Trombolisis intravenosa en cuadros imitadores de isquemia cerebral: experiencia de un centro / Thrombolysis in stroke mimics: experience in 10 cases

Background: The effectiveness of intravenous thrombolysis (IVT) in cerebral ischemia is time dependent. Stroke mimics (SM) are frequent in emergency rooms. The effort to reduce door to needle time, can lead to administer thrombolytics to SM. Aim: To describe the frequency and prognosis of SM treated with IVT. Material and Methods: Prospective analysis of all patients evaluated in a Chilean private clinic between December 2004 and July 2015 with a suspected acute ischemic stroke (AIS). We calculated the number of SM that were treated with IVT. In these patients, we analyzed the presence of symptomatic cerebral hemorrhage defined as the presence of a neurological deterioration of four points or more on the National Institute of Health Stroke Scale, the presence of extracranial bleeding according to Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries criteria and the patient’s functional status at three months by modified Rankin scale (MRS). Results: We evaluated 1,417 patients with suspected AIS, of which 240 (16.9%) were finally diagnosed as SM. A total of 197 patients were treated with IVT, of these 10 (5%) corresponded to SM. All SM patients treated with thrombolytic drugs were functionally independent at 3 months and showed no bleeding complications. Conclusions: Occasionally SM patients were treated with IVT. This treatment was not associated with bleeding complications and the prognosis of these patients at three months was favorable.

Impacto de intervención temprana a cuidadores de pacientes secuelados de un accidente cerebrovascular: estudio piloto / Impact of early intervention for stroke caregivers: a pilot study

Introducción: Los cuidadores de personas secueladas de un Accidente Cerebro Vascular (ACV), perciben que durante los primeros meses carecen de la información necesaria sobre el proceso de su familiar, afectando sobre su estado afectivo y percepción de estrés. Objetivo: Evaluar la intervención realizada a cuidadores de pacientes secuelados de un ACV como factor protector en el estado afectivo y de carga en los cuidadores. Sujetos y métodos: Se reclutaron cuidadores directos, de personas con secuelas de ACV, según Escala de Rankin durante el período hospitalario. Se realizo un taller teórico práctico, consistentes en 4 sesiones; 3 durante el periodo hospitalario del usuario y 1 dentro del primer mes posterior al alta, los temas tratados eran organización y distribución de la rutina, integración de rutinas de tiempo libre y relajación y manejo del paciente en el hogar. Se evalúo a los cuidadores con escalas diagnósticas de carga emocional (Zarit, Indice de Esfuerzo del Cuidador) y ansiedad (Goldberg). Resultados: Luego del taller hubo una reducción significativa de 20 por ciento en el número de cuidadores con depresión (p=0,036) y 37 por ciento en el número de cuidadores con ansiedad (p=0,034.). Asimismo hubo una disminución significativa en el puntaje de sobrecarga emocional del cuidador medido mediante la escala de Zarit (p = 0,044). Conclusiones: La intervención evaluada en el presente estudio piloto parece ser una medida que contribuye en disminuir la sobrecarga emocional y ansiedad del cuidador.

Background: Caregivers of ischemic stoke damaged patients feels during the first months after the event a lack of information on how to help their relative, affecting the sense of stress and anxiety. We made an intervention to caregivers of the stroke unit of the University of Chile Hospital, in 2008.Objective: Determine whether the intervention to caregivers of stroke damaged patients is a protective factor in their emotional state and stress on caregivers. Subjects and methods: Direct healthy caregivers were recruited with a severe impaired family member within the hospitalization period. Intervention was conducted in 4 sessions, 3 during the hospital period and 1 in his home within the first month after discharge, where the issues discussed with caregiver was self-care and patient management. To measure the intervention we evaluated before the workshop and 2 months after the last session with some standardized tests (Zarit, Caregiver Stress Index) and anxiety (Goldberg). Results: After the intervention there was a significant 20 percent reduction in the number of caregivers with depression (p=0.036) and 37percent in the number of caregivers with anxiety (p=0.034.). There was also a significant decrease in the score of caregiver's emotional overload measured by the Zarit scale (p=0.044). Conclusions: The intervention evaluated in this pilot study appears to be an effective measure in reducing the emotional overload and anxiety of the caregiver, with an evident improvement in their mood.

Derrame isquêmico como a primeira manifestação de hipertrabeculação/não-compactação ventricular grave / Ischemic stroke as the first manifestation of severe ventricular hypertrabeculation/non-compaction

Um raro defeito congênito do miocárdio, conhecido como hipertrabeculação/não-compactação do ventrículo esquerdo (HTVE/NCVE) tem sido ocasionalmente descrito em associação com a formação de trombos com um potencial risco embólico sistêmico, mas sua associação com derrames isquêmicos permanece controversa. Reportamos o caso de um derrame isquêmico em paciente com grave (HTVE/NCVE) e disfunção ventricular como uma possível associação sinérgica etiológica. Na ausência de outras fontes embólicas, uma grave HTVE/NCVE associada com disfunção ventricular poderia constituir uma fonte potencial de embolismo cerebral, especialmente em pacientes com alta suspeita de um mecanismo embólico de derrame sistêmico.

A rare congenital myocardial defect, known as left ventricular hypertrabeculation/non-compaction (LVHT), has been occasionally described associated with thrombus formation with a potential systemic embolic risk, but its association with ischemic strokes remains controversial. We report a case of ischemic stroke in a patient with severe LVHT and ventricular dysfunction as a possible etiologic synergistic association. In absence of other embolic sources, a severe LVTH associated with ventricular dysfunction could constitute a potential source of brain embolism, especially in patients with high suspicion of an embolic mechanism of ischemic stroke.

Trombolisis cerebral en el adulto mayor: Caso clínico / Thrombolysis for stroke in 93 years old female: Report of one case

Most studies evaluating the usefulness of intravenous thrombolysis for acute stroke have excluded subjects aged over 80 years. Therefore there is no evidence to support or contraindícate this therapy in this age group. We report a 93 year-old female subjected to intravenous thrombolysis using tissue plasminogen activator (r-tPA), according to the National Institute of Neurological Disorders protocol. The treatment was successful, there were no hemorrhagic complications and three months later, the patient was practically without any disability. Therefore age is not an absolute contraindication for intravenous thrombolysis in elderly subjects.