En respuesta a «Trombectomía mecánica en el ictus isquémico agudo, conociendo nuestros resultados» / In reply to "Mechanical thrombectomy in acute ischemic stroke, knowing our results"

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Temblor ortostático como manifestación aislada de tirotoxicosis tras arteriografía cerebral / Orthostatic tremor as the only manifestation of thyrotoxicosis following cerebral angiography

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Resultados y evolución funcional de pacientes críticos con ictus isquémico sometidos a trombectomía mecánica / Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit

OBJETIVO: Estudiar los resultados y las complicaciones del tratamiento endovascular (TEV) en pacientes con ictus isquémico agudo ingresados en una unidad de cuidados intensivos (UCI). Analizar los factores que podrían influir en la mortalidad y en el grado de discapacidad al alta y un año después del ictus. DISEÑO: Estudio prospectivo observacional. Ámbito: UCI polivalente. Hospital de tercer nivel. PACIENTES: Sesenta pacientes adultos. Muestra consecutiva. INTERVENCIONES: Ninguna. Variables de interés: Datos epidemiológicos, tiempo desde la clínica inicial hasta el TEV, resultado angiográfico, tiempo de estancia en UCI, días de ventilación mecánica, complicaciones neurológicas, National Institutes of Health Stroke Scale (NIHSS) al ingreso y al alta de UCI, escala de Rankin modificada (mRS) al año de evolución. RESULTADOS: Edad media 68,90±8,84años. Mediana de tiempo hasta el TEV: 180min. Mediana NIHSS al ingreso: 17,5; al alta: 3. Flujo distal en el 90% de los casos. Mediana estancia en UCI: 3días. Ventilación mecánica: 81,7%. Independencia funcional (mRS≤2) 50% al año del ictus. Fallecimientos: 22 (36,6%); 8 (13,3%) en la UCI y el resto durante el primer año. CONCLUSIONES: Las variables asociadas a un peor estado funcional fueron la transformación hemorrágica sintomática, la ausencia de recanalización y las complicaciones durante el procedimiento. La transformación hemorrágica y la hidrocefalia se asociaron a mayor mortalidad. Se consiguió flujo distal en la mayoría de los casos, con una baja tasa de complicaciones. La mitad de los pacientes alcanza independencia funcional al año del ictus

PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None. Variables of interest: Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. RESULTS: Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. CONCLUSIONS: The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke

[Analysis of the direct costs associated with mechanical thrombectomy and intravenous fibrinolysis in the Hospital Universitario Central de Asturias]. / Analisis de los costes directos asociados a la trombectomia mecanica y a la fibrinolisis intravenosa en el Hospital Universitario Central de Asturias.

INTRODUCTION: The increase in the indications for mechanical thrombectomy and its implementation in Spanish hospitals makes it necessary to determine the costs related to this treatment so as to be able to streamline economic resources and allow them to be distributed in an appropriate manner. AIMS: To analyse the direct costs associated with patients with acute ischaemic stroke who are treated with intravenous fibrinolysis and with mechanical thrombectomy, and to assess the effectiveness and safety of both treatments during the first 90 days of progression in the Hospital Universitario Central de Asturias. PATIENTS AND METHODS: A retrospective analysis was performed that included 44 patients who received intravenous fibrinolysis and 61 patients treated with mechanical thrombectomy, in whom a series of clinical and economic variables were analysed. RESULTS: The mean final total cost per patient was 16,059 euros in treatments with thrombectomy and 8,169 euros in those in which intravenous fibrinolysis was administered. The percentage of patients with a good functional prognosis at 90 days was 63.93% in those treated by endovascular means and 56.82% in those who received intravenous fibrinolysis. Mortality rates were 18.03 and 11.36%, respectively. CONCLUSIONS: The mean cost of treatment with mechanical thrombectomy, as well as the total mean cost per patient during the acute phase of the disease associated with this technique, is higher than in the case of intravenous fibrinolysis. In our setting, both intravenous fibrinolysis and mechanical thrombectomy are considered to be effective and safe.

