Infarto medular: etiología, hallazgos radiológicos y factores pronósticos en una serie de 41 pacientes / Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients

Introducción: El infarto medular es una entidad infrecuente y con elevada morbilidad. El diag-nóstico puede resultar difícil y el tratamiento óptimo sigue siendo controvertido. Existen pocasseries de casos publicadas.Métodos: Estudio retrospectivo de infarto medular en un hospital terciario desde 1999 a 2020.Se evaluaron la etiología, las características clínicas, radiológicas, terapéuticas y pronósticas.Resultados: Se incluyeron 41 pacientes (58,5% varones, edad media 61 ±17 a˜nos). Treinta y unpacientes (75,6%) presentaban factores de riesgo vascular (FRV). Presentaron déficit motor (39,95,1%), dolor (20, 48,8%), déficit sensitivo (33, 80,4%) y alteración autonómica (24, 58,5%). Serealizó resonancia magnética (RM) en 37 pacientes (90,2%). En los 12 pacientes con secuenciasde difusión, esta estaba alterada en 10. La localización más afectada fue la dorsal (68,2%). Serealizó estudio vascular en 33 pacientes (80,4%). Las etiologías más frecuentes fueron disecciónaórtica en 6, ateroesclerosis demostrada en estudio vascular en 6, embolia fibrocartilaginosa en6, posquirúrgico en 5 e hipotensión en 4. El mecanismo etiológico quedó sin filiar en 12 pacientes(29,3%), 9 presentaban FRV. Al final del periodo de seguimiento (mediana 24 meses, rangointercuartílico 3-70), 12 pacientes (29,2%) presentaban deambulación autónoma. La presenciade FRV y la paraparesia se asociaron significativamente a peor pronóstico (p < 0,05).Discusión: El infarto medular es una patología con una etiología variada, que en muchos delos pacientes queda sin resolver. El pronóstico funcional a largo plazo es malo y depende de lascaracterísticas basales del paciente y de la forma de presentación clínica. La RM, especialmentelas secuencias de difusión, es útil en el diagnóstico precoz.(AU)

Introduction: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosiscan be challenging and controversy remains regarding the best treatment. Few case series havebeen published.Methods: We conducted a retrospective review of cases of spinal cord infarction attended ina tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic featureswere assessed.Results: Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) wereincluded in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficitswere recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomicdysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted imageswere available for 12 patients, with 10 showing diffusion restriction. The thoracic region wasthe most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients(80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demons-trated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases),and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 ofthese presented vascular risk factors. At the end of the follow-up period (median, 24 months;interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascularrisk factors and paraparesis were significantly associated with poorer prognosis (P < .05).Discussion: Spinal cord infarction may present diverse aetiologies, with the cause remainingundetermined in many patients. Long-term functional prognosis is poor, and depends on baselinecharacteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, isuseful for early diagnosis.(AU)

Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients.

INTRODUCTION: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. METHODS: We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. RESULTS: Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P < .05). DISCUSSION: Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.

Spinal cord infarction: aetiology, imaging findings, and prognostic factors in a series of 41 patients. / Infarto medular: etiología, hallazgos radiológicos y factores pronósticos en una serie de 41 pacientes.

INTRODUCTION: Spinal cord infarction is a rare disease with a high rate of morbidity. Its diagnosis can be challenging and controversy remains regarding the best treatment. Few case series have been published. METHODS: We conducted a retrospective review of cases of spinal cord infarction attended in a tertiary hospital from 1999 to 2020. Aetiology and clinical, imaging, and prognostic features were assessed. RESULTS: Forty-one patients (58.5% men, mean [standard deviation] age 61 [17] years) were included in the study. Thirty-one patients (75.6%) presented vascular risk factors. Motor deficits were recorded in 39 (95.1%), pain in 20 (48.8%), sensory deficits in 33 (80.4%), and autonomic dysfunction in 24 (58.5%). MRI was performed in 37 (90.2%) patients. Diffusion-weighted images were available for 12 patients, with 10 showing diffusion restriction. The thoracic region was the most frequently affected (68.2%). Vascular imaging studies were performed in 33 patients (80.4%). The most frequent aetiologies were aortic dissection (6 cases), atherosclerosis demonstrated by vascular imaging (6 cases), fibrocartilaginous embolism (6 cases), surgery (5 cases), and hypotension (4 cases). Aetiology was undetermined in 12 patients (29.3%), although 9 of these presented vascular risk factors. At the end of the follow-up period (median, 24 months; interquartile range, 3-70), 12 patients (29.2%) were able to walk without assistance. Vascular risk factors and paraparesis were significantly associated with poorer prognosis (P<.05). DISCUSSION: Spinal cord infarction may present diverse aetiologies, with the cause remaining undetermined in many patients. Long-term functional prognosis is poor, and depends on baseline characteristics and clinical presentation. MRI, and especially diffusion-weighted sequences, is useful for early diagnosis.

COVID-19 in Parkinson's disease: what holds the key?

INTRODUCTION: Parkinson's disease (PD) is more frequent in the elderly and increases the risk of respiratory infections. Previous data on PD and SARS-CoV-2 are scarce, suggesting a poor prognosis in advanced disease and second-line therapies. METHODS: A retrospective case-control study comparing patients with PD and COVID-19 and patients with PD without COVID-19 was conducted during the pandemic period in Spain (March 1st-July 31st 2020) in a tertiary university hospital. RESULTS: Thirty-nine (COVID-19 +) and 172 (COVID-19-) PD patients were included. Fifty-nine percent were males in both groups, with similar age (75.9 ± 9.0 COVID-19 + , 73.9 ± 10.0 COVID-19-), disease duration (8.9 ± 6.2 COVID-19 + , 8.5 ± 5.6 COVID-19-) and PD treatments. COVID-19 was mild in 10 (26%), required admission in 21 (54%) and caused death in 8 (21%) patients. Dementia was the only comorbidity more frequent in COVID-19 + patients (36% vs. 14%, p = 0.0013). However, in a multivariate analysis, institutionalization was the only variable associated with COVID-19 + (OR 17.0, 95% CI 5.0-60.0, p < 0.001). When considering severe COVID-19 (admission or death) vs. mild or absent COVID-19, institutionalization, neoplasm, dementia and a lower frequency of dopamine agonists were associated with severe COVID-19. In multivariate analysis, only institutionalization [OR 5.17, 95% CI 1.57-17, p = 0.004] and neoplasm [OR 8.0, 95%CI 1.27-49.8, p = 0.027] remained significantly associated. CONCLUSION: In our experience, institutionalization and oncologic comorbidity, rather than PD-related variables, increased the risk of developing COVID-19, and impacted on its severity. These findings suggest that epidemiologic factors and frailty are key factors for COVID-19 morbidity/mortality in PD. Appropriate preventive strategies should be implemented in institutionalized patients to prevent infection and improve prognosis.

Afectación encefálica global y uso de L-arginina en un paciente con síndrome de MELAS / Global cerebral involvement and L-arginine use in a patient with MELAS síndrome

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The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis mimicking an acute stroke.

BACKGROUND AND PURPOSE: The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) can present as sudden onset of focal neurological deficits which are clinically and radiologically indistinguishable from an ischaemic stroke. Its diagnosis requires a lumbar puncture (LP), which contraindicates intravenous thrombolytic therapy (IV-tPA). METHODS: All patients referred to our stroke centre as a stroke code resulting in a final diagnosis of HaNDL syndrome from June 2005 to June 2015 were retrospectively analysed. RESULTS: Nine cases were identified: seven women and two men (mean age 27.6 years, range 15-51). Clinical onset consisted of isolated aphasia (two) and aphasia with right hemiparesis/hemiparaesthesia (seven). All patients had headache in the acute setting, lasting 2-12 h. Cranial computed tomography (CT) and CT angiography (CTA) were normal in all patients. Perfusion CT was performed in seven patients, showing left hemispheric focal hypoperfusion in five cases; the remaining two were normal. Five patients were initially diagnosed as stroke and treated uneventfully with IV-tPA. Cranial magnetic resonance imaging within 48 h was normal in all cases. LP performed in all patients showed pleocytosis (range 17-351 cells/mm(3) ), high protein levels (range 0.4-1.6 g/l) and normal glucose levels. All cases recovered within 12 h and suffered a second episode within 72 h. Patients were asymptomatic between episodes and after remission. CONCLUSIONS: The decision to thrombolyse or perform an LP in HaNDL patients mimicking a stroke is difficult in the acute setting. Perfusion CT can provide misleading results and CTA may be useful in ruling out occlusion of a cerebral vessel.

Limbic encephalitis: a clinical-radiological comparison between herpetic and autoimmune etiologies.

BACKGROUND: Herpetic (HE) and autoimmune (AE) encephalitis share clinical and radiological features. We compared both types of encephalitis with the aim of making a differential clinical-radiological pattern. MATERIALS AND METHODS: All cases with a clinical diagnosis of encephalitis who attended our hospital between 1999 and 2012 were reviewed. We selected those cases with positive polymerase chain reaction for herpes simplex virus 1 (HSV-1) in the cerebrospinal fluid (CSF), and those with antineuronal antibodies or paraneoplastic etiology. We compared epidemiological, clinical, CSF, electroencephalographic and radiological findings. RESULTS: Twelve patients with positive polymerase chain reaction for HSV-1, and 10 patients with antineuronal antibody or paraneoplastic etiology were found. The only features found exclusively in one group were the presence of psychiatric symptoms and tumors in AE. Acute onset of symptoms, fever and aphasia were more frequent in HE, which showed higher level of proteins and erythrocyte count in CSF. Neuroimaging was abnormal in all cases of HE, but only in 60% of AE. Insular and diffuse temporal lobe involvement and absence of basal ganglia involvement were more frequent in HE, and mesial temporal involvement in AE. The highest diagnostic values for differentiating HE from AE were the association of acute onset of symptoms and fever (sensitivity 0.92, specificity 1), and the absence of basal ganglia involvement (sensitivity 0.82, specificity 1). CONCLUSIONS: There are few differences between HE and AE. Psychiatric symptoms and association with tumors were unique for AE. Acute onset with fever and absence of basal ganglia involvement in magnetic resonance imaging support a diagnosis of HE.

Multiple sclerosis patients with anti-lipid oligoclonal IgM show early favourable response to immunomodulatory treatment.

BACKGROUND AND PURPOSE: Interferon beta and Glatiramer acetate are safe immunomodulatory treatments (IT) for multiple sclerosis (MS), but not always effective. New drugs are available, although they show more side-effects and unknown long-term safety profile. Anti-lipid oligoclonal IgM bands (OCMB) distinguish MS patients with early aggressive course. We prospectively studied if IT are effective in these patients or if they are candidates for more aggressive drugs as first therapeutic option. METHODS: Seventy-five clinically isolated syndrome patients were studied. OCMB and conversion to MS were assessed. Patients suffering at least two demyelinating events within 3 years were considered eligible to start IT. RESULTS: Eighteen patients showed OCMB (M+) and 57 lacked them (M-). All M+ patients and only 25 M- patients were treated. The other 32 M- patients suffered less MS attacks than those required to initiate treatment. IT similarly reduced relapse rate in both treated groups (P < 0.0001) and reduced Expanded Disability Status Scale (EDSS) progression in M+ patients, whose EDSS score had significantly increased before treatment. EDSS did not change in M- patients during follow-up, regardless if they were treated or not. CONCLUSIONS: Oligoclonal IgM bands identify MS patients who are candidates for early immunomodulatory treatment as IT improves their initial aggressive disease course.

Influencia de la curva de aprendizaje y del código ictus extrahospitalario en el tratamiento trombolítico del ictus agudo / Influence of the experience and of out-of-hospital stroke code in thrombolytic treatment of acute stroke

Introducción. Se presenta la experiencia en el tratamientodel ictus isquémico con activador del plasminógeno tisularrecombinante (rt-PA) en un hospital universitario. Seevalúa la influencia de la curva de aprendizaje, individual ycolectiva, y de la activación del código ictus extrahospitalario(CIE) en las demoras hasta el inicio del tratamiento, en elnúmero de pacientes tratados y en su evolución.Método. Registro prospectivo de pacientes con ictus isquémicotratados con rt-PA entre enero de 2004 y diciembrede 2006. Análisis comparativo entre los pacientes tratadosen los 3 años del estudio y en función de la experienciadel neurólogo que aplica el tratamiento, así como en pacientestratados con o sin activación del CIE.Resultados. Se trataron 87 pacientes (66,6±13,7 años).El tiempo puerta-aguja fue de 79±21 min en 2004, 64±22 minen 2005 y 63±26 min en 2006 (p=0,003). Los neurólogoscon experiencia aplicaron el tratamiento más rápido (tiempopuerta-aguja: 62±22 frente a 75±27 min; p=0,03). La activacióndel CIE redujo el tiempo puerta-aguja (53±17 frentea 65±21 min; p=0,032) y el tiempo puerta-tomografíacomputarizada (21±10 frente a 29±24 min; p=0,016). Nohubo diferencias en la evolución de los pacientes en los distintosgrupos.Conclusión. La experiencia adquirida y la activación delCIE disminuyen las demoras intrahospitalarias, contribuyendoa aumentar el número de pacientes tratados con trombólisis.El tratamiento trombolítico es seguro y eficaz, inclusosi se aplica por neurólogos sin experiencia si se siguencriterios estrictos (AU)

Introduction. We present the experience for thrombolytictreatment using recombinant tisular plasminogenactivator (rt-PA) at a university hospital. We analyze theinfluence of individual and collective acquired experienceand of the activation of an out-of-hospital stroke code(OSC) on the delays to onset of treatment, number ofpatients treated and outcome.Method. Prospective register of patients with ischemicstroke treated with rt-PA within the period 1/2004-12/2006. Comparison of results between patients treatedduring the three years of study and based on the individualexperience of the neurologist who applies the treatmentand on the patients treated with or without activationof OSC.Results. A total of 87 patients were treated (meanage: 66.6±13.7). Door-to-needle time was 79±21 min in2004, 64±22 in 2005 and 63±26 in 2006 (p=0.003).Experienced neurologists started thrombolysis sooner(door-to-needle time: 62±22 min vs 75±27, p=0.03).Activation of the ESC reduced door-to-needle time (53±17 min vs 65±21; p=0.032) and door-to-computed tomographyscan time (21±10 min vs 29±24; p=0.016). Therewere no differences in outcome in the different groups.Conclusions. Individual and collective acquired experienceand the activation of an OSC can lower in-hospitaldelays. This contributes to increasing the number of patientseligible for thrombolysis. Thrombolytic therapy issafe and effective even when it is applied by inexperiencedneurologists if strict guidelines are followed (AU)

[Massive cerebral infarction secondary to apoplexy due to pituitary adenoma]. / Infarto cerebral masivo secundario a apoplejía de un adenoma hipofisario.

INTRODUCTION: Pituitary apoplexy is a rare clinical entity. It is a rare cause of stroke, whose pathogenic mechanism has not been fully understood. Compression in intracavernous carotid artery and vasospastic mechanism have been described. It may initially begin as a meningeal syndrome, in which neuroimaging techniques may be fundamental, above all resonance magnetic imaging for a correct diagnosis of the disease and its complications. CASE REPORT: We report the case of a 23 year-old male who suffered a massive stroke due to bilateral carotid compression in its intracavernous portion due to apoplexy of a previously unknown pituitary tumor. The diffusion sequences and acute angioresonance of the circle of Willis are presented. CONCLUSIONS: This is a rare entity with controversial management. An exhaustive review of cases and series of patients with pituitary apoplexy related stroke is also presented.

[Influence of the experience and of out-of-hospital stroke code in thrombolytic treatment of acute stroke]. / Influencia de la curva de aprendizaje y del código ictus extrahospitalario en el tratamiento trombolítico del ictus agudo.

INTRODUCTION: We present the experience for thrombolytic treatment using recombinant tisular plasminogen activator (rt-PA) at a university hospital. We analyze the influence of individual and collective acquired experience and of the activation of an out-of-hospital stroke code (OSC) on the delays to onset of treatment, number of patients treated and outcome. METHOD: Prospective register of patients with ischemic stroke treated with rt-PA within the period 1/2004- 12/2006. Comparison of results between patients treated during the three years of study and based on the individual experience of the neurologist who applies the treatment and on the patients treated with or without activation of OSC. RESULTS: A total of 87 patients were treated (mean age: 66.6 +/- 13.7). Door-to-needle time was 79 +/- 21 min in 2004, 64 +/-22 in 2005 and 63 +/- 26 in 2006 (p=0.003). Experienced neurologists started thrombolysis sooner (door-to-needle time: 62 +/- 22 min vs 75 +/- 27, p=0.03). Activation of the ESC reduced door-to-needle time (53 +/ 17 min vs 65 +/- 21; p=0.032) and door-to-computed tomography scan time (21 +/- 10 min vs 29 +/-24; p=0.016). There were no differences in outcome in the different groups. CONCLUSIONS: Individual and collective acquired experience and the activation of an OSC can lower in-hospital delays. This contributes to increasing the number of patients eligible for thrombolysis. Thrombolytic therapy is safe and effective even when it is applied by inexperienced neurologists if strict guidelines are followed.

Influence of oligoclonal IgM specificity in multiple sclerosis disease course.

Oligoclonal IgM bands (OCMB) against myelin lipids predict an aggressive multiple sclerosis (MS) course. However, the clinical significance of OCMB without lipid specificity, present in other MS patients, remains unknown. We describe here a characterization of these antibodies and study their role in MS progression. Fifty-four MS patients showing CSF-restricted OCMB were included in this study at disease onset and followed-up during 61.1 +/- 2.7 months. The specificity of OCMB and the CSF B-cell profile were investigated. A second CSF IgM study was performed in a group of eight patients. Thirty-eight patients showed OCMB against myelin lipids (M+L+) and other sixteen had OCMB lacking this specificity (M+L-). The CD5+ B cell subpopulation, responsible for most persistent IgM responses, was considerably higher in M+L+ than in M+L- patients (3.3 +/- 0.6% versus 0.8 +/- 0.2, P = 0.009). In addition, M+L+ bands persisted during disease course, while M+L- disappeared during follow-up. M+L+ patients suffered more relapses (4.2 +/- 0.6 versus 1.6 +/- 0.3, P = 0.002) and reached higher disability (EDSS score of 2.2 +/- 0.2 versus 1.2 +/- 0.2, P = 0.02) than M+L- group. These data corroborate that anti-lipid OCMB associate with an aggressive MS course and show that OCMB that do not recognize myelin lipids represent a transient immune response related to a more benign disease course.

Hematoma espinal masivo espontáneo / Massive spinal epidural hematoma

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Tratamiento trombolítico del ictus isquémico agudo en un centro sin experiencia previa (réplica) / Thrombolytic treatment of acute ischemic stroke in a center without previous experience (reply)

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[Clinical variability and diagnostic controversies in CADASIL]. / Variabilidad clínica y controversias diagnósticas en el CADASIL.

Cardiovascular risk factors are present in 85% of patients with stroke. However, up to 6%-15% of patients have a stroke secondary to unusual reasons such as systemic diseases, coagulation disorders, etc., and, in some cases, no reason can be identified even after performing an extensive study. This usually happens in young people. In this regard, the diagnostic screening must consider hereditary causes of stroke. CADASIL, an autosomal dominant brain white matter angiopathy, is emerging as a not uncommon cause of stroke with diverse clinical manifestations. Its clinical diagnosis is controversial because of the diverse role of the brain imaging study, the biopsy of the vessels of skin or other tissues and the DNA study.

Variabilidad clínica y controversias diagnósticas en el CADASIL / Clinical variability and diagnostic controversies in CADASIL

Los factores de riesgo cardiovascular están presentes en un 85% de los pacientes con enfermedad cerebrovascular. No obstante, en un 6-15% de los pacientes el ictus se debe a causas poco frecuentes como enfermedades sistémicas, alteraciones de la coagulación, etc. y, en algunos casos, a pesar de un estudio exhaustivo, no es posible identificar la causa del ictus. Esto ocurre con más frecuencia en pacientes jóvenes. En estos casos es necesario ampliar el estudio al examen de causas genéticas de la enfermedad cerebrovascular. CADASIL, una arteriopatía autosómica dominante que afecta a la sustancia blanca cerebral, está emergiendo como una causa no infrecuente de enfermedad cerebrovascular con diversas manifestaciones clínicas. Su diagnóstico es objeto de controversia por el diferente papel que tiene el estudio de imagen cerebral, el examen mediante biopsia de los vasos de la piel u otros órganos y el estudio genético molecular (AU)

Cardiovascular risk factors are present in 85% of patients with stroke. However, up to 6%-15% of patients have a stroke secondary to unusual reasons such as systemic diseases, coagulation disorders, etc., and, in some cases, no reason can be identified even after performing an extensive study. This usually happens in young people. In this regard, the diagnostic screening must consider hereditary causes of stroke. CADASIL, an autosomal dominant brain white matter angiopathy, is emerging as a not uncommon cause of stroke with diverse clinical manifestations. Its clinical diagnosis is controversial because of the diverse role of the brain imaging study, the biopsy of the vessels of skin or other tissues and the DNA study (AU)

[Thrombolytic treatment in acute ischemic stroke in a center without previous experience. Development of internal organization and first results]. / Tratamiento trombolítico del ictus isquémico agudo en un centro sin experiencia previa. Desarrollo de la organización interna y primeros resultados.

BACKGROUND AND OBJECTIVE: Treatment of acute ischemic stroke within three hours with intravenous tissue-type plasminogen activator (t-PA) has been recently approved by the European Drug Agency. We present the development of an internal organization system that has permitted thrombolytic treatment in our center without previous experience as well as the results of the first year. PATIENTS AND METHOD: Development of the thrombolysis educational program for the staff informed, of the internal organization system, and combined care protocols among the participating services. Prospective registry of patients treated with t-PA within the period 1/2004-2/2006. We collected demographic data, stroke assessment scales score (NIHSS), time to treatment, seven day and three months mortality, symptomatic hemorrhagic transformation, systemic bleedings, functional independency at three months, early significant improvement and significant deterioration. RESULTS: Fifty-three patients were treated. Mean age: 65 +/- 13 years; 56% women. Mean NIHSS pre-treatment: 14 +/- 4.7. Mean time to hospital arrival: 62 +/- 40 minutes; door-to-treatment: 68 +/- 22 minutes, and mean time from stroke onset to treatment: 130 +/- 31 minutes. Symptomatic hemorrhagic transformation: 5.8%. Systemic bleeding: 3.8%. Seven day mortality: 5.6%; three months mortality: 15.1%. Early significant improvement: 51%. Significant neurological deterioration: 7.5%. Functional independency at three months: 51%. CONCLUSIONS: Treatment of acute ischemic stroke within three hours with intravenous t-PA is safe and is associated with a favourable outcome when it is applied by neurologists specifically trained in acute stroke management.

Tratamiento trombolítico del ictus isquémico agudo en un centro sin experiencia previa. Desarrollo de la organización interna y primeros resultados / Thrombolytic treatment in acute ischemic stroke in a center without previous experience. Development of internal organization and first results

Introducción. El tratamiento del infarto cerebral agudo de menos de tres horas de evolución con activador del plasminógeno tisular (t-PA) ha sido recientemente aprobado por la Agencia Europea del Medicamento. Presentamos el desarrollo de una organización interna para el tratamiento trombolítico del ictus en un centro sin experiencia previa y los resultados de los dos primeros años. Pacientes y método. Desarrollo del programa de formación para el personal involucrado, del sistema de organización intrahospitalaria y de los protocolos de atención conjunta entre los servicios que intervienen. Registro prospectivo de todos los pacientes con ictus agudo tratados con t-PA en el período 1/2004-2/2006. Se recogen variables demográficas, escalas de evaluación del déficit neurológico (NIHSS), demora en la aplicación del tratamiento, mortalidad a los 7 días y tres meses, transformación hemorrágica sintomática, complicaciones hemorrágicas sistémicas, independencia funcional a los tres meses, mejoría significativa precoz y empeoramiento significativo. Resultados. Se trataron 53 pacientes. Edad media: 65 ± 13 años; 56% mujeres. NIHSS pretratamiento: 14 ± 4,7. Tiempo medio de llegada: 62 ± 40 minutos; tiempo puerta-aguja: 68 ± 22 minutos, y tiempo ictus-tratamiento: 130 ± 31 minutos. Transformación hemorrágica sintomática: 5,8%. Hemorragias sistémicas: 3,8%. Mortalidad a los 7 días: 5,6%; a los tres meses: 15,1%. Mejoría clínica significativa: 51%. Deterioro neurológico significativo: 7,5%. Independencia funcional a los tres meses: 51%. Conclusión. El tratamiento trombolítico del ictus agudo de menos de tres horas es seguro y eficaz cuando es administrado por neurólogos con formación específica en este tratamiento

Background and objective. Treatment of acute ischemic stroke within three hours with intravenous tissue-type plasminogen activator (t-PA) has been recently approved by the European Drug Agency. We present the development of an internal organization system that has permitted thrombolytic treatment in our center without previous experience as well as the results of the first year. Patients and method. Development of the thrombolysis educational program for the staff informed, of the internal organization system, and combined care protocols among the participating services. Prospective registry of patients treated with t-PA within the period 1/2004-2/2006. We collected demographic data, stroke assessment scales score (NIHSS), time to treatment, seven day and three months mortality, symptomatic hemorrhagic transformation, systemic bleedings, functional independency at three months, early significant improvement and significant deterioration. Results. Fifty-three patients were treated. Mean age: 65 ± 13 years; 56% women. Mean NIHSS pre-treatment: 14 ± 4.7. Mean time to hospital arrival: 62 ± 40 minutes; door-to-treatment: 68 ± 22 minutes, and mean time from stroke onset to treatment: 130 ± 31 minutes. Symptomatic hemorrhagic transformation: 5.8%. Systemic bleeding: 3.8%. Seven day mortality: 5.6%; three months mortality: 15.1%. Early significant improvement: 51%. Significant neurological deterioration: 7.5%. Functional independency at three months: 51%. Conclusions. Treatment of acute ischemic stroke within three hours with intravenous t-PA is safe and is associated with a favourable outcome when it is applied by neurologists specifically trained in acute stroke management