[Preadmission statins treatment in stroke patients: opportunity to treat high vascular risk patients]. / Antecedente del uso de estatinas en el ictus: oportunidad de mejora en el paciente con alto riesgo vascular por aterotrombosis.

AIM: To describe the use of preadmission statins in patients with cerebrovascular accident and the possible predictive factors. PATIENTS AND METHODS: Cross-sectional observational study of 795 consecutive patients with acute cerebrovascular accident. We assessed the differences among patients who were on preadmission statins (161) and those who were not (634), regarding vascular risk factors and clinical and neurosonological atherothrombotic disease markers. For univariate analysis, we used squared chi test, and for multivariate analysis, logistic regression analysis. RESULTS: Preadmission statins were 20.3%. In high vascular risk patients defined based on National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), this reached 28% and it might be 72%. Predictive factors for preadmission statins use were, in a positive sense, the antecedent of hypercholesterolemia diagnosis (OR = 189; 95% CI = 58-615; p < or = 0.001) and stroke (OR = 2.1; 95% CI = 1.2-3.6; p < or = 0.01), and in a negative sense, smoking (OR = 0.38; 95% CI = 0.18-0.81; p = 0.012). CONCLUSIONS: In our population of patients with stroke, the predictive factors of preadmission statins did not adjust to the current therapeutic NCEP-ATP III recommendations; treatment with statins in high vascular risk population was way below the indications, it was 28% and it might be 72%.

[Delays before and after arrival at the hospital in the treatment of strokes]. / Retraso extrahospitalario e intrahospitalario en el tratamiento del ictus.

INTRODUCTION: Only a minority of patients with acute stroke are eligible for fibrinolysis, and the main reason for this is that time runs out and goes beyond the therapeutic window. The chief delay occurs prior to arrival at the hospital, but there is also a nosocomial delay, which has received far less attention. AIMS: The purpose of our study was to describe the data on delays occurring before and after arrival at the hospital in a sample of patients with acute stroke, and to analyse possible associated factors, including the overload on health care services in the Emergency department, an aspect that has not previously been evaluated. PATIENTS AND METHODS: Epidemiological data, times of delays before and after entering the hospital, means of transport used and the health care workload in the Emergency department of the day of admission were collected for all the stroke patients admitted to the Stroke Unit of the Hospital General Universitario de Alicante throughout the period under study. RESULTS: From an initial sample of 460 patients, 423 were finally included in the study, with a mean delay before and after admission to hospital of 3.99 and 2.36 hours, respectively. Use of an ambulance and the haemorrhagic and transient ischemic attack subtypes were linked to a shorter delay before reaching the hospital, and arrival during the night shift was the only factor associated to a longer delay once inside the hospital. CONCLUSIONS: In our environment, there is a need to establish strategies aimed at shortening the times stroke patients take to reach the hospital and the time that elapses before they are attended.

Retraso extrahospitalario e intrahospitalario en el tratamiento del ictus / Delays before and after arrival at the hospital in the treatment of strokes

Introducción. Sólo una minoría de pacientes con ictus agudo es candidata a fibrinólisis, y el principal motivo es sobrepasar temporalmente la ventana terapéutica. El principal retraso se produce hasta la llegada al hospital, pero también existe, y ha sido menos estudiado, un retraso intrahospitalario. Objetivo. Describir los datos de retraso extrahospitalario e intrahospitalario en una muestra de pacientes con ictus agudo y analizar los posibles factores asociados, entre ellos la sobrecarga asistencial en el área de Urgencias, aspecto previamente no evaluado. Pacientes y métodos. Se recogieron de forma sistemática los datos epidemiológicos, los tiempos de retraso extrahospitalario e intrahospitalario, el medio de trasporte empleado y la carga asistencial en Urgencias en el día del ingreso de todos los pacientes con ictus que ingresaron en la Unidad de Ictus del Hospital General Universitario de Alicante durante el período de estudio. Resultados. De una muestra inicial de 460 pacientes, se incluyeron en el estudio 423, con una mediana de retraso extrahospitalario e intrahospitalario de 3,99 y 2,36 horas, respectivamente. El uso de ambulancia y los subtipos hemorrágico y accidente isquémico transitorio se asociaron a un menor retraso extrahospitalario, mientras que la llegada durante el turno de noche fue el único factor asociado a un mayor retraso intrahospitalario. Conclusiones. Se evidencia la necesidad en nuestro medio de iniciar estrategias encaminadas a mejorar las latencias con la que los pacientes con enfermedad cerebrovascular acuden y se atienden en el ámbito hospitalario

