Thrombectomy for Stroke in the Public Health Care System of Brazil.

BACKGROUND: Randomized trials involving patients with stroke have established that outcomes are improved with the use of thrombectomy for large-vessel occlusion. These trials were performed in high-resource countries and have had limited effects on medical practice in low- and middle-income countries. METHODS: We studied the safety and efficacy of thrombectomy in the public health system of Brazil. In 12 public hospitals, patients with a proximal intracranial occlusion in the anterior circulation that could be treated within 8 hours after the onset of stroke symptoms were randomly assigned in a 1:1 ratio to receive standard care plus mechanical thrombectomy (thrombectomy group) or standard care alone (control group). The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. RESULTS: A total of 300 patients were enrolled, including 79 who had undergone thrombectomy during an open-label roll-in period. Approximately 70% in the two groups received intravenous alteplase. The trial was stopped early because of efficacy when 221 of a planned 690 patients had undergone randomization (111 to the thrombectomy group and 110 to the control group). The common odds ratio for a better distribution of scores on the modified Rankin scale at 90 days was 2.28 (95% confidence interval [CI], 1.41 to 3.69; P = 0.001), favoring thrombectomy. The percentage of patients with a score on the modified Rankin scale of 0 to 2, signifying an absence of or minor neurologic deficit, was 35.1% in the thrombectomy group and 20.0% in the control group (difference, 15.1 percentage points; 95% CI, 2.6 to 27.6). Asymptomatic intracranial hemorrhage occurred in 51.4% of the patients in the thrombectomy group and 24.5% of those in the control group; symptomatic intracranial hemorrhage occurred in 4.5% of the patients in each group. CONCLUSIONS: In this randomized trial conducted in the public health care system of Brazil, endovascular treatment within 8 hours after the onset of stroke symptoms in conjunction with standard care resulted in better functional outcomes at 90 days than standard care alone. (Funded by the Brazilian Ministry of Health; RESILIENT ClinicalTrials.gov number, NCT02216643.).

Primary cerebrospinal fluid leak complicated with meningitis and parainfectious vasculitis: case report and literature review / Fístula liquórica primária complicada com meningite e vasculite parainfecciosa: relato de caso e revisão de literatura

This paper aims to describe a case of an immunocompetent 60-year-old patient presenting a subarachnoid hemorrhage in the absence of aneurysmal disease. Initial evaluation pointed to vasculitis of the central nervous system secondary to meningeal infection. After initial treatment, a cerebrospinal fluid leak was identified, with no antecedent of trauma, elucidating the origin of infection. Primary cerebrospinal fluid rhinorrhea has nonspecific symptomatology, defying diagnosis, and potentially serious complications. It represents an unusual predisposing factor for meningeal infection and secondary vasculitis. This case report exemplifies a feared complication of spontaneous cerebrospinal fluid leakage.

O estudo objetiva relatar um caso clínico de uma paciente imunocompetente de 60 anos apresentando hemorragia subaracnoide na ausência de doença aneurismática. Avaliação inicial apontou para vasculite de sistema nervoso central secundária à infecção meníngea. Após tratamento inicial, uma fístula liquórica foi identificada, sem antecedente de trauma, elucidando a origem da infecção. Rinorreia liquórica primária possui sintomatologia inespecífica, diagnóstico desafiador e complicações potencialmente graves. Representa um raro fator predisponente para infecção meníngea e vasculite. Este relato de caso exemplifica uma complicação temida da rinorreia liquórica espontânea.

Derivo Embolization Device for the Treatment of Intracranial Aneurysms.

