[Moyamoya in Aragon: epidemiology and self-perception of quality of life]. / Moyamoya en Aragón. Epidemiología y calidad de vida autopercibida.

INTRODUCTION: Moyamoya angiopathy is a vasculopathy caused by stenosis/occlusion of one or both intracranial internal carotid arteries. Although more common in Eastern countries, its prevalence is increasing in the West. An angioresonance or angiography is essential for its diagnosis. There are two options for treatment: conservative (medical) treatment or surgical bypass techniques. PATIENTS AND METHODS: Nineteen patients were selected using International Classification of Diseases codes, and their demographic characteristics and health outcomes were studied. They were administered a scale for the screening of anxious-depressive syndrome (the Hospital Anxiety and Depression Scale - HADS) and another scale for self-perceived quality of life (SF-36). After applying the inclusion/exclusion criteria, eight of these patients were studied. RESULTS: Nineteen patients were studied (52.63% male, 57.89% European) and the Aragonese prevalence was estimated at 1.37/100,000 inhabitants. The most frequent clinical presentation was ischaemic stroke (73.68%). The HADS detected two positive cases of anxiety and one case of depression. According to the SF-36, the worst self-rated aspects were vitality (median: 35/100) and general health (median: 42.5/100), while the best rated was physical function (mean: 93.57/100). CONCLUSIONS: This is the Spanish series with the highest prevalence and the only one that addresses self-perceived health and screening of the anxious-depressive syndrome. Further research is needed to address this entity and determine its true prevalence in the West.

TITLE: Moyamoya en Aragón. Epidemiología y calidad de vida autopercibida.Introducción. La angiopatía de moyamoya es una vasculopatía originada por la estenosis/oclusión de una o ambas carótidas internas intracraneales. Aunque es más frecuente en países orientales, está aumentando su prevalencia en Occidente. Para su diagnóstico es imprescindible una angiorresonancia o una angiografía. En su tratamiento hay dos opciones: el tratamiento conservador (médico) o las técnicas quirúrgicas de bypass. Pacientes y métodos. Se seleccionó a 19 pacientes mediante códigos de la Clasificación internacional de enfermedades, y se estudiaron sus características demográficas y resultados en salud. Se les administró una escala para el cribado de síndrome ansiosodepresivo ­escala de ansiedad y depresión hospitalaria (HADS)­ y otra de autopercepción de calidad de vida (SF-36). De estos pacientes, se estudió a ocho al aplicar los criterios de inclusión/exclusión. Resultados. Se estudió a 19 pacientes (52,63%, hombres; 57,89%, europeos) y se estimó la prevalencia aragonesa en 1,37/100.000 habitantes. La clínica más frecuente fue el ictus isquémico (73,68%). La HADS detectó dos casos positivos para ansiedad y un caso de depresión. Según el SF-36, los aspectos peor autopercibidos fueron la vitalidad (mediana: 35/100) y la salud general (mediana: 42,5/100); mientras que el mejor valorado fue la función física (media: 93,57/100). Conclusiones. Se trata de la serie española con mayor prevalencia y la única que aborda la salud autopercibida y el cribado del síndrome ansiosodepresivo. Son necesarios más estudios que permitan abordar esta entidad y cuál es la verdadera prevalencia en Occidente.

Moyamoya en Aragón. Epidemiología y calidad de vida autopercibida / Moyamoya in Aragon: epidemiology and self-perception of quality of life