Introduction. Only a minority of patients with acute stroke are eligible for fibrinolysis, and the main reason for this is that time runs out and goes beyond the therapeutic window. The chief delay occurs prior to arrival at the hospital, but there is also a nosocomial delay, which has received far less attention. Aims. The purpose of our study was to describe the data on delays occurring before and after arrival at the hospital in a sample of patients with acute stroke, and to analyse possible associated factors, including the overload on health care services in the Emergency department, an aspect that has not previously been evaluated. Patients and methods. Epidemiological data, times of delays before and after entering the hospital, means of transport used and the health care workload in the Emergency department of the day of admission were collected for all the stroke patients admitted to the Stroke Unit of the Hospital General Universitario de Alicante throughout the period under study. Results. From an initial sample of 460 patients, 423 were finally included in the study, with a mean delay before and after admission to hospital of 3.99 and 2.36 hours, respectively. Use of an ambulance and the haemorrhagic and transient ischemic attack subtypes were linked to a shorter delay before reaching the hospital, and arrival during the night shift was the only factor associated to a longer delay once inside the hospital. Conclusions. In our environment, there is a need to establish strategies aimed at shortening the times stroke patients take to reach the hospital and the time that elapses before they are attended

[Neurosonological studies in patients over 80 years old]. / Estudio neuroecográfico en mayores de 80 años.

INTRODUCTION: The link between cardiovascular risk factors and carotid atheromatosis has been shown to be more important in middle aged subjects than in the elderly. AIMS: Our aim was to study the frequency of carotid and intracranial atheromatosis in a population over the age of 80 and to compare the presence of neurosonological anomalies depending on whether the patients have suffered a stroke or not. We also wished to compare the findings according to the sex of the patient. PATIENTS AND METHODS: Patients over the age of 80 were studied at our Neurosonology laboratory using carotid and transcranial Doppler ultrasonography. The patients were analysed according to whether they had suffered an ischemic stroke or not. With regard to the carotid, a distinction was made between normal, non-significant atheromatosis and significant atheromatosis (stenosis > 50%). Intracranially, both the middle cerebral artery (normal, stenosis, microangiopathy and post-stenosis) and the basilar artery (normal, stenosis, microangiopathy and hyperdynamics) were studied. RESULTS: We recorded data concerning 832 patients: 342 males (44.1%), mean age 83.63 +/- 3.25 years, and 527 (63.3%) with stroke. The carotid study was pathological, with a higher frequency in stroke patients (32.1% compared with 41.9%; p = 0.002). The presence of atheromatosis was significantly linked to a higher risk of suffering a stroke and more intensely to its being more severe. Carotid studies were pathological with a higher frequency among males (28.7% compared with 40%; p < 0.001). No significant differences were found intracranially in any of the parameters analysed. CONCLUSIONS: There is a high frequency of carotid atheromatosis in patients over 80 years of age. Regardless of the age, carotid atheromatosis appears even more frequently in patients who have suffered a stroke and in males, and is significantly associated to the risk of suffering a stroke. Intracranially, no differences were found.

[Neurosonological findings in the carotid artery in a sample of patients with lacunar infarction]. / Hallazgos neurosonológicos carotídeos en una muestra de pacientes con infarto lacunar.

INTRODUCTION: Carotid stenosis has been reported as being associated to lacunar infarcts (LI) with variable frequency, but the aetiopathogenic relation between them is still subject to some controversy. AIMS: Our aim was to describe the prevalence of carotid disorders in a neurosonological study of a sample of patients with LI. PATIENTS AND METHODS: We analysed the results of the neurosonological study conducted on patients with clinical-radiological criteria of LI who were admitted to our Stroke Unit during the period of study. RESULTS: We studied 140 patients, and results were normal in only 42% of the cases. Stenosis > 50% was found in 10% of the cases and plaque without stenosis in 40.3% of the patients. In patients without plaque there was an increase in the tunica intima-media thickness in 7.2% of the cases. CONCLUSION: In most of the patients with LI there were anomalies in the study of the carotid performed using ultrasound scanning.

Estenosis basilar con ataques isquémicos transitorios de repetición: a propósito de un caso de buena respuesta a la anticoagulación

No disponible

No disponible

[Modification of clinical profile of stroke in atrial fibrillation patients. Effect of antithrombotic treatment]. / Modificacion del perfil clinico de los ictus en enfermos con fibrilacion auricular. Efecto del tratamiento antitrombotico.

BACKGROUND: Atrial fibrillation is present in 24% of the population over 60 and it increases the risk of stroke by 2,4% 3%/year. Antithrombotic treatment is considered as the treatment of choice for cardioembolic stroke prevention in this patients. As far as we know there are not relevant data about the influence of these treatments on the type of stroke that may develop in these patients. AIM: Analyze whether there are differences in the clinical profile and functional prognosis after stroke in patients with atrial fibrillation depending on the type of treatment they were on at the time of occurrence of the event. PATIENTS AND METHODS: We identified 67 patients who were admitted consecutively to our stroke unit with a stroke and atrial fibrillation over a period of 2 years. Patients were classified according to the type of antithrombotic treatment they were on. Functional prognosis was estimated by Rankin score at discharge. RESULTS: Treated patient showed a non significant tendency to suffer less severe strokes and present a better functional situation at discharge than those who were not on prophylactic treatment. Treated patients had a significant higher prevalence of previous TIA (44,2% vs 9,1%; p= 0,0042) and HBP (81,4% vs 52%; p= 0,041) than non treated patients. Embolic strokes were more frequent in non treated patients. CONCLUSION: Antithrombotic treatment not only prevents strokes but may also contribute to the development of less severe strokes with a better functional prognosis in patients with AF and does not contribute to increase complications in these group of patients.

Modificación del perfil clínico de los ictus en enfermos con fibrilación auricular. Efecto del tratamiento antitrombótico / Modification of clinical profile of stroke in atrial fibrillation patients. Effect of antithrombotic treatment

Background. Atrial fibrillation is present in 2-4% of the population over 60 and it increases the risk of stroke by 2,4-3% per year. Antithrombotic treatment is considered as the treatment of choice for cardioembolic stroke prevention in this patients. As far as we know there are not relevant data about the influence of these treatments on the type of stroke that may develop in these patients. Aim. Analyze whether there are differences in the clinical profile and functional prognosis after stroke in patients with atrial fibrillation depending on the type of treatment they were on at the time of occurrence of the event. Patients and methods. We identified 67 patients who were admitted consecutively to our stroke unit with a stroke and atrial fibrillation over a period of 2 years. Patients were classified according to the type of antithrombotic treatment they were on. The clinical picture was evaluated by the Canadian scale. Functional prognosis was estimated by Rankin score at discharge. Results. Treated patient showed a non-significant tendency to suffer less serious strokes and present a better functional situation at discharge than those who were not on prophylactic treatment. Treated patients had a significant higher prevalence of previous TIA (44,2% vs 9,1%; p = 0,0042) and HBP (81,4% vs 52%; p = 0,041) than non-treated patients. Embolic strokes were more frequent in non-treated patients. Conclusion. Antithrombotic treatment not only prevents strokes but may also contribute to the development of less serious strokes with a better functional prognosis in patients with AF and does not contribute to increase complications in these group of patients (AU)

Introducción. La fibrilación auricular (FA) aparece en el 2-4 por ciento de la población mayor de 60 años y hace aumentar el riego de ictus en un 2,4-3 por ciento por año. El tratamiento antitrombótico es el tratamiento de elección para prevenir los ictus de origen embólico. No existen datos relevantes sobre la influencia de estos tratamientos en el tipo de ictus que aparece en estos pacientes. Objetivo. Analizar si existen diferencias en la clínica y el pronóstico funcional entre pacientes con ictus y FA según se traten o no. Pacientes y métodos. Hemos incluido a 67 pacientes que ingresaron consecutivamente en nuestra Unidad de Ictus con FA asociada al ictus durante un período de 2 años. Hemos clasificado a los pacientes de acuerdo con el tipo de tratamiento profiláctico que recibían. Estimamos la clínica inicial mediante la escala canadiense, y la situación funcional al alta, mediante la escala de Rankin. Resultados. Encontramos una tendencia estadísticamente no significativa a una clínica menos grave al ingreso y un mejor estado funcional al alta a favor de los tratados respecto los no tratados. También encontramos diferencias significativas a favor de los tratados en cuanto a los antecedentes de accidente isquémico transitorio (44,2 por ciento frente a 9,1 por ciento; p = 0,0042) y a HTA (81,4 por ciento frente a 52 por ciento; p = 0,041), así como una mayor proporción de ictus embólicos en los no tratados. Conclusión. El tratamiento antitrombótico adecuado en un paciente con FA podría asociarse, en caso de aparecer un ictus, a una clínica inicial menos grave y un mejor estado funcional final respecto los no tratados sin aumentar el número de complicaciones (AU)

[Gabapentin in 50 patients with epilepsy]. / Gabapentina en 50 pacientes con epilepsia.

OBJECTIVE: To evaluate monotherapy treatment with the anticonvulsant drug gabapentin, its efficacy and tolerability when used in patients with partial and secondary generalized partial epileptic seizures of recent onset who had not received treatment or who, in spite of treatment with other antiepileptic drugs failed to attain control over their seizures. PATIENTS AND METHODS: We made an open prospective study of 50 patients diagnosed as having partial and secondarily generalized partial epileptic seizures. The patients were given treatment at their first visit and them regularly followed up for two years. Treatment was given progressively until a maintenance dose of 1.200 mg/day was reached, and the dose them adjusted individually. RESULTS: We included 50 patients in the study; 78% were treated with gabapentin. Ten percent stopped this treatment because it was ineffective. All the patients who continued their treatment with gabapentin had their seizures reduced by over 50%. This reduction in the number of seizures is statistically significant (p < 0.05) for patients with partial and secondarily generalized partial seizures. Twelve percent of the group of patients stopped their treatment because of side-effects. CONCLUSIONS: When the results of our study are evaluated and compared with those published in the literature, it may be seen that gabapentin is a safe, effective drug which is well tolerated when used as monotherapy for the treatment of patients with partial seizures.

[Multifocal neurologic syndrome and Fanconi disease]. / Síndrome neurológico multifocal y enfermedad de Fanconi.

A patient suffering from Faconi's anemia presented multifocal neurologic complications, initially with an exacerbating-remitting clinical presentation, next followed by chronic progressive course. Both as a nosologic association or as neurologic complication of Fanconi's anemia, this case is un unpublished observation, to our knowledge.

[Ischemic cerebrovascular accident and climatologic factors]. / Accidente cerebrovascular isquémico y factores climatológicos.

The authors have studied the influence of certain meteorological factors (air temperature, atmospheric pressure and humidity) on the onset of acute cerebrovascular disorders. The investigations related to 232 persons of both sexes affected by stroke. The case material was subjected to detailed statistical analysis. On the basis of their investigations the authors conclude that there is some parallelism between the particular meteorological factors examined and development of strokes.