Rapid assessment of transient ischaemic attack in a hospital with no on-call neurologist.

BACKGROUND: Risk of stroke soon after a transient ischaemic attack (TIA) is high. Urgent care can reduce this risk. Our aim is to describe and evaluate the efficacy of rapid assessment of TIA patients in a hospital without a neurologist available 24 hours a day. METHODS: In February 2007, we set up a protocol of rapid management of patients with symptoms consistent with acute TIA, with the aim of prioritising urgent care and reducing hospital admissions, without increasing risk of recurrences. We analyse our results since the protocol was implemented with particular focus on the analysis of delay in neurological and neurovascular assessment, percentage and reasons for hospitalisation, and stroke recurrence rates after 3 months. RESULTS: Four hundred and eleven patients were studied, with a final diagnosis of TIA in 282 (68.6%). Among other diagnoses, the most frequent were a vasovagal reaction (5.6%) and confusional syndrome (4.6%). Delay between emergency arrival and neurovascular assessment was <24h in 82% of the cases, and <48 h in 93%. After neurological evaluation, 28.7% of the patients were immediately admitted to hospital (most common causes: severe stenosis of a large artery and crescendo TIA). The incidence of ischaemic stroke in TIA patients was 3.55% after 3 months and 70% of them suffered the recurrence within the first week after the initial TIA. CONCLUSIONS: In a hospital without a neurologist available 24 hours a day, early assessment and management of TIA patients can be carried out in accordance with the guidelines, and may avoid hospitalisation in most cases without increasing recurrence rates.

[Cryptogenic infarct. A follow-up period of 1 year study]. / Infartos criptogénicos. Estudio de 1 año de seguimiento.

OBJECTIVE: To analyze the outcome of patients with a cryptogenic infarct (CI) after a follow-up period of 1 year. METHODS: From our prospective registry of stroke, during a 4-year period, we've identified 121 consecutive patients with a CI (15.1% of all infarcts). They have been followed up for 1 year and we have registered stroke recurrence, cardiovascular events and other incidences. RESULTS: Mean age 70.6 years-old, 53% male. Middle cerebral artery (MCA) was the most often involved territory (52 cases), 70% of them with cortical involvement. No patient died during admission, 95.8% received antiplatelet therapy and 4.1% oral anticoagulant. Fourteen patients were lost of follow-up. During 1-year period, atrial fibrillation (AF) was detected in 7 patients (6.54%), their mean age was 75 years-old, in 5 of them the CI was in MCA territory (4 with cortical involvement, 1 only deep infarct). Three patients (2.76%) suffered a recurrent ischemic stroke, in weeks 15, 16 and 44 after the CI. In all 3 cases the infarct was considered cryptogenic again. Two patients suffered a myocardial infarction and 4 died during follow-up period. CONCLUSION: In our series rate of stroke recurrence and cardiovascular events after a CI was low. An 11% of patients with a CI involving cortical MCA territory developed FA during the following year.

Infartos criptogénicos. Estudio de 1 año de seguimiento / Cryptogenic infarct. A follow-up period of 1 year study

Objetivo. Analizar la evolución de los pacientes con un infartocriptogénico (IC) tras 1 año de seguimiento.Método. De nuestro registro prospectivo de ictus, durante unperíodo de 4 años, identificamos 121 pacientes consecutivos con unIC (15,1% del total de infartos). Se recogen datos de recurrencia delictus, eventos cardiovasculares y otras incidencias tras 1 año de seguimiento.Resultados. Edad media: 70,6 años, 53,7% de varones. La arteriacerebral media (ACM) fue el territorio más afectado (52 casos), el70% de ellos con afectación cortical. Ningún paciente falleció duranteel ingreso, un 95,8% recibió tratamiento antiagregante y un4,1% anticoagulante. En 14 pacientes no se pudo completar el añode seguimiento por diferentes motivos.Durante el período de seguimiento se detectó fibrilación auricular(FA) a 7 pacientes (6,54%), su edad media fue 75 años y en 5 deellos el IC había sido en el territorio de la ACM (4 superficial y 1 profundo).Tres pacientes (2,76%) sufrieron una recurrencia de ictus isquémicoen las semanas 15, 16 y 44 después del IC. En los 3 casos elictus fue considerado de nuevo criptogénico. Dos pacientes sufrieronun infarto agudo de miocardio y 4 fallecieron (infarto de miocardio,neoplasia de esófago, neumonía y muerte súbita).Conclusión. En nuestra serie, la tasa de recurrencia y de episodioscardiovasculares en el primer año tras un IC es baja. Un 11% depacientes con un IC en el territorio cortical de la ACM desarrollaronuna FA en el año siguiente (AU)