Introducción La angiopatía de moyamoya es una vasculopatía originada por la estenosis/oclusión de una o ambas carótidas internas intracraneales. Aunque es más frecuente en países orientales, está aumentando su prevalencia en Occidente. Para su diagnóstico es imprescindible una angiorresonancia o una angiografía. En su tratamiento hay dos opciones: el tratamiento conservador (médico) o las técnicas quirúrgicas de bypass. Pacientes y métodos Se seleccionó a 19 pacientes mediante códigos de la Clasificación internacional de enfermedades, y se estudiaron sus características demográficas y resultados en salud. Se les administró una escala para el cribado de síndrome ansiosodepresivo –escala de ansiedad y depresión hospitalaria (HADS)– y otra de autopercepción de calidad de vida (SF-36). De estos pacientes, se estudió a ocho al aplicar los criterios de inclusión/exclusión. Resultados Se estudió a 19 pacientes (52,63%, hombres; 57,89%, europeos) y se estimó la prevalencia aragonesa en 1,37/100.000 habitantes. La clínica más frecuente fue el ictus isquémico (73,68%). La HADS detectó dos casos positivos para ansiedad y un caso de depresión. Según el SF-36, los aspectos peor autopercibidos fueron la vitalidad (mediana: 35/100) y la salud general (mediana: 42,5/100); mientras que el mejor valorado fue la función física (media: 93,57/100). Conclusiones Se trata de la serie española con mayor prevalencia y la única que aborda la salud autopercibida y el cribado del síndrome ansiosodepresivo. Son necesarios más estudios que permitan abordar esta entidad y cuál es la verdadera prevalencia en Occidente. (AU)

INTRODUCTION Moyamoya angiopathy is a vasculopathy caused by stenosis/occlusion of one or both intracranial internal carotid arteries. Although more common in Eastern countries, its prevalence is increasing in the West. An angioresonance or angiography is essential for its diagnosis. There are two options for treatment: conservative (medical) treatment or surgical bypass techniques. PATIENTS AND METHODS Nineteen patients were selected using International Classification of Diseases codes, and their demographic characteristics and health outcomes were studied. They were administered a scale for the screening of anxious-depressive syndrome (the Hospital Anxiety and Depression Scale – HADS) and another scale for self-perceived quality of life (SF-36). After applying the inclusion/exclusion criteria, eight of these patients were studied. RESULTS Nineteen patients were studied (52.63% male, 57.89% European) and the Aragonese prevalence was estimated at 1.37/100,000 inhabitants. The most frequent clinical presentation was ischaemic stroke (73.68%). The HADS detected two positive cases of anxiety and one case of depression. According to the SF-36, the worst self-rated aspects were vitality (median: 35/100) and general health (median: 42.5/100), while the best rated was physical function (mean: 93.57/100). CONCLUSIONS This is the Spanish series with the highest prevalence and the only one that addresses self-perceived health and screening of the anxious-depressive syndrome. Further research is needed to address this entity and determine its true prevalence in the West. (AU)

Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study.

INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE: The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS: We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 10 Spanish centres. RESULTS: We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3 to 6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P =  .03), focal deficits (P = .001), and encephalopathy (P < .001) showing a statistically significant association with poor prognosis (mRS > 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION: The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.

Impact of a series of measures for optimisation hospital code stroke care on door-to-needle times.

INTRODUCTION: Time continues to be a fundamental variable in reperfusion treatments for acute ischaemic stroke. Despite the recommendations made in clinical guidelines, only around one-third of these patients receive fibrinolysis within 60minutes. In this study, we describe our experience with the implementation of a specific protocol for patients with acute ischaemic stroke and evaluate its impact on door-to-needle times in our hospital. METHODS: Measures were gradually implemented in late 2015 to shorten stroke management times and optimise the care provided to patients with acute ischaemic stroke; these measures included the creation of a specific on-call neurovascular care team. We compare stroke management times before (2013-2015) and after (2017-2019) the introduction of the protocol. RESULTS: The study includes 182 patients attended before implementation of the protocol and 249 attended after. Once all measures were in effect, the overall median door-to-needle time was 45minutes (vs 74 minutes before, a 39% reduction; P<.001), with 73.5% of patients treated within 60minutes (a 47% increase; P<.001). Median overall time to treatment (onset-to-needle time) was reduced by 20minutes (P<.001). CONCLUSIONS: The measures included in our protocol achieved a significant, sustained reduction in door-to-needle times, although there remains room for improvement. The mechanisms established for monitoring outcomes and for continuous improvement will enable further advances in this regard.

