Respiratory disorders during sleep in patients with acute ischemic stroke. / [Trastornos respiratorios durante el sueño en pacientes con accidente cerebrovascular isquémico.]

Introduction: Sleep breathing disorders (SBD) especially obstructive hypopnea apnea syndrome (OSA) in patients with stroke are common and can complicate their evolution. The objective was analyzing the different sleep breathing disorders in patients with stroke. Methods: Descriptive, cross-sectional and retrospective study of acute ischemic stroke patients, using nightly polysomnography with oximetry (PSG). Results: It was a descriptive, cross-sectional, retrospective study during 19 months; 53 patients with stroke were included, with a men age of 67 ±12 years and 62% were men. SBD was evaluated by nocturnal polysomnography with oximetry within 10 days of installing the stroke. The Apnea hypopnea index (AHI) was 24.5±20, of mild grade in 21%, moderate in 31%, severe grade in 34%. The average oxygen saturation time less than 90% was 38 ±51 minutes. The minimum oxygen saturation was marked in infratentorial lesions. Conclusion: We found a high percentage of OSA, which was associated with older patients and a higher body mass index. There was a marked decrease in the minimum oxygen saturation and greater tendency to present central apneas in infratentorial lesion. Early diagnosis and treatment could minimize neuronal damage and improve prognosis.

Introducción: Los trastornos respiratorios durante el sueño (TRDS), sobre todo el síndrome de apneas hipopneas obstructivas (SAHOS) en pacientes con accidente cerebrovascular o ACV, son frecuentes y pueden complicar su evolución. El objetivo fue analizar diversos TRDS en pacientes con ACV. Métodos: Estudio descriptivo, de corte transversal y retrospectivo de 19 meses, en pacientes con ACV, mediante polisomnografía nocturna con oximetría (PSG). Resultados: Se incluyó a 53 pacientes, con edad media de 67 ± 12 años, y 62% pertenecían al sexo masculino. Se evaluó los TRDS mediante polisomnografía nocturna con oximetría dentro de los 10 días de instalado el ACV. Se detectó un índice de apneas hipopneas durante el sueño (IAH) de grado leve en 21%, grado moderado en 31% y severo en 34%. La media de tiempo de saturación de oxígeno < a 90% fue de 38 ±51 minutos. La saturación mínima de oxígeno fue marcada en lesiones infratentoriales. Conclusión: Nosotros hemos encontrado en nuestro estudio, un alto porcentaje de SAHOS, que se asoció a pacientes de mayor edad y mayor índice de masa corporal. Se constató descenso marcado de la saturación mínima y mayor tendencia a presentar apneas centrales en lesiones infratentoriales. El diagnóstico y tratamiento precoz podría minimizar el daño neuronal y mejorar el pronóstico.

[Long-term psychosocial impact in young stroke survivors: a frequent but often under diagnosed complication]. / Impacto psicosocial del ataque cerebral en pacientes jóvenes: una complicación frecuente y habitualmente sub-diagnosticada.

INTRODUCTION: Approximately 15% of all strokes occur in young patients, affecting them in the most productive years of their lives. Currently, there is limited information (particularly in Latin America) regarding the long-term psychosocial consequences of stroke in young patients. Therefore, the objective of our study was to analyze the functional impact of stroke in this group of patients, regarding both cognitive and psychosocial aspects. MATERIAL AND METHODS: A Beck Depression Inventory (BDI) was administered to outpatients with ischemic stroke between 16 and 55 years of age in two centers of Argentina. The following variables were compared in depressed and non-depressed individuals: NIHSS, modified Rankin Score, Mini-Mental State Examination, Barthel Index, as well as clinical-demographic variables. A BDI score greater than 10 was considered as marker of depression. RESULTS: Thirty-four patients with cerebral infarction were included, 67% (n = 23) were women, mean age: 45.53 ± 9.78 years (range: 21-59). Eleven patients (33%) had depression; 50% of the population was unable to continue with their previous job and 15% divorced or separated from their partner after the vascular event. The stroke recurrence rate was 0.03%. CONCLUSIONS: A high proportion of patients with depressive symptoms was observed. It should be noted that, in the majority, symptoms of depression had not been recognized and the patients were under-treated. Likewise, depression spread persistently after several years of the cerebrovascular event. Likewise, a significant proportion of patients were not able to re-insert themselves into their usual work activity. Moreover, stroke also had an important impact on their affective relationships. Treatment of depression after stroke should be particularly considered in these individuals due to their long-term survival, and should be offered to achieve the highest possible quality of recovery after stroke.

Cerebral venous thrombosis in Argentina: clinical presentation, predisposing factors, outcomes and literature review.

BACKGROUND: Cerebral venous thrombosis (CVT) is a rare medical condition that primarily affects young adults. The clinical spectrum is broad and its recognition remains a challenge for clinicians. Limited information is available on CVT in Argentina. Our goal was to report the results of the first National registry on CVT in Argentina and to compare clinical presentation, predisposing factors and outcomes with other international registries. MATERIAL AND METHOD: The Argentinian National Registry on CVT (ANR-CVT) is a multicenter retrospective cohort study comprising patients aged 18 and older with a diagnosis of CVT from January 2015 to January 2019. We evaluated demographics, predisposing factors, clinical presentation, and radiological characteristics (e.g. number of involved sinuses, venous infarction or hemorrhage on CT and MRI scans at admission), therapeutic interventions and functional outcomes at discharge and at 90 days. Our results were compared to a literature review of CVT registries. RESULTS: Overall, one hundred and sixty-two patients met the inclusion criteria. The mean age was 42 (±17) years; 72% were women. Seventy percent of patients were younger than 50 years. The most common presenting symptom was headache (82%). The transverse sinus was the most common site of thrombosis (70%) followed by the sigmoid sinus (46%). The main predisposing factor in women was contraceptive use (44%), 3% of the events occurred during pregnancy and 9% during the puerperium. Participants 50 years and older had a higher frequency on malignancy related (7.5% vs. 30%, p = 0.0001) and infections (2% vs. 11%, p = 0.001). The modified Rankin Scale (mRS) ≤2 at discharge was 81% and the rate of mortality at discharge was 4%. At 90 days, the mRS≤2 was 93%. When the ANR-CVT was compared with larger registries from Europe and Asia, the prevalence of cancer among patients with CVT was two to five-fold higher (15% vs. 7% and 3%, respectively; p = 0.002 and p < 0.001). Anticoagulation rates at discharge were also higher (94%) compared to registries from Asia (ASCVT - 68%) or Turkey (VENOST - 67%). CONCLUSION: Participants in the first ANR-CVT had a low mortality and disability at 90 days. Clinical and radiological characteristics were similar to CVT from other international registries with a higher prevalence of cancer. There was a high variability in treatment adherence to guidelines as reflected by anticoagulation rates (range 54.5%-100%) at discharge.

Role of EMSE and STESS scores in the outcome evaluation of status epilepticus.

Status epilepticus (SE) is a severe neurological condition with significant morbidity and mortality. A reliable tool for prognosis is needed to take decision regarding treatment strategies. We compared 2 available prognostic scores of outcome: the Status Epilepticus Severity Score (STESS) and the Epidemiology-based Mortality score in SE (EMSE). We included 46 patients with SE evaluated out the last 5years in our hospital. We excluded patients with postanoxic encephalopathy or incomplete data. Among the 46 patients with SE, in-hospital mortality was 28%. The receiver operating characteristic (ROC) curve for predicting of death by STESS had an area under the curve (AUC) of 0.80 with cutoff point ≥4. The best EMSE variable combination to predict mortality was EMSE-AEL using an optimized cutoff point of 34 (age/etiology/loss of consciousness) with an area under the ROC of 0.79. The STESS and EMSE would be useful tools to predict in-hospital mortality in SE.