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OBJECTIVE: We present an update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. DEVELOPMENT: We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. CONCLUSIONS: In primary prevention, the patient's vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value <55 mg/dL is recommended; in non-atherothombotic ischaemic strokes, given the unclear relationship with dyslipidaemia, target value should be established according to the vascular risk group of each patient. In both primary and secondary prevention, statins are the drugs of first choice, and ezetimibe and/or PCSK9 inhibitors may be added in patients not achieving the target value.
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Dislipidemias , Neurologia , Acidente Vascular Cerebral , Dislipidemias/tratamento farmacológico , Humanos , Inibidores de PCSK9 , Pró-Proteína Convertase 9 , Acidente Vascular Cerebral/prevenção & controleRESUMO
OBJECTIVE: To update the recommendations of the Spanish Society of Neurology regarding lifestyle interventions for stroke prevention. DEVELOPMENT: We reviewed the most recent studies related to lifestyle and stroke risk, including randomised clinical trials, population studies, and meta-analyses. The risk of stroke associated with such lifestyle habits as smoking, alcohol consumption, stress, diet, obesity, and sedentary lifestyles was analysed, and the potential benefits for stroke prevention of modifying these habits were reviewed. We also reviewed stroke risk associated with exposure to air pollution. Based on the results obtained, we drafted recommendations addressing each of the lifestyle habits analysed. CONCLUSIONS: Lifestyle modification constitutes a cornerstone in the primary and secondary prevention of stroke. Abstinence or cessation of smoking, cessation of excessive alcohol consumption, avoidance of exposure to chronic stress, avoidance of overweight or obesity, a Mediterranean diet supplemented with olive oil and nuts, and regular exercise are essential measures in reducing the risk of stroke. We also recommend implementing policies to reduce air pollution.
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Poluição do Ar , Dieta Mediterrânea , Neurologia , Acidente Vascular Cerebral , Poluição do Ar/efeitos adversos , Humanos , Estilo de Vida , Acidente Vascular Cerebral/prevenção & controleRESUMO
OBJECTIVE: To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension. DEVELOPMENT: We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations. CONCLUSIONS: In primary stroke prevention, antihypertensive treatment should be started in patients with BP levelsâ¯>⯠140/90â¯mmHg, with a target BP of < 130/80â¯mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24â¯hours), with a target BP of < 130/80â¯mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable.
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Acidente Vascular Cerebral , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Humanos , Hipertensão/complicações , Neurologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
OBJECTIVE: To update the Spanish Society of Neurology's guidelines for stroke prevention in patients with type 2 diabetes or prediabetes, analysing the available evidence on the effect of metabolic control and the potential benefit of antidiabetic drugs with known vascular benefits in addition to conventional antidiabetic treatments in stroke prevention. DEVELOPMENT: PICO-type questions (Patient, Intervention, Comparison, Outcome) were developed to identify practical issues in the management of stroke patients and to establish specific recommendations for each of them. Subsequently, we conducted systematic reviews of the PubMed database and selected those randomised clinical trials evaluating stroke as an independent variable (primary or secondary). Finally, for each of the PICO questions we developed a meta-analysis to support the final recommendations. CONCLUSIONS: While there is no evidence that metabolic control reduces the risk of stroke, some families of antidiabetic drugs with vascular benefits have been shown to reduce these effects when added to conventional treatments, both in the field of primary prevention in patients presenting type 2 diabetes and high vascular risk or established atherosclerosis (GLP-1 agonists) and in secondary stroke prevention in patients with type 2 diabetes or prediabetes (pioglitazone).
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Diabetes Mellitus Tipo 2 , Estado Pré-Diabético , Acidente Vascular Cerebral , Diabetes Mellitus Tipo 2/complicações , Humanos , Neurologia , Pioglitazona , Estado Pré-Diabético/complicações , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
OBJECTIVE: We present an update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. DEVELOPMENT: We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. CONCLUSIONS: In primary prevention, the patient's vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value <55mg/dL is recommended; in non-atherothombotic ischaemic strokes, given the unclear relationship with dyslipidaemia, target value should be established according to the vascular risk group of each patient. In both primary and secondary prevention, statins are the drugs of first choice, and ezetimibe and/or PCSK9 inhibitors may be added in patients not achieving the target value.
