The Direct Referral to Endovascular Center criteria: a proposal for pre-hospital evaluation of acute stroke in the Madrid Stroke Network.

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.

[A clinico-anatomical correlation study of logorrhoea]. / Estudio de correlación clinicoanatómica de la logorrea.

INTRODUCTION: The degree of verbal production necessary to be considered logorrhoea has still not been defined, and no clear correlation has been established between the topography of the dysfunction and this symptom. AIMS: To provide quantitative data about normal verbal production and to identify the location within the brain of the alterations observed in neuroimage of patients with logorrhoea. SUBJECTS AND METHODS: The oral verbal production of 60 control subjects between 20 and 80 years of age was quantified by analysing five speeches. Ten patients who exceeded the 75th percentile in at least two of the five speeches underwent structural and functional neuroimaging tests. RESULTS. The data on verbal production of normal subjects are reported. Age, sex and habits (smoking, coffee, alcoholic drinks) did not exert an influence, but the degree of schooling was seen to have an effect. All the patients were diagnosed with frontotemporal degeneration, although in one case there were also coexisting vascular risk factors and subcortical vascular lesions, which reduce the degree of certainty of the diagnosis. Cortical atrophy is located in the right anterior temporal lobes (100% anteromedial, 100% anteroinferior, 70% anterolateral), left anterior temporal (90% anteromedial, 90% anteroinferior, 60% anterolateral), right prefrontal (30% basal, 50% dorsolateral, 20% medial) and left prefrontal (20% basal, 30% dorsolateral, 20% medial). CONCLUSIONS: Oral verbal production is influenced by level of education and, in a sample of patients with probable frontotemporal degeneration and logorrhoea, all the patients showed alterations in the anteroinferior and anteromedial regions of the right temporal lobe.

Estudio de correlación clinicoanatómica de la logorrea / A clinico anatomical correlation study of logorrhoeaa

Resumen. Introducción. Aún no se ha definido el grado de producción verbal necesario para identificar una logorrea y tampoco se ha establecido una correlación clara entre la topografía de la disfunción y el síntoma. Objetivos. Aportar datos cuantitativos de producción verbal normal e identificar la localización cerebral de las alteraciones en neuroimagen de pacientes con logorrea. Sujetos y métodos. Se ha cuantificado la producción verbal oral de 60 sujetos de control de entre 20 y 80 años, analizando cinco discursos. A 10 pacientes que superaron el percentil 75 en al menos dos de los cinco discursos se les realizaron pruebas de neuroimagen estructural y funcional. Resultados. Se presentan los datos de producción verbal de los sujetos normales. La edad, el sexo y hábitos (tabaco, café, bebidas alcohólicas) no mostraron influencia, pero sí el grado de formación académica. Todos los enfermos fueron diagnosticados de degeneración frontotemporal, aunque en un caso coexistían factores de riesgo vascular y lesiones vasculares subcorticales, que reducen seguridad al diagnóstico. La atrofia cortical se localiza en los lóbulos temporal anterior derecho (el 100% anteromedial, el 100% anteroinferior, el 70% anterolateral), temporal anterior izquierdo (el 90% anteromedial, el 90% anteroinferior, el 60% anterolateral), prefrontal derecho (el 30% basal, el 50% dorsolateral, el 20% medial) y prefrontal izquierdo (el 20% basal, el 30% dorsolateral, el 20% medial). Conclusiones. La producción verbal oral está influida por la formación académica y, en una muestra de pacientes con degeneración frontotemporal probable y logorrea, todos los enfermos mostraron alteración en las regiones anteroinferior y anteromedial del lóbulo temporal derecho (AU)

Summary. Introduction. The degree of verbal production necessary to be considered logorrhoea has still not been defined, and no clear correlation has been established between the topography of the dysfunction and this symptom. Aims. To provide quantitative data about normal verbal production and to identify the location within the brain of the alterations observed in neuroimage of patients with logorrhoea. Subjects and methods. The oral verbal production of 60 control subjects between 20 and 80 years of age was quantified by analysing five speeches. Ten patients who exceeded the 75th percentile in at least two of the five speeches underwent structural and functional neuroimaging tests. Results. The data on verbal production of normal subjects are reported. Age, sex and habits (smoking, coffee, alcoholic drinks) did not exert an influence, but the degree of schooling was seen to have an effect. All the patients were diagnosed with frontotemporal degeneration, although in one case there were also coexisting vascular risk factors and subcortical vascular lesions, which reduce the degree of certainty of the diagnosis. Cortical atrophy is located in the right anterior temporal lobes (100% anteromedial, 100% anteroinferior, 70% anterolateral), left anterior temporal (90% anteromedial, 90% anteroinferior, 60% anterolateral), right prefrontal (30% basal, 50% dorsolateral, 20% medial) and left prefrontal (20% basal, 30% dorsolateral, 20% medial). Conclusions. Oral verbal production is influenced by level of education and, in a sample of patients with probable frontotemporal degeneration and logorrhoea, all the patients showed alterations in the anteroinferior and anteromedial regions of the right temporal lobe (AU)