Objective. To analyze the outcome of patients with a cryptogenicinfarct (CI) after a follow-up period of 1 year.Methods. From our prospective registry of stroke, during a4-year period, we’ve identified 121 consecutive patients with a CI(15.1% of all infarcts). They have been followed up for 1 year andwe have registered stroke recurrence, cardiovascular eventsand other incidences.Results. Mean age 70.6 years-old, 53 % male. Middle cerebralartery (MCA) was the most often involved territory (52 cases),70% of them with cortical involvement. No patient died duringadmission, 95.8% received antiplatelet therapy and 4.1% oralanticoagulant. Fourteen patients were lost of follow-up.During 1-year period, atrial fibrillation (AF) was detected in7 patients (6.54%), their mean age was 75 years-old, in 5 of themthe CI was in MCA territory (4 with cortical involvement, 1 onlydeep infarct). Three patients (2.76 %) suffered a recurrent ischemicstroke, in weeks 15, 16 and 44 after the CI. In all 3 cases theinfarct was considered cryptogenic again. Two patients suffereda myocardial infarction and 4 died during follow-up period.Conclusion. In our series rate of stroke recurrence and cardiovascularevents after a CI was low. An 11 % of patients with aCI involving cortical MCA territory developed FA during the followingyear (AU)

Reconocimiento de los síntomas del ictus y respuesta frente a ellos en la población / Knowledge about stroke symptoms and attitude towards them in the population

Introducción. Conocer el significado de los síntomas de un ictus y tener percepción de urgencia ante ellos es un factor decisivo para reducir la demora extrahospitalaria. El objetivo es analizar el grado de reconocimiento de sus síntomas en los pacientes con un ictus, su actitud ante ellos y los factores que influyen en el conocimiento de la enfermedad. Métodos. Se estudian prospectivamente 292 pacientes consecutivos diagnosticados de ictus mediante un protocolo de recogida de datos que incluye 76 variables. Se realiza análisis univariante y multivariante para identificar las variables que se asocian independientemente con una mejor interpretación de sus síntomas y percepción de urgencia. Resultados. Sólo un 34% de pacientes reconoció saber que estaba sufriendo un ictus. El antecedente de ictus previo (OR: 3,97), vivir en una residencia (odds ratio [OR]: 3,20), tener síntomas motores (OR: 1,92) y un ictus más grave (OR: 1,05) se asociaron de forma independiente a un mejor reconocimiento de los síntomas. Sólo un 31,8 % de pacientes (41% de los que reconocieron los síntomas del ictus) decidió acudir inmediatamente al hospital o llamó a una ambulancia. La etiología cardioembólica del infarto (OR: 2,62), no tener hipertensión (OR: 0,48) y reconocer correctamente sus síntomas (OR: 0,62) son factores asociados de forma independiente a una mayor percepción de urgencia. Conclusión. Sólo un 14 % de los pacientes tienen un buen conocimiento del ictus y actúan correctamente cuando éste ocurre. Es necesario desarrollar programas de formación de la población en los que se resalte la urgencia ante la presencia de síntomas sugestivos de ictus (AU)

Introduction. To know the meaning of stroke symptoms and to perceive them as an emergency is a decisive factor to reduce hospital admission delay. The aim of the study is to analyze the degree of recognition of stroke symptoms by the patients, their attitude towards them, and which factors contribute to a better knowledge on cerebrovascular diseases. Methods. A total of 292 patients diagnosed of stroke were studied prospectively, following a protocol designed for data collection that included 76 variables. Univariate and multivariate analyses were conducted to identify which variables were independently associated with a better interpretation of stroke symptoms and emergency perception. Results. Only 34% of all patients recognized they were suffering a stroke. The background that was independently associated with a better interpretation of symptoms included previous stroke (odds ratio [OR]: 3.97), institutionalized subjects (old people's home) (OR: 3.20), motor symptoms (OR: 1.92) and more serious stroke (OR: 1.05). Only 31% of all patients, 41% of whom had recognized stroke symptoms, decided to go immediately to hospital or call for an ambulance. Variables that were independently associated with a better perception of emergency included cardioembolic stroke (OR: 2.62), not having hypertension (OR: 0.48) and a correct interpretation of stroke symptoms (OR: 0.62). Conclusion. Only 14% of all patients have a good knowledge about stroke and correctly act when it occurs. It is necessary to develop education programs aimed at the population that emphasize the emergency when symptoms suggesting stroke appear (AU)