Preexisting Depression and Ambulatory Status After Stroke: Florida-Puerto Rico Collaboration to Reduce Stroke Disparities.

OBJECTIVE: Stroke is a global public health burden, and therefore it is critical to identify modifiable risk factors to reduce stroke incidence and improve outcomes. Depression is such a risk factor; however, the association between preexisting depression and stroke outcomes, such as independent ambulation, is not well studied, especially among racial-ethnic minority groups. To address this gap in the literature, effects of preexisting depression on ambulatory status at hospital discharge after stroke were evaluated among individuals participating in the racially and ethnically diverse Florida-Puerto Rico Collaboration to Reduce Stroke Disparities project. METHODS: Data were analyzed from a total of 42,031 ischemic stroke patients, who were independently ambulatory prior to their stroke, after discharge from 84 hospitals between 2014 and 2017. Preexisting depression was confirmed by medical history or antidepressant medication use. Multilevel multivariate logistic regression analyses were used to assess the association of preexisting depression with independent ambulation at hospital discharge. Effects of sex and race-ethnicity on this association were examined. RESULTS: Of 42,031 participants (mean±SD age=70.4±14.2 years; 48% were female; race-ethnicity: 16% Black, 12% Hispanic living in Florida, and 7% Hispanic living in Puerto Rico), 6,379 (15%) had preexisting depression. Compared with participants without depression, those with preexisting depression were older, were more likely to be female and non-Hispanic White, and had a greater burden of vascular risk factors or comorbid conditions. Independent ambulation at hospital discharge was less frequent among women, Black participants, and individuals with vascular risk factors or comorbid conditions. In multivariate models, preexisting depression decreased the likelihood of independent ambulation at discharge (odds ratio=0.88, 95% CI=0.81, 0.97). No interactions were found between preexisting depression and race-ethnicity or sex. CONCLUSIONS: Preexisting depression was independently associated with dependent ambulation at hospital discharge after stroke, regardless of sex and race-ethnicity. Treating depression may contribute to primary stroke prevention and could improve ambulatory status at discharge.

Actuación de enfermería en el infarto cerebral agudo / Nursing performance in acute cerebral stroke

La enfermedad vascular cerebral (EVC) es una patología caracterizada por un déficit neurológico súbito, secundario a oclusión o ruptura de un vaso sanguíneo cerebral; se divide en isquémica o infarto cerebral (IC) y hemorrágica. La EVC es reconocida como la primera causa de discapacidad y la quinta causa de muerte en México, registrándose cerca de 170 mil casos nuevos al año. Existe amplia evidencia que demuestra una reducción en los desenlaces negativos, como muerte y discapacidad, al realizar intervenciones rápidas, incluyendo la administración de trombolisis intravenosa con rt-PA (activador tisular de plasminógeno recombinante) y trombectomía mecánica. La coordinación multidisciplinaria del equipo de salud y los cuidados efectivos de enfermería, son vitales durante todas las etapas de atención de la EVC. Esta revisión da a conocer un panorama general del manejo del infarto cerebral e identificar las intervenciones indispensables del profesional de enfermería realiza durante las etapas prehospitalarias, pretrombolisis, durante trombolisis y postrombolisis.

Cerebralvascular disease (CVD) is a pathology characterized by a sudden neurological deficit secondary to occlusion or rupture of a cerebral blood vessel; it is divided into ischemic or cerebral infarction (CI) and hemorrhagic. CVD is recognized as the first cause of disability and the fifth cause of death in Mexico, with nearly 170,000 new cases registered each year. There is ample evidence that shows a reduction in negative outcomes, such as death and disability, with rapid interventions, including the administration of intravenous thrombolysis with rt-PA (recombinant tissue plasminogen activator) and mechanical thrombectomy. Multidisciplinary coordination of the health care team and effective nursing care are vital during all stages of CVD care. This review provides an overview of the management of cerebral infarction and identifies essential nursing interventions during the prehospital, prethrombolysis, during thrombolysis, and postthrombolysis stages.

Cerebral hemodynamics in the non-alcoholic fatty liver.