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BACKGROUND AND PURPOSE: The existence of contraindications to intravenous thrombolysis (IVT) is considered a criterion for direct transfer of patients with suspected acute stroke to thrombectomy-capable centers in the prehospital setting. Our aim was to assess the utility of this criterion in a setting where routing protocols are defined by the Madrid - Direct Referral to Endovascular Center (M-DIRECT) prehospital scale. METHODS: This was a post hoc analysis of the M-DIRECT study. Reported contraindications to IVT were retrospectively collected from emergency medical services reports and categorized into late window, anticoagulant treatment and other contraindications. Final diagnosis and treatment rates were compared between patients with and without reported IVT contraindications and according to anticoagulant treatment or late window categories. RESULTS: The M-DIRECT study included 541 patients. Reported IVT contraindications were present in 227 (42.0%) patients. Regarding final diagnosis no significant differences were found between patients with or without reported IVT contraindications: ischaemic stroke (any) 65.6% vs. 62.1%, ischaemic stroke with large vessel occlusion (LVO) 32.2% vs. 28.3%, hemorrhagic stroke 15.4% vs. 15.6%, stroke mimic 18.9% vs. 22.3% respectively. Amongst patients with LVO, endovascular thrombectomy (EVT) was performed less often in the presence of IVT contraindications (56.2% vs. 74.2%). M-DIRECT-positive patients had higher rates of LVO and EVT compared with M-DIRECT-negative patients independent of reported IVT contraindications. CONCLUSIONS: Reported IVT contraindications alone do not increase EVT likelihood and should not be considered to determine routing in urban stroke networks.
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Isquemia Encefálica , Serviços Médicos de Emergência , Procedimentos Endovasculares , Acidente Vascular Cerebral , Isquemia Encefálica/tratamento farmacológico , Contraindicações , Fibrinolíticos , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Trombectomia , Terapia Trombolítica , Resultado do Tratamento , TriagemRESUMO
INTRODUCTION: The overload of the healthcare system and the organisational changes made in response to the COVID-19 pandemic may be having an impact on acute stroke care in the Region of Madrid. METHODS: We conducted a survey with sections addressing hospital characteristics, changes in infrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation, and outpatient care. We performed a descriptive analysis of results according to the level of complexity of stroke care (availability of stroke units and mechanical thrombectomy). RESULTS: The survey was completed by 22 of the 26 hospitals in the Madrid Regional Health System that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent of hospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neurology ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathways were modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in 50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neurology wards in 42%. Twenty-four hour on-site availability of mechanical thrombectomy was improved in 10 hospitals, which resulted in a reduction in the number of secondary hospital transfers. The admission of patients with transient ischaemic attack or minor stroke was avoided in 45% of hospitals, and follow-up through telephone consultations was implemented in 100%. CONCLUSIONS: The organisational changes made in response to the SARS-Co2 pandemic in hospitals in the Region of Madrid have modified the allocation of neurology department staff and infrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions, and outpatient follow-up.
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Betacoronavirus , Infecções por Coronavirus , Procedimentos Clínicos/organização & administração , Atenção à Saúde/organização & administração , Pandemias , Pneumonia Viral , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Doença Aguda , Assistência Ambulatorial/organização & administração , Agendamento de Consultas , Conversão de Leitos , COVID-19 , Infecções por Coronavirus/diagnóstico , Atenção à Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Departamentos Hospitalares/organização & administração , Hospitais Urbanos/organização & administração , Hospitais Urbanos/estatística & dados numéricos , Humanos , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/terapia , Trombólise Mecânica/estatística & dados numéricos , Neurologia/organização & administração , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral/diagnóstico , SARS-CoV-2 , Espanha/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Telemedicina , Terapia Trombolítica/estatística & dados numéricosRESUMO
INTRODUCTION: The COVID-19 pandemic has resulted in complete saturation of healthcare capacities, making it necessary to reorganise healthcare systems. In this context, we must guarantee the provision of acute stroke care and optimise code stroke protocols to reduce the risk of SARS-CoV-2 infection and rationalise the use of hospital resources. The Madrid Stroke multidisciplinary group presents a series of recommendations to achieve these goals. METHODS: We conducted a non-systematic literature search using the keywords "stroke" and "COVID-19" or "coronavirus" or "SARS-CoV-2." Our literature review also included other relevant studies known to the authors. Based on this literature review, a series of consensus recommendations were established by the Madrid Stroke multidisciplinary group and its neurology committee. RESULTS: These recommendations address 5 main objectives: 1) coordination of action protocols to ensure access to hospital care for stroke patients; 2) recognition of potentially COVID-19-positive stroke patients; 3) organisation of patient management to prevent SARS-CoV-2 infection among healthcare professionals; 4) avoidance of unnecessary neuroimaging studies and other procedures that may increase the risk of infection; and 5) safe, early discharge and follow-up to ensure bed availability. This management protocol has been called CORONA (Coordinate, Recognise, Organise, Neuroimaging, At home). CONCLUSIONS: The recommendations presented here may assist in the organisation of acute stroke care and the optimisation of healthcare resources, while ensuring the safety of healthcare professionals.
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Isquemia Encefálica/terapia , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Doença Aguda , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/diagnóstico por imagem , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções Comunitárias Adquiridas/transmissão , Contenção de Riscos Biológicos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Tomada de Decisão Compartilhada , Gerenciamento Clínico , Serviço Hospitalar de Emergência , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Hospitalização , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Tempo de Internação , Neuroimagem , Pandemias/prevenção & controle , Transferência de Pacientes , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Roupa de Proteção , Espanha/epidemiologia , TelemedicinaRESUMO
INTRODUCTION: Stigma manifests both in prejudices and rejection from society towards patients who suffer from a specific pathology, and by patient's internalization of this discrimination, with the consequent repercussions on their state of mind and quality of life. The aim of the study was to quantify the stigma associated with migraine and analyze whether it is related to the clinical-demographic characteristics of the patients, as well as the possible impact on their daily lives. MATERIALS AND METHODS: The stigma scale for chronic illness (SSCI) and other questionnaires were administered to 56 patients with episodic migraine (EM), 18 with chronic migraine (CM), and 21 with epilepsy, as a control group. RESULTS: The mean SSCI score was higher (51.6 ± 15.0) in the CM group than in the EM (45.0 ± 13.5) and epilepsy (47.6 ± 15.5) groups, without reaching statistical significance. In addition, the score was higher in patients who were unemployed, divorced, and in those who had migraine with aura. A statistically significant correlation was found between the SSCI score and the impact of migraine on daily life, the presence of stress, anxiety and depression, and low self-esteem. CONCLUSIONS: There is a stigma around migraine in our society, which seems to be more prevalent in patients with certain socio-demographic characteristics, and that is related to stress, mood alterations, and low self-esteem. Trying to reduce stigma could contribute to improve the control of migraine and reduce the impact of the disease at a socio-economic level.
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Transtornos de Enxaqueca , Qualidade de Vida , Ansiedade , Humanos , Transtornos de Enxaqueca/epidemiologia , Estigma Social , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND PURPOSE: For patients with acute ischaemic stroke due to large-vessel occlusion, it has recently been shown that mechanical thrombectomy (MT) with stent retrievers is better than medical treatment alone. However, few hospitals can provide MT 24 h/day 365 days/year, and it remains unclear whether selected patients with acute stroke should be directly transferred to the nearest MT-providing hospital to prevent treatment delays. Clinical scales such as Rapid Arterial Occlusion Evaluation (RACE) have been developed to predict large-vessel occlusion at a pre-hospital level, but their predictive value for MT is low. We propose new criteria to identify patients eligible for MT, with higher accuracy. METHODS: The Direct Referral to Endovascular Center criteria were defined based on a retrospective cohort of 317 patients admitted to a stroke center. The association of age, sex, RACE scale score and blood pressure with the likelihood of receiving MT were analyzed. Cut-off points with the highest association were thereafter evaluated in a prospective cohort of 153 patients from nine stroke units comprising the Madrid Stroke Network. RESULTS: Patients with a RACE scale score ≥ 5, systolic blood pressure <190 mmHg and age <81 years showed a significantly higher probability of undergoing MT (odds ratio, 33.38; 95% confidence interval, 12-92.9). This outcome was confirmed in the prospective cohort, with 68% sensitivity, 84% specificity, 42% positive and 94% negative predictive values for MT, ruling out 83% of hemorrhagic strokes. CONCLUSIONS: The Direct Referral to Endovascular Center criteria could be useful for identifying patients suitable for MT.
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Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Serviços Médicos de Emergência/métodos , Procedimentos Endovasculares , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Transferência de Pacientes , Projetos Piloto , Estudos Retrospectivos , Espanha , Stents , Trombectomia , Tempo para o TratamentoRESUMO
INTRODUCTION: Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. METHODS: A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. RESULTS: During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was 13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. CONCLUSIONS: Acute CS management in the Region of Madrid resulted consumes large amounts of resources (13,139), mainly due to hospital stays and rehabilitation.
