ABSTRACT
Introduction: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009. Material and methods: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine. Results: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7days a week in 2009). There were 3 hospitals offering clinical telemedicine services. Conclusions: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS (AU)
Introducción: El ictus constituye un importante problema sociosanitario. Por ese motivo, el Ministerio de Sanidad aprobó en 2008 la Estrategia Nacional en Ictus (ENI) con el objetivo de mejorar la prevención, tratamiento y rehabilitación del paciente con ictus. Se pretende garantizar una atención neurológica en todo el país y a cualquier hora del día para final del 2010. Nuestro objetivo fue analizar la situación de la atención al ictus en España en el año 2009. Material y métodos: Se constituyó un comité de neurólogos de las diferentes CC. AA. que no hubieran participado en la ENI. Se elaboró una encuesta nacional que recogió el número de unidades de ictus (UI) y la dotación (monitorización, guardia de neurología 24h/7 días, ratio de enfermería y existencia de protocolos), ratio cama UI/100.000 habitantes, presencia de trombólisis iv, intervencionismo neurovascular (INV) y telemedicina. Resultados: Se incluyeron datos de 145 hospitales. Existen 39 UI distribuidas de un modo desigual. La relación cama de UI/número de habitantes/comunidad autónoma osciló entre 1/75.000 a 1/1.037.000 habitantes, cumpliendo el objetivo Navarra y Cantabria. Se realiza trombólisis iv en 80 hospitales, el número osciló entre 7-536 tratamientos/CC. AA. durante el año 2008. Se realiza INV en el 63% de las CC. AA., teniendo 28 centros capacitados, aunque sólo 1 la realizaba en 2009 las 24h/7 día. Existen 3 centros con telemedicina. Conclusiones: La asistencia al ictus ha mejorado en España respecto a unos años atrás, pero todavía existen importantes desigualdades por CC. AA. que deberían superarse si se quiere cumplir el objetivo de la ENI (AU)
Subject(s)
Humans , Stroke/epidemiology , Health Care Rationing/trends , Thrombolytic Therapy/statistics & numerical data , Stroke/economics , /statistics & numerical data , Health Status DisparitiesABSTRACT
INTRODUCTION: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009. MATERIAL AND METHODS: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine. RESULTS: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7 days a week in 2009). There were 3 hospitals offering clinical telemedicine services. CONCLUSIONS: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS.
Subject(s)
Cerebrovascular Disorders , Delivery of Health Care , Health Resources , Stroke/therapy , Data Collection , Fibrinolytic Agents/therapeutic use , Hospitals , Humans , Infusions, Intravenous , Neurology , Societies , Spain , Telemedicine , Thrombolytic Therapy/methods , WorkforceABSTRACT
OBJECTIVE: This document intends to review the main features of Binswanger's disease and its differential diagnosis with other vascular pathologies of the white matter. DEVELOPMENT: Nowadays, the raise of the elderly group of population has led to a remarkable increase in dementia's prevalence, therefore it becomes necessary to study deeply vascular dementias, the second most common kind of dementia behind Alzheimer's disease. The detection of Binswanger's disease has increased due to the progress of neuroimaging techniques, that allow to identify ischemic lesions situated in the cerebral white matter and the existence of multiple lacunar infarcts. This clinical entity represents the most frequent type of subcortical dementia, although controversy still remains about its pathogeny, ethiology, and nosologic limits. CONCLUSIONS: The search for unified criteria is the first step in the microangiopathic subcortical dementia's field to achieve valuable treatment strategies.
Subject(s)
Dementia, Vascular/diagnosis , Aged , Cognition Disorders/diagnosis , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Risk FactorsABSTRACT
Introducción. El presente trabajo pretende ser una somera revisión de las principales características de la enfermedad de Binswanger, de su diagnóstico diferencial con diversos procesos vasculares que cursan con daño de la sustancia blanca y de sus posibles mecanismos patogénicos. Desarrollo. En una época como la actual, en la que el envejecimiento de la población ha provocado un incremento importante en la prevalencia de las demencias, resulta necesario profundizar en el estudio de las demencias vasculares, grupo que constituye la segunda causa de deterioro mental tras la enfermedad de Alzheimer y que ofrece un posible tratamiento preventivo. Dentro de este grupo se sitúa la llamada enfermedad de Binswanger o demencia vascular microangiopática tipo Binswanger, proceso cuya detección ha aumentado progresivamente con la constante mejora de los métodos de diagnóstico radiológico, que permiten identificar perfectamente el daño isquémico de la sustancia blanca hemisférica cerebral y la presencia de pequeños y múltiples infartos lacunares. Este cuadro de evolución fluctuante e inexorablemente progresiva representa la demencia vascular de tipo subcortical más frecuente pero, a pesar de ello, en la actualidad todavía existen controversias acerca de su patogenia, su etiología y sus límites nosológicos. Conclusiones. El espectro etiológico de las demencias microangiopáticas subcorticales es amplio, y todavía existe una importante confusión respecto a su terminología y definición conceptual; la clarificación y unificación de criterios es el primer paso necesario para intentar un tratamiento que pueda resultar eficaz (AU)
Subject(s)
Middle Aged , Aged , Male , Female , Humans , Risk Factors , Dementia, Vascular , Cognition Disorders , Diagnosis, Differential , Neuropsychological TestsABSTRACT
The case of a female patient with multiple ectodermal and mesodermal malformations present since birth is reported. The cutaneous lesions were of two types: Jadassohn's nevus sebaceus and nevus unius lateris. These entities have been described in the literature as congenital dermatologic alterations of nevoid character and organoid structure. They can be considered as congenital epidermal nevi. In many cases, including this one, there are various associated disorders especially of the nervous system, eyes, and skeleton. Both syndromes are cutaneous hamartomas which can be differentiated histologically but not by the anomalies accompanying them. Their dermatologic aspects are very similar. The histopathologic characteristics of the skin lesions of nevus unius lateris consist of hyperkeratosis, acanthosis, and epidermal papillomatosis. In Jadassohn's nevus sebaceus there are also alterations of the skin adnexa, namely the absence of hair follicles and the presence of numerous mature sebaceus and hyperplastic glands. In general, the presence of organoid nevus may be a sign of multiple ectodermal and mesodermal malformations. Both syndromes are often present in the same patient, as in the case described here, and their etiology is the same. It is based on an alteration in embryogenic development affecting primarily, though not exclusively, the formations of ectodermal origin. Thus Jadassohn's nevus sebaceus and nevus unius lateris are both forms of phacomatosis. Clinical cases have in common the cutaneous cited above, either in combination or singly. The other possible signs and symptoms are variable, depending on which stage of embryogenic development is affected. There may be defects in the structures of both ectodermal and mesodermal origin.
