Accidente cerebrovascular en una Unidad de Cuidados Intensivos Pediátricos. "11años de ACV en UCIP" / Stroke in a Pediatric Intensive Care Unit. "11 years of stroke in the PICU "

Introducción: La incidencia de ACV (Accidente Cerebrovascular) en niños es de 2-13/100.000 niños por año, siendo una de las 10 causas más frecuentes de muerte en la infancia. La misma varía entre 6-40% dependiendo de las series publicadas y de los subtipos de ACV. Existen diferencias importantes entre el ACV en niños y adultos, ya que las características neurológicas y de la hemostasia son muy distintas en cada grupo. En niños deben ser investigados múltiples factores de riesgo que a menudo se superponen entre sí. Materiales y métodos: Trabajo descriptivo retrospectivo por revisión de historias clínicas, de una población de niños con diagnóstico de ACV ingresados en UCIP en un período de 10 años. Resultados: Se confirmó el diagnóstico de ACV en un total de 84 pacientes. El 70,24% de la población correspondía a ACVH (Accidente Cerebrovascular Hemorrágico) y un 29,76% ACVI (Accidente Cerebrovascular Isquémico). El 60,71 % eran masculinos. La mediana del tiempo entre el inicio de los síntomas y el ingreso a UCIP, en ambos grupos fue de 1 día con rango entre 1-17 días para los ACVH y 1-9 para los ACVI. Se evaluaron variables clínicas, de diagnóstico y de tratamiento según ambos tipos de ACV. Conclusión: El ACV requiere de un abordaje multidisciplinario. La realización de neuro-imágenes es un pilar fundamental para el diagnóstico y no debe ser pospuesto. El monitoreo y tratamiento está enfocado en minimizar el daño en el parénquima cerebral circundante (AU)

Introduction: The incidence of stroke in children is 2-13/100,000 children a year, being one of the 10 most common causes of death in childhood. Mortality varies between 6 and 40% depending on the series reported and according to the different subtypes of stroke. There are important differences between childhood and adult stroke, as the neurological features and characteristics of hemostasis vary greatly. In children, multiple risk factors that often overlap should be investigated. Material and methods: A retrospective descriptive review of the clinical records of a series of patients with stroke admitted to the pediatric intensive care unit (PICU) over a period of 10 years was conducted. Results: The diagnosis of stroke was confirmed in 84 patients; 70.24% had hemorrhagic and 29.76% ischemic stroke. Overall, 60.71% were boys. Median time between symptom onset and admission to the PICU was one day in both groups, ranging from 1-17 días for those with hemorrhagic and from 1-9 days for those with ischemic stroke. Clinical, diagnostic, and treatment variables were evaluated for both types of stroke. Conclusion: Stroke requires a multidisciplinary approach. Neuroimaging is essential for the diagnosis and should not be postponed. Monitoring and treatment is focused on minimizing damage to the surrounding brain parenchyma (AU)

Perfil epidemiológico dos pacientes com acidente vascular cerebral isquêmico atendidos em um hospital / Epidemiological profile of patients with ischemic stroke treated in a Hospital

OBJETIVO: Descrever o perfil epidemiológico dos pacientes com acidente vascular cerebral isquêmico atendidos em um hospital. MÉTODOS: Pacientes vítimas de acidente vascular cerebral isquêmico no período de agosto a novembro de 2012 foram selecionados para o estudo e avaliados na alta hospitalar pela escala de Rankin e do National Institutes of Health Stroke Scale (NIHSS), além da etiologia do acidente vascular cerebral isquêmico, por meio da classificação de Trial of ORG 10172 in Acute Stroke Treatment (TOAST). ESULTADOS: Um total de 57 pacientes foram avaliados, sendo a maioria homem (56,1%).A escala de Rankin média foi de 3,2 e de 8,1 para o NIHSS. Foi observado aumento na pontuação de ambas, conforme o avançar da idade. A classificação TOAST mostrou maior prevalência de acidente vascular cerebral isquêmico de origem ardioembólica e aterosclerótico de grandes vasos, com 29,8% cada. CONCLUSÃO: O envelhecimento aumenta não apenas a prevalência do acidente vascular cerebral isquêmico, mas também sua gravidade, como observado nas escalas aferidas no estudo.(AU)

OBJECTIVE: To describe the epidemiological profile of patients with ischemic stroke attended in a hospital. METHODS: Patients with ischemic stroke from August to November 2012 were selected for the study, and evaluated at the discharge from hospital through the Rankin Scale and the National Institutes of Health Stroke Scale; the etiology of ischemic stroke was evaluated through the classification of the Trial Of Org 10172 in Acute Stroke Treatment. RESULTS: A total of 57 patients were evaluated, with most of them being males (56.1%). The mean was 3.2 for the Rankin Scale, and 8.1 for the National Institutes of Health Stroke Scale; an increase in the score of both was observed as the age increased. The classification of Trial of Org 10172 in Acute Stroke Treatment showed a higher prevalence of great vessels ischemic stroke of cardioembolic and atherosclerotic nature, with 29.8% each. CONCLUSION: Aging not only increases the prevalence of ischemic stroke, but also its severity, as observed in the scales used in the study.(AU)

Association between neurological injury and the severity of oropharyngeal dysphagia after stroke

ABSTRACT Purpose To associate the degree of biomechanical impairment in the swallowing process with the severity (National Institute of Health Stroke Scale – NIHSS) and type of neurological injury in patients post stroke. Methods A cross-sectional, descriptive study conducted with 42 patients (22 females), aged 65.7 years on average diagnosed with stroke. All patients underwent clinical neurological evaluation and application of the NIHSS in the first 48 hours after stroke. The swallowing function was evaluated using the Functional Oral Intake Scale (FOIS) and the Protocol for the Investigation of Oropharyngeal Dysphagia in Adults. The Fisher’s Exact Probability Test was used to assess the correlation between the degree of swallowing impairment and the severity (NIHSS score) and type of stroke. The study results were statistically analyzed at 5% significance level (p≤0.05). Results 92.9% of the patients presented ischemic stroke; 59.5% presented impairment of the anterior cerebral circulation. Statistically significant correlation was found between the neurological scale (NIHSS) scores and the swallowing impairment scale (p=0.016). Conclusion An association between stroke severity and oropharyngeal dysphagia severity was observed. A high proportion of patients with ischemic stroke with circulation affected in the anterior cerebral region presented severe oropharyngeal dysphagia. No statistically significant correlation was observed between the FOIS scale and stroke severity.

Characteristics of Inpatient Care and Rehabilitation for Acute First-Ever Stroke Patients

PURPOSE: The purpose of this study was to analyze the status of inpatient care for acute first-ever stroke at three general hospitals in Korea to provide basic data and useful information on the development of comprehensive and systematic rehabilitation care for stroke patients. MATERIALS AND METHODS: This study conducted a retrospective complete enumeration survey of all acute first-ever stroke patients admitted to three distinct general hospitals for 2 years by reviewing medical records. Both ischemic and hemorrhagic strokes were included. Survey items included demographic data, risk factors, stroke type, state of rehabilitation treatment, discharge destination, and functional status at discharge. RESULTS: A total of 2159 patients were reviewed. The mean age was 61.5+/-14.4 years and the ratio of males to females was 1.23:1. Proportion of ischemic stroke comprised 54.9% and hemorrhagic stroke 45.1%. Early hospital mortality rate was 8.1%. Among these patients, 27.9% received rehabilitation consultation and 22.9% underwent inpatient rehabilitation treatment. The mean period from admission to rehabilitation consultation was 14.5 days. Only 12.9% of patients were transferred to a rehabilitation department and the mean period from onset to transfer was 23.4 days. Improvements in functional status were observed in the patients who had received inpatient rehabilitation treatment after acute stroke management. CONCLUSION: Our analysis revealed that a relatively small portion of patients who suffered from an acute first-ever stroke received rehabilitation consultation and inpatient rehabilitation treatment. Thus, applying standardized clinical practice guidelines for post-acute rehabilitation care is needed to provide more effective and efficient rehabilitation services to patients with stroke.

The Incidence of Stroke by Socioeconomic Status, Age, Sex, and Stroke Subtype: A Nationwide Study in Korea / 예방의학회지

OBJECTIVES: To date, studies have not comprehensively demonstrated the relationship between stroke incidence and socioeconomic status. This study investigated stroke incidence by household income level in conjunction with age, sex, and stroke subtype in Korea. METHODS: Contributions by the head of household were used as the basis for income levels. Household income levels for 21 766 036 people were classified into 6 groups. The stroke incidences were calculated by household income level, both overall within income categories and further by age group, sex, and stroke subtype. To present the inequalities among the six ranked groups in a single value, the slope index of inequality and relative index of inequality were calculated. RESULTS: In 2005, 57 690 people were first-time stroke patients. The incidences of total stroke for males and females increased as the income level decreased. The incidences of stroke increased as the income level decreased in those 74 years old and under, whereas there was no difference by income levels in those 75 and over. Intracerebral hemorrhage for the males represented the highest inequality among stroke subtypes. Incidences of subarachnoid hemorrhage did not differ by income levels. CONCLUSIONS: The incidence of stroke increases as the income level decreases, but it differs according to sex, age, and stroke subtype. The difference in the relative incidence is large for male intracerebral hemorrhage, whereas the difference in the absolute incidence is large for male ischemic stroke.

Diretrizes de atenção à reabilitação da pessoa com acidente vascular cerebral / Guidelines for the rehabilitation of individual with cerebrovascular accident / Directrices para la atención a la rehabilitación de la persona con accidente vascular cerebral

Segundo o Relatório Mundial sobre a Deficiência, publicadopela Organização Mundial da Saúde (OMS) em parceria com o BancoMundial, em 2011, mais de um bilhão de pessoas no mundo convivemcom algum tipo de deficiência. Esta é considerada uma questãode direitos humanos, porque essas pessoas enfrentam desigualdades,por exemplo, quando não têm acesso igualitário aos serviços de saúde,educação, emprego ou participação política em função de sua deficiência.Essa afirmação exige atenção aos cuidados para que esses indivíduospossam ser atendidos considerando todas as suas necessidades.A Convenção Internacional sobre os Direitos das Pessoas comDeficiência destaca, entre outros aspectos, a reabilitação. Nesse sentido,enfatiza que os Estadospartes devem adotar medidas efetivas eapropriadas para possibilitar que as pessoas com deficiência conquisteme conservem o máximo de autonomia e plena capacidade física,mental, social e profissional, bem como plena inclusão e participaçãoem todos os aspectos da vida. Para tanto, deverão ser organizados, fortalecidose ampliados serviços e programas completos de reabilitação,além da promoção da capacitação inicial e continuada de profissionaise de equipes...

Intravenous thrombolysis is more effective in ischemic cardioembolic strokes than in non-cardioembolic? / A trombólise endovenosa é mais eficaz nos acidentes vasculares cerebrais isquêmicos cardioembólicos do que nos não cardioembólicos?

It was suggested that intravenous thrombolysis (IT) leads to larger extent recanalization in cardioembolic stroke. In this work we assess if this has beneficial clinical traduction. METHOD: We evaluated 177 patients undergoing IT, which were categorized into cardioembolic (CE) and non-cardioembolic (NCE). National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale were compared. RESULTS: The mean age was 67.4±12.01 and 53.8 percent were male. The mean NIHSS was: 14 (admission), 9 (24 h) and 6 (discharge), similar in subgroups. The difference between NIHSS at admission and 24 hours was 4.17±4.92 (CE: 4.08±4.71; NCE: 4.27±5.17, p=0.900) and at admission and discharge there was an average difference of 6.74±5.58 (CE: 6.97±5.68; NCE: 6.49±5.49, p=0.622). The mRS at discharge and 3 months was not significantly different by subtype, although individuals whose event was NCE are more independent at 3 months. CONCLUSION: Ours findings argue against a specific paper of IT in CE. It can result from heterogeneity of NCE group.

Alguns estudos sugerem que a trombólise endovenosa (TE) conduz a melhor recanalização nos acidentes vasculares cerebrais isquêmicos (AVCI) cardioembólicos. Neste trabalho questionamos se isto terá tradução em benefício clínico. MÉTODO: Avaliamos 177 doentes submetidos a TE, os quais foram categorizados como cardioembólicos (CE) e não cardioembólicos (NCE). Compararam-se a National Institutes of Health Stroke Scale (NIHSS) e escala de Rankin modificada. RESULTADOS: A idade média foi 67,4±12,01 e 53,8 por cento eram homens. NIHSS média foi: 14 (admissão), 9 (24 h), 6 (alta), semelhante nos subgrupos. A diferença entre NIHSS à admissão e 24 h foi de 4,17±4,92 (CE: 4,08±4,71; NCE: 4,27±5,17, p=0,900) e entre a admissão e a alta de 6,74±5,58 (CE: 6,97±5,68; NCE: 6,49±5,49, p=0,622). A classificação na mRS não foi significativamente diferente nos subgrupos (alta e 3 meses), mas os doentes com eventos NCE estavam mais independentes aos 3 meses. CONCLUSÃO: Os nossos resultados não documentam um papel específico da TE nos CE, o que pode resultar da heterogeneidade do grupo NCE.

O impacto das sequelas sensório-motoras na autonomia eindependência dos pacientes pós-AVE / The impact of sensorial-motor sequels in the autonomy and independence of patients affected by cerebrovascular accidents (CVA) / El impacto de las secuelas sensorio-motoras en la autonomía y la independencia de pacientes afectados por accidentes cerebrovasculares (ACV)

O Acidente Vascular Encefálico (AVE) é a segunda causa de mortes no mundo e uma das maiores causas de sequelas permanentes, em escala correspondente à gravidade da lesão. O objetivo deste trabalho foi avaliar, sob a perspectiva do paciente pós-AVE, o impacto das sequelas em sua autonomia e independência funcional. É um estudo qualitativo, com entrevistas semiestruturadas de 4 sujeitos, de ambos os sexos, entre 44 e 71 anos. Os dados foram analisados pela técnica de análise de conteúdo temático e emergiram em quatro categorias: o socorro imediato e o tratamento hospitalar; o impacto das sequelas na autonomia e independência; o modo deencarar as limitações; e o papel da fisioterapia na reabilitação. As limitações impostas pelas sequelas interferem nas atividades cotidianas,porém não são impeditivas, graças às adaptações desenvolvidas.

Cerebrovascular Accidents (CVA) is the second cause of deaths in the world and one of the most common permanent causes of sequels, in a scale corresponding to the gravity of the injury. The aim of this work was to evaluate, under the perspective of theafter-CVA patients, the impact of sequels in their autonomy and functional independence. It is a qualitative study, with semistructured interviews of 4 subjects, both male and female, with ages from 44 to 71 years. Data were analyzed by the technique of thematic content analysis and lead to the emergence of four categories: immediate help and hospital treatment; the impact of sequels in the autonomyand independence; ways to face the limitations; and the role of physiotherapy in rehabilitation. The limitations sequels cause interferein daily activities, although they are not impeditive, thanks to the adaptations developed.

Los Accidentes Cerebrovasculares (ACV) son la segunda causa de muertes en el mundo y una de las causas permanentes mascomunes de secuelas, en una escala que corresponde a la gravedad de lesión. La meta de este trabajo fue evaluar, bajo la perspectivade pacientes post-ACV, el impacto de secuelas en su autonomía e independencia funcional. Es un estudio cualitativo, con entrevistassemiestructuradas de 4 sujetos, hombres y mujeres, con edades desde 44 hacia 71 años. Los datos fueran analizados de promedio latécnica del análisis del contenido temático y hicieran emerger cuatro categorías: ayuda inmediata y tratamiento hospitalario; el impactode secuelas en la autonomía y la independencia; maneras de hacer frente a las limitaciones; y el papel de la fisioterapia en la rehabilitación. Las limitaciones causadas por las secuelas interfieren en las actividades diarias, aunque no sean impeditivas, gracias alas adaptaciones desarrolladas.

Stroke subtypes on imaging in a Jamaican population a hospital-based study: estudio en un hospital / Subtipos de accidente cerebrovascular en la imagen médica en una población Jamaicana

OBJECTIVE: To examine the pattern of stroke subtypes found on Computed Tomography (CT), Magnetic Resonance Imaging (MRI) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. METHOD: A retrospective review was conducted for all patients diagnosed with stroke and who were subjected to CT or MRI evaluation at UHWI between January 2001 and December 2004. Data were collected for patient age and gender and type of stroke. RESULTS: Four hundred and thirty-three patients were identified and classified as having cerebral infarct, intra-parenchymal haemorrhage or subarachnoid haemorrhage. There were 414 patients who had CT scans and 19 had MRI scans. Within and across genders, over 80% suffered infarcts with no significant statistical difference between male and female patients. Subarachnoid haemorrhage was the least frequent subtype and occurred in younger patients. CONCLUSION: The pattern of stroke subtypes seen in this population was similar to that of Australian and European cohorts of patients but differed from that reported in Asians. Ischaemic infarct was the most frequent stroke subtype followed by intra- parenchymal haemorrhage and subarachnoid haemorrhage. There was no gender predilection for any specific type of stroke.

OBJETIVO: Examinar el patrón de los subtipos de accidente cerebrovascular encontrados en las imágenes de TAC y MRI en el Hospital Universitario de West Indies (HUWI), Kingston, Jamaica. MÉTODO: Se realizó un examen retrospectivo de todos los pacientes con diagnóstico de accidente cerebrovascular, sometidos a evaluación mediante TAC o MRI, entre enero 2001 y diciembre 2004. Los datos fueron recogidos teniendo en cuenta la edad y el género del paciente, así como el tipo de accidente. RESULTADOS: Cuatrocientos treinta y tres (433) pacientes fueron identificados y clasificados como pacientes con un infarto cerebral, hemorragia intraparenquimal o hemorragia subaracnoidea (HSA). Hubo 414 pacientes examinados con TAC y 19 con MRI. Dentro de ellos, ambos géneros incluidos, más del 80% sufrió infartos sin que hubiese diferencias estadísticas significativas entre hombres y mujeres. La hemorragia subaracnoidea fue el tipo menos frecuente, y se produjo en pacientes jóvenes. CONCLUSIÓN: El patrón de subtipos de accidente cerebrovascular en esta población fue similar al de cohortes de pacientes australianos y europeos, pero diferente al reportado para los asiáticos. El infarto isquémico fue el subtipo de accidente cerebrovascular más frecuente, seguido por la hemorragia intraparenquimal y la hemorragia subaracnoidea. No hubo preferencia de géneros en relación con ninguno de los tipos específicos de accidente cerebrovascular.

Epidemiología de los accidentes cerebrales vasculares en el Hospital Nacional / Epidemiology of the stroke in the national Hospital

El accidente cerebral vascular (ACV) es un síndrome clínico caracterizado por un súbito deterioro en las funciones cerebrales, que persiste más 24 horas, originado por deficit circulatorio prolongado en el sistema nervioso central, dejando muchas veces secuelas discapacitantes. Puede ser de tipo isquémico o hemorrágico. Se halla muy relacionado a factores de riesgo que deben reconocerse pues muchos de ellos son modificables, permitiendo así la prevención de esta patología. Se realizó un estudio observacional, descriptivo, de los pacientes ingresados entre enero de 2004 y diciembre de con el diagnóstico de ACV en el Departamento de Medicina Interna del Hospital Nacional. Fueron incluidos 749 casos. Los factores de riesgo más frecuentes fueron: hipertensión arterial (77,9%), diabetes mellitus (12,6%), fibrilación auricular (10,3%), tabaquismo (6,9%), etilismo (6,9%), 0besidad (6,7%) y miocardiopatía dilatada (6,5%). Comparando los factores riesgo en relación al tipo de ACV, se halló una asociación estadísticamente significativa en la presencia de hipertensión arterial en el ACV hemorrágico y la presencia de edad mayor a 65 años, diabetes mellitus, fibrilación auricular y miocardiopatía dilatada en el ACV isquémico. La mortalidad global fue de 10,6% y estuvo estadísticamente relacionada a edad mayor a 65 años, presencia de hipertensión arterial y neumonía por aspiración...

Frequency of seizures and epilepsy after ischaemic stroke

To evaluate the frequency and risk factors of seizures and epilepsy after ischemic stroke. This prospective observational study was conducted on patients with Ischemic Stroke in the Department of Neurology; Postgraduate Medical Institute, Lady Reading Hospital, Peshawar. These stroke patients were followed up for a total period of 2 years. Initially 210 patients were enlisted in the study. Out of these, 10 patients died or lost to follow up so they were excluded from the final analysis leaving a figure of 200. The main outcome measures were the occurrence of single or recurrent seizures as well as the occurrence of both early [within 2 weeks] and late [after 2 weeks] seizures were recorded. Patients who already had history of seizures, those with intra-cerebral bleed and sub-arachnoid hemorrhage were excluded from the study. Out of 200 patients [130 males and 70 female], 6 [3%] patients had early seizures while 10 [5%] patients presented for the first time with late onset seizures. So a total of 16 [8%] patients had post stroke seizures. Early seizures were mostly generalized tonic clonic seizures, while late seizures were mostly partial with or without secondary generalization. Epilepsy characterized by recurrent seizures occured in 3 patient's [1.5%]. Stroke patients have overall 8% risk of seizures and 1.5% risk of epilepsy in the first 2 years after an ischemic stroke. Majority of these seizures occurred after 2 weeks of onset of stroke

Características de los accidentes cerebro vascular (ACV) en niños / Characteristics of the accidents vascular brain (ACV) in children

Objetivos: presentar las características de los ACV en la población infantil del HCIPS. Materiales y métodos: es un estudio observacional, retrospectivo con revisión de historias clínicas de pacientes con diagnóstico de ACV ingresados a la sala de neurología en el período comprendido entre julio 2004 a julio 2006. Resultados: durante el periodo de estudio se registraron 10 pacientes con diganóstico de ACV, y un total de 13 episodios; en 3 pacientes se presentaron 2 eventos. La distribución por grupo etario: preescolares 2 (20%), escolares 5 (50%), adolescentes 3 (30%), según sexo 5 (50%) femenino y 5 (50%) masculino. Los sintomas predominantes fueron cefalea 92% (12/13), paresias 69% (1/13) y en la forma de inicio, el brusco correspondió 53 (7/13) e insidioso 47% (6/13). El tipo de ACV mas frecuente fue el hemorrágico 77% e isquémico 23%, de las 3 recidivas 2 fueron hemorrágico y uno isquémico.Entre las causas de los 10 pacientes es el 50% (5/10) no se encontró etiología, las causas definida: malformación arteriovenosa (MAV), enfermedad de Moya-Moya, leucemia mieloide aguda, vasculitis por herpes virus (recidiva) y afibrinogenemia, 1 en cada caso. Conclusión: los síntomas mas frecuentes fueron la cefalea y las paresias/plejias. La TAC cráneo constituye el primer eslabón en el estudio del ACV en niños, pero los estudios por RMN ofrecieron mejor calidad de resolución para caracterizar las lesiones. El estudio sistemático de todos los agentes causales es importante para identificar las causas etiológicas como lo demostró esta serie. El terrirorio de la arteria carótida interna fue la única afectada en todos los eventos, y la evolución entre los no fallecidos fue buena por no hubo secuelas graves.

Prise en charge initiale des accidents vasculaires cerebraux a phase aigue

N.A.

Confiabilidade de escalas de comprometimento neurológico em pacientes com acidente vascular cerebral / Reliability of neurological assessment scales in patients with stroke / Reliability of neurological assessment scales in patients with stroke

Escalas de comprometimento neurológico são utilizadas na avaliação de novos tratamentos, no acompanhamento da evolução clínica e em decisões terapêuticas. Estudamos a confiabilidade de três escalas: a Escala de Rankin (ER), o índice de Barthel (IB) e a National Institute of Health Stroke Scale (NIHSS) versadas em português, em 51 indivíduos com acidente vascular cerebral, estimando a concordância entre resultados de diferentes examinadores. Utilizamos os coeficientes de concordância Kappa e Coeficiente de Correlação Intraclasse. A ER teve coeficientes moderados, substanciais ou excelentes. No IB estes foram substanciais ou excelentes nos totais e nos itens, assim como quando foi estratificado em agrupamentos prognósticos e funcionais. A NIHSS apresentou coeficientes excelentes nos totais, substanciais nos itens e moderados e excelentes nas estratificações em grupos de pontos e de itens afins. Estes resultados indicam que as versões em português da ER, o IB e a NIHSS apresentam adequada confiabilidade.

Scales for the assessment of neurological impairment are employed in clinical trials, outcome evaluation and in therapeutic decisions. We evaluated the reliability of the Portuguese version of the Rankin Scale (RS), Barthel Index (BI) and the NIHSS (National Institute of Health Stroke Scale) in 51 stroke patients, estimating the agreement of the results for examiners. The interrater reliability was measured using the Kappa Coefficient and Intraclass Correlation Coefficient. The RS showed moderate, substantial and excellent coefficients of agreement. The BI showed from substantial to excellent coefficients of agreement as a whole and also for its constituents. This scale was stratified in prognostic and functional groups, both presenting coefficients of agreement from substantial to excellent. The NIHSS presented excellent agreement on its total and substantial agreements on its individual items. The NIHSS was also stratified in groups of points, which presented moderate or excellent coefficient, and in groups of congruous items, wich showed a moderate to excellent agreement. These results suggest that the Portuguese version of the RS, BI and the NIHSS present adequate reliability.

Post-stroke motor and functional evaluations: a clinical correlation using Fugl-Meyer assessment scale, Berg balance scale and Barthel index / Avaliações motoras e funcionais pós-AVC: correlação clínica usando a escala de desempenho físico de Fugl-Meyer, a escala de equilíbrio de Berg e o índice de Barthel

Stroke is one of the major causes of morbidity and mortality. Sequels deriving from this event may lead to motor disability and from mild to severe deficits. In order to better classify sensory-motor dysfunction, balance and ability to perform activities of daily living, quantitative and qualitative evaluation scales have been used. OBJECTIVE: To correlate the scales Fugl-Meyer assessment scale, Berg balance scale and Barthel index. Twenty subjects with sequel after a single, unilateral stroke in chronic phase (>6 months post ictus) were evaluated for about one hour. RESULTS: Barthel scale was statistically related to the total motor score of Fugl-Meyer assessment (r=0.597, p=0.005). The lower limb section at Fugl-Meyer had positive correlation with Berg scale (r=0.653, p=0.002) and with the balance section of Fugl-Meyer own scale (r=0.449, p=0.047). Both balance scales were correlated one with other (r=0.555, p=0.011). Statistical divergence appeared when Barthel's Index was correlated with Berg's Scale (r=0.425, p=0.062), and it is not statistically significant. CONCLUSION: The use of both quantitative and qualitative scales was shown to be a good measuring instrument for the classification of the general clinical performance of the patient, especially when positively related joint evaluations are applied.

O acidente vascular cerebral (AVC) é reconhecido como uma das maiores causas de morbidade e mortalidade. Seqüelas decorrentes deste evento podem levar a inabilidade motora e déficits leves a graves. Para classificar melhor a disfunção sensitivo-motora, o equilíbrio e as habilidades para as atividades de vida diária, escalas de avaliações quantitativas e qualitativas estão sendo utilizadas. OBJETIVO: Correlacionar a escala de desempenho físico de Fugl-Meyer, a escala de equilíbrio de Berg e o índice de Barthel. MÉTODO: Foram selecionados 20 sujeitos com sequela de um único e unilateral AVC em fase crônica (>6 meses pós ictal), que passaram pelas avaliações por cerca de uma hora. RESULTADOS: A escala de Barthel correlacionou-se com a pontuação motora total de Fugl-Meyer (r=0,597, p=0,005). A seção para membros inferiores de Fugl-Meyer teve correlação positiva com a de Berg (r=0,653, p=0,002) e com a seção de equilíbrio da própria escala de Fugl-Meyer (r=0,449, p=0,047). Ambas as escalas de equilíbrio tiveram correlação entre si (r=0555, p=0,011). A divergência estatística apareceu quando se correlacionou a Escala de Barthel com o índice de Berg (r=0,425, p=0,062), não sendo estatisticamente significativo. CONCLUSÃO: O uso de escalas quantitativas e qualitativas mostrou ser um bom instrumento de medida para a classificação do quadro físico geral do paciente, ainda mais quando são aplicadas avaliações em conjunto que se relacionam positivamente.

Registro de enfermedad cerebrovascular isquémica / Ischemic stroke registry

El conocimiento de los factores de riesgo y los aspectos epidemiológicos del accidente cerebrovascular (ACV) provienen fundamentalmente de estudios de EE.UU. y Europa, con escasa información procedente de los países en desarrollo. Las características clínicas y epidemiológicas del ACV son variables en relación a factores regionales, por lo cual es necesario conocer cuál es la situación en nuestro continente. El objetivo del trabajo es describir los subtipos clínicos y los factores de riesgo de los pacientes con ACV isquémico. Se analizaron consecutivamente los pacientes ingresados desde el 01/06/2003 al 01/06/2005 con diagnostico de ACV isquémico. Sobre un total de 395 pacientes, la edad media fue de 71.36 años (± 13.82), el 55% fueron varones. Los subtipos de ACV fueron los siguientes: infarto lacunar (40%), enfermedad de gran arteria (20%), cardioembolia (10%) y otras causas (5%). La hipertensión arterial (76%), la dislipidemia (50%) y el antecedente de ACV previo (34%) fueron los factores de riesgo más frecuentes. Los pacientes con síntomas corticales presentaron más frecuentemente estenosis carotídea > del 70% en el doppler de vasos de cuello, siendo esto estadísticamente significativo. La información sobre el ACV en los países en desarrollo es difícil de obtener. Esta puede ser la razón del escaso número de registros provenientes de Sudamérica. La hipertensión fue el factor de riesgo más prevalente en nuestra serie. El subtipo de ACV difiere de lo informado en otras regiones del mundo predominando la enfermedad de pequeña arteria

Current knowledge of stroke risk factors and epidemiology is based mostly on USA or European studies; scarce data have been published from developing countries. Because epidemiological and clinical characteristics in stroke vary according to regional factors, we need to know the peculiarities of stroke on this subcontinent. The purpose is to describe the clinical subtypes and risk factors in patients with ischemic stroke. We analyzed all consecutive ischemic stroke in patients admitted at Hospital Italiano of Buenos Aires, between June 1, 2003 and June 1, 2005. Among 395 ischemic stroke patients, the mean age was 71.36 years (± 13.82) and 55% were male. Ischemic stroke subtypes were as follows: 40% patients had lacunar, 20% atherosclerotic stroke, 10% cardioembolic infarction, and 5% other causes of stroke. Hypertension (76%), hyperlipemia (50%) and prior stroke (34%) were the most frequent risk factors. Most patients with cortical symptoms had significant large-artery atherosclerosis (> 70%). Stroke informations in developing countries is difficult to obtain. This could be the reason for the very few stroke registries in South America. Hypertension was the most frequent risk factor in our registry. The pattern of stroke subtypes seems to be different from that reported in other regions of the world, with a higher frequency of small-vessel disease

Analysis of hospital-based stroke registry in a neurological centre in Kolkata.

This was a retrospective analysis of 7-year (January 1995-December 2001) hospital-based in-patient medical records of stroke cases (subarachnoid haemorrhage excluded) who arrived from various parts of West Bengal. The total number of cases was 801 out of whom 792 had neuro-imaging. There were 399 caes of intracerebral haemorrhage (ICH) and 393 cases of cerebral infarct (CI). The CI: ICH ratio was 0.98. Less than 25% patients reached hospital within 3 hours of stroke onset. Twenty-nine per cent of cases presented with mild stroke (Canadian stroke score > 8.5). Hypertension was observed in 77.3% of ICH cases. The striking finding of this study was a remarkably high number of ICH among the admitted patients. This indicates the need of population-based studies to be conducted at different parts of West Bengal to determine whether them is truly a high prevalence and incidence of ICH in this Indian state.