Stroke in rural Ecuador: a three-phase, door-to-door survey.

The authors carried out a three-phase door-to-door survey in Atahualpa, Ecuador to assess epidemiologic and pathogenetic mechanisms of stroke. They found 10 stroke patients among 1,568 individuals aged > or =15 years (crude prevalence, 638 per 100,000). There was only one incident case (incidence, 64 per 100,000). Six of the 10 patients had hypertensive arteriolopathy (five with ischemic and one with hemorrhagic stroke). Additional work is needed to increase knowledge on stroke in developing countries.

[Validation of a screening questionnaire for stroke detection in Spanish-speaking communities]. / Validación de un cuestionario para detección de ictus en poblaciones hispanoparlantes.

OBJECTIVE: To evaluate the accuracy of an screening questionnaire for stroke detection in speaking-speaking communities. PATIENTS AND METHODS: We performed a door-to-door survey in Atahualpa (a rural community in coastal Ecuador) using a modified version of the Spanish translation of the OMS questionnaire for stroke detection. Subjects suspected of having a stroke as well as a 2% sample of negative subjects were evaluated by neurologists to evaluate sensitivity, specificity, and predictive value of the questionnaire and that of each of its questions. RESULTS: We found 18 possible cases among 1,568 individuals around 15 years old. Of these, 10 were confirmed stroke patients and 8 were false-positive (crude stroke prevalence of 6.38 per 1,000). We did not find false-negative cases. Sensitivity of the questionnaire was 100%, specificity was 99.5%, positive predictive value was 0.55 and negative predictive value was 1. The accuracy of each question as well as the number of questions answered as affirmative were different between patients and false-positive cases. CONCLUSIONS: The current questionnaire is highly sensitive but its positive predictive value is poor. This causes problems in large-scale studies, as the detection of many false-positives may compromise its viability. We propose a modification of the questionnaire that will turn it more accurate.

Validación de un cuestionario para la detección del ictus en poblaciones hispanoparlantes / Validation of a screening questionnaire for stroke detection in Spanish-speaking communities

Objetivo. Evaluar la fiabilidad de un cuestionario para la detección del ictus en comunidades hispanoparlantes. Pacientes y métodos. Realizamos un estudio puerta a puerta en Atahualpa -población rural del litoral ecuatoriano- empleando una versión modificada de la traducción al español del cuestionario de la OMS para la detección del ictus. Los casos sospechosos, así como el 2 por ciento de los no sospechosos, fueron examinados examinados por neurólogos para valorar la sensibilidad, la especificidad y el valor predictivo del cuestionario y de cada una de sus preguntas. Resultados. Encontramos 18 sospechosos entre 1.568 individuos de más de 15 años de edad. De éstos, 10 se confirmaron -prevalencia realista de ictus de 6,38 por 1.000- y ocho fueron falsos positivos. No se encontraron falsos negativos entre los no sospechosos. La sensibilidad del cuestionario fue del 100 por ciento, su especificidad, del 99,5 por ciento, su valor predictivo positivo fue 0,55 y su valor predictivo negativo, 1.La confiabilidad de cada pregunta, así como el número de preguntas respondidas afirmativamente, fue diferente entre los pacientes y los falsos positivos. Conclusiones. El cuestionario utilizado es altamente sensible, pero su valor predictivo positivo es relativamente bajo. Esto causa problemas en estudios a gran escala, ya que la detección de muchos falsos positivos puede afectar su viabilidad. Sugerimos una modificación, que volverá al cuestionario más confiable (AU)

Objective. To evaluate the accuracy of an screening questionnaire for stroke detection in speaking-speaking communities. Patients and methods. We performed a door-to-door survey in Atahualpa (a rural community in coastal Ecuador) using a modified version of the Spanish translation of the WHO questionnaire for stroke detection. Subjects suspected of having a stroke as well as a 2% sample of negative subjects were evaluated by neurologists to evaluate sensitivity, specificity, and predictive value of the questionnaire and that of each of its questions. Results. We found 18 possible cases among 1,568 individuals ≥ 15 years old. Of these, 10 were confirmed stroke patients and 8 were false-positive (crude stroke prevalence of 6.38 per 1,000). We did not find false-negative cases. Sensitivity of the questionnaire was 100%, specificity was 99.5%, positive predictive value was 0.55 and negative predictive value was 1. The accuracy of each question as well as the number of questions answered as affirmative were different between patients and false-positive cases. Conclusions. The current questionnaire is highly sensitive but its positive predictive value is poor. This causes problems in large-scale studies, as the detection of many false-positives may compromise its viability. We propose a modification of the questionnaire that will turn it more accurate (AU)

Albendazole therapy for giant subarachnoid cysticerci.

Albendazole is considered to be the drug of choice for treatment of parenchymal brain cysticercosis. Its efficacy, however, for treatment of subarachnoid cysticerci has not been established, to our knowledge. In this study, we treated four patients who had giant subarachnoid cysticerci with albendazole at daily doses of 15 mg/kg of body weight for 8 days. Computed tomographic studies showed that all cysts disappeared 3 months after the end of treatment. This was associated with marked clinical improvement in every case. Our results indicated that albendazole is highly effective for treatment of this form of the disease.

Bilateral internuclear ophthalmoplegia after smoking "crack" cocaine.

A previously healthy 35-year-old man developed sudden diplopia after smoking "crack" cocaine. Neuroophthalmologic examination revealed findings consistent with a tegmental mesencephalic lesion which correlated closely with the computed tomographic documentation of a small midbrain hemorrhage. Cocaine abuse is a recognized cause of intracranial hemorrhage. In most patients, however, the bleeding is localized in the subarachnoid space or the subcortical white matter. To our knowledge, this is the first case of isolated midbrain hemorrhage secondary to cocaine abuse.

[Intracerebral hematoma: clinical and prognostic correlations (author's transl)]. / Hematoma intracerebral: correlaciones clínicas y pronósticas.

Forty-eight patients with intracranial hematomas are reviewed. In all cases diagnosis was established by CT scan. Volume was calculated with the Steiner method. Treatment was supportive for all patients. Mortality rate was 33%. Arterial hypertension was an associated factor in 58.33%. Clinical evolution was influenced by age of patient, volume and site of the hematoma. Mortality rate was highest in the cases with thalamic hematomas. Early coma or hemiplegia also carried a poor prognosis.