Disease burden based on gender and age and risk factors for stroke in China, 2019 / 中南大学学报(医学版)

OBJECTIVES@#Stroke has become the leading cause of death and disability among adults in China. This study aims to analyze the disease burden based on gender and age and the risk factors for stroke subtypes in China 2019, and to provide reference for targeted stroke prevention and control.@*METHODS@#Based on 2019 data of the Global Burden of Disease (GBD), the gender and age in patients with different stroke subtypes (ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage) in China 2019 was described by using disability-adjusted life years (DALY), and attributable burden of related risk factors was analyzed.@*RESULTS@#In 2019, the burden of intracranial hemorrhage was the heaviest one in China, resulting in 22.210 6 million person years of DALY, following by ischemic stroke and subarachnoid hemorrhage, resulting in 21.393 9 and 2.344 7 million person years of DALY, respectively. Among them, except the 0-14 age group, the disease burden of different subtypes of stroke in men was higher than that in women. The disease burden of ischemic stroke was increased with age in both men and women, with the heaviest disease burden in ≥70 years group. The disease burden of intracranial hemorrhage and subarachnoid hemorrhage was the heaviest in males aged 50-69 years old, and in females aged ≥70 years and 50-69 years, respectively. Metabolic factors were the main risk factors in all ages of different stroke subtypes, and the most important risk factor was high systolic blood pressure. Other risk factors were different between men and women. Smoking, high body mass index, high low-density lipoprotein, and outdoor particulate matter pollution were the main risk factors for stroke in men, while high body mass index, outdoor particulate matter pollution, and high fasting blood glucose were the main risk factors of stroke in women. The main risk were different among different age groups.@*CONCLUSIONS@#The burden and attributable risk factors for different stroke subtypes are discrepancy in different gender and age groups. Targeted interventions should be conducted in the future to reduce the burden of stroke.

Epidemiología de la hemorragia subaracnoidea espontánea aneurismática en el Uruguay / Epidemiology of spontaneous aneurysmal subarachnoid hemorrhage in Uruguay

Introducción: las HSA representan el 3-5% de los ACV, siendo una patología de alto impacto en la sociedad, por su elevada morbi-mortalidad. El 80 a 85% de las HSA se deben a rotura de un aneurisma y su incidencia varía según la región entre 6 casos/100.000 habitantes-año en países como China y 22 casos/100.000 habitantes-año en países como Finlandia y Japón. Objetivo: estimar la incidencia de la HSAea en Uruguay y describir sus principales características epidemiológicas. Métodos: fueron incluidos en el estudio todos los pacientes mayores de 18 años con diagnóstico de HSAea, que consultaron en algún centro asistencial del país entre el 01/11/2019 y el 31/10/2020. Fueron relevadas las características clínicoepidemiológicas y comorbilidades al momento del diagnóstico, el tipo de tratamiento recibido y variables de evolución clínica durante los siguientes 6 meses. El análisis estadístico de los datos se basó en el cálculo de la incidencia acumulada en el período evaluado, descripción de las variables estudiadas y en la identificación de factores predictores de mala evolución clínica. Debido al carácter multicéntrico y nacional del estudio, debió ser sometido a evaluación por todos los CEI de las instituciones de salud participantes, por la CNEI y por el MSP. Resultados: se observó un total de 211 casos incidentes en el período evaluado. La media de edad fue de 57 años con predominancia del sexo femenino (75%). La tasa de incidencia fue de 8,4 nuevos casos de HSAea cada 100,000 habitantes-año. En el 24 % de los pacientes se constató que el diagnóstico inicial estuvo mal planteado (error diagnóstico). En el 82% de los casos, el estudio vascular utilizado fue la angio-TC. La topografía aneurismática más frecuente fue: arteria comunicante anterior (27,5%), arteria cerebral media (27%), y arteria comunicante posterior (23%). Un 27% tuvieron aneurismas múltiples. En el 74% de los casos fue indicado algún tipo de tratamiento específico (43% cirugía abierta y 31% terapia endovascular), mientras al resto de los pacientes no se les pudo tratar el aneurisma por su grave situación neurológica. Hubo un 25% de complicaciones vinculadas al tratamiento recibido, observándose una mayor proporción de éstas en el caso de la cirugía abierta respecto a la terapia endovascular (42% vs. 27%; p=0,006). La complicación más frecuente por la HSA fue la HCF aguda constatada en el 64% de los casos, seguida del vasoespasmo en un 38%. De las complicaciones de la HSAea vinculadas a un eventual error diagnóstico, se pudo evidenciar el vasosespasmo como único candidato. La mortalidad a los 6 meses del diagnóstico fue del 54,5%, identificándose las siguientes condiciones como predictoras independientes de un mayor riesgo de mortalidad: presencia de HSA grave desde el inicio del cuadro (HyH y WFNS 4-5), presencia de aneurismas de tipo disecante o fusiforme vs sacular, la presencia de cuello ancho o ausencia de cuello en la relación cuello-fondo del aneurisma vs cuello chico, y una edad mayor de 60 años al momento del diagnóstico. Conclusiones: Este trabajo aporta las primeras cifras sobre incidencia anual de la HSAea en el Uruguay, siendo ésta comparable a lo descrito en la literatura internacional Por otra parte, y si bien se trata de una afección grave, la sobrevida y pronóstico a corto plazo de los pacientes en nuestro país está en el límite superior de lo reportado en otras regiones del mundo

Prognosis of Patients Victim of Spontaneous Subarachnoid Hemorrhage: A Comparison between Radiologic Scales

Objective To analyze the population and the earlymortality rate (up to thirty days) of patients victim of spontaneous subarachnoid hemorrhage (SAH) according to the Hunt-Hess clinical scale and the Fisher and modified Fisher radiological scales. Materials and Methods We analyzed 46 medical records and skull computed tomography (CT) scans of patients with spontaneous SAH admitted between February 2014 and December 2017 at Hospital Universitário Evangélico Mackenzie, in the city of Curitiba, state of Paraná, Brazil. The method of the study was exploratorydescriptive, transversal and retrospective, with a quantitative approach. We analyzed epidemiological (gender, age), clinical (life habits, pathologies, Glasgow coma scale and Hunt-Hess scale) and radiological (Fisher and modified Fisher scales) variables, and the Hunt-Hess and the Fisher scales were correlated with risk of death. The data was submitted to statistical analysis considering values of p<0.05. Result There was a higher prevalence of spontaneous SAH among women (69.5%), as well as among patients aged between 51 and 60 years (34.7%). Regarding the grades on the scales, there was higher prevalence of Fisher 4, Modified Fisher 4 and Hunt-Hess 2. Evolution to death was higher among women (76.4%) and patients aged between 61 and 70 years (35,2%). Conclusion Mortality was higher among patients classified as Fisher 3, Modified Fisher 4 and Hunt-Hess > 3. The Fisher scale is better than the modified Fisher scale to assess the risk of mortality.

Anterior Communicating Artery Aneurysm Uncommon Hemorrhagic Presentation: Case Report

Intracranial aneurysm rupture causes subarachnoid hemorrhage in 80% of the cases, and it may be associated with intracerebral hemorrhage and/or intraventricular hemorrhage (IVH) in 34% and 17% of the patients, respectively. However, on rare occasions, aneurysm rupturemay be present causing isolate intracerebral hemorrhage or IVH without subarachnoid hemorrhage. We describe an unusual case of an anterior communicating aneurysm rupture presented with IVH, without subarachnoid hemorrhage. Although isolated IVH is rare, aneurysm rupture is a possible condition. Patients presenting with head computed tomography revealing IVH without subarachnoid hemorrhage should be promptly investigated with contrasted image exam to identify and treat possible causes, even in the absence of subarachnoid hemorrhage.

Caracterización epidemiológica de pacientes con enfermedad cerebral vascular aguda en un hospital de Chile en base a registros de grupos relacionados al diagnóstico / An epidemiological characterization of patients with acute stroke in a single Chilean hospital using diagnosis-related group registers

Resumen Introducción Las enfermedades cerebrales vasculares son la primera causa específica de muerte y discapacidad en Chile. Objetivo Analizar características epidemiológicas de pacientes hospitalizados con diagnóstico de accidentes vasculares cerebrales en el Complejo Asistencial Víctor Ríos Ruiz. Metodología Estudio observacional, transversal. Se analizaron los egresos hospitalarios con diagnóstico de accidentes vasculares cerebrales entre 2014 y 2017. Se recolectaron datos sobre el diagnóstico de accidentes vasculares cerebrales mediante registro CIE 10, datos demográficos, tipo de accidentes vasculares cerebrales y datos respecto de la letalidad y estadía intrahospitalaria. Las variables cuantitativas fueron expresadas mediante promedios y desviación estándar (± DS) mientras que las variables categóricas fueron evaluadas mediante frecuencias absolutas y relativas. Las diferencias entre las variables fueron analizadas mediante T de Student y ANOVA de un factor. Se consideraron resultados significativos los valores p < 0,05. Resultados Se caracterizó un total de 1856 egresos, 58,6% fueron hombres, edad media de 66,9 (± 13,9) años y estadía media de 10,4 (± 16,7) días. En mujeres, la edad media fue 69,9 (± 16) años y estadía media 11,1 (± 16,5) días. El 55,5% correspondió a accidentes vasculares cerebrales isquémicos y 17,4% accidentes vasculares cerebrales hemorrágicos. Los principales factores de riesgo fueron hipertensión arterial (72%) y diabetes mellitus (33%). La letalidad intrahospitalaria global fue de 10,6%. Tanto la letalidad y estadía prolongada estuvieron asociadas a hemorragia subaracnoidea y accidentes vasculares cerebrales hemorrágicos (valor p < 0,05). Conclusiones La prevalencia de accidentes vasculares cerebrales es similar en hombres y mujeres. La hipertensión arterial fue el factor de riesgo más prevalente. A pesar de que el accidente vascular cerebral isquémico fue el más frecuente, la hemorragia subaracnoidea y el accidente cerebral vascular hemorrágico fueron relacionados con una mayor letalidad y estadía prolongada.

Abstract Introduction Stroke is the leading cause of death and disability in Chile. Objective To analyze the epidemiological characteristics of hospitalized patients with a diagnosis of stroke in our hospital unit (Complejo Asistencial Víctor Ríos Ruiz). Methods We performed an observational, cross-sectional study. We included patients who were discharged from our hospital with a diagnosis of stroke between 2014 and 2017. We extracted data on stroke-related ICD codes, demographic variables, types of stroke, case fatality rates, and hospital stay. Quantitative variables were expressed as averages with standard deviation (± SD), and categorical variables were expressed as absolute and relative frequencies. Differences were analyzed using Student t-distribution and ANOVA. We defined a p-value of < 0.05 as statistically significant. Results In total, 1856 patients were discharged of which 58.6% were male, with an average age of 66.9 (± 13.9) years, and an average stay of 10.4 (± 16.7) days. In the female population, the average age was 69.9 (± 16), and the average hospitalization was 11.1 (± 16.5) days. 55.5% of stroke cases was ischemic, and 17.4% was hemorrhagic. The main risk factors were hypertension (72%) and type 2 diabetes (33%). We found an overall in-hospital case fatality rate of 10.6%. Both the case fatality rate and prolonged in-hospital stay were associated with subarachnoid hemorrhage and hemorrhagic stroke (p < 0.05). Conclusions Prevalence of stroke is similar in both men and women. Hypertension was the leading risk factor associated with acute stroke. Although ischemic stroke was the most frequent diagnosis, both subarachnoid hemorrhage and hemorrhagic stroke were related to an increased case fatality rate and a more extended hospital stay.

Análise de casos cirúrgicos para o tratamento de hemorragia subaracnóidea aneurismática / Analysis of Surgical Cases for the Treatment of Subarachnoid Hemorrhage Aneurysmal

Objetivo Avaliar o perfil epidemiológico, os resultados cirúrgicos e os casos de hemorragia subaracnóidea aneurismática ocorridos no Hospital de Ensino da Univasf. Métodos Estudo descritivo e analítico, com abordagem quantitativa, baseado no caráter não experimental, documental e retrospectivo, os prontuários dos pacientes com diagnóstico de hemorragia subaracnóidea aneurismática não traumática admitidos em um hospital de ensino de setembro de 2008 a setembro de 2012. esultados Verificou-se uma prevalência de hemorragia subaracnóidea aneurismá-tica em Petrolina de 1,8 para cada 10 mil habitantes. Dos 55 prontuários, o sexo feminino foi o mais acometido (61,81%), com faixa etária de 41 a 50 anos. Aneurismas múltiplos foram encontrados em 23,5%. Com relação às escalas de Hunt-Hess e Fisher, obtivemos respectivamente 40% com Hunt-Hess grau dois e 35,7% com Fisher grau três. Não apresentaram nenhum tipo de déficit neurológico desde a admissão até a alta hospitalar 54,8% dos pacientes, e somente 1,81% apresentaram déficit neurológico após o procedimento cirúrgico. A reabordagem cirúrgica foi necessária em 3,7% dos casos. A mortalidade cirúrgica foi de 3,5%. Conclusão Existe uma prevalência de hemorragia subaracnóidea aneurismática em Petrolina/PE de 1,8 por 10 mil habitantes.

Objective To evaluate the epidemiological profile, the surgical results and cases of Subarachnoid Hemorrhage Aneurysmal occurred in the UNIVASF Teaching Hospital. Methods A descriptive and analytical study with a quantitative approach based on non-experimental, documentary and retrospective study, the charts of patients with nontraumatic Subarachnoid Hemorrhage Aneurysmal admitted to a teaching hospital from September 2008 to September 2012. Results It has been found a prevalence of Subarachnoid Hemorrhage Aneurysmal in Petrolina 1.8 per 10 thousand inhabitants. Of the 55 records, females were more prevalent 61.81%, ranging in age from 41 to 50 years; 23.5% had multiple aneurysms. Regarding Hunt-Hess and Fisher scales, respectively obtained 40% with Hunt-Hess grade two and 35.7% with Fisher grade three. 54.8% did not experience any neurological deficit from admission to discharge, and only 1.81% had neurological deficits after surgery; 3.7% of cases needed to be surgically re-approached. Operative mortality was 3.5%. Conclusion There is a prevalence of Subarachnoid Hemorrhage Aneurysmal in Petrolina/PE 1.8 per 10,000 inhabitants.

Subarachnoid hemorrhage with transient ischemic attack: Another masquerader in cerebral venous thrombosis.

Cerebral venous thrombosis has a wide spectrum of clinical manifestations that may mimic many other neurological disorders and lead to frequent misdiagnoses or delay in diagnosis. The most frequent symptoms and signs are headache, seizures, focal deficits, and papilledema. A number of rare atypical manifestations have been described. Cerebral venous thrombosis may present with an isolated intracranial hypertension type picture, thunderclap headache, attacks of migraine with aura, isolated psychiatric disturbances, pulsatile tinnitus, isolated or multiple cranial nerve involvement, and occasionally as subarachnoid hemorrhage (SAH) or transient ischemic attack. Our patient presented with thunderclap headache and transient ischemic attack like episode with obvious SAH on CT scan. Acute SAH suggests the presence of a vascular lesion, such as ruptured aneurysm, and CVT is not generally considered in the diagnostic workup of SAH. The case emphasizes the importance of cerebral venous study in nonaneurysmal cases of SAH. It is important to have a high index of suspicion in such atypical cases to avoid delay in diagnosis.

Stroke subtypes on imaging in a Jamaican population a hospital-based study: estudio en un hospital / Subtipos de accidente cerebrovascular en la imagen médica en una población Jamaicana

OBJECTIVE: To examine the pattern of stroke subtypes found on Computed Tomography (CT), Magnetic Resonance Imaging (MRI) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. METHOD: A retrospective review was conducted for all patients diagnosed with stroke and who were subjected to CT or MRI evaluation at UHWI between January 2001 and December 2004. Data were collected for patient age and gender and type of stroke. RESULTS: Four hundred and thirty-three patients were identified and classified as having cerebral infarct, intra-parenchymal haemorrhage or subarachnoid haemorrhage. There were 414 patients who had CT scans and 19 had MRI scans. Within and across genders, over 80% suffered infarcts with no significant statistical difference between male and female patients. Subarachnoid haemorrhage was the least frequent subtype and occurred in younger patients. CONCLUSION: The pattern of stroke subtypes seen in this population was similar to that of Australian and European cohorts of patients but differed from that reported in Asians. Ischaemic infarct was the most frequent stroke subtype followed by intra- parenchymal haemorrhage and subarachnoid haemorrhage. There was no gender predilection for any specific type of stroke.

OBJETIVO: Examinar el patrón de los subtipos de accidente cerebrovascular encontrados en las imágenes de TAC y MRI en el Hospital Universitario de West Indies (HUWI), Kingston, Jamaica. MÉTODO: Se realizó un examen retrospectivo de todos los pacientes con diagnóstico de accidente cerebrovascular, sometidos a evaluación mediante TAC o MRI, entre enero 2001 y diciembre 2004. Los datos fueron recogidos teniendo en cuenta la edad y el género del paciente, así como el tipo de accidente. RESULTADOS: Cuatrocientos treinta y tres (433) pacientes fueron identificados y clasificados como pacientes con un infarto cerebral, hemorragia intraparenquimal o hemorragia subaracnoidea (HSA). Hubo 414 pacientes examinados con TAC y 19 con MRI. Dentro de ellos, ambos géneros incluidos, más del 80% sufrió infartos sin que hubiese diferencias estadísticas significativas entre hombres y mujeres. La hemorragia subaracnoidea fue el tipo menos frecuente, y se produjo en pacientes jóvenes. CONCLUSIÓN: El patrón de subtipos de accidente cerebrovascular en esta población fue similar al de cohortes de pacientes australianos y europeos, pero diferente al reportado para los asiáticos. El infarto isquémico fue el subtipo de accidente cerebrovascular más frecuente, seguido por la hemorragia intraparenquimal y la hemorragia subaracnoidea. No hubo preferencia de géneros en relación con ninguno de los tipos específicos de accidente cerebrovascular.

Frequency of stroke types at an emergency hospital in Natal, Brazil

We performed a cross-sectional study of stroke type frequency at a local emergency hospital, in Natal, Brazil. The sample consisted of all patients who were admitted to an emergency hospital with a presumptive diagnosis of stroke. Of the 416 patients, 328 were studied, 88 were excluded for not meeting inclusion criteria, 74.7 percent (n= 245) had ischemic stroke 17.7 percent (n=58) had intracerebral hemorrhage, 7.6 percent (n=25) had subarachnoid hemorrhage; 173 were men (52.7 percent). Mean age was 64.1 years. The intrahospital mortality rate was 10.2 percent, 17.2 percent and 36 percent for ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage, respectively. The most prevalent modifiable risk factor was hypertension for ischemic stroke (67.6 percent) and hemorrhage stroke (57.8 percent). Logistic regression analysis identified diabetes (OR=3.70; CI=1.76-7.77) as independent risk factor for ischemic stroke. The ischemic stroke was most common type of stroke. Hypertension and diabetes were important risk factors for stroke.

Realizamos um estudo de prevalência para determinar a freqüência dos tipos de acidente vascular cerebral (AVC) num hospital de urgência de Natal. Estudaram-se todos os pacientes que foram admitidos no hospital de urgência com diagnóstico presuntivo de AVC. Dos 416 pacientes, 328 foram estudados, 88 foram excluídos por não cumprirem os critérios de inclusão, 74,7 por cento (n= 245) tiveram AVC isquêmico, 17,7 por cento (n=58) hemorragia intracerebral e 7,6 por cento (n=25) hemorragia subaracnóidea. O gênero mais prevalente foi o masculino (52,7 por cento). A média de idade foi 64,1 anos. A letalidade intra-hospitalar foi de 10,2 por cento, 17,2 por cento e 36 por cento para o tipo isquêmico, hemorrágico e hemorragia subaracnóide, respectivamente. O principal fator de risco modificável foi a hipertensão arterial sistêmica (HAS) para AVC isquêmico (67,6 por cento) e AVC hemorrágico (57,8 por cento). A regressão logística identificou diabetes como fator de risco independente para AVC isquêmico (OR=3,70; IC=1,76-7,77). O AVC isquêmico foi o tipo mais comum. HAS e diabetes foram importantes fatores de risco.

Child abuse: radiographic findings at King Chulalongkorn Memorial Hospital.

OBJECTIVE: To describe radiographic findings in physically abused children. MATERIAL AND METHOD: The physically abused children diagnosed in King Chulalongkorn Memorial Hospital from 1998 to 2002 were retrospectively reviewed of medical records and radiographic imaging. RESULT: Eighteen of 30 physically abused children had positive radiographic findings and 15 of 18 were related to head injury. Subdural hematomas and skull fractures were the two most common findings found in 11 cases and 9 cases respectively. Seven of 11 cases of head injury had retinal hemorrhage. Fractures other than the skull were detected in 6 patients, located at the long bones, ribs and spines. The abused children with positive radiographic findings were more commonly found in younger infants and mucocutaneous lesions might be absent. CONCLUSION: Inflicted head injury was the most common radiographic findings in the present series. Shaking-impact mechanism was likely to play a significant role in this group of patients.

