An 86-year-old woman presented with an acute onset of confusion, garbled speech, and decreased left arm movement. On exam, she had a forced right gaze, left homonymous hemianopsia, left hemiparesis, and left face and arm hypoesthesia. Forty-eight hours after successful revascularization therapies, the patient started complaining of abnormal involuntary movements. This manuscript discusses the phenomenology of these involuntary movements, their neuroanatomical correlates, management, and evolution. Neurologists should be mindful of post-stroke movement disorders, their latency period after stroke, and the functional-anatomic networks involved.
Ictus
Actualización y aproximación clínica a los modelos teóricos de la apraxia de extremidades. Approaching theorical models of limb apraxia: a clinical update
Apraxia is a common disorder in people who have suffered a left hemispheric stroke, with significant impact on their quality of life. Although several models have been proposed for its interpretation and approach, some aspects are still under study. The objective of this study is to review the current models of limb apraxia, to analyze the available evaluation tools and to make recommendations for clinical practice. The review shows that in the literature there is a greater interest in the conceptual system within the lexical-semantic route, without developing in detail the conceptual system within the visuomotor route. This article proposes a model of apraxia that overcomes these limitations and describes an assessment method focused on body knowledge within the visuomotor route. Finally, it is concluded that more studies are necessary to experimentally validate the proposed model and the associated evaluation methods.
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Conocimiento Acerca Del Ictus Isquémico En Ecuatorianos. Knowledge About Ischemic Stroke In Ecuadorian People.
Introduction. The arrival of patients with ischemic stroke to the hospital in the period of the therapeutic window, depends to a great extent on the identification of their clinical signs and the recognition that it is a medical emergency. Methods. A prospective, longitudinal, cross-sectional study was carried out, based on a structured interview with closed questions. The aim was to assess the degree of the population’s knowledge about the ischemic stroke. Results. A total of 135 subjects without a diagnosis of stroke were interviewed, randomly selected from the relatives of patients. The average age was 42.6 years, women predominated (92 / 68.1%), with an average level of education. 95.5% (129 subjects) admitted having little knowledge about stroke. Only 11.1% correctly indicated the clinical manifestations; The most recognized symptom was damping (59.3%) followed by speech disorders. 80.9% (109 respondents) identify stroke as a preventable condition. Less than half of the participants adequately named the risk factors (66 / 48.9%). 88.2% take a correct attitude to the symptoms. Conclusions. In the group of people interviewed there is a perception of risk regarding stroke, but knowledge about the manifestations and vascular risk factors is poor. It is necessary to carry out information campaigns aimed to improve knowledge of t he disease.
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Fístula Carótido Cavernosa. Utilidad del ultrasonido Doppler en el diagnóstico. Cavernous carotid fistula. Utility of Doppler ultrasound in diagnosis.
Introduction. Carotid cavernous fistulas are infrequent vascular malformations that generate a pathological arteriovenous shunt, which compromises ocular function. The definitive diagnosis is established by cerebral arteriography. However, its invasive nature limits its use in follow-up. The aim of this work is to illustrate the value of the study with transcranial doppler ultrasound for the diagnosis of cavernous carotid fistulas and to describe the flow parameters that could be modified. Patients. A retrospective review of the clinical histories of the patients treated with a diagnosis of cavernous carotid fistula was carried out in the stroke unit of the Hermanos Ameijeiras Hospital in Havana, between January 2005 and May 2014. Demographic and disease variables were collected, as well as the results of imaging and ultrasound studies. Results. We describe the clinical and imaging characteristics of three patients in whom carotid cavernous fistula was confirmed. In the two patients with direct communications, an increase of the mean flow velocity in the ophthalmic vein, arterialized, with decrease in pulsatility were registered; in addition to an increase in the diastolic peak velocity in the internal carotid artery ipsilateral to the fistula. In the patient with the indirect fistula the changes were less marked. Conclusion. The ultrasound study was useful in the diagnosis of carotid cavernous fistulas, showing differences in the flow parameters that can be used to classify the fistulas.
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Palabras clave: Doppler transcraneal,
Fistula arteriovenosa dural,
Fistula carótido cavernosa,
Ictus,
ultrasonido,
Tabaquismo y su Asociación con Mortalidad Intrahospitalaria en Pacientes con Ictus Hemorrágico. Cigarette Smoking And Its Association With In-Hospital Mortality In Hemorrhagic Stroke Patients.
Background: Smoking is a well-known reversible risk factor associated with acute ischemic stroke (AIS), however, some data showed that in-hospital mortality rates among smoker’s patients with hemorrhagic stroke is lower when compared with non-smokers patients. The objective of this analysis was to assess in-hospital patient mortality rate between smokers and non-smokers patients with confirmed diagnosis of hemorrhagic stroke. Methods and Results: We analyzed all the data from patients diagnosed with hemorrhagic stroke that were registered in the Florida Stroke database from 2008-2012. Among the 21,013 patients diagnosed with hemorrhagic stroke, 10.9% of patients were smokers. A Multivariable model was used to estimate the adjusted odds ratio of in-hospital mortality rate in smokers versus non-smokers. Smoking was associated with lower in-hospital mortality in hemorrhagic patients. (UOR= 0.71 vs. AOR= 0.75). Other risk factors like hypertension, BMI>40 and hyperlipidemia, remained significantly associated after modeling, and some others like gender, race, health insurance coverage, and diabetes became insignificant. The difference between unadjusted and adjusted odds ratios for smoking (0.71 versus 0.75) indicates no presence of substantial confounding by age and other control variables. Conclusions: Among patients hospitalized for hemorrhagic stroke, smoking is a risk factor for early age of onset, even among those with few vascular risk factors. The persistent association with lower in-hospital mortality after adjusted analyses probably represents other unmeasured confounding, although a biological effect of smoking cannot be excluded. Further clinical and prospective population-based studies are needed to explore variables that contribute to outcomes in these patients.
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Enfermedad Cerebrovascular en el Ecuador: Análisis de los Últimos 25 Años de Mortalidad, Realidad Actual y Recomendaciones
Background. Cerebrovascular disease is the second cause of death and occupies the third place as a factor causing disability worldwide. At present, despite the recognition of its importance, the available data about Ecuador is scarce and there are not published analysis of its behavior. Methods. Retrospective longitudinal analysis of available public data on cerebrovascular disease in Ecuador, from 1991 to 2015. Results Cerebrovascular disease was the leading cause of mortality by 77 897 (6.70%) deaths and it is the only one with a constant trend pattern in the last 25 years. Conclusions. Cerebrovascular disease is the number one cause of death in Ecuador and its mortality is steadily increasing. Government policies must be implemented to reduce their mortality.
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Subtipos de Enfermedad Cerebrovascular: Análisis del registro de la Unidad de Ictus del Hospital Clínica Kennedy.
The main goal of this study was to determine the relative incidence of the different subtypes of stroke in a group of people from Guayaquil, considered of a relatively high socioeconomic stratus, to establish a relationship that was previously proposed as a probable cause of the etiologic stroke subtype variation found in our city. We conducted a retrospective study, in which were identified 100 consecutive patients with acute first-ever stroke admitted to the stroke unit of Hospital-Clínica Kennedy. The results were: male prevalence (57% vs 43%), mean age of onset 70 years for infarcts and 54 years for hemorrhages. Sixtythree patients had a cerebral infarction and 37 had an intracranial hemorrhage. As conclusion, we found that this relatively high prevalence of hemorrhages were related to rupture of intracranial aneurysms, and that most infarcts were related to hypertensive vasculopathy. We also found that the main risk factors were arterial hypertension and cardiopathies (p<0.05). Is important to resolve the controversies that were provoke in the last years about onset variability in types and subtypes of stroke, for which more studies and further are required.
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Activador del Plasminógeno tisular, realidad actual. Estudio transversal retrospectivo entre los años 2007-2009 en el Hospital Regional Dr. Teodoro Maldonado Carbo.
Objective: To determine the proportion in which the variables for the administration of tissue plasminogen inhibitor (tPA) are present in the population admitted to a hospital in Guayaquil-Ecuador.
Methods: Cross-sectional study with patients admitted to the Neurology service at the Regional Hospital Dr. Teodoro Maldonado Carbo between January 1, 2007 and December 31, 2009 with diagnosis of acute stroke. The inclusion and exclusion criteria were the same ones used on the guidelines for the use of tPA in patients with stroke during the first 3 hours and between the first 3-4.5 hours of onset.
Results: 550 patients were included in the analysis. 434 patients had ischemic stroke and 116 hemorrhagic stroke. 6 patients arrived to the hospital in the first 3 hours from onset and 13 patients arrived between the 3-4.5 hours from onset. In the first 3 hours, 4 out of 6 patients (66%) were candidates for the administration of tPA and between the first 3-4.5 hours, 6 out of 13 patients (59%) were candidates for tPA.
Conclusions: The majority of the patients that arrived to this hospital; did so after 4.5 hours from the onset of symptoms. If these patients would have arrived earlier, a great proportion could have received a treatment potentially beneficial that would produce a clinical improvement and a better prognosis if the treatment was available in the hospital.
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Síndrome de Moyamoya en un niño con Drepanocitosis.
Sickle cell disease is one of the main causes of ischemic stroke in the childhood, generally related with stenosis of the arteries of the anterior carotid circulation. We present the results of the studies carried out in a patient with sickle cell with no history of stroke, in treatment with hidroxyurea. Transcraneal Doppler and Magnetic Resonance Imaging demonstrated the existence of stenosis in medial cerebral arteries and a Moyamoya pattern in the cerebral circulation with hemodynamic ischemic lesions.
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Palabras clave: Doppler transcraneal,
Drepanocitosis,
enfermedad cerebrovascular,
Hematología,
Ictus,
Moyamoya,
