In-Hospital Symptoms of Depression and Anxiety are Strong Risk Factors for Post-Stroke Depression 90 Days After Ischemic Stroke.

Background and Purpose: Acute ischemic stroke (AIS) and depression are the major causes of disability and decreased quality of life worldwide. Psychiatric disorders are common after stroke, especially post-stroke depression (PSD), which affects one-third of survivors. Although frequent, little is known about the real complexity of the pathophysiology and the factors associated with PSD. Methods: This research aimed to provide data about risk factors and predictors of PSD 90 days after AIS. A cohort study was conducted in a tertiary stroke center located in southern Brazil. We interviewed 148 patients with AIS who were consecutively hospitalized between January 2020 and January 2021. The Hospital Anxiety and Depression Scale (HADS) was applied during hospitalization and at follow-up 90 days after AIS. Furthermore, sociodemographic, clinical, and radiological variables were investigated. Predictive factors were assessed using univariate and multivariate linear regression. The impact of the COVID-19 pandemic on the data was also evaluated. Results: The frequency of PSD 90 days after AIS was 33.9%. In-hospital symptoms of depression and anxiety each represented a 2-fold risk for PSD at follow-up. Furthermore, the HADS - anxiety score 90 days after AIS was strongly associated with the HADS - depression value 90 days after stroke (R: .71; B: .56; P < .01). Conclusions: The present study highlighted a noteworthy frequency of PSD 90 days after AIS. Psychiatric variables during hospitalization and in the follow-up appeared to be the leading associated factors with PSD. These data might support the determination of which patients require more psychiatric management.

Factors associated with post-stroke depression in the acute phase of ischemic stroke: A cross-sectional study.

OBJECTIVES: Ischemic stroke is a remarkable cause of death and disability worldwide. Post-stroke depression (PSD) is the most common psychiatric disturbance after stroke. Despite PSD being a potentially treatable condition, it still requires approaches to improve the early diagnosis. The present study aims to investigate the factors associated and correlated variables associated with PSD during hospitalization. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted in a specialized center of neurology in Santa Catarina, Brazil. 148 patients with acute ischemic stroke hospitalized between January 2020 and February 2021 were included. Sociodemographic, clinical and radiological variables were assessed during hospitalization. The Hospital Anxiety and Depression Scale (HADS) was applied, as well as the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Factors associated were investigated through binary logistic regression and continuous variables through correlation tests. RESULTS: The prevalence of PSD during hospitalization was 31.1%. Factors associated with PSD in the acute phase of the stroke were female sex (OR: 2.6; CI 95%: 1.3-5.4; p < 0.01) and post-stroke anxiety during hospitalization (OR: 4.9; CI 95%: 2.3-10.3; p < 0.01). The variables NIHSS, mRS, and stroke area were positively correlated with HADS - depression values. CONCLUSIONS: This research evidenced a high prevalence of PSD in the acute phase of stroke. Despite the study being conducted during the COVID-19 pandemic, the frequency is similar to the non-pandemic periods. The research provided clues to identify and timely treat patients at greater risk of developing PSD during hospitalization.

Protocolo estadual para atendimento de casos suspeitos ou confirmados de síndrome de trombose com trombocitopenia (STT) associada à vacinação com vacinas de vetor de adenovírus não replicante contra a covid-19 / State protocol for the care of suspected or confirmed cases of thrombosis syndrome with thrombocytopenia (STT) associated with vaccination with non-replicating adenovirus vector vaccines against covid-19