INTRODUCTION AND OBJECTIVES: The association between non-alcoholic fatty liver disease and cerebral hemodynamics arises from cardiovascular damage mechanisms such as endothelial dysfunction, arterial wall increased stiffness, high thickness of the intimate index of the internal carotid artery, left ventricular hypertrophy, left diastolic dysfunction, calcification coronary arteries and increased epicardial fat. The multidirectional relationship between systemic inflammation and lipid metabolism constitutes a common and simultaneous mechanism that causes vascular damage. This study aims to provide insight into the relationship between non-alcoholic fatty liver disease and the function of systemic circulation and cerebral circulation using Doppler ultrasound. PATIENTS AND METHODS: Is an observational, cross-sectional, prospective, comparative study conducted at Medica Sur Hospital. Thirty-five patients were selected consecutively. The patients consulted neurological service for various symptoms without severity criteria, such as vertigo, primary headache and balance disturbances. RESULTS: There is a difference in the variables mean of the right MCA PI (p = 0.023), left MCA PI" (p = 0.004), and left VA PI (p = 0.036) between the control and NAFLD groups. The correlation analysis between these variables and the CAP showed a positive correlation of the three variables with the CAP, "right MCA PI" (r = 0.384), left MCA PI "(r = 0.509) and" left VA PI " (r = 0.551). CONCLUSIONS: This study demonstrates a subclinical process of the middle cerebral artery in subjects with NAFLD, which suggests it may be involved in the disease development and points the need to make decisions for this liver manifestation prevention and treatment.

Trombosis venosa cerebral en la Unidad de Cuidados Intensivos Neurológicos del Instituto Nacional de Neurología y Neurocirugía / Brain venous thrombosis in the unit of neurological intensive care of the National Institute of Neurology and Neurosurgery / Trombose venosa cerebral na Unidade de Terapia Intensiva Neurológica do Instituto Nacional de Neurologia e Neurocirurgia

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Abstract: Cerebral venous thrombosis (TVC) is a potentially devastating state that occurs in young adults, especially women. Less frequent subtype of cerebral vascular disease (EVC), represented only 0.5% in EVC patients. Headache is the most common symptom common. It requires an accurate diagnosis since the pathophysiology and treatment differ from the arterial EVC. The understanding of the risk factors is the key to the prognosis of the TVC. Objective: To determine the prevalence, the main clinical, radiological findings and prognosis of TVC in Neurological Intensive Care Unit. Material and methods: Retrospective, longitudinal and analytical study of an observational nature. All patients admitted to the Neurological Intensive Care Unit of the National Institute of Neurology and Neurosurgery (INNN) with the diagnosis of TVC from January 2010 to July 2019 confirmed by venous phase computed tomography (vein CT) and/or vein were considered MRI (vein MRI), which will have clinical information and cabinet studies, as well as, the evolution, treatment and prognosis at hospital discharge. Results: Of a total of 14 patients, with an average age of 33 years of age. Of which 85.72% (n = 12) were women and 14.28 (n = 2) were men. Headache occurred 50% of cases. The main predisposing cause for TVC was the use of oral contraceptives in 6 patients (42.85%) and puerperium in three patients (21.42%). The delay in diagnosis was an average of 48 hours. The imaging method used for diagnosis in 64.28% of those with computed tomography in venous phase and in 37.71% with vein magnetic resonance. The upper longitudinal sinus was the most affected in 50% of cases. The average stay in the Intensive Care Unit (ICU) was seven days, where 100% of patients received anticoagulation. Three patients (21.4%) developed intracranial hypertension who underwent decompressive craniectomy between the second and fifth day of stay. The days of mechanical ventilation on average were seven days. With an average hospital stay of 20 days. Mortality at hospital discharge was 21.42%. Conclusions: TVC is less frequent than ischemic stroke or intracerebral hemorrhage. The spectrum of the clinic is broad, with pivotal headache. The confirmation of the diagnosis must be performed with CT vein and/or RM vein. The therapeutic intervention within the acute phase is aimed at the recanalization of the thrombosed sinus or sinuses and the prevention of complications; anticoagulation with low molecular weight heparin is the first-line treatment, which has shown an impact on the prognosis of patients. We must keep in mind that thrombolysis and thrombectomy are an option in treatment. In the case of decompressive craniectomy, it is indicated only in cases of malignant venous infarctions. The results after TVC are generally favorable, they also depend on the patient's factors, such as sex and the specific risk factors of women.

Resumo: Trombose venosa cerebral (TVC) é um estado potencialmente devastador que ocorre em adultos jovens, especialmente mulheres. Subtipo menos frequente do acidente vascular cerebral (AVC), representou apenas 0.5% nos pacientes com AVC. Cefaléia é o sintoma mais comum. Exige um diagnóstico preciso, pois a fisiopatologia e o tratamento diferem da AVC arterial, e a compreensão dos fatores de risco é a chave para o prognóstico da TVC. Objetivo: Determinar a prevalência, os principais achados clínicos, radiológicos e prognósticos da TVC na unidade de terapia intensiva neurológica. Material e métodos: Estudo retrospectivo, longitudinal e analítico de natureza observacional. Todos os pacientes admitidos na unidade de terapia intensiva neurológica do Instituto Nacional de Neurologia e Neurocirurgia (INNN) com diagnóstico de TVC de janeiro de 2010 a julho de 2019 confirmados por tomografia computadorizada de fase venosa (Veno-TC) e/ou veno ressonância magnética (veno-RM), que contaram com informações clínicas e estudos de gabinete, bem como a evolução, tratamento e prognóstico na alta hospitalar. Resultados: Do total de 14 pacientes, com idade média de 33 anos. Dos quais 85.72% (n = 12) eram mulheres e 14.28 (n = 2) eram homens. A cefaléia ocorreu em 50% dos casos. A principal causa predisponente para TVC foi o uso de contraceptivos orais em 6 pacientes (42.85%) e puerpério em 3 pacientes (21.42%). O atraso no diagnóstico foi em média de 48 horas. O método de imagem utilizado para o diagnóstico em 64.28% daqueles com tomografia computadorizada na fase venosa e em 37.71% com veno ressonância magnética. O seio sagital superior foi o mais acometido em 50% dos casos. A permanência média na unidade de terapia intensiva (UTI) foi de 7 dias, onde 100% dos pacientes receberam anticoagulação. Três pacientes (21.4%) desenvolveram hipertensão intracraniana submetidos a craniectomia descompressiva entre o segundo e o quinto dia de internação. Os dias de ventilação mecânica foram em média 7 dias. Com internação média de 20 dias. A mortalidade na alta hospitalar foi de 21.42%. Conclusões: A TVC é menos frequente que o AVC isquêmico ou hemorragia intracerebral. O espectro da clínica é amplo, tendo como sintoma principal cefaléia. A confirmação do diagnóstico deve ser realizada com veno TC e/ou veno RM. A intervenção terapêutica na fase aguda visa à recanalização do seio ou seios trombosados e à prevenção de complicações; a anticoagulação com heparina de baixo peso molecular é o tratamento de primeira linha que demonstrou um impacto no prognóstico dos pacientes. Devemos ter em mente que trombólise e trombectomia são uma opção no tratamento. No caso da craniectomia descompressiva, é indicado apenas em casos de infartos venosos malignos. Os resultados após o TVC são geralmente favoráveis, também dependem de fatores do paciente, como sexo e fatores de risco específicos da mulher.

Índice leuco-glucémico asociado con complicaciones en isquemia cerebral aterotrombótica / Leuco-glycemic index associated to complications in atherothrombotic cerebral ischemia

Resumen: OBJETIVO: Evaluar el índice leuco-glucémico (ILG) como marcador pronóstico de mortalidad y complicaciones en pacientes con enfermedad vascular cerebral de tipo isquémico aterotrombótico. MATERIAL Y MÉTODO: Estudio prospectivo efectuado en pacientes con enfermedad vascular de tipo isquémico aterotrombótico durante la fase aguda del infarto, que ingresaron entre enero y diciembre de 2017 al servicio de Medicina Interna del Hospital General Ticomán. Se recolectaron datos clínicos y de laboratorio, incluyendo glucemia y leucograma al ingreso, a partir de los cuales se calculó el ILG y se evaluó su valor pronóstico, así como su relación con las escalas de NIHSS y Rankin y con la mortalidad a 21 días. RESULTADOS: Se incluyeron 72 pacientes. Los pacientes con mayor número de complicaciones durante la hospitalización tuvieron valores superiores de ILG (p = 0.02). Se obtuvo un valor ≥ 900 como punto de corte; los pacientes con valores superiores tuvieron tres veces mayor probabilidad de complicaciones durante la hospitalización (razón de momios = 3.02; IC95%: 1.03 a 9.9; p = 0.04), por lo que el índice leuco-glucémico constituyó un predictor significativo. CONCLUSIONES: El índice leuco-glucémico se relacionó con mayor severidad de enfermedad vascular cerebral en las escalas de NIHSS y Rankin, además, se asoció con complicaciones intrahospitalarias.

Abstract: BACKGROUND: The glycemia and the determination of serum leukocytes on admission have demonstrated prognostic importance in patients with ischemic cerebral vascular disease (CVD). The leuko-glycemic index (ILG) is recently studied as a prognostic marker, but knowledge about its value is lacking. OBJECTIVE: To evaluate the leuko-glycemic index (ILG) as a prognostic marker of mortality and complications in patients with atherothrombotic ischemic stroke. MATERIAL AND METHOD: A prospective study was conducted on patients with atherothrombotic ischemic vascular disease during the acute phase of the infarction, who were admitted to the Internal Medicine Department of the Ticoman General Hospital from January to December 2017. Clinical and laboratory data were collected, including glycemia and leukogram at admission, from which the ILG was calculated and its prognostic value was evaluated, as well as its relationship with the NIHSS and Rankin scales and/or with the 21-day mortality. RESULTS: There were included 72 patients. Patients with a higher number of complications during hospitalization had higher ILG values (p = 0.02). A value ≥ 900 was obtained as a cut-off point; patients with higher values presented a three times higher probability of complications during hospitalization (odds ratio: 3.02, CI95%: 1.03 to 9.9, p = 0.04), so the ILG was a significant predictor. CONCLUSIONS: Leuko-glycemic index was associated with greater severity of cerebral vascular disease in the NIHSS and Rankin scales, and was associated with intrahospital complications.

Caracterización de los cuidadores de adultos mayores hemipléjicos a causa de enfermedad cerebrovascular / Characterization of caregivers of hemiplegic aged patients with cerebrovascular illness

Se realizó un estudio descriptivo y transversal de 45 cuidadores de adultos mayores hemipléjicos a causa de enfermedad cerebrovascular, atendidos en la Sala de Rehabilitación Integral del Policlínico Universitario Luis Augusto Turcios Lima del municipio y provincia de Pinar del Río, desde julio hasta diciembre de 2015, con vistas a caracterizar a dichos cuidadores según variables de interés para la investigación. En la serie prevalecieron los cuidadores de 50-59 años de edad (53,3 por ciento), del sexo femenino (44,4 por ciento), con nivel educacional preuniversitario (37,8 por ciento), con lazos de parentesco (71,1 por ciento) y con un tiempo en esta labor entre 7-9 meses (40,0 por ciento). El parentesco existente entre el cuidador y la persona cuidada es un factor importante que influye en gran medida en la experiencia del cuidado

A descriptive and cross-sectional study of 45 caregivers of aged hemiplegic adults with cerebrovascular disease, assisted in the Comprehensive Rehabilitation room of Luis Augusto Turcios Lima University Polyclinic in Pinar del Río municipality and province, was carried out from July to December of 2015, with the aim of characterizing this caretakers, according to variables of interest for the investigation. In the series the caregivers of 50-59 years of age (53,3 percent), the female sex (44,4 percent), preuniversity educational level (37,8 percent), family relationship (71,1 percent) and with a period in this activity among 7-9 months (40,0 percent) prevailed. The existent family relationship between the caregiver and the sick elderly is an important factor that influences greatly in the experience of the care

Repercusiones físicas, mentales y sociales del cuidador primario de adultos mayores con enfermedad vascular cerebral en el Hospital Juárez de México / Physical, mental and social repercussions of the primary caregiver of older adults with CVD at the Juárez de México hospital

El adulto mayor hospitalizado con dependencia total a causa de la Enfermedad Vascular Cerebral (EVC), que se determina como crónica y degenerativa, está incapacitado para la realización de las actividades básicas de la vida diaria, por lo cual requiere la atención continua de un familiar denominado cuidador primario quien le brinda apoyo en diferentes aspectos. De ahí, que el cuidador primario se afecte en los ámbitos físico, mental y social. En este sentido, se visualiza la figura de cuidador primario como el sujeto-objeto de investigación. OBJETIVO. Determinar las repercusiones en los ámbitos personal, familiar y social del cuidador primario que brinda atención a un adulto mayor con EVC. MÉTODO. Se realizó un estudio usando la técnica de investigación cualitativa, fenomenológica, exploratoria, descriptiva. Se eligió a 6 cuidadores primarios cuyo familiar adulto mayor (AM) presentara dependencia total a causa de EVC. Se les aplicó la Entrevista en Profundidad. Los resultados se analizaron de acuerdo con el instrumento: Análisis de contenido de tipo temático. RESULTADOS. Se encontró, a través de la codificación libre en el texto de las entrevistas, 3 categorías y 9 subcategorías. 1. Cambio en la vida del cuidador: a) Disminuyen sus ingresos económicos, debido a que el cuidador primario dedica el mayor tiempo al cuidado del AM, por ello abandona parcial o totalmente su actividad remunerada; b) Deja de cuidar su salud, al priorizar la atención del AM en detrimento de la propia, presenta alteraciones del sueño, fatiga, alimentación inadecuada lo cual impacta negativamente en su salud; c) Deja de socializar con familiares y amigos, la permanencia en el hospital hasta por 36 horas continuas aísla al cuidador primario de su contexto familiar. 2. Enseñanza y aprendizaje: a) Fuentes de adquisición de nuevos conocimientos, el cuidador primario aun cuando cuente con conocimientos previos para el cuidado, no está capacitado de manera formal para el desempeño de las actividades que debe desarrollar en el hospital, aprende observando, preguntando a otros cuidadores o profesionales y por ensayo y error, lo cual le genera angustia. No existe un programa que capacite al cuidador primario para brindar la atención adecuada al AM; b) Cuidando en el hospital, el cuidado en el hogar difiere en gran medida del cuidado en el hospital, sus actividades son de apoyo al personal de salud debido a que el cuidador primario no recibe una enseñanza formal para el cuidado, lo cual le genera estrés, además de que pudiera representar un riesgo para el AM; 3) La vida en el hospital: a) Percepción del cuidado, el cuidador primario reconoce que el personal médico brinda atención de calidad al AM, no así lo refiere del personal de enfermería, ya que en sus discursos evidencia que no le capacitan para el desempeño de sus actividades, además de percibir maltrato o tardanza para la atención, por otro lado, justifica lo anterior debido a que el personal es insuficiente y los pacientes numerosos; b) Vigilancia en el hospital, con base en los discursos se observó que la relación cuidador primario-personal de vigilancia es complicada porque éstos se apegan rigurosamente a la normatividad del hospital descuidando las normas morales y el trato digno a que tienen derecho los cuidadores primarios; c) Actividades del cuidador primario en el hospital, son las acciones físicas de cuidado, acompañamiento y organización de los relevos, sin embargo, la principal es la de acompañar al AM, aunque el cuidador primario puede ser un colaborador del equipo de salud; d) Espacio de socialización, la permanencia constante del cuidador primario en el hospital, convierte este sitio en el espacio de socialización, en el que convive con otros pacientes y sus familiares, personal de salud y otras personas creando nuevos vínculos para compartir experiencias y ayuda mutua. CONCLUSIÓN. Los resultados obtenidos sugieren que el cuidador primario es un colaborador fundamental para la atención del AM hospitalizado, de ahí que es necesario implementar en los planes de estudio de la Licenciatura en Enfermería un área de formación en la cual se contemple al cuidador primario como persona vulnerable que debe recibir atención al igual que su paciente y la enseñanza formal que le capacite para atender las necesidades del AM, por otro lado, es preciso establecer programas para incluirle en un plan de atención y salud básica.

The older adult hospitalized with total dependence because of Cerebral Vascular Disease (CVD) , which is determined as chronic and degenerative, is unable to perform basic activities of daily life, which requires continuous care of a family called primary caregiver who provides support in different aspects. Hence, the primary caregiver affect on the physical, mental and social fields. In this sense, the figure of primary caregiver as the subject-object research is displayed. OBJECTIVE. Determine the impact on personal, family and social areas of the primary caregiver who provides care to an older adult with CVD. METHOD. A study was conducted using qualitative research technique, phenomenological, exploratory, descriptive study was conducted. 6 primary caregivers whose family AM present total dependence because of CVD was chosen. It was applied in-depth interview. The results were analyzed according to the instrument: analysis of thematic content. RESULTS. It was found through the free coding in the text of the interviews, 3 and 9 sub-categories. 1. Change in the caregiver's life: a) reduce their income, because the primary caregiver spends more time taking care of AM, thus partially or totally abandon their remunerated activity; b) Stop health care, prioritizing the attention of AM detriment of their own, presents sleep disturbances, fatigue, inadequate food which negatively impacts on their health; c) Stop socializing with family and friends, stay in the hospital for up to 36 continuous hours isolates the primary caregiver of the family context. 2. Teaching and learning: a) Sources of acquiring new knowledge, the primary caregiver even when it has prior knowledge care is not formally trained to carry out the activities to be developed in the hospital, learns by watching, asking other caregivers or professionals and by trial and error, which generates anxiety. There is a program that enables the primary caregiver to provide adequate attention to AM; b) Taking care in hospital, home care differs greatly from hospital care, their activities are supportive health personnel because the primary caregiver does not receive a formal education for care, which generates stress, and that could pose a risk to the AM; 3) Life in the hospital: a) Perception of care, the primary caregiver recognizes that medical personnel providing quality care to AM, not so concerned nursing staff, since in his evidence speeches that do not train you for the performance of its activities, in addition to perceived abuse or delay for attention, on the other hand, justifies the above because the staff is insufficient and many patients; b) Monitoring in the hospital, based on the speeches was observed that the primary-care staff monitoring relationship is complicated because they are strictly adhere to the regulations of the hospital neglecting moral standards and fair treatment they are entitled to primary caregivers ; c) Activities of the primary caregiver in the hospital, are the physical actions of care, support and organization of the relays, however, the principal is to accompany the AM, although the primary caregiver can be a partner of the health team; d) Space socialization, constant permanence of the primary caregiver in the hospital, makes this site in the space of socialization, which coexists with other patients and families, health workers and others creating new links to share experiences and help mutual. CONCLUSION. The results suggest that the primary caregiver is a key partner for the attention of AM hospitalized, hence need to be implemented in the curricula of Nursing a training area in which the primary caregiver as a vulnerable person is contemplated which should receive attention as patient education and formal training enabling them to meet the needs of AM, on the other hand, we must establish programs to include him in a care plan and basic health.

Ictus hemorrágico en los servicios clínicos del hospital José R López Tabrane: primer cuatrimestre del 2012 / Hemorrhagic ictus at the clinical services of the hospital José R. López Tabrane: First quarter of 2012

Se realizó un estudio descriptivo del seguimiento a 14 pacientes que ingresaron con el diagnóstico clínico y radiológico de enfermedad cerebrovascular hemorrágica en los servicios clínicos del hospital José Ramón López Tabrane de Matanzas, en el periodo de enero a abril del 2012. Se observa que el grupo de 66–75 años predominó con 6 casos para un 42,8 por ciento, siendo el sexo masculino el más afectado con 8 pacientes para un 57,1 por ciento. Se apreció una estrecha relación entre escala de Glasgow, evolución clínica y estado al egreso. Se observó con escala Glasgow 15/15 solo 1 paciente vivo, para un 7,1 por ciento; con escala de 9-14/15 hubo 9 pacientes para un 64,2 por ciento y dentro de estos 4 fallecidos para una letalidad de 44,4 por ciento, con Glasgow de menos de 8/15 se presentaron 4 pacientes que todos fallecieron para una letalidad del 100 por ciento. Se comprueba mediante estudios de neuroimagen que el 24,1 por ciento son hemorragias e infarto sin efecto de masa, el 57,1 por ciento son hemorragias con efecto de masa, el 14,2 por ciento son hemorragias subaracnoideas y el 7,1 por ciento corresponde a la hemorragia intraventricular. El 100 por ciento de los pacientes recibieron tratamiento convencional, la alimentación precoz se utilizó en 10 pacientes para un 71,4 por ciento. La estadía hospitalaria se comportó entre 2 y 15 días. Se muestra la presencia de factores de riesgo en los pacientes estudiados. Se concluye que la escala de Glasgow permite establecer un pronóstico de morbimortalidad de los pacientes que ingresan con enfermedad cerebrovascular hemorrágica.

We carried out a descriptive study of the follow up of 14 patients who entered the clinical services of the hospital José R. López Tabrane, of Matanzas, with the radiological and clinical diagnosis of hemorrhagic cerebral vascular disease, in the period form January to April 2012. We observed that there was a predominance of the 66-75-years-old age group with 6 cases for 42,8 percent, being the male genre the most affected with 6 patients for 57,1 percent. We found a tight relation among Glasgow scale, clinical evolution and health status at discharge. It was observed only one alive patient, 7,1 percent, with Glasgow scale 15/15; with Glasgow scale value 9-14/15 there were 9 patients for 64,2 percent, among them 4 passed away for 44,4 percent lethality; with Glasgow scale of less than 8/15 there were 4 patients; all of them died for 100 percent lethality. Through neuro-imaging studies we verified that 34,1 percent of the cases are hemorrhages and infarct without mass effect, 57,1 percent are hemorrhages with mass effect, 14,2 percent are sub-arachnoid hemorrhages, and 7,1 percent are intra-ventricular hemorrhages. 100 percent of the patients received conventional treatment, precocious feeding was used in 10 patients for 71,4. Hospital staying ranged between 2 and 15 days. It was showed the presence of risk factors in the studied patients. We arrived to the conclusion that the Glasgow scale allows to establish a morbimortality prognosis of the patients entering with hemorrhagic cerebral vascular disease.

Contribucion a la evaluación del conocimiento de médicos de familia en enfermeddad cerebro vascular / Contribution to the evaluation of the knowledge of family doctors in ilness vascular brain

Se diseñó un estudio descriptivo mediante el cual se evaluó la competencia de los médicos de familia de un área de salud del municipio Playa, perteneciente al Policlínico Jorge Ruiz Ramírez en cuanto a la atención del paciente con enfermedad cerebral vascular. Se exploraron los conocimientos básicos en cuanto a la prevención primaria, el manejo del ictus en fase aguda, y la prevención secundaria de estos. Para lograr los objetivos trazados, se confeccionó una encuesta de 15 preguntas. Se pudo demostrar que 68,1 % de los médicos encuestados, estaban mal preparados en los temas explorados. Además, detectamos que el manejo de la crisis aguda fue en el área explorada donde más dificultades se encontraron, siendo las preguntas que exploraron esta área las que mayores diferencias estadísticas tuvieron para diferenciar los médicos encuestados.

A descriptive study was designed, by which we measured the proficiency of the family physicians in a health area of the Jorge Ruiz Ramirez Policlinic in Playa Municipality regarding the care of the patients with cerebral vascular diseases. The basic knowledge in connection with primary prevention and management of ictus in its acute phase was explored, as well as the secondary prevention of them. To achieve this objectives we made a questionnaire of 15 questions. We could prove that 68,1% of the questioned doctors were not prepared in the explored topics. Besides, we detected that the acute crisis management was the ecplored area where more difficulties were found being the explored questions in this area the ones with more statistic significance to make it relevant of the doctors questioned about it.

Acidente vascular cerebral e outras complicações do sistema nervoso central nas doenças falciformes / Stroke and other vascular complications of the central nervous system in sickle cell disease

A principal complicação da doença falciforme na infância é a das artérias cerebrais, mas após os 20 anos também pode se manifestar, como seqüela de lesões anteriores ou neoformadas. A vasculopatia tem a maior importância no desenvolvimento da criança e na qualidade de vida. Além do acidente vascular cerebral completo ou incompleto ("silencioso"), existem outras complicações do sistema nervoso central, porém não exclusivas. O diagnóstico da vasculopatia cerebral falciforme necessita auxílio neurorradiológico. O tratamento se faz basicamente com transfusões de eritrócitos contendo hemoglobina A. O objetivo deste trabalho é rever a literatura médica, procurando selecionar a melhor conduta em diagnóstico e tratamento que seja possível empregar de imediato, para reduzir a morbidade e mortalidade da vasculopatia cerebral e elevar a qualidade de vida dos pacientes, principalmente na infância. Os fatores de risco clínicos e laboratoriais, incluindo a triagem por ultra-sonografia Doppler das artérias cerebrais e imagens de ressonância magnética, devem influenciar a decisão de instituir transfusões crônicas e a quelação do ferro transfusional deve acompanhar este tratamento.

In children with sickle cell disease, cerebral arteries are prone to lesions that may cause deficiencies and poor quality of life. After the age of 20, new lesions may also occur. Besides stroke and silent cerebral ischemia, other lesions may occur. Radiologic images are necessary to diagnose and blood transfusions to treat. We reviewed the literature to choose best practices and guidelines to reduce morbidity and mortality and improve the quality of life of children with sickle cell disease. Risk factors identified from clinical and laboratory data and screening by Doppler ultrasonography and magnetic resonance must be used in order to make decisions about transfusion and iron chelation therapy.

Variação temporal no desempenho em testes de memória em pacientes com doença vascular cerebral / Temporal variation in memory tests performance in cerebral vascular disease patients

Buscando adequar a avaliação neuropsicológica à organização temporal do organismo humano, avaliou-se o desempenho em testes de memória em 12 pacientes pós Doença Vascular Cerebral e 12 indivíduos controle, de ambos os sexos, com idade de 45 a 65 anos. Foram aplicados dois testes de memória com estímulos visuais (figuras) e dois com estímulos verbais (palavras), em 3 dias consecutivos por semana, às 08:00, 10:00 e 12:00 h na primeira semana e às 14:00 e 16:00 h na seguinte. Os pacientes apresentaram menor número de acertos do que os indivíduos controle em todos os testes aplicados (p<0,05). A sensibilidade foi maior às 14h00min para o teste de evocação livre e às 16h00min para os testes de reconhecimento. Diante dos resultados, conclui-se que a avaliação neuropsicológica deva ser realizada preferencialmente à tarde, tanto na avaliação inicial quanto nas reavaliações.

This study intended to investigate the performance in memory tests in order to adequate the neuropsychological evaluation to the temporal order of the human organism. Twelve cerebral vascular accident patients and 12 controls, of both sexes and 45-65 years old were studied. Two memory tests with visual stimuli (pictures) and two with verbal stimuli (words) were applied three times a day (08:00, 10:00 and 12:00 h) during the first week and twice a day (14:00 and 16:00 h) in the second week, during three consecutive days in two consecutive weeks. The patients showed lower scores than control subjects in all applied tests (p<0,05). The greater test sensitivity was at 14:00 h for the free recall test and at 16:00 h for recognition tests. According to these results, it is concluded that neuropsychological evaluations should be conducted preferably in the afternoon, as well for the first evaluation as for the re-evaluations.