Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação / Functional independence, clinical aspects, and sociodemographic factors in patients in the acute phase of stroke: an association analysis

RESUMO Objetivo Analisar a associação da independência funcional com aspectos clínicos de comprometimento neurológico, a localização e extensão do dano neuronal e os fatores sociodemográficos em pacientes na fase aguda do AVC. Método Estudo analítico de recorte transversal, realizado com 90 pacientes adultos e idosos acometidos por AVC isquêmico, que tiveram admissão no ambiente hospitalar nas primeiras 24 horas após o evento vascular. A coleta dos dados referentes aos aspectos clínicos e fatores sociodemográficos foi realizada pelo prontuário eletrônico e/ou entrevista para descrever o perfil dos pacientes, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale e a Medida de Independência Funcional. Resultados O comprometimento neurológico, de acordo com a National Institute of Health Stroke Scale, foi associado à funcionalidade nas primeiras 24 horas após o AVC. Além disso, a presença de hipertensão arterial, idade, trabalho inativo, tabagismo e extensão do dano neuronal estiveram associados à dependência funcional, mas não permaneceram no modelo final deste estudo. Conclusão A dependência funcional está associada à hipertensão arterial, idade, trabalho inativo, tabagismo, extensão do dano neuronal e grau de comprometimento neurológico nas primeiras 24 horas após o evento vascular. Além disso, um nível mais elevado de comprometimento neurológico foi independentemente associado a níveis aumentados de dependência funcional.

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

National Institutes of Health Stroke Scale: comparison of original and modified versions for Singapore culture

INTRODUCTION@#The National Institutes of Health Stroke Scale (NIHSS), originally designed in the United States of America, contains items on dysphasia and dysarthria that are deemed culturally unsuitable for the Singapore context. We compared the error rates of dysphasia objects, dysphasia phrases and dysarthria words between the original and alternative items in a cohort of Singaporean subjects without dysphasia or dysarthria.@*METHODS@#In this prospective study, 140 English-speaking Singaporean subjects without impairments of dysphasia or dysarthria had an assessment of NIHSS items 9 and 10 using the original and alternative items. Paired analyses were conducted for comparison of error rates.@*RESULTS@#The error rates were high for four original dysphasia objects (Hammock: 62.9%, Cactus: 38.6%, Feather: 23.6%, Glove: 20.7%) and significantly lower for alternative items (Snail: 5%, Horse: 1.4%, Hanger: 1.4%, Car: 0%) (P < 0.001). For dysphasia phrases and dysarthria words, the error rates were low and there were no differences in error rates between the original and alternative items.@*CONCLUSION@#There are cultural issues with several dysphasia objects in the original NIHSS as evidenced by the high error rates, which were lowered with more culturally suitable alternatives. This study formed a basis to derive a more suitable version of the NIHSS for English-speaking subjects in Singapore.

Migraine with aura and stroke - the role of warning signs in the context of secondary headaches: case report / Enxaqueca com aura e acidente vascular cerebral ­ o papel dos sinais de alerta no contexto das cefaleias secundárias: relato de caso

Introduction: Headache is a very common complaint in doctors' offices, with primary causes being the majority in relation to secondary ones. Despite this, the identification of secondary headaches is very relevant in clinical practice, since these can be a life-threatening condition, functionality or even a reversible cause. However, imaging screening for all individuals with headache is costly and unrewarding. Therefore, it is important to know the warning signs that, together with the clinical context, lead to a more precise indication of these exams and early and well-targeted therapeutic interventions. Clinical case: This is a 60-year-old man, previously dyslipidemic and smoker, with migraine with aura reported since childhood, who underwent treatment with sodium valproate, with headache attack suppression. About 4 months before admission, he presented with an alteration in the pain pattern, amaurosis fugax in the right eye, dizziness and mild paresis and hypoesthesia in the left side of the body, primarily treated by him as migraine crises, without improvement with the use of triptans. A new outpatient investigation was carried out, which showed multiple small infarcts in the right hemisphere secondary to atheromatous plaque in the right carotid bulb with an obstruction of approximately 85%. Diagnostic and therapeutic arteriography was performed, with stent implantation, uneventfully. Conclusion: The differential diagnosis between migraine with aura and a cerebrovascular event has already been widely reported in the literature and constitutes a pitfall in the routine of headaches, since a serious and potentially disabling condition can be overlooked. The joint evaluation of the alarm signs with the global context becomes an important tool in the propaedeutics of these patients, with knowledge of this casuistry being something relevant within clinical practice.

Introdução: A cefaleia é uma queixa muito comum nos consultórios médicos, sendo as causas primárias majoritárias em relação às secundárias. Apesar disso, a identificação de cefaleias secundárias é muito relevante na prática clínica, uma vez que estas podem ser uma condição potencialmente fatal, funcional ou mesmo uma causa reversível. No entanto, o rastreio imagiológico para todos os indivíduos com cefaleias é dispendioso e pouco recompensador. Portanto, é importante conhecer os sinais de alerta que, juntamente com o contexto clínico, levam a uma indicação mais precisa destes exames e a intervenções terapêuticas precoces e bem direcionadas. Caso clínico: Trata-se de um homem de 60 anos, previamente dislipidémico e fumador, com queixa de enxaqueca com aura desde a infância, que realizou tratamento com valproato de sódio, com supressão das crises de cefaleia. Cerca de 4 meses antes da internação apresentou alteração do padrão álgico, amaurose fugaz em olho direito, tontura e leve paresia e hipoestesia no lado esquerdo do corpo, tratada por ele primariamente como crises de enxaqueca, sem melhora com o uso de triptanos. Foi realizada nova investigação ambulatorial que evidenciou múltiplos pequenos infartos no hemisfério direito secundários a placa de ateroma no bulbo carotídeo direito com obstrução de aproximadamente 85%. Foi realizada arteriografia diagnóstica e terapêutica, com implante de stent, sem intercorrências. Conclusão: O diagnóstico diferencial entre enxaqueca com aura e evento cerebrovascular já foi amplamente relatado na literatura e constitui uma armadilha na rotina das cefaleias, uma vez que uma condição grave e potencialmente incapacitante pode ser negligenciada. A avaliação conjunta dos sinais de alarme com o contexto global torna-se uma ferramenta importante na propedêutica destes pacientes, sendo o conhecimento desta casuística algo relevante dentro da prática clínica.

Accidente cerebrovascular por COVID-19 en una lactante de 6 meses / Stroke due to COVID-19 in a Six-month-old infant

Introducción: En de la población adulta predomina la enfermedad pulmonar, pero el coronavirus infantil grave parece más tipificado por una respuesta inflamatoria inmunomediada, con o sin síndrome inflamatorio multisistémico asociado. Objetivo: Examinar un paciente pediátrico con accidente cerebrovascular, como consecuencia de la enfermedad producida por el coronavirus tipo 2. Presentación del caso: Lactante femenina de 6 meses, que se presentó a emergencia con historia de fiebre de 39 oC, sin predominio de horario, de 10 días de evolución que no cedió con antipiréticos tipo acetaminofén, y dificultad respiratoria en los 3 días previos a su presentación en emergencia del hospital. Antecedentes familiares patológicos positivos, por la enfermedad del coronavirus en su padre. En la radiografía de tórax se observó infiltrado alveolar derecho y se ingresó con diagnóstico de neumonía por síndrome respiratorio agudo grave por coronavirus tipo 2. La tomografía de cráneo registró foco isquémico frontal parasagital derecho y parietal izquierdo; posteriormente se confirmó con resonancia magnética, en cuyo informe se definió la presencia de infartos en fase aguda a nivel frontal derecho y parietal izquierdo. Conclusiones: Se expuso una manifestación infrecuente en población pediátrica asociada a la enfermedad por coronavirus. La tasa de eventos tromboembólicos en el curso de las infecciones virales no es baja, y por coronavirus no es la excepción. Se requieren mayores estudios y pruebas para determinar el papel del síndrome respiratorio agudo severo por coronavirus tipo 2 en el accidente cerebrovascular pediátrico(AU)

Introduction: Pulmonary disease predominates in the adult population, but severe infantile coronavirus appears more typified by an immune-mediated inflammatory response, with or without associated multisystem inflammatory syndrome. Objective: To examine a pediatric patient with stroke resulting from coronavirus type 2 disease. Case presentation: 6-month-old female infant presenting to emergency with history of fever of 39 ℃ with no hourly predominance, of 10 days of evolution that did not subside with acetaminophen-type antipyretics and respiratory distress in the three days prior to presentation to hospital emergency. Positive family history of coronavirus disease in his father. Chest X-ray showed right alveolar infiltrate and she was admitted with a diagnosis of severe acute respiratory syndrome pneumonia due to coronavirus type 2. The cranial tomography recorded a right frontal parasagittal and left parietal ischemic focus, later confirmed by magnetic resonance imaging whose report defined the presence of acute phase infarcts at the right frontal and left parietal levels. Conclusions: An infrequent manifestation in pediatric population associated with coronavirus disease is exposed. The rate of thromboembolic events in the course of viral infections is not low and coronavirus is no exception. Further studies and evidence are required to determine the role of severe acute respiratory syndrome due to coronavirus type 2 in pediatric stroke(AU)

Conhecimento de idosos sobre acidente vascular cerebral no contexto emergencial: Revisão integrativa / Conocimiento de ancianos sobre accidente vascular cerebro en el contexto de emergencia: Revisión integrativa / Elderly knowledge about brain vascular accident in the emergency context: Integrative review

Objetivo:identificar o conhecimento de idosos sobre acidente vascular cerebral relacionado à busca pelo atendimento emergencial. Método:revisão integrativa realizada em maio e junho de 2021,na Biblioteca Virtual em Saúde, National Library of Medicine and National Institutes of Health, Scientific Eletronic Library Online, Cumulative Index to Nursing and Allied Health Literature, SCOPUS e Web of Science, empregados Descritores de Ciências da Saúde, Medical Subject Headings e termos alternativos, publicados em 2016 a 2021.Resultados:compuseram 33 artigos o corpus da revisão, categorizados em duas vertentes: os conhecimentos sobre fatores de risco, prevenção e identificação do AVC; e a busca pelo atendimento precoce no serviço de urgência e emergência. Conclusão:idosos geralmente desconhecema doença e a necessidade de busca precoce doatendimento, o que ressalta a importância de ações de promoção à saúde e orientações relacionadas ao AVC, sejam elas por meio das mídias ou de pessoas que compõem a rede de apoio(AU)

Objective: to identify the knowledge of the elderly about stroke related to the search for emergency care. Method: integrative review carried out in May and June 2021 at the Virtual Health Library, National Library of Medicine and National Institutes of Health, Scientific Electronic Library Online, Cumulative Index to Nursing and Allied Health Literature, SCOPUS and Web of Science, employees Health Sciences, Medical Subject Headings and alternative terms, published in the years 2016 to 2021. Results: the review corpus comprised 33 articles, categorized into two aspects: knowledge about risk factors, prevention and identification of stroke; and the search for early care in the urgency and emergency service. Conclusion: the elderly are generally unaware of the disease and the need to seek care early, which highlights the importance of health promotion actions and guidelines related to stroke, whether through the media or people who make up the support network.(AU)

Objetivo: identificar el conocimiento de los ancianos sobre el accidente cerebrovascular relacionado con la búsqueda de atención de emergencia. Método: revisión integradora realizada en mayo y junio de 2021 en la Biblioteca Virtual en Salud, Biblioteca Nacional de Medicina e Institutos Nacionales de Salud, Scientific Electronic Library Online, Cumulative Index to Nursing and Allied Health Literature, SCOPUS y Web of Science, empleados Ciencias de la Salud , Medical Subject Headings y términos alternativos, publicados en los años 2016 a 2021. Resultados: el corpus de revisión comprendió 33 artículos, categorizados en dos aspectos: conocimiento sobre factores de riesgo, prevención e identificación del ictus; y la búsqueda de atención temprana en el servicio de urgencias y emergencias. Conclusión: los ancianos generalmente desconocen la enfermedad y la necesidad de buscar atención temprana, lo que destaca la importancia de las acciones y directrices de promoción de la salud relacionadas con el accidente cerebrovascular, ya sea a través de los medios de comunicación o de las personas que componen la red de apoyo.(AU)

Research progress on intelligent assessment system for upper limb function of stroke patients / 生物医学工程学杂志

At present, the upper limb function of stroke patients is often assessed clinically using a scale method, but this method has problems such as time-consuming, poor consistency of assessment results, and high participation of rehabilitation physicians. To overcome the shortcomings of the scale method, intelligent upper limb function assessment systems combining sensors and machine learning algorithms have become one of the hot research topics in recent years. Firstly, the commonly used clinical upper limb functional assessment methods are analyzed and summarized. Then the researches on intelligent assessment systems in recent years are reviewed, focusing on the technologies used in the data acquisition and data processing parts of intelligent assessment systems and their advantages and disadvantages. Lastly, the current challenges and future development directions of intelligent assessment systems are discussed. This review is hoped to provide valuable reference information for researchers in related fields.

Pacientes atendidos com suspeita de acidente vascular encefálico: análise de associação entre diagnóstico e desfecho clínico / Patients treated with suspected stroke: analysis of the association between diagnosis and clinical outcome / Pacientes tratados con sospecha de accidente cerebrovascular: análisis de la asociación entre diagnóstico y evolución clínica

Objetivo: verificar a associação entre o diagnóstico e desfechos clínicos em casos suspeitos de Acidente Vascular Encefálico, atendidos no pronto-socorro de um hospital de alta complexidade. Método: estudo transversal e observacional, com dados secundários e abordagem quantitativa, realizado sobre atendimentos de pacientes com suspeita de Acidente Vascular Encefálico isquêmico ou hemorrágico durante seis meses. Resultados: do total de 50 atendimentos, observou-se que entre os diagnósticos de Acidente Vascular Encefálico, destacaram-se o isquêmico com 18 casos (36%) e o hemorrágico com cinco (10%), sendo que este representou a maior proporção de óbitos, com o total de três (6%). Dentro da amostra, 24 (48%) não tiveram confirmação de AVE, sem qualquer ocorrência de óbito (p-valor= 0,001). Conclusão: observou-se na amostra a associação entre o diagnóstico de Acidente Vascular Encefálico e seu desfecho clínico, com a alta hospitalar como principal desfecho, porém com um alto percentual de óbitos.

Objective: to verify the association between diagnosis and clinical outcomes in suspected cases of stroke treated in the emergency room of a high complexity hospital. Method: a cross-sectional and observational study, with secondary data and a quantitative approach, carried out on visits to patients with suspected ischemic or hemorrhagic stroke for six months. Results: from the total of 50 consultations, it was observed that among the diagnoses of stroke, the ischemic one with 18 cases (36%) and the hemorrhagic one with five (10%) stood out, and this represented the largest proportion of cases. deaths, with a total of three (6%). Within the sample, 24 (48%) had no confirmation of stroke, without any occurrence of death (p-value= 0.001). Conclusion: an association between the diagnosis of stroke and its clinical outcome was observed in the sample, with hospital discharge as the main outcome, but with a high percentage of deaths.

Objetivo: verificar la asociación entre el diagnóstico y los resultados clínicos en casos sospechosos de Accidente cerebrovascular atendidos en el servicio de urgencias de un hospital de alta complejidad. Método: estudio transversal y observacional, con datos secundarios y abordaje cuantitativo, realizado en visitas a pacientes con sospecha de ictus isquémico o hemorrágico durante seis meses. Resultados: del total de 50 consultas, se observó que entre los diagnósticos de Accidente cerebrovascular se destacó el isquémico con 18 casos (36%) y el hemorrágico con cinco (10%), representando la mayor proporción de casos defunciones, con un total de tres (6%). Dentro de la muestra, 24 (48%) no tuvieron confirmación de diagnóstico, sin ocurrencia de muerte (p-valor= 0,001). Conclusión: se observó en la muestra una asociación entre el diagnóstico de Accidente cerebrovascular y su desenlace clínico, siendo el alta hospitalaria el principal desenlace, pero con un alto porcentaje de óbitos.

Diagnóstico de Fibrilação Atrial na Comunidade Utilizando Eletrocardiograma e Autorrelato: Análise Transversal do ELSA-Brasil / Atrial Fibrillation Diagnosis using ECG Records and Self-Report in the Community: Cross-Sectional Analysis from ELSA-Brasil

Resumo Fundamento: A fibrilação ou flutter atrial (FFA) é a arritmia cardíaca sustentada mais comum. Existem poucos dados sobre a epidemiologia da FFA na América do Sul. Objetivo: O presente estudo procurou descrever a epidemiologia clínica da FFA e o uso de anticoagulantes na avaliação da linha de base do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). Métodos: Foram analisados dados de 13.260 participantes do ELSA-Brasil. A FFA foi definida pelo eletrocardiograma ou por autorrelato. Modelos de regressão logística foram construídos para analisar fatores associados à FFA. Este estudo também analisou se idade e sexo estavam associados ao uso de anticoagulantes para evitar acidente vascular cerebral. O nível de significância foi de 5%. Resultados: A idade mediana foi de 51 anos, e 7.213 (54,4%) participantes eram mulheres. A FFA foi detectada em 333 (2,5%) participantes. O aumento da idade (razão de chances [RC]:1,05; intervalo de confiança de 95% [IC95%]: 1,04-1,07), hipertensão (RC:1,44; IC95%:1,14-1,81) coronariopatia (RC: 5,11; IC95%:3,85-6,79), insuficiência cardíaca (RC:7,37; IC95%:5,00-10,87) e febre reumática (RC:3,38; IC95%:2,28-5,02) foram associadas à FFA. Dos 185 participantes com FFA e pontuação no CHA2DS2-VASc≥2, apenas 20 (10,8%) usavam anticoagulantes (50,0% entre aqueles com FFA no eletrocardiograma de linha de base). O uso de anticoagulantes nesse grupo foi associado a maior idade (1,8% vs 17,7% naqueles com idade ≤ 54 e ≥ 65 anos, respectivamente; p=0,013). Observou-se uma tendência ao menor uso de anticoagulantes em mulheres (7,1% vs. 16,4% em mulheres e homens, respectivamente; p=0,055). Conclusões: No recrutamento do ELSA-Brasil, 2,5% dos participantes tinham FFA. O baixo uso de anticoagulantes era comum, o que representa um desafio para os cuidados de saúde nesse cenário.

Abstract Background: Atrial fibrillation or flutter (AFF) is the most common sustained cardiac arrhythmia. Limited data can be found on AFF epidemiology in South America. Objective: The present study sought to describe the clinical epidemiology of AFF and the use of stroke prevention medication in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. Methods: This study analyzed data from 13,260 ELSA-Brasil participants. AFF was defined according to ECG recording or by self-report. Logistic regression models were built to analyze factors associated with AFF. This study also analyzed if age and sex were associated with anticoagulant use for stroke prevention. Significance level was set at 5%. Results: Median age was 51 years and 7,213 (54.4%) participants were women. AFF was present in 333 (2.5%) participants. Increasing age (odds ratio [OR]:1.05; 95% confidence interval [95%CI]: 1.04-1.07), hypertension (OR:1.44; 95%CI: 1.14-1.81), coronary heart disease (OR: 5.11; 95%CI: 3.85-6.79), heart failure (OR:7.37; 95%CI: 5.00-10.87), and rheumatic fever (OR:3.38; 95%CI: 2.28-5.02) were associated with AFF. From 185 participants with AFF and a CHA2DS2-VASc score ≥2, only 20 (10.8%) used anticoagulants (50.0% among those with AFF in the baseline ECG). Stroke prevention in this group was associated with a higher age (1.8% vs 17.7% in those aged ≤ 54 and ≥ 65 years, respectively; p=0.013). A trend towards a reduced anticoagulant use was observed in women (7.1% vs. 16.4% in women and men, respectively; p=0.055). Conclusions: At the ELSA-Brasil baseline, 2.5% of the participants had AFF. The lack of stroke prevention was common, which is an especially challenging point for healthcare in this setting.

