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1.
Artigo em Inglês | MEDLINE | ID: mdl-34948486

RESUMO

Stroke is the leading cause of acquired disability in adults which is a cerebrovascular disease of great impact in health and social terms, not only due to its prevalence and incidence but also because of its significant consequences in terms of patient dependence and its consequent impact on the patient and family lives. The general objective of this study is to determine whether an early occupational therapy intervention at hospital discharge after suffering a stroke has a positive effect on the functional independence of the patient three months after discharge-the patient's level of independence being the main focus of this research. Data will be collected on readmissions to hospitals, mortality, returns to work and returns to driving, as well as an economic health analysis. This is a prospective, randomized, controlled clinical trial. The sample size will be made up of 60 patients who suffered a stroke and were discharged from the neurology unit of a second-level hospital in west Malaga (Spain), who were then referred to the rehabilitation service by the joint decision of the neurology and rehabilitation department. The patients and caregivers assigned to the experimental group were included in an early occupational therapy intervention program and compared with a control group that receives usual care.


Assuntos
Terapia Ocupacional , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Adulto , Hospitais , Humanos , Alta do Paciente , Estudos Prospectivos , Acidente Vascular Cerebral/terapia
4.
Emergencias (St. Vicenç dels Horts) ; 27(1): 34-38, feb. 2015.
Artigo em Espanhol | IBECS | ID: ibc-134021

RESUMO

Objetivo: Analizar las variables que influyen en un mejor pronóstico funcional a los tres meses en un grupo de pacientes con ictus isquémico agudo fibrinolisado. Material y métodos: Se analizaron retrospectivamente 63 pacientes con características de código ictus y que recibieron fibrinólisis en un hospital de referencia de Málaga Oeste. Se determinó el tiempo de inicio de fibrinolisis (TIF), la gravedad del infarto mediante la puntuación NIHSS basal y a las 24 horas y el pronóstico funcional a los 3 meses mediante la escala Rankin modificada (mRS). Resultados: Se incluyeron 63 pacientes, edad media 65 (DE 11) años. El TIF fue de 151 (DE 42) minutos. Se obtuvo una puntuación media en la escala NIHSS basal de 15,5 (DE 4,8) y a las 24 horas de 9,1 (DE 7,13), y una diferencia media de NIHSS a las 24 horas de 6,3 (DE 5,8). Se realizó análisis de correlación entre mRS y NIHSS a las 24 horas(Rho = 0,73; p < 0,01); NIHSS a la llegada (Rho = 0,34; p = 0,01); edad (Rho = 0,41; p = 0,001); TIF (Rho = 0,21;p = 0,09); y diferencia de NIHSS a las 24 h (Rho = –0,61; p = 0,001). Conclusión: El pronóstico funcional de los pacientes con ictus agudo que reciben tratamiento fibrinolítico endovenoso depende de factores como la edad, el tiempo desde que se administra el tratamiento, la gravedad inicial del infarto y la situación del paciente a las 24 horas, siendo este último el factor el más relacionado con el pronóstico funcional (AU)


Objective: To analyze the variables associated with better functional outcome 3 months after ischemic stroke treated with fibrinolytic agents. Material and methods: The cases of 63 patients with characteristics leading to activation of a stroke code were analyzed retrospectively. The patients received fibrinolytic therapy in a referral hospital for the western district of Malaga, Spain. We recorded the time until start of fibrinolytic therapy, severity according to the National Institute of Health Stroke Scale (NIHSS) at baseline and at 24 hours, and functional outcome at 3 months according to the modified Rankin Scale. Results: Data for 63 patients with a mean (SD) age of 65 (11) years were included. The mean time until start of fibrinolytic therapy was 151 (42) minutes. The mean NIHSS scores were 15.5 (4.8) points at baseline and 9.1 (7.13) at 24hours. The mean change in score at 24 hours was 6.3 (5.8) points. The findings of correlation analysis between scores on the modified Rankin scale and other variables were as follows: NIHSS score at 24 hours, ρ = 0.73; P < .01; NIHSS at baseline, ρ = 0.34; P = .01); age, ρ = 0.41; P = .001); time until start of fibrinolysis, ρ = 0.21; P = .09); change in NIHSS score at 24 hours, ρ = –0.61; P = .001). Conclusions: The prognosis for the functional recovery of patients given intravenous fibrinolytic therapy after stroke depends on such factors as age, time treatment is started, severity, and the patient’s status at 24 hours. The last factor34-38 im/tab is the one that is most strongly related to prognosis (AU)


Assuntos
Humanos , Ataque Isquêmico Transitório/epidemiologia , Fibrinolíticos/uso terapêutico , Ativador de Plasminogênio Tecidual/uso terapêutico , Tempo/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Risco
5.
Rev. neurol. (Ed. impr.) ; 55(5): 283-296, 1 sept., 2012. ilus
Artigo em Espanhol | IBECS | ID: ibc-101803

