Leonardo González

Differences in Stroke Subtypes Among Natives and Caucasians in Boston and Buenos Aires

Background and Purpose Several issues regarding ethnic-cultural factors, sex-related variation, and risk factors for stroke have been described in the literature. However, there have been no prospective studies comparing ethnic differences and stroke subtypes between populations from South America and North America. It has been suggested that natives from Buenos Aires, Argentina, may have higher frequency of hemorrhagic strokes and penetrating artery disease than North American subjects. The aim of this study was to validate this hypothesis. Methods We studied the database of all consecutive acute stroke patients admitted to the Ramos Mejia Hospital (RMH) in Buenos Aires and to the Beth Israel Deaconess Medical Center (BIMC) in Boston, Massachusetts, from July 1997 to March 1999. Stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. All information on patients (demographic, clinical, and radiographic) was recorded prospective to the assessment of the stroke subtype. Results Three hundred sixty-one and 479 stroke patients were included at RMH and BIMC stroke data banks, respectively. Coronary artery disease was significantly more frequent in BIMC (P <0.001), whereas tobacco and alcohol intake were significantly more frequent in RMH (P <0.001). Intracerebral hemorrhage (P <0.001) and penetrating artery disease (P <0.001) were significantly more frequent in the RMH registry, whereas large-artery disease (P <0.02) and cardioembolism (P <0.001) were more common in the BIMC data bank. Conclusions Penetrating artery disease and intracerebral hemorrhage were the most frequent stroke subtypes in natives from Buenos Aires. Lacunar strokes and intracerebral hemorrhage were more frequent among Caucasians from Buenos Aires than Caucasians from Boston. Poor risk factor control and dietary habits could explain these differences.

Pupillary diameter assessment: Need for a graded scale

Assessment of pupillary diameter is useful for lesion location, a necessary step in diagnosing neurologic disorders.1,2 Recognition of pupillary changes can serve as an early warning of acute brain injury, and may, with prompt treatment, prevent further injury. However, not all pupillary changes are relevant, because size changes in various physiologic or pharmacologic conditions.1 A few studies have evaluated the reliability of nurses to assess pupils,3,4 but none evaluated the reliability of physicians. Because, in practice, physicians usually use their own impression to assess pupillary diameter, we questioned if such a practice is justified. In this study, the inter- and intrarater reliability of physicians assessing pupillary diameters using their own judgment or a graded scale was evaluated. Four third- and fourth-year neurology residents consecutively evaluated the pupil size of 100 subjects (60% men; median age, 41.5 years) in randomized order. Subjects gave informed consent. Raters assessed pupil diameter twice with a 20-minute difference between …

Atención del stroke agudo en una unidad de stroke y una sala general

Resumen Introduccion el stroke es una de las principales causas de discapacidad y muerte. Las Unidades de Stroke (US) mejoraron el tratamiento de la enfermedad cerebrovascular. Objetivo comparar la atencion del stroke agudo en una sala de Neurologia general (SNe) y en una US. Pacientes y metodo retrospectivamente se reviso la atencion de pacientes con stroke agudo en la SNe en el periodo comprendido entre agosto de 1997 a agosto de 1998 (previo a la apertura de US) y la atencion en la US en el lapso de tiempo desde agosto de 2004 a agosto de 2005. Se evaluaron los tiempos en llegar al hospital, en pasar a la sala apropiada y el tiempo de internamiento en el hospital. Resultados hubo 164 pacientes; 69 (42,09%) en la SNe y 95 (57,93%) en US. El 86,32% de los casos en US fueron stroke isquemico, en SNe fueron el 72,46%. El tiempo en llegar al hospital fue similar para ambas salas. El lapso en ingresar en la sala especializada fue de 4 horas 19 minutos en US y de 3 dias 43 minutos en Neurologia (p= 0,003). El tiempo medio de estancia hospitalaria fue 7 dias 16 horas en US y 23 dias 13 horas en la sala de Neurologia general (p= 0,001). Conclusiones en la US con un equipo multidisciplinario hubo un menor tiempo de internamiento que en la SNe. La presencia de un medico neurologo entrenado en patologia cerebrovascular, junto con una US, acelero el ingreso en una sala especializada. No hubo diferencias en las complicaciones ni en la mortalidad.

Cataleptic postures in thalamic hemorrhage: case report

We report a case of catalepsy associated with thalamic hemorrhage. A 72 year-old hypertensive woman had acute onset of right-sided weakness and speech disturbances. She was on anticoagulants because of aortic valve replacement. When postures were imposed, the patient maintained the left upper limb raised for several minutes, even in uncomfortable or bizarre positions. A CT scan of the head revealed a left thalamic hemorrhage. Cataleptic postures have been reported in few cases with acute stroke.