Background and Purpose- Flow diverter technology improvements are necessary to provide safe and good results and enable the treatment of a larger variety of aneurysms. We report a nationwide experience with the Derivo Embolization Device in the treatment of intracranial aneurysms. Methods- BRAIDED (Brazilian Registry of Aneurysms Assigned to Intervention With the Derivo Embolization Device) is a multicenter, prospective, interventional, single-arm trial of the Derivo Embolization Device for the treatment of intracranial aneurysms. The primary effectiveness end point was total aneurysm occlusion at 6- and 12-month angiographies. The secondary safety end point was the absence of serious adverse events during follow-up. Univariable and multivariable logistic regression was performed to identify predictors of aneurysm persistence, periprocedural complications, and adverse events during follow-up. Results- Between December 2016 and October 2018, 146 patients harboring 183 intracranial aneurysms were treated in 151 interventions at 7 centers. Derivo Embolization Device placement was technically successful in all patients. Most aneurysms (86.9%) were located at the internal carotid artery, and the mean diameter was 6.7 mm. At 6 months, 113 of 140 (80.7%) aneurysms met the study's primary end point, and 74 of 83 (89.2%) met the study's primary end point at 12 months. Saccular morphology of the aneurysm (odds ratio, 5.66; 95% CI, 1.01-31.77) and the presence of a branch arising from the sac (odds ratio, 6.36; 95% CI, 2.11-22.36) predicted persistence. A long duration of follow-up (odds ratio, 0.86; 95% CI, 0.78-0.95) predicted total occlusion. Of the 146 enrolled patients, 138 (94.5%) were treated without serious adverse events during follow-up. In the multivariable analysis, aneurysms located at a sidewall were less likely to experience these events than those located at bifurcations (odds ratio, 0.07; 95% CI, 0.01-0.51). Conclusions- The Derivo Embolization Device is a safe and effective treatment for intracranial aneurysms. Clinical Trial Registration- URL: http://plataformabrasil.saude.gov.br/login.jsf. Unique identifier: CAAE 77089717.7.1001.5125.

Influence of Anatomic Changes on the Outcomes of Carotid Siphon Aneurysms After Deployment of Flow-Diverter Stents.

BACKGROUND: Flow-diverter stent (FDS) deployment can cause morphological and hemodynamic changes in the carotid siphon (CS), influencing the occlusion rate of aneurysms in this location. OBJECTIVE: To evaluate morphological changes to the CS after FDS deployment and their relationship with the rate of occlusion of intracranial aneurysms. METHODS: A cohort of 183 patients with CS aneurysms were treated by deployment of Pipeline® FDS (Medtronic Inc, Dublin, Ireland). Their CSs were classified as type U, V, C, or S, depending on morphology. The posterior and anterior bend angles were measured on strict lateral cerebral angiogram with digital subtraction before FDS deployment, immediately after deployment, and at 6 mo. Differences between angles were analyzed to identify any correlations with rates of aneurysm occlusion, using the O'Kelly-Marotta classification. RESULTS: FDS deployment was associated with immediate changes in CS morphology. The mean anterior angle increased from 3.97 ± 25.06° to 22.05 ± 25.18° (P < .001) and the mean posterior angle increased from 71.98 ± 31.27° to 79.43 ± 31.80° (P < .001). Multivariate analysis revealed a progressive, statistically significant increase in frequency of complete (grade D) occlusion at 6-mo follow-up with increasing anterior bend angle (prevalence ratios (PR) = 1.42 for increases between 5.3° and 12°, P = .017; PR = 1.56 for increases between 12.1° and 27.6°, P = .002; PR = 1.83 for increases >27.6°, P < .001, all vs increases <5.3°). CONCLUSION: FDS deployment induces changes in CS morphology. Specifically, increases in mean anterior angle are associated with better radiological results on 6-mo follow-up digital subtraction angiography.

Role of terminal and anastomotic circulation in the patency of arteries jailed by flow-diverting stents: from hemodynamic changes to ostia surface modifications.

OBJECTIVE The outcome for jailing arterial branches that emerge near intracranial aneurysms during flow-diverting stent (FDS) deployment remains controversial. In this animal study, the authors aimed to elucidate the role of collateral supply with regard to the hemodynamic changes and neointimal modifications that occur from jailing arteries with FDSs. To serve this purpose, the authors sought to quantify 1) the hemodynamic changes that occur at the jailed arterial branches immediately after stent placement and 2) the ostia surface values at 3 months after stenting; both parameters were investigated in the presence or absence of collateral arterial flow. METHODS After an a priori power analysis, 2 groups (Group A and Group B) were created according to an animal flow model for terminal and anastomotic arterial circulation; each group contained 7 Large White swine. Group A animals possessed an anastomotic-type arterial configuration to supply the territory of the right ascending pharyngeal artery (APhA), while Group B animals possessed a terminal-type arterial configuration to supply the right APhA territory. Subsequently, all animals underwent FDS placement, thereby jailing the right APhAs. Mean flow rates and velocities inside the jailed branches were quantified using time-resolved 3D phase-contrast MR angiography before and after stenting. Three months after stent placement, the jailed ostia surface values were quantified on scanning electron micrographs. The data were analyzed using descriptive statistics and group comparisons with parametric and nonparametric tests. RESULTS The endovascular procedures were feasible, and there were no findings of in situ thrombus formation on postprocedural optical coherence tomography or ischemia on postprocedural diffusion-weighted imaging. In Group A, the mean flow rate values at the jailed right APhAs were reduced immediately following stent placement as compared with values obtained before stent placement (p = 0.02, power: 0.8). In contrast, the mean poststenting flow rates for Group B remained similar to those obtained before stent placement. Three months after stent placement, the mean ostia surface values were significantly higher for Group B (527,911 ± 306,229 µm2) than for Group A (89,329 ± 59,762 µm2; p < 0.01, power: 1.00), even though the initial dimensions of the jailed ostia were similar between groups. A statistically significant correlation was found between groups (A or B), mean flow rates after stent placement, and ostia surface values at 3 months. CONCLUSIONS When an important collateral supply was present, the jailing of side arteries with flow diverters resulted in an immediate and significant reduction in the flow rate inside these arteries as compared with the prestenting values. In contrast, when competitive flow was absent, jailing did not result in significant flow rate reductions inside the jailed arteries. Ostium surface values at 3 months after stent placement were significantly higher in the terminal group of jailed arteries (Group B) than in the anastomotic group (Group A) and strongly correlated with poststenting reductions in the velocity value.

Jailed Artery Ostia Modifications After Flow-Diverting Stent Deployment at Arterial Bifurcations: A Scanning Electron Microscopy Translational Study.

BACKGROUND: Even though flow-diverting stents are being increasingly used to treat intracranial aneurysms, the fate of jailed side branches remains controversial, with recent clinical data contradicting finding of earlier animal studies that reported patency. OBJECTIVE: To quantify the surface area of the ostia after 3 months of jailing by flow-diverting stents as a more accurate means of patency evaluation. METHODS: Ten large white swine were stented by flow-diverting stents placed at common carotid-ascending pharyngeal arterial bifurcation sites. A dual antiplatelet regimen was initiated 72 hours before stenting and maintained during follow-up. Optical coherence tomography was used to search for per-procedural thrombus formation. Selective control digital subtraction angiography was performed 12 weeks post-stenting. Subsequently, the stented arterial segments were harvested en bloc and observed under scanning electron microscopy, photographed, and quantified. RESULTS: The absence of per-procedural thrombus formation was confirmed. All ostia were patent at 12 weeks (or 3 months) post stenting, with no angiographic or scanning electron microscopy-evident thrombus formation. The mean initial ostium surface was 2 048 617 ± 731 625 µm. At 3 months, the mean nonendothelialized ostium surface was 229 218 ± 140 172 µm, and mean endothelialized ostium surface was 1 819 399 ± 672 632 µm. A statistically significant difference (reduction) was observed between the initial and 12-week ostium surfaces (P < .001), with an significant statistical power (1.000). CONCLUSION: Jailed side branches remained patent after stenting, but the surface quantifications showed significant endothelial coverage, with a significant reduction of patent ostium surfaces at 12 weeks post-stenting. ABBREVIATIONS: APhA, ascending pharyngeal arteryCI, confidence interval3DRA, 3-dimensional rotational angiographyDSA, digital subtraction angiographyFDS, flow-diverting stentOCT, optical coherence tomographyOS, ostium surfaceSEM, scanning electron microscopy.

Intravascular optical coherence tomography for the evaluation of arterial bifurcations covered by flow diverters.

BACKGROUND AND OBJECTIVE: Due to its high spatial resolution, intravascular optical coherence tomography (OCT) has been used as a valid method for in vivo evaluation of several types of coronary stents at straight lumen and bifurcation sites. We sought to evaluate its effectiveness for flow diverting stents deployed in arterial bifurcation sites involving jailing of a side branch. METHODS: Four large white swine were stented with flow diverting stents covering the right common carotid artery-ascending pharyngeal artery bifurcation. After 12 weeks of follow-up the animals were evaluated by digital subtraction angiography and intravascular OCT and subsequently sacrificed. Neointimal thickness on the parent arteries and the free segments of the stent were measured. The stented arteries were harvested and underwent scanning electron microscopy (SEM) imaging. Ostia surface values were measured with OCT three-dimensional (3D) reconstructions and SEM images. RESULTS: All endovascular procedures and OCT pullback runs were feasible. Stent apposition was satisfactory on the immediate post-stent OCT reconstructions. At 12-week controls, all stents and jailed branches were patent. Mean neointimal thickness was 0.11±0.04 mm on the free segments of the stent. The mean ostia surface at 12 weeks was 319 750±345 533 µm2 with 3D-OCT reconstructions and 351 198±396 355 µm2 with SEM image-derived calculations. Good correlation was found for ostia surface values between the two techniques; the values did not differ significantly in this preliminary study. CONCLUSIONS: Intravascular OCT appears to be a promising technique for immediate and follow-up assessment of the orifice of arterial branches covered by flow diverting stents.

Role of terminal and anastomotic circulation in the patency of arteries jailed by flow-diverting stents: animal flow model evaluation and preliminary results.

OBJECTIVE The authors describe herein the creation of an animal model capable of producing quantifiable data regarding blood flow rate and velocity modifications in terminal and anastomotic types of cerebrofacial circulation. They also present the preliminary results of a translational study aimed at investigating the role of terminal and anastomotic types of circulation in arterial branches jailed by flow-diverting stents as factors contributing to arterial patency or occlusion. METHODS Two Large White swine were used to validate a terminal-type arterial model at the level of the right ascending pharyngeal artery (APhA), created exclusively by endovascular means. Subsequently 4 Large White swine, allocated to 2 groups corresponding to the presence (Group B) or absence (Group A) of terminal-type flow modification, underwent placement of flow-diverting stents. Blood flow rates and velocities were quantified using a dedicated time-resolved 3D phase-contrast MRA sequence before and after stenting. Three months after stent placement, the stented arteries were evaluated with digital subtraction angiography (DSA) and scanning electron microscopy (SEM). Patent (circulating) ostia quantification was performed on the SEM images. RESULTS Terminal-type flow modification was feasible; an increase of 75.8% in mean blood velocities was observed in the right APhAs. The mean blood flow rate for Group A was 0.31 ± 0.19 ml/sec (95% CI -1.39 to 2.01) before stenting and 0.21 ± 0.07 ml/sec (95% CI -0.45 to 0.87) after stenting. The mean blood flow rate for Group B was 0.87 ± 0.32 ml/sec (95% CI -1.98 to 3.73) before stenting and 0.76 ± 0.13 ml/sec (95% CI -0.41 to 1.93) after stenting. Mean flow rates after stenting showed a statistically significant difference between Groups A and B (Welch test). Mean and maximal blood velocities were reduced in Group A cases and did not decrease in Group B cases. Control DSA and SEM findings showed near occlusion of the jailed APhAs in both cases of anastomotic circulation (mean patent ostium surface 32,776 µm2) and patency in both cases of terminal-type circulation (mean patent ostium surface 422,334 µm2). CONCLUSIONS Terminal-type arterial modification in swine APhAs is feasible. Sufficient data were acquired to perform an a priori analysis for further research. Flow diversion at the level of the APhA ostium resulted in significant stenosis in cases of anastomotic circulation, while sufficient patency was observed in terminal-type circulation.

Transvenous Embolization in Pediatric Plexiform Arteriovenous Malformations.

BACKGROUND: Transvenous embolization is a developing concept for curative therapy of cerebral arteriovenous malformations (AVMs). The feasibility of this endovascular method has not been reported in children. OBJECTIVE: To report our experience treating pediatric AVMs with the transvenous approach (TVA). METHODS: A cohort of 7 pediatric patients (younger than 18 years of age) who underwent the TVA for cerebral AVMs between January 2012 and January 2014. The TVA was used alone or in conjunction with other arterial approaches in definitive embolization sessions. Patient demographics, AVM characteristics, clinical outcomes, and angiographic results were independently assessed. Pial arteriovenous fistulae and vein of Galen malformations were excluded. Control angiograms were obtained at 6 months, and curative treatment was determined by the anatomic obliteration of the nidus. RESULTS: All patients had anatomic exclusion of the AVM. The mean size was 2 ± 0.6 cm, and hemorrhage was the most common presentation (100%, n = 7). Most AVMs were deeply placed (71%, n = 5), and a proximal approach to the nidus was achieved in all cases. Transvenous embolization alone was performed in 3 patients (43%), whereas combined arterial and venous embolization was required in 4 patients (57%). The mean follow-up period was 20.2 ± 10.5 months. There were no hemorrhagic or thromboembolic events, and venous infarction was not documented. No recurrence was documented. CONCLUSION: This is the first report that demonstrates the feasibility of transvenous Onyx embolization of AVMs in the pediatric population. Such a technique may be considered in certain AVMs that meet anatomic criteria in which microsurgery and radiosurgery might not be indicated.