Impacto en los tiempos puerta-aguja de un conjunto de medidas para optimizar la atención hospitalaria del código ictus / Impact of a series of measures for optimisation hospital code stroke care on door-to-needle times

Introducción: El tiempo sigue siendo una variable determinante para los tratamientos de reperfusión del ictus isquémico agudo. A pesar de las recomendaciones de las guías clínicas, solo alrededor de la tercera parte de los pacientes con ictus isquémico agudo son fibrinolizados en ≤ 60 min. El objetivo de este trabajo es describir nuestra experiencia implementando un protocolo específico de atención del ictus isquémico agudo y evaluar su impacto en nuestros tiempos puerta-aguja.MétodosA finales del 2015, se implantaron gradualmente unas medidas diseñadas para acortar los tiempos de actuación y optimizar la atención del ictus isquémico agudo incluyendo una guardia específica de Neurovascular. Se compararon los tiempos de actuación antes (2013-2015) y después (2017-2019) de la introducción de este protocolo.ResultadosSe incluyó a 182 pacientes antes y 249 después de la intervención. Cuando todas las medidas fueron introducidas, la mediana global de tiempo puerta-aguja fue de 45 min (previa 74 min, 39% menos, p < 0,001) con un 73,5% de pacientes tratados en ≤ 60 min (47% más que preintervención, p < 0,001). El tiempo global al tratamiento (inicio síntoma-aguja) se redujo en 20 min de mediana (p < 0,001).ConclusionesLas medidas asociadas en nuestro protocolo han conseguido una disminución del tiempo puerta-aguja de forma significativa y sostenida, aunque todavía nos queda margen de mejora, la dinámica establecida de control de resultados y mejora continua hará posible seguir avanzando en este sentido. (AU)

Introduction: Time continues to be a fundamental variable in reperfusion treatments for acute ischaemic stroke. Despite the recommendations made in clinical guidelines, only around one-third of these patients receive fibrinolysis within 60 minutes. In this study, we describe our experience with the implementation of a specific protocol for patients with acute ischaemic stroke and evaluate its impact on door-to-needle times in our hospital.MethodsMeasures were gradually implemented in late 2015 to shorten stroke management times and optimise the care provided to patients with acute ischaemic stroke; these measures included the creation of a specific on-call neurovascular care team. We compare stroke management times before (2013-2015) and after (2017-2019) the introduction of the protocol.ResultsThe study includes 182 patients attended before implementation of the protocol and 249 attended after. Once all measures were in effect, the overall median door-to-needle time was 45 minutes (vs 74 minutes before, a 39% reduction; P<.001), with 73.5% of patients treated within 60 minutes (a 47% increase; P<.001). Median overall time to treatment (onset-to-needle time) was reduced by 20 minutes (P<.001).ConclusionsThe measures included in our protocol achieved a significant, sustained reduction in door-to-needle times, although there remains room for improvement. The mechanisms established for monitoring outcomes and for continuous improvement will enable further advances in this regard. (AU)

Selection of patients for percutaneous closure in nonlacunar cryptogenic stroke associated with patent foramen ovale. Data from the NORDICTUS cooperative registry.

INTRODUCTION: There is an extending use of percutaneous closure of patent foramen ovale (PFO) as therapy for PFO-associated cryptogenic strokes. The aim of our study was to investigate the clinical practice of percutaneous closure of PFO and to analyse the variables for decision-making on the selection of patients for this procedure. METHOD: A prospective observational multicentric survey was conducted using all the cases of cryptogenic stroke/transient ischaemic attack associated with PFO recorded in the NORDICTUS hospital registry during the period 2018-2021. Clinical data, radiological patterns, echocardiogram data and factors related to PFO-associated stroke (thromboembolic disease and paradoxical embolism criteria) were recorded. The indication for closure was analysed according to age (≤/> 60 years) and the characteristics of the PFO. RESULTS: In the group ≤ 60 years (n = 488), 143 patients (29.3%) underwent PFO closure. The most influential variables for this therapy were detection of a high-risk PFO (OR 4.11; IC 2.6-6.5, P < .001), criteria for paradoxical embolism (OR 2.61; IC 1.28-5.28; P = .008) and previous use of antithrombotics (OR 2.67; IC 1.38-5.18; P = .009). In the > 60 years group (n = 124), 24 patients had PFO closure (19%). The variables related to this option were history of pulmonary thromboembolism, predisposition to thromboembolic disease, paradoxical embolism criteria, and high-risk PFO. CONCLUSIONS: The detection of a high-risk PFO (large shunt, shunt with associated aneurysm) is the main criterion for a percutaneous closure-based therapy. Other conditions to consider in the eligibility of patients are the history of thromboembolic disease, paradoxical embolism criteria or the previous use of antithrombotics.

Guardias médicas durante la formación del residente de neurología en España: cambios en la última década / 24-hour on-duty shifts during the training of neurology residents in Spain: changes in the last decade

Introducción: El programa formativo de neurología en España, aprobado en 2006, incide en la realización de guardias específicas supervisadas por un neurólogo. En una evaluación de la Comisión Nacional de Neurología en 2008, se constató un cumplimiento desigual de este objetivo docente: el 60,3% de las unidades ofrecía a sus residentes una guardia de 24 horas con supervisión física, y sólo el 43% era en su propio centro. Tras más de una década, y con un nuevo plan formativo en redacción, queremos conocer la situación actual y posibles factores implicados. Material y métodos. Estudio mediante encuestas autoadministradas a las unidades docentes de neurología que hubiesen formado recientemente una promoción completa de residentes (n = 77). Se recogieron respuestas entre octubre de 2021 y febrero de 2022. Resultados: Respondió el 100% de las unidades. En 2021, el 88,3% cumplía los objetivos docentes, con un 83% con guardias de 24 horas con supervisión física en su propio centro. Entre los factores relacionados, se observó una asociación directa y estadísticamente significativa con el tamaño del centro y la existencia de unidad de ictus. Discusión. La supervisión de residentes durante la guardia de neurología está siguiendo la línea marcada por el plan formativo y la comisión nacional de la especialidad, aunque siguen existiendo diferencias que van más allá de aspectos puramente asistenciales. El futuro plan estatal podría marcar nuevas pautas que nos ayuden a conseguir una menor heterogeneidad, a fin de ofrecer una misma capacitación en el abordaje urgente del paciente neurológico.(AU)

Introduction: The neurology training program in Spain, approved in 2006, emphasizes the importance of residents’ on-duty shifts supervised by a neurologist. An evaluation of the Specialty National Commission in 2008 showed an unequal fulfillment of this goal: 60.30% of the training units offered their residents 24-hour shifts with on-duty supervision, and only 43% in their own center. After more than a decade, and a new national training program on design, we would like to know the current situation and possible factors that might be involved. Material and methods. Cross-sectional study through self-administered surveys to neurology training units that had recently graduated residents (n = 77). Responses were collected between October 2021 and February 2022. Results: All units answered the survey. In 2021, 88.30% met the supervision objectives, and 83% offered their trainees 24-hour on-duty shifts with a neurologist in their center. Among related factors, there is a significant direct relationship between this kind of shift, the hospital’s size, and the existence of a stroke unit. Discussion. Residents’ guidance during the 24-hour neurology on-duty shifts follows the path set by the training program and the national commission. However, there are still some differences that go beyond purely healthcare aspects. The future national program could establish new guidelines that help us achieve less heterogeneity, in order to offer the same training in the assessment of acute neurological patients.(AU)

[24-hour on-duty shifts during the training of neurology residents in Spain: changes in the last decade]. / Guardias médicas durante la formación del residente de neurología en España: cambios en la última década.

INTRODUCTION: The neurology training program in Spain, approved in 2006, emphasizes the importance of residents' on-duty shifts supervised by a neurologist. An evaluation of the Specialty National Commission in 2008 showed an unequal fulfillment of this goal: 60.30% of the training units offered their residents 24-hour shifts with on-duty supervision, and only 43% in their own center. After more than a decade, and a new national training program on design, we would like to know the current situation and possible factors that might be involved. MATERIAL AND METHODS: Cross-sectional study through self-administered surveys to neurology training units that had recently graduated residents (n = 77). Responses were collected between October 2021 and February 2022. RESULTS: All units answered the survey. In 2021, 88.30% met the supervision objectives, and 83% offered their trainees 24-hour on-duty shifts with a neurologist in their center. Among related factors, there is a significant direct relationship between this kind of shift, the hospital's size, and the existence of a stroke unit. DISCUSSION: Residents' guidance during the 24-hour neurology on-duty shifts follows the path set by the training program and the national commission. However, there are still some differences that go beyond purely healthcare aspects. The future national program could establish new guidelines that help us achieve less heterogeneity, in order to offer the same training in the assessment of acute neurological patients.

TITLE: Guardias médicas durante la formación del residente de neurología en España: cambios en la última década.Introducción. El programa formativo de neurología en España, aprobado en 2006, incide en la realización de guardias específicas supervisadas por un neurólogo. En una evaluación de la Comisión Nacional de Neurología en 2008, se constató un cumplimiento desigual de este objetivo docente: el 60,3% de las unidades ofrecía a sus residentes una guardia de 24 horas con supervisión física, y sólo el 43% era en su propio centro. Tras más de una década, y con un nuevo plan formativo en redacción, queremos conocer la situación actual y posibles factores implicados. Material y métodos. Estudio mediante encuestas autoadministradas a las unidades docentes de neurología que hubiesen formado recientemente una promoción completa de residentes (n = 77). Se recogieron respuestas entre octubre de 2021 y febrero de 2022. Resultados. Respondió el 100% de las unidades. En 2021, el 88,3% cumplía los objetivos docentes, con un 83% con guardias de 24 horas con supervisión física en su propio centro. Entre los factores relacionados, se observó una asociación directa y estadísticamente significativa con el tamaño del centro y la existencia de unidad de ictus. Discusión. La supervisión de residentes durante la guardia de neurología está siguiendo la línea marcada por el plan formativo y la comisión nacional de la especialidad, aunque siguen existiendo diferencias que van más allá de aspectos puramente asistenciales. El futuro plan estatal podría marcar nuevas pautas que nos ayuden a conseguir una menor heterogeneidad, a fin de ofrecer una misma capacitación en el abordaje urgente del paciente neurológico.

Epidemiología y características del ictus isquémico en el adulto joven en Aragón / Epidemiology and characteristics of ischaemic stroke in young adults in Aragon

Introducción: Alrededor de 15 millones de personas sufren un ictus cada año, de los que un 10-15% ocurre en menores de 50 años (ictus en el adulto joven). La prevalencia de los distintos factores de riesgo vascular y las estrategias sanitarias para el manejo del ictus varían a nivel mundial, siendo interesante conocer la epidemiología y las características específicas de cada región. El objetivo de este estudio fue determinar la prevalencia de los diferentes factores de riesgo vascular, la etiología y las características de los ictus isquémicos en el adulto joven en la comunidad autónoma de Aragón. Métodos: Estudio multicéntrico, de corte transversal, realizado por los Servicios de Neurología de todos los hospitales del Servicio Aragonés de Salud (SALUD). Se identificó a todos los pacientes entre 18 y 50 años que ingresaron en cualquiera de estos hospitales con el diagnóstico de ictus isquémico o AIT entre enero del 2005 y diciembre del 2015. Se recogieron variables demográficas, factores de riesgo vascular y tipo de ictus isquémico entre otras. Resultados: En el periodo de estudio, 786 pacientes entre 18 y 50 años ingresaron con el diagnóstico de ictus isquémico o AIT en algún hospital del SALUD, con una tasa anual promedio de 12,3 por 100.000 habitantes. La mediana de su edad fue de 45 años (RIQ: 40-48 años). El factor de riesgo vascular más prevalente fue el tabaquismo, 404 (51,4%). La mayoría fue de causa indeterminada (36,2%), seguida por «otras causas» (26,5%). La mediana de puntuación en la escala NIHSS fue de 3,5 (RIQ: 2,07,0). En total, 211 (26,8%) de los ingresos fueron por AIT. De los pacientes que ingresaron con el diagnóstico de ictus isquémico, 59 (10,3%) se fibrinolizaron. Conclusiones: El ictus isquémico en el adulto joven no es infrecuente en Aragón y en un importante número de casos es de etiología indeterminada, por lo que es necesario implementar medidas que nos permitan mejorar su estudio, disminuir su incidencia y prevenir su recurrencia. (AU)

Introduction: Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. Methods: A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. Results: During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. Conclusions: Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence. (AU)

Paediatric stroke in the northern Spanish region of Aragon: incidence, clinical characteristics, and outcomes.

BACKGROUND: Recent years have seen considerable changes in the prevention and treatment of acute ischaemic stroke in adult patients. However, the low incidence of paediatric stroke makes the development of specific guidelines more challenging. This study aims to clarify the situation of these children in our region in order to establish a regional protocol to improve the care provided to these patients. METHODS: We performed a regional incidence study of pediatric stroke (≤ 15 years of age) in Aragon, Spain (1308728 population, 15% aged ≤ 15 years) between 2008 and 2019. Data were obtained from hospital discharge records, including deaths, from the regional health service of Aragón, according to ICD codes for cerebrovascular disease. We analysed demographic, clinical, diagnostic/therapeutic, and prognostic variables. RESULTS: A total of 21 events were recorded: 8 ischaemic (38.1%) and 13 haemorrhagic strokes (61.9%). The mean age (SD) was 9.3 years (1.0). The sample included 12 boys and nine girls. No statistically significant differences were found between ischaemic and haemorrhagic strokes, except in the chief complaint (language and motor impairment in ischaemic stroke and headache in haemorrhagic stroke). None of the patients with ischaemic stroke received reperfusion therapies. Including the 3 patients who died during hospitalisation, eight patients (42.1%) had modified Rankin Scale scores > 2 at 12 months. Motor deficits were the most common sequela (n=9). CONCLUSION: Though infrequent, paediatric stroke has an important functional impact. In Spain, Madrid was the first region to adapt the existing code stroke care networks for adult patients. In Aragon, this review has enabled us to work closely with the different stakeholders to offer a care plan for acute paediatric ischaemic stroke. Nevertheless, prospective national registries would be valuable to continue improving the care provided to these patients.

Incidence, outcomes, and associated factors of isolated striatocapsular infarct after mechanical thrombectomy.

OBJECTIVE: To describe baseline and procedural characteristics and clinical outcomes of isolated striatocapsular infarct (iSCI) after mechanical thrombectomy in patients with large-vessel occlusion of the anterior cerebral circulation and its clinical outcome. METHODS: We performed a longitudinal study including all patients treated with mechanical thrombectomy at our centre between 2015 and 2017; patients were divided into 2 groups (iSCI and non-iSCI) according to whether they presented iSCI in a control CT scan at 24 hours. RESULTS: Of the 83 patients identified, 22.9% developed an iSCI. There were no statically significant differences in baseline characteristics or in reperfusion times. Patients presenting iSCI showed better collateral circulation and better reperfusion rates in the bivariate analysis. No significant difference was observed for mortality at discharge or at 3 months, or for functional prognosis at 3 months. CONCLUSIONS: Even if successful reperfusion is achieved, iSCI is a common sequela, independently of reperfusion time, especially in patients with good collateral circulation.

Validation of the Spanish-language version of the simplified modified Rankin Scale telephone questionnaire.

INTRODUCTION: The modified Rankin Scale (mRS) is the main functional assessment tool used after stroke. The simplified mRS questionnaire (smRSq) has recently been validated in English, and represents a simpler, reliable scale with an excellent reproducibility via telephone. The present study aims to validate a Spanish-language version of the telephone smRSq. METHODS: We conducted a prospective cohort study, assessing 50 patients 3 months after they presented an ischaemic stroke. We assessed the Spanish-language smRSq by telephone and in person, the mRS with a structured interview, the Spanish-language smRSq, and the Stroke Impact Scale-16. Inter-rater reliability, test-retest reliability, construct validity, and criterion validity were assessed. RESULTS: Inter-rater reliability showed strong agreement (k = 0.810); test-retest reliability and criterion validity showed moderate agreement (k = 0.639 and k = 0.759, respectively), and construct validity showed moderate agreement (Spearman correlation coefficient = -0.728). CONCLUSIONS: The Spanish-language telephone smRSq is reliable and simple, and saves time in the functional assessment after a stroke.

Epidemiology and characteristics of ischaemic stroke in young adults in Aragon.

INTRODUCTION: Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. METHODS: A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. RESULTS: During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. CONCLUSIONS: Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.

Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study. / Manejo de la trombosis venosa cerebral en España: estudio descriptivo MOTIVATE.

INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE: The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS: We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 11 Spanish centres. RESULTS: We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3-6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P=.03), focal deficits (P=.001), and encephalopathy (P <.001) showing a statistically significant association with poor prognosis (mRS> 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION: The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.

Pronóstico funcional a 3 meses de pacientes hospitalizados por ictus isquémico agudo en Aragón: análisis regional de la repercusión de la COVID-19 / Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: Rregional analysis of the impact of COVID-19

Introducción: La pandemia por COVID-19 ha tenido un impacto en el manejo del ictus isquémico; se ha descrito una disminución de los ingresos hospitalarios e incluso una interrupción en la cadena de atención y un aumento de la mortalidad intrahospitalaria. Sin embargo, falta evidencia sobre su impacto en el pronóstico funcional. El objetivo de este estudio es analizar el efecto de la pandemia por COVID-19 en el pronóstico funcional a 3 meses de los pacientes con ictus isquémico agudo hospitalizados en Aragón.Material y métodosRevisamos los datos de todos los pacientes ingresados por ictus isquémico en todos los hospitales de nuestro sistema sanitario entre el 30 de diciembre del 2019 y el 3 de mayo del 2020. Comparamos su mRS y la mortalidad a 3 meses de los hospitalizados antes y después de haberse establecido el estado de emergencia secundario a la pandemia por COVID-19.ResultadosEn total, 318 pacientes con ictus isquémico agudo cumplieron nuestros criterios de inclusión. No hubo diferencias en las características globales y específicas de cada periodo, excepto por una mayor proporción de pacientes mayores de 80 años de edad durante el periodo pre-CoV (42,2% vs. 29,0%, p = 0,028). En el análisis comparativo, no encontramos una diferencia significativa en la mortalidad (12,3 vs. 7,9, p = 0,465) o la proporción de pacientes con mRS ≤ 2 (57,7% vs. 57,1%, p = 0,425) a los 3 meses.ConclusiónHasta donde sabemos, este es el primer estudio que analiza el impacto de la pandemia por COVID-19 en el pronóstico funcional a 3 meses de pacientes con ictus isquémico. En nuestra comunidad autónoma, no ha habido un incremento en la mortalidad o discapacidad a 3 meses de pacientes hospitalizados por ictus isquémico durante el periodo de COVID-19. (AU)

Introduction: The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain).Materil and methodsWe reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic.ResultsIn total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs. 29.0%, P=.028). In the comparative analysis, we found no significant differences in mortality (12.3 vs. 7.9, P=.465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs. 57.1%, P=.425) at 3 months.ConclusionTo our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic. (AU)

Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: regional analysis of the impact of COVID-19.

INTRODUCTION: The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain). METHODS: We reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic. RESULTS: In total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs 29.0%, P = .028). In the comparative analysis, we found no significant differences in mortality (12.3 vs 7.9, P = .465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs 57.1%, P = .425) at 3 months. CONCLUSION: To our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic.

[Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: Rregional analysis of the impact of COVID-19]. / Pronóstico funcional a 3 meses de pacientes hospitalizados por ictus isquémico agudo en Aragón: análisis regional de la repercusión de la COVID-19.

Introduction: The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain). Materil and methods: We reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic. Results: In total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs. 29.0%, P=.028). In the comparative analysis, we found no significant differences in mortality (12.3 vs. 7.9, P=.465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs. 57.1%, P=.425) at 3 months. Conclusion: To our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic.

[Diagnosis and treatment of a mobile carotid thrombus. A case report]. / Diagnóstico y tratamiento del trombo móvil carotídeo. A propósito de un caso.

TITLE: Diagnóstico y tratamiento del trombo móvil carotídeo. A propósito de un caso.