RESUMO

Resumen. La estenosis carotídea asintomática es una patología relativamente frecuente sobre la que sigue existiendo una importante disparidad de criterios cuando se plantea la posibilidad de su manejo quirúrgico. En el presente trabajo se realiza un amplio recorrido por esta entidad, que viaja desde su concepto y epidemiología hasta los estudios que propiciaron el auge del tratamiento quirúrgico en los años noventa. Se revisan, además, aquellas herramientas disponibles para una mejor selección de los casos con potencial mayor beneficio quirúrgico, la presencia de lesiones cerebrales silentes, la gravedad de la estenosis, su progresión, las características de la placa, los estudios de colateralidad y vasorreactividad, la detección de microembolias, la presencia de factores de riesgo independientemente asociados a la conversión sintomática de la estenosis, y otros elementos de reciente descripción clínica o experimental. Finalmente, el artículo expone el estado actual de la técnica quirúrgica y los avances del tratamiento farmacológico. Esta revisión no pretende desempeñarel papel de una guía de práctica clínica, sino ofrecer una panorámica integradora global sobre el manejo de la estenosis carotídea asintomática de alto grado (AU)


Summary. Asymptomatic carotid stenosis is a relatively frequent pathology, although when considering the possibility ofmanaging it surgically, there is still an important amount of disagreement concerning the criteria to be taken into account.This study conducts a broad examination of the condition, from its concept and epidemiology to the studies that triggered the boom in its surgical treatment during the nineties. The research also reviews the tools available for a better selection of cases that could potentially benefit most from surgery, the presence of silent brain lesions, the severity of the stenosis, its progression, the characteristics of the plaque, colaterality and vasoreactivity studies, the detection of micro-emboli, the presence of risk factors independently associated to the symptomatic conversion of the stenosis, and other elements that have recently been reported either clinically or experimentally. Finally, the article outlines the current state of the surgical technique andthe advances being made in its pharmacological treatment. This review is not intended to be a set of clinical practice guidelines, but to offer a global integrating overview of the management of high-grade asymptomatic carotid stenosis (AU)


Assuntos
Humanos , Estenose das Carótidas/diagnóstico , Endarterectomia das Carótidas , Estenose das Carótidas/cirurgia , Fatores de Risco , Placa Aterosclerótica/complicações , Ultrassonografia Doppler Transcraniana
6.
Rev. neurol. (Ed. impr.) ; 53(11): 649-656, 1 dic., 2011. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-92131

RESUMO

Introducción. Los trastornos psicógenos son frecuentes en la práctica neurológica, y, en ocasiones, obligan a hospitalizar al paciente para descartar una patología orgánica potencialmente grave. Objetivo. Conocer el perfil de los pacientes con diagnóstico al alta de trastorno psicógeno que ingresan en la planta de neurología de un hospital español. Pacientes y métodos. Se revisaron los informes de alta de neurología de los últimos 10 años, se seleccionaron los pacientes que tenían un diagnóstico de ‘no organicidad’ y se recogieron hasta un total de 28 variables demográficas, epidemiológicas y clínicas. Resultados. Sesenta y cuatro pacientes (el 1% de los hospitalizados) tenían diagnóstico de psicogenicidad, con una edad media de 40 años. La proporción de sexos era de 1 a 1, y la estancia media, de 10 días. Los síntomas mixtos eran los más habituales (50%), seguidos de los motores aislados (22%). Los posibles diagnósticos neurológicos de ictus isquémico y enfermedad desmielinizante fueron la mayoría de los casos. Sólo se consultó un 25% a psiquiatría durante el ingreso. En un 11% de los casos hubo historia posterior de intento de autolisis y en ocho casos (12,5%) se llegó a un diagnóstico ambulatorio de organicidad gracias al seguimiento evolutivo (‘error’ en el diagnóstico provisional al alta). Conclusión. Este trabajo dibuja por vez primera en nuestro medio el perfil del paciente psicógeno que ingresa en la planta de neurología, y examina su manejo hospitalario y su seguimiento ambulatorio. Se recuerda la necesidad de no menospreciaresta patología y de generar una vía ordenada para su manejo, siempre multidisciplinar y con el protagonismo del neurólogo y el psiquiatra


Introduction. Psychogenic disorders are frequently seen in neurological practice and sometimes make it necessary to hospitalise the patient in order to rule out a potentially severe organic pathology. Aim. To determine the profile of patients with a discharge diagnosis of psychogenic disorder that are admitted to the neurology unit of a Spanish hospital. Patients and methods. The neurology unit discharge abstracts from the last 10 years were reviewed and the patients who were diagnosed with ‘non-organicity’ were selected; a total of 28 demographic, epidemiological and clinical variables were also collected. Results. A total of 64 patients (1% of those admitted to hospital), with a mean age of 40 years, had a diagnosis of psychogenicity. The proportion between sexes was one to one and the mean length of stay in hospital was 10 days. Mixed symptoms were the most usual (50%), followed by isolated motor symptoms (22%). Most cases consisted of possible neurological diagnoses of ischaemic stroke and demyelinating disease. Only 25% of cases consulted psychiatry during hospitalisation. In 11% of cases there was a later history of suicide attempts and in eight cases (12.5%) an ambulatory diagnosis of organicity was reached thanks to the developmental follow-up (‘error’ in the provisional diagnosis on discharge). Conclusions. This study traces, for the first time in our setting, the profile of the psychogenic patient who is admitted to the neurology unit and examines their hospital management and their outpatient follow-up. We highlight the need not to underestimate this pathological condition and to generate an ordered way of managing it, which should always be multidisciplinary with the leading roles played by the neurologist and the psychiatrist


Assuntos
Humanos , Transtornos Psicóticos/epidemiologia , Hospitalização/estatística & dados numéricos , Atenção Terciária à Saúde , Transtorno Conversivo/epidemiologia , Transtornos Somatoformes/epidemiologia , Histeria/epidemiologia
7.
Rev. neurol. (Ed. impr.) ; 53(4): 193-200, 16 ago., 2011. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-91822

RESUMO

Introducción. El infarto talámico paramediano bilateral sincrónico, asimilado habitualmente al infarto de la arteria de Percheron, se considera infrecuente y de difícil diagnóstico clínico, basándose su caracterización en la descripción original y en pequeñas series. Objetivo. Caracterizar el infarto talámico paramediano bilateral sincrónico clínicamente mediante aglutinación de casos e identificar las claves de su dificultad diagnóstica precoz. Pacientes y métodos. Seis casos de nuestro centro, y 115 mediante búsqueda sistemática y lectura crítica de artículos, cumplieron los criterios de infarto talámico paramediano bilateral sincrónico. Se analizaron las variables edad, género, factores de riesgo vascular, etiología, alteración y fluctuaciones del nivel de consciencia, necesidad de intubación, trastorno cognitivo-conductual, alteraciones pupilares, otra focalidad neurológica y afectación del troncoencéfalo en neuroimagen. Resultados. En nuestra serie, destacan el trastorno del nivel de consciencia (n = 5), sus fluctuaciones (n = 3) y la demora diagnóstica (siete días, con resonancia magnética en cuatro pacientes). Sólo en uno se objetivó lesión bitalámica en la tomografía computarizada inicial. El análisis conjunto determinó edad media de 61 años; predominio masculino (58%); presencia de factores de riesgo vascular en el 77%; etiología dominante, la cardioembólica (el 34% entre los especificados); afectación del sensorio en el 75% (intubación en el 7% y fluctuaciones en el 16,5%), cognitivo-conductual en el 43%, oculomotora en el 73%, pupilar en el 31%, y de otro tipo en el 67%; y lesión del tronco especificada en el 37%. Conclusiones. El infarto talámico paramediano bilateral sincrónico constituye un síndrome de presentación variable, con una tomografía computarizada inicial de baja sensibilidad, y que precisa una resonancia magnética cerebral para su tipificación. Ello explica la dificultad diagnóstica y la probable infraestimación de su frecuencia (AU)


Introduction. Synchronous bilateral paramedian thalamic stroke (SBPTS), usually equated to Percheron artery infarction, is considered to be uncommon and difficult to diagnose clinically. Its characterization is based on the original description plus a few small series. Aim. To characterize SBPTS clinically by collecting cases and identifying the key difficulties for an early diagnosis. Patients and methods. Six cases at our centre plus another 115 located by systematic literature search and critical reading of articles fulfilled the criteria for SBPTS. An analysis was made of the variables age, gender, vascular risk factors, aetiology, alterations and fluctuations of consciousness, need for intubation, cognitive-behavioural disorders, pupillary changes, other neurological focal disorders and brainstem involvement on imaging studies. Results. Of note in our series were disorders of consciousness (n = 5), their fluctuations (n = 3) and the diagnostic delay (seven days, with MRI in four patients). In only one case was a bilateral thalamic lesion seen on the initial CT. Joint analysis of all the cases showed a mean age of 61 years, a predominance of men (58%), the presence of vascular risk factors in 77%, a mainly cardioembolic aetiology (34% among those that were specified), sensory involvement in 75% (intubation in 7% and fluctuations in 16.5%), cognitive-behavioural disorders in 43%, oculomotor in 73%, pupillary in 31%, other in 67% and specified brainstem lesion in 37%. Conclusions. The SBPTS syndrome has a variable presentation with a low sensitivity on the initial CT, requiring brain MRI for typification. This explains the diagnostic difficulty and the fact that its frequency is probably underestimated (AU)


Assuntos
Humanos , Doenças Talâmicas/diagnóstico , Infarto da Artéria Cerebral Média/diagnóstico , Diagnóstico Diferencial , Núcleos Intralaminares do Tálamo/fisiopatologia , Tomografia Computadorizada por Raios X
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