembólico. Objetivo: avaliar e correlacionar o perfil e desfechos clínicos de pacientes com AVC isquêmico do subtipo cardioembólico com os achados tomográficos de isquemia, segundo escores tomográficos. Métodos:estudo retrospectivo de um grupo de pacientes com AVC do tipo cardioembólico segundo a classificação TOAST, selecionados através de uma amostra de conveniência dos pacientes que foram atendidos em um centro de referência de emergências cerebrovasculares (março de 2014 a março de 2015). Os exames tomográficos destes pacientes foram avaliados por dois observadores (um radiologista com 10 anos e outro com 2 anos de experiência em exames tomográficos) treinados na avaliação de escores tomográficos relacionados a alterações isquêmicas encefálicas e cegados para os dados clínicos e laboratoriais dos pacientes. A análise estatística correlacionou os achados clínicos que incuíram fatores e preditores de risco, bem como transformação hemorrágica com os escores tomográficos que avaliam a isquemia cerebral. Resultados:o grupo com escore ASPECTS ≤7 apresentou significativamente maior uso de antiarrítmico, exclusão de trombólise, maior NIHSS, escala Rankin em 24h mais elevada e mais dias de internação quando comparado ao ASPECTS >7. Os pacientes com transformação hemorrágica apresentaram proporção significativamente maior de escore ASPECTS ≤ 7, mais do que um terço de acometimento do território da artéria cerebral média e AVC maior considerado pelo escore BASIS. Conclusão:os pacientes avaliados com AVC isquêmico cardioembólico que apresentaram transformação hemorrágica têm valores piores nos escores tomográficos de isquemia, com NHISS mais elevado e maior número de dias de internação. Houve uma correlação positiva entre o escore ASPECTS e os escores tomográficos regra de um terço e BASIS. / Introduction: although known worldwide, the correlation between tomographic cerebral ischemia evaluation scores and clinical outcome in patients with ischemic cerebral vascular accident (CVA), the evidences on patients with cardioembolic subtype are limited. Objective: evaluate and correlate the profile and clinical outcomes of patients with embolic subtype ischemic CVA with ischemia tomographic findings, according to tomographic scores. Methods: retrospective study of a patients group with cardioembolic subtype CVA according to TOAST classification, selected through a convenience sample from the patients that were treated at the cerebral vascular disease reference center emergency, (March 2014 to March 2015). These patients tomographic exams were evaluated by two observers (a radiologist with 10 years of expertise and another with 2 years of expertise in tomographic exams) trained in the assessment of tomographic scores related to encephalic ischemia alterations and blinded for the patients clinical and laboratorial data. The statistical analysis correlated the clinical findings, which included risk factors and predictors, as well as hemorrhagic transformation with the tomographic scores that evaluate cerebral ischemia. Results: groups with ASPECTS score ≤7 presented significantly higher use of antiarrhythmics, thrombolysis exclusion, higher NIHSS, higher 24 hours Rankin scale and more days of hospitalization when compared to ASPECTS >7. Patients with hemorrhagic transformation presented a significantly higher proportion of ASPECTS score ≤7. Conclusion: evaluated patients with cardioembolic ischemic CVA that had hemorrhagic transformation have worse tomographic ASPECTS score for ischemia, with higher NHISS and more hospitalization days. There was positive correlation between ASPECTS score and one third rule and BASIS tomographic scores.

Introdução:embora seja mundialmente conhecida a correlação entre os escores tomográficos de avaliação isquêmica cerebral com achados e desfechos clínicos em pacientes com acidente vascular cerebral (AVC) isquêmico, são limitadas as evidencias em pacientes do subtipo cardioembólico. Objetivo: avaliar e correlacionar o perfil e desfechos clínicos de pacientes com AVC isquêmico do subtipo cardioembólico com os achados tomográficos de isquemia, segundo escores tomográficos. Métodos:estudo retrospectivo de um grupo de pacientes com AVC do tipo cardioembólico segundo a classificação TOAST, selecionados através de uma amostra de conveniência dos pacientes que foram atendidos em um centro de referência de emergências cerebrovasculares (março de 2014 a março de 2015). Os exames tomográficos destes pacientes foram avaliados por dois observadores (um radiologista com 10 anos e outro com 2 anos de experiência em exames tomográficos) treinados na avaliação de escores tomográficos relacionados a alterações isquêmicas encefálicas e cegados para os dados clínicos e laboratoriais dos pacientes. A análise estatística correlacionou os achados clínicos que incuíram fatores e preditores de risco, bem como transformação hemorrágica com os escores tomográficos que avaliam a isquemia cerebral. Resultados:o grupo com escore ASPECTS ≤7 apresentou significativamente maior uso de antiarrítmico, exclusão de trombólise, maior NIHSS, escala Rankin em 24h mais elevada e mais dias de internação quando comparado ao ASPECTS >7. Os pacientes com transformação hemorrágica apresentaram proporção significativamente maior de escore ASPECTS ≤ 7, mais do que um terço de acometimento do território da artéria cerebral média e AVC maior considerado pelo escore BASIS. Conclusão:os pacientes avaliados com AVC isquêmico cardioembólico que apresentaram transformação hemorrágica têm valores piores nos escores tomográficos de isquemia, com NHISS mais elevado e maior número de dias de internação. Houve uma correlação positiva entre o escore ASPECTS e os escores tomográficos regra de um terço e BASIS. / Introduction: although known worldwide, the correlation between tomographic cerebral ischemia evaluation scores and clinical outcome in patients with ischemic cerebral vascular accident (CVA), the evidences on patients with cardioembolic subtype are limited. Objective: evaluate and correlate the profile and clinical outcomes of patients with embolic subtype ischemic CVA with ischemia tomographic findings, according to tomographic scores. Methods: retrospective study of a patients group with cardioembolic subtype CVA according to TOAST classification, selected through a convenience sample from the patients that were treated at the cerebral vascular disease reference center emergency, (March 2014 to March 2015). These patients tomographic exams were evaluated by two observers (a radiologist with 10 years of expertise and another with 2 years of expertise in tomographic exams) trained in the assessment of tomographic scores related to encephalic ischemia alterations and blinded for the patients clinical and laboratorial data. The statistical analysis correlated the clinical findings, which included risk factors and predictors, as well as hemorrhagic transformation with the tomographic scores that evaluate cerebral ischemia. Results: groups with ASPECTS score ≤7 presented significantly higher use of antiarrhythmics, thrombolysis exclusion, higher NIHSS, higher 24 hours Rankin scale and more days of hospitalization when compared to ASPECTS >7. Patients with hemorrhagic transformation presented a significantly higher proportion of ASPECTS score ≤7. Conclusion: evaluated patients with cardioembolic ischemic CVA that had hemorrhagic transformation have worse tomographic ASPECTS score for ischemia, with higher NHISS and more hospitalization days. There was positive correlation between ASPECTS score and one third rule and BASIS tomographic scores.