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Embolia/complicações , Cardiopatias/complicações , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Embolia/terapia , Feminino , Cardiopatias/terapia , Custos Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reabilitação/economia , Espanha/epidemiologia , Acidente Vascular Cerebral/etiologiaRESUMO
OBJECTIVES: To identify possible differences in the early response to intravenous thrombolysis (IVT) or in stroke outcome at 3 months, based on stroke subtype in patients with acute ischaemic stroke (IS). METHODS: Multicentre stroke registry data were used, with prospective inclusion of consecutive patients with acute IVT-treated IS in five acute stroke units. We compared clinical improvement (National Institutes of Health Stroke Scale, NIHSS) at 24 h and at day 7 as well as functional outcome at 3 months (Modified Rankin Scale, mRS) amongst the different stroke subtypes (ICD-10). RESULTS: In total, 1479 patients were included; 178 (12%) had large vessel disease (LVD) with carotid stenosis ≥ 50%, 175 (11.8%) had other LVD, 638 (43%) had cardioembolism, 60 (4.1%) had lacunar infarction, 72 (4.9%) were patients with IS of other/unusual cause and 356 (24.1%) had unknown/multiple causes. Patients with lacunar infarction had lower stroke severity (median NIHSS 6) whilst cardioembolic IS was the most severe (median NIHSS 14) (P < 0.001). No differences in NIHSS improvement were found at 24 h. LVD patients with carotid stenosis (odds ratio 0.544; 95% CI 0.383-0.772; P = 0.001) were less likely to improve at day 7 after adjustment for age, gender, vascular risk factors and stroke severity. However, adjusted multivariate analysis showed no influence of stroke subtype on stroke outcome (mRS) at 3 months. Age, systolic blood pressure on admission and stroke severity were independently associated with mRS > 2 at 3 months. CONCLUSION: Although LVD patients with arterial stenosis ≥ 50% improve less than the other aetiologies at day 7, stroke aetiological subtype does not determine differences in IS outcome at 3 months after IVT.
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Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Idoso , Feminino , Humanos , Infusões Intravenosas , Masculino , Recuperação de Função Fisiológica , Sistema de Registros , EspanhaRESUMO
The vitamin K antagonists (VKA) available for stroke prevention in patients with atrial fibrillation have many drawbacks due to their difficult clinical use and high risk of bleeding. Currently, several drugs are being developed as possible substitutes for VKA that have many advantages such as the lack of monitoring requirement and scarce pharmacologic and food interactions. The present article provides an update on the new oral anticoagulants that are in a more advanced stage of clinical research, their pharmacologic properties, advantages and disadvantages and their results in recent clinical trials.
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Anticoagulantes/uso terapêutico , Azetidinas/uso terapêutico , Benzimidazóis/uso terapêutico , Benzilaminas/uso terapêutico , Morfolinas/uso terapêutico , Planejamento de Assistência ao Paciente , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Tiofenos/uso terapêutico , beta-Alanina/análogos & derivados , Administração Oral , Anticoagulantes/efeitos adversos , Anticoagulantes/farmacologia , Azetidinas/efeitos adversos , Azetidinas/farmacologia , Benzimidazóis/efeitos adversos , Benzimidazóis/farmacologia , Benzilaminas/efeitos adversos , Benzilaminas/farmacologia , Ensaios Clínicos como Assunto , Dabigatrana , Monitoramento de Medicamentos , Drogas em Investigação , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Humanos , Morfolinas/efeitos adversos , Morfolinas/farmacologia , Estudos Multicêntricos como Assunto , Pirazóis/efeitos adversos , Pirazóis/farmacologia , Piridonas/efeitos adversos , Piridonas/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Rivaroxabana , Acidente Vascular Cerebral/etiologia , Tiofenos/efeitos adversos , Tiofenos/farmacologia , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Vitamina K/antagonistas & inibidores , beta-Alanina/efeitos adversos , beta-Alanina/farmacologia , beta-Alanina/uso terapêuticoRESUMO
INTRODUCTION: Delays on arrival time and specialized care at hospital are still the first cause that hampers the application of best possible treatments to the stroke patients. AIM: To analyze the arrival time to the hospital up to the neurological care of patients, in a multicentric series of stroke patients. PATIENTS AND METHODS: The EPICES registry is an observational and prospective study performed with a methodology of registering consecutive clinical records of stroke patients admitted to the hospital under neurological attention. The sample used to analyze starting-door times it was 5,454 patients, for the door-neurologist time it was 5,379 patients, and for the time of stay at ER room it was 5,825 patients. RESULTS: 90% of the patients presented a stroke between 8 and 24 h. The season of the year had no influence on the frequency, neither on the distribution of stroke type. onset-door time was 264.1 ± 318.3 minutes; 34.7% of the patients arrived to the hospital during the first hour after the onset of the symptoms, and 63.7% of them arrived during the first three hours. Door-neurologist time was 378.1 ± 731.4 minutes; patients' age (p < 0.0001) and previous strokes (p < 0.0001) significantly prolonged such time. The availability of neurologist on call at the emergency service and of stroke units were associated to a significant reduction of hospital indoor times. CONCLUSION: In relation to previous data, current study shows an important reduction of onset-door and door-neurologist times.