Risk factors and outcome in 100 patients with aneurysmal subarachnoid hemorrhage

OBJECTIVE: Clinical and surgical outcome of patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm were assessed in comparison to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding. METHODS: We evaluated 100 consecutive patients with aneurysmal SAH. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and before surgery Hunt Hess scale, need for cerebro-spinal fluid shunt, presence of complications during the surgical procedure, Glasgow Outcome Scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. For statistical analysis, we applied the chi-squared test or Fisher's test using the pondered kappa coeficient. Kruskal-Wallis test was used for comparison of continue variables. Tendency of proportion was analyzed through Cochran-Armitage test. Significance level adopted was 5 percent. RESULTS: Patients studied were mainly white, female, without previous history of hypertension and non-smokers. Upon hospital admittance, grade 2 of Hunt-Hess scale was most frequently observed (34 percent), while grade 3 of Fisher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, between 12 and 24 mm. The most frequent Glasgow Outcome Scale observed was 5 (60 percent). Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome (p=0.00002 and p=0.001, respectively). Other variables were not significantly correlated to prognosis. Tendency of proportion was observed between Hunt-Hess scale and Fisher scale. CONCLUSION: Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms, the Hunt-Hess scale upon the moment of surgery and the presence of surgical adversities are statistically related to degree of disability

Enfermedad cerebrovascular hemorrágica en la región central de Cuba / The hemorrhagic cerebrovascular disease in the central region of Cuba

Se realizó un estudio para determinar el comportamiento de la enfermedad cerebrovascular hemorrágica en la región central del país y definir sus tasas, curvas de tendencia, meteorolabilidad, porcentajes según sus tipos, marcadores de riesgo principales, evolución, pilares de tratamiento más empleados, unidades de atención y complicaciones. Es un estudio, descriptivo, retrospectivo, con revisión de 1 401 expedientes clínicos para obtención de datos procesados por sistema EPI 6.0 con determinación de media, desviación estándar y chi cuadrado, los principales resultados se expresaron en figuras y tablas. Se observó una tasa media total de 8,76 por 10 000 habitantes con una curva de tendencia variable por número de enfermos durante los 3 años analizados. Se asoció la enfermedad con posibles factores meteorológicos y el mayor porcentaje correspondió a la hemorragia intraparenquimatosa con 38,54 porciento y las edades avanzadas de la vida (p<0,001), el marcador de riesgo más reportado fue la hipertensión arterial (p<0,01). Se empleó el tratamiento quirúrgico en 81 enfermos con hemorragia subaracnoidea, predominaron las malformaciones de arteria cerebral media y anterior, los pilares de tratamiento más empleados fueron depletantes y anticálcicos, la ventilación mecánica y el apoyo vasoactivo fueron necesarios en considerable número de casos, la mayoría fueron atendidos en unidades de Terapia Intermedia Polivalente y la principal complicación fue la sepsis

Hemorragia Subaracnoidea Producida por la Ruptura de los Aneurismas Cerebrales / Subarachnoid Hemorrhage from Rupture of Cerebrals Aneurysms

La hemorragia subaracnoidea producida por la ruptura de un aneurisma cerebral es una entidad relativamente frecuente que afecta a una población activa y es capaz de generar altos grados de incapacidad y mortalidad. Se debe resaltar la importancia que el diagnóstico precoz tiene sobre el pronóstico. Los dos principales problemas que generan las mayores complicaciones son el resangrado y el vasoespasmo arterial. Un adecuado entendimiento de la fisiología es vital para obtener los mejores resultados terapéuticos, evitando aumentar la morbi-mortalidad que ya posee por si sola esta entidad

Descripción Epidemiológica Intrahospitalaria de Desórdenes Vasculares Cerebrales. / Intrahospitalary Epidemiological description of Cerebral Vascular Disorders.

Como parte de un proyecto para estudiar in extenso la historia natural de los Desórdenes Vasculares Cerebrales en el Perú,presentamos la descripción epidemiológica intrahospitalaria lograda después de dos años de observaciones en 208 pacientes: A)Frecuencia porcentual por tipo:oclusión o estenosis 70.7% (aterotrombosis 61.1%, embolia 9.6%), hemoragia intracerebral 26.9%, hemorragia subaracnoidea 1.9% y mal definido 0.5%. B)Edad de inicio:Promedio Global 62.22 años, oclusión o estenosis 63.91 años(trombosis 64.30 años, embolia 61.45 años), hemorragia intracerebral 58.14 años. C)Mortalidad:Porcentaje global 16.3%, oclusión o estenosis 8.8% (trombosis 7.1%,embolia 20%), hemorragia intracerebral 37.5%. D)Tiempo de supervivencia en los casos fatales:oclusión o estenosis 27.23 días (trombosis 26.11 días, embolia 29.75 días), hemorragia intracerebral 9.95 días. En la discusión de los resultados se señala la característica propia que tiene la historia natural de los desórdenes vasculares cerebrales en nuestro medio. Llama la atención cierta similitud con datos obtenidos en países orientales.