Long insular artery damage might be a key sign for predicting functional prognosis of putaminal hemorrhage / El daño de la arteria insular larga podría ser un signo clave para predecir el pronóstico funcional de la hemorragia putaminal

Objective Although the putamen is the most common area of spontaneous intracerebral hemorrhage, previous reports about the effects of surgery are limited. We sometimes experience a poor prognosis in patients in whom there is no damage to the internal capsule, but with injury in the long insular artery (LIA) region. The purpose of this study was to confirm the relationship between LIA damage and patient prognosis following surgery for putaminal hemorrhage. Methods We retrospectively collected data of 287 surgical cases who presented with putaminal hemorrhage between January 2004 and March 2022. Among them, we chose patients without initial damage to the posterior limb of the internal capsule, and divided these patients into two groups, those without (Group A) and with (Group B) final damage in the LIA region. We compared positivity rates of final manual muscle test (MMT) scores≥3 and related factors. Results Sixty-three of the 287 patients were included in this study. Of them, 11 cases in Group A were positive for MMT scores≥3 (68.8%) and 9 cases (19.1%) in Group B had MMT scores≥3 seven days after surgery. Group A thus had a significantly higher rate of MMT scores≥3 than group B (p=0.00). Conclusion In patients without initial damage to the internal capsule, LIA injury might be a key sign for predicting the functional prognosis of putaminal hemorrhage (AU)

Objetivo Aunque el putamen es la zona más común de la hemorragia intracerebral espontánea, los informes previos sobre los efectos de la cirugía son limitados. En ocasiones se observa un mal pronóstico en los pacientes en los que no hay daño en la cápsula interna, pero sí en la región de la arteria insular larga (AIL). El propósito de este estudio fue confirmar la relación entre el daño de la AIL y el pronóstico de los pacientes tras la cirugía de la hemorragia putaminal. Métodos Se recogieron retrospectivamente los datos de 287 casos quirúrgicos que se presentaron con hemorragia putaminal entre enero de 2004 y marzo de 2022. Entre ellos, elegimos a los pacientes sin daño inicial en la extremidad posterior de la cápsula interna, y dividimos a estos pacientes en 2 grupos, los que no tenían (grupo A) y los que tenían (grupo B) daño final en la región AIL. Se compararon las tasas de positividad de las puntuaciones finales de la prueba muscular manual (TMM)≥3 y los factores relacionados. Resultados Sesenta y tres de los 287 pacientes fueron incluidos en este estudio. De ellos, 11 casos del grupo A tuvieron puntuaciones de MMT≥3 positivas (68,8%) y 9 casos (19,1%) del grupo B tuvieron puntuaciones de MMT≥3, 7 días después de la cirugía. Así pues, el grupo A tuvo una tasa significativamente mayor de puntuaciones MMT≥3 que el grupo B (p=0,00). Conclusión En los pacientes sin daño inicial en la cápsula interna, la lesión del AIL podría ser un signo clave para predecir el pronóstico funcional de la hemorragia putaminal (AU)

Utilidad de la monitorización neurofisiológica intraoperatoria como valor pronóstico de la parálisis facial posquirúrgica en schwannomas vestibulares / Utility of the intraoperative neurophysiological monitoring as a prognostic value of postoperative facial paresis in vestibular schwannomas

Antecedentes y objetivo La monitorización neurofisiológica intraoperatoria permite predecir la situación funcional del nervio facial tras la cirugía de schwannoma vestibular. Dada la gran variabilidad de los protocolos neurofisiológicos utilizados para ello, el objetivo del presente estudio es determinar la capacidad pronóstica del protocolo neurofisiológico usado en nuestro servicio. Material y métodos Se realizó un análisis estadístico de los datos de monitorización neurofisiológica recogidos en los pacientes intervenidos entre marzo de 2009 y julio de 2021 en el Servicio de Neurocirugía de Salamanca según su situación funcional, tanto en el período posquirúrgico inmediato como al año de la cirugía. Resultados Se analizó a 51 pacientes de entre 46 y 63 años (mediana: 54). Al estudiar el valor umbral de la intensidad de estimulación del nervio facial y la variación de los potenciales motores evocados córtico-bulbares, se hallaron diferencias significativas (p=0,043 y p=0,011, respectivamente) entre los pacientes con buena y mala situación clínica tras la cirugía. El valor umbral de intensidad más discriminativo fue 0,35mA (sensibilidad: 85%; especificidad: 48%). No se halló relación estadística en el grupo de estudio al año de la cirugía. Conclusiones El protocolo de monitorización intraoperatoria utilizado nos permite predecir la situación clínica de los pacientes en el período posquirúrgico inmediato y mejorar la información al paciente y sus familiares tras la intervención. No podemos, en cambio, utilizar estos parámetros para la predicción de la situación funcional al año de la cirugía ni para la toma de decisiones clínicas al respecto (AU)

Background and objective Intraoperative neurophysiological monitoring allows us to predict the functional status of the facial nerve after vestibular schwannoma surgery. Due to the great variability of the neurophysiological protocols used for it, the goal of this study is to determine the prognostic ability of our neurophysiological protocol. Material and methods We have performed a statistical analysis of the neurophysiological monitoring data collected from patients operated between March 2009 and July 2021 at the Neurosurgery Service of Salamanca according to their functional status, both in the immediate post-surgical period and one year after surgery. Results A number of 51 patients between 46 and 63 years old (median: 54) were analyzed. We have found significant differences studying the threshold value of the stimulation intensity of the facial nerve and the variation of the Cortico-bulbar Evoked Motor Potentials (P=0.043 and P=0.011, respectively) between the patients with good and bad clinical situation after surgery. The most discriminating intensity threshold value was 0.35mA (Sensitivity: 85%; Specificity: 48%). No statistical relationship was found in the study group one year after surgery. Conclusions Our intraoperative monitoring protocol allows us to predict the clinical situation of patients in the immediate postoperative period and improve information for the patient and her relatives after surgery. We cannot, however, use these parameters to predict the functional situation one year after surgery and make clinical decisions in this regard (AU)

[Utility of the intraoperative neurophysiological monitoring as a prognostic value of postoperative facial paresis in vestibular schwannomas]. / Utilidad de la monitorización neurofisiológica intraoperatoria como valor pronóstico de la parálisis facial posquirúrgica en schwannomas vestibulares.

BACKGROUND AND OBJECTIVE: Intraoperative neurophysiological monitoring allows us to predict the functional status of the facial nerve after vestibular schwannoma surgery. Due to the great variability of the neurophysiological protocols used for it, the goal of this study is to determine the prognostic ability of our neurophysiological protocol. MATERIAL AND METHODS: We have performed a statistical analysis of the neurophysiological monitoring data collected from patients operated between March 2009 and July 2021 at the Neurosurgery Service of Salamanca according to their functional status, both in the immediate post-surgical period and one year after surgery. RESULTS: A number of 51 patients between 46 and 63 years old (median: 54) were analyzed. We have found significant differences studying the threshold value of the stimulation intensity of the facial nerve and the variation of the Cortico-bulbar Evoked Motor Potentials (P=0.043 and P=0.011, respectively) between the patients with good and bad clinical situation after surgery. The most discriminating intensity threshold value was 0.35mA (Sensitivity: 85%; Specificity: 48%). No statistical relationship was found in the study group one year after surgery. CONCLUSIONS: Our intraoperative monitoring protocol allows us to predict the clinical situation of patients in the immediate postoperative period and improve information for the patient and her relatives after surgery. We cannot, however, use these parameters to predict the functional situation one year after surgery and make clinical decisions in this regard.

Long insular artery damage might be a key sign for predicting functional prognosis of putaminal hemorrhage.

OBJECTIVE: Although the putamen is the most common area of spontaneous intracerebral hemorrhage, previous reports about the effects of surgery are limited. We sometimes experience a poor prognosis in patients in whom there is no damage to the internal capsule, but with injury in the long insular artery (LIA) region. The purpose of this study was to confirm the relationship between LIA damage and patient prognosis following surgery for putaminal hemorrhage. METHODS: We retrospectively collected data of 287 surgical cases who presented with putaminal hemorrhage between January 2004 and March 2022. Among them, we chose patients without initial damage to the posterior limb of the internal capsule, and divided these patients into two groups, those without (Group A) and with (Group B) final damage in the LIA region. We compared positivity rates of final manual muscle test (MMT) scores≥3 and related factors. RESULTS: Sixty-three of the 287 patients were included in this study. Of them, 11 cases in Group A were positive for MMT scores≥3 (68.8%) and 9 cases (19.1%) in Group B had MMT scores≥3 seven days after surgery. Group A thus had a significantly higher rate of MMT scores≥3 than group B (p=0.00). CONCLUSION: In patients without initial damage to the internal capsule, LIA injury might be a key sign for predicting the functional prognosis of putaminal hemorrhage.

Analysis of the prognostic value of emergency blood tests in ischaemic stroke.

OBJECTIVES: This study aims to evaluate the prognostic value of emergency blood test results in patients with acute ischaemic stroke. METHODS: We evaluated 592 prospectively patients with neuroimaging-confirmed ischaemic stroke admitted to our stroke unit between 2015 and 2018. We gathered emergency blood test results and calculated the neutrophil-to-lymphocyte ratio and the neutrophil-to-platelet ratio (neutrophils × 1.000/platelets). The association between blood test results and functional prognosis (as measured with the modified Rankin Scale) and such complications as haemorrhagic transformation was evaluated by logistic regression analysis. The additional predictive value of blood test parameters was assessed with receiver operating characteristic curves and the net reclassification index. RESULTS: An neutrophil-to-lymphocyte ratio ≥ 3 at admission was associated with a two-fold increase in the risk of functional dependence at 3 months (OR: 2.24; 95% CI: 1.35-3.71) and haemorrhagic transformation (OR: 2.11; 95% CI: 1.09-4.05), while an neutrophil-to-lymphocyte ratio ≥ 3.86 resulted in an increase of 2.4 times in the risk of mortality at 3 months (OR: 2.41; 95% CI: 1.37-4.26) after adjusting for the traditional predictors of poor outcomes. Patients with neutrophil-to-platelet ratio ≥ 32 presented 3 times more risk of haemorrhagic transformation (OR: 3.17; 95% CI: 1.70-5.92) and mortality at 3 months (OR: 3.07; 95% CI: 1.69-5.57). Adding these laboratory parameters to standard clinical-radiological models significantly improved discrimination and prognostic accuracy. CONCLUSIONS: Basic blood test parameters provide important prognostic information for stroke patients and should therefore be analysed in combination with standard clinical and radiological parameters to optimise ischaemic stroke management.

Ischaemic stroke as a complication of cardiac catheterisation. Clinical and radiological characteristics, progression, and therapeutic implications.

INTRODUCTION: Ischaemic stroke is the most common neurological complication of cardiac catheterisation. This study aims to analyse the clinical and prognostic differences between post-catheterisation stroke code (SC) and all other in-hospital and prehospital SC. METHODS: We prospectively recorded SC activation at our centre between March 2011 and April 2016. Patients were grouped according to whether SC was activated post-catheterisation, in-hospital but not post-catheterisation, or before arrival at hospital; groups were compared in terms of clinical and radiological characteristics, therapeutic approach, functional status, and three-month mortality. RESULTS: The sample included 2224 patients, of whom 31 presented stroke post-catheterisation. Baseline National Institutes of Health Stroke Scale score was lower for post-catheterisation SC than for other in-hospital SC and pre-hospital SC (5, 10, and 7, respectively; P=.02), and SC was activated sooner (50, 100, and 125minutes, respectively; P<.001). Furthermore, post-catheterisation SC were more frequently due to transient ischaemic attack (38%, 8%, and 9%, respectively; P<.001) and less frequently to proximal artery occlusion (17.9%, 31.4%, and 39.2%, respectively; P=.023). The majority of patients with post-catheterisation strokes (89.7%) did not receive reperfusion therapy; 60% of the patients with proximal artery occlusion received endovascular treatment. The mortality rate was 12.95% for post-catheterisation strokes and 25% for all other in-hospital strokes. Although patients with post-catheterisation stroke had a better functional prognosis, the adjusted analysis showed that this effect was determined by their lower initial severity. CONCLUSIONS: Post-catheterisation stroke is initially less severe, and presents more often as transient ischaemic attack and less frequently as proximal artery occlusion. Most post-catheterisation strokes are not treated with reperfusion; in case of artery occlusion, mechanical thrombectomy is the preferred treatment.

Validez predictiva de la capacidad funcional del cuestionario CUPAX en pacientes ancianos afectos de fractura de cadera / Predictive validity of the functional capacity of the CUPAX questionnaire in older adults with hip fracture

Antecedentes y objetivoLa fractura osteoporótica de cadera es una enfermedad relevante por su prevalencia e impacto social y sanitario. El objetivo de este estudio es explorar la validez predictiva del cuestionario CUPAX sobre la mortalidad, el lugar de residencia y la funcionalidad posfractura.Materiales y métodosEstudio observacional prospectivo. Se incluyeron 206 pacientes mayores de 65 años ingresados tras una fractura de cadera. Se recogió la puntuación del cuestionario CUPAX prefractura y al año, y el lugar de residencia y la supervivencia al alta hospitalaria y a los 6 y 12 meses. El análisis estadístico se ha realizado con los programas SAS® 9.4 y Stata® 13.1.ResultadosLa edad mediana de la muestra fue 87 años (80,1% mujeres). La tasa de mortalidad intrahospitalaria y al año fue del 5,8% y 19,1%, respectivamente. La mayoría de los pacientes procedían de su domicilio (71,4%), y el destino al alta más frecuente fue un centro sociosanitario (48,2%). El porcentaje de retención del nivel funcional previo en el total de la muestra fue del 50%, siendo mayor en los pacientes más jóvenes. El área bajo la curva ROC para la mortalidad al año fue 0,697 (IC 95%: 0,626-0,760) y para el destino al alta de los pacientes procedentes del domicilio 0,659 (IC 95%: 0,576-0,741). La valoración de la retención funcional al año permite identificar 3 grupos de pacientes en función del valor del CUPAX prefractura.ConclusionesEstos hallazgos apoyan la utilidad clínica del cuestionario CUPAX como herramienta funcional predictiva en pacientes ancianos afectos de fractura de cadera.

Predictive validity of the functional capacity of the CUPAX questionnaire in older adults with hip fracture. / Validez predictiva de la capacidad funcional del cuestionario CUPAX en pacientes ancianos afectos de fractura de cadera.

BACKGROUND AND OBJECTIVES: Osteoporotic hip fracture is a relevant pathology due to its prevalence and social and health impact. The aim of this study is to explore the predictive validity of the CUPAX questionnaire on mortality, place of residence and post-fracture functionality. MATERIALS AND METHODS: Prospective observational study. Two hundred and six patients older than 65 years were included, admitted after a hip fracture. The CUPAX questionnaire score was collected before fracture and one year later, and the place of residence and survival at hospital discharge, and after 6 and 12 months. The statistical analysis was carried out with the SAS® 9.4 and Stata® 13.1 programmes. RESULTS: The median age of the sample was 87.0 years (80.1% women). The in-hospital and one-year mortality rate were 5.8% and 19.1%, respectively. Most of the patients were admitted from home (71.4%), and the most frequent discharge destination was a social health centre (48.2%). The percentage of retention of previous functional level in the total sample was 50%, being higher in the younger patients. The area under the curve ROC for mortality one year later was .697 (95% CI .626-.760) and .659 (95% CI .576-.741) for the discharge destination of patients admitted from home. Evaluation of functional retention one year after the fracture, identified three groups of patients based on the pre-fracture CUPAX value. CONCLUSIONS: These findings support the clinical utility of the CUPAX questionnaire as a predictive functional tool in elderly patients with hip fracture.

Uricemia como factor pronóstico del ictus isquémico agudo / Hyperuricaemia as a prognostic factor for acute ischaemic stroke

Introducción: En el proceso de búsqueda de biomarcadores para el pronóstico del ictus agudo, en los últimos años los estudios realizados en torno al ácido úrico han mostrado resultados contradictorios.MétodosSe recogieron muestras analíticas de 600 pacientes ingresados de manera consecutiva en un hospital de tercer nivel y se analizó la relación entre los niveles de ácido úrico y el pronóstico funcional de los pacientes medido mediante la escala de Rankin modificada (mRS). Se excluyeron los pacientes que habían recibido terapias de reperfusión, ya que podría existir un efecto diferencial en los mismos respecto a los no tratados.ResultadosEl 73% de los pacientes tuvieron una mRS ≤ 2 y los niveles medios de ácido úrico fueron de 5,22 mg/dl. Se encontró una relación no lineal entre el pronóstico funcional al alta y los niveles de ácido úrico sérico en el momento del ingreso al excluir del análisis la medida de la National Institutes of Health Stroke Scale (NIHSS).ConclusionesLos valores séricos de ácido úrico en pacientes afectos de un ictus isquémico agudo se asocian significativamente con el pronóstico funcional en el momento de su alta, pero esta relación es no lineal. Se asocia un peor pronóstico a las concentraciones extremas, muy bajas o muy elevadas, de ácido úrico. Esto podría revelar un doble papel del ácido úrico en su relación con el ictus, como factor de riesgo asociado y/o como posible neuroprotector dado su papel antioxidante. (AU)

Introduction: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results.MethodsWe collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels.ResultsA total of 73% of patients had mRS scores ≤ 2; the mean uric acid level was 5.22 mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis.ConclusionsSerum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect. (AU)

Hyperuricaemia as a prognostic factor for acute ischaemic stroke. / Uricemia como factor pronóstico del ictus isquémico agudo.

INTRODUCTION: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results. METHODS: We collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels. RESULTS: A total of 73% of patients had mRS scores ≤2; the mean uric acid level was 5.22mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis. CONCLUSIONS: Serum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect.

Ischaemic stroke as a complication of cardiac catheterisation. Clinical and radiological characteristics, progression, and therapeutic implications. / Ictus isquémico como complicación del cateterismo cardíaco. Características clínicas, radiológicas y evolutivas e implicaciones terapéuticas.

INTRODUCTION: Ischaemic stroke is the most common neurological complication of cardiac catheterisation. This study aims to analyse the clinical and prognostic differences between post-catheterisation stroke code (SC) and all other in-hospital and prehospital SC. METHODS: We prospectively recorded SC activation at our centre between March 2011 and April 2016. Patients were grouped according to whether SC was activated post-catheterisation, in-hospital but not post-catheterisation, or before arrival at hospital; groups were compared in terms of clinical and radiological characteristics, therapeutic approach, functional status, and three-month mortality. RESULTS: The sample included 2224 patients, of whom 31 presented stroke post-catheterisation. Baseline National Institutes of Health Stroke Scale score was lower for post-catheterisation SC than for other in-hospital SC and pre-hospital SC (5, 10, and 7, respectively; P=.02), and SC was activated sooner (50, 100, and 125minutes, respectively; P<.001). Furthermore, post-catheterisation SC were more frequently due to transient ischaemic attack (38%, 8%, and 9%, respectively; P<.001) and less frequently to proximal artery occlusion (17.9%, 31.4%, and 39.2%, respectively; P=.023). The majority of patients with post-catheterisation strokes (89.7%) did not receive reperfusion therapy; 60% of the patients with proximal artery occlusion received endovascular treatment. The mortality rate was 12.95% for post-catheterisation strokes and 25% for all other in-hospital strokes. Although patients with post-catheterisation stroke had a better functional prognosis, the adjusted analysis showed that this effect was determined by their lower initial severity. CONCLUSIONS: Post-catheterisation stroke is initially less severe, and presents more often as transient ischaemic attack and less frequently as proximal artery occlusion. Most post-catheterisation strokes are not treated with reperfusion; in case of artery occlusion, mechanical thrombectomy is the preferred treatment.

[Impacto en el desenlace funcional en pacientes con ictus: experiencia de una unidad de cuidados neurovasculares].

Background and objective: Neurovascular care units (NCU) have a positive impact on the functional prognosis of stroke patients. The effectiveness of NCUs in Mexico has not been evaluated. Our objective was to determine the impact of an NCU in a third-level academic hospital in northeastern of Mexico. Method: We performed a prospective observational, analytic cohort study. The population was divided into two periods: the first one consisted of those patients admitted before the implementation of the NCU (2008-2010), and the second period consisted of patients admitted after the implementation of the UCN (2010-2014). Functional status was assessed with the modified Rankin scale at discharge and 3 months. Results and conclusions: 598 patients were included (period 1: 246; period 2: 352). Patients in period 2 had a higher deep venous thrombosis prophylaxis (odds ratio [OR]: 3.235; 95 % confidence interval [95 % CI]: 2.18-4.80; p = 0.01), a shorter hospital stay (OR: 0.42; 95 % CI: 0.29-0.62; p = 0.01) and less severe disability (Rankin ≥ 3) at 3 months of follow-up (OR: 0.42; 95 % CI: 0.29-0.62; p = 0.01). The implementation of an NCU in a third-level academic hospital improved the functional outcome at 3 months and decreased the days of in-hospital stay of patients with stroke.

Antecedentes y objetivo: Las unidades de cuidados neurovasculares (UCN) impactan favorablemente en el pronóstico funcional del paciente con ictus en comparación con las salas de internamiento general. La efectividad de las UCN en México no ha sido evaluada. Nuestro objetivo fue determinar el impacto que tiene una UCN en un hospital académico de tercer nivel del noreste de México. Método: Estudio de cohorte prospectivo, observacional y analítico. La población fue dividida en dos periodos: el primero consistió en aquellos pacientes ingresados antes de la implementación de la UCN (2008-2010), y el segundo consistió en pacientes ingresados posterior a la implementación de la UCN (2010-2014). Se evaluó el estado funcional al egreso y a los 3 meses. Resultados y conclusiones: Se incluyeron 598 pacientes (periodo 1: 246; periodo 2: 352). En el periodo 2 se incrementó la profilaxis de trombosis venosa profunda (razón de momios [RM]: 3.235; intervalo de confianza del 95 % [IC 95 %]: 2.18-4.80; p = 0.01) y se redujeron la estancia hospitalaria (RM: 0.42; IC 95 %: 0.29-0.62; p = 0.01) y la discapacidad funcional grave (Rankin ≥ 3) a los 3 meses de seguimiento (RM: 0.42; IC 95 %: 0.29-0.62; p = 0.01). La implementación de una UCN mejoró el desenlace funcional a 3 meses y disminuyó los días de estancia intrahospitalaria de pacientes con ictus.

Presión arterial sistólica y pronóstico funcional en pacientes con enfermedad vascular cerebral aguda: Registro mexicano de enfermedad vascular cerebral / Systolic blood pressure and functional outcome in patients with acute stroke: A Mexican registry of acute cerebrovascular disease (RENAMEVASC)

Objetivo: Analizar la asociación de la presión arterial sistólica (PAS) al ingreso hospitalario y la evolución clínica a 30 días en pacientes con enfermedad vascular cerebral (EVC) aguda. Métodos: El REgistro NAcional Mexicano de Enfermedad VAScular Cerebral (RENAMEVASC) es un registro hospitalario multicéntrico realizado de noviembre de 2002 a octubre de 2004. Se registraron 2000 pacientes con distintos síndromes clínicos de EVC aguda confirmados por neuroimagen. La estratificación de la evolución clínica se realizó mediante la escala de Rankin modificada. Resultados: Se analizaron 1721 pacientes con registro de la PAS: 78 (4.5%) con isquemia cerebral transitoria, 894 (51.9%) con infarto cerebral, 534 (30.9%) con hemorragia intracerebral, 165 (9.6%) con hemorragia subaracnoidea y 50 (2.9%) con trombosis venosa cerebral. De los 1036 (60.2%) pacientes con el antecedente de hipertensión, sólo 32.4% tenía un tratamiento regular. La tasa de mortalidad a 30 días presentó un patrón en J con respecto a la PAS, de tal manera que el riesgo de muerte fue máximo en <100 mmHg (37.5%), descendió entre 100 mmHg y 139 mmHg, para alcanzar gradualmente un nuevo cenit en >220 mmHg (35.3%). El mejor desenlace funcional correspondió a los pacientes que tuvieron una PAS entre 100 mmHg y 159 mmHg. Mediante un modelo de riesgos proporcionales de Cox se encontró que una PAS <100 mmHg o >220 mmHg fue un factor independiente de riesgo de muerte a 30 días (RR: 1.52, IC 95%: 1.07 - 2.15), al igual que el antecedente de hipertensión (RR: 1.33, IC 95%: 1.06 - 1.65) y edad >65 años (RR: 2.16, IC 95%: 1.74 - 2.67). Conclusión: Tanto la hipotensión como la hipertensión arterial significativa al ingreso hospitalario se asocian a un pronóstico adverso en la EVC aguda. No obstante, un buen pronóstico funcional se puede lograr en un amplio rango de cifras de PAS.

Objective: To analyze the association between the admission systolic blood pressure (SBP) and 30-day outcome in patients with acute cerebrovascular disease. Methods: The REgistro NAcional Mexicano de Enfermedad VAScular Cerebral (RENAMEVASC) is a hospital-based multicenter registry performed between November 2002 and October 2004. A total of 2000 patients with clinical syndromes of acute cerebrovascular disease confirmed by neuroimaging were registered. The modified Rankin scale was used for outcome stratification. Results: We analyzed 1721 patients who had registered their SBP: 78 (4.5%) had transient ischemic attack, 894 (51.9%) brain infarction, 534 (30.9%) intracerebral hemorrhage, 165 (9.6%) subarachnoid hemorrhage and 50 (2.9%) cerebral venous thrombosis. Among 1036 (60.2%) patients with the antecedent of hypertension, only 32.4% had regular treatment. The 30-day case fatality rate presented a J pattern with respect to SBP, so that the risk of death was highest in <100 mmHg (37.5%), decreased between 100 and 139, and reached gradually a new zenith in >220 mmHg (35.3%). The best functional outcome corresponded to patients who had SBP between 100 mmHg and 159 mmHg. In a Cox proportional hazards model, SBP <100 mmHg or >220 mmHg was an independent risk factor for 30-day mortality (RR: 1.52, IC 95%: 1.07 - 2.15), as well as the antecedent of hypertension (RR: 1.33, IC 95%: 1.06 - 1.65) and age >65 years (RR: 2.16, IC 95%: 1.74 - 2.67). Conclusion: Both hypotension and significant arterial hypertension at hospital admission are associated with an adverse outcome after acute cerebrovascular disease. Nevertheless, a good functional outcome can be attained in a wide range of SBP.