Comparative analysis of multiple sleep latency tests (MSLT) parameters and occurrence of dreaming in patients with daytime sleepiness of narcoleptic and non-narcoleptic origin / Estudo comparativo de parâmetros de testes de latências múltiplas do sono (TLMS) e ocorrência de sonhos em pacientes hipersones narcolépticos e não-narcolépticos

OBJECTIVE: To compare MSLT parameters in two groups of patients with daytime sleepiness, correlated to the occurrence and onset of dreams. METHOD: Patients were submitted to the MSLT between January/1999 and June/2002. Sleep onset latency, REM sleep latency and total sleep time were determined. The occurrence of dreams was inquired following each MSLT series. Patients were classified as narcoleptic (N) or non-narcoleptic (NN). RESULTS: Thirty patients were studied, 12 were classified as narcoleptics (N group; 40 percent), while the remaining 18 as non-narcoleptic (NN group; 60 percent). Thirty MSLT were performed, resulting in 146 series. Sleep was detected in 126 series (86 percent) and dreams in 56 series (44.44 percent). Mean sleep time in the N group was 16.0±6.3 min, while 10.5±7.5 min in the NN group (p<0.0001). Mean sleep latency was 2.0±2.2 min and 7.2±6.0 min in the N and NN group, respectively (p<0.001). Mean REM sleep latency in the N group was 3.2±3.1min and 6.9±3.7 min in the NN group (p=0.021). Dreams occurred in 56.9 percent of the N group series and 28.4 percent in that of the NN group (p=0.0009). Dream frequency was detected in 29.8 percent and 75 percent of the NREM series of the N and NN groups, respectively (p=0.0001). CONCLUSION: Patients from the N group, compared to the NN group, slept longer and earlier, demonstrated a shorter REM sleep onset and greater dream frequency. NN patients had a greater dream frequency in NREM series. Thus, the occurrence of dreams during NREM in the MSLT may contribute to differentially diagnose narcolepsy and daytime sleepiness.

OBJETIVO: Comparar variáveis do TLMS em dois grupos de pacientes hipersones e correlacionar presença e momento de ocorrência de sonhos. MÉTODO: Os pacientes foram submetidos a TLMS entre janeiro de 1999 e junho de 2002. Analisou-se a média das latências de sono, latências de sono REM e tempo total de sono. A presença de sonhos foi inquirida após cada série. Classificou-se os pacientes em narcolépticos (N) e não-narcolépticos (NN). RESULTADOS: Do total de 30 pacientes, 12 foram classificados no grupo N (40 por cento) e 18 no NN (60 por cento). Dos 30 TLMS foram obtidas 146 séries. Houve sono em126 (86 por cento) e sonho em 56 (44,44 por cento). O tempo médio de sono no grupo N foi 16,0±6,3min e no NN 10,5±7,5min (p<0,0001). A latência média de sono no grupo N foi 2,0±2,2min e no NN 7,2±6,0min (p<0,001). A latência média do sono REM no N foi 3,2±3,1min e no NN 6,9±3,7min (p=0,021). Houve sonhos em 56,9 por cento das séries do grupo N e 28,4 por cento do NN (p=0,0009). A freqüência de sonhos em séries NREM no N foi 29,8 por cento e no NN 75 por cento (p= 0,0001). CONCLUSÃO: Os pacientes do grupo N dormiram mais e mais rapidamente, apresentaram REM mais precocemente e maior freqüência de sonhos que os NN. Estes apresentaram maior freqüência de sonhos em séries NREM. A presença de sonhos em NREM no TLMS pode contribuir no diagnóstico diferencial entre narcolepsia e hipersonia diurna.

Comparative analysis of multiple sleep latency tests (MSLT) parameters and occurrence of dreaming in patients with daytime sleepiness of narcoleptic and non-narcoleptic origin.

