Prophylactic treatment can modify vascular risk biomarkers in high-frequency episodic and chronic migraine patients: a pilot study.

To evaluate whether preventive treatment can modify endothelial and oxidative biomarkers of vascular disease risk in patients with high-frequency episodic and chronic migraine. In this observational, prospective pilot study, 88 prophylactic treatment-naïve patients with episodic and chronic migraine and 56 healthy sex/age matched controls underwent ultrasonography exams and blood tests at baseline, and again in the migraine patients after 3 months' treatment with metoprolol or topiramate. Biomarkers for endothelial function and oxidative stress were analyzed. At baseline, patients with migraine in the low-frequency episodic group had differences exclusively in nitrates 17.6 versus 27.33 µM; p = 0.046 compared to the controls. However, when comparing the group comprised of patients with high-frequency episodic migraine and chronic migraine versus controls, statistically significant differences appeared in hsCRP 2.68 versus 1.64 mg/dL; p = 0.049, vWF antigen (133% vs. 110%; p = 0.020, vWF activity (111% vs. 90%; p = 0.010) and isoprostane levels (181 vs. 238 µM; p = 0.05). Only in the chronic migraine subgroup did we found statistically significant differences in CIMT (0.60 vs. 0.54 mm; p = 0.042) which were significantly greater than in the controls. After treatment, patients who respond to preventive treatment exhibited significantly higher levels of nitrates (24.2-13.8 µM; p = 0.022) and nitrites (10.4-3.43 µM; p = 0.002) compared than non-responders. Moreover, biomarker levels improved in treatment-responsive patients with migraine; hsCRP levels decreased from 2.54 to 1.69 mg/dL (p < 0.05), vWF activity levels decreased from 124 to 103 IU/dL (p = 0.003) and prothrombin activity decreased from 1.01 to 0.93 (p = 0.01). These differences were also observed in the high-frequency and chronic migraine subgroup and reach statistical significance in the case of hsCRP, which decreased from 2.12 to 0.83 mg/dL (p = 0.048). Patients with migraines have differences in biomarker levels compared to controls, suggesting endothelial and oxidative dysfunction. The greatest differences in biomarker levels compared to controls are observed in migraine patients in the high-frequency and chronic migraine subgroups. Based on our results, preventive treatment is capable of modifying markers of endothelial dysfunction and oxidative stress in migraine patients, even in cases of chronic and high-frequency migraine.

Prehospital care process and hospital outcomes in stroke-code cases: comparison of basic and advance life support ambulance attendance. / Proceso de atención prehospitalaria y resultados hospitalarios del código ictus: estudio comparativo entre unidades de soporte vital básico y avanzado.

OBJECTIVES: To study prehospital care process in relation to hospital outcomes in stroke-code cases first attended by 2 different levels of ambulance. To analyze factors associated with a satisfactory functional outcome at 3 months. MATERIAL AND METHODS: Prospective multicenter observational cohort study. All stroke-code cases attended by prehospital emergency services from January 2016 to April 2022 were included. Prehospital and hospital variables were collected. The classificatory variable was type of ambulance attending (basic vs advanced life support). The main outcome variables were mortality and functional status after ischemic strokes in patients who underwent reperfusion treatment 90 days after the ischemic episode. RESULTS: Out of 22 968 stroke-code activations, ischemic stroke was diagnosed in 12 467 patients (54.3%) whose functional status was good before the episode. Basic ambulances attended 93.1%; an advanced ambulance was ordered in 1.6% of the patients. Even though there were differences in patient and clinical characteristics recorded during the prehospital process, type of ambulance was not independently associated with mortality (adjusted odds ratio [aOR], 1.1; 95% CI, 0.77-1.59) or functional status at 3 months (aOR, 1.05; 95% CI, 0,72-1,47). CONCLUSION: The percentage of patient complications in stroke-code cases attended by basic ambulance teams is low. Type of ambulance responding was not associated with either mortality or functional outcome at 3 months in this study.

OBJETIVO: Comparar el proceso asistencial prehospitalario y los resultados hospitalarios de los pacientes categorizados como Código Ictus (CI) en función del tipo de ambulancia que realiza la primera valoración, y analizar los factores asociados con un buen resultado funcional y la mortalidad a los 3 meses. METODO: Estudio observacional de cohortes prospectivo multicéntrico. Incluyó todos los CI atendidos por un sistema de emergencias prehospitalario desde enero del 2016 a abril del 2022. Se recogieron variables prehospitalarias y hospitalarias. La variable de clasificación fue el tipo de ambulancia que asiste el CI: unidad de soporte vital básico (USVB) o avanzado (USVA). Las variables de resultado principal fueron la mortalidad y el estado funcional de los ictus isquémicos sometidos a tratamiento de reperfusión a los 90 días del episodio. RESULTADOS: Se incluyeron 22.968 pacientes, de los cuales 12.467 (54,3%) presentaron un ictus isquémico con un buen estado funcional previo. El 93,1% fueron asistidos por USVB y se solicitó una USVA en el 1,6% de los casos. A pesar de presentar diferencias en el perfil clínico del paciente atendido y en los tiempos del proceso CI prehospitalario, el tipo de unidad no mostró una asociación independiente con la mortalidad (OR ajustada 1,1; IC 95%: 0,77- 1,59) ni con el estado funcional a los 3 meses (OR ajustada 1,05; IC 95%: 0,72-1,47). CONCLUSIONES: El porcentaje de complicaciones de los pacientes con CI atendidos por USVB es bajo. El tipo de unidad que asistió al paciente inicialmente no se asoció ni con el resultado funcional ni con la mortalidad a los 3 meses.

Epidemiology of Intracranial Haemorrhages Associated with Vitamin K Antagonist Oral Anticoagulants in Spain: TAC Registry.

BACKGROUND: Vitamin K antagonist oral anticoagulants (VKA-OACs) are effective for primary and secondary prevention of embolic events. The rate of haemorrhagic neurological complications in patients admitted to neurology departments in Spain is not yet known. AIMS: We aimed to determine the clinical and epidemiological characteristics of patients with intracranial haemorrhage secondary to VKA-OACs as well as the incidence of this severe complication. METHODS: We conducted a retrospective, descriptive, multi-centre study using information from the medical records of all patients admitted to neurology departments, diagnosed with spontaneous intracranial haemorrhage, and treated with VKA-OACs within a 1-year period. We collected demographic and care data from centres, patients' medical records [demographic data, medical history, haemorrhage origin, vascular risk factors, concomitant treatment, and National Institutes of Health Stroke Scale (NIHSS) scores], and patients' outcome at 3 months [independence (modified Rankin Scale score <3) and mortality rate]. RESULTS: Twenty-one hospitals serving a population of 8,155,628 inhabitants participated in the study. The total number of cases was 235, the mean age was 78.2 (SD 9.4) years, and the baseline NIHSS score was 11.6 (SD 9.5; median 9; interquartile range 14). The VKA-OACs used were acenocoumarol in 95.3% (224 patients) and warfarin in 4.7% (11 patients). The haemorrhage origin was deep in 29.8%, lobar in 25.5%, intraventricular in 11.5%, extensive in 17.4% (>100 ml), cerebellar in 12.3%, and in the brainstem in 3.4%. The international normalised ratio was within therapeutic ranges at admission (according to indication) in 29.4% (69 patients). The global incidence (cases per 100,000 inhabitants per year) is 2.88. The in-hospital mortality rate was 40%, and 24.3% of the patients were independent at 3 months, while the mortality at 3 months was 42.6%. CONCLUSION: VKA-OAC treatment is associated with a large percentage of all cases of spontaneous intracranial haemorrhage, an event leading to high dependence and mortality rates.

