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Lacunar infarction (LI) in the hospital de clínicas stroke unit, Montevideo Uruguay
Abstracts / Journal of the Neurological Sciences 357 (2015) e363–e423
Cardiovascular Universitario Hospital de Clínicas Facultad de Medicina UdelaR Montevideo Uruguay, Montevideo, Uruguay Background: Although intravenous thrombolysis is the most effective treatment for Cerebral Infarction (CI) it is under used in Uruguay Objective: To report the largest registry of intravenous thrombolysis for CI in Uruguay. Material and Method: Descriptive retroprospective design. Population: Patients with thrombolyzed CI in the Stroke Unit (SU) of Clinicas Hospital, Montevideo from 1/7/2010 to 1/8/2014. Results: 53 patients thrombolyzed. Average age: 66; Oxford Classification: TACI 34%, PACI 32%, LACI 26%, POCI 8%; NIHSS at admission and discharge: 11 (3-24) and 3 (0-20). