Introduction: Information on stroke mortality in people residing at high altitudes is controversial, and during the coronavirus disease 2019 (COVID-19) pandemic, there was a decrease in in-person care. Our objective is to evaluate mortality and functional prognosis after 3 months in stroke patients residing at high altitude during the COVID-19 pandemic. Methods: An analytical longitudinal study was conducted from January 2020 to January 2022 in a hospital in Cusco (3300 m above sea level), including adult patients diagnosed with stroke but without COVID-19 diagnosis, who were followed up for 90 days, evaluating mortality and functional disability (modified Rankin scale ≥ 3). Clinical and laboratory risk factors were evaluated, obtaining crude and adjusted hazard ratios (HR) through Cox regression models with 95% confidence intervals (CI95%). Results: One hundred twenty-three stroke patients were evaluated. After 90 days of follow-up, 28 patients (22.7%) died and 80 patients (65.0%) were diagnosed with functional disability. In models adjusted for gender, age, Alberta stroke program early CT (ASPECTS) score, and hypertension background, the only variable with increased risk was National Institutes of Health Stroke Scale (NIHSS) score at admission, both for mortality (HR 1.14, CI95% 1.09–1.20) and functional disability (HR 1.07, CI95% 1.04–1.11). Conclusions: Regarding stroke patients cared for in a high-altitude city during the COVID-19 pandemic, NIHSS score at admission is the most important risk factor for determining the 90-day mortality or functional disability, with a risk increase of approximately 10% for both outcomes for each additional point on the scale.
infarto cerebral
Alta viscosidad sanguínea en pacientes con Ictus Isquémico que residen a gran altitud. High blood viscosity in patients with ischemic stroke residing at high altitude.
Introduction: Risk factors for ischemic stroke have been extensively studied. However, few studies have been conducted in populations residing in high-altitude cities, where acclimatization processes cause elevations in blood viscosity. Our objective is to evaluate the association between blood viscosity and ischemic stroke in patients residing at altitude and to identify the most frequent subtype of ischemic stroke among these patients.
Methods: This case-control study was conducted in a hospital in Cusco, Peru (3,399 m) and included patients with and without ischemic stroke. Patients were included in the ischemic stroke group (cases) after having had up to three days of confirmed illness. The control group comprised patients hospitalized for other causes. Blood viscosity (in centipoise [cP]) was measured using a cone/plate viscometer. Viscosity data are reported as medians with interquartile ranges (IQR), and associations were evaluated using logistic regression with odds ratios (OR).
Results: A total of 386 patients were included, of which 141 (36.5%) had ischemic stroke. The median age was 67 years (IQR 52-80), and 165 (42.7%) patients were women. Blood viscosity was significantly higher in the ischemic stroke group (5.9 cP; IQR, 5.2–6.8) than in the control group (5.5 cP; IQR, 4.9–6.1; p<0.001). An increase in blood viscosity (in 1 cP increments) was associated with an increased risk of developing ischemic stroke (OR 1.40; 95% confidence interval, 1.16–1.69; p<0.001). Patients with the small-vessel occlusion subtype had the highest blood viscosity (6.1 cP; IQR, 5.8–6.3), which was significantly higher than in patients without stroke (p=0.002) or with other ischemic stroke subtypes (p=0.03).
Conclusions: Patients with ischemic stroke residing at high altitudes have higher blood viscosity than control patients regardless of ischemic stroke subtype, although the small-vessel occlusion subtype corresponded with the highest blood viscosity.
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Presentación rara de síndrome antifosfolípido primario asociado a hiperhomocisteinemia como causa de enfermedad cerebrovascular isquémica recurrente en varón joven. Rare presentation of primary antiphospholipid syndrome associated with hyperhomocysteinemia as a cause of recurrent ischemic stroke in young male.
We present the case of a 38-year-old male patient with a history of recurrent ischemic cerebrovascular disease without determined etiology and venous thrombosis in lower limbs. Due to the aetiological diversity of cerebral infarction in a young adult, he underwent a series of clinical tests, which resulted in the diagnosis of a primary antiphospholipid syndrome associated with hyperhomocysteinemia.
Once the diagnosis was made, he was given therapy with anticoagulants and corticoid pulses; with posterior improvement. Antiphospholipid syndrome is part of the differential diagnosis in young women with cerebral infarction; most cases have been reported in its secondary form, but finding it in primary form and in a male patient is rare. Also, increased homocysteine values are related to the severity of the first cerebrovascular event, but not to recurrent events.
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Fibrinólisis Farmacológica en el Ictus Isquémico Agudo. Experiencia en un Hospital Terciario del Ecuador. Pharmacological Thrombolysis In Ischemic Stroke. Experience In A Tertiary Hospital From Ecuador.
Introduction. Pharmacological thrombolysis in ischemic stroke is associated with a better recovery.
Objective. Describe the thrombolysis results after using r-Tpa applying an intrahospital stroke code, during one year.
Methods. A prospective, longitudinal study was performed in patients with cerebral infarction admitted to the stroke unit, with clinical follow-up up to 3 months after hospital discharge. The variables evaluated were compared in two groups of patients (only one group received the treatment).
Results. 107 patients were studied: 16 (14.9%) were thrombolyzed, 29 (27.1%) arrived in the therapeutic window period and 76 (71%) arrived after 4.5 hours. The average age was 68, 8 years and women predominated. The greatest impact of thrombolysis was on the difference in score between the initial assessment and the discharge on the NIHSS scale. At three months of evolution, the percentage of patients with mild disability (Rankin 0-2) was almost equal in the two groups. Mortality increased in patients with more severe disability (Rankin 3-5).
Conclusions. Treatment with r-Tpa shows benefits at hospital discharge. Further analysis is required with a greater number of cases.
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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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Retardo en la Llegada de Pacientes con Ictus Isquémico a un Hospital Terciario de Ecuador. Delay In The Arrival Of Ischemic Stroke Patients At A Tertiary Hospital In Ecuador.
Introduction. In an Stroke unit, the ischemic stroke treatment with a pharmacological thrombolysis is associated with a better recovery. The aim of this study is to identify the variables having a significant impact in the delay of the arrival of patients at a tertiary hospital. Methods. A prospective and longitudinal study was undertaken in patients with an ischemic stroke diagnosis, who were admitted to the Stroke Unit of Eugenio Espejo Hospital of Quito city in Ecuador in the time period from November 2016 to July 2017. Patients treated with r-Tpa were compared to those who arrived 4,5 hours later. Results. A total of 61 patients were analyzed: of those, 51 arrived 4,5 hours after first symptoms at the hospital, and 10 (16,4%) were thrombolysed in the period of therapeutic window. None of the social, demographic and clinical variables were related to the early arrival, except the history of an atrial fibrillation. In the group of patients who received r-Tpa, a significantly higher percent sought for medical care as a first option compared with those arriving after the 4,5 hours (90 vs 49%, p 0,0170). The greatest impact of the early referral and the thrombolysis concerned the difference of score between the initial medical evaluation and the hospital discharge in the NIHSS scale. Conclusions. The results of this study point out to the unawareness of the stroke and the behavior to follow. The r-Tpa treatment shows clear benefits to the patients in our environment.
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Infarto Talámico Bilateral
Cadena de supervivencia del Ictus: Un desafío de la medicina actual.
A quasi experimental study was carried out in patients with cerebrovascular disease, through the stroke survival chain at the Municipality Holguín, in order to characterize the access getting of these patients to the secondary care unit at the Hospital Provincial Docente V. I. Lenin, from May to October 2006. Neurological evaluation and cerebrovascular risk scales were applied, obtaining the following results: ages from 60 to 74 years were the more affected, predominantly in male. Atherotrombotic cerebral infarcts were the more frequent. Only 8 patients (23,5%) arrived to the hospital during the first three hours of the event. High blood pressure, history of cerebrovascular disease and cardiopathies were the more frequent risk factors. Glasgow coma scale above 11 points was observed in all the cases. We conclude that, in order to reestablish cerebral blood flow after stroke, it is necessary to participate in a whole performance survival chain.
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La Creatinfosfokinasa tiene utilidad en la Evaluación Pronóstica Temprana de Discapacidad en el Infarto Cerebral.
Introduction: Cerebral infarction is the third cause of morbidity and mortality in the occidental world. The diagnosis is usually based on clinical and imaging studies, like computerized axial tomography. However, the prognostic value is limited especially in the first 48 h after the event. Currently, creatinphosphokinase tests are not known as a prognostic tool.
Objective: To study the creatinphosphokinase serum levels in patients with cerebral infarction in the first hours after the event, to determinate prognosis and establish a relation with disability.
Patients and methods: Forty hospitalized patients with cerebral infarction were studied. Levels of creatinphosphokinase in serum were measured at 12, 24 and 48 hours after infarction and were associated with disability using the Rankin modified scale.
Results: The creatinphosphokinase concentration increased during the first 12 hours after infarction, was higher at 24 hours and, at 48 hours, it began to decrease. The levels of creatinphosphokinase are correlated with disability results in the Rankin scale.
Conclusions: The creatinphosphokinase can be a useful tool in the prognostic evaluation of disability in patients suffering brain infarction, in the first hours after the event takes place, and preceding tomographic alterations.
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Infarto cerebral y síndrome antifosfolípido primario.
Antiphospholipid syndrome (AFS) is one of the most frequent acquired thrombophilias, is characterized by venous thromboembolism, and/or arterial thromboembolism, and/or pregnancy morbidity, together with the presence of antiphospholipid antibodies. Thrombosis can be at both venous and arterial level, are usually recurrent and frequently affect cerebral circulation. Cerebral ischemia associated with antiphospholipid antibodies is the most common arterial manifestation and the only neurological manifestation accepted for diagnosis. Although it is difficult to predict which patients with antiphospholipid antibodies will develop thrombosis, once a thrombotic event has taken place, secondary prevention with anticoagulation is mandatory. We review the main epidemiological and diagnostic aspects and secondary prevention treatment in patients with ischemic stroke secondary to AFS.
