Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain.

BACKGROUND AND PURPOSE: Spain has been one of the countries more heavily stricken by SARS-CoV-2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID-19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. METHODS: This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra- and intra-hospital times of action, Code Stroke activation pathway, COVID-19 status, reperfusion rate, and short-term outcome before and after the setting of the emergency state were analysed. RESULTS: A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out-of-hospital (95.0 vs. 110.0 min, P = 0.001) and door-to-needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID-19 patients had more in-hospital mortality. CONCLUSION: A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out-of-hospital and door-to-needle times and worse reperfusion rates in northwest Spain. COVID-19 patients had more in-hospital mortality.

Analysis of stroke care resources in Spain in 2012: have we benefitted from the Spanish Health System's stroke care strategy?

INTRODUCTION: The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. MATERIAL AND METHODS: The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24h/7d, nurse ratio, protocols), SU bed ratio/100,000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability. RESULTS: We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine. CONCLUSION: Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives.

Hemorragia intracerebral lobular: análisis de una serie y características en pacientes antiagregados y anticoagulados / Lobar intracerebral haemorrhage: analysis of a series and characteristics of patients receiving anti-platelet or anticoagulation treatment

Introducción: La hemorragia intracerebral lobular (HIL) es una causa poco frecuente de ictus y representan cerca del 20% de las hemorragias intracerebrales primarias. La causa más frecuente son la angiopatía amiloidea cerebral (AAC), la hipertensión arterial (HTA) y otras como el tratamiento antiagregante o anticoagulante. Analizar una serie de pacientes con HIL y compararla con subgrupos de pacientes con HIL antiagregados o anticoagulados previamente. Determinar el volumen de la hemorragia y su valor predictivo de mortalidad.Pacientes y métodos: Se incluyó de forma consecutiva y retrospectiva a 162 pacientes diagnosticados de HIL y atendidos en el servicio de neurología del Hospital Meixoeiro de Vigo entre los años 1991 y 2009. Se recogieron características demográficas, factores de riesgo, etiologías y clínica, y se realizó un análisis comparativo entre la serie general y los subgrupos de paciente antiagregados y anticoagulados.Resultados: En la serie general la causa más frecuente fue la AAC posible o probable seguida de la HTA. En los subgrupos de pacientes antiagregados o anticoagulados no había diferencias en las variables estudiadas excepto en la frecuencia de cardiopatía. Sí existían diferencias en cuanto a la edad, la cardiopatía y la volumen de la hemorragia entre la serie general (sin los pacientes antiagregados o anticoagulados) cuando se compararon con los subgrupos de antiagregados y anticoagulados.Conclusiones: Aportamos algunas novedades respecto al comportamiento clínico de la HIL y sus diferencias en los pacientes antiagregados o anticoagulados. La mortalidad es superior en las HIL anticoaguladas. Son variables predictivas de defunción el sexo femenino y el volumen de la hemorragia (AU)

Introduction: Lobar intracerebral haemorrhage (LIH), is a rare cause of stroke which accounts for about 20% of primary intracerebral haemorrhages. The most common causes are cerebral amyloid angiopathy (CAA), high blood pressure and others, such as using anti-platelet or anticoagulation agents. We analysed a series of patients with LIH and compared it with subgroups of patients with LIH who were previously receiving anti-platelet or anticoagulation agents. We determined the volume of the bleeding and its predictive value for mortality. Patients and methods: We consecutively and retrospectively included 162 patients diagnosed with LIH and cared for in the Neurology Department of Hospital Meixoeiro in Vigo between 1991 and 2009. We collected demographic characteristics, risk factors, aetiologies and symptoms, and conducted a comparative analysis between the general series and the subgroups of patients receiving anticoagulation and anti-platelet agents. Results: In the general series, the most common cause was possible or probable CAA followed by hypertension. In the subgroup of patients receiving anti-platelet or anticoagulation agents there were no differences in the variables studied, except for the frequency of heart disease. Nonetheless, there were differences with respect to age, heart disease and bleeding volume between the general series (patients not treated with anti-platelet or anticoagulation agents) when compared with the subgroups of patients receiving anti-platelet and anticoagulation agents. Conclusions: We provide new information regarding the clinical behaviour of LIH and its differences in patients receiving anti-platelet or anticoagulation agents. Mortality is higher in cases of LIH on anticoagulants. LIH. Female sex and the volume of bleeding are predictors of mortality (AU)

Lobar intracerebral haemorrhage: analysis of a series and characteristics of patients receiving antiplatelet or anticoagulation treatment.

INTRODUCTION: Lobar intracerebral haemorrhage (LIH), is a rare cause of stroke which accounts for about 20% of primary intracerebral haemorrhages. The most common causes are cerebral amyloid angiopathy (CAA), high blood pressure and others, such as using anti-platelet or anticoagulation agents. We analysed a series of patients with LIH and compared it with subgroups of patients with LIH who were previously receiving anti-platelet or anticoagulation agents. We determined the volume of the bleeding and its predictive value for mortality. PATIENTS AND METHODS: We consecutively and retrospectively included 162 patients diagnosed with LIH and cared for in the Neurology Department of Hospital Meixoeiro in Vigo between 1991 and 2009. We collected demographic characteristics, risk factors, aetiologies and symptoms, and conducted a comparative analysis between the general series and the subgroups of patients receiving anticoagulation and anti-platelet agents. RESULTS: In the general series, the most common cause was possible or probable CAA followed by hypertension. In the subgroup of patients receiving anti-platelet or anticoagulation agents there were no differences in the variables studied, except for the frequency of heart disease. Nonetheless, there were differences with respect to age, heart disease and bleeding volume between the general series (patients not treated with anti-platelet or anticoagulation agents) when compared with the subgroups of patients receiving anti-platelet and anticoagulation agents. CONCLUSIONS: We provide new information regarding the clinical behaviour of LIH and its differences in patients receiving anti-platelet or anticoagulation agents. Mortality is higher in cases of LIH on anticoagulants. LIH. Female sex and the volume of bleeding are predictors of mortality.

[Lobar intracerebral haemorrhage and cerebral amyloid angiopathy: analysis of a series of 106 patients]. / Hemorragia intracerebral lobular y angiopatía amiloidea cerebral: análisis de una serie de 106 pacientes.

INTRODUCTION: Lobar intracerebral haemorrhage (LH) is an uncommon cause of stroke. Many LH are caused by cerebral amyloid angiopathy (CAA). The aim of the present study is to analyse the clinical signs, risk factors, lesion volume and development, of a consecutive series of patients suffering from LH and to compare the various characteristics between haemorrhages which comply with the Boston criteria for CAA and those which do not comply with these inclusion criteria. METHODS: A consecutive series of 106 patients suffering from LH and admitted to the neurological service in the Meixoeiro Hospital of Vigo between 1991 and 2005 is described. The Boston criteria were applied to all patients suffering from LH associated with possible, probable and confirmed CAA. The clinical signs, risk factors, haemorrhage sizes, evolution and complications of the patients complying with the CAA inclusion criteria were compared to those who did not comply with the inclusion criteria. RESULTS: The 106 patients from the series, represent 14.4% of intracerebral haemorrhages and 3.7% of all strokes. Fifty-four percent (54 %) of the patients were female and arterial hypertension was an important risk factor. Twenty point eight percent (20.8%) of the patients were admitted in coma and 60% with hemiparesis. Of these LH patients 28.3% died. The haemorrhage volume and the female gender were the only predictive factors for death. No significant variables were observed to differentiate the groups in the comparative analysis of the subgroups of patients with CAA inclusion criteria and those without. CONCLUSIONS: The series studied showed similar risk factors and clinical characteristics to other published series. No predictive clinical variables were found to differentiate between LH which complied with CAA inclusion criteria and those that did not comply.

[Cerebral amyloid angiopathy, recurrent intracerebral haemorrhages and Down's syndrome]. / Angiopatía amiloidea cerebral, hemorragias cerebrales de repetición y síndrome de Down.

Middle-age Down's syndrome patients develop dementia with antomicopathological changes that are characteristic for Alzheimer's disease. Cerebral amyolid angiopathy (CAA) most commonly manifests itself as a lobar intracerebral haemorrhage that tends to recur. Multiple haemorrhages may occur simultaneously. CAA is frequently associated with Alzheimer's disease, however the relationship between CCA and Down's syndrome is poorly know. Although there are established clinical criteria for the diagnosis of CAA related to lobar intracerebral haemorrhage, definitive CAA needs anatomicopathologial confirmation. This paper presents the case of a male with Down's syndrome and recurrent lobar intracerebral haemorrhage. An autopsy showed lesions in leptomeningeal and cortical arteries which are characteristic of CAA in addition to anatomicopathological changes of Alzheimer s disease that were mostly seen in entorhinal cortex and hippocampus. The paper also discusses the pathological association between beta-amyloid protein, apolipoprotein alleles, CAA, Alzheimer's disease and Down's syndrome.