Utilidad de los nuevos criterios diagnósticos y la introducción de los biomarcadores en el continuum de la enfermedad de Alzheimer / Usefullness of new diagnosis criteria and introduction of biomarkers in Alzheimer’s disease continuum

Objetivos: los nuevos criterios diagnósticos de enfermedad de Alzheimer (EA) y deterioro cognitivo leve (DCL) apoyan la utilización de los biomarcadores. Valoramos la utilidad de añadir los biomarcadores en la práctica clínica habitual para confirmar y/o modificar el grado de certeza en el diagnóstico de EA y DCL. Pacientes y métodos: presentamos 40 pacientes en los que de forma consecutiva se realizó la determinación de biomarcadores en líquido cefalorraquídeo (LCR) (amilode, tau y p-tau) y evaluación neuropsicológica según los criterios establecidos en nuestra unidad. Resultados: presentamos las características demográficas de los pacientes. En el 52 % de los pacientes los biomarcadores permitieron modificar el grado de certeza del diagnóstico. La mayor aportación es poder reclasificar a los pacientes con DCL en pacientes con DCL y alto riesgo de EA (7), riesgo intermedio (6) o riesgo bajo (12). En dos casos de inicio rápidamente progresivo, los biomarcadores fueron compatibles con EA. Además, su determinación basal ayuda a predecir el riesgo de progresión a EA tras 2 años de seguimiento. Conclusiones: la utilización de los biomarcadores en la práctica clínica habitual ayuda a modificar el grado de certeza del diagnóstico clínico y, por tanto, el pronóstico de los pacientes, especialmente en fase prodrómica y en presentaciones atípicas (AU)

Background: The new diagnostic criteria for Alzheimer's disease (AD) and mild cognitive impairment (MCI) supports the use of biomarkers. We appreciate the value of adding biomarkers to routine clinical practice to confirm and/or modify the degree of certainty in the diagnosis of AD and MCI. Methods: We present 40 patients consecutively determining CSF biomarkers (amyloid, tau and p-tau) and neuropsychological evaluation was performed according to the criteria set out in our unit. Results: We present the demographic characteristics of the patients. In 52% of patients allowed biomarkers modify the degree of certainty of the diagnosis. The greatest contribution is to reclassify patients with MCI in MCI patients at high risk of AD (7), intermediate risk (7) or low risk of AD (12). In both cases of rapidly progressive onset biomarkers were consistent with AD. Besides, basal CSF biomarkers are useful to predict progression to AD after two years follow-up. Conclusion: The use of biomarkers in clinical practice helps to modify the degree of certainty of the clinical diagnosis, and therefore the prognosis of patients, especially in prodromal phase and atypical presentations (AU)

[Lack of usefulness of ABCD score in the early risk of recurrent stroke in transient ischemic attack patients]. / Ausencia de utilidad de la escala clínica ABCD en el riesgo de infarto cerebral precoz en pacientes con accidente isquémico transitorio.

BACKGROUND AND OBJECTIVE: Recently a clinical score (ABCD) to identify individuals at high seven-day risk of stroke after transient ischemic attack (TIA) was proposed. The aim of this study was to test this clinical model. PATIENTS AND METHOD: We validated the ABCD score (age > or = 65 years = 1; hypertension = 1; unilateral weakness = 2, speech disturbance without weakness = 1, duration of symptoms in minutes > or = 60 = 2; 10-59 = 1; < 10 = 0) in 325 consecutive TIA patients. Clinical data, symptoms duration, CT scan, and ultrasonographic (carotid and transcranial) findings were collected. Seven-day risk of stroke was recorded. RESULTS: A total of 16 (4.9%) patients had a stroke recurrence within the first seven days after symptoms onset. Six out of 16 (37.5%) strokes occurred in 115 (35.4%) patients with a score of 5 or greater, while the 7-day risk was 4.8% (95% CI 2.04-7.56) in 210 (63.5%) patients with a score less than 5. In cox proportional hazards multivariate analyses only large-artery occlusive disease remained an independent predictor of stroke recurrence [hazard ratio = 5.66 (95% CI 2.06-15.57; p = 0.001)]. CONCLUSIONS: Clinical data are not enough to identify patients at higher risk. The combination of clinical, radiological and vascular information may improve the predictive accuracy of stroke recurrence risk. The routine use of combined carotid/transcranial ultrasound testing performed early will be useful for identifying high risk individuals in order to plan urgent aggressive prevention therapies.

Ausencia de utilidad de la escala clínica ABCD en el riesgo de infarto cerebral precoz en pacientes con accidente isquémico transitorio / Lack of usefulness of ABCD score in the early risk of recurrent stroke in transient ischemic attack patients

Fundamento y objetivo: El riesgo de recurrencia precoz tras un ataque isquémico transitorio (AIT) es elevado. Recientemente se ha descrito una escala clínica (ABCD score) para predecir los pacientes con mayor riesgo de nuevos ictus dentro de los primeros 7 días de seguimiento. Validamos dicha escala en una población de pacientes con AIT atendidos en nuestro centro. Pacientes y método: Estudiamos a 325 pacientes con AIT consecutivos. En todos ellos se cuantificó la escala ABCD, que tiene una puntuación máxima de 6 puntos (edad >= 65 años = 1; hipertensión arterial = 1; síntomas clínicos: paresia unilateral = 2; alteración del lenguaje = 1; duración de los síntomas: >= 60 min = 2; 10-59 min = 1; < 10 min = 0). Además se recogieron datos clínicos, de neuroimagen y de ultrasonografía de troncos supraaórticos y transcraneal. Resultados: Durante la primera semana de seguimiento, 16 (4,9%) pacientes sufrieron un infarto cerebral. Seis de 16 accidentes vasculares cerebrales (37,5%) tuvieron lugar en 115 (35,4%) pacientes con una escala igual o mayor de 5, mientras que el riesgo a los 7 días fue de 4,8% (IC del 95%, 2,04-7,56) en 210 (63,5%) pacientes con un valor inferior a 5. El análisis multivariante (regresión de Cox) identificó únicamente la etiología aterotrombótica como predictor independiente de recurrencia de ictus a los 7 días (razón de riesgos = 5,66; intervalo de confianza [IC] del 95%, 2,06-15,57; p = 0,001). Conclusiones: El riesgo de infarto cerebral precoz de los pacientes con un AIT no puede establecerse únicamente con variables clínicas, sino que es necesario un estudio etiológico exhaustivo y precoz que incluya un estudio ultrasonográfico tanto de los troncos supraaórticos como de la circulación intracraneal, para detectar a los pacientes en mayor riesgo de recurrencia e iniciar las medidas terapéuticas más adecuadas

Background and objective: Recently a clinical score (ABCD) to identify individuals at high seven-day risk of stroke after transient ischemic attack (TIA) was proposed. The aim of this study was to test this clinical model. Patients and method: We validated the ABCD score (age >= 65 years = 1; hypertension = 1; unilateral weakness = 2, speech disturbance without weakness = 1, duration of symptoms in minutes >= 60 = 2; 10-59 = 1; < 10 = 0) in 325 consecutive TIA patients. Clinical data, symptoms duration, CT scan, and ultrasonographic (carotid and transcranial) findings were collected. Seven-day risk of stroke was recorded. Results: A total of 16 (4.9%) patients had a stroke recurrence within the first seven days after symptoms onset. Six out of 16 (37.5%) strokes occurred in 115 (35.4%) patients with a score of 5 or greater, while the 7-day risk was 4.8% (95% CI 2.04-7.56) in 210 (63.5%) patients with a score less than 5. In cox proportional hazards multivariate analyses only large-artery occlusive disease remained an independent predictor of stroke recurrence [hazard ratio = 5.66 (95% CI 2.06-15.57; p = 0.001)]. Conclusions: Clinical data are not enough to identify patients at higher risk. The combination of clinical, radiological and vascular information may improve the predictive accuracy of stroke recurrence risk. The routine use of combined carotid/transcranial ultrasound testing performed early will be useful for identifying high risk individuals in order to plan urgent aggressive prevention therapies

Hemorragia cerebelosa espontánea asociada a la ingestión de Ginkgo biloba / Spontaneous cerebellar haemorrhage associated with Ginkgo biloba ingestion

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