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.

Assessment of external gamma exposure and radon levels in a dwelling constructed with phosphogypsum plates.

Phosphogypsum, a fertilizer industry by-product, is being worldwide stockpiled, posing environmental concerns. Since this material contains natural radionuclides in significant concentrations, its use as a building material has radiological implications. In order to confirm the feasibility of the use of a new material mainly composed by phosphogypsum, an experimental house was built, having some of its rooms entirely lined with this material. Measurements of samples of phosphogypsum plates from different origins resulted in values of 0.2 to 2.6 for the external radiation index, thus justifying a more detailed investigation. In this paper, the application of a previously developed computational model to forecast external doses indoors is described. A comprehensive radiological evaluation is being performed, including measurement of the external gamma exposure and radon concentrations in one of the rooms of the house. The results show that the annual increment in the effective dose to an inhabitant of the house will remain below the 1 mSv limit for every reasonable scenario. The radon measurements were carried out over a period of 18 months, in order to determine the long-term average levels of the indoor radon concentrations. The results obtained are below 200 Bq m(-3), the recommended investigation level for radon.

[Quality of neurological care in the emergency services: a study from the community-hospital]. / Calidad de la asistencia neurológica en urgencias: un estudio desde el área.

INTRODUCTION: The medical conditions shared by hospital emergency services and community-hospital neurology clinics (CHNC) have not been described, and the quality of the medical care received in these conditions has not been evaluated in our environment. METHODS: Over a 2 month period, those patients presenting at any of the seven CHNC in a Health Care Area 1 of Madrid due to previously attended medical conditions in the emergency services were systematically registered. The area neurologists of the CHNC collected administrative and clinical variables and made a judgment on the medical care (primary outcome measure) and diagnoses (secondary outcome measure) received. RESULTS: A total of 181 patients were included (mean age: 58 years; 60% women). The inclusion rate was one patient per working day, and 31% of patients were visited out of the established quota number of patients for the clinic. The most frequent reasons for visiting the emergency room were: headache (20%), focal neurological syndrome (16%) and loss of consciousness (14%). The most frequent diagnoses at the CHNC were: primary headache (19 %), stroke (11%) and epilepsy (9 %). Emergency care was deemed correct in 56 % of patients. When the patients with intervention were compared to those with no intervention, participation of the neurology service in the emergency room was associated to a greater percentage of correct diagnoses (59% vs. 41%; p=0.019) and care (69% vs. 47%; p=0.003). CONCLUSIONS: The medical conditions shared with the emergency services represent a small but relevant proportion of the patients assisted in the CHNC. Some of these conditions (primary headaches, syncopes) should be canalized into primary health care. Others (epilepsy) require a circuit between emergency room and CNNC, but the appointment system should be adapted. The intervention of a neurologist in the emergency room raises the quality of the care.

Calidad de la asistencia neurológica en urgencias: un estudio desde el área / Quality of neurological care in the emergency services: a study from the community-hospital

Introducción. Los procesos compartidos por los servicios hospitalarios de urgencias y las consultas de neurología del área sanitaria (CNA) no han sido descritos y su calidad asistencial no ha sido evaluada en nuestro medio. Métodos. Durante 2 meses se registraron todos los pacientes que acudieron a las siete CNA 1 de Madrid debido a procesos médicos que habían sido previamente atendidos en urgencias. Los neurólogos del área sanitaria recogieron variables organizativas y clínicas y emitieron un juicio acerca de la asistencia (variable de efecto primaria) y del diagnóstico (variable de efecto secundaria) realizados. Resultados. Fueron incluidos 181 pacientes (edad media: 58 años; 60% mujeres), a un promedio de un paciente por día de consulta. El 31% estaban citados fuera del cupo. Los motivos más frecuentes de la visita a urgencias habían sido: cefalea (20%), focalidad neurológica (16 %) y pérdida de conciencia (14 %). Los diagnósticos más frecuentes en la CNA fueron: cefalea primaria (19%), accidente cerebrovascular (11%) y epilepsia (9 %). La asistencia en urgencias fue correcta en el 56% de los pacientes. Comparado con los procesos en que no intervino, la participación de neurología se asoció a un mayor porcentaje de diagnóstico y de asistencia correctos (59 frente a 41%; p=0,019, y 69 frente a 47%; p=0,003, respectivamente). Conclusiones. Los procesos compartidos con urgencias suponen una proporción pequeña pero no desdeñable del total de pacientes atendidos en las CNA. Algunos de estos procesos (cefaleas primarias, síncopes) deberían canalizarse hacia la asistencia primaria. Otros (epilepsia) precisan del circuito urgencias-CNA, pero el sistema de citaciones debe adaptarse. La actuación del neurólogo en urgencias eleva la calidad asistencial (AU)

Introduction: The medical conditions shared by hospital emergency services and community-hospital neurology clinics (CHNC) have not been described, and the quality of the medical care received in these conditions has not been evaluated in our environment. Methods: Over a 2 month period, those patients presenting at any of the seven CHNC in a Health Care Area 1 of Madrid due to previously attended medical conditions in the emergency services were systematically registered. The area neurologists of the CHNC collected administrative and clinical variables and made a judgment on the medical care (primary outcome measure) and diagnoses (secondary outcome measure) received. Results: A total of 181 patients were included (mean age: 58 years; 60% women). The inclusion rate was one patient per working day, and 31% of patients were visited out of the established quota number of patients for the clinic. The most frequent reasons for visiting the emergency room were: headache (20%), focal neurological syndrome (16%) and loss of consciousness (14%). The most frequent diagnoses at the CHNC were: primary headache (19 %), stroke (11%) and epilepsy (9 %). Emergency care was deemed correct in 56 % of patients. When the patients with intervention were compared to those with no intervention, participation of the neurology service in the emergency room was associated to a greater percentage of correct diagnoses (59% vs. 41%; p=0.019) and care (69% vs. 47%; p=0.003). Conclusions: The medical conditions shared with the emergency services represent a small but relevant proportion of the patients assisted in the CHNC. Some of these conditions (primary headaches, syncopes) should be canalized into primary health care. Others (epilepsy) require a circuit between emergency room and CNNC, but the appointment system should be adapted. The intervention of a neurologist in the emergency room raises the quality of the care (AU)

[Importance of the clinical-radiological complementarity in superficial cerebral siderosis]. / Relevancia de la complementariedad clinicorradiológica en la siderosis superficial cerebral.

We report two cases of superficial siderosis of central nervous system. In one case it was idiopathic and in the other secondary to an unidentified subarachnoid hemorrhage. The symptoms that characterized the clinical picture of both were gait disturbance and hypoacusis. The MRI study showed a superficial rim of hypointensity that covered the cerebellum and brainstem, and extended along the cranial nerves and the brain surface. The findings were clearer in the T2 spin echo series. Due to the high sensitivity for hemosiderin deposits, MRI made it possible to make the final diagnosis of this rare disease.

[Symptomatic paroxysmal dystonia (non-kinesigenic forms): two new cases]. / Distonía paroxística sintomática (variedad acinesigénica): dos nuevos casos.

We report two new cases of symptomatic paroxysmal non-kinesigenic dystonia. The first is a 68-year-old woman with paroxysmal spontaneous dystonic spasms in her right arm lasting 1 minute. They occurred 1-2/day, a few months after a cerebral infarction (left internal capsule and left lenticular nucleus) which occurred 6 years ago. The second is a 30-year-old woman with a 7-year-history of spontaneous dystonic postures (flexion spasms) in her left arm lasting 15 minutes and occurring monthly. In this case an Arnold-Chiari malformation with cervical syringomyelia was discovered.

[Idiopathic cervical plexopathy]. / Plexopatía cervical idiopática.

We describe a 26 year-old woman with cervical plexopathy with damage of left superficial or cutaneous branches, and left cervical sensory dorsal rami. Picture began acutely and vanished few days later. We ruled out known etiologies like traumatisms, tumours and surgical and anaesthetic complicated procedures, therefore the patient suffered an idiopathic cervical plexopathy. We hypothesize two possibilities for this clinical picture: an autoimmune reaction or a muscular entrapment.

First seizure in adults: a prospective study from the emergency department.

A prospective study of 98 consecutive adults with a first seizure to determine the most important etiological factors and the optimum diagnostics. 27 were thought to have cryptogenic seizures. Main causes of symptomatic seizures were: cerebral infarction, alcohol-withdrawal, CNS infections, tumors, vascular malformations, traumatism and miscellanea. Eight were infected by human immunodeficiency virus (HIV-1) representing 8.2% of all the patients with a first seizure and 20% of the 15-45-year age group. CT disclosed structural lesions in 33 cases. MRI in those with normal CT and no other explanation of seizure revealed additional lesions in 22.2%, but did not change management in any. We conclude that CT is essential in evaluation of adults with first seizure. MRI may be useful in selected cases. The HIV-infected now represent an important group with a first seizure.