Importancia del sistema de preaviso y elección del centro asistencial en el accidente cerebrovascular agudo / Importance of the forewarning system and assistance center selection in acute stroke

Resumen El accidente cerebrovascular (ACV) es una urgencia tiempo dependiente, ya que las conductas de mayor impacto pronóstico dependen del tiempo trascurrido. El objetivo de este trabajo fue analizar nuestros tiempos puerta aguja (TPA), comienzo aguja (TCA) y el efecto que tiene sobre estos el sistema preaviso y la elección adecuada del centro asistencial. Se realizó un estudio observacional con datos obtenidos de histo rias clínicas de pacientes internados en la unidad de ACV. Analizamos el número de tratamientos trombolíticos endovenosos, entre agosto 2015 y diciembre 2019. Comparamos TPA según utilización de pre-aviso, llegada directa por sus propios medios vs. en ambulancia sin pre-aviso, y TCA según llegada directa al centro con unidad de ACV vs. llegada a otro centro para posterior derivación. De 265 pacientes en ventana terapéutica, se realizó tratamiento en 143. Llegaron 137 pacientes derivados de otro centro, 70 recibieron tratamiento trombolítico. El TPA con sistema preaviso y sin preaviso fue 41 ± 23 (media ± DE) y 81 ± 43 minutos, respectivamente (p = 0.001). El TPA con llegada directa por sus propios medios 79 ± 43 y en ambulancia sin preaviso 84 ± 44 minutos (p = 0.7) a unidad de ACV. El TCA en llegada directa a unidad de ACV fue 159 ± 59 y a otro centro para su derivación 199 ± 44 minutos (p = 0.001). La utilización de un sistema de preaviso y la elección directa de un centro con unidad de ACV son medidas clave para reducir los tiempos de tratamiento.

Abstract Acute ischemic stroke (AIS) is a time-dependent emergency, since the greatest impact depends on the time elapsed to treatment. The objective of this work was to analyze door to needle (DTN) and start treatment (STT) times and the effect of pre-notification system (PNS) and the appropriate choice of the healthcare center on these variables. An observational study with data obtained from records of patients admitted to the Stroke Unit (SU) was conducted between August 2015 to December 2019. We analyzed the number of intravenous thrombolytic treatments (IVT), DTN and STT and compared them according to PNS use, direct arrival at the center with SU or arrival at another center for subsequent referral. An overall of 472 patients were hospitalized during the studied period and the treatment was performed in 143 out of 265 patients. One hundred thirty-seven patients arrived from another center, 70 received IVT. Average DNT with PNS and without PNS were 41 ± 23 and 81 ± 44 minutes, respectively (p = 0.001). STT on direct arrival to SU was 159 ± 59 minutes and to another center for referral was 199 ± 44 (p = 0.001). The use of a PNS and the direct choice of a center where IVT is performed significantly improve treatment

Guía para el manejo del stroke agudo: respuesta hospitalaria / Handling of acute stroke guide: hospitalary answer

Recomendaciones actualizadas dirigidas a médicos de primeros auxilios, de emergencias, clínicos, internistas, neurólogos y demßs profesionales que puedan encontrarse con esta patología. Se intenta orientar en su diagnóstico y en el tratamiento de la isquemia aguda para reducir posibles complicaciones y modificar el pronóstico del paciente

Cataleptic postures in thalamic hemorrhage: case report

We report a case of catalepsy associated with thalamic hemorrhage. A 72 year-old hypertensive woman had acute onset of right-sided weakness and speech disturbances. She was on anticoagulants because of aortic valve replacement. When postures were imposed, the patient maintained the left upper limb raised for several minutes, even in uncomfortable or bizarre positions. A CT scan of the head revealed a left thalamic hemorrhage. Cataleptic postures have been reported in few cases with acute stroke

Further studies on HTLV-I associated myelopathy in Argentina

We report 10 HTLV-I virus seropositive subjects, eight of them with HTLV-I associated myelopathy (HAM), two of them also infected with HIV as well as two asymptomatic HTLV-I+ relatives of two unrelated patients. HTLV-I is endemic in several tropical areas, where it causes different neurological diseases. Only few patients have been reported in our country since 1994. We studied 8 patients, who fulfilled the clinical criteria for chronic spastic paraplegia, and 2 other non-symptomatic HTLV-I seropositive relatives, with electromyography (EMG), motor and sensory conduction velocities (NCV), somatosensory, visual and brainstem auditory evoked potentials (SSEP, VEP and BAEP), Magnetic Resonance Images (MRI) and cerobrospinal fluid (CSF) analysis. The latter was carried out only in seven symptomatic patients. In every case positive ELISA tests for HTLV-I/II were confirmed by Western Blot. The two asymptomatic persons were clinically and electromyographically assessed, one of them was also submitted to SSEPs studies. Three patients were males. Patient's ages ranged from 5 to 65 years old. All symptomatic patients showed muscular weakness, spasticity with pyramidal signs and sphincter disturbances. Five of them had paresthesias and 2 had burning pain on their feet. The EMGS and the NCVs were normal in 7 patients and in the 2 asymptomatic ones. SSEPs, obtained by stimulating the posterior tibial nerves, were impaired in 7 patients and in the asymptomatic person who received the procedure. The 7 symptomatic patients who underwnt lumbar puncture had positive tests for HTLV-I in CSF, 3 out of these 7 patients had also high protein levels and 4 had increased number of lymphocytes. In 2 patients intrathecal IgG production could also be demonstrated. MRI were normal in 7 patients and in the 2 asymptomatics, the exception being a female who had bilateral hypertense lesions in cerebral white matter in T2. In conclusion, tropical spastic paraparesis is apparently a rare disorder in Argentina. However, some cases have been reported recently. Most probably, its prevalence is currently underestimated. Its diagnosis should be considered in every patient with progressive spastic paraplegia.