RESUMEN
BACKGROUND: Multimorbidity is highly relevant for both service commissioning and clinical decision-making. Optimization of variables assessing multimorbidity in order to enhance chronic care management is an unmet need. To this end, we have explored the contribution of multimorbidity to predict use of healthcare resources at community level by comparing the predictive power of four different multimorbidity measures. METHODS: A population health study including all citizens ≥18 years (n = 6,102,595) living in Catalonia (ES) on 31 December 2014 was done using registry data. Primary care service utilization during 2015 was evaluated through four outcome variables: A) Frequent attendants, B) Home care users, C) Social worker users, and, D) Polypharmacy. Prediction of the four outcome variables (A to D) was carried out with and without multimorbidity assessment. We compared the contributions to model fitting of the following multimorbidity measures: i) Charlson index; ii) Number of chronic diseases; iii) Clinical Risk Groups (CRG); and iv) Adjusted Morbidity Groups (GMA). RESULTS: The discrimination of the models (AUC) increased by including multimorbidity as covariate into the models, namely: A) Frequent attendants (0.771 vs 0.853), B) Home care users (0.862 vs 0.890), C) Social worker users (0.809 vs 0.872), and, D) Polypharmacy (0.835 vs 0.912). GMA showed the highest predictive power for all outcomes except for polypharmacy where it was slightly below than CRG. CONCLUSIONS: We confirmed that multimorbidity assessment enhanced prediction of use of healthcare resources at community level. The Catalan population-based risk assessment tool based on GMA presented the best combination of predictive power and applicability.
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Servicios de Salud/estadística & datos numéricos , Multimorbilidad , Afecciones Crónicas Múltiples/epidemiología , Polifarmacia , Atención Primaria de Salud/estadística & datos numéricos , Servicio Social/estadística & datos numéricos , Adulto , Anciano , Femenino , Servicios de Atención de Salud a Domicilio , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores de Riesgo , España/epidemiologíaRESUMEN
OBJECTIVE: To determine clinical variables related to recurrent lacunar infarction following a previous lacunar stroke. METHODS: A total of 122 out of 733 consecutive patients with lacunar infarction collected from a hospital based registry between 1986 and 2004 were readmitted because of a recurrent lacunar infarction. In a subset of 59 patients, cognition was assessed using the Mini-Mental State Examination (MMSE). Predictors of lacunar infarction recurrence were assessed by logistic regression analysis. RESULTS: First lacunar infarction recurrence occurred in 101 patients (83%) and multiple recurrences in 21. The mean time between first ever lacunar infarction and recurrent lacunes was 58.3 months (range 2-240). In the subset of 59 patients in whom cognition was studied, cognitive impairment, defined as an MMSE score <24, was detected in 16% (8/49) of patients with first lacunar infarction recurrence and in 40% (4/10) of those with multiple lacunar infarction recurrences. In the multivariate analysis, hypertension (odds ratio 2.01, 95% CI 1.23 to 3.30) and diabetes (odds ratio 1.62, 95% CI 1.07 to 2.46) were significant predictors of lacunar stroke recurrence, whereas hyperlipidaemia was inversely associated (odds ratio 0.52, 95% CI 0.30 to 0.90). CONCLUSIONS: Hypertension and diabetes were significant factors related to recurrent lacunar infarction. Hyperlipidaemia appeared to have a protective role. Cognitive impairment was a frequent finding in patients with multiple lacunar infarction recurrences.
Asunto(s)
Infarto Encefálico/epidemiología , Anciano , Anciano de 80 o más Años , Encéfalo/irrigación sanguínea , Infarto Encefálico/patología , Infarto Encefálico/fisiopatología , Áreas de Influencia de Salud , Circulación Cerebrovascular/fisiología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Evaluación de la Discapacidad , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Pruebas Neuropsicológicas , Recurrencia , Sistema de Registros , Índice de Severidad de la Enfermedad , España/epidemiologíaRESUMEN
To describe the clinical characteristics of haemorrhagic pure motor stroke (PMS). Twelve patients with haemorrhagic PMS were identified. Haemorrhagic PMS accounted for 3.2% of all cases of pure motor hemiparesis (n = 380) and 3.3% of intracerebral haemorrhage (n = 364) entered in the database. When compared with PMS of ischaemic origin, patients with haemorrhagic PMS were more likely to be younger (62.2 vs. 75.2 years, P = 0.003) and to have headache (33% vs. 6.3%, P =0.007) and thalamus involvement (25% vs. 2.4%, P = 0.005). Limb weakness (100% vs. 74.1%; P = 0.03), involvement of the internal capsule (50% vs. 17.3%, P = 0.012) and symptom free at discharge (25% vs. 3.7%, P = 0.012) were significantly more frequent in patients with haemorrhagic PMS than in the remaining cases of haemorrhagic stroke, whereas nausea and vomiting (0% vs. 25.9%, P = 0.03), altered consciousness (0% vs. 42.9%, P = 0.001), sensory symptoms (8.3% vs. 46.9%, P =0.007) and ventricular haemorrhage (0% vs. 26.1%, P = 0.028) were significantly less frequent. Haemorrhagic PMS is a very infrequent stroke subtype. Headache at stroke onset may be useful sign for distinguishing haemorrhagic PMS from other causes of lacunar stroke. There are important differences between haemorrhagic PMS and the remaining intracerebral haemorrhages.
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Hemorragia Cerebral/complicaciones , Paresia/etiología , Accidente Cerebrovascular/etiología , Distribución por Edad , Anciano , Encéfalo/patología , Isquemia Encefálica/complicaciones , Hemorragia Cerebral/diagnóstico , Extremidades , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Paresia/epidemiología , Paresia/fisiopatología , Estudios Prospectivos , Sistema de Registros , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/fisiopatologíaRESUMEN
OBJECTIVE: To identify determinants of early outcome in spontaneous lobar hemorrhage. MATERIALS AND METHODS: From 2500 acute stroke patients included in a prospective hospital-based stroke registry over a 12-year period, 97 cases of lobar hematoma were selected. Determinants of in-hospital mortality were studied in multiple regression models. RESULTS: Lobar hematomas accounted for 3.9% of all acute stroke patients and 35.9% of intracerebral hemorrhages. The presence of chronic obstructive pulmonary disease (COPD) was a significant predictive variable in the model based on demographic variables and vascular risk factors [odds ratio (OR): 17.18; 95% CI: 1.77-166.22] and in the model based on these variables plus clinical data (OR: 15.12; 95% CI: 1.27-179.59). Other predictive variables included altered consciousness, previous cerebral infarct and chronic liver disease. CONCLUSIONS: COPD appeared as the most important predictor of death during hospitalization after lobar cerebral hemorrhage, a finding not generally acknowledged earlier.
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Hemorragia Cerebral/mortalidad , Mortalidad Hospitalaria , Accidente Cerebrovascular/mortalidad , Anciano , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/diagnóstico , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Sistema de Registros , Factores de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Tasa de SupervivenciaRESUMEN
The aim of this study was to describe the clinical characteristics of atypical lacunar syndrome (ALS) based on data collected from a prospective acute stroke registry. In total, 2500 acute stroke patients were included in a hospital based prospective stroke registry over a 12 year period, of whom 39 were identified as having ALS and radiologically proven (by computed tomography or magnetic resonance imaging) lacunes. ALS accounted for 1.8% of all acute stroke patients, 2.1% of acute ischaemic stroke, and 6.8% of lacunar syndromes. ALS included dysarthria facial paresis (n = 12) or isolate dysarthria (n = 9), isolated hemiataxia (n = 4), pure motor hemiparesis with transient internuclear ophthalmoplegia (n = 4), pure motor hemiparesis with transient subcortical aphasia (n = 3), unilateral (n = 2) or bilateral (n = 3) paramedian thalamic infarct syndrome, and hemichorea hemiballismus (n = 2). Atypical lacunar syndromes were due to small vessel disease in 96% of patients. Atherothrombotic infarction occurred in one patient and cardioembolic infarct in another, both presenting pure dysarthria. Outcome was good (in hospital mortality 0%, symptom free at discharge 28.2%). After multivariate analysis, the variables of speech disturbances, nausea/vomiting, ischaemic heart disease, and sensory symptoms were found to be significantly associated with ALS. In conclusion, atypical lacunar syndrome is an infrequent stroke subtype (one of each 14 lacunar strokes). ALS occurred in 6.8% of lacunar strokes. Isolated dysarthria or dysarthria facial paresis were the most frequent presenting forms. The prognosis of this infrequent non-classic lacunar syndrome is good.
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Infarto Encefálico/diagnóstico , Imagen por Resonancia Magnética , Examen Neurológico , Tomografía Computarizada por Rayos X , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Infarto Encefálico/epidemiología , Causalidad , Diagnóstico Diferencial , Femenino , Humanos , Arteriosclerosis Intracraneal/diagnóstico , Arteriosclerosis Intracraneal/epidemiología , Masculino , Persona de Mediana Edad , SíndromeRESUMEN
OBJECTIVES: To compare the characteristics of lacunar stroke (LS) in patients with and without intermittent claudication. MATERIAL AND METHODS: Data of 484 consecutive patients with LS were collected from a prospective hospital-based stroke registry in which 2500 patients are included. RESULTS: Of the 142 patients with ischemic stroke and intermittent claudication, 39 (27.5%) had LS (8% of all lacunes). In the multivariate analysis, small centrum ovale topography (odds ratio 7.35), carotid stenosis >50% (odds ratio 3.17), and absence of limitation at discharge (odds ratio 2.01) were independent variables significantly associated with LS in patients with intermittent claudication. CONCLUSION: Only 8% of patients with LS had intermittent claudication. The short-term prognosis is good with a spontaneous early neurological recovery at discharge in 51.3% of patients. LS patients with intermittent claudication showed a striking similarity in risk factors and clinical syndromes in comparison with the LS patients without intermittent claudication.
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Infarto Encefálico/etiología , Infarto Encefálico/patología , Claudicación Intermitente/complicaciones , Sistema de Registros/estadística & datos numéricos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/patología , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Hospitales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de RiesgoRESUMEN
We compared risk factors, clinical features, neuroimaging data, and outcome between hypertensive and non-hypertensive ischemic stroke patients. Differential features of ischemic stroke patients with hypertension (n = 768) and without hypertension (n = 705) were assessed by bivariate analysis. Independent predictors of hypertensive ischemic stroke were determined by multivariate analysis. Atherothrombotic infarction and lacunar infarct were significantly more common in the hypertensive group, in which older age and a higher occurrence of previous cerebral infarction, hyperlipidemia, acute stroke onset, lacunar syndrome, and pons topography was also observed. Age of 85 years or older, valvular heart disease, and decreased consciousness were more common in non-hypertensive patients. After multivariate analysis, lacunar syndrome, female gender, and previous infarction were directly associated with hypertensive ischemic stroke. Age of 85 years or older and valvular heart disease were inversely associated with hypertensive ischemic stroke. Hypertension was the main cardiovascular risk factor only for lacunes and atherothrombotic infarction, that is, ischemic stroke associated with small- and large-artery disease.
Asunto(s)
Fibrilación Atrial/etiología , Infarto Cerebral/etiología , Hipertensión/complicaciones , Accidente Cerebrovascular/complicaciones , Factores de Edad , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/patología , Infarto Cerebral/patología , Distribución de Chi-Cuadrado , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/patología , Imagen por Resonancia Magnética/métodos , Masculino , Análisis Multivariante , Oportunidad Relativa , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/patologíaRESUMEN
BACKGROUND: We hypothesized that previous transient ischemic attack (TIA) had a favorable effect on early outcome after acute nonlacunar ischemic stroke. METHODS: Data of 1,753 consecutive patients with ischemic stroke collected from a prospective hospital-based stroke registry were studied. A comparison was made of the groups with and without previous TIA. Favorable outcome included spontaneous neurological recovery or grades 0-2 of the modified Rankin scale at hospital discharge. RESULTS: Previous TIA occurred in 55 (11.5%) of 484 patients with lacunar stroke and in 166 (13.1%) of 1,269 patients with nonlacunar stroke. The percentage of nonlacunar ischemic stroke patients with favorable outcome was 21.7% in those with a history of TIA compared to 15% without TIA (p < 0.03). In the lacunar stroke group, differences were not significant. In the multivariate analysis, TIA was an independent predictor of spontaneous in-hospital recovery. CONCLUSIONS: Prior TIA was associated with a favorable outcome in nonlacunar ischemic stroke, suggesting a neuroprotective effect of TIA possibly by inducing a phenomenon of ischemic tolerance allowing better recovery from a subsequent ischemic stroke.
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Actividades Cotidianas , Ataque Isquémico Transitorio/complicaciones , Ataque Isquémico Transitorio/fisiopatología , Recuperación de la Función/fisiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Factores de TiempoRESUMEN
The aim of the study was to analyse the impact of sleep-related breathing disorders in a 2-yr survival follow-up of patients with a first ever stroke or transient ischaemic attack. The study followed 161 patients. Complete neurological assessment was performed in order to determine cerebrovascular risk factors, functional disability, and parenchymatous and vascular localisation, as well as stroke subtype categorisation. A sleep study was carried out using a portable respiratory recording device, The entire cohort was followed over a mean period of 22.8 months. The main outcome event was death and time of survival since the neurological event. A multivariate Cox's model was estimated. The patients were ages 72+/-9 yrs (mean+/-SD), and had a body mass index of 26.6+/-3.9 kg x m(-2) and apnoea/hypopnoea index (AHI) of 21.2+/-15.7. Overall, mortality occurred in 22 cases, and the survival rate was 86.3%. Vascular disease accounted for 63.6% of deaths. Multivariate analysis selected four independent variables associated with mortality: 1) age; 2) AHI, with an implied 5% increase in mortality risk for each additional unit of AHI; 3) involvement of the middle cerebral artery; and 4) the presence of coronary disease. In conclusion, the findings suggest that sleep-related breathing disorders are an independent prognostic factor related to mortality after a first episode of stroke.
Asunto(s)
Causas de Muerte , Ataque Isquémico Transitorio/mortalidad , Síndromes de la Apnea del Sueño/mortalidad , Accidente Cerebrovascular/mortalidad , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Ataque Isquémico Transitorio/diagnóstico , Masculino , Análisis Multivariante , Probabilidad , Modelos de Riesgos Proporcionales , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Síndromes de la Apnea del Sueño/diagnóstico , España/epidemiología , Accidente Cerebrovascular/diagnóstico , Análisis de SupervivenciaRESUMEN
OBJECTIVES: Although dysarthria-clumsy hand syndrome (DCHS) is a well known and infrequent lacunar syndrome, there are few data regarding the spectrum of associated clinical characteristics, anatomical site of lesion, and aetiopathogenetic mechanisms. We report a clinical description of this subtype of lacunar stroke based on data collected from a prospective acute stroke registry. METHODS: From 2500 acute stroke patients included in a hospital based prospective stroke registry over a 12-year period, 35 patients were identified as having DCHS. RESULTS: DCHS accounted for 1.6% of all acute stroke patients (35/2110), 1.9% of acute ischaemic stroke (35/1840), and 6.1% of lacunar syndromes (35/570) admitted consecutively to a neurology department and included in the stroke registry over this period. The results supported the lacunar hypothesis in 94.3% of patients (n = 33). Atherothrombotic and cardioembolic infarction occurred in only one patient each (2.9%). No patient with DCHS had an intracerebral haemorrhage. Outcome was good (mortality in hospital 0%, symptom free at discharge 45.7%). After multivariate analysis, absence of limitation at discharge, limb weakness but not cerebellar-type ataxia, and internal capsule (40%), pons (17%), and corona radiata (8.6%) location were significantly associated with DCHS. CONCLUSIONS: DCHS is a rare cerebrovascular syndrome, and supports the criteria of the lacunar hypothesis. The majority of patients in this study had internal capsule infarcts. The prognosis is good with striking similarity compared with other types of lacunar strokes. There are important differences between DCHS and non-lacunar strokes. Internal capsule and pons are the most frequent cerebral sites.
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Infarto Encefálico/complicaciones , Isquemia Encefálica/complicaciones , Encéfalo/irrigación sanguínea , Encéfalo/fisiopatología , Disartria/etiología , Mano/fisiopatología , Trastornos del Movimiento/etiología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Cápsula Interna/patología , Masculino , Trastornos del Movimiento/fisiopatología , Debilidad Muscular/fisiopatología , Músculo Esquelético/fisiopatología , Estudios Prospectivos , Sistema de RegistrosRESUMEN
Nine of 2000 consecutive stroke patients included in the Sagrat Cor Hospital of Barcelona Stroke Registry over a 10-year period fulfilled the strictly defined International Headache Society criteria for migrainous stroke and in whom other causes of stroke were ruled out. They accounted for 13% of all first-ever ischaemic stroke of unusual cause. Migrainous stroke was more common in women (67%) and in patients aged 45 years or younger (78%) compared to the remaining ischaemic strokes of unusual cause. No patient died during hospital stay and 67% were symptom-free at discharge. In the multivariate analysis, nausea or vomiting (odds ratio (OR) 8.40, 95% confidence interval (CI) 1.49-47.21) and age (OR 0.95, 95% CI 0.91-0.99) were predictors of migrainous stroke. Migrainous stroke is a rare entity. Vascular risk factors are uncommon and the prognosis is generally good. Patients with migrainous stroke present some different clinical features from other ischaemic strokes of unusual aetiology.
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Infarto Cerebral/epidemiología , Infarto Cerebral/etiología , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/epidemiología , Sistema de Registros/estadística & datos numéricos , Adulto , Distribución de Chi-Cuadrado , Intervalos de Confianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , España/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiologíaRESUMEN
OBJECTIVES: To describe the influence of the site of the bleeding on clinical spectrum and early outcome of patients with acute spontaneous intracerebral hemorrhage (ICH). MATERIALS AND METHODS: ICH was diagnosed in 229 (11%) of 2000 consecutive stroke patients included in a prospective stroke registry over a 10-year period. Frequency of demographic variables, risk factors, clinical events, neuroimaging data, and early outcome (until hospital discharge) according to different sites of bleeding was assessed. Each topography of the bleeding (independent variable) was compared with the remaining ICH cases by means of logistic regression analysis. RESULTS: In the multivariate analysis, sensory deficit was significantly associated with ICH in the thalamus; lacunar syndrome and hypertension with ICH in the internal capsule-basal ganglia; seizures, non-sudden stroke onset, and hypertension with lobar ICH; ataxia and sensory deficit with ICH in the cerebellum; cranial nerve palsy with ICH in the brainstem; and limb weakness, diabetes, and altered consciousness with multiple topographic involvement. The overall in-hospital mortality rate was 31%, but this varied from 65% for multiple topographic involvement, 44% for intraventricular ICH, and 40% for ICH in the brainstem to 16% for ICH in the internal capsule-basal ganglia. CONCLUSION: These data show the heterogeneous clinical profile of ICH, but they also suggest a difference in the clinical spectrum and in-hospital mortality according to the site of bleeding.
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Hemorragia Cerebral/mortalidad , Hemorragia Cerebral/patología , Anciano , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/fisiopatología , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Sistema de Registros , Factores de Riesgo , España/epidemiologíaRESUMEN
The objective was to assess the frequency of pure motor stroke caused by different stroke subtypes and to compare demographic, clinical, neuroimaging, and outcome data of pure motor stroke with those of patients with other lacunar stroke as well as with those of patients with non-lacunar stroke. Data from 2000 patients with acute stroke (n=1761) or transient ischaemic attack (n=239) admitted consecutively to the department of neurology of an acute care 350 bed teaching hospital were prospectively collected in the Sagrat Cor Hospital of Barcelona stroke registry over a 10 year period. For the purpose of the study 222 (12.7%) patients with pure motor stroke were selected. The other study groups included 218 (12.3%) patients with other lacunar strokes and 1321 (75%) patients with non-lacunar stroke. In relation to stroke subtype, lacunar infarcts were found in 189 (85%) patients, whereas ischaemic lacunar syndromes not due to lacunar infarcts occurred in 23 (10.4%) patients (atherothrombotic stroke in 12, cardioembolic stroke in seven, infarction of undetermined origin in three, and infarction of unusual aetiology in one) and haemorrhagic lacunar syndromes in 10 (4.5%). Patients with pure motor stroke showed a better outcome than patients with non-lacunar stroke with a significantly lower number of complications and in hospital mortality rate, shorter duration of hospital stay, and a higher number of symptom free patients at hospital discharge. After multivariate analysis, hypertension, diabetes, obesity, hyperlipidaemia, non-sudden stroke onset, internal capsule involvement, and pons topography seemed to be independent factors of pure motor stroke in patients with acute stroke. In conclusion, about one of every 10 patients with acute stroke had a pure motor stroke. Pure motor stroke was caused by a lacunar infarct in 85% of patients and by other stroke subtypes in 15%. Several clinical features are more frequent in patients with pure motor stroke than in patients with non-lacunar stroke.
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Corteza Motora/fisiopatología , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis MultivarianteRESUMEN
In 2,000 consecutive stroke patients collected in a prospective hospital-based stroke registry over a 10-year period, we assessed whether stroke in men and women was different in respect to vascular risk factors, clinical features and natural history. The frequency of the different variable in men and women was analyzed by means of univariate analysis and logistic regression models. Women accounted for 48% of the study population (n = 967) and were older than men (mean age 75 vs. 69 years, p < 0.001). In the age group of 85 years or older, stroke was more frequent in women than in men (69.8 vs. 30.2%, p < 0.001). Women showed a higher frequency of cardioembolic infarction and a lower occurrence of lacunar infarction and stroke of undetermined cause than men. In-hospital mortality (17.4 vs. 13.3%) and length of hospital stay (19.6 vs. 16.7 days) was significantly higher (p < 0.001) in women than in men. In the model based on demographic variables and cardiovascular risk factors, obesity, heart failure, atrial fibrillation and age were significant predictors of stroke in women, while intermittent claudication, ischemic heart disease, chronic obstructive pulmonary disease, cigarette smoking and alcohol abuse were predictors in male sex. Hypertension and limb weakness were predictors for stroke in women, and absence of neurological deficit at hospital discharge, lacunar syndrome and ataxia were predictors in men in the models based on all variables. Women differ from men in the distribution of risk factors and stroke subtype, stroke severity and outcome. Differences in stroke pathology and/or differences in functional anatomy or plasticity of the brain between sexes may account for these findings.
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Trastornos Cerebrovasculares/epidemiología , Accidente Cerebrovascular/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Trastornos Cerebrovasculares/etiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Accidente Cerebrovascular/etiologíaRESUMEN
The clinical features, etiology and neurological outcome of ischemic stroke of unusual cause (ISUC) have rarely been reported. We retrospective reviewed all patients with this stroke subtype entered in the Sagrat Cor Hospital of Barcelona Stroke Registry, which includes data from 2000 consecutive first-ever stroke patients admitted to the hospital between 1986 and 1995. Patients with previous ischemia and/or hemorrhagic stroke were excluded. Topographic, anamnestic, clinical and neuroimaging characteristics of ISUC were assessed. Predictors of this stroke subtype were determined by logistic regression analysis. Ischemic stroke of unusual etiology was diagnosed in 70 patients (32 men and 38 women), with a mean +/- SD age of 52 +/- 22.4 years. This stroke subtype accounted for 4.3% of all first-ever strokes and 6% of all first-ever brain infarcts. Etiologies included hematological disorders in 17 cases, infection in 11, migraine stroke in 10, cerebral infarction secondary to venous thrombosis in nine, primary inflammatory vascular conditions in six and miscellaneous causes in 17. In the multivariate analysis after excluding cerebral venous thrombosis (n = 9) and arterial dissection (n = 4), because of typical clinical and radiological features, independent predictors of ISUC included 45 years of age or less (odds ratio [OR] 14.8), seizures (OR 6.8), headache (OR 5.2), hemianopia (OR 2.6) and occipital lobe involvement (OR 3.0). Patients with ISUC presented a lower in-hospital mortality rate (7.1% vs. 14.4%; P < 0.05), were more frequently symptom free at discharge (35.7% vs. 25.80%; P < 0.05) and experienced a longer mean length of hospital stay (23.7 days vs. 18.2 days; P = 0.06) than non-ISUC patients. We conclude that ISUC is infrequent, etiologies are numerous and hematologic disorders are the most frequent cause. We emphasize the better prognosis and the need to distinguish it from other ischemic stroke subtypes which have a different treatment approach and outcome.
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Isquemia Encefálica/etiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infarto Cerebral/complicaciones , Niño , Femenino , Enfermedades Hematológicas/complicaciones , Humanos , Infecciones/complicaciones , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/complicaciones , Vasculitis/complicaciones , Trombosis de la Vena/complicacionesRESUMEN
OBJECTIVES: To characterize the vascular risk factor profiles in different subtypes of ischemic stroke. MATERIAL AND METHODS: The study population consisted of 1473 consecutive ischemic stroke patients collected in a prospective stroke registry. The prevalence of vascular risk factors in each stroke subtype was analyzed independently and in comparison with other subtypes of stroke pooled together by means of univariate analysis and logistic regression models. RESULTS: Hypertension was present in 52% of patients followed by atrial fibrillation in 27% and diabetes in 20%. The pattern of risk factors associated with atherothrombotic stroke included chronic obstructive pulmonary disease (COPD) (odds ratio [OR] = 2.63), hypertension (OR = 2.55), diabetes (OR = 2.26), transient ischemic attack (OR = 1.61), and age (OR = 1.03). Previous cerebral hemorrhage (OR = 4.72), hypertension (OR = 4.29), obesity (OR = 2.45), and diabetes (OR = 1.73) were strong predictors of lacunar stroke. In the case of cardioembolic stroke, atrial fibrillation (OR = 22.24), valvular heart disease (OR = 10.97), and female gender (OR = 1.66) occurred more frequently among patients with this stroke subtype than among the other stroke subtypes combined. CONCLUSION: Different potentially modifiable vascular risk factor profiles were identified for each subtype of ischemic stroke, particularly COPD in the case of atherothrombotic stroke and previous cerebral hemorrhage and hypertension in the case of lacunar infarction.
Asunto(s)
Isquemia Encefálica/etiología , Encéfalo/irrigación sanguínea , Sistema de Registros , Anciano , Isquemia Encefálica/epidemiología , Femenino , Hospitales , Humanos , Masculino , Factores de Riesgo , España/epidemiologíaRESUMEN
OBJECTIVE: We tested the hypothesis that diabetes is an independent determinant of outcome after intracerebral hemorrhage (ICH). RESEARCH DESIGN AND METHODS: This was a hospital-based prospective study The setting was an acute care 350-bed hospital in the city of Barcelona, Spain. Spontaneous ICH was diagnosed in 229 (11%) of 2,000 consecutive stroke patients included in a prospective stroke registry during a 10-year period. Main outcome measures were frequency of demographic variables, risk factors, clinical events, neuroimaging data, and outcome in ICH patients with and without diabetes. Variables related to vital status at discharge (alive or dead) in the univariate analysis plus age were studied in 4 logistical regression models. RESULTS: A total of 35 patients (15.3%) had diabetes. The overall in-hospital mortality rate was 54.3% in the diabetic group and 26.3% in the nondiabetic group (P < 0.001). Previous cerebral infarction, altered consciousness, sensory symptoms, cranial nerve palsy, multiple topography of the hematoma, intraventricular hemorrhage, and infectious complications were significantly more frequent in diabetic patients than in nondiabetic patients. The presence of diabetes was a significant predictive variable in the model based on demographic variables and cardiovascular risk factors (odds ratio 2.98 [95% CI 1.37-6.46]) and in the models based on these variables plus clinical variables (5.76 [2.01-16.51]), neuroimaging variables (5.59 [1.87-16.691), and outcome data (6.10 [2.04-18.291). CONCLUSIONS: Diabetes is an independent determinant of death after ICH. ICH in diabetic individuals presents some different clinical features compared with ICH in nondiabetic patients.
Asunto(s)
Hemorragia Cerebral/mortalidad , Diabetes Mellitus , Angiopatías Diabéticas/mortalidad , Mortalidad Hospitalaria , Anciano , Anciano de 80 o más Años , Hemorragia Cerebral/fisiopatología , Demografía , Angiopatías Diabéticas/fisiopatología , Femenino , Hospitales con 300 a 499 Camas , Humanos , Masculino , Sistema de Registros , Factores de Riesgo , España , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Población UrbanaRESUMEN
A total of 17 patients with lacunar syndromes due to intracerebral hemorrhage or hemorrhagic lacunar stroke (pure motor hemiparesis 9, sensorimotor stroke 5, pure sensory stroke 3) are reported. Data from these patients were obtained from consecutive stroke patients included in the prospective Hospital Sagrat Cor-Aliança Stroke Registry. Hemorrhagic lacunar stroke accounted for 3.8% of all cases of lacunar syndrome (n = 439) and 7.4% of all cases of intracerebral hemorrhage (n = 229) entered in the database. Demographic, anamnestic, clinical and neuroimaging variables in patients with hemorrhagic lacunar stroke, non-lacunar intracerebral hemorrhage and non-hemorrhagic lacunar stroke were compared. Predictors of hemorrhagic lacunar stroke were assessed by logistic regression analysis. Hypertension, cigarette smoking and involvement of the internal capsule were significantly more frequent in patients with hemorrhagic lacunar stroke than in those with non-lacunar intracerebral hemorrhage, whereas nausea and vomiting, altered consciousness, speech disturbances, hemianopia, and ventricular hemorrhage were significantly less frequent. As compared with non-hemorrhagic lacunar stroke, patients with hemorrhagic lacunar stroke were more likely to have hypertension, sudden stroke onset (minutes), head injury, headache, and basal ganglia involvement and less likely to have diabetes, gradual stroke onset (hours), and dysarthria. After multivariate analysis, only headache (OR 10.14), sudden onset (OR 9.89), and dysarthria (OR 0.10) were independent predictors of hemorrhagic lacunar stroke. Accordingly, the presence of headache and sudden onset of symptoms and absence of dysarthria may be useful signs for distinguishing hemorrhagic lacunar stroke from other causes of lacunar stroke.
Asunto(s)
Hemorragias Intracraneales/fisiopatología , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Disartria , Femenino , Cefalea , Humanos , Hemorragias Intracraneales/complicaciones , Hemorragias Intracraneales/diagnóstico , Masculino , Persona de Mediana Edad , Análisis Multivariante , Sistema de Registros , Análisis de Regresión , Factores de Riesgo , España , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , SíndromeRESUMEN
The aim of the study was to compare demographic characteristics, anamnestic findings, cerebrovascular risk factors, and clinical and neuroimaging data of cardioembolic stroke patients with and without atrial fibrillation and of atherothrombotic stroke patients with and without atrial fibrillation. Predictors of early diagnosis of cardioembolic vs. atherothrombotic stroke infarction in atrial fibrillation patients were also determined. Data of cardioembolic stroke patients with (n=266) and without (n=81) atrial fibrillation and of atherothrombotic stroke patients with (n=75) and without (n=377) were obtained from 2000 consecutive patients included in the prospective Sagrat Cor-Alianza Hospital of Barcelona Stroke Registry. Risk factors, clinical characteristics and neuroimaging features in these subgroups were compared. The independent predictive value of each variable on early diagnosis of stroke subtype was assessed with a logistic regression analysis. In-hospital mortality in patients with atrial fibrillation was significantly higher than in non-atrial fibrillation patients both in cardioembolic (32.6% vs. 14.8%, P<0. 005) and atherothrombotic stroke (29.3% vs. 18.8%, P<0.04). Valvular heart disease (odds ratio (OR) 4.6; 95% confidence interval (95% CI) 1.19-17.68) and sudden onset (OR 1.8; 95% CI 0.97-3.63) were predictors of cardioembolic stroke, and subacute onset (OR 8; 95% CI 1.29-49.42), COPD (OR 5.2; 95% CI 1.91-14.21), hypertension (OR 3. 63; 95% CI 1.92-6.85), hypercholesterolemia (OR 2.67; 95% CI 1.13-6. 28), transient ischaemic attack (OR 2.49; 95% CI 1.05-5.90), ischaemic heart disease (OR 2.30; 95% CI 1.15-4.60) and diabetes (OR 2.26; 95% CI 1.14-4.47) of atherothrombotic stroke. In conclusion, some clinical features at stroke onset may help clinicians to differentiate cerebral infarction subtypes in patients with atrial fibrillation. Atrial fibrillation is associated with a higher in-hospital mortality both in cardioembolic and atherothrombotic stroke patients.
Asunto(s)
Fibrilación Atrial/complicaciones , Cardiopatías/complicaciones , Arteriosclerosis Intracraneal/complicaciones , Embolia y Trombosis Intracraneal/epidemiología , Accidente Cerebrovascular/epidemiología , Anciano , Análisis de Varianza , Femenino , Humanos , Embolia y Trombosis Intracraneal/etiología , Funciones de Verosimilitud , Masculino , Oportunidad Relativa , Factores de Riesgo , España/epidemiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiologíaRESUMEN
OBJECTIVES: To compare the occurrence of lacunar infarcts in the very elderly ( > or = 85 years of age) and in patients below 85. MATERIAL AND METHODS: Data of 374 consecutive patients with lacunar infarcts were collected from a prospective hospital-based stroke registry in which 2000 patients are included. Distinctive clinical features of lacunar infarct in the very elderly were assessed by multiple logistic regression analysis. RESULTS: Lacunar infarcts were diagnosed in 39 (15%) of the 262 very elderly patients of our stroke registry. Lacunar infarcts in the very elderly accounted for 10.5% of all lacunes. There was no statistical difference in the occurrence of different lacunar syndromes between the very elderly patients and patients below 85. However, the very old group with lacunar infarct showed a significantly higher proportion of the female sex (56.4% vs 37.3%) and history of atrial fibrillation (28.2% vs 8.7%), chronic renal disease and pathologic condition and a significantly lower proportion of hypertension (61.5% vs 77.3%), diabetes (7.7%) vs 28.4%), ischemic heart disease, hypercholesterolemia, and absence of neurologic deficit at discharge from the hospital than patients below 85. After multivariate analysis only atrial fibrillation (OR = 3.77), female gender (OR =2.52), hypertension (OR = 0.35), and diabetes (OR = 0.16) were independent clinical factors for developing lacunar infarction in the very elderly. CONCLUSION: In the very elderly the higher occurrence of atrial fibrillation, the lower prevalence of hypertension and diabetes, and the greater focal neurological impairment suggest that the cardioembolic pathogenetic mechanisms may be more frequent than generally established for lacunar infarcts in stroke patients.