TITLE: Analisis de los costes directos asociados a la trombectomia mecanica y a la fibrinolisis intravenosa en el Hospital Universitario Central de Asturias.Introduccion. La ampliacion de las indicaciones de la trombectomia mecanica y su implementacion en los hospitales españoles hacen necesario conocer los costes relacionados con este tratamiento para racionalizar los recursos economicos y permitir una adecuada distribucion de estos. Objetivos. Analizar los costes directos asociados a los pacientes con ictus isquemico agudo tratados con fibrinolisis intravenosa y con trombectomia mecanica, y valorar la efectividad y seguridad de ambos tratamientos durante los primeros 90 dias de evolucion en el Hospital Universitario Central de Asturias. Pacientes y metodos. Se realizo un analisis retrospectivo en el que se incluyo a 44 pacientes que recibieron fibrinolisis intravenosa y a 61 pacientes tratados con trombectomia mecanica, en los que se analizaron una serie de variables clinicas y economicas. Resultados. El coste total final medio por paciente fue de 16.059 euros en los tratados con trombectomia y de 8.169 euros en los que se administro fibrinolisis intravenosa. El porcentaje de pacientes con buen pronostico funcional a los 90 dias fue del 63,93% en los tratados de forma endovascular y del 56,82% en los que recibieron fibrinolisis intravenosa. Las tasas de mortalidad fueron del 18,03% y 11,36%, respectivamente. Conclusiones. El coste medio del tratamiento con trombectomia mecanica, asi como el coste medio total por paciente durante la fase aguda de la enfermedad asociado a esta tecnica, es mayor que en el caso de la fibrinolisis intravenosa. Tanto la fibrinolisis intravenosa como la trombectomia mecanica se configuran en nuestro medio como tratamientos efectivos y seguros.

Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit. / Resultados y evolución funcional de pacientes críticos con ictus isquémico sometidos a trombectomía mecánica.

PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None. VARIABLES OF INTEREST: Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. RESULTS: Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. CONCLUSIONS: The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke.

[Sex differences in the integrated stroke management in a rural healthcare area in Asturias]. / Diferencias de sexo en el abordaje integral del ictus en un area sanitaria rural de Asturias.

INTRODUCTION: Sex differences and the (rural or urban) nature of populations largely determine the integrated management of time-dependent pathologies such as strokes, which is the main cause of female hospitalisation and mortality in our setting. AIM: To determine whether any differential characteristics can be observed between male and female stroke patients in a rural healthcare area in the Principality of Asturias. PATIENTS AND METHODS: A descriptive retrospective study was conducted at the Jarrio Hospital. Different variables were reviewed using the computerised medical records of patients who suffered a stroke in 2013. RESULTS: Altogether 126 patients were discharged, 53.2% among females, who suffered the disease with a five-year delay (p < 0.008) with respect to males. These latter smoked more and also drank harmful amounts of alcohol (p < 0.000). The pre-hospital delay did not yield any significant sex differences. Language disorder was the main symptom in the female group (p < 0.008), who scored higher on the National Institute of Health Stroke Scale (p < 0.046). Complementary studies, such as Holter monitoring (p < 0.04) and ultrasound scanning of the supra-aortic trunks (p < 0.02), are conducted less often in females, who mainly received conservative treatment with greater parenteral hydration (p < 0.017) and rest. The female group suffered more complications, disability at discharge (p < 0.001) and at three months (p < 0.004), and recorded higher percentages of subsequent institutionalisation (p < 0.005). CONCLUSIONS: There are demographic sex differences in the cerebrovascular risk profile, clinical presentation, hospital management and comorbidity of stroke in this rural population, which suggest that there are areas where there is room for improvement.

TITLE: Diferencias de sexo en el abordaje integral del ictus en un area sanitaria rural de Asturias.Introduccion. Las diferencias de sexo y el caracter (rural o urbano) de las poblaciones determinan en gran medida el abordaje integral de patologias dependientes del tiempo, como el ictus, principal causa de hospitalizacion y mortalidad femenina en nuestro medio. Objetivo. Determinar si en un area sanitaria rural del Principado de Asturias se ponen de manifiesto las caracteristicas diferenciales entre mujeres y hombres con ictus. Pacientes y metodos. Estudio descriptivo retrospectivo realizado en el Hospital de Jarrio. Se revisaron variables a traves de las historias clinicas informatizadas de los pacientes que sufrieron ictus en 2013. Resultados. Se produjeron 126 altas totales, el 53,2% en las mujeres, que sufrieron la enfermedad con un retraso de cinco años (p < 0,008) en relacion con los varones, los cuales fueron mas fumadores y consumidores perjudiciales de alcohol (p < 0,000). La demora prehospitalaria no arrojo diferencias de sexo significativas. El trastorno del lenguaje fue el sintoma principal en el grupo femenino (p < 0,008), que registro una puntuacion superior en la National Institute of Health Stroke Scale (p < 0,046). Los estudios complementarios, como el Holter (p < 0,04) y la ecografia de troncos supraaorticos (p < 0,02), se realizaron menos en las mujeres, que recibieron un tratamiento principalmente conservador con mayor hidratacion parenteral (p < 0,017) y reposo. El grupo femenino sufrio mas complicaciones, discapacidad al alta (p < 0,001) y a los tres meses (p < 0,004), y registro porcentajes mas elevados de institucionalizacion posterior (p < 0,005). Conclusiones. Existen diferencias de sexo demograficas, en el perfil de riesgo cerebrovascular, la presentacion clinica, el manejo hospitalario y la comorbilidad del ictus en esta poblacion rural, que sugieren areas de mejora.

