[Neurological complication due to the drug and the maneuver for the treatment and prevention of cerebrovascular diseases: iatrogenic neurology].
Neurological sequela which occur with the medication and procedure to treat or prevent cerebrovascular diseases are reviewed. The report by the NINDS upon the recombinant tissue plasminogen activator (rt-PA) for cerebral infarction showed overall improved prognosis and increased number of cerebral hemorrhage from 1 to 9. Individual approach rather than statistical analysis should be applied to the adverse effect of the treatment. The rhabdomyolysis by statin, the HMG-CoA reductase inhibitor, is well known. The frequency of elevation in serum creatine kinase activity increases from water-soluble statin to lipid-soluble statin and to statin of longer half-life and with entero-hepatic recirculation. All of the interventional procedure such as embolization, stent, intravascular thrombolysis, endarterectomy and EC-IC bypass are possibly complicated by bleeding, arterial occlusion, distal embolism and so on. Guidelines are also a possible source of iatrogenic diseases. For example, 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension recommend at least 3 months of non-pharmacological treatment before starting the anti-hypertensive medications. The possibility to develop stroke within 3 months after the initial examination, however, is not zero. This is what can be called as guideline-induced neurological disease, of which practical physician should be reminded.
Takagi
Shigeharu
S
Division of Neurology, Department of Internal Medicine, Tokai University School of Medicine.
D002543:Cerebral Hemorrhage / Q000139:chemically induced*; D002561:Cerebrovascular Disorders / Q000517:prevention & control* / Q000628:therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects; D004691:Endarterectomy / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D007049:Iatrogenic Disease; D008019:Life Style; D009422:Nervous System Diseases / Q000209:etiology*; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins / Q000009:adverse effects; D012206:Rhabdomyolysis / Q000139:chemically induced*; D015607:Stents / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator