Presencia de puntos gatillo miofasciales en pacientes con ictus isquémico agudo: estudio piloto descriptivo transversal / Presence of myofascial trigger points in patients with acute ischaemic stroke: A cross-sectional descriptive pilot study

Objetivos: Determinar la presencia de PGM activos y latentes en 4 músculos de hombro y 4 de cadera de las extremidades paréticas y no paréticas, en pacientes con ictus isquémico agudo, y analizar si existe relación con el grado de fuerza de las propias extremidades paréticas. Participantes y métodos: Se seleccionó a 22 pacientes con ictus isquémico de menos de 5 días de evolución, ingresados en la Unidad de Ictus de un centro hospitalario, que cursaron con una gravedad neurológica leve o moderada (escala National Institute of Health Stroke Scale 3-15) y paresia braquial o crural, y que, previamente al ingreso, presentaban autonomía funcional o incapacidad leve o muy leve (escala Rankin modificada 0-2). Se registraron los PGM en 4 músculos de fácil acceso palpatorio de cada hombro y 4 de cada cadera, siguiendo los criterios diagnósticos de Simons, Travell & Simons. Resultados: Todos los pacientes mostraron PGM latentes en hombro y cadera paréticos, siendo más frecuentes en el infraespinoso (94,4%) y en el glúteo mayor (78,9%). El grado de fuerza de las extremidades paréticas se correlacionó con la presencia de PGM latentes en áreas concretas de ambos músculos. Conclusiones: Los resultados orientan hacia una elevada presencia de PGM, predominantemente latentes, en hombro y cadera de las extremidades paréticas secundarias al ictus isquémico agudo. A su vez, apuntan a la posible correlación entre la propia presencia de PGM latentes y el grado de fuerza de las mismas extremidades paréticas. Sin embargo, son necesarios estudios de mayor tamaño muestral que permitan corroborar lo hallado en el presente estudio piloto

Objectives: To determine the presence of active and latent MTrPs in 4 shoulder muscles and 4 hip muscles of the paretic and non-paretic limbs, in patients with acute ischaemic stroke, and to analyse if there is a relationship with the degree of strength of the paretic extremities. Patients and methods: 22 patients with ischaemic stroke of less than 5 days' evolution were selected, admitted to the Stroke Unit of a hospital centre with mild or moderate neurological severity (National Institute of Health Stroke Scale 3-15), brachial and / or leg paresis, and that prior to admission presented functional autonomy or mild or very mild disability (modified Rankin scale 0-2). The MTrPs were recorded in 4 muscles of easy palpable access of each shoulder and 4 of each hip, following the diagnostic criteria of Simons, Travell & Simons. Results: All the patients showed latent MTrPs in the shoulder and hip pads, being more frequent in the infraspinatus (94.4%) and in the gluteus maximus (78.9%). The degree of strength of the paretic limbs correlated with the presence of latent PGMs in specific areas of both muscles. Conclusions: The results point towards a high presence of MTrPs, predominantly latent, in the shoulder and hip of the paretic limbs secondary to acute ischaemic stroke. In turn, they suggest a possible correlation between the presence of latent MTrPs and the degree of strength of the same paretic limbs. However, studies of larger sample size are needed to corroborate what was found in this pilot study

Clinical Outcome of Ischemic Stroke in Old Patients Versus Oldest-Old.

BACKGROUND: It is unclear whether very old patients benefit from stroke unit. The aim of our work was to compare the clinical outcome of patients with ischemic stroke aged either 70 or 80 (G 1) versus oldest-old greater than or equal to 81 years (G 2). METHODS: Of 1187 patients admitted with stroke during 5 years in our stroke unit, we included 252 patients with independent functional status (modified Rankin scale, [mRS] ≤ 2) before the stroke. All patients underwent clinical examination, blood test, electrocardiography, brain imaging, and cerebrovascular ultrasound. Clinical outcome was assessed with the mRS and National Institutes of Health Stroke Scale (NIHSS) at discharge. We considered favorable outcome mRS 0-2 at discharge. RESULTS: Of 252 patients included, 55% were male, 150 (59.5%) patients belonged to G1 and 102 (40.5%) G2. We detected a significant increase of atrial fibrillation, bronchoaspiration, mortality, higher NIHSS at admission, and worse functional status at discharge in G2. No significant differences in other demographic, vascular risk factors, hospital stay, NIHSS at discharge or subtype of stroke were found. NIHSS at discharge was the only independent predictor of good functional status (odds ratio 0.4; 95% confidence interval, 0.3-0.6; P < .001). CONCLUSIONS: Oldest-old patients showed similar NIHSS at discharge than younger patients despite having higher neurological severity at admission. Our results support the hypothesis that oldest-old patients have good recovery potential, and should not be excluded from the stroke unit. The worse functional status detected at discharge in these patients could be attributed to others factors and not to neurological severity.

Predictors of occult cancer in acute ischemic stroke patients.

BACKGROUND: We investigated the prevalence of occult malignancy (OM) in acute ischemic stroke patients to evaluate if any biological marker could help to detect the presence of OM. METHODS: We retrospectively reviewed all ischemic stroke patients during 48 months. We did not perform any screening for OM. Demographic data, vascular risk factors, routine blood chemistry with fibrinogen and C-reactive protein (CRP), National Institutes of Health Stroke Scale (NIHSS), and etiological subtype of stroke according to Trial of Org 10172 in Acute Stroke Treatment criteria were analyzed. The patients were divided into 2 groups (Non-OM versus OM). RESULTS: We analyzed 631 patients with acute ischemic stroke. The mean age was 69.7 ± 12.7 years, and 59% were men. The distribution of vascular risk factors, etiological subgroups, and NIHSS was comparable between both groups. We detected 13 cases (2.1%) with OM, and this percentage was higher in patients with stroke of undetermined etiology (5.3%). We detected significant higher levels of fibrinogen and CRP in patients with stroke of undetermined cause with OM. Receiver operating characteristic curves showed a sensitivity of 75% and specificity of 96% for levels of CRP more than 20 mg/L, and a sensitivity of 67% and specificity of 91% for fibrinogen levels greater than 600 mg/dL. CONCLUSIONS: OM was present in 2.1 % of overall patients, and 5.3% of patients with stroke of undetermined cause. Baseline levels of fibrinogen more than 600 mg/dL or CRP greater than 20 mg/L in patients with undetermined stroke might be good predictors of OM.

Consumo de bebidas energizantes con alcohol, una mezcla arriesgada / Consumption of energy drinks with alcohol, hazardous mixture

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