ABSTRACT
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.
Subject(s)
COVID-19 , Ischemic Stroke/therapy , Pandemics , Reperfusion , Adult , Aged , Aged, 80 and over , Emergency Medical Services/statistics & numerical data , Endovascular Procedures/statistics & numerical data , Female , Humans , Ischemic Stroke/epidemiology , Length of Stay , Male , Middle Aged , Patient Admission/statistics & numerical data , Registries , Retrospective Studies , Spain/epidemiology , Thrombolytic Therapy/statistics & numerical data , Treatment OutcomeSubject(s)
Brain Diseases , Leukoencephalopathies , Adult , Age of Onset , Brain Diseases/genetics , Brain Diseases/pathology , Brain Diseases/physiopathology , Diagnosis, Differential , Humans , Leukoencephalopathies/genetics , Leukoencephalopathies/pathology , Leukoencephalopathies/physiopathology , Male , Young AdultABSTRACT
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Subject(s)
Humans , Male , Young Adult , Leukoencephalopathies/diagnosis , Psychomotor Agitation/etiology , Tomography, X-Ray ComputedABSTRACT
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Subject(s)
Female , Aged , Humans , Dura Mater/pathology , Hernia/complications , Hernia/diagnosis , Hernia/pathology , Spinal Cord/pathology , Spinal Cord Diseases/etiology , Cervical Vertebrae , Magnetic Resonance Imaging , MyelographyABSTRACT
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Subject(s)
Female , Aged , Humans , Tomography, Emission-Computed/standards , Fatal Outcome , Neoplasm Staging , Fluorodeoxyglucose F18 , Fluorodeoxyglucose F18/metabolism , Neoplasms/diagnosis , Neoplasms/pathology , Pleural Neoplasms/diagnosis , Pleural Neoplasms/pathologyABSTRACT
We present the case of a patient with late neuroborreliosis and a spontaneous temporal lobe hemorrhage. Although ischemic stroke and subarachnoid hemorrhage have been reported in association with Lyme disease, intraparenchymal brain hemorrhage has not been previously described in the course of this disease. The patient is a 48-year old male with a progressive spastic paraparesis of months' duration who presented acute headache, confusion, severe left hemiparesis with sensory deficit and homonymous hemianopsia. A cranial computed tomography scan showed an extensive right temporal lobe hemorrhage with subarachnoid invasion. Brain angiographic and angio-magnetic resonance imaging studies excluded hemorrhage-predisposing vascular abnormalities. Cerebrospinal fluid (CSF) studies disclosed mononuclear pleocytosis with elevated protein levels. Both serum and CSF anti-Borrelia titers were significantly increased, and serum Western Blot showed bands to protein 34 (ops B), 57, 59 and 62. The patient was treated with ceftriaxone for 4 weeks, with a favorable outcome. It is suspected that cause of the hemorrhage was parenchymatous Lyme-associated vascular damage and/or microaneurysmatic rupture.
Subject(s)
Cerebral Hemorrhage/etiology , Lyme Neuroborreliosis/complications , Temporal Lobe , Antibodies, Bacterial/blood , Antibodies, Bacterial/cerebrospinal fluid , Borrelia burgdorferi Group/immunology , Cerebral Hemorrhage/blood , Cerebral Hemorrhage/cerebrospinal fluid , Humans , Immunoglobulin G/blood , Immunoglobulin G/cerebrospinal fluid , Lyme Neuroborreliosis/blood , Lyme Neuroborreliosis/cerebrospinal fluid , Male , Middle AgedABSTRACT
Presentamos el caso de un paciente con neuroborreliosis tardía y una hemorragia espontánea en el lóbulo temporal derecho. Aunque el infarto isquémico cerebral y la hemorragia subaracnoidea han sido descritos en asociación con la enfermedad de Lyme, la hemorragia cerebral intraparenquimatosa no ha sido comunicada previamente en el curso de esta enfermedad. El paciente es un varón de 48 años de edad, que en el curso de una paraparesia espástica progresiva de meses de evolución presenta cefalea, confusión, hemiparesia izquierda con déficit sensitivo y hemianopsia homónima. Una tomografía axial computarizada reveló una hemorragia temporal derecha, extensa, con invasión subaracnoidea secundaria. Los estudios angiográficos y de angiorresonancia craneales no evidenciaron alteraciones vasculares potencialmente hemorrágicas. Estudios del líquido cefalorraquídeo (LCR) objetivaron una pleocitosis mononuclear con elevación de proteinorraquia. Los títulos de anticuerpos anti-Borrelia estaban elevados de forma significativa tanto en suero como en LCR, y el Western-Blot en suero reveló bandas a proteínas 34 (ops B), 57, 59 y 62. El paciente fue tratado con ceftriaxona durante 4 semanas, con buena evolución.Es probable que la causa de la hemorragia fuera una vasculopatía asociada a enfermedad de Lyme y/o rotura microaneurismática (AU)
Subject(s)
Middle Aged , Male , Humans , Temporal Lobe , Borrelia burgdorferi Group , Lyme Neuroborreliosis , Antibodies, Bacterial , Cerebral Hemorrhage , Immunoglobulin GABSTRACT
A 34-year-old male, son of consanguineous parents, had a progressive neurological illness characterized by seizures, tics, choreic movements and mood changes. Acanthocytosis was present in blood. The level of creatine kinase was elevated. Normobetalipoproteinemia was noted. No KX group changes of McLeod syndrome were found. Serial neuroimaging studies demonstrated progressive caudate atrophy. Muscular biopsy confirmed the existence of non-specific myopathy. Genetic study demonstrated homozigosity for the 9q21 region.
Subject(s)
Chorea/genetics , Chromosomes, Human, Pair 9/genetics , Gene Expression/genetics , Genes, Recessive/genetics , Adult , Brain/pathology , Chorea/diagnosis , Chromosome Aberrations/genetics , Chromosome Disorders , Homozygote , Humans , Magnetic Resonance Imaging , Male , PedigreeABSTRACT
Un varón de 34 años, hijo de padres consanguíneos, desarrolló una afección neurológica progresiva, caracterizada por convulsiones y posteriormente tics, movimientos coreicos y cambio del carácter. En el estudio de frotis sanguíneo se observó acantocitosis. Había elevación de la CK, pero no alteraciones en el lípidograma ni hallazgos en el grupo KX característicos del síndrome de McLeod. Los estudios consecutivos de neuroimagen evidenciaron atrofia progresiva y gliosis del núcleo caudado. Existían datos de miopatía inespecífica en la biopsia muscular. El estudio genético demostró homozigosidad en la región q21 del cromosoma 9 (AU)
Subject(s)
Adult , Male , Humans , Gene Expression , Pedigree , Chromosome Disorders , Chorea , Chromosomes, Human, Pair 9 , Chromosome Aberrations , Homozygote , Magnetic Resonance Imaging , Genes, Recessive , TelencephalonABSTRACT
BACKGROUND: Stroke is the cardiovascular disease which causes the greatest number of deaths in Galicia, mortality, particularly in women, being higher than in the rest of Spain. The aim of this study was to investigate the risk factors of stroke and its importance in Galicia. METHODS: A hospitalary study of cases and controls was performed including 76 patients with stroke and 76 controls individually paired for age, sex, population habitat and date of admission with anamnesis, weight, height and blood pressure, analysis and electrocardiogram being carried out in all. RESULTS: An association was found between the disease and family history of stroke (odds ratio = 3.6, confidence interval 95% = 1.2-13.3), personal history of stroke (17.9; 4.0-79.1), personal history of atrial fibrillation (15.0; 3.3-68.3), high blood pressure (4.5; 1.9-11.6) and ingestion of alcohol greater than or equal to 80 g/day in comparison with abstemious patients adjusted for the effect of high blood pressure (2.5; 1.1-5.7). An association was also observed with serum cholesterol levels greater than or equal to 250 mg/dl (6.46 mmol/l) (3.3; 1.2-8.8, in comparison with cholesterol less than 200 mg/dl). No association was found with the cigarette smoking (1.2; 0.7-2.3). CONCLUSIONS: The results observed for high blood pressure and the ingestion of alcohol regardless of the same are of importance in primary prevention due to being modifiable risk factors. The association with family history of stroke and auricular fibrillation reinforce the needs for primary prevention measures in these subpopulations while having had a stroke or a transitory ischemic attack is the characteristic with the most risk reinforcing the need for secondary prevention measures which have found to be effective. The controls presented abnormally low cholesterol levels that do not reflect those of the population from which they originate, thus existing the possibility that the association observed is spurious.
