[Stroke mimics: a challenge for the emergency physician]. / Imitadores del ictus: un reto para el médico de urgencias.

BACKGROUND: To study the number of patients diagnosed with a stroke in the emergency service of a first level hospital and the proportion of these patients who were finally stroke mimics, as well as to describe and analyze the variables that can help in differential diagnosis in hospital emergency services. METHOD: Nine month prospective study. All patients evaluated in emergency services and admitted with a diagnosis of stroke were included. Different clinical variables were analyzed that included prior history, history of the current event, general physical and neurological examination, NIHSS classification and Oxfordshire Community Stroke Project Classification. The final diagnosis was made by a panel of experts with access to clinical characteristics, image studies and other tests. The univariate and multivariate analysis determined the characteristics that help in distinguishing strokes from stroke mimics. RESULTS: One hundred and forty-four cases of stroke were registered; the final sample was made up of 140 patients. The final diagnosis was stroke in 103 out of 140 (73.6%) and stroke mimic in the rest. Eleven variables predicted the diagnosis in patients with a suspected stroke: age over 70 years (p=0.012), NIHSS classification > 5, reaching a clinical classification (p=0.019) capable of determining the exact start (p=0.000), abnormal vascular findings (p=0.014), gaze deviation (p=0.042), sight loss (p=0.052) and extensor plantar response (p=0.025) favored diagnosis of stroke, while epileptic seizures (p=0.029), neurological symptoms not congruent with the vascular territory (p=0.022) and abnormal findings in other systems (p=0.14) favored diagnosis of stroke mimic. CONCLUSION: Stroke mimics constitute one-third of the patients admitted from emergency services as strokes, with a highly varied etiology. Achieving a suitable clinical history and a precise physical examination is of great importance and can help less experienced doctors.

[Biliary surgery on those over 70: an analysis of 109 cases]. / La cirugía biliar en mayores de 70 años: análisis de 109 casos.

109 patients older than seventy years of age and operated of gallstone disease in our service during a period of 4.5 years are presented. The average age of the series was 78.8 years, with a male/female (M/F) ratio of 1/1.6. 77% of the patients were admitted on an emergency basis due to a complication derived from the gallstone disease they were suffering. Only 39.8% of the patients were previously diagnosed of gallstone disease at the time of admission and 10% presented an associated surgical condition which was treated simultaneously. Overall morbidity of the series was 36%, with a mortality of 2 cases (1.9%).