OBJECTIVE: To compare MSLT parameters in two groups of patients with daytime sleepiness, correlated to the occurrence and onset of dreams. METHOD: Patients were submitted to the MSLT between January/1999 and June/2002. Sleep onset latency, REM sleep latency and total sleep time were determined. The occurrence of dreams was inquired following each MSLT series. Patients were classified as narcoleptic (N) or non-narcoleptic (NN). RESULTS: Thirty patients were studied, 12 were classified as narcoleptics (N group; 40%), while the remaining 18 as non-narcoleptic (NN group; 60%). Thirty MSLT were performed, resulting in 146 series. Sleep was detected in 126 series (86%) and dreams in 56 series (44.44%). Mean sleep time in the N group was 16.0+/-6.3 min, while 10.5+/-7.5 min in the NN group (p<0.0001). Mean sleep latency was 2.0+/-2.2 min and 7.2+/-6.0 min in the N and NN group, respectively (p<0.001). Mean REM sleep latency in the N group was 3.2+/-3.1min and 6.9+/-3.7 min in the NN group (p=0.021). Dreams occurred in 56.9% of the N group series and 28.4% in that of the NN group (p=0.0009). Dream frequency was detected in 29.8% and 75% of the NREM series of the N and NN groups, respectively (p=0.0001). CONCLUSION: Patients from the N group, compared to the NN group, slept longer and earlier, demonstrated a shorter REM sleep onset and greater dream frequency. NN patients had a greater dream frequency in NREM series. Thus, the occurrence of dreams during NREM in the MSLT may contribute to differentially diagnose narcolepsy and daytime sleepiness.

Perfil nosológico e microbiológico das úlceras de pressão em pacientes neurocirúrgicos / Nosologic and microbiological profile of pressure ulcers in the neurosurgical patients

Objetivos. Estudar a freqüência, os fatores de risco e perfil microbiológico das úlceras de pressão dos pacientes neurocirúgicos do Hospital de Base do Distrito Federal. Métodos. Estudo transversal, realizado de 7 a 11 de março de 2005, durante o qual realizou-se busca ativa de pacientes com úlceras de pressão entre os pacientes internados na Unidade de Neurocirurgia do Hospital de Base. Analisou-se, então, nos pacientes portadores de úlcera de pressão, os fatores de risco, a cultura e o antibiograma das amostras das lesões. Resultados. Dos 81 pacientes neurocirúrgicos restritos ao leito, 11 (13,5%) apresentaram úlceras de pressão. A unidade de terapia intensiva apresentou a maior freqüência entre os setores (33,3%). Os fatores de risco encontrados foram: anemia em oito pacientes e distúrbio nutricional em oito. Havia quatro pacientes com traumatismo cranioencefálico e três com traumatismo raquimedular. Apuraram-se 16 casos de úlceras, com maior prevalência nos pacientes com acometimento encefálico. Houve maior prevalência de Klebsiella pneumoniae, Acinetobacter baumannii e Pseudomonas aeruginosa nas culturas, com relevante resistência antimicrobiana a antibióticos de última geração. Conclusão. A freqüência das úlceras de pressão na Unidade de Neurocirurgia do Hospital de Base é semelhante aos descrito na literatura. Os pacientes mais susceptíveis são aqueles que têm comprometimento encefálico, passagem pela UTI, sobrepeso, longa internação e anemia. As bactérias mais freqüentes nas lesões foram Klebsiella pneumoniae, Acinetobacter baumannii e Pseudomonas aeruginosa.

Objective. To study the prevalence of the pressure ulcers, risk factors and microbiological profile of the neurosurgical patients at the Hospital de Base do Distrito Federal. Methods. It deals qith a transversal study, made from 2005 March 7 to 11 at the Department of Neurosurgery of Hospital Base (DNHB). There was na active search for patients with pressure ulcers. A number of patients were evaluated in relation to risk factors of pressure ulcers. Cultures and antibiograms were made from samples of the ulcers. Results. Among 81 bedridden neurosurgical patients, 11 showed pressure ulcers, with mean prevalence of 13.6% in the DNHB. The Intensive Care Unit showed the highest prevalence between de sectors (33,33%). Among the 11 patients with ulcer, 8 patients were anemic and 8 had a nutritional disturbance. Four patients had brain injury from trauma and 3 had spine injury from trauma. We studied 16 patients with ulcers, with the highest prevalence in patients with brain injury. The klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa were the most prevalent bactéria on cultures and they showed na important antimicrobial resistance for the last generation antibiotics. Conclusion. The pressure ulcers prevalence in the DNBH is compatible with the literature. The patiens more susceptible had brain injury, Intensive Care Unit admission, overweight, log hospitalization and anemia. The most prevalent bactéria were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa.