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INTRODUCTION: Scarce data exist about clinical/radiological differences between acute ischemic strokes diagnosed in the emergency room (AISER) and stroke chameleons (SCs). We aimed at describing the differences observed in a comprehensive stroke center in Chile. METHODS: Prospective observational study of patients with ischemic stroke syndromes admitted to the emergency room (ER) of Clínica Alemana between December 2014 and October 2023. RESULTS: 1,197 patients were included; of these 63 (5.2%, 95% CI: 4.1-6.6) were SC; these were younger (p < 0.001), less frequently hypertensive (p = 0.03), and they also had lower systolic (SBP) (p < 0.001), diastolic blood pressures (DBP) (p = 0.011), and NIHSS (p < 0.001). Clinically, they presented less frequently gaze (p = 0.008) and campimetry alterations (p = 0.03), facial (p < 0.001) and limb weakness (left arm [p = 0.004], right arm (p = 0.041), left leg (p = 0.001), right leg p = 0.0029), sensory abnormalities (p < 0.001), and dysarthria (p < 0.001). Neuroradiological evaluations included less frequently large vessel occlusions (p = 0.01) and other stroke locations (p = 0.005); they also differed in their etiologies (p < 0.001). Brainstem strokes (p < 0.001) and extinction/inattention symptoms (p < 0.001) were only seen in AISER. In multivariate analysis, younger age (OR: 0.945; 95% CI: 0.93-0.96), DBP (OR: 0.97; 95% CI, 0.95-0.99), facial weakness (OR: 0.39; 95% CI: 0.19-0.78), sensory abnormities (OR: 0.16.18; 95% CI, 0.05-0.4), infratentorial location (OR: 0.36; 95% CI, 0.15-0.78), posterior circulation involvement (OR: 3.02; 95% CI, 1.45-6.3), cardioembolic (OR: 3.5; 95% CI, 1.56-7.99), and undetermined (OR: 2.42; 95% CI, 1.22-4.7; 95%) etiologies, remained statistically significant. A stepwise analysis including only clinical elements present on the patient's arrival to the ER, demonstrates that age (OR: 0.95; 95% CI: 0.94-0.97), DBP (OR: 0.97; 95% CI, 0.95-0.99), the presence of atrial fibrillation (OR: 2.22; 95% CI, 1.04-4.75, NIHSS (OR: 0.88; 95% CI, 0.71-0.89) and the presence in NIHSS of 1a level of consciousness (OR: 5.66; CI: 95% 1.8-16.9), 1b level of consciousness questions (OR: 3.023; 95% CI, 1.35-6.8), facial weakness (OR: 0.3; CI: 95% 0.17-0.8), and sensory abnormalities (OR: 0.27; 95% CI, 0.1-0.72) remained statistically significant. CONCLUSION: SC had clinical and radiological differences compared to AISER. An additional relevant finding is that neurological symptoms in a patient with atrial fibrillation, even with a negative diffusion-weighted imaging, should be carefully evaluated as a potential stroke until other causes are satisfactorily ruled out.

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Millard-Gubler syndrome is a pontine syndrome caused by a lesion in the lower pons region. It is characterised by ipsilateral facial paralysis and VI paresis and contralateral brachiocrural palsy. We present the case of a female patient, G4P2A1, at 21 weeks of gestation, with preeclampsia, complaints of blurred vision, diplopia, and right hemiparesis, in whom a clinical diagnosis of Millard-Gubler syndrome was made. Neuroimaging showed an intraparenchymal haemorrhage towards the central portion of the bulbopontine junction. An extensive aetiological study was carried out to determine the cause of the hypertensive disorder syndrome during pregnancy. The patient improved satisfactorily from the neurological deficit after delivery of an early stillbirth.

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La periodontitis es un trastorno inmunoinflamatorio de etiología microbiana causado por gérmenes únicos en la cavidad bucal que pueden diseminarse a través del torrente sanguíneo, activan la respuesta inflamatoria del huésped y favorecen la formación, maduración y exacerbación de la placa de ateroma. Varios estudios clínicos han investigado la posible relación entre la enfermedad periodontal y las enfermedades consecuentes de la aterosclerosis como la cardiopatía isquémica y la enfermedad cerebrovascular isquémica. Se realizó una revisión bibliográfica exhaustiva de artículos científicos publicados en las bases de datos: Pubmed, Medline, LILACS, Scielo, en el período comprendido entre el 2012 y el 2022, en idioma español e inglés. Se utilizaron como descriptores: periodontitis, enfermedad cerebrovascular y aterosclerosis. Los reportes incluidos indican que la enfermedad cerebrovascular y la enfermedad aterosclerótica presentan las alteraciones con mayores asociaciones con la periodontitis, sin embargo, se necesitan estudios más amplios para determinar el papel de la severidad y extensión de la periodontitis en estas enfermedades.

Periodontitis is an immunoinflammatory disorder of microbial etiology caused by unique germs in the oral cavity that can spread through the bloodstream, activate the host's inflammatory response and promote the formation, maturation and exacerbation of atheromatous plaque. Several clinical studies have investigated the possible relationship between periodontal disease and diseases resulting from atherosclerosis such as ischemic heart disease and ischemic cerebrovascular disease. An exhaustive bibliographic review of scientific articles published in the databases: Pubmed, Medline, LILACS, Scielo, in the period between 2012 and 2022, in Spanish and English was carried out. The following were used as descriptors: periodontitis, cerebrovascular disease and atherosclerosis. The included reports indicate that cerebrovascular disease and atherosclerotic disease present the alterations with the greatest associations with periodontitis, however, larger studies are needed to determine the role of the severity and extent of periodontitis in these diseases.

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OBJECTIVE: To assess the incidence, characteristics, and risk factors for developing persistent headache attributed to past ischemic stroke. BACKGROUND: Although the most recent International Classification of Headache Disorders has recognized the existence of persistent headache attributed to past ischemic stroke, there has been limited research in this area. METHODS: This was a prospective cohort study. We initially assessed patients hospitalized with ischemic stroke admitted within 72 h of symptom onset. All patients underwent diffusion-weighted magnetic resonance imaging. These patients were re-interviewed by telephone 1 year after the stroke. Semi-structured questionnaires, the National Institutes of Health Stroke Scale (NIHSS), and six-item Headache Impact Test were used. RESULTS: A total of 119 participants answered the interview conducted 1 year after the stroke. The mean (standard deviation) age was 64 (13.1) years, 82/119 (68.9%) were female, and the median (interquartile range) NIHSS score was 2 (1.0-4.0). The incidence rate of persistent headache attributed to past ischemic stroke was 12/119 (10.1%; 95% confidence interval [CI] 5.3-17.0%). The most frequent pattern presented was a migraine-like pattern in seven of the 12 (58.3%) patients, which had a substantial/severe impact on five of the 12 (41.7%). For most patients this headache continued, although it began to improve. Previous migraine (odds ratio 7.1, 95% CI 1.06-50.0; p = 0.043) and headache intensity in the acute phase of stroke (odds ratio 1.75, 95% CI 1.13-2.7; p = 0.012) were associated with the occurrence of persistent headache attributed to past ischemic stroke. CONCLUSION: Persistent headache attributed to past ischemic stroke is a frequent complication after stroke. It often has a significant impact on patients' lives and presents a migraine-like pattern as its most frequent phenotype.

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Introducción: Uno de los aspectos que más interés suscita en lo referente a la distribución geográfica de la mortalidad por cáncer es la formación de conglomerados espaciales. Objetivo: Identificar el patrón espacial de la mortalidad por cáncer, cardiopatía isquémica y enfermedad cerebrovascular isquémica mediante la detección y descripción de conglomerados espaciales en la provincia de Santiago de Cuba. Métodos: Se realizó un estudio ecológico exploratorio espacial de los fallecimientos por cáncer, cardiopatía isquémica y enfermedad cerebrovascular isquémica durante el período comprendido desde el 1 de enero hasta el 31 de diciembre de 2019 en la provincia de Santiago de Cuba, para lo cual se procedió a la detección de conglomerados espaciales de elevada y baja mortalidad por las causas antes citadas. Se empleó el método de escaneo espacial estadístico con el programa Satscan y las variables independientes fueron divididas en demográficas y clínicas. Resultados: De los 36 conglomerados espaciales de mortalidad detectados, 23 correspondieron al cáncer (65,8 %), 7 a cardiopatía isquémica (18,4 %) y 6 a enfermedad cerebrovascular isquémica (15,8 %); asimismo, 44,7 % del total eran de elevado riesgo y 55,3 % de bajo riesgo. Conclusiones: El patrón de la distribución espacial de mortalidad por cáncer de próstata, pulmón, mama, colon, esófago, cardiopatía isquémica y enfermedad cerebrovascular isquémica se caracterizó por la formación de conglomerados espaciales de elevada y baja mortalidad.

Introduction: One of the aspects that more interest raises regarding the geographical distribution of mortality due to cancer is the formation of space conglomerates. Objective: To identify the space pattern of mortality due to cancer, ischemic heart disease and ischemic cerebrovascular disease by means of the detection and description of space conglomerates in Santiago de Cuba province. Methods: A space exploratory ecological study of deaths due to cancer, ischemic heart disease and ischemic cerebrovascular disease was carried out during January 1st to December 31, 2019 in Santiago de Cuba province, for which space conglomerates of high and low mortality due to the abovementioned causes were detected. The statistical space escanning method was used with the Satscan program and the independent variables were divided in demographic and clinical. Results: Of the 36 space conglomerates of mortality detected, twenty three corresponded to cancer (65.8%), seven to ischemic heart disease (18.4%) and six to ischemic cerebrovascular disease (15.8%); also, 44.7% of the total was of high risk and 55.3% of low risk. Conclusions: The space distribution pattern of mortality due to prostate, lung, breast, colon, esophagus cancer, ischemic heart disease and ischemic cerebrovascular disease was characterized by the formation of high and low mortality space conglomerates.

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Background Cerebrovascular disease is the second leading cause of death and the third leading cause of disability following heart disease. In 2019, there were over 101 million people living with a stroke and 12.2 million incidents of stroke globally. For the past three decades, stroke has remained the leading cause of death in Brazil, causing over 100,000 fatalities annually, along with numerous functional impairments among those who survive. The Brazilian healthcare system has witnessed notable advancements in the last decade, including the establishment of additional hospitals and a rise in the count of healthcare professionals specializing in cardiovascular and neurological surgery. However, there exists a gap in the research landscape for continuous comprehensive studies aimed at exploring the evolving mortality rates related to cerebrovascular diseases, of which the last one included data up to 2019. This study aimed to address this gap by meticulously analyzing the trends in cerebrovascular disease mortality in Brazil from 2000 to 2021, for the variables age, sex, state of residence, and geographic region. Methods This is a descriptive, ecological, and time series study. Nationwide data for annual cerebrovascular mortality from Brazil were used for the period 2000-2021. Age-adjusted mortality rates (AAMRs) by direct standardization, encompassing people above 20 years of age, were calculated and expressed per 100,000 persons. Mortality trends were assessed using joinpoint regression analysis by calculating the annual percentage change (APC) and its corresponding 95% confidence interval (CI) across categories of age, sex, and state and region of residence. Results The mortality rates decreased for the sex categories over the analyzed years. The AAMR for the categories decreased as follows: males and females (95 deaths/100,000 to 52 deaths/100,000 inhabitants), males (108 deaths/100,000 to 63 deaths/100,000 inhabitants), and females (83 deaths/100,000 to 44 deaths/100,000 inhabitants). The most substantial reduction in AAMR for males occurred in the 30-39-year age group (APC: -4.10), while the smallest decline was observed in the 20-29-year age group (APC: -1.44). All five macro-regions demonstrated statistically significant and downward AAPC values in mortality rates. The south and midwest regions decreased at a stable rate, as denoted by the same APC and AAPC values (-4.05 and -3.11, respectively). The north and northeast regions exhibited an increase in AAMR, followed by a decrease (APC: 0.68 to -1.42 and 2.63 to -2.35, respectively). Conclusions Our comprehensive analysis revealed a downward trend in cerebrovascular disease mortality rates across diverse demographic groups and macro-regions. Females experienced a more substantial reduction compared to males. Despite higher mortality rates among individuals aged 50 and above, all age groups displayed a marked decrease. The continuous decline can be attributed to policy interventions aimed at enhancing healthcare delivery, increased awareness, and healthier diets and lifestyles. With regard to the macro-regions, the regions in the southern zone demonstrated a more significant decrease as compared to the northern part. In Brazil, a more significant decline in cerebrovascular disease mortality rates could be achieved through increased focus on prevention measures and efforts toward mitigating disparities and inequalities between macro-regions.

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Objective: To identify the worldwide bibliometric characteristics of research on SARS-CoV-2 infection and cerebrovascular disease. Methods: A retrospective, descriptive, and bibliometric study was performed. We analyzed 1834 publications about COVID-19 and cerebrovascular disease from the Scopus database considering the time since the beginning of the pandemic between 2019 and 2020. Bibliometric indicators were evaluated such as number of citations, citations per publication by authors, countries, journals, and collaborations at national, international, institutional, and impact levels according to Cite Score Quartile and h-index metrics. All analysis was performed using SciVal software. Results: The highest percentage of articles corresponded to universities in the United States, including Harvard and New York with 59 and 20 publications, respectively, and the University of Toronto in Canada with 22 publications. In relation to citation indicators, journals such as Stroke and Journal Stroke and Cerebrovascular diseases obtained 1971 and 561 citations, respectively. Regarding collaboration indicators, the national collaboration index was 39.4% and the institutional collaboration index was 31.1%. Finally, neurology, cardiovascular medicine, and cardiology and surgery were the subject areas with the highest research results, with 424, 217, and 128 studies, respectively. Conclusion: It was observed that the United States was the country with the highest scientific production on COVID-19 and cerebrovascular disease in the year 2020 in the different health areas; however, more research is still needed worldwide for a better analysis of the bibliometric indicators on the subject.

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Introducción: La enfermedad cerebrovascular (ECV) es una urgencia neurológica que en ocasiones se encuentra influenciada por los cambios del tiempo. La ECV isquémica es una emergencia médica con una ventana estrecha para su diagnóstico y tratamiento. El daño generado por esta enfermedad se estima mediante de la mortalidad, discapacidad e impacto social. Objetivo: Proponer un programa de capacitación basado en los efectos fisiopatológicos que provocan en los pacientes, cambios de tiempo y ritmo circadiano en el contexto de la adaptación al cambio climático. Método: Se desarrolló un estudio multietápico prospectivo en el Hospital Universitario Mártires del 9 de Abril del municipio Sagua la Grande entre los años 1993 a 2017. En la primera etapa se seleccionó un universo de 52 profesionales de la salud que atendieron a estos pacientes; en la segunda, 48 y en la tercera, 61. Resultados: El nivel de conocimiento del personal de salud en una primera etapa era inadecuado (78,85 %); en la tercera, este porcentaje disminuyó (14,75 %). Como resultado de la capacitación mejoraron los tiempos de atención a los pacientes con ECV a su llegada al hospital, y en la tercera, más del 50 % de los enfermos fueron atendidos antes de las seis horas de inicio de los síntomas. Conclusiones: La capacitación sobre ECV basada en los efectos fisiopatológicos que provocan en los pacientes el cambio climático y el ritmo circadiano disminuyó el tiempo de espera, y se asoció con una reducción de la morbilidad y la mortalidad, después de aplicar este programa.

Introduction: cerebrovascular disease (CVD) is a neurological emergency that is sometimes influenced by climate changes. Ischemic CVD is a medical emergency with a narrow window for diagnosis and treatment. The damage generated by this disease is estimated through mortality, disability and social impact. Objective: to propose a training program based on the pathophysiological effects in patients caused by changes in time and circadian rhythm in the context of adaptation to climate change. Methods: a multistage prospective study was conducted at "Mártires del 9 de Abril" University Hospital in Sagua la Grande municipality between 1993 and 2017. A universe of health professionals who cared for these patients was selected as follows: 52 in the first stage; 48 in the second stage, and 61 in the third ones. Results: the level of knowledge of health personnel in the first stage was inadequate (78.85%); this percentage decreased in the third stage (14.75%). Care times for CVD patients improved upon arrival at the hospital as a result of the training, as well as in the third ones, more than 50% of the patients were seen within six hours of the onset of symptoms. Conclusions: CVD training based on the pathophysiological effects of climate change and circadian rhythm on patients decreased waiting time, and was associated with reduced morbidity and mortality, after applying this program.

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BACKGROUND: The prevalence of risk factors for cerebrovascular diseases in Mexico is increasing although stroke mortality declined from 1990 to 2010, without meaningful changes afterward. While improving access to adequate prevention and care could explain this trend, miscoding and misclassification in death certificates need to be assessed to unveil the true burden of stroke in Mexico. Practices in death certification along with the presence of multi-morbidity could contribute to this distortion. Analyses of multiple causes of death could reveal ill-defined stroke deaths, providing a glimpse of this bias. METHODS: Cause-of-death information from 4,262,666 death certificates in Mexico from 2009 to 2015, was examined to determine the extent of miscoding and misclassification on the true burden of stroke. Age-standardized mortality rates per 100,000 inhabitants (ASMR) were calculated for stroke as underlying and multiple causes of death, by sex and state. Deaths were classified following international standards as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and unspecified, which were kept as an independent category to measure miscoding. To approximate misclassification, we compared ASMR under three misclassification scenarios: (1) current (the status quo); (2) moderate, which includes deaths from selected causes mentioning stroke; and (3) high which includes all deaths mentioning stroke. National and subnational data were analyzed to search for geographical patterns. RESULTS: The burden of stroke in Mexico is underreported due to miscoding and misclassification. Miscoding is an important issue since almost 60% of all stroke deaths are registered as unspecified. Multiple cause analysis indicates that stroke ASMR could increase 39.9%-52.9% of the current ASMR under moderate and high misclassification scenarios, respectively. Both problems indicate the need to improve death codification procedures and cause-of-death classification. CONCLUSIONS: Miscoding and misclassification lead to underestimation of the burden of stroke in Mexico. Stroke deaths are underreported when other important causes coexist, being diabetes the most frequent.

