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- CLINICA NEUROL, 43: 877－879, 2003
- Vol.43 No.11 contents
The 44th Annual Meeting of the Japanese Society of Neurology
Symposium 7-4: Neurological complication due to the drug and the maneuver for the treatment and prevention of cerebrovascular diseases: iatrogenic neurology
Shigeharu Takagi, M.D.
Division of Neurology, Department of Internal Medicine, Tokai University School of Medicine
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 Hypertention-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.
(CLINICA NEUROL, 43: 877－879, 2003)
key words: iatrogenic disease, cerebrovascular disease, guidelines, statistics
(Received: 17-May-03)
