Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação / Functional independence, clinical aspects, and sociodemographic factors in patients in the acute phase of stroke: an association analysis

RESUMO Objetivo Analisar a associação da independência funcional com aspectos clínicos de comprometimento neurológico, a localização e extensão do dano neuronal e os fatores sociodemográficos em pacientes na fase aguda do AVC. Método Estudo analítico de recorte transversal, realizado com 90 pacientes adultos e idosos acometidos por AVC isquêmico, que tiveram admissão no ambiente hospitalar nas primeiras 24 horas após o evento vascular. A coleta dos dados referentes aos aspectos clínicos e fatores sociodemográficos foi realizada pelo prontuário eletrônico e/ou entrevista para descrever o perfil dos pacientes, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale e a Medida de Independência Funcional. Resultados O comprometimento neurológico, de acordo com a National Institute of Health Stroke Scale, foi associado à funcionalidade nas primeiras 24 horas após o AVC. Além disso, a presença de hipertensão arterial, idade, trabalho inativo, tabagismo e extensão do dano neuronal estiveram associados à dependência funcional, mas não permaneceram no modelo final deste estudo. Conclusão A dependência funcional está associada à hipertensão arterial, idade, trabalho inativo, tabagismo, extensão do dano neuronal e grau de comprometimento neurológico nas primeiras 24 horas após o evento vascular. Além disso, um nível mais elevado de comprometimento neurológico foi independentemente associado a níveis aumentados de dependência funcional.

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

Conhecimento de idosos sobre acidente vascular cerebral no contexto emergencial: Revisão integrativa / Conocimiento de ancianos sobre accidente vascular cerebro en el contexto de emergencia: Revisión integrativa / Elderly knowledge about brain vascular accident in the emergency context: Integrative review

Objetivo:identificar o conhecimento de idosos sobre acidente vascular cerebral relacionado à busca pelo atendimento emergencial. Método:revisão integrativa realizada em maio e junho de 2021,na Biblioteca Virtual em Saúde, National Library of Medicine and National Institutes of Health, Scientific Eletronic Library Online, Cumulative Index to Nursing and Allied Health Literature, SCOPUS e Web of Science, empregados Descritores de Ciências da Saúde, Medical Subject Headings e termos alternativos, publicados em 2016 a 2021.Resultados:compuseram 33 artigos o corpus da revisão, categorizados em duas vertentes: os conhecimentos sobre fatores de risco, prevenção e identificação do AVC; e a busca pelo atendimento precoce no serviço de urgência e emergência. Conclusão:idosos geralmente desconhecema doença e a necessidade de busca precoce doatendimento, o que ressalta a importância de ações de promoção à saúde e orientações relacionadas ao AVC, sejam elas por meio das mídias ou de pessoas que compõem a rede de apoio(AU)

Objective: to identify the knowledge of the elderly about stroke related to the search for emergency care. Method: integrative review carried out in May and June 2021 at the Virtual Health Library, National Library of Medicine and National Institutes of Health, Scientific Electronic Library Online, Cumulative Index to Nursing and Allied Health Literature, SCOPUS and Web of Science, employees Health Sciences, Medical Subject Headings and alternative terms, published in the years 2016 to 2021. Results: the review corpus comprised 33 articles, categorized into two aspects: knowledge about risk factors, prevention and identification of stroke; and the search for early care in the urgency and emergency service. Conclusion: the elderly are generally unaware of the disease and the need to seek care early, which highlights the importance of health promotion actions and guidelines related to stroke, whether through the media or people who make up the support network.(AU)

Objetivo: identificar el conocimiento de los ancianos sobre el accidente cerebrovascular relacionado con la búsqueda de atención de emergencia. Método: revisión integradora realizada en mayo y junio de 2021 en la Biblioteca Virtual en Salud, Biblioteca Nacional de Medicina e Institutos Nacionales de Salud, Scientific Electronic Library Online, Cumulative Index to Nursing and Allied Health Literature, SCOPUS y Web of Science, empleados Ciencias de la Salud , Medical Subject Headings y términos alternativos, publicados en los años 2016 a 2021. Resultados: el corpus de revisión comprendió 33 artículos, categorizados en dos aspectos: conocimiento sobre factores de riesgo, prevención e identificación del ictus; y la búsqueda de atención temprana en el servicio de urgencias y emergencias. Conclusión: los ancianos generalmente desconocen la enfermedad y la necesidad de buscar atención temprana, lo que destaca la importancia de las acciones y directrices de promoción de la salud relacionadas con el accidente cerebrovascular, ya sea a través de los medios de comunicación o de las personas que componen la red de apoyo.(AU)

Diagnóstico de Fibrilação Atrial na Comunidade Utilizando Eletrocardiograma e Autorrelato: Análise Transversal do ELSA-Brasil / Atrial Fibrillation Diagnosis using ECG Records and Self-Report in the Community: Cross-Sectional Analysis from ELSA-Brasil

Resumo Fundamento: A fibrilação ou flutter atrial (FFA) é a arritmia cardíaca sustentada mais comum. Existem poucos dados sobre a epidemiologia da FFA na América do Sul. Objetivo: O presente estudo procurou descrever a epidemiologia clínica da FFA e o uso de anticoagulantes na avaliação da linha de base do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). Métodos: Foram analisados dados de 13.260 participantes do ELSA-Brasil. A FFA foi definida pelo eletrocardiograma ou por autorrelato. Modelos de regressão logística foram construídos para analisar fatores associados à FFA. Este estudo também analisou se idade e sexo estavam associados ao uso de anticoagulantes para evitar acidente vascular cerebral. O nível de significância foi de 5%. Resultados: A idade mediana foi de 51 anos, e 7.213 (54,4%) participantes eram mulheres. A FFA foi detectada em 333 (2,5%) participantes. O aumento da idade (razão de chances [RC]:1,05; intervalo de confiança de 95% [IC95%]: 1,04-1,07), hipertensão (RC:1,44; IC95%:1,14-1,81) coronariopatia (RC: 5,11; IC95%:3,85-6,79), insuficiência cardíaca (RC:7,37; IC95%:5,00-10,87) e febre reumática (RC:3,38; IC95%:2,28-5,02) foram associadas à FFA. Dos 185 participantes com FFA e pontuação no CHA2DS2-VASc≥2, apenas 20 (10,8%) usavam anticoagulantes (50,0% entre aqueles com FFA no eletrocardiograma de linha de base). O uso de anticoagulantes nesse grupo foi associado a maior idade (1,8% vs 17,7% naqueles com idade ≤ 54 e ≥ 65 anos, respectivamente; p=0,013). Observou-se uma tendência ao menor uso de anticoagulantes em mulheres (7,1% vs. 16,4% em mulheres e homens, respectivamente; p=0,055). Conclusões: No recrutamento do ELSA-Brasil, 2,5% dos participantes tinham FFA. O baixo uso de anticoagulantes era comum, o que representa um desafio para os cuidados de saúde nesse cenário.

Abstract Background: Atrial fibrillation or flutter (AFF) is the most common sustained cardiac arrhythmia. Limited data can be found on AFF epidemiology in South America. Objective: The present study sought to describe the clinical epidemiology of AFF and the use of stroke prevention medication in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. Methods: This study analyzed data from 13,260 ELSA-Brasil participants. AFF was defined according to ECG recording or by self-report. Logistic regression models were built to analyze factors associated with AFF. This study also analyzed if age and sex were associated with anticoagulant use for stroke prevention. Significance level was set at 5%. Results: Median age was 51 years and 7,213 (54.4%) participants were women. AFF was present in 333 (2.5%) participants. Increasing age (odds ratio [OR]:1.05; 95% confidence interval [95%CI]: 1.04-1.07), hypertension (OR:1.44; 95%CI: 1.14-1.81), coronary heart disease (OR: 5.11; 95%CI: 3.85-6.79), heart failure (OR:7.37; 95%CI: 5.00-10.87), and rheumatic fever (OR:3.38; 95%CI: 2.28-5.02) were associated with AFF. From 185 participants with AFF and a CHA2DS2-VASc score ≥2, only 20 (10.8%) used anticoagulants (50.0% among those with AFF in the baseline ECG). Stroke prevention in this group was associated with a higher age (1.8% vs 17.7% in those aged ≤ 54 and ≥ 65 years, respectively; p=0.013). A trend towards a reduced anticoagulant use was observed in women (7.1% vs. 16.4% in women and men, respectively; p=0.055). Conclusions: At the ELSA-Brasil baseline, 2.5% of the participants had AFF. The lack of stroke prevention was common, which is an especially challenging point for healthcare in this setting.

Pre-hospital Care for Suspected Stroke Patients, Cared for by Mobile Emergency Care Units in Northern Minas Gerais

Abstract Background Stroke management require rapid identification, assessment, and transport of patients to qualified health care centers. However, there is little description in the literature on the multiple challenges associated with the pre-hospital transport of suspected stroke patients. Objective To characterize the pre-hospital care provided to suspected stroke patients by the Brazilian Emergency Medical Service (SAMU in Portuguese), by means of a descriptive case study. Methods This is a descriptive study of a series of cases. Data from the SAMU regarding the responses to emergency calls from suspected stroke patients were collected. Independent reviewers confirmed the diagnostic hypothesis and all discordances were assessed using kappa statistics. Clinical data and transport times were described as frequency and proportion or central tendency and dispersion measures. Normality of continuous variable distribution was assessed using the Kolmogorov-Smirnov test. The Mann-Whitney U test was used for comparison of medians, with a 5% significance level. Results During the studied period, 556 suspected stroke patients were treated. The kappa index was 0.82 (95% CI 0.737 to 0.919) CI. In 74.7% of the cases, the symptom onset time was not recorded. The median time elapsed between the call for emergency services and the ambulance arrival was 18 minutes, and the median transport time was 38 minutes. A total of 34% of the patients were taken to referral hospitals for stroke. Conclusion This study revealed a low level of knowledge regarding the need to determine the exact time of symptom onset of suspected stroke patients. Also, the study showed the low rate of patients taken to referral hospitals. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

Stroke-mimics in stroke-units. Evaluation after changes imposed by randomized trials / Imitadores de AVC em unidades de AVC. Avaliação após alterações impostas por ensaios randomizados

Abstract A larger therapeutic window for stroke treatment requires a significant change in the organization of emergency services, avoiding the increase in number of imaging exams and indirectly the time to treatment. Objective: To highlight the relation between faster clinical evaluation and stroke over-suspicion and consequently excessive imaging acquisition. To identify predictors of ischemic stroke and stroke mimics (SM), aiming for better patient selection for comprehensive neuroimaging and reperfusion therapies. Methods: Retrospective, cohort, observational, single-center study that reviewed all consecutive files of patients presenting with acute neurological symptoms who underwent CT scan or MRI from July 1, 2016 to July 1, 2017. Results: 736 patient files were reviewed. 385 patients (52.3%) presented with confirmed acute ischemic infarct, 93 (12.6%) had another brain lesion mimicking acute ischemia, and 258 (35.1%) had normal imaging. Acute stroke was more frequent in elderly patients with atrial fibrillation, arterial hypertension, or dysarthria or right motor impairment. Stroke mimic was associated with female patients with low vascular risk factors, low NIHSS, and patients with decreased level of consciousness or symptoms suggestive of posterior circulation. Discussion: 47.7% of all patients seen at the stroke unit did not have acute stroke lesions. Clinical assessment data have been used to provide indicators of acute stroke and stroke mimic patients, and symptoms corresponding to acute stroke and stroke mimic seem to be similar in the literature. Conclusion: Considering that the number of patients admitted for stroke treatment will increase even further with a larger therapeutic window for mechanical thrombectomy and for thrombolysis, a diagnostic decision-making algorithm for stroke patients is required in order to reinforce the suspicion of stroke indicating an urgent MRI.

Resumo Uma janela terapêutica maior para o tratamento do AVC exige uma mudança significativa na organização dos serviços de emergência, para evitar o aumento do número de exames de imagem e indiretamente o tempo de tratamento. Objetivo: destacar a relação entre avaliação clínica mais rápida e suspeita de acidente vascular cerebral e, consequentemente, aquisição de imagem excessiva, e identificar preditores de acidente vascular cerebral isquêmico e imitações de acidente vascular cerebral (SM), visando uma melhor seleção de pacientes para terapias abrangentes de neuroimagem e reperfusão. Métodos: estudo observacional de coorte retrospectivo, em centro único, que revisou todos os arquivos consecutivos de pacientes com sintomas neurológicos agudos submetidos à tomografia computadorizada ou ressonância magnética de 1 de julho de 2016 a 1 de julho de 2017. Resultados: Foram revisados 736 prontuários. 385 pacientes (52,3%) apresentaram infarto isquêmico agudo confirmado, 93 (12,6%) apresentaram outra lesão cerebral imitando isquemia aguda e 258 (35,1%) apresentaram imagem normal. O AVC agudo foi mais frequente em pacientes idosos com fibrilação atrial, hipertensão arterial, ou disartria ou comprometimento motor direito. A imitação de acidente vascular cerebral foi associada a pacientes do sexo feminino com baixos fatores de risco vascular, NIHSS baixo e pacientes com diminuição do nível de consciência ou sintomas sugestivos de circulação posterior. Discussão: 47,7% de todos os pacientes atendidos na unidade de AVC não apresentaram lesões agudas de AVC. Conclusão: Considerando que o número de pacientes admitidos para tratamento de AVC aumentará ainda mais com uma janela terapêutica maior para trombectomia e trombólise IV, é necessário um algoritmo de tomada de decisão diagnóstica para pacientes com AVC, a fim de reforçar a suspeita de AVC indicando uma imagem cerebral urgente.

Estudio experimental de intervención educativa en conocimientos, actitudes y prácticas para ictus / Experimental study of educational intervention in knowledge, attitudes and practices for ictus

El ictus es una de las patologías neurológicas de mayor prevalencia en el país.Objetivo: determinar la eficacia de la intervención educativa en el cambio de conocimientos, actitudes y prácticas frente a los factores de riesgo del ictus.Método: estudio experimental con muestra al azar de intervención en 68 sujetos, quienes recibieron programa educativo y al mismo tiempo actua-ron como control. Se aplicó un cuestionario sobre conocimientos, actitudes y prácticas validado pre y post intervención. Además, se realizó toma de su presión arterial, determinación del índice de masa corporal, perfil lipídico, hemoglobina glicosilada. La efectividad de la intervención educativa se representa como cambio en porcentaje pre y post intervención en un lapso de tres meses.Resultados: la media de edad fue de 61.07 años, 64.7% fueron mujeres, el porcentaje de conocimientos, actitudes y prácticas adecuadas mejoró de 61.36% a 73.7%; de 64.94% a 83.94%; 87.92% y 76.52% respectivamente. La efectividad total fue un incremento del 22%. Las variables cuantitativas como índice de masa corporal, tensión arterial, niveles de perfil lipídico, así como hemoglobina glicosilada no alcanzaron diferencia significativa.Conclusiones: existe una relación directa y eficacia mayor del 20% cuan-do los pacientes son intervenidos educativamente para modificar positiva-mente los conocimientos, actitudes y prácticas sobre los factores de riesgo de ictus.(AU).

Objective: to determine the effectiveness of the educational intervention in the change of knowledge, attitudes and practices regarding ictus.Method: It is a quasi-experimental study with a random sample of intervention in 68 subjects, who received an educational program and at the same time acted as control. A questionnaire on knowledge, attitudes and practices validated before and after intervention was applied.In addition, blood pressure, determination of body mass index, lipid profile and glycosylated hemoglobin were taken. The effectiveness of the educational intervention is represented as a change in pre and post intervention percentage in a period of three months.Results: the average age was 61.07 years, 64.7% were women, the percentage of knowledge, attitudes and appropriate practices improved from 61.36% to 73.7%; from 64.94% to 83.94%; 87.92% and 76.52% respectively. The total effectiveness was an increase of 22%. The quantitative variables such as body mass index, blood pressure, lipid profile levels, as well as glycosylated hemoglobin did not reach a significant difference.Conclusions: there is a direct and efficacy relationship greater than 20% when patients are educated to positively modify knowledge, attitudes and practices on risk factors regarding ictus. (AU).

Pacientes com acidente vascular cerebral (avc) agudo em cuidados paliativos: uma revisão sistemática / Acute stroke patients in palliative care: a systematic review

INTRODUÇÃO: O acidente vascular encefálico (AVC), um importante problema de saúde pública, pode ter consequências catastróficas para o indivíduo e seus familiares. Cuidados paliativos (CP) são promovidos por equipe multiprofissional, com intuito de prevenir e aliviar sofrimentos de pacientes com doença ameaçadora à vida e de seus familiares. OBJETIVOS: Identificar necessidades de CP em pacientes com AVC agudo grave e seus familiares. MÉTODOS: Uma revisão sistemática foi conduzida nas bases de dados: MEDLINE, PubMed, SciELO, LILACS, DOAJ e Cochrane, em artigos publicados no período de 2000 a 2018. RESULTADOS: Dos 114 artigos encontrados na busca inicial, 16 foram selecionados após aplicação de critérios de inclusão e exclusão. Mostraram discussões sobre prognóstico; prevalência de sintomas e principais barreiras de comunicação. Foi evidenciado que estes pacientes e seus familiares têm necessidades multidimensionais não atendidas. O principal motivo para solicitar CP foi a abordagem de diretivas avançadas de vontade e de cuidados de fim-de-vida. CONCLUSÃO: Há indicação e beneficio à inserção de cuidados paliativos em pacientes acometidos por AVC agudo grave. Para isto, são fundamentais: o trabalho interdisciplinar da equipe de saúde, boa comunicação, estratégias educacionais e deliberação política.

BACKGROUND: Stroke, an important public health problem, can have catastrophic consequences for the individual and his or her family. Palliative care (PC) is promoted by a multiprofessional team to prevent and alleviate the suffering of patients with life-threatening illness and their relatives. OBJECTIVES: To identify needs to PC in severe acute stroke patients and their relatives. METHODS: A systematic review was conducted in the databases MEDLINE, PubMed, SciELO, LILACS, DOAJ and Cochrane in articles published from 2000 to 2018. RESULTS: Of the 114 articles found in the initial search, 16 were selected after application of inclusion and exclusion criteria. They showed discussions about prognosis; prevalence of symptoms and main communication barriers. It was evidenced that these patients and their families have multidimensional needs not met. The main reason for requesting PC was an approach to end-of-life decision-making and end-of-life care. CONCLUSION: There is indication and benefit the insertion of palliative care in patients affected by severe acute stroke. For this, the interdisciplinary work of the health team, good communication, educational strategies and political deliberation are fundamental.

Carotid plaque is a predictor of major adverse cardiac and cerebrovascular events in patients undergoing coronary angiography / La presencia de placa carotídea es predictor de eventos adversos cardiacos y cerebrovasculares en sujetos sometidos a coronariografía

Abstract Introduction: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions: CP is an independent predictor of MACCE in patients undergoing coronary angiography.

Resumen La enfermedad carotídea, definida como grosor de íntima media (GIMC) y placa (PC), se asocia con eventos adversos cardiacos y cerebrovasculares (EACC) en sujetos sin aterosclerosis previa; sin embargo hay pocos datos en pacientes sometidos a coronariografía. El objetivo del estudio es determinar si la enfermedad carotídea se asocia a EACC en pacientes remitidos a coronariografía Métodos: Entre 2002 y 2013 390 pacientes fueron sometidos a coronariografía tras ecocardiograma de esfuerzo y ecografía carotídea. Se definió EACC como accidente cerebrovascular, infarto de miocardio por progresión aterosclerótica o muerte por accidente cerebrovascular o causa cardiaca. Resultados: Durante un seguimiento medio de 6 años (desviación estándar 2, 9) se registraron 2 pérdidas y 52 eventos (13,4%). La supervivencia media libre de eventos a uno, cinco y diez años fue 96.4% (1.0), 88.7% (1.7) y 81.4% (2.8). Hubo mayor número de eventos a 10 años en el grupo de PC (23.2% frente 10.2%, p = 0.013) y GIMC > 0.9 mm (25,9% frente 13.3%, p = 0.023). En el análisis multivariado los predictores de EACC fueron tabaquismo (hazard ratio [HR] 2.51, intervalo de confianza [IC] al 95% 1.36-4.62, p = 0.003), filtrado glomerular renal (HR 0.98 IC95% 0.98-0.99), estenosis aórtica (HR 2.99, IC 95% 1.24-7.21, p = 0.014), revascularización incompleta/no revascularización (HR 1.97, IC 95% 1.06-3.67, p = 0.033), tratamiento con insulina (HR 2.63, IC 95% 1.30-5.31, p = 0.006) y PC (HR 2.36, 95%CI 1.02-5.44, p = 0.044). Conclusiones: La PC es un predictor independiente de EACC en pacientes sometidos a coronariografía.

Caracterización epidemiológica de pacientes con enfermedad cerebral vascular aguda en un hospital de Chile en base a registros de grupos relacionados al diagnóstico / An epidemiological characterization of patients with acute stroke in a single Chilean hospital using diagnosis-related group registers

Resumen Introducción Las enfermedades cerebrales vasculares son la primera causa específica de muerte y discapacidad en Chile. Objetivo Analizar características epidemiológicas de pacientes hospitalizados con diagnóstico de accidentes vasculares cerebrales en el Complejo Asistencial Víctor Ríos Ruiz. Metodología Estudio observacional, transversal. Se analizaron los egresos hospitalarios con diagnóstico de accidentes vasculares cerebrales entre 2014 y 2017. Se recolectaron datos sobre el diagnóstico de accidentes vasculares cerebrales mediante registro CIE 10, datos demográficos, tipo de accidentes vasculares cerebrales y datos respecto de la letalidad y estadía intrahospitalaria. Las variables cuantitativas fueron expresadas mediante promedios y desviación estándar (± DS) mientras que las variables categóricas fueron evaluadas mediante frecuencias absolutas y relativas. Las diferencias entre las variables fueron analizadas mediante T de Student y ANOVA de un factor. Se consideraron resultados significativos los valores p < 0,05. Resultados Se caracterizó un total de 1856 egresos, 58,6% fueron hombres, edad media de 66,9 (± 13,9) años y estadía media de 10,4 (± 16,7) días. En mujeres, la edad media fue 69,9 (± 16) años y estadía media 11,1 (± 16,5) días. El 55,5% correspondió a accidentes vasculares cerebrales isquémicos y 17,4% accidentes vasculares cerebrales hemorrágicos. Los principales factores de riesgo fueron hipertensión arterial (72%) y diabetes mellitus (33%). La letalidad intrahospitalaria global fue de 10,6%. Tanto la letalidad y estadía prolongada estuvieron asociadas a hemorragia subaracnoidea y accidentes vasculares cerebrales hemorrágicos (valor p < 0,05). Conclusiones La prevalencia de accidentes vasculares cerebrales es similar en hombres y mujeres. La hipertensión arterial fue el factor de riesgo más prevalente. A pesar de que el accidente vascular cerebral isquémico fue el más frecuente, la hemorragia subaracnoidea y el accidente cerebral vascular hemorrágico fueron relacionados con una mayor letalidad y estadía prolongada.

Abstract Introduction Stroke is the leading cause of death and disability in Chile. Objective To analyze the epidemiological characteristics of hospitalized patients with a diagnosis of stroke in our hospital unit (Complejo Asistencial Víctor Ríos Ruiz). Methods We performed an observational, cross-sectional study. We included patients who were discharged from our hospital with a diagnosis of stroke between 2014 and 2017. We extracted data on stroke-related ICD codes, demographic variables, types of stroke, case fatality rates, and hospital stay. Quantitative variables were expressed as averages with standard deviation (± SD), and categorical variables were expressed as absolute and relative frequencies. Differences were analyzed using Student t-distribution and ANOVA. We defined a p-value of < 0.05 as statistically significant. Results In total, 1856 patients were discharged of which 58.6% were male, with an average age of 66.9 (± 13.9) years, and an average stay of 10.4 (± 16.7) days. In the female population, the average age was 69.9 (± 16), and the average hospitalization was 11.1 (± 16.5) days. 55.5% of stroke cases was ischemic, and 17.4% was hemorrhagic. The main risk factors were hypertension (72%) and type 2 diabetes (33%). We found an overall in-hospital case fatality rate of 10.6%. Both the case fatality rate and prolonged in-hospital stay were associated with subarachnoid hemorrhage and hemorrhagic stroke (p < 0.05). Conclusions Prevalence of stroke is similar in both men and women. Hypertension was the leading risk factor associated with acute stroke. Although ischemic stroke was the most frequent diagnosis, both subarachnoid hemorrhage and hemorrhagic stroke were related to an increased case fatality rate and a more extended hospital stay.

Effects of virtual reality therapy on upper limb function after stroke and the role of neuroimaging as a predictor of a better response / Efeitos da terapia de realidade virtual na função do membro superior após AVC e o papel da neuroimagem como preditor de melhor resposta

ABSTRACT Background: Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT. Methods: Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function. Results: Eighteen patients were studied (55.5 ± 13.9 years of age). Quality of life, functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery. Conclusion: VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed.

RESUMO Introdução: A realidade virtual (RV) é uma intervenção interativa que induz a neuroplasticidade. O objetivo deste estudo foi avaliar os efeitos da RV associado à reabilitação convencional na função do membro superior após o AVC e as características preditores de neuroimagem de melhor resposta a esta terapia. Métodos: os pacientes com AVC foram selecionados, e as características neurológicas, a função do membro superior e a qualidade de vida foram avaliadas. A análise estatística foi realizada por meio de modelo linear geral comparando resultados pré e pós-intervenção. As lesões foram segmentadas na tomografia computadorizada após o AVC. A abordagem de mapeamento da lesão-sintoma baseada em voxel foi utilizada para avaliar a relação entre a lesão e a função do membro superior. Resultados: Foram estudados 18 pacientes (8 mulheres, 55,5 ± 13,9 anos). A qualidade de vida, independência funcional, características funcionais e destreza do membro superior apresentaram melhora após RV (p < 0,001). A análise de imagem mostrou correlações negativas principalmente entre a cápsula interna e a recuperação funcional do membro superior. Conclusão: A RV mostrou benefícios para pacientes com AVC, mas quando houve lesão da cápsula interna apresentaram pior resposta à terapia.

Stroke recurrence in the different subtypes of ischemic stroke. The importance of the intracranial disease / Recorrência nos diferentes subtipos de acidente vascular cerebral isquêmico. A importância da doença intracraniana

ABSTRACT The aim of the study was to analyze the long-term recurrence rate in patients with a first-ever ischemic stroke secondary to intracranial large artery atherosclerosis (LAA) in a Brazilian population. Methods: All stroke patients admitted to the hospital between October 2012 and September 2015 were evaluated. The stroke mechanism subtypes were classified as cardioembolism, LAA, small-vessel occlusion, other determined etiologies, and stroke of undetermined etiology. Results: The 359 first-ever ischemic stroke patients were followed up for a mean time of 21.6 ± 15.1 months. The LAA intracranial (38.9%) and extracranial (24.6%) stroke patients presented with a higher stroke recurrence. Intracranial LAA [HR, 10.2 (3.6-29.1); p < 0.001] and extracranial LAA [HR, 5.05 (1.79-14.2); p = 0.002] were the only conditions to show positive correlation with the recurrence rate, after adjusting for risk factors, thrombolysis, and National Institutes of Health Stroke Scale score at admission. Conclusion: Intracranial LAA presents a higher incidence of recurrence of ischemic stroke when compared with other etiologies in a Southern Brazilian population.

RESUMO O objetivo do presente estudo é analisar a taxa de recorrência a longo prazo em pacientes com o primeiro AVCi secundário à aterosclerose de grande artéria intracraniana em uma amostra brasileira. Métodos: Pacientes admitidos entre outubro de 2012 e setembro de 2015 foram analisados. Os subtipos do mecanismo de AVC foram classificados como cardioembolismo, aterosclerose de grandes artérias, oclusão de pequenos vasos, outras etiologias determinadas e AVCi de causa indeterminada. Resultados: Foram avaliados 359 pacientes com primeiro AVCi. O tempo médio de seguimento foi de 21,6 ± 15,1 meses. A aterosclerose de grande artéria, intracraniana (38,9%) e extracraniana (24,6%), apresentou a maior taxa de recorrência. A aterosclerose de grande artéria intracraniana [HR, 10,2 (3,6-29,1); p < 0,001] e extracraniana [HR, 5,05 (1,79-14,2); p = 0,002] demonstraram correlação positiva com a taxa de recorrência, após o ajuste para fatores de risco, trombólise e gravidade dos sintomas na admissão. Conclusão: A aterosclerose de grande artéria, tanto intracraniana como extracraniana, apresenta maior recorrência comparado aos outros mecanismos de AVCi em uma amostra do Sul do Brasil.

Perfil dos pacientes com diagnóstico de AVC atendidos em um hospital de Minas Gerais credenciado na linha de cuidados / Profile of patients with a diagnosis of stroke attended at a hospital in Minas Gerais accredited in the care line

Introdução: Acidente Vascular Cerebral é um problema de saúde pública em que estudos epidemiológicos evidenciam a importância da prevenção, promoção e tratamento da doença no Brasil. Objetivo: descrever a distribuição de pacientes com Acidente Vascular Cerebral nos diferentes setores de internação de um hospital da rede pública credenciado pelo Ministério da Saúde na linha de cuidados. Métodos: Estudo transversal em que foram avaliados pacientes com Acidente Vascular Cerebral admitidos no Hospital Risoleta Tolentino Neves de Belo Horizonte no período de janeiro a junho de 2015. Dados sócio-demográficos e clínicos foram extraídos dos prontuários e/ ou por meio de entrevistas, sendo analisadas as informações: sexo; idade; mecanismo fisiopatológico; tempo de ictus; fatores de risco para o AVC; setor de internação; tempo de internação e complicações clínicas. Resultados: Dos 223 pacientes internados, 55% eram sexo masculino e idade média de 64,3 anos. Em relação aos setores hospitalares, 169 foram alocados para a Unidade de Acidente Vascular Cerebral (82% isquêmico), 24 no Centro de Tratamento Intensivo (79% hemorrágico), 23 no Pronto Atendimento (74% Ataque Isquêmico Transitório) e sete na Enfermaria Geral. A média do tempo de ictus foi de 13,2 horas. O tempo médio de internação foi de 12,4 ± 9,8 dias, entretanto a Enfermaria Geral e o Centro de Tratamento Intensivo apresentaram maiores tempos de internação e número de complicações clínicas. Conclusão: A linha de cuidado em Acidente Vascular Cerebral nos hospitais pode reduzir complicações clínicas, mortalidade e tempo de internação, contribuindo para organização de setores de internação e utilização de recursos hospitalares.(AU)

Background: Stroke is a public health problem in which epidemiological studies evidence the importance of the prevention, promotion and treatment of the disease in Brazil. Purpose: To describe the distribution of patients with Stroke in different hospital sectors of a public hospital accredited by the Ministry of Health in care line. Methods: Cross-sectional study which evaluated patients with Stroke admitted to the Hospital Risoleta Tolentino Neves Belo Horizonte in the period January-June 2015. socio-demographic and clinical data were extracted from medical records and / or through interviews, and analyzed information: gender; age; Pathophysiological mechanism; Stroke time; Risk factors for stroke; Hospitalization; Length of hospital stay and clinical complications. Results: Of the 223 hospitalized patients, 55% were male and mean age was 64.3 years. In the hospital sectors, 169 were allocated to the Stroke Unit (82% ischemic), 24 in the Intensive Care Center (79% hemorrhagic), 23 in the Emergency Care Unit (74% Transient Ischemic Attack) and 7 in the General Nursing. The mean stroke time was 13.2 hours. The mean length of hospital stay was 12.4 ± 9.8 days, although the General Nursing and Intensive Care had longer hospitalization times and number of clinical complications. Conclusion: The line of care in stroke in hospitals can reduce clinical complications, mortality and length of stay, contributing to the organization of hospitalization sectors and use of hospital resources. (AU)

Key performance indicators for stroke from the Ministry of Health of Brazil: benchmarking and indicator parameters / Indicadores de performance de AVC do Ministério da Saúde do Brasil: avaliação comparativa e parametrização dos indicadores

ABSTRACT The present study aimed to analyze the stroke units in two centers for the key performance indicators (KPIs) required by the Ministry of Health in Brazil. Methods All 16 KPIs were analyzed, including the percentage of patients admitted to the stroke unit, venous thromboembolism prophylaxis in the first 48 hours after admission, pneumonia and hospital mortality due to stroke, and hospital discharge on antithrombotic therapy in patients without cardioembolic mechanism. Results Both centers admitted over 80% of the patients in their stroke unit. The incidence of venous thromboembolism prophylaxis was > 85%, that of in-hospital pneumonia was < 13%, the hospital mortality for stroke was < 15%, and the hospital discharge on antithrombotic therapy was > 70%. Conclusion Our results suggest using the parameters of all of the 16 KPIs required by the Ministry of Health of Brazil, and the present results for the two stroke units for future benchmarking.

RESUMO O objetivo do presente estudo é analisar os indicadores de qualidade (IQ) exigidos pelo Ministério da Saúde no Brasil em duas unidades de AVC. Métodos Foram analisados os 16 IQ, incluindo a percentagem de pacientes internados na unidade de AVC, profilaxia de tromboembolismo venoso (TEV) nas primeiras 48 horas após a admissão; pneumonia e mortalidade hospitalar e alta hospitalar em terapia antitrombótica (TAT) em pacientes sem mecanismo cardioembólico. Resultados Ambos os centros admitiram mais de 80% dos pacientes na unidade de AVC. A profilaxia do TEV foi realizada em mais de 85% dos casos; a pneumonia hospitalar foi inferior a 13%; a mortalidade hospitalar foi menor que 15% e a alta hospitalar em uso de TAT foi acima de 70%. Conclusão O presente estudo sugere os parâmetros dos 16 IQ exigidos pelo Ministério da Saúde do Brasil e os resultados obtidos em duas unidades de AVC para avaliação comparativa futura

Strain auricular izquierdo y biomarcadores cardíacos como predictores de accidente cerebrovascular en pacientes con fibrilación auricular de reciente comienzo / Left atrial strain and biomarkers for stroke in patients with recent onset atrial fibrillation

Introducción: La miopatía y fibrosis auricular representan el sustrato protrombótico y proarrítmico en pacientes con fibrilación auricular (FA). Estudios recientes muestran relación entre el strain auricular izquierdo (SAI), eventos cardiovasculares y recurrencia en pacientes con FA. La asociación entre SAI y bio-marcadores cardíacos como predictores de accidente cerebrovascular silente (ACVs) en pacientes con FA de reciente comienzo (FArc) no ha sido estudiada. Objetivo: Determinar si la asociación entre SAI y biomarcadores cardíacos contribuye a la predicción de ACV en pacientes con FArc. Métodos: Se realizó un estudio prospectivo que permitió reclutar 57 pacientes con FArc (primer episodio de < de 8 semanas de evolución). Obtenido consentimiento informado (CI) se realizó recolección de datos clínicos y muestras de sangre para determinación de Pro-BNP, Dimero-D y GDF-15. Se realizó resonancia nuclear magnética cerebral (RNMc) y ecocardiograma transtorácico (ETT) durante los primeros 3 días de inclusión y en ritmo sinusal. Para la evaluación de SAI se consideró la curva de deflexión positiva durante la sístole ventricular (SAIs), derivada de speckle tracking, considerando el promedio de 5 ciclos. Se utilizó Mann Whitney U test y Spearman Rho para análisis estadístico. Resultados: La edad promedio fue 70±8,2 años y el 70% fueron hombres. El CHA2DS2-VASc score promedio fue 3,1±1 y el promedio de pro-BNP, Di-mero-D y GDF-15 fue 96,1±12,4 pg/ml, 990±140 ng/ ml y 12 ng/ml respectivamente. 15% de los pacientes (n=9) presentaban ACVs en la RNMc al momento del diagnóstico. Se observó, además, que los pacientes con ACV presentaban un SAIs más bajo que los pacientes sin eventos (5,5±1,1% y 14,6±7,3% respectivamente p=0.04). Adicionalmente, se encontró una correlación significativa entre SAIs y pro-BNP, Dimero-D y GDF-15. Conclusiones: En este trabajo se evidenció que el 15% de los pacientes con FArc presenta ACVs al momento del diagnóstico. El SAIs bajo se correlaciona de forma inversa con los biomarcadores de sobrecarga, trombogénesis, fibrosis auricular y presencia de ACV silente. Estos resultados pueden ser utilizados para una mejor estratificación del riesgo de ACV en pacientes con FA.

Introduction: Atrial myopathy and fibrosis constitute a pro-arrhythmic and pro-thromboembolic substrate in patients with atrial fibrillation (AF). Recent studies using left atrial strain (LAS) have shown that LAS contributes to predict AF recurrence in patients with paroxysmal AF. The association between LAS and cardiac biomarkers in predicting silent stroke (SS) in patients with new AF has not been studied. Aim: The association of LAS and cardiac biomarkers contribute to predict SS in patients with new AF. Methods: We have prospectively evaluated 57 consecutive patients with new AF (first episode with less than 8 weeks of evolution). Baseline clinical characteristics and blood samples for determinations of Pro-BNP, D-Dimer and GDF-15 were obtained. Brain magnetic resonance (BMRI) and 2D Echo were performed within 3 days. In sinus rhythm, the positive deflection during ventricular systole of the LAS curve derived from speckle tracking was considered (mean of 5 cycles) (LASS). Mann Whitney U test and Spearman Rho were used for statistical analysis. Results: Mean age was 70±8,2 years, 70% were men. The mean CHA2DS2-VASc score was 3,1±1. Mean pro-BNP, D-Dimer and GDF-15 were 96,1±12,4 pg/ml, 990±140 ng/ml and 12 ng/ml, respectively. Fifteen percent of patients (n=9) had evidence of previous SS in BMRI. Patients with SS had significantly less LASS than patients without events (5,5±1,1% and 14,6±7,3% respectively p=0,04). In addition, a significant correlation between LASs and pro-BNP, D-Dimer and GDF-15 was found. Conclusion: Evidence of SS was found in 15% of patients with new AF. This was associated with LASs impairment, which was inversely correlated with cardiac biomarkers of LV overload, thrombogenesis and LA fibrosis. These findings could be utilized for a better risk stratification of stroke in patients with new AF.

Perception of stroke symptoms and utilization of emergency medical services / Percepción de los síntomas del accidente cerebrovascular y utilización de los servicios de emergencias médicos

ABSTRACT Lack of stroke awareness and slow activation of emergency medical services (EMS) are frequently reported reasons for delayed arrival to the hospital. We evaluated these variables in our population. Methods Review of hospital records and structured telephone interviews of 100 consecutive stroke patients. Forward stepwise logistic regression was used for the statistical analysis. Results Seventy patients (75%) arrived at the hospital 4.5 hours after stroke symptoms onset. The use of EMS did not improve arrival times. Most patients who recognized their symptoms did not use EMS (p < 0.02). Nineteen patients (20%) were initially misdiagnosed. Eighteen of them were first assessed by non-neurologist physicians (p < 0.001). Conclusions Our population showed a low level of stroke awareness. The use of EMS did not improve arrival times at the hospital and the non-utilization of the EMS was associated with the recognition of stroke symptoms. There was a concerning rate of misdiagnosis, mostly by non-neurologist medical providers.

RESUMO La falta de reconocimiento de los síntomas del accidente cerebrovascular (ACV) y la lenta activación de los servicios de emergencias médicos (SEM) son causas frecuentes de demoras en el arribo hospitalario. Nuestro objetivo fue evaluar ambas variables en nuestra población. Métodos Revisión de registros hospitalarios y entrevista telefónica estructurada de 100 pacientes consecutivos internados por ACV. El análisis estadístico se realizó mediante un modelo de regresión logística multivariada por pasos. Resultados Setenta pacientes (75%) arribaron al hospital luego de 4.5 horas del comienzo de los síntomas. El uso de los SEM no mejoró los tiempos de arribo al hospital (p < 0.02). Inicialmente, 19 pacientes (20%) recibieron un diagnóstico erróneo. Dieciocho de ellos fueron evaluados por médicos no neurólogos. (p < 0.001). Conclusiones El reconocimiento de los síntomas de ACV en nuestra población fue bajo. El uso de los SEM no mejoró los tiempos de arribo hospitalario y la no utilización de los mismos se asoció con el correcto reconocimiento de los síntomas por parte de los pacientes. La proporción de diagnósticos erróneos fue preocupante, fundamentalmente entre médicos no neurólogos.

Efeitos da irradiação de força contralateral na extensão de punho de pacientes após acidente vascular cerebral / Efects of contralateral force irradiation in the wrist extention, in patients after stroke

FUNDAMENTO: Um dos princípios de irradiação de força da facilitação neuromuscular proprioceptiva (FNP) é estimular a musculatura fraca, a partir da resistência da musculatura forte, contribuindo para o aprendizado motor. Por esta razão, este procedimento básico tem sido utilizado em pacientes após acidente vascular cerebral (AVC), no tratamento da hemiparesia contralateral à lesão. OBJETIVO: Avaliar os efeitos da técnica de irradiação de força contralateral no controle motor para ativação dos músculos extensores de punho em pacientes após AVC. MÉTODOS: Foram incluídos 10 participantes de ambos os sexos (62±6,4 anos), divididos em grupo hemiparético (n=5) e controle saudável (n+5). Foi realizado o padrão da FNP: flexão, abdução e rotação externa no membro não afetado do grupo hemiparético e no braço direito do controle. O sinal eletromiográfico dos músculos extensores radial longo e curto do carpo foi registrado em duas etapas (FNP1 e FNP2). Foram realizadas quatro repetições do padrão, mantidas por 6 segundos. A ativação muscular foi analisada pela root mean square (RMS). RESULTADOS: Houve aumento na ativação da musculatura extensora do punho por irradiação entre as etapas FNP1 e FNP2 de 7,32% no grupo hemiparético e de 18,62% no grupo saudável, porém sem diferença estatística (p>0,05). A resposta motora foi maior na etapa FNP2, após a repetição das diagonais. CONCLUSÃO: Não houve ativação significativa dos extensores de punho em pacientes hemiparéticos com o procedimento de irradiação de força da FNP. Todavia, a repetição parece aumentar a resposta de irradiação de força em pacientes após AVC.

BACKGROUND: A principle of force irradiation of proprioceptive neu-romuscular facilitation (PNF) is to stimulate the weak muscles by applying resistance in strong muscles, contributing to motor learning. Therefore, this technique is used in patients after stroke, to treat the hemiplegia contralateral to the lesion. OBJECTIVE: To evaluate controlateral force irradiation effects in motor control for activation of the wrist extensors in patients after ischemic stroke. METHODS: The study included 10 subjects of both sexes (62±6.4 years) divided into hemiparetic group (n=5) and healthy controls (n=5). We performed the PNF pattern: flexion, abduction and external rotation in the unaffected member of the hemiparetic group and in the right arm of the control. The electromyography signal of the long and short radial extensor carpi was recorded in the first stage (FNP1) , in which the diagonal was repeated 4 times, and in the standard learning stage (FNP2), with 4 times. The contractions were maintained for 6 seconds. Muscle activation was analyzed by the root mean square (RMS). RESULTS: The-re was an increase in the extensor muscles of the wrist activation by irradiation between FNP1 and FNP2 stages, of 7.32% in hemiparetic group and 18.62% in healthy group, without statiscal difference (p>0.05). Motor response was higher in FNP2 stage, after the repetition of the diagonals. CONCLUSION: There was no significant activation of the wrist extensors in hemiparetic patients with the technique of force irradiation of PNF. However, the repetition seems to increase the force irradiation response in patients after stroke.

Performance of four ischemic stroke prognostic scores in a Brazilian population / Desempenho de quatro escalas de prognóstico de AVCI em uma população brasileira

ABSTRACT Objective Ischemic stroke (IS) prognostic scales may help clinicians in their clinical decisions. This study aimed to assess the performance of four IS prognostic scales in a Brazilian population. Method We evaluated data of IS patients admitted at Hospital Paulistano, a Joint Commission International certified primary stroke center. In-hospital mortality and modified Rankin score at discharge were defined as the outcome measures. The performance of National Institutes of Health Stroke Scale (NIHSS), Stroke Prognostication Using Age and NIHSS (SPAN-100), Acute Stroke Registry and Analysis of Lausanne (ASTRAL), and Totaled Health Risks in Vascular Events (THRIVE) were compared. Results Two hundred six patients with a mean ± SD age of 67.58 ± 15.5 years, being 55.3% male, were included. The four scales were significantly and independently associated functional outcome. Only THRIVE was associated with in-hospital mortality. With area under the curve THRIVE and NIHSS were the scales with better performance for functional outcome and THRIVE had the best performance for mortality. Conclusion THRIVE showed the best performance among the four scales, being the only associated with in-hospital mortality.

RESUMO Objetivo Escalas de avaliação prognóstica do acidente vascular cerebral isquêmico (AVCI) podem ajudar decisões clinicas. O objetivo deste estudo foi avaliar o desempenho de quatro escalas prognósticas em uma população brasileira. Método Foram avaliados os dados de pacientes admitidos com AVCI no Hospital Paulistano, um hospital acreditado pela “Joint Commission International”. A mortalidade intra-hospitalar e a escala de Rankin foram definidos como desfechos de evolução clínica. O desempenho de quatro escalas: National Institutes of Health Stroke Scale (NIHSS), Stroke Prognostication Using Age and NIHSS (SPAN-100), Acute Stroke Registry and Analysis of Lausanne (ASTRAL) e Totaled Health Risks in Vascular Events (THRIVE) foi comparado. Resultados Foram incluídos duzentos e seis pacientes, com uma idade média de 67,58 ± 15,5 anos, sendo 55,3% dos sexo masculino. Todas as quatro escalas associaram-se de forma independente com prognóstico funcional. Apenas o THRIVE correlacionou-se com a mortalidade hospitalar. O THRIVE e o NIHSS tiveram melhor desempenho para prognóstico funcional e o THRIVE teve o melhor desempenho para mortalidade pela área sob a curva. Conclusão O THRIVE mostrou-se a escala com melhor performance, sendo a única correlacionada com a mortalidade hospitalar.

In-hospital mortality risk factors for patients with cerebral vascular events in infectious endocarditis: A correlative study of clinical, echocardiographic, microbiologic and neuroimaging findings / Factores de riesgo de mortalidad intrahospitalaria en pacientes con endocarditis infecciosa y accidentes cerebrovasculares: Estudio correlativo de hallazgos clínicos, ecocardiográficos, microbiológicos y neuroimágen

Objective: Cardiac complications in infectious endocarditis (IE) are seen in nearly 50% of cases, and systemic complications may occur. The aim of the present study was to determine the characteristics of inpatients with IE who suffered acute neurologic complications and the factors associated with early mortality. Methods: From January 2004 to May 2010, we reviewed clinical and imaging charts of all of the patients diagnosed with IE who presented a deficit suggesting a neurologic complication evaluated with Computed Tomography or Magnetic Resonance within the first week. This was a descriptive and retrolective study. Results: Among 325 cases with IE, we included 35 patients (10.7%) [19 males (54%), mean age 44-years-old]. The most common underlying cardiac disease was rheumatic valvulopathy (n = 8, 22.8%). Twenty patients survived (57.2%, group A) and 15 patients died (42.8%, group B) during hospitalization. The main cause of death was septic shock (n = 7, 20%). There was no statistical difference among groups concerning clinical presentation, vegetation size, infectious agent and vascular territory. The overall number of lesions was significantly higher in group B (3.1 vs. 1.6, p = 0.005) and moderate to severe cerebral edema were more frequent (p = 0.09). Sixteen patients (45.7%) (12 in group A and 4 in group B, p = 0.05) were treated by cardiac surgery. Only two patients had a favorable outcome with conservative treatment (5.7%). Conclusions: In patients with IE complicated with stroke, the number of lesions observed in neuroimaging examinations and conservative treatment were associated with higher in-hospital mortality.

Objetivo: Las complicaciones cardíacas por endocarditis infecciosa (EI) se presentan en casi 50% de los casos y pueden presentarse complicaciones generalizadas. El interés del estudio fue determinar las características de los pacientes hospitalizados con EI que presentaron complicaciones neurológicas agudas y factores asociados a mortalidad temprana. Métodos: Revisamos expedientes y estudios de imagen desde enero del 2004 hasta mayo del 2010 de todos los pacientes con EI y complicaciones neurológicas evaluadas con tomografía computarizada o resonancia magnética durante la primera semana después de la complicación. El estudio fue descriptivo y retrolectivo. Resultados: De 325 casos con EI, incluimos 35 (10.7%) [varones 19 (54%), media 44 años]. La cardiopatía subyacente más frecuente fue valvulopatía reumática (n = 8, 22.8%). Veinte pacientes sobrevivieron (57.2%, grupo A) y 15 fallecieron (42.8%, grupo B) durante su hospitalización. La principal causa de muerte fue choque séptico (n = 7, 20%). No hubo significado estadístico entre ambos grupos independientemente de presentación clínica, tamaño de vegetación, agente infeccioso o territorio vascular del ACV. La cantidad total de lesiones cerebrales fue mayor en el grupo B (3.1 vs. 1.6, p = 0.005) y el edema cerebral moderado a grave fue más frecuente (p = 0.09). Dieciséis pacientes (45.7%) (12 grupo A y 4 grupo B, p = 0.05) fueron tratados con cirugía cardiaca. Sólo 2 pacientes tuvieron resultados favorables con tratamiento conservador (5.7%). Conclusiones: En pacientes hospitalizados por EI complicada con ACVs, la cantidad de lesiones observadas en estudios de neuroimágen y el tratamiento conservador se asociaron a una mayor tasa de mortalidad intrahospitalaria.

The influence of patient’s knowledge about stroke in Brazil: a cross sectional study / A influência do conhecimento do paciente sobre o AVC no Brasil: um estudo transversal

Little is known about stroke patients’ awareness about the warning signs of stroke and its therapeutic time window in Brazil. Method We interviewed consecutive patients with acute stroke admitted to a terciary public hospital in Brazil. Data collected included demographics, mode of arrival, National Institutes of Health Stroke Scale (NIHSS) scores and knowledge of stroke warning signs and therapeutic time window. Early arrival was defined as within 4.5 hours of symptoms onset. Results Although 66.2% of patients knew the warning signs of stroke, only 7.8% reported to know that stroke had a limited therapeutic time window. Stroke severity measured by the NIHSS was independently associated with early arrival, but not knowledge of stroke signs and symptoms. Conclusion Knowledge about stroke symptoms was not a predictor of early arrival. .

Pouco se sabe sobre o conhecimento dos pacientes com acidente vascular cerebral (AVC) acerca dos sinais de alarme da doença e sua janela terapêutica no Brasil. Método Foram entrevistados consecutivamente os pacientes com AVC agudo internados em um hospital público terciário no Brasil. Os dados coletados incluíram dados demográficos, o modo de chegada, escala de AVC do National Institute of Health (NIH) e conhecimento sobre a janela de tempo terapêutica e os sinais de alerta do AVC através de um questionário padronizado. Chegada precoce foi definida como aquela dentro de 4,5 horas do início dos sintomas. Resultados Embora 66,2% dos pacientes sabiam os sinais de alerta do AVC , apenas 7,8% relataram saber que a doença tinha uma janela de tempo terapêutica limitada. A gravidade do AVC avaliada pela escala do NIH foi preditora de chegada precoce, mas conhecimento acerca dos sinais e sintomas do AVC não foram. Conclusão O conhecimento acerca dos sintomas do AVC não foi preditivo de chegada precoce ao hospital. .