Os efeitos generalizados exercidos pela pandemia da doença do Coronavírus 2019 (COVID-19) obrigaram governos e instituições de saúde mundiais a deslocar recursos para a contenção da crise sanitária e a desenvolver métodos para reduzi-los. As vacinas foram elencadas como principal método para conter a pandemia, com mais de um bilhão de doses administradas em todo o mundo. Entre as vacinas produzidas até o momento para combate ao vírus causador, SARS-CoV-2, estão as vacinas de vetores de adenovírus da Oxford-AstraZeneca (AZD1222) e a da Johnson & Johnson (Ad26.COV2.S). Após a implementação da vacinação em massa da população mundial, relatou-se um distúrbio pró-trombótico extremamente raro associado a ambas vacinas com trombocitopenia concomitante e desenvolvimento de anticorpos antiplaquetários fator 4 (anti-PF4). Esta desordem foi denominada inicialmente como Síndrome da Trombose com Trombocitopenia (STT) e posteriormente como Trombose Trombocitopênica Imune induzida por Vacina (TTIV). Os primeiros casos de trombose relacionados à vacinação para o SARS-CoV-2 começaram a ser reportados no final de fevereiro de 2021. Os relatos levaram à abertura de uma investigação pelas Agências do Reino Unido de Regulação de Produtos de Saúde e Medicina (MHRA) e Europeia de Medicina (EMA), as quais anunciaram em 11 de março de 2021 que não havia uma associação identificada. Entretanto, três grupos de cientistas da Noruega, Alemanha e Reino Unido reportaram, na semana seguinte, um caso de trombose localizada no seio venoso cerebral com trombocitopenia e anticorpos antiplaquetários fator 4 em um indivíduo que havia recebido a vacina da Oxford-AstraZeneca. Após maiores investigações, em 7 de abril de 2021, MHRA e EMA anunciaram a nova Síndrome de Trombose com Trombocitopenia e anticorpos antiplaquetários fator 4. Em 11 de novembro de 2021, houve a elaboração de uma definição de caso para STT, realizada pelo Brighton Collaboration, a qual engloba 5 critérios: (1) evidência de trombocitopenia sem exposição recente à heparina; (2) presença de trombose ou tromboembolismo confirmado por exame de imagem, procedimento cirúrgico, exame patológico ou dor de cabeça persistente com elevação de D-dímero (sugerindo trombose de seio venoso cerebral); (3) sintomas clínicos de trombose (Quadro 1); (4) exames de imagem e achados laboratoriais que confirmem o diagnóstico de trombose ou tromboembolismo; (5) achados laboratoriais que confirmem o diagnóstico de anticorpos de ativação plaquetária mediados por trombose, como enzima-imunoensaio (EIA) positivo para anti-PF4 e teste funcional positivo de ativação plaquetária com adição de PF4.

Acute ischemic stroke and COVID-19 pandemic in Brazil: a comparative study of frequency and risk factors before and during SARS-CoV-2 era.

BACKGROUND: COVID-19 pandemic directly impacted the request for hospital care and medical assistance for several diseases worldwide, as occurred with acute ischemic stroke. The present study sought to compare the incidence and severity of acute ischemic stroke (AIS), in addition to sociodemographic, clinical, and radiological characteristics of patients hospitalized in the prepandemic (2018-2019) and pandemic (2020-2021) eras. METHODS: An incidence case-control, observational, and analytical research was carried out in the Stroke Unit of Hospital Governador Celso Ramos, Florianopolis, Santa Catarina, Brazil, including 171 patients admitted with acute ischemic stroke from April 2018 to April 2019 (prepandemic era) and 148 patients between January 2020 and January 2021 (during pandemic). RESULTS: The mean incidence of AIS hospital admissions was significantly lower in the pandemic period (CI 95%, 0.2 to 5.6; p = 0.04), being lower in the lockdown periods and when the incidence of new COVID-19 cases increased. Besides, referring to AIS severity, the mean areas of AIS were larger during the pandemic period (p < 0.01), especially in August, September, December, and January (p < 0.05). Sociodemographic and clinical variables did not show any difference between the two periods of the study. CONCLUSIONS: Hospital admissions for AIS decreased in the COVID-19 pandemic, mostly during months of higher incidences of new COVID-19 cases. When the incidence of admissions diminished, an increase in the severity of AIS was observed, characterized by larger areas. These findings might contribute to other similar referral centers in managing public policies related to stroke.

Perfil dos pacientes acometidos com Acidente Vascular Cerebral Isquêmico hospitalizados no Hospital Governador Celso Ramos / Descriptive characteristics of patients with Ischemic Stroke hospitalized at Hospital Governador Celso Ramos

Introdução: O Acidente Vascular Encefálico (AVE) éuma das principais causas de morte no mundo e a primeirano Brasil, resultando em milhares de pacientescom sequelas neurológicas, incapazes de manter suasatividades de vida diária normalmente. O presente estudoteve como objetivo identificar e definir o perfilepidemiológico dos pacientes acometidos com AVE,atendidos em hospital terciário de referência em Neurologia.Métodos: Foram incluídos no estudo os pacientesque sofreram AVE isquêmicos e que foram internadosno Hospital Governador Celso Ramos no período de01 de março a 31 de agosto de 2010. Foram coletadasvariáveis clínicas e demográficas, além de escalas específicaspara avaliação da gravidade do AVE. Resultados:Foram avaliados 47 pacientes, com média de idade de66 anos, sendo 53.2% do sexo feminino, e 87.2% caucasianos.Hipertensão arterial sistêmica foi encontradaem 78.7% dos pacientes, dislipidemia em 40.4% e diabetesmellitus em 29.8%. Hemiparesia foi o sintomade apresentação em 89.4% dos pacientes, e o NIHSSde admissão teve média de 12 pontos, reduzindo paramédia de 6 pontos na alta hospitalar. Da amostra estudada,apenas 6 pacientes foram submetidos à trombólise.Conclusão: No presente estudo foi observada maiorincidência de AVE com o avançar da idade, além dapresença de fatores de risco como hipertensão arterialsistêmica e dislipidemia. Atribuímos a baixa incidênciade trombólise pelo tempo ictus-porta ter sido maior de4.5h na maioria dos pacientes.

Background: Stroke is a leading cause of death worldwideand the first in Brazil, resulting in thousands ofpatients with neurological impairment, unable to maintaintheir daily activities normally. This study aimed toidentify and define the epidemiological profile of affectedpatients with ischemic stroke treated at a tertiaryhospital in Neurology. Methods: The study includedpatients who experienced ischemic stroke and were admittedto the Hospital Governador Celso Ramos in theperiod from 01 March to 31 August 2010. We collecteddemographic and clinical variables, and specific scalesfor assessment of stroke severity. Results: We evaluated47 patients with a mean age of 66 years, 53.2%female and 87.2% Caucasian. Hypertension was foundin 78.7% of patients, dyslipidemia in 40.4% and diabetesmellitus in 29.8%. Hemiparesis was the presentingsymptom in 89.4% of patients, and admission NIHSShad a mean of 12 points, falling to mean of 6 pointsat discharge. Out of the sample, only 6 patients underwentthrombolysis. Conclusion: In this study therewas a higher incidence of stroke with advancing age,and the presence of risk factors such as hypertensionand dyslipidemia. We attribute the low incidence ofstroke thrombolysis by time ictus-gate being greaterthan 4.5h in most patients.

Neurological complications following bariatric surgery.

OBJECTIVE: It was to report on Brazilian cases of neurological complications from bariatric surgery. The literature on the subject is scarce. METHOD: Cases attended by neurologists in eight different Brazilian cities were collected and described in the present study. RESULTS: Twenty-six cases were collected in this study. Axonal polyneuropathy was the most frequent neurological complication, but cases of central demyelination, Wernicke syndrome, optical neuritis, radiculits, meralgia paresthetica and compressive neuropathies were also identified. Twenty-one patients (80%) had partial or no recovery from the neurological signs and symptoms. CONCLUSION: Bariatric surgery, a procedure that is continuously increasing in popularity, is not free of potential neurological complications that should be clearly presented to the individual undergoing this type of surgery. Although a clear cause-effect relation cannot be established for the present cases, the cumulative literature on the subject makes it important to warn the patient of the potential risks of this procedure.

Neurological complications following bariatric surgery / Complicações neurológicas da cirurgia bariátrica

OBJECTIVE: It was to report on Brazilian cases of neurological complications from bariatric surgery. The literature on the subject is scarce. METHOD: Cases attended by neurologists in eight different Brazilian cities were collected and described in the present study. RESULTS: Twenty-six cases were collected in this study. Axonal polyneuropathy was the most frequent neurological complication, but cases of central demyelination, Wernicke syndrome, optical neuritis, radiculits, meralgia paresthetica and compressive neuropathies were also identified. Twenty-one patients (80%) had partial or no recovery from the neurological signs and symptoms. CONCLUSION: Bariatric surgery, a procedure that is continuously increasing in popularity, is not free of potential neurological complications that should be clearly presented to the individual undergoing this type of surgery. Although a clear cause-effect relation cannot be established for the present cases, the cumulative literature on the subject makes it important to warn the patient of the potential risks of this procedure.

OBJETIVO: Foi relatar casos de pacientes brasileiros com complicações neurológicas da cirurgia bariátrica. A literatura no assunto é escassa. MÉTODO: Foram reunidos e descritos casos atendidos por neurologistas em oito cidades brasileiras diferentes. RESULTADOS: Vinte e seis casos foram coletados neste estudo. A complicação neurológica mais frequente foi a polineuropatia axonal, mas também foram identificados casos de desmielinização central, síndrome de Wernicke, neurite óptica, radiculites, meralgia parestésica e neuropatias compressivas. Vinte e um pacientes (80%) não tiveram recuperação ou tiveram apenas recuperação parcial dos sinais e sintomas neurológicos. CONCLUSÃO: A cirurgia bariátrica, procedimento cada vez mais popularizado, não está livre de potenciais complicações neurológicas as quais deveriam ser claramente expostas aos indivíduos que a ela se submetem. Embora não possa ser estabelecida uma clara relação causa-efeito entre essa cirurgia e os sinais e sintomas referidos nos casos aqui apresentados, a literatura consultada mostrou ser importante alertar o indivíduo acerca dos riscos potenciais envolvidos nesse procedimento.