RESUMEN
We aimed to characterize spontaneous cervical artery dissection (CeAD) patients with and without stroke and describe risk factors for cerebrovascular complications in a Chilean prospective cohort. METHODS: Consecutive CeAD patients admitted to a Chilean center confirmed by neuroimaging. Logistic regression was used. RESULTS: 168 patients were included, median follow-up time was 157 days. Stroke occurred in 49 (29.2%) cases, 4 (2%) patients died, all of whom had a stroke, and 10 (6%) presented CeAD recurrence. In univariate analyses, men (odds ratio [OR] 3.97, 95% confidence interval [CI] 1.97-8.00, P < 0.001), internal carotid artery CeAD (OR 2.82, 95% CI 1.38-5.78, Pâ¯=â¯0.005) and vessel occlusion (OR 4.45, 95% CI 1.38-14.38, Pâ¯=â¯0.035) increased stroke risk. Conversely, vertebral artery dissection (OR 0.35, 95% CI 0.16-0.74, Pâ¯=â¯0.006) and longer symptom onset to admission (O-A) time (OR 0.79, 95% CI 0.70-0.90, P < 0.001) were associated to decreased stroke risk. After multivariate analysis, men (OR 2.88, 95% CI 1.32-6.27, Pâ¯=â¯0.008) and O-A time (OR 0.80, 95% CI 0.69-0.92, Pâ¯=â¯0.002) remained independently associated with stroke. CONCLUSION: CeAD presented commonly as a non-stroke entity, with favorable prognosis. Albeit to a higher frequency of CeAD in women, stroke occurred predominantly in men, who were admitted earlier.
Asunto(s)
Accidente Cerebrovascular/epidemiología , Disección de la Arteria Vertebral/epidemiología , Adulto , Causas de Muerte , Chile/epidemiología , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente , Pronóstico , Estudios Prospectivos , Recurrencia , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Factores de Tiempo , Tiempo de Tratamiento , Disección de la Arteria Vertebral/diagnóstico por imagen , Disección de la Arteria Vertebral/mortalidad , Disección de la Arteria Vertebral/terapiaRESUMEN
BACKGROUND: All winters, there is an increase in the number of pediatric consultations, associated to three factors: cold weather, air pollution and respiratory virus epidemics. AIM: To study the influence of these three factors in the demand for pediatric consultations between March and September, in an area of Metropolitan Santiago. PATIENTS AND METHODS: The number of consultations between March and September 1998 in the emergency room and the number of hospital discharges due to lower respiratory tract infections, were registered in a public pediatric hospital of Santiago. A respiratory virus surveillance (respiratory syncytial virus, adenovirus, influenza and parainfluenza virus) was done among children admitted for lower respiratory infections. Atmospheric temperature values and air pollution, measured as the number of particles of 10 microns or more per m3 (MP 10), were obtained from local health services. RESULTS: Two elevation waves of outpatient consultations were detected at weeks 19 and 26, that coincided with the periods of maximal detection of influenza and syncytial respiratory virus, respectively. The epidemics of respiratory syncytial virus coincided with the maximal number of hospital admissions for lower respiratory tract infections at week 27. There was no correlation between air pollution and the number of pediatric consultations. The lower ambient temperatures coincided with the higher detection of respiratory syncytial virus at week 28, moment in which the demand for consultations or hospital admissions was descending. CONCLUSIONS: There is a direct relationship between respiratory virus epidemics and the demand for pediatric consultations. There is also a minor influence of ambient temperature.