Pre-hospital Care for Suspected Stroke Patients, Cared for by Mobile Emergency Care Units in Northern Minas Gerais

Abstract Background Stroke management require rapid identification, assessment, and transport of patients to qualified health care centers. However, there is little description in the literature on the multiple challenges associated with the pre-hospital transport of suspected stroke patients. Objective To characterize the pre-hospital care provided to suspected stroke patients by the Brazilian Emergency Medical Service (SAMU in Portuguese), by means of a descriptive case study. Methods This is a descriptive study of a series of cases. Data from the SAMU regarding the responses to emergency calls from suspected stroke patients were collected. Independent reviewers confirmed the diagnostic hypothesis and all discordances were assessed using kappa statistics. Clinical data and transport times were described as frequency and proportion or central tendency and dispersion measures. Normality of continuous variable distribution was assessed using the Kolmogorov-Smirnov test. The Mann-Whitney U test was used for comparison of medians, with a 5% significance level. Results During the studied period, 556 suspected stroke patients were treated. The kappa index was 0.82 (95% CI 0.737 to 0.919) CI. In 74.7% of the cases, the symptom onset time was not recorded. The median time elapsed between the call for emergency services and the ambulance arrival was 18 minutes, and the median transport time was 38 minutes. A total of 34% of the patients were taken to referral hospitals for stroke. Conclusion This study revealed a low level of knowledge regarding the need to determine the exact time of symptom onset of suspected stroke patients. Also, the study showed the low rate of patients taken to referral hospitals. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

Aspecto da artéria coronária circunflexa retroaórtica por ecocardiografia transesofágica / Retroaortic circumflex coronary artery appearance by transesophageal echocardiography

O sinal RAC (retroaortic anomalous coronary ou artéria coronária anômala retroaórtica) é um achado desconhecido, descrito ao ecocardiograma transtorácico como uma estrutura tubular ecogênica, localizada na face atrial do sulco atrioventricular. Apresentamos um caso onde o sinal RAC se apresenta na ecocardiografia transesofágica (ETE). O conhecimento do sinal RAC e a avaliação com ETE aumentam a sensibilidade e a especificidade e conferem a oportunidade de avaliar características anatômicas de alto risco, importantes na avaliação do risco de morte súbita.(AU)

Nivel de conocimientos sobre accidentes cerebro vasculares en hombres de 25 a 55 años del condominio Las Palmas de Maipú, Chile, en el año 2020 / Level of knowledge about cerebrovascular accident that the male population from 25 to 55 years of the condominium Las Palmas on Maipu, Chile, in the year 2020 presents

INTRODUCCIÓN: El Accidente cerebrovascular corresponde a una patología súbita, que requiere de atención inmediata, donde se ve comprometida una región cerebral por obstrucción de un vaso sanguíneo, en la mayoría de los casos. OBJETIVOS: Determinar el nivel de conocimiento respecto al accidente cerebrovascular que presenta la población masculina de 25 a 55 años del condominio Las Palmas de Maipú en el año 2020, Identificar si la población masculina reconoce signos, síntomas, factores de riesgos y acciones a tomar frente a un ACV. MÉTODOS: Estudio transversal, descriptivo, Se reclutaron 80 participantes masculinos residentes de condominio Las Palmas de Maipú, Chile. Instrumento y mediciones: Cuestionario tipo encuesta, considerando como variable primaria el nivel de conocimientos de la población y secundaria las variables sociodemográficas. RESULTADOS: Se evaluaron 80 participantes masculinos con rango etario de 25 a 55 años, se obtuvo como resultado un relativo conocimiento respecto a los ACV, reconociéndolo como una emergencia médica (93%), que requiere de un tratamiento oportuno (85%). No obstante, se evidencia un déficit de conocimiento sobre los factores de riesgos asociados a un ACV (30%). CONCLUSIONES: Se evidencia que la población masculina estudiada, si bien distingue la importancia clínica de un ACV, existe un déficit de conocimiento sobre los factores predisponentes para la presencia de este, lo que resulta relevante a considerar en la prevención de un evento cerebrovascular.

INTRODUCTION: Stroke corresponds to a sudden pathology, which requires immediate attention, where a brain region is compromised by obstruction of a blood vessel, in most cases. OBJECTIVES: Determine the level of knowledge regarding stroke in the male population aged 25 to 55 years of the Las Palmas de Maipú condominium in 2020, Identify if the male population recognizes signs, symptoms, risk factors and actions to be taken. to a stroke. METHODS: Cross-sectional, descriptive study. 80 male participants were recruited from the Las Palmas de Maipú condominium, Chile. Instrument and measurements: Survey-type questionnaire, considering the level of knowledge of the population as the primary variable and the sociodemographic variables as secondary. RESULTS: 80 male participants with an age range of 25 to 55 years were evaluated, a relative knowledge regarding stroke was obtained as a result, recognizing it as a medical emergency (93%), which requires timely treatment (85%). However, there is evidence of a deficit in knowledge about the risk factors associated with stroke (30%). CONCLUSIONS: It is evident that the male population studied, although it distinguishes the clinical importance of a stroke, there is a deficit of knowledge about the predisposing factors for its presence, which is relevant to consider in the prevention of a cerebrovascular event.

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)

Infarto simultáneo cardio-cerebral agudo: a propósito de un caso / Acute cardio-cerebral simultaneous infarction: a purpose of a case

OBJETIVO Informar Sobre Un Caso De Infarto Simultáneo Cardio-Cerebral Y Sus Características, Comparado Con Lo Descrito En La Actualidad. CASO CLÍNICO Paciente Femenina De 64 Años, Con Infarto Simultáneo Cardio-Cerebral (Isquemia En Territorio De Arteria Cerebral Media Derecha Y Elevación Del Segmento St En Cara Antero Inferior), Tratada Con Fibrinólisis. RESULTADOS Evoluciona Con Sensorio Fluctuante, Requiriendo Intubación Orotraqueal Y Manejo En Unidad De Terapia Intensiva Por Sangrado Cerebral CONCLUSIONES El infarto simultáneo cardio-cerebral es infrecuente y representa un desafío para el equipo de salud a fin de evitar que el manejo temprano de una condición retrase la otra

OBJETIVE To Report On A Case Of Simultaneous Cardio-Cerebral Infarction And Its Characteristics, Compared With What Is Currently Described. CLINICAL CASE A 64-year-old female patient with simultaneous cardio-cerebral infarction (ischemia in the territory of the right middle cerebral artery and elevation of the st segment in the lower anterior aspect), treated with fibrinolysis. RESULTS It evolves with fluctuating sensory, requiring orotracheal intubation and management in intensive therapy unit due to cerebral bleeding. CONCLUSIONS The Simultaneous Cardio-Cerebral Infarction Is Infrequent And Represents A Challenge For The Health Team In Order To Avoid That The Early Management Of One Condition Delays The Other

Conhecimento da população sobre acidente vascular cerebral em Torres RS / Knowledge of stroke in Torres-RS population

INTRODUÇÃO: O Acidente Vascular Cerebral (AVC) é uma das principais causas de morbi-mortalidade na América Latina, poucos estudos avaliam o conhecimento da população brasileira sobre o mesmo. OBJETIVO: Avaliar o conhecimento da população de Torres/RS sobre fatores de risco e sinais/sintomas de AVC. MÉTODO: Foi realizado um estudo do tipo transversal de caráter descritivo e exploratório, com entrevista a 375 habitantes, no qual responderam a dois questionários, um sociodemográfico e outro relativo ao conhecimento dos sinais e sintomas do Acidente vascular cerebral. O teste de Qui-Quadrado (χ2) e teste T-student foram realizados para avaliar a associação existente entre as variáveis qualitativas e para verificar diferenças na frequência absoluta e percentual das variáveis. RESULTADOS: A idade média dos participantes foi de 39,7 (+/- 14,6) anos, sendo 230 mulheres, a média de acertos sobre fatores de risco foi de 3.7/11 (34.4%) e de reconhecimento de sinais/sintomas foi de 3,2/10 (32,5%). Em relação aos fatores de risco, Hipertensão Arterial Sistêmica foi descrita por 229 (17,4%) indivíduos e quanto aos sinais/sintomas, o mais descrito foi a Paralisia Facial Central, relatada por 197 (17,2%). Além disso, foi observado que indivíduos com menor nível de instrução, do sexo masculino e com menos de 39 anos, apresentaram um pior desempenho em relação ao conhecimento sobre AVC. CONCLUSÃO: Dessa forma, sugere-se a necessidade de implementar políticas públicas que levem à população informações sobre a importância do reconhecimento destes sinais e sintomas com a necessidade do socorro rápido a este paciente.

INTRODUCTION: Stroke is a leading cause of mortality and disability in Latin America and few paper evaluate the knowledge of brazilian population about this subject. OBJECTIVE: Evaluate the knowledge of Torres/RS about stroke risk factors and signs/symptoms of stroke. METHODS: It was performed a transversal study with 375 inhabitants of Torres, in which they answered two questionnaires, a sociodemographic and the other related to the knowledge of the signs and symptoms of stroke. The Chi-square test (χ2) and the T-student test were performed to assess the association between qualitative variables and to verify differences in the absolute frequency and percentage of variables. RESULTS: The mean age of the participants was 39.7 (+/-14.6) years, (230 were women). The average of correct answers about risk factors was 3.7/11 (34.4%) and recognition of signs/symptoms was 3.2/10 (32.5%). Systemic Arterial Hypertension was the risk factor most recognized by the population (229 individuals). Facial Paralysis reported by 197 individuals was the signs/symptoms most recognized by the Torres population. In addition, it was observed that individuals with a lower level of education, male and under 39 years old, presented a worse performance in relation to knowledge about stroke. CONCLUSION: The implementation of public policies that provide the population information about the importance of the early recognization of stroke signs and symptoms is fundamental for a better result in the care of this disease.

Rehabilitación física de los pacientes con accidente vascular cerebral diagnosticados con hemiparesia / Physical rehabilitation of patients with cerebral vascular accident diagnosed with hemiparesis

Introduction: The present investigation arises from the insufficiencies in the physical rehabilitation of the hemiparesic patients of the orthopedic center of Viana, in many cases, determined by the low preparation of the physiotherapists for the use of the physical exercises with therapeutic aims. Objective: To elaborate a set of therapeutic physical exercises to favor the physical rehabilitation of patients diagnosed with hemiparesis. Methods: To develop the present investigation, the following methods were used: analytical-synthetic, hypothetical-deductive, inductive-deductive and systemic-structural-functional; and as empirical methods were used document analysis, observation, the Tinetti test and the experiment, which were supported by the survey and interview techniques, as well as by the statistical-mathematical empirical frequency distribution method. Conclusions: The correct selection, dosage and application of the physical therapeutic exercises allowed favoring the physical rehabilitation of two patients diagnosed with hemiparesis of the orthopedic center of Viana, results evaluated by the Tinetti test(AU)

Introducción: La presente investigación surge de las insuficiencias en la rehabilitación física de los pacientes hemiparésicos del centro ortopédico de Viana, en muchos casos, determinadas por la baja preparación de los fisioterapeutas para el uso de los ejercicios físicos con fines terapéuticos. Objetivo: Elaborar un conjunto de ejercicios físicos terapéuticos para favorecer la rehabilitación física de los pacientes diagnosticados con hemiparesia. Métodos: Para desarrollar la presente investigación se utilizaron como métodos teóricos los siguientes: analítico-sintético, hipotético-deductivo, inductivo-deductivo y sistémico-estructural-funcional; y como métodos empíricos se utilizaron el análisis de documentos, la observación, la medición, el test de Tinetti y el experimento, que fueron apoyados por las técnicas de encuesta y entrevista, así como por el método estadístico-matemático distribución empírica de frecuencias. La muestra utilizada estuvo constituida por seis pacientes y tres fisioterapeutas del centro ortopédico de Viana, Luanda, Angola. Resultados: Después del diagnóstico inicial, se elaboró el conjunto de ejercicios físicos terapéuticos, el cual se aplicó desde el mes de mayo hasta el mes de noviembre del 2018, donde se aplicó al medición final, que permitió determinar las mejoras en la rehabilitación física de los pacientes diagnosticados con hemiparesia, al mejorar la marcha y el equilibrio Conclusiones: La correcta selección, dosificación y aplicación de los ejercicios físicos terapéuticos permitió favorecer la rehabilitación física dos pacientes diagnosticados con hemiparesia del centro ortopédico de Viana, resultados evaluados mediante el test de Tinetti(AU)

Stroke-mimics in stroke-units. Evaluation after changes imposed by randomized trials / Imitadores de AVC em unidades de AVC. Avaliação após alterações impostas por ensaios randomizados

Abstract A larger therapeutic window for stroke treatment requires a significant change in the organization of emergency services, avoiding the increase in number of imaging exams and indirectly the time to treatment. Objective: To highlight the relation between faster clinical evaluation and stroke over-suspicion and consequently excessive imaging acquisition. To identify predictors of ischemic stroke and stroke mimics (SM), aiming for better patient selection for comprehensive neuroimaging and reperfusion therapies. Methods: Retrospective, cohort, observational, single-center study that reviewed all consecutive files of patients presenting with acute neurological symptoms who underwent CT scan or MRI from July 1, 2016 to July 1, 2017. Results: 736 patient files were reviewed. 385 patients (52.3%) presented with confirmed acute ischemic infarct, 93 (12.6%) had another brain lesion mimicking acute ischemia, and 258 (35.1%) had normal imaging. Acute stroke was more frequent in elderly patients with atrial fibrillation, arterial hypertension, or dysarthria or right motor impairment. Stroke mimic was associated with female patients with low vascular risk factors, low NIHSS, and patients with decreased level of consciousness or symptoms suggestive of posterior circulation. Discussion: 47.7% of all patients seen at the stroke unit did not have acute stroke lesions. Clinical assessment data have been used to provide indicators of acute stroke and stroke mimic patients, and symptoms corresponding to acute stroke and stroke mimic seem to be similar in the literature. Conclusion: Considering that the number of patients admitted for stroke treatment will increase even further with a larger therapeutic window for mechanical thrombectomy and for thrombolysis, a diagnostic decision-making algorithm for stroke patients is required in order to reinforce the suspicion of stroke indicating an urgent MRI.

Resumo Uma janela terapêutica maior para o tratamento do AVC exige uma mudança significativa na organização dos serviços de emergência, para evitar o aumento do número de exames de imagem e indiretamente o tempo de tratamento. Objetivo: destacar a relação entre avaliação clínica mais rápida e suspeita de acidente vascular cerebral e, consequentemente, aquisição de imagem excessiva, e identificar preditores de acidente vascular cerebral isquêmico e imitações de acidente vascular cerebral (SM), visando uma melhor seleção de pacientes para terapias abrangentes de neuroimagem e reperfusão. Métodos: estudo observacional de coorte retrospectivo, em centro único, que revisou todos os arquivos consecutivos de pacientes com sintomas neurológicos agudos submetidos à tomografia computadorizada ou ressonância magnética de 1 de julho de 2016 a 1 de julho de 2017. Resultados: Foram revisados 736 prontuários. 385 pacientes (52,3%) apresentaram infarto isquêmico agudo confirmado, 93 (12,6%) apresentaram outra lesão cerebral imitando isquemia aguda e 258 (35,1%) apresentaram imagem normal. O AVC agudo foi mais frequente em pacientes idosos com fibrilação atrial, hipertensão arterial, ou disartria ou comprometimento motor direito. A imitação de acidente vascular cerebral foi associada a pacientes do sexo feminino com baixos fatores de risco vascular, NIHSS baixo e pacientes com diminuição do nível de consciência ou sintomas sugestivos de circulação posterior. Discussão: 47,7% de todos os pacientes atendidos na unidade de AVC não apresentaram lesões agudas de AVC. Conclusão: Considerando que o número de pacientes admitidos para tratamento de AVC aumentará ainda mais com uma janela terapêutica maior para trombectomia e trombólise IV, é necessário um algoritmo de tomada de decisão diagnóstica para pacientes com AVC, a fim de reforçar a suspeita de AVC indicando uma imagem cerebral urgente.

Association of circulating long non-coding RNA MALAT1 in diagnosis, disease surveillance, and prognosis of acute ischemic stroke

We aimed to investigate the association of long non-coding RNA metastasis-associated lung adenocarcinoma transcript 1 (lnc-MALAT1) with acute ischemic stroke (AIS), and its association with disease severity, inflammation, and recurrence-free survival (RFS) in AIS patients. One hundred and twenty AIS patients and 120 controls were recruited. Venous blood samples from AIS patients (within 24 h after symptoms onset) and controls (at entry to study) were collected to detect plasma lnc-MALAT1 expression by real-time quantitative polymerase chain reaction. AIS severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) score. Plasma concentrations of inflammation factors (including C-reactive protein (CRP), tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-8, IL-10, IL-17, and IL-22) were measured and RFS was calculated. lnc-MALAT1 expression was decreased in AIS patients compared to controls, and it had a close correlation with AIS (AUC=0.791, 95% CI: 0.735-0.846). For disease condition, lnc-MALAT1 expression negatively correlated with NIHSS score and pro-inflammatory factor expression (including CRP, TNF-α, IL-6, IL-8, and IL-22), while it positively correlated with anti-inflammatory factor IL-10 expression. Furthermore, lnc-MALAT1 expression was elevated in AIS patients with diabetes. For prognosis, no statistical correlation of lnc-MALAT1 expression with RFS was found, while a trend for longer RFS was observed in patients with lnc-MALAT1 high expression compared to those with lnc-MALAT1 low expression.

Facteurs pronostiques de mortalité par accident vasculaire cérébral artériel à la phase aiguë dans une population nord-africaine

Introduction : l'accident vasculaire cérébral (AVC) constitue un problème majeur de santé publique, tant par le nombre de personnes atteintes, que par ses conséquences médicales, sociales et économiques. L'objectif était de dégager les facteurs de mauvais pronostic vital à la phase aiguë de l'AVC artériel. Méthodes: il s'agit d'une étude prospective durant 4 mois portant sur les patients présentant une symptomatologie évocatrice d'AVC aux deux CHU de Sfax, Tunisie. Le suivi a été de 1 mois. Résultats: nous avons colligé 200 patients. Après un mois de suivi, la mortalité était de 19,9%. Les facteurs de mauvais pronostic vital étaient: le sexe masculin, la consommation de tabac, l'antécédent d'AVC, le score de Glasgow bas, le NIHSS élevé, les céphalées, les crises épileptiques symptomatiques aigues, le signe de Babinski, la mydriase, l'aphasie, la déviation conjuguée de la tête et des yeux, les chiffres élevés de pression artérielle systolique (PAS), pression artérielle diastolique (PAD) et pression artérielle pulmonaire (PAP), l'hyperthermie, l'hyperglycémie, l'hyperleucocytose, l'augmentation des CRP, créatinine, urée et la troponine Tc, la nature hémorragique de l'AVC, l'œdème péri lésionnel, l'effet de masse, l'engagement, la topographie sylvienne totale de l'ischémie, la présence de signes précoces d'ischémie, l'hémorragie méningée, l'inondation ventriculaire, l'hydrocéphalie, le recours à une assistance respiratoire, au traitement anti-œdémateux et antihypertenseur, la transformation hémorragique, l'épilepsie vasculaire, les complications infectieuses, métaboliques et de décubitus. Conclusion: l'identification des facteurs prédictifs du devenir vital permet d'optimiser les procédures thérapeutiques et mieux organiser les filières de prise en charge. Une étude comparative sera envisagée afin de mesurer l'impact des mesures correctives