[Diagnosis of stroke due to cocaine and its complications]. / Diagnostico del ictus por cocaina y sus complicaciones.

INTRODUCTION. Cocaine is an independent cerebrovascular risk factor both for ischaemic and haemorrhagic events, above all among persons under 55 years of age. CASE REPORT. A case report of stroke due to the consumption of cocaine is used to review its pathophysiology and the complexity involved in the management and diagnosis of the associated complications. One of these complications reported in relation to the consumption of cocaine is vasospasm. This condition shares findings observed in ultrasound imaging studies with other conditions, such as early-onset post ischaemic hyperperfusion. Yet, there are important differences between the two as regards their treatment and prognosis. CONCLUSIONS. The consumption of cocaine is associated with cerebrovascular disease through a number of different mechanisms, which each give rise to different complications. By identifying these complications, correct management can be implemented.

TITLE: Diagnostico del ictus por cocaina y sus complicaciones.Introduccion. La cocaina es un factor de riesgo cerebrovascular independiente, tanto para eventos isquemicos como hemorragicos, sobre todo entre los menores de 55 años. Caso clinico. A traves de un caso clinico de ictus por consumo de cocaina, se revisa su fisiopatologia y la complejidad en el manejo y diagnostico de las complicaciones asociadas. Una de estas complicaciones descritas en relacion con el consumo de cocaina es el vasoespasmo. Esta entidad comparte con otras entidades, como la hiperperfusion postisquemica precoz, los hallazgos en estudios ecograficos. Sin embargo, ambas presentan importantes diferencias en cuanto a tratamiento y pronostico se refiere. Conclusiones. El consumo de cocaina se asocia con la enfermedad cerebrovascular a traves de multiples mecanismos, de los que se derivan diferentes complicaciones. Identificar estas complicaciones permite su correcto abordaje.

Disartria y mareo persistente con estudio neurológico previo: hasta dónde seguir investigando / Acute persistent dysarthria and dizziness with previous neurogical study: is it enough to establish a diagnosis?

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Tratamiento endovascular de la estenosis carotídea: experiencia en el Hospital Universitario Central de Asturias / Endovascular treatment of carotid stenosis: an experience in the Hospital Universitario Central de Asturias

Introducción. La estenosis carotídea es responsable de aproximadamente el 25% de los eventos cerebrovasculares isquémicos. La angioplastia-stent carotídeo (ASC) constituye un procedimiento mínimamente invasivo utilizado como alternativa a la endarterectomía carotídea, especialmente en pacientes de alto riesgo quirúrgico. Objetivo. Analizar la eficacia y seguridad del tratamiento endovascular de la estenosis carotídea en el Hospital Universitario Central de Asturias. Pacientes y métodos. Análisis retrospectivo de las estenosis carotídeas tratadas mediante ASC entre febrero de 2005 y abril de 2010, con registro de datos demográficos, diagnóstico clínico, indicación de tratamiento, tiempo entre el inicio de los síntomas y la realización del tratamiento, resultados angiográficos, complicaciones y seguimiento a largo plazo (incluyendo la tasa de reestenosis). Resultados. Se trataron 121 pacientes (77,8% varones y 22,2% mujeres), con una edad media de 70,8 ± 10,7 años. Los principales factores de riesgo vascular fueron hipertensión arterial (65,3%), tabaquismo (61,2%) y dislipidemia (42,1%). En el 86% de los casos se trataba de estenosis sintomáticas y en el 14% de asintomáticas. En un 60,3% de los casos se trataba de estenosis > 70%; en un 30,6%, de estenosis preoclusivas, y en un 9,1%, de recanalizaciones de oclusiones carotídeas inestables. El tiempo medio de tratamiento fue de 17,0 ± 8,3 días tras el evento isquémico. La estenosis residual fue inferior al 30% en todos los casos. La tasa de morbimortalidad a 30 días fue del 4,1% y la tasa de reestenosis a lo largo de un seguimiento medio de 31,2 ± 10,8 meses fue del 2,4%. Conclusiones. La ASC en nuestro hospital se configura como una técnica eficaz y segura, con una tasa de complicaciones dentro de los parámetros que justifican su indicación (AU)

Introduction. Carotid stenosis accounts for about 25% of all ischaemic cerebrovascular events. Carotid angioplasty and stenting (CAS) is a minimally invasive procedure used as an alternative to carotid endarterectomy, especially in high surgical risk patients. Aim. To analyse the effectiveness and safety of the endovascular treatment of carotid stenosis in the Hospital Universitario Central de Asturias. Patients and methods. The study consisted in a retrospective analysis of the carotid stenoses treated by means of CAS between February 2005 and April 2010, and the following information was recorded: demographic data, clinical diagnosis, indication of treatment, time between the onset of symptoms and beginning of treatment, angiographic findings, complications and long-term follow-up (including the rate of restenosis). Results. Altogether 121 patients were treated (77.8% males and 22.2% females), with a mean age of 70.8 ± 10.7 years. The main vascular risk factors were arterial hypertension (65.3%), smoking (61.2%) and dyslipidaemia (42.1%). In 86% of cases the stenoses were symptomatic and in the remaining 14% they were asymptomatic. In 60.3% of cases they were stenoses > 70%, in 30.6% they were preocclusive stenoses and in 9.1% they were recanalisations of unstable carotid occlusions. The mean treatment time was 17.0 ± 8.3 days after the ischaemic event. The residual stenosis was less than 30% in all cases. The morbidity and mortality rate at 30 days was 4.1% and the rate of restenosis throughout a mean follow-up of 31.2 ± 10.8 months was 2.4%. Conclusions. In our hospital CAS is considered an effective and safe technique, with a rate of complications that is within the parameters that justify its indication (AU)

Recursos asistenciales en ictus en España 2010: análisis de una encuesta nacional del Grupo de Estudio de Enfermedades Cerebrovasculares / Health care resources for stroke patients in Spain, 2010: analysis of a national survey by the Cerebrovascular Diseases Study Group

Introduction: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009. Material and methods: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine. Results: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7days a week in 2009). There were 3 hospitals offering clinical telemedicine services. Conclusions: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS (AU)

Introducción: El ictus constituye un importante problema sociosanitario. Por ese motivo, el Ministerio de Sanidad aprobó en 2008 la Estrategia Nacional en Ictus (ENI) con el objetivo de mejorar la prevención, tratamiento y rehabilitación del paciente con ictus. Se pretende garantizar una atención neurológica en todo el país y a cualquier hora del día para final del 2010. Nuestro objetivo fue analizar la situación de la atención al ictus en España en el año 2009. Material y métodos: Se constituyó un comité de neurólogos de las diferentes CC. AA. que no hubieran participado en la ENI. Se elaboró una encuesta nacional que recogió el número de unidades de ictus (UI) y la dotación (monitorización, guardia de neurología 24h/7 días, ratio de enfermería y existencia de protocolos), ratio cama UI/100.000 habitantes, presencia de trombólisis iv, intervencionismo neurovascular (INV) y telemedicina. Resultados: Se incluyeron datos de 145 hospitales. Existen 39 UI distribuidas de un modo desigual. La relación cama de UI/número de habitantes/comunidad autónoma osciló entre 1/75.000 a 1/1.037.000 habitantes, cumpliendo el objetivo Navarra y Cantabria. Se realiza trombólisis iv en 80 hospitales, el número osciló entre 7-536 tratamientos/CC. AA. durante el año 2008. Se realiza INV en el 63% de las CC. AA., teniendo 28 centros capacitados, aunque sólo 1 la realizaba en 2009 las 24h/7 día. Existen 3 centros con telemedicina. Conclusiones: La asistencia al ictus ha mejorado en España respecto a unos años atrás, pero todavía existen importantes desigualdades por CC. AA. que deberían superarse si se quiere cumplir el objetivo de la ENI (AU)

Health care resources for stroke patients in Spain, 2010: analysis of a national survey by the Cerebrovascular Diseases Study Group.

INTRODUCTION: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009. MATERIAL AND METHODS: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine. RESULTS: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7 days a week in 2009). There were 3 hospitals offering clinical telemedicine services. CONCLUSIONS: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS.

Tratamiento quirúrgico del ictus de la arteria cerebral media / Surgical treatment of the stroke in the middle cerebral artery

Introducción. La craniectomía descompresiva aumenta la supervivencia en los infartos malignos de la arteria cerebral media (ACM). Se analizan los signos radiológicos y clínicos que predicen la evolución maligna del infarto de la ACM,y factores asociados a un peor pronóstico. Pacientes y métodos. Se estudian 30 pacientes divididos en tres grupos: pacientes operados, y pacientes no operados con ingreso en cuidados intensivos o en planta de neurología. La técnica quirúrgica consistióen la creación de una ventana ósea de al menos 10 cm de diámetro y apertura dural. Para la valoración inicial del paciente se utilizó la escala de Glasgow y la escala de ictus del National Institute of Health, y para el seguimiento, la escala modificadade Rankin, el índice de Barthel y la Glasgow Outcome Scale a los seis meses. Resultados. Los pacientes más jóvenes tienen un mejor pronóstico funcional que los mayores de 60 años. La desviación de la línea media mayor de 10 mm se asocia con un peor pronóstico, al igual que volúmenes de tejido infartado mayores de 350 cm3. Menor puntuación en la escala de Glasgow al ingreso se asocia a peor pronóstico vital y a mayor número de secuelas, así como su disminución durante el ingreso. Conclusiones. La edad condiciona la presencia de secuelas en estos pacientes. La presencia de signos clínicos de herniación (anisocoria, menor puntuación inicial o descenso importante en la escala de Glasgow) y radiológicos (desplazamiento de la línea media, volumen infartado) implica un peor pronóstico. La cirugía precoz en aquellos pacientes en que estuviera indicada reduce el número de secuelas y aumenta la supervivencia (AU)

Introduction. Decompressive craniectomy increases the survival rate in cases of malignant middle cerebral artery (MCA) stroke. The imaging and clinical signs that predict a malignant progression of stroke of the MCA are analysed, together with factors associated with a poorer prognosis. Patients and methods. The study involved 30 patients, who were divided into three groups: patients who had undergone surgery, and patients who had not undergone surgery but were admitted to intensive care or to neurology wards. The surgical procedure consisted in creating a bone window with a diameter of at least 10 cm and a dural opening. The initial evaluation of the patient was performed using the Glasgow scale and the National Institute of Health stroke scale; follow-up was carried out using the modified Rankin scale, the Barthel index and the Glasgow Outcome Scale at six months. Results. Younger patients have a better functional prognosis than those over 60 years of age. A deviation of more than 10 mm from the mean line is associated with a poorer prognosis, as are volumes of infarcted tissue above 350 cm3. Lower scores on the Glasgow scale on admission are associated with a poorer prognosis for survival and a higher number of sequelae, as well as their reduction during hospitalisation. Conclusions. Age conditions the presence of sequelae in these patients. The presence of clinical signs of herniation (anisocoria, lower initial score or important drop on the Glasgow scale) and imaging signs (displacement of the mean line, volume of infarcted tissue) imply a poorer prognosis. Early surgery in those patients in whom it is indicated reduces the number of sequelae and increases the rate of survival (AU)

[Surgical treatment of the stroke in the middle cerebral artery]. / Tratamiento quirúrgico del ictus de la arteria cerebral media.

INTRODUCTION: Decompressive craniectomy increases the survival rate in cases of malignant middle cerebral artery (MCA) stroke. The imaging and clinical signs that predict a malignant progression of stroke of the MCA are analysed, together with factors associated with a poorer prognosis. PATIENTS AND METHODS: The study involved 30 patients, who were divided into three groups: patients who had undergone surgery, and patients who had not undergone surgery but were admitted to intensive care or to neurology wards. The surgical procedure consisted in creating a bone window with a diameter of at least 10 cm and a dural opening. The initial evaluation of the patient was performed using the Glasgow scale and the National Institute of Health stroke scale; follow-up was carried out using the modified Rankin scale, the Barthel index and the Glasgow Outcome Scale at six months. RESULTS: Younger patients have a better functional prognosis than those over 60 years of age. A deviation of more than 10 mm from the mean line is associated with a poorer prognosis, as are volumes of infarcted tissue above 350 cm3. Lower scores on the Glasgow scale on admission are associated with a poorer prognosis for survival and a higher number of sequelae, as well as their reduction during hospitalisation. CONCLUSIONS: Age conditions the presence of sequelae in these patients. The presence of clinical signs of herniation (anisocoria, lower initial score or important drop on the Glasgow scale) and imaging signs (displacement of the mean line, volume of infarcted tissue) imply a poorer prognosis. Early surgery in those patients in whom it is indicated reduces the number of sequelae and increases the rate of survival.