¿Guardia específica de ictus?. Réplica / A specific on-call stroke service? Reply

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¿Es útil una guardia específica de ictus? / Is a specific on-call stroke service useful?

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[Decompressive craniectomy in malignant middle cerebral artery infarction. Experience after the implementation of a response protocol]. / Craniectomía descompresiva en el infarto maligno de la arteria cerebral media. Experiencia tras la implantación de un protocolo de actuación.

INTRODUCTION: Descompressive craniectomy (DC) for treatment of malignant infarction of the middle cerebral artery (MIMCA) reduces mortality and increases the probability of favourable outcome. AIM: To present the experience in daily practice after implantation of a clinical protocol of DC. PATIENTS AND METHODS: Prospective register of patients with MIMCA treated with DC. Age, stroke severity -National Institute of Health Stroke Scale (NIHSS) score-, basal characteristics, delay until DC, mortality, modified Rankin Scale (mRS) score at three and twelve months and questionnaire of satisfaction are recorded. RESULTS: From February 2008 to December 2010, 15 patients were treated. Mean age: 60 years (range: 35-69); basal NIHSS, median (p25/p75): 17 (15.5/21), NIHSS before craniectomy: 20 (18/23.5). DC was performed within 48 hours in 8 patients (53.3%). 5 subjects (33.3%) died during in-hospital stay. Mortality was 25% among those treated within 48 hours and 42.9% among those treated later and 37.5% among patients <= 60 years vs 28.6% in older patients. All survivors scored <= 4 in the mRS at three months and expressed satisfaction with surgery despite sequelae. Rate of favourable outcome (mRS <= 3) was higher among patients under 60 (63%) and among those treated before 48 h (50%). CONCLUSION: DC is safe in clinical practice and reduces mortality after MIMCA, especially if it is performed within 48 hours from stroke onset. Benefit appears to be greater in younger patients, but older people may benefit also. The decision to perform DC should be made on an individual basis.

Relevance of stroke code, stroke unit and stroke networks in organization of acute stroke care--the Madrid acute stroke care program.

Stroke is a neurological emergency. The early administration of specific treatment improves the prognosis of the patients. Emergency care systems with early warning for the hospital regarding patients who are candidates for this treatment (stroke code) increases the number of patients treated. Currently, reperfusion via thrombolysis for ischemic stroke and attention in stroke units are the bases of treatment. Healthcare professionals and health provision authorities need to work together to organize systems that ensure continuous quality care for the patients during the whole process of their disease. To implement this, there needs to be an appropriate analysis of the requirements and resources with the objective of their adjustment for efficient use. It is necessary to provide adequate information and continuous training for all professionals who are involved in stroke care, including primary care physicians, extrahospital emergency teams and all physicians involved in the care of stroke patients within the hospital. The neurologist has the function of coordinating the protocols of intrahospital care. These organizational plans should also take into account the process beyond the acute phase, to ensure the appropriate application of measures of secondary prevention, rehabilitation, and chronic care of the patients that remain in a dependent state. We describe here the stroke care program in the Community of Madrid (Spain).

Recomendaciones para el tratamiento y prevención del ictus, 2004 / Recommendations for the treatment and prevention of the ictus, 2004

Según la Organización Mundial de la Salud, la enfermedad cerebrovascular constituye la tercera causa de muerte y la primera de invalidez en la población adulta en el mundo. La atención urgente del paciente con ictus, en un centro hospitalario bien dotado de medios materiales y personales (neurólogos expertos) y la aplicación de un programa protocolizado de cuidados, métodos diagnósticos y tratamiento específico (unidades o equipos de ictus) mejora significativamente la evolución de los pacientes afectados. Desarrollo. Para difundir las evidencias científicas disponibles acerca del tratamiento y la prevención del ictus, un comité ad hoc de la Sociedad Iberoamericana de Enfermedad Cerebrovascular ha redactado esta guía, que recoge de manera esquemática todas las recomendaciones vigentes, con los niveles de evidencia que las respaldan y el grado de recomendación para cada caso. Este documento pretende servir de apoyo y guía para el tratamiento y la prevención en los pacientes con ictus en todos los países de Iberoamérica, y contribuir a lograrlos medios necesarios para mejorar la atención al paciente con ictus en las distintas administraciones sanitarias