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Background and Aim: There are significant disparities in stroke care and outcomes between low- and middle-income countries compared to high-income countries. Haiti, a lower-middle-income country, suffers from a lack of resources for acute stroke management. This study is the first to report the epidemiological profile of the Haitian population presenting with stroke symptoms at the largest academic hospital in the nation. Methods: This is an observational study conducted over a period of 5 months from April 2021 to August 2021 in the Internal Medicine Department of the State University Hospital of Haiti. There were 51 included patients who were suspected to have had an acute stroke. A descriptive statistical analysis was conducted. A scoping review of the literature was also conducted. Results: Over 50% of included patients were between 19 and 65 years old. The mean age at presentation was 61 years, and patients were predominantly female (64.7%). The prevalence of severe motor deficits was over 96%. The mean National Institutes of Health Stroke Scale was 12. Only 15.7% of patients (8/51) had a computed tomography (CT) scan during their hospitalization. The median time to CT scan was 84 h after symptom onset. About 80% of those with complications took more than 24 h to arrive at the hospital after the onset of symptoms. Eleven percent of patients had complications, and the mortality rate was 3.9%. There was a significant association between the Modified Rankin Scale and the occurrence of complications (p = 0.016). National Institutes of Health Stroke Scale (NIHSS) score had a significant association with the Glasgow score (F = 6.3; p < 0.001) where an inversely proportional correlation was observed between them (r = -0.7; p < 0.001) and a proportional correlation with the Rankin prediction score and the NIHSS (r = 0.3, p = 0.04). Little is known about the epidemiology of stroke patients in Haiti, and this limits the ability to develop targeted interventions to improve outcomes. In our scoping review, only three pertinent studies were identified over a 25-year period, this leads to a lack of data in regard to stroke care in Haiti mainly due to the absence of trained personnel. Conclusion: In our cohort, stroke is mainly affecting female patients. The majority of stroke patients have moderate to severe motor deficits and took more than 24 h to arrive at the hospital. Urgent assistance is needed to strengthen personnel and infrastructure dedicated to stroke. Neurological assessment based on NIHSS and Rankin score should be systematic in stroke evaluation in Haiti. Relevance for Patients: This study is relevant for patients because it emphasizes the challenges of stroke management in Haiti due to the non-availability of reference drugs, the time to arrive at the hospital to start treatment, as well as the means of diagnosis which are limited, like the CT scan. While stroke prevalence is on the rise in the country, it is the highest in the Caribbean and Latin America region.

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BACKGROUND: A correlation between worse functional outcomes in Parkinson's disease (PD) patients with cerebrovascular disease (CVD) or the Akinetic-rigid phenotype has been argued in recent studies. We aimed to evaluate the association of cerebral hemodynamics impairments, assessed by Transcranial Color-coded Doppler sonography (TCCS), on PD patients with different phenotypes of the disease and with risk factors for CVD. METHODOLOGY: Idiopathic PD patients (n = 51) were divided into motor subtypes: Akinetic-rigid (AR) (n = 27) and Tremor-dominant (TD) (n = 24) and into two groups regarding vascular risk factors: when ≥2 were present (PDvasc) (n = 18) and <2 (PDnvasc) (n = 33). In a parallel analysis, the Fazekas scale on brain magnetic resonance imaging (MRI) was applied to a sample to assess the degree of leukoaraiosis. TCCS examinations were prospectively performed obtaining middle cerebral artery Mean Flow Velocities (Vm), Resistance Index (RI), and Pulsatility Index (PI). The Breath-Holding Index (BHI) was calculated to assess cerebrovascular reactivity (cVR). Standardized functional scales were administered (UPDRS III and Hoehn&Yahr). RESULTS: The phenotype groups were similar in age, disease duration and demographic parameters, but there were significantly higher H&Y scores than TD group. cVR was impaired in 66.7% of AR vs. 37.5% of TD. AR group exhibited lower BHI (0.53 ± 0.31 vs. 0.91 ± 0.62; p = 0.000), lower Vm after apnea (44.3 ± 9.0 cm/s vs. 53.4 ± 11.4 cm/s; p = 0.003), higher PI (0.91 ± 0.26 vs. 0.76 ± 0.12; p = 0.000) and RI (0.58 ± 0.11 vs. 0.52 ± 0.06; p = 0.021). PDvasc group showed higher PI (0.98 vs. 0.76; p = 0.001) and higher frequency of altered cVR (72.2% vs. 42.2%; p = 0.004). There was a significant predominance of higher values on Fazekas scale in the PDvasc group. We found no difference between the Fazekas scale when comparing motor subtypes groups but there was a trend toward higher scores in the AR phenotype. CONCLUSIONS: TCCS, a cost-effective method, displayed impaired cVR in Parkinsonian patients with risk factors for CVD with higher degree of MRI leukoaraiosis. PD patients with the AR disease phenotype also presented impaired cVR on TCCS and greater functional impairment, although with just a trend to higher scores on MRI Fazekas.

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INTRODUCTION: There is controversy as to whether migraine affects the behavior of ischemic penumbra during the acute phase of an ischemic stroke, thereby accelerating the formation of cerebral infarction. OBJECTIVES: To assess whether migraine modifies the existence and volume of the divergence between the areas of diffusion and perfusion in the stroke (the penumbra) and whether migraine implies a poorer prognosis after the stroke. METHODS: This was a prospective cohort study. We included hospitalized patients with ischemic stroke within 72 h of symptom onset (convenience sampling). A semi-structured questionnaire, the National Institute of Health Stroke Scale, and the modified Rankin Scale (mRS) were used. Patients underwent magnetic resonance imaging (MRI) of the brain with diffusion and with perfusion. Patients were assessed by telephone 3 months after the stroke to determine the prognosis. Scores of > 2 on the mRS were considered to have a poor prognosis. RESULTS: A total of 221 patients were included, 131/221 (59%) of whom were male, and with a mean (SD) age of 68.2 (13.8) years. Ischemic penumbra analysis was performed in 118 patients. There was no association between migraine and the absence of ischemic penumbra (16/63 [25%] vs. 12/55 [22%]; odds ratio 1.22, 95% confidence interval 0.52-2.87; p = 0.64). There was no difference in stroke volume between those with and without migraine (median [interquartile range] 1.0 [0.4-7.9] vs. 1.8 [0.3-9.4] cm3 ; p = 0.99). Migraine was not associated with the stroke prognosis after multivariable analysis. CONCLUSION: Migraine is not associated with the absence of ischemic penumbra, the volume of the ischemic penumbra, or the stroke prognosis.

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Introduction: Cerebral small vessel disease (CSVD) frequently occurs in individuals with vascular risk factors. This condition might go unrecognised or result in only mild functional deficits. Objective: To evaluate the relationship between cardiovascular (CV) risk calculated with the HEARTS app and CSVD burden in a population without cardio-cerebrovascular diseases, and to estimate the prevalence of CSVD in low risk (LR) individuals. Methods: Asymptomatic subjects with vascular risk factors were included from primary health areas in Havana. The WHO's revised CV disease risk prediction chart (HEARTS app) was applied to all individuals, who were classified into two groups: LR and moderate/high risk (M/HR). Brain MRI was performed in all subjects. Results: 170 patients were included: 43 (25.3%) classified as low CV risk and 127 (74.7%) had M/HR CV risk. Half of the neurologically healthy individuals included displayed cerebral small vessel involvement (51.2%). White matter hyperintensities (WMH) and enlarged perivascular spaces were the most frequent lesions observed in both groups. WMH were more severe and more severe global score for CSVD were more frequent in the M/HR group (57.5%). It was noteworthy that 32.6% of LR-patients also exhibited more severe CSVD. The multivariate regression analysis revealed an independent association of arterial hypertension and age with the severity of CSVD. Conclusions: CV risk stratification through the HEARTS app has limited utility for predicting brain health in individuals with low CV risk. Identifying silent CSVD in individuals with apparently low CV risk is important, especially if they suffer from arterial hypertension.

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Introducción: El accidente cerebrovascular (ACV) es una afección con alta morbimortalidad, producida por la interrupción de la perfusión cerebral. Este artículo tiene como objetivo analizar la tendencia de egresos hospitalarios por ACV agudo en el periodo 2018-2021 en Chile. Metodología: Estudio descriptivo observacional, que incluyó egresos hospitalarios con diagnóstico de ACV agudo en el periodo 2018-2021, en Chile (n=19.274), según datos del Departamento de Estadísticas e Información de Salud de Chile. Se calculó la tasa de egreso hospitalario (TEH) según variable, utilizando datos del censo chileno 2017. No requirió comité de ética. Resultados: El 2018 tuvo la mayor TEH por ACV agudo (28,99) y el 2021 la menor (26,39). El grupo de "80 años y más" presenta la mayor TEH, mientras que el de "5-9 años" la menor. La mayor y menor TEH las tienen las regiones de Ñuble (263,00) y Tarapacá (10,29), respectivamente. Discusión: La disminución de TEH durante dicho periodo podría deberse al fortalecimiento de la Ley de Urgencia, al Programa Nacional de Telesalud y el impacto de la reciente pandemia. A mayor edad, aumenta la prevalencia y gravedad de las comorbilidades, lo cual explicaría la mayor TEH en el grupo más longevo. La mayor TEH masculina podría ser porque los hombres presentan mayor cantidad y severidad de factores de riesgo. La mayor TEH en la región del Ñuble posiblemente sea por los elevados niveles de pobreza y ruralidad, y la menor TEH en Tarapacá podría relacionarse con la presencia de una población nacional más joven.

Introduction: Stroke (CVA) is a condition with high morbidity and mortality, produced by the interruption of cerebral perfusion. This article aims to analyze the trend of hospital discharges for acute stroke in the period 2018-2021 in Chile. Methodology: Descriptive observational study, which included hospital discharges with a diagnosis of acute stroke in the period 2018-2021, in Chile (n=19,274), according to data from the Chilean Department of Health Statistics and Information. The hospital discharge rate (HTE) was calculated according to variable, using data from the 2017 Chilean census. No ethics committee was required. Results: 2018 had the highest HTE for acute stroke (28.99) and 2021 the lowest (26.39). The group aged "80 years and older" had the highest TEH, while the group aged "5-9 years" had the lowest TEH. The regions of Ñuble (263.00) and Tarapacá (10.29) have the highest and lowest HTE, respectively. Discussion: The decrease in HTE during this period could be due to the strengthening of the emergency law, the National Telehealth Program and the impact of the recent pandemic. The higher the age, the higher the prevalence and severity of comorbidities, which would explain the higher HTE in the older group. The higher male HTE may be due to the fact that men have a greater number and severity of risk factors. The higher HTE in the Ñuble region is possibly due to the high levels of poverty and rurality, and the lower HTE in Tarapacá would be related to having a younger national population.

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Objective: Describe the incidence of contrast-induced acute renal injury (CI-AKI) and the changes in hematocrit in a cohort of patients undergoing elective cerebral digital subtraction angiography (DSA). Methods: In this prospective study, patients undergoing cerebral DSA were assessed for hematocrit level and CI-AKI risk factors before the procedure and for developing CI-AKI 72 h after exposure to the contrast media. Results: Among 215 patients (109 men, mean age 36.6 years). The most frequently found CI-AKI risk factor was hypertension. There were no cases of permanent renal impairment after 14 days. Significant changes were observed in hematocrit (45.7 ± 4.9, vs. 44.5 ± 4.6, p = 0.001), estimated creatinine clearance (129.7 ± 48.3, vs. 123.1 ± 40.5, p = 0.002), and serum creatinine (0.72 ± 0.19, vs 0.74 ± 0.18, p = 0.031). The mean change in serum creatinine 72 h after contrast administration was +0.27 ± 0.10 mg/dL (p < 0.05). Conclusions: The incidence of CI-AKI after elective cerebral DSA was 1.4%. A significant decrease in hematocrit was observed up to 72 h after the procedure.

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Abstract Background Atherosclerosis is a condition in which fats, cholesterol, fibrin, and other substances accumulate into plaque on the arterial walls. Plaque can harden and narrow the arteries, in turn limiting the blood flow and resulting in diseases, such as acute myocardial infarction (AMI), ischemic stroke (IS), or peripheral arterial disease (PAD). There is a fairly high risk of a secondary atherosclerotic event if patients are not treated after the primary episode. Objective To calculate the statistical probability of developing AMI, IS, or PAD after treating the primary disease. Methods Data for statistical probability studies included 507,690 patients with primary atherosclerotic disease, who were in treatment during the study period and who did or did not develop a secondary atherosclerotic disease event. Result Statistical probability data indicate that few AMI patients can develop IS (2.99%) or PAD (2.86%) as a secondary disease. Patients with primary diagnoses of IS showed a 5.07% risk of developing PAD and a 0.95% risk of developing AMI; however, PAD patients showed a higher probability for both AMI (9.17%) and IS (8.79%). Conclusion Secondary atherosclerotic disease episodes after IS, AMI, and PAD were confirmed by statistical probability and are consistent with data from the literature. The study revealed that a primary PAD event leads to high rates of secondary episodes, and special attention should be given to the diagnosis and treatment of PAD in order to decrease the occurrence of secondary events.