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Hospitalização , Acidente Vascular Cerebral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Fatores de Tempo , Adulto JovemRESUMO
INTRODUCTION: Hospital-based population studies are a good way to determinate the number and features of strokes that occur in a given society. The major stroke subtypes have different patterns of incidence and outcome, for that reason information on the natural history of stroke subtypes is essential. AIM: To determine the incidence of the stroke subtypes and the prevalence of the major risk factors in the Spanish population. PATIENTS AND METHODS: EPICES is an observational, multicenter and prospective study. Methodology includes systematic review of consecutive medical records of hospitalized stroke patients in neurological care. 6,197 patients were included during the period April 2008 and January 2009. 3,544 (57.2%) were men. Mean age was 71.4 ± 12.8 years. RESULTS: Intracerebral haemorrhage was diagnosed in 771 patients (12.4%) and ischemic stroke in 5,426 (87.6%). 1,543 (28.4%) were classified as large-artery atherosclerosis, cardioembolic 1,424 (26.2%), small-vessel occlusion 1,202 (22.5%), undetermined etiology 1,125 (20.7%). Stroke of other uncommon origin was founded in 132 (2.4%). Hypertension is the most common risk factor in both ischemic stroke (67%) and intracerebral haemorrhage (69.1%). The different types of ischemic and hemorrhagic stroke showed differences in risk factors prevalence. CONCLUSIONS: The overall distribution of stroke subtypes are not significantly different from those of most Western countries. The frequency of vascular risk factors differs between stroke subtypes. Hypertension remains the most important modifiable risk factor.
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Pacientes Internados/estatística & dados numéricos , Corpo Clínico Hospitalar/estatística & dados numéricos , Neurologia , Sistema de Registros/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/epidemiologia , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Embolia Intracraniana/epidemiologia , Hemorragias Intracranianas/epidemiologia , Trombose Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral Lacunar/epidemiologiaAssuntos
Angioplastia/efeitos adversos , Encéfalo/patologia , Stents/efeitos adversos , Hemorragia Subaracnóidea/etiologia , Idoso , Angiografia , Encéfalo/irrigação sanguínea , Evolução Fatal , Humanos , Masculino , Hemorragia Subaracnóidea/patologia , Síndrome , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Stroke is the primary cause of mortality and incapacity of women in Spain. Current therapeutic guidelines are based on clinical trials in which the number of females taking part is insufficient, and overall benefits are then dangerously extrapolated to women. DEVELOPMENT AND CONCLUSIONS: Strokes in women have important features that distinguish them from those suffered by males, both as regards risk factors and aetiology, and in prevention and the therapeutic treatment that is performed during the fertile stage, pregnancy and menopause. There is, then, a need for further studies and specific clinical trials about strokes in females. Health professionals, society and the authorities, as well as women themselves, also need to be made more aware of the importance of strokes and to be provided with more information. If not, this epidemic will increase, especially if we bear in mind the foreseeable increase in life expectancy, and mortality and loss of independence in women will rise along with it.
