Differential Characteristics of Ischemic and Hemorrhagic Stroke in Patients with Cerebral Small Vessel Disease.

BACKGROUND: Small vessel disease (SVD) is the underlying anatomical substrate for both lacunar infarction and subcortical hemorrhage. AIM: To assess predictive factors of ischemic or hemorrhagic stroke in patients with cerebral SVD. MATERIALS AND METHODS: Prospective hospital-based stroke registry ("The Sagrat Cor Hospital of Barcelona Stroke Registry") in an acute-care teaching hospital in Barcelona, Spain. From 4597 acute stroke patients included in the stroke registry over a 24-year period, 440 cases of lacunar stroke and 210 of subcortical intracerebral hemorrhage were selected. Demographics, clinical characteristics, risk factors, and early outcome were compared. Predictors of lacuna versus subcortical hemorrhage were assessed by multivariate analyses. RESULTS: In a logistic regression model based on demographics, risk factors, clinical features and outcome, dyslipidemia (odds ratio [OR] 2.06 (95% confidence interval (CI) 1.17-3.62) and diabetes (OR 1.97, 95% CI 1.19-3.26) were independent risk factors for lacunar infarction. Anticoagulation therapy (OR 0.05, 95% CI 0.01-0.28), sudden onset (OR 0.51, 95% CI 0.33-0.78), motor symptoms (OR 0.44, 95% CI 0.26-0.76), headache (OR 0.23, 95% CI 0.12-0.41), altered consciousness (OR 0.10, 95% CI 0.05-0.21), respiratory complications (OR 0.19, 95% CI 0.08-0.46), and in-hospital death (OR 0.08, 95% CI 0.02-0.36) were predictors of subcortical hemorrhage. CONCLUSION: Identification of differential clinical and prognostic profile between ischemic and hemorrhagic consequences of underlying cerebral SVD is useful for risk stratification in the current process pursuing precision medicine.

Cardioembolic stroke: risk factors, clinical features, and early outcome in 956 consecutive patients

ABSTRACT Background: There is little information about the early clinical features of cardioembolic stroke before complementary examinations. Objective: The aim of this study was to identify risk factors, clinical features, and early outcomes of cardioembolic stroke. Methods: Retrospective study based on prospectively collected data available from a university medical center hospital-based stroke registry. Consecutive patients diagnosed with cardioembolic infarction were selected and compared to those diagnosed with an atherothrombotic stroke. Predictors of cardioembolic infarction were assessed by multivariate analysis. Results: From a cohort of 4597 consecutive patients, we studied 956 patients diagnosed with cardioembolic infarction (80 years [standard deviation (SD) 9.14]; 63% women) and 945 with atherothrombotic infarction (77.01 years [SD 9.75]; 49.8% women). The univariate comparative analysis reported that advanced age (≥ 85 years), female gender, atrial fibrillation (AF), ischemic heart disease, and congestive heart failure were significantly more frequent in the cardioembolic group, whereas hypertension, diabetes, peripheral vascular disease, heavy smoking, hyperlipidemia, and previous transient ischemic attack were significant in the atherothrombotic group. In the logistic regression model, AF (odds ratio [OR] 15.75, 95% confidence interval [CI]: 12.14-20.42), ischemic heart disease (OR 3.12, 95% CI: 2.16-4.5), female gender (OR 1.56, 95% CI: 1.22-2.00), and sudden-onset (OR 1.97, 95% CI: 1.54-2.51), were independent significant predictors of cardioembolic stroke. Conclusions: Potential cardioembolic stroke requires a comprehensive evaluation, since early classification and identification through predictors would improve effective management. (REV INVEST CLIN. 2021;73(1):23-30)

Cardioembolic Stroke: Risk Factors, Clinical Features, and Early Outcome in 956 Consecutive Patients.

BACKGROUND: There is little information about the early clinical features of cardioembolic stroke before complementary examinations. OBJECTIVE: The aim of this study was to identify risk factors, clinical features, and early outcomes of cardioembolic stroke. METHODS: Retrospective study based on prospectively collected data available from a university medical center hospitalbased stroke registry. Consecutive patients diagnosed with cardioembolic infarction were selected and compared to those diagnosed with an atherothrombotic stroke. Predictors of cardioembolic infarction were assessed by multivariate analysis. RESULTS: From a cohort of 4597 consecutive patients, we studied 956 patients diagnosed with cardioembolic infarction (80 years [standard deviation (SD) 9.14]; 63% women) and 945 with atherothrombotic infarction (77.01 years [SD 9.75]; 49.8% women). The univariate comparative analysis reported that advanced age (≥ 85 years), female gender, atrial fibrillation (AF), ischemic heart disease, and congestive heart failure were significantly more frequent in the cardioembolic group, whereas hypertension, diabetes, peripheral vascular disease, heavy smoking, hyperlipidemia, and previous transient ischemic attack were significant in the atherothrombotic group. In the logistic regression model, AF (odds ratio [OR] 15.75, 95% confidence interval [CI]: 12.14-20.42), ischemic heart disease (OR 3.12, 95% CI: 2.16-4.5), female gender (OR 1.56, 95% CI: 1.22-2.00), and sudden-onset (OR 1.97, 95% CI: 1.54-2.51), were independent significant predictors of cardioembolic stroke. CONCLUSIONS: Potential cardioembolic stroke requires a comprehensive evaluation, since early classification and identification through predictors would improve effective management.

Guillain-Barré-Strohl syndrome and COVID-19: Case report and literature review.

In recent months, the new beta-coronavirus has caused a pandemic with symptoms affecting mainly the respiratory system. It is established that the virus may play a neurotropic role and in recent months several cases of Guillain-Barré-Strohl syndrome (GBS) have been reported in patients infected with COVID-19. We report the case of a 54-year-old patient with acute demyelinating polyneuropathy during infection by SARS-CoV-2 who progressed clinically to require assisted ventilation. After several weeks of specific symptomatic treatment, the patient had a favorable outcome. In conclusion, despite being a rare complication, we think it is important to consider the possibility of diffuse involvement of the peripheral nervous system in patients with COVID-19 to adjust clinical monitoring and treatment in these cases.

Predictive clinical features of cardioembolic infarction in patients aged 85 years and older.

OBJECTIVE: To assess predictive clinical factors of cardioembolic infarction in very old patients (85 years of age and older). METHODS: Prospective hospital-based stroke registry ("The Sagrat Cor Hospital of Barcelona Stroke Registry") is an acute-care teaching hospital in Barcelona, Catalonia, Spain. From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period, 639 were younger than 85 years of age and 317 were 85 years or older (mean age: 88.9 years). Demographics, clinical characteristics, risk factors and early outcome were compared. Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses. RESULTS: In a logistic regression model based on demographics, risk factors, clinical features and complications, female gender (odds ratio [OR] = 1.74, 95% confidence interval [CI]: 1.27-2.39), heart failure (OR = 2.27, 95% CI: 1.46-3.56), altered consciousness (OR = 1.76, 95% CI: 1.28-2.42), and infectious complications (OR = 2.01, 95% CI: 1.39-2.91) were predictors of cardioembolic stroke in the oldest age group. By contrast, heavy smoking, heart valve disease, hypertension, headache, early seizures, sensory deficit, and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group. CONCLUSIONS: Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.

Perfil clínico diferencial entre los infartos lacunares y los infartos cerebrales aterotrombóticos / Differential clinical profile of lacunar infarcts compared to atherothrombotic brain infarcts

Aims and objectives: The present study makes a comparative analysis between the clinical profile of lacunar infarcts (LI) and that of atherothrombotic brain infarcts (ABI). Methods: Hospital-based descriptive study of 1809 consecutive patients admitted over a period of 24 years with a diagnosis of lacunar cerebral infarction (n = 864) or atherothrombotic cerebral infarction (n = 945). A comparative analysis of the demographic data, cerebral vascular risk factors, clinical data and hospital evolution between both subtypes of cerebral infarction was performed using a univariate and multivariate statistical methodology. Results: LI accounted for 26.5% and ABI for 28.9% of all cerebral infarctions in the registry. The variables directly and independently associated with ABI were: ischemic heart disease, previous transient ischemic attack, previous cerebral infarction, peripheral vascular disease, anticoagulant therapy, age > 85 years, vegetative symptoms, decreased level of consciousness, sensory deficit, visual deficit, speech disorders, and neurological, respiratory and urinary complications during hospital admission. In contrast, the absence of neurological symptoms at hospital discharge was directly associated with LI. Conclusions: LI and ABI have a distinct clinical profile. The best functional prognosis of LI during the acute phase of the disease is characteristic. In contrast, ICAs have a higher atherosclerotic burden and a worse prognosis.

Fundamentos y objetivo: El objetivo del estudio es efectuar un análisis comparativo entre el perfil clínico de los infartos lacunares (IL) y el perfil de los infartos cerebrales aterotrombóticos (ICA). Métodos: Estudio hospitalario descriptivo de 1809 pacientes consecutivos ingresados durante un período de 24 años con el diagnóstico de infarto cerebral de tipo lacunar (n = 864) o por infarto cerebral aterotrombótico (ICA) (n = 945). Se realizó un análisis comparativo de los datos demográficos, factores de riesgo vascular cerebral, datos clínicos y de evolución hospitalaria utilizando una metodología estadística univariada y, posteriormente, multivariada. Resultados: Los IL representaron el 26.5% y los ICA el 28.9% del total de infartos cerebrales del registro. Las variables asociadas directamente y de forma independiente con los ICA fueron: cardiopatía isquémica, ataque isquémico transitorio previo, infarto cerebral previo, enfermedad vascular periférica, uso de anticoagulantes, edad > 85 años, síntomas vegetativos, disminución del nivel de conciencia, déficit sensitivo, déficit visual, trastornos del habla y complicaciones neurológicas, respiratorias y urinarias durante el ingreso hospitalario. En cambio, la ausencia de sintomatología neurológica al alta se asoció directamente con los IL. Conclusiones: Los IL y los ICA tienen un perfil clínico diferenciado. Es característico el mejor pronóstico funcional de los IL durante la fase aguda de la enfermedad. En cambio, los ICA presentan mayor carga aterosclerótica y peor pronóstico evolutivo.

Complementary examinations other than neuroimaging and neurosonology in acute stroke.

The etiologic diagnosis of cerebrovascular diseases requires non-routine complementary examinations to be performed. Thus, in specific cases, after neuroimaging (computed tomography/magnetic resonance imaging cerebral scan sequences) and neurosonology (Doppler test of the supra-aortic trunks, transcranial echography and echocardiography), which academically allow us to classify the patients according to their etiologic stroke subtype, further examinations must be used to make a correct etiologic diagnostic. The present review aims to update knowledge about the usefulness of the different tests of blood and urine, plain chest radiography, X-ray of the spine, skull and abdomen, lumbar puncture, electroencephalography, evoked potentials, polysomnography, and pathologic examination after biopsy of the artery, skin, muscles, nerves, meninges, and brain, in the management of patients who have suffered an acute stroke.

Hematological disorders: a commonly unrecognized cause of acute stroke.

INTRODUCTION: Hematological disorders account for about 1.3% of all causes of acute stroke. This systematized review presents updated information on the implications of this category of heterogeneous diseases as a cause of stroke. AREAS COVERED: The most relevant aspects of the relationship between stroke and hematological disorders are reported. A high index of suspicion is needed in young stroke patients, patients with recurrent stroke of undetermined cause, and in patients with prior history of venous thrombosis to identify a potential hematological disorder as the definitive etiology of stroke Expert commentary: Stroke can be the presenting manifestation of a specific hematological disease or may appear as a complication in the course of hematological disorders. It is important to make a correct diagnosis of the underlying hematological disorder in order to treat stroke patients promptly and appropriately as well as to establish the optimal secondary prevention strategy for recurrent vascular cerebral disease.

Ictus en adultos jóvenes: rasgos clínicos y frecuencia de presentación en 280 pacientes según el subtipo etiológico / Stroke in young adults: incidence and clinical picture in 280 patients according to their aetiological subtype

Fundamento y objetivo: Analizar los rasgos clínicos y la frecuencia de presentación de los ictus en adultos jóvenes (55 o menos años de edad). Métodos: Estudio hospitalario de 280 pacientes jóvenes consecutivos ingresados por presentar un ictus durante un período de 24 años. Se efectúa una comparación con los 4.312 pacientes restantes ingresados con ictus. Resultados: Los ictus en adultos jóvenes representan el 6,1% del total de los ictus, el 5,7% de los ataques isquémicos transitorios, el 5,8% de los infartos cerebrales y el 8,4% de las hemorragias cerebrales. Su frecuencia fue mínima en los infartos cardioembólicos (2,1%) y en los aterotrombóticos (3,4%). Se observó en el 5,9% de los lacunares y en el 10,7% de los infartos esenciales, y su frecuencia fue máxima en los infartos de causa inhabitual (36%). Las variables asociadas a los ictus jóvenes de forma independiente fueron el tabaquismo (OR 4,23; IC del 95% 3,02-5,93; p = 0,000), la etiología inhabitual (OR 4,97; IC del 95% 3,15-7,84; p = 0,000), la cefalea (OR 4,57; IC del 95% 2,59-8,07; p = 0,000), el abuso de alcohol (OR 3,93; IC del 95% 2,46-6,29; p = 0,000), los anovulatorios (OR 14,07; IC del 95% 2,37-83,40; p = 0,004), la fibrilación auricular (OR 0,15; IC del 95% 0,08-0,28; p = 0,000), la hipertensión arterial (OR 0,43; IC del 95% 0,33-0,57; p = 0,000), la EPOC (OR 0,20; IC del 95% 0,09-0,44; p = 0,000), el infarto aterotrombótico (OR 0,51; IC del 95% 0,34-0,77; p = 0,001), el sexo femenino (OR 0,71; IC del 95% 0,52-0,97; p = 0,029), la diabetes mellitus (OR 0,66; IC del 95% 0,46-0,98; p = 0,030), la cardiopatía isquémica (OR 0,56; IC del 95% 0,33-0,95; p = 0,032) y la claudicación intermitente (OR 0,48; IC del 95% 0,24-0,94; p = 0,033). Conclusiones: Los ictus en adultos jóvenes son infrecuentes (6,1% del total), pero representan el 36% de los infartos de causa inhabitual. Las ictus en adultos jóvenes presentan un perfil clínico propio y diferenciado (AU)

Background and objective: To assess the clinical features and incidence rate of stroke in young adults (less than 55 years of age). Methods: Hospital-based descriptive study of 280 young inpatients consecutively admitted for stroke over a period of 24 years. We conducted a comparison with the remaining 4,312 patients admitted for stroke. Results: Stroke in young adults represented 6.1% of all strokes, 5.7% of transient ischaemic attacks, 5.8% of cerebral infarctions and 8.4% of brain haemorrhages. However, reported minimal frequency of cardioembolic (2.1%) and atherothrombotic (3.4%) infarctions, accounted for 5.9% of lacunar and for 10.7% of essential infarctions and showed a maximum frequency in those infarctions of unusual aetiology (36%). Factors independently associated with stroke in young adults were cigarette smoking (OR 4.23; 95% CI 3.02-5.93; P = .000), unusual aetiology (OR 4.97; 95% CI 3.15-7.84; P = .000), headache (OR 4.57; 95% CI 2.59-8.07; P = .000), alcohol abuse (OR 3.93; 95% CI 2.46-6.29; P = .000), oral contraceptives (OR 14.07; 95% CI 2.37-83.40; P = .004), atrial fibrillation (OR 0.15; 95% CI 0.08-0.28; P = .000), arterial hypertension (OR 0.43; 95% CI 0.33-0.57; P = .000), COPD (OR 0.20; 95% CI 0.09-0.44; P = .000), atherothrombotic infarction (OR 0.51; 95% CI 0.34-0.77; P = .001), female sex (OR 0.71; 95% CI 0.52-0.97; P = .029), diabetes mellitus (OR 0.66; 95% CI 0.46-0.98; P = .030), ischaemic heart disease (OR 0.56; 95% CI 0.33-0.95; P = .032) and intermittent claudication (OR 0.48; 95% CI 0.24-0.94; P = .033). Conclusions: Stroke in young adults is infrequent (6.1% of the total), but represents the highest frequency of cerebral infarcts of unusual aetiology (36%). We conclude that stroke in younger patients presents its own and differentiated clinical profile (AU)

[Stroke in young adults: incidence and clinical picture in 280 patients according to their aetiological subtype]. / Ictus en adultos jóvenes: rasgos clínicos y frecuencia de presentación en 280 pacientes según el subtipo etiológico.

BACKGROUND AND OBJECTIVE: To assess the clinical features and incidence rate of stroke in young adults (less than 55 years of age). METHODS: Hospital-based descriptive study of 280 young inpatients consecutively admitted for stroke over a period of 24 years. We conducted a comparison with the remaining 4,312 patients admitted for stroke. RESULTS: Stroke in young adults represented 6.1% of all strokes, 5.7% of transient ischaemic attacks, 5.8% of cerebral infarctions and 8.4% of brain haemorrhages. However, reported minimal frequency of cardioembolic (2.1%) and atherothrombotic (3.4%) infarctions, accounted for 5.9% of lacunar and for 10.7% of essential infarctions and showed a maximum frequency in those infarctions of unusual aetiology (36%). Factors independently associated with stroke in young adults were cigarette smoking (OR 4.23; 95% CI 3.02-5.93; P=.000), unusual aetiology (OR 4.97; 95% CI 3.15-7.84; P=.000), headache (OR 4.57; 95% CI 2.59-8.07; P=.000), alcohol abuse (OR 3.93; 95% CI 2.46-6.29; P=.000), oral contraceptives (OR 14.07; 95% CI 2.37-83.40; P=.004), atrial fibrillation (OR 0.15; 95% CI 0.08-0.28; P=.000), arterial hypertension (OR 0.43; 95% CI 0.33-0.57; P=.000), COPD (OR 0.20; 95% CI 0.09-0.44; P=.000), atherothrombotic infarction (OR 0.51; 95% CI 0.34-0.77; P=.001), female sex (OR 0.71; 95% CI 0.52-0.97; P=.029), diabetes mellitus (OR 0.66; 95% CI 0.46-0.98; P=.030), ischaemic heart disease (OR 0.56; 95% CI 0.33-0.95; P=.032) and intermittent claudication (OR 0.48; 95% CI 0.24-0.94; P=.033). CONCLUSIONS: Stroke in young adults is infrequent (6.1% of the total), but represents the highest frequency of cerebral infarcts of unusual aetiology (36%). We conclude that stroke in younger patients presents its own and differentiated clinical profile.

Clinical characteristics of acute lacunar stroke in young adults.

INTRODUCTION: Acute lacunar stroke in subjects under 55 years of age has been poorly characterized. METHODS: We assessed the clinical features of lacunar stroke in 51 patients aged ≤55 years (84.5% men, mean standard deviation [SD] age 49.8 [5.2] years) collected from a prospective hospital-based stroke registry in Barcelona, Catalonia, Spain. RESULTS: This subset of young lacunar stroke patients accounted for only 5.2% of all lacunar strokes, 1.2% of all ischemic strokes, and 1.1% of all acute strokes included in the registry over a 24-year period. In the multivariate analysis, factors independently associated with acute lacunar stroke in patients aged ≤55 years were alcohol consumption (>60 g/day) (odds ratio [OR] = 6.67), heavy smoking (>20 cigarettes/day) (OR = 3.02), obesity (OR = 2.81), essential etiology (OR = 2.73), and headache at stroke onset (OR = 2.45). CONCLUSION: Characterization of the clinical profile of acute lacunar stroke in younger patients contributes to a better knowledge of the full clinical expression of this ischemic stroke subtype.

Malignant middle cerebral artery infarction: a clinical study of 32 patients.

BACKGROUND AND OBJECTIVE: Malignant middle cerebral artery infarction is a devastating type of ischemic stroke whose clinical predictors remain scarcely known. The present study aims to improve the knowledge about the prognosis factors through an analysis of a malignant middle cerebral artery infarction sample of patients from our stroke registry. MATERIAL AND METHODS: From a total of 1,396 patients with ischemic stroke in the middle cerebral artery included in the "Sagrat Cor Hospital of Barcelona Stroke Registry", we identified 32 patients with malignant middle cerebral artery infarction (2.3%). Demographic, anamnestic, clinical, and outcome variables in this subgroup of patients were compared with those of the middle cerebral artery. The independent predictive value of each variable on the development of malignant middle cerebral artery infarction was assessed with a logistic regression analysis. RESULTS: The mean age was 74.7 (SD, 11.4) years and 50% were males. In-hospital death was observed in eight patients (25%) and early bad prognosis (in-hospital death or severe residual focality at discharge) was present in 16 patients (50%). Decreased consciousness (OR: 4.17; 95% CI: 2.02-8.61), presence of nausea or vomiting (OR: 3.65; 95% CI: 1.40-8.49), and heavy smoking (> 20 cigarettes/day; OR: 2.62; 95% CI: 1.03-6.64) appeared to be independent prognostic factors for malignant middle cerebral artery infarction in the multivariate analysis. CONCLUSIONS: Malignant middle cerebral artery infarction is an infrequent clinical condition associated with poor prognosis and high mortality rate. In our sample, decreased consciousness, nausea or vomiting, and heavy smoking are the main clinical factors associated.

Gender differences and woman-specific trends in acute stroke: results from a hospital-based registry (1986-2009).

OBJECTIVE: We assessed gender differences and women-specific secular trends in stroke. METHODS: Data from 2318 women and 2274 men with first-ever stroke collected from the Sagrat Cor Hospital Stroke Registry of Barcelona between 1986 and 2009 were analyzed. RESULTS: Patient's age increased significantly from a mean of 74.5 years in 1986-1992 to 81.2 years in 2004-2009 (P < 0.001). Patients aged ≥ 85 years increased from 18.5% to 38.5% (P = 0.0001) as were patients with hypertension, atrial fibrillation, and cardioembolic stroke. The in-hospital death decreased from 17.6% to 11% (P = 0.02), median length of hospital from 14 to 9 days (P = 0.0001) and prolonged hospital stay (> 12 days) from 59.7% to 33.7% (P = 0.0001). Lacunar infarction was more frequent in men (21.5% vs. 16.2%, P = 0.0003) and cardioembolic infarction in women (26% vs. 15.6%, P = 0.0001). Acute stroke in women continues to be a severe disease with high risk of death in the immediate post-stroke phase (13.5%) and low probability of early full neurological recovery (13.9% vs. 11.8%, P = 0.029). CONCLUSION: Women differ from men in the distribution of risk factors and stroke subtype, stroke severity, and outcome. An increase in the patient's age, hypertension, atrial fibrillation and cardioembolic infarction, as well as a decrease mortality and length of hospitalization over a 24-year period was recorded.

Variaciones en el perfil clínico y pronóstico de las hemorragias intracerebrales no traumáticas (1986-2004) / Trends in risk factors, clinical characteristics and prognosis in primary intracerebral haemorrhage (1986-2004)

Fundamento y objetivo: Analizar las variaciones de los factores de riesgo y el perfil clínico de las hemorragias intracerebrales no traumáticas (HIC) entre 1986 y 2004 a partir del registro de ictus del Hospital del Sagrat Cor, y comparar los datos de las HIC con los de los infartos cerebrales. Pacientes y método: Estudio hospitalario de 380 pacientes consecutivos con HIC y 2.082 pacientes con infarto cerebral. Se efectúa un análisis comparativo de las tendencias y variaciones clínicas observadas entre los períodos 1986-1992, 1993-1998 y 1999-2004. Resultados: La edad se incrementó significativamente (p < 0,001) durante los 3 períodos de estudio y se observó un aumento significativo en la frecuencia de fibrilación auricular, enfermedad pulmonar obstructiva crónica (EPOC) y de topografía cerebral lobular. El uso de la resonancia magnética (RM) cerebral también aumentó de forma significativa a través del período de estudio. En comparación con los infartos cerebrales, en las HIC fue más frecuente la mortalidad hospitalaria (28,2 frente al 12%) y menos habituales la presencia de un síndrome lacunar (9,5 frente al 31,4%) y la ausencia de sintomatología neurológica al alta hospitalaria (6,1 frente al 18,3%). Conclusiones: Se observan variaciones clínicas significativas durante dicho período de tiempo de 19 años, con un incremento en la edad de presentación, en la frecuencia de fibrilación auricular y EPOC y en el uso de la RM cerebral. La HIC constituye un subtipo de ictus grave con una mayor mortalidad precoz y una menor frecuencia de ausencia de sintomatología al alta hospitalaria en comparación con los infartos cerebrales (AU)

Background and objectives: Cardiovascular risk factors, clinical features and early outcome of first-ever primary intracerebral haemorrhage (PIH) from 1986 to 2004 using the Sagrat Cor Hospital of Barcelona Stroke Registry were assessed, and compared with data from patients with first-ever ischemic stroke. Patients and methods: The study population consisted of 380 patients with PIH and 2,082 patients with ischemic stroke. Secular trends for the periods 1986-1992, 1993-1998 and 1999-2004 were analyzed. Results: Age increased significantly (P < .001) throughout the 3 study periods and there was a significant increase in the percentage of patients with atrial fibrillation, chronic obstructive pulmonary disease (COPD) and lobar topography. The use of brain magnetic resonance imaging (MRI) also increased significantly throughout the study periods. In comparison with ischemic stroke in-hospital death was more frequent (28,2 vs. 12%) and lacunar syndrome (9,5 vs. 31,4%) and symptom-free patients at discharge were less frequent in the intracerebral haemorrhage group (6,1 vs. 18,3%). Conclusions: Significant changes over a 19-year period included an increase in the patient's age, frequency of COPD and atrial fibrillation and use of MRI imaging studies. PIH is a severe subtype of stroke with a higher risk of early death and lower asymptomatic frequency at discharge than ischemic cerebral infarct (AU)

[Trends in risk factors, clinical characteristics and prognosis in primary intracerebral haemorrhage (1986-2004)]. / Variaciones en el perfil clínico y pronóstico de las hemorragias intracerebrales no traumáticas (1986-2004).

BACKGROUND AND OBJECTIVES: Cardiovascular risk factors, clinical features and early outcome of first-ever primary intracerebral haemorrhage (PIH) from 1986 to 2004 using the Sagrat Cor Hospital of Barcelona Stroke Registry were assessed, and compared with data from patients with first-ever ischemic stroke. PATIENTS AND METHODS: The study population consisted of 380 patients with PIH and 2,082 patients with ischemic stroke. Secular trends for the periods 1986-1992, 1993-1998 and 1999-2004 were analyzed. RESULTS: Age increased significantly (P<.001) throughout the 3 study periods and there was a significant increase in the percentage of patients with atrial fibrillation, chronic obstructive pulmonary disease (COPD) and lobar topography. The use of brain magnetic resonance imaging (MRI) also increased significantly throughout the study periods. In comparison with ischemic stroke in-hospital death was more frequent (28,2 vs. 12%) and lacunar syndrome (9,5 vs. 31,4%) and symptom-free patients at discharge were less frequent in the intracerebral haemorrhage group (6,1 vs. 18,3%). CONCLUSIONS: Significant changes over a 19-year period included an increase in the patient's age, frequency of COPD and atrial fibrillation and use of MRI imaging studies. PIH is a severe subtype of stroke with a higher risk of early death and lower asymptomatic frequency at discharge than ischemic cerebral infarct.

Hemorragia intracerebral no traumática recurrente: estudio de 28 pacientes / Relapsing non-traumatic intracerebral hemorrhage: study of 28 patients

Fundamento y objetivo. Analizar las características demográficas, pronósticas y el perfil clínico relacionado con las hemorragias intracerebrales no traumáticas recurrentes (HCR). Pacientes y método. Estudio hospitalario descriptivo de 28 pacientes consecutivos ingresados durante un período de 19 años por presentar HCR. Se efectúa una comparación con 380 pacientes con una primera hemorragia intracerebral no traumática. Resultados. Las HCR representan el 6,8% del total de hemorragias intracerebrales primarias. Las HCR fueron mayoritariamente lobulares (67,9%). Otras topografías incluyen: el talámo (10,7%), la región capsuloganglionar (7,1%), la zona intraventricular (3,6%) y la topografía múltiple (10,7%). Aunque las HCR tienen mal pronóstico evolutivo, este no es peor en comparación con el de las primeras hemorragias cerebrales primarias, tanto por su elevada mortalidad hospitalaria (17,9 frente al 28,2%), como por su baja frecuencia de ausencia de limitación al alta hospitalaria (3,6 frente al 6,1%). El perfil clínico significativamente asociado con las HCR fue: presencia de valvulopatía (odds ratio [OR] 5,32; intervalo de confianza del 95% [IC 95%] 1,45-19,47), la topografía lobular (OR 3,53; IC 95% 1,53-8,13) y la presencia de náuseas y vómitos (OR 2,43; IC 95% 1,06-5,52). Conclusiones. Las HCR constituyen menos de una décima parte de las hemorragias intracerebrales no traumáticas ingresadas en el Servicio de Neurología, siendo más frecuentes las localizadas en los lóbulos cerebrales. Aunque su pronóstico es grave, este no es peor -durante su fase aguda- que el de las primeras hemorragias intracerebrales. Las HCR presentan un perfil clínico propio y diferenciado(AU)

Background and objetive. To characterize the clinical factors and prognosis and identify determinants of hemorrhage recurrence (HCR) in patients with acute non-traumatic intracerebral hemorrhage. Patients and method. Stroke patterns were studied in 28 consecutive recurrent non-traumatic intracerebral hemorrhage patients admitted to the Department of Neurology of the Sagrat Cor Hospital of Barcelona for a 19 year period. Demographic, risk factors, clinical, neuroimaging and outcome variables were analyzed and compared with patients with first-ever non-traumatic intracerebral hemorrhage (n=380) to identify predictors of hemorrhage recurrence. Significant variables were entered into a multivariate logistic regression analysis. Results. HCR accounted for 6.8% of all patients with acute consecutive non-traumatic intracerebral hemorrhages. The HCR were mostly lobar (67.9%). Other topographies include: thalamus (10.7%), capsule-ganglionar (7.1%), intraventricular (3.6%) and multiple topographies (10.7%). Although the HCR have poor prognosis, it is not worse compared to the first-ever intracerebral hemorrhages, both at the high hospital mortality (17.9 vs. 28.2%) as the low frequency of absence of limitation at discharge (3.6 vs. 6.1%). The clinical profile significantly associated with HCR was: valvular heart disease (odds ratio [OR] 5.32; 95% confidence interval [95% CI] 1.45-19.47), lobar topography (OR 3.53, 95% IC 1.53-8.13), and the presence of nausea and vomiting (OR 2.43, 95% IC 1.06-5.52). Conclusions. HCR constitute less than one tenth of non-traumatic intracerebral hemorrhages and are most commonly located in the brain lobes. Although the prognosis is serious, this is no worse during the acute phase, than of the first-ever non-traumatic intracerebral hemorrhages. Clinical profiles were different in recurrent non-traumatic intracerebral hemorrhage patients when compared to first-ever non-traumatic intracerebral hemorrhage patients(AU)

Spontaneous primary intraventricular hemorrhage: clinical features and early outcome.

Purpose. Primary hemorrhage in the ventricular system without a recognizable parenchymal component is very rare. This single-center retrospective study aimed to further characterize the clinical characteristics and early outcome of this stroke subtype. Methods. All patients with primary intraventricular hemorrhage included in a prospective hospital-based stroke registry over a 19-year period were assessed. A standardized protocol with 161 items, including demographics, risk factors, clinical data, neuroimaging findings, and outcome, was used for data collection. A comparison was made between the groups of primary intraventricular hemorrhage and subcortical intracerebral hemorrhage. Predictors of primary intraventricular hemorrhage were identified by logistic regression analysis. Results. There were 12 patients with primary intraventricular hemorrhage (0.31% of all cases of stroke included in the database) and 133 in the cohort of subcortical hemorrhage. Very old age (≥85 years) (odds ratio (OR) 9.89), atrial fibrillation (OR 8.92), headache (OR 6.89), and altered consciousness (OR 4.36) were independent predictors of intraventricular hemorrhage. The overall in-hospital mortality rate was 41.7% (5/12) but increased to 60% (3/5) in patients aged 85 years or older. Conclusion. Although primary intraventricular hemorrhage is uncommon, it is a severe clinical condition with a high early mortality. The prognosis is particularly poor in very old patients.

[Relapsing non-traumatic intracerebral hemorrhage: study of 28 patients]. / Hemorragia intracerebral no traumática recurrente: estudio de 28 pacientes.

BACKGROUND AND OBJECTIVE: To characterize the clinical factors and prognosis and identify determinants of hemorrhage recurrence (HCR) in patients with acute non-traumatic intracerebral hemorrhage. PATIENTS AND METHOD: Stroke patterns were studied in 28 consecutive recurrent non-traumatic intracerebral hemorrhage patients admitted to the Department of Neurology of the Sagrat Cor Hospital of Barcelona for a 19 year period. Demographic, risk factors, clinical, neuroimaging and outcome variables were analyzed and compared with patients with first-ever non-traumatic intracerebral hemorrhage (n=380) to identify predictors of hemorrhage recurrence. Significant variables were entered into a multivariate logistic regression analysis. RESULTS: HCR accounted for 6.8% of all patients with acute consecutive non-traumatic intracerebral hemorrhages. The HCR were mostly lobar (67.9%). Other topographies include: thalamus (10.7%), capsule-ganglionar (7.1%), intraventricular (3.6%) and multiple topographies (10.7%). Although the HCR have poor prognosis, it is not worse compared to the first-ever intracerebral hemorrhages, both at the high hospital mortality (17.9 vs. 28.2%) as the low frequency of absence of limitation at discharge (3.6 vs. 6.1%). The clinical profile significantly associated with HCR was: valvular heart disease (odds ratio [OR] 5.32; 95% confidence interval [95% CI] 1.45-19.47), lobar topography (OR 3.53, 95% IC 1.53-8.13), and the presence of nausea and vomiting (OR 2.43, 95% IC 1.06-5.52). CONCLUSIONS: HCR constitute less than one tenth of non-traumatic intracerebral hemorrhages and are most commonly located in the brain lobes. Although the prognosis is serious, this is no worse during the acute phase, than of the first-ever non-traumatic intracerebral hemorrhages. Clinical profiles were different in recurrent non-traumatic intracerebral hemorrhage patients when compared to first-ever non-traumatic intracerebral hemorrhage patients.

Trends in clinical features and early outcome in patients with acute cardioembolic stroke subtype over a 19-year period.

OBJECTIVES: To assess changing trends in clinical characteristics and early outcome of patients with acute cardioembolic stroke (ACS) over a 19-year period. MATERIALS AND METHODS: Data of 575 patients with first-ever ACS included in the Sagrat Cor Hospital of Barcelona Stroke Registry were analyzed. Changing trends for 1986-1992, 1993-1998, and 1999-2004 periods were compared. RESULTS: A statistically significant increase (P < 0.001) in the age of patients (74.6 years in 1986-1992 vs. 81.4 years in 1999-2004) and the percentage of patients older than 85 years of age (16% vs. 38.2%) was observed. Patients with hypertension increased from 40.5 to 60.8% (P = 0.001) as were patients with diabetes, chronic bronchitis, and obesity (P = NS). The median length of hospital stay decreased from 18 to 12 days (P = 0.031) and prolonged hospital stay (>12 days) from 18.3 to 13.1 (P = 0.033). In-hospital death rate remained around 20%. CONCLUSIONS: ACS continues to be a severe ischemic stroke subtype with high risk of in-hospital death. The lack of improvement in the early prognosis over a 19-year period may be explained by an increase in the prevalence of major cardiovascular risk factors and progressive aging of the population.