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OBJECTIVE: Decompressive craniectomy is part of the acute management of several neurosurgical illnesses, and is commonly followed by cranioplasty. Data are still scarce on the functional and cognitive outcomes following cranioplasty. We aim to evaluate these outcomes in patients who underwent cranioplasty following traumatic brain injury (TBI) or stroke. METHODS: In this prospective cohort, we assessed 1-month and 6-month neuropsychological and functional outcomes in TBI and stroke patients who underwent cranioplasty at a Brazilian tertiary center. The primary outcome was the change in the Digits Test at 1 and 6 months after cranioplasty. Repeated measures general linear models were employed to assess the patients' evolution and interactions with baseline characteristics. Effect size was estimated by the partial η2. RESULTS: A total of 20 TBI and 14 stroke patients were included (mean age 42 ± 14 years; 52.9% male; average schooling 9.5 ± 3.8 years; 91.2% right-handed). We found significant improvements in the Digits Tests up to 6 months after cranioplasty (p = 0.004, partial η2 = 0.183), as well as in attention, episodic memory, verbal fluency, working memory, inhibitory control, visuoconstructive and visuospatial abilities (partial η2 0.106-0.305). We found no interaction between the cranioplasty effect and age, sex or schooling. Patients submitted to cranioplasty earlier (<1 year) after injury had better outcomes. CONCLUSION: Cognitive and functional outcomes improved after cranioplasty following decompressive craniectomy for stroke or TBI. This effect was consistent regardless of age, sex, or education level and persisted after 6 months. Some degree of spontaneous improvement might have contributed to the results.

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Background: Stroke is a highly incapacitating disease that can lead to disabilities due to cognitive impairment, physical, emotional, and social sequelae, and a decrease in the quality of life of those affected. Moreover, it has been suggested that cognitive reserve (patients' higher levels of education or having a skilled occupation), for instance, can promote faster cognitive recovery after a stroke. For this reason, this review aims to identify the cognitive, functional, and behavioral effects of computerized rehabilitation in patients aged 50 years or older who had a stroke, considering cognitive reserve proxies. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-PRISMA, and performed the search for peer-reviewed randomized controlled trials without a date restriction on CINAHL, LILACS, PubMed, Scopus, and Web of Science databases were chosen. Results: We screened 780 papers and found 19 intervention studies, but only 4 met the inclusion criteria and shared data. These studies included computerized tools for motor and cognitive rehabilitation in the experimental groups. In all studies, computerized training was combined with other interventions, such as standard therapy, occupational therapy, and aerobic exercises. There were 104 participants affected by ischemic or hemorrhagic stroke, predominantly male (57.69%), and all with cognitive impairment. Conclusion: Despite a limited number of studies, varied methods and insufficient information available, schooling as a CR proxy combined with high-intensity computerized cognitive training was key to mediating cognitive improvement. The systematic review also identified that the associated ischemic stroke and shorter time of onset for rehabilitation contribute to the cognitive evolution of patients. Findings do not support a greater benefit of computerized cognitive training compared to conventional cognitive therapies. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296193], identifier [CRD42022296193].

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OBJECTIVE: The objective of this study was to determine if there are differences between the presentation patterns of hemorrhagic stroke (HS) associated to COVID-19. METHODS: It was performed a systematic search based on PRISMA guidelines of the cases reported in PUBMED of HS associated to SARS-CoV-2 infection and we added to this sample cases from our own hospital cohort. Patients in the database were separated by groups according to presentation symptoms: if they debuted with neurological symptoms or debuted with pulmonary symptoms. RESULTS: Seventy cases were included in the study. Patients that debuted with pulmonary symptoms accounted for 68.6% of the cases with an interval between the development of symptoms and the presentation of HS of 15.6 days. We found that the use of anticoagulants during hospitalization, multifocal image pattern, and the elevation of D-dimer, Ferritin, and lactate dehydrogenase levels were significantly associated with the group of pulmonary presentation, whereas the presence of hypertension during hospitalization, and a lower hemoglobin level was associated with the group of neurologic symptoms. CONCLUSION: Although HS associated with COVID-19 is a clinical entity with increasing evidence, it is necessary to establish that there are two forms of presentation with their own characteristics.

OBJETIVO: determinar si existen diferencias entre los patrones de presentación de hemorragia intracraneal asociada a COVID-19. PACIENTES Y MÉTODOS: Se realizó una búsqueda sistemática basada en la guía PRISMA de los casos reportados en PUBMED de hemorragia intracraneal asociados a infección por SARS-CoV-2 y se agregaron a esta muestra casos de nuestra propia cohorte hospitalaria. RESULTADOS: se incluyeron 70 casos. Los pacientes que debutaron con síntomas pulmonares representaron el 68.6% de los casos con un intervalo entre el desarrollo de los síntomas y la presentación de la hemorragia intracraneal de 15.6 días. Encontramos que el uso de anticoagulantes durante la hospitalización, el patrón de imagen multifocal y la elevación de los niveles de dímero D, ferritina y deshidrogenasa láctica se asociaron significativamente con el grupo de presentación pulmonar, mientras que la presencia de hipertensión durante la hospitalización, y un nivel de hemoglobina más bajo se asoció con el grupo que debutó con síntomas neurológicos. CONCLUSIÓN: si bien la hemorragia intracraneal asociada a COVID-19 es una entidad clínica con evidencia creciente, es necesario establecer que existen dos formas de presentación con características propias.

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