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Acidente Vascular Cerebral/terapia , Adolescente , Adulto , Idoso , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Anticoncepcionais Orais Hormonais/efeitos adversos , Endarterectomia das Carótidas , Feminino , Promoção da Saúde , Terapia de Reposição Hormonal , Humanos , Hiperlipidemias/complicações , Hiperlipidemias/tratamento farmacológico , Pessoa de Meia-Idade , Pós-Menopausa , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/epidemiologia , Transtornos Puerperais/tratamento farmacológico , Transtornos Puerperais/epidemiologia , Sistema Renina-Angiotensina/fisiologia , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
INTRODUCTION: Although in clinical practice no distinction is usually made in the prevention and management of strokes according to the sex of the patient, some studies suggest the existence of significant clinical differences in the strokes suffered by females. PATIENTS AND METHODS: The purpose of our study was to confirm and characterize these differences in patients admitted to hospitals in our community; to do so, we performed an analysis of the stroke or little stroke patients included in the Spanish Neurology Society's Stroke Database (BADISEN), from 1996 to 2001, belonging to eight Spanish hospitals. We analyzed the social aspects, risk factors, clinical features, diagnostic data, situation and referral on discharge of 4,248 female patients (39%). A univariate and, later, a multivariate analysis were performed using logistic regression of the variables that showed significant differences (p<0.2). RESULTS: The findings from our study confirm a number of differences between male and female stroke victims. Strokes occur later in females (71 years old compared with 69 in males), when the patient lives alone. The following also occur more frequently in these patients than in males: arterial hypertension (62.8 versus 51.9%, p<0.0001), cardiac insufficiency (8.0 as opposed to 4.5%, p<0.0001) and atrial fibrillation (21.4 versus 11.3%, p<0.0001) as risk factors; cardioembolic causation (22.4 against 15.4%, p<0.0001) in anterior circulation (44.0 compared to 36.1%, p<0.0001); severity is increased (6.8 on the Canadian scale versus 7.5%, p<0.0001); more medical complications (40.5 compared to 33.7%, p<0.0001), more serious sequelae (64.2 on the Barthel index compared to 72.9%, p<0.0001) and a higher institutionalization rate, among other distinguishing facts. CONCLUSIONS: Such differences must be taken into account in the prevention and management of strokes in females.
Assuntos
Hospitais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Interpretação Estatística de Dados , Feminino , Humanos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Acidente Vascular Cerebral/complicaçõesRESUMO
INTRODUCTION AND OBJECTIVE: Hypercholesterolemia has been shown to be a definite risk factor for coronary disease, although its relevance in cerebrovascular disease is more controversial. This study reviews the part played by different hypolipemic treatments in primary and secondary prevention of the complications of atherothrombotic diseases, particularly stroke. DEVELOPMENT: We based our study mainly on the HMG-CoA inhibitors (3-hydroxyl 3 methyl glutaryl coenzyme A) reductase, or statins++. This group of drugs acts by inhibiting the synthesis of cholesterol and increasing the expression of LDL-c receptors, achieving a 25-35% lowering of plasma LDL-c levels. In diverse clinical trials they have been shown to have a beneficial effect in the prevention of cardiovascular disease. The results of these studies indicate that, in addition to their purely hypolipemic effect, other anti-atherothrombotic mechanisms are involved. We analyze the main studies on hypolipemic drugs in the primary and secondary prevention of coronary and cardiovascular disease. CONCLUSIONS: The role of statins is clearly defined in reduction of the risk of overall and cardiovascular mortality, and also in reduction of the incidence of cardiovascular incidents in patients with a past history of coronary disease and a cholesterol level over 155 mg/dl. Reduction of the risk from cerebrovascular disease has only been observed in primary prevention studies (patients with a past history of coronary disease). Therefore, we shall have to await the results of the clinical trials currently being carried out to determine the true role of statins in the secondary prevention of cerebrovascular disease.
Assuntos
Anticolesterolemiantes/uso terapêutico , Arteriosclerose/tratamento farmacológico , Adulto , Idoso , Arteriosclerose/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
OBJECTIVE: To study main factors determining medical decision in admitting patients with acute cerebrovascular disease (ACVD). PATIENTS AND METHODS: This is an observational and transversal study. We analyze a hospitalary cohort made by all consecutive patients with ACVD coming to Emergency Room to Hospital Universitario de la Princesa during 1 year. Neurologist on call made on his/her own decision to admit the patient to hospital. Clinical and epidemiological characteristics of those patients admitted with those who went home are compared. RESULTS: 517 patients were studied, 147 had transient ischemic attacks (TIA) and 370 had a stroke, 12.3% TIA and 68.4% stroke patients were hospitalized. Age, Canadian Stroke Scale (CSS) on admission, subtype of stroke, atrial fibrillation and abnormal EKG, old lesions in CT, previous TIA and/or CVD, diminished conscious level, orientation and language, sphincter control and evolution time greater than 48 hours were statistically significative in deciding admission. Logistic regression analysis (84.2% total predictive value) showed independent predictive value in age, CSS, previous CVD and some subtypes of stroke (ischemic non lacunar and hemorrhage). CONCLUSIONS: We hospitalize younger patients, with a worse clinical condition and overall hemorrhagic stroke. The percentage of admissions among TIA patients is low. On the other hand, date, time and physicians-team features do not affect the percentage of admissions.