Accidente isquémico y ¿transitorio? Resonancia magnética en el AIT: experiencia de 106 casos / Ischaemic or transient attack? Magnetic resonance imaging in transient ischaemic attack: a review of 106 cases

Introducción: El accidente isquémico transitorio (AIT) clásicamente se ha definido como un episodio de déficit focal neurológico autolimitado con duración máxima de 24 horas, sin evidencia en la neuroimagen de lesión isquémica aguda establecida. Sin embargo, la definición de esta entidad está variando y se está adaptando a los nuevos tiempos y técnicas diagnósticas, incluida la resonancia magnética (RM) con secuencias en difusión. Es importante un abordaje íntegro y precoz del AIT, con RM cerebral, para descartar ictus isquémicos establecidos recuperados clínicamente, y así optimizar el manejo diagnóstico y terapéutico de los pacientes. Pacientes y métodos: Se identificó a los pacientes ingresados en un período de seis meses como sospecha de AIT en nuestra unidad de ictus, y se estudió el diagnóstico definitivo y su abordaje basándose en las pruebas realizadas. Resultados: Se estudiaron 106 sospechas de AIT en las que se realizó una RM precoz. De ellas, 43 (40,57%) fueron ictus isquémicos clínicamente recuperados (IICR); 31 (29,24%), otras patologías (nueve trastornos funcionales, seis crisis epilépticas, cinco auras migrañosas, dos amyloid spells y nueve otras causas); 26 (24,52%), AIT; y seis (5,66%), ictus hemorrágicos. De 43 IICR, ocho (18,6%) fueron cardioembólicos; ocho (18,6%), aterotrombóticos; ocho (18,6%), ictus embólico de origen desconocido; seis (13,95%), lacunares; cinco (11,62%) de causa infrecuente; cuatro (9,3%) microangiopáticos y cuatro (9,3%), de causa indeterminada. Los IICR recibieron un manejo terapéutico significativamente más individualizado respecto a los pacientes con AIT. Conclusiones: El uso de RM precoz en la sospecha clínica de AIT permite evidenciar la existencia de IICR y optimizar el abordaje diagnóstico y terapéutico de los pacientes.(AU)

Introduction: Transient ischaemic attack (TIA) has classically been defined as an episode of self-limited focal neurological deficit lasting up to 24 hours, with no neuroimaging evidence of established acute ischaemic injury. However, the definition of this entity is changing, and is adapting to new times and new diagnostic techniques, including magnetic resonance imaging (MRI) with diffusion sequences. An early and comprehensive approach to TIA, including MRI, is important to rule out clinically recovered established ischaemic strokes, in order to optimise the diagnostic and therapeutic management of patients. Patients and methods: Patients admitted to our stroke unit over a six-month period with suspected TIA were identified, and the definitive diagnosis and approach was studied based on the tests performed.Results: A sample of 106 suspected cases of TIA were studied, in which early MRI was performed. Of these, 42 (39.62%) were clinically recovered ischaemic strokes (CRIS); 32 (30.18%), other pathologies (six epileptic seizures, five migraine auras, nine functional disorders, two amyloid spells and nine other causes, totalling 31); 26 (24.52%), TIAs; and six (5.66%), haemorrhagic stroke. Of 43 CRIS, eight (18.6%) were cardioembolic; eight (18.6%), atherothrombotic; eight (18.6%), embolic stroke of unknown origin; six (13.95%), lacunar stroke; five (11.62%) of infrequent cause; and four (9.3%), totalling 39, of undetermined cause. CRIS patients received significantly more individualised therapeutic management than TIA patients. Conclusions: The early use of MRI in the clinical suspicion of TIA makes it possible to gather evidence of CRIS and optimises the diagnostic and therapeutic approach for patients.(AU)

[Ischaemic or transient attack? Magnetic resonance imaging in transient ischaemic attack: a review of 106 cases]. / Accidente isquémico y ¿transitorio? Resonancia magnética en el AIT: experiencia de 106 casos.

INTRODUCTION: Transient ischaemic attack (TIA) has classically been defined as an episode of self-limited focal neurological deficit lasting up to 24 hours, with no neuroimaging evidence of established acute ischaemic injury. However, the definition of this entity is changing, and is adapting to new times and new diagnostic techniques, including magnetic resonance imaging (MRI) with diffusion sequences. An early and comprehensive approach to TIA, including MRI, is important to rule out clinically recovered established ischaemic strokes, in order to optimise the diagnostic and therapeutic management of patients. PATIENTS AND METHODS: Patients admitted to our stroke unit over a six-month period with suspected TIA were identified, and the definitive diagnosis and approach was studied based on the tests performed. RESULTS: A sample of 106 suspected cases of TIA were studied, in which early MRI was performed. Of these, 42 (39.62%) were clinically recovered ischaemic strokes (CRIS); 32 (30.18%), other pathologies (six epileptic seizures, five migraine auras, nine functional disorders, two amyloid spells and nine other causes, totalling 31); 26 (24.52%), TIAs; and six (5.66%), haemorrhagic stroke. Of 43 CRIS, eight (18.6%) were cardioembolic; eight (18.6%), atherothrombotic; eight (18.6%), embolic stroke of unknown origin; six (13.95%), lacunar stroke; five (11.62%) of infrequent cause; and four (9.3%), totalling 39, of undetermined cause. CRIS patients received significantly more individualised therapeutic management than TIA patients. CONCLUSIONS: The early use of MRI in the clinical suspicion of TIA makes it possible to gather evidence of CRIS and optimises the diagnostic and therapeutic approach for patients.

TITLE: Accidente isquémico y ¿transitorio? Resonancia magnética en el AIT: experiencia de 106 casos.Introducción. El accidente isquémico transitorio (AIT) clásicamente se ha definido como un episodio de déficit focal neurológico autolimitado con duración máxima de 24 horas, sin evidencia en la neuroimagen de lesión isquémica aguda establecida. Sin embargo, la definición de esta entidad está variando y se está adaptando a los nuevos tiempos y técnicas diagnósticas, incluida la resonancia magnética (RM) con secuencias en difusión. Es importante un abordaje íntegro y precoz del AIT, con RM cerebral, para descartar ictus isquémicos establecidos recuperados clínicamente, y así optimizar el manejo diagnóstico y terapéutico de los pacientes. Pacientes y métodos. Se identificó a los pacientes ingresados en un período de seis meses como sospecha de AIT en nuestra unidad de ictus, y se estudió el diagnóstico definitivo y su abordaje basándose en las pruebas realizadas. Resultados. Se estudiaron 106 sospechas de AIT en las que se realizó una RM precoz. De ellas, 43 (40,57%) fueron ictus isquémicos clínicamente recuperados (IICR); 31 (29,24%), otras patologías (nueve trastornos funcionales, seis crisis epilépticas, cinco auras migrañosas, dos amyloid spells y nueve otras causas); 26 (24,52%), AIT; y seis (5,66%), ictus hemorrágicos. De 43 IICR, ocho (18,6%) fueron cardioembólicos; ocho (18,6%), aterotrombóticos; ocho (18,6%), ictus embólico de origen desconocido; seis (13,95%), lacunares; cinco (11,62%) de causa infrecuente; cuatro (9,3%) microangiopáticos y cuatro (9,3%), de causa indeterminada. Los IICR recibieron un manejo terapéutico significativamente más individualizado respecto a los pacientes con AIT. Conclusiones. El uso de RM precoz en la sospecha clínica de AIT permite evidenciar la existencia de IICR y optimizar el abordaje diagnóstico y terapéutico de los pacientes.

Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain.

BACKGROUND AND PURPOSE: Spain has been one of the countries more heavily stricken by SARS-CoV-2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID-19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. METHODS: This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra- and intra-hospital times of action, Code Stroke activation pathway, COVID-19 status, reperfusion rate, and short-term outcome before and after the setting of the emergency state were analysed. RESULTS: A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out-of-hospital (95.0 vs. 110.0 min, P = 0.001) and door-to-needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID-19 patients had more in-hospital mortality. CONCLUSION: A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out-of-hospital and door-to-needle times and worse reperfusion rates in northwest Spain. COVID-19 patients had more in-hospital mortality.

[Analysis of the reasons for visits to a neurology office in Asturias]. / Análisis de los motivos de consulta en una consulta de Neurología de área en Asturias.

INTRODUCTION: In recent years, the out-patient neurological demand has been growing constantly. Many studies exist on the characteristics of this in our country. However, up to date, none of them have been made in the Principality of Asturias. We have proposed to learn the characteristics of the out-patient neurological care in our area and consequently to contribute to an improvement in medical care planning. PATIENTS AND METHODS: The requests for consultation received were collected prospectively over 18 months. Annual demand was calculated using the population data. One thousand patients were finally included in the study. The following data were gathered: age, gender, origin, reason for consultation, and destination. RESULTS: Demand for first visits was 11.94 per 1.000 inhabitants/year. Average age was of 62.04 years, the highest published to date. More women (59%) than men consulted. The most frequent age range was 75-80 years. Headache was the most common condition. Cognitive problems were the most common one in patients over 65 years. Non-neurological problems were the third reason for consultation. A total of 50.4% of the patients were not given an appointment for follow-up. CONCLUSIONS: Mean age of the patients seem in Neurology seems to be progressively increasing and consequently, consultations for cognitive problems, which together with headaches, are the most frequent reason of consultation. A high percentage of non-neurological conditions can be related with a high percentage of discharges.

Análisis de los motivos de consultaen una consulta de Neurología de áreaen Asturias / Analysis of the reasons for visits to a Neurology office in Asturias

Introducción. En los últimos años, la demanda neurológica ambulatoriaha ido creciendo constantemente. Existen numerosos estudiossobre las características de la misma en nuestro país, pero hastaahora ninguno realizado en el Principado de Asturias. Nos planteamosconocer las características de la asistencia neurológica ambulatoriaen nuestra área y con ello contribuir a una mejor planificaciónde la asistencia sanitaria.Pacientes y métodos. Se recogen de modo prospectivo las peticionesde consulta recibidas durante 18 meses. Con los datos de poblaciónse calcula la demanda anual. Se incluyen 1.000 pacientes enel estudio, de los cuales se recogen los siguientes datos: edad, sexo,procedencia, motivo de consulta y destino.Resultados. La demanda de primeras visitas se situó 11,94 por1.000 habitantes/año. La edad media fue de 62,04 años, la más altapublicada hasta la fecha. Consultaron más mujeres (59%) que hombres.El rango de edad más frecuente estuvo entre 75 y 80 años.La patología más frecuente fue la cefalea. En los enfermos mayoresde 65 años, lo fueron los problemas cognitivos. Como tercer motivo deconsulta se sitúa la patología no neurológica. Un 50,4% de los pacientesno fue citado para revisiones posteriores.Conclusiones. La edad media de los pacientes que acuden aNeurología parece ir aumentando de modo progresivo, y, consecuentemente,las consultas por problemas cognitivos, que, junto a las cefaleas,son el motivo de consulta más frecuente. Existe un importanteporcentaje de patología no neurológica que puede estarrelacionado con un elevado número de altas (AU)

Introduction. In recent years, the out-patient neurologicaldemand has been growing constantly. Many studies exist on thecharacteristics of this in our country. However, up to date, noneof them have been made in the Principality of Asturias. We haveproposed to learn the characteristics of the out-patient neurologicalcare in our area and consequently to contribute to an improvementin medical care planning.Patients and methods. The requests for consultation receivedwere collected prospectively over 18 months. Annual demandwas calculated using the population data. One thousandpatients were finally included in the study. The following datawere gathered: age, gender, origin, reason for consultation, anddestination.Results. Demand for first visits was 11.94 per 1.000 inhabitants/year. Average age was of 62.04 years, the highest publishedto date. More women (59 %) than men consulted. The mostfrequent age range was 75-80 years. Headache was the mostcommon condition. Cognitive problems were the most commonone in patients over 65 years. Non-neurological problems werethe third reason for consultation. A total of 50.4% of the patientswere not given an appointment for follow-up.Conclusions. Mean age of the patients seem in Neurologyseems to be progressively increasing and consequently, consultationsfor cognitive problems, which together with headaches, arethe most frequent reason of consultation. A high percentage ofnon-neurological conditions can be related with a high percentageof discharges (AU)

[Thrombosis of the cavernous sinus following prone-position spinal surgery in a patient with factor V Leiden]. / Trombosis de seno cavernoso tras una cirugía raquídea en decúbito prono en un paciente portador del factor V de Leiden.

INTRODUCTION: Non-infectious thrombosis of the cavernous sinus has sometimes been reported as a complication following neurosurgical procedures and, in one case, after carrying out the operation in a prone position. Factor V Leiden is a genetic risk factor for presenting an intracranial venous thrombotic disease. We report the case of a patient who suffered thrombosis of the cavernous sinus following prolonged surgery in the prone position and in whom a mutation of factor V Leiden in a heterozygotic state was discovered. CASE REPORT: A 64-year-old male, with arterial hypertension as the only known vascular risk factor, who, after prolonged surgery in a prone position, presented amaurosis in the left eye accompanied some hours later by ocular pain, conjunctival ecchymosis, proptosis and abolition of extrinsic ocular mobility. An angiography scan confirmed the existence of thrombosis in the cavernous sinus. Treatment was established with low-molecular-weight heparin without the occurrence of any other kinds of complications. The patient gradually recovered extrinsic ocular mobility but not visual acuity. A heterozygotic mutation for factor V Leiden was found in a hypercoagulability study that was later performed. CONCLUSIONS: The coexistence of a risk factor for presenting a venous thrombotic disease and a mechanical phenomenon, venous statis, due to the posture adopted for the surgical intervention together account for the complication presented by the patient.

Trombosis de seno cavernoso tras una cirugía raquídea en decúbito prono en un paciente portador del factor V de Leiden / Thrombosis os the carvenous sinus following prone-position spinal surgery in a patient with factor y leiden

Introducción. La trombosis del seno cavernoso no infecciosa ha sido descrita en ocasiones como complicación tras la realización de procedimientos neuroquirúrgicos y, en un caso, después de llevarla a cabo en decúbito prono. El factor V de Leiden es un factor de riesgo genético para presentar una enfermedad trombótica venosa intracraneal. Presentamos el caso de un paciente que sufre una trombosis del seno cavernoso tras una cirugía prolongada en decúbito prono y en quien se descubrió una mutación del factor V de Leiden en estado heterocigoto. Caso clínico. Varón de 64 años de edad, con hipertensión arterial como único factor de riesgo vascular conocido, quien, tras una intervención quirúrgica prolongada en decúbito prono, presentó una amaurosis en el ojo izquierdo acompañada, en las horas posteriores, de dolor ocular, equimosis conjuntival, proptosis y abolición de la motórica ocular extrínseca. Una angiografía confirmó la existencia de una trombosis del seno cavernoso. Se instauró tratamiento con heparinas de bajo peso molecular sin que se produjeran otros tipos de complicaciones. El paciente recuperó paulatinamente la motórica ocular extrínseca, pero no la agudeza visual. En el estudio de hipercoagulabilidad realizado posteriormente se encontró una mutación heterocigota para el factor V de Leiden. Conclusión. La coexistencia de un factor de riesgo para presentar una enfermedad trombótica venosa junto con un fenómeno mecánico, de estasis venosa, a causa de la posición quirúrgica, explican la complicación que presentó el paciente (AU)

Introduction. Non-infectious thrombosis of the cavernous sinus has sometimes been reported as a complication following neurosurgical procedures and, in one case, after carrying out the operation in a prone position. Factor V Leiden is a genetic risk factor for presenting an intracranial venous thrombotic disease. We report the case of a patient who suffered thrombosis of the cavernous sinus following prolonged surgery in the prone position and in whom a mutation of factor V Leiden in a heterozygotic state was discovered. Case report. A 64-year-old male, with arterial hypertension as the only known vascular risk factor, who, after prolonged surgery in a prone position, presented amaurosis in the left eye accompanied some hours later by ocular pain, conjunctival ecchymosis, proptosis and abolition of extrinsic ocular mobility. An angiography scan confirmed the existence of thrombosis in the cavernous sinus. Treatment was established with low-molecular-weight heparin without the occurrence of any other kinds of complications. The patient gradually recovered extrinsic ocular mobility but not visual acuity. A heterozygotic mutation for factor V Leiden was found in a hypercoagulability study that was later performed. Conclusions. The coexistence of a risk factor for presenting a venous thrombotic disease and a mechanical phenomenon, venous statis, due to the posture adopted for the surgical intervention together account for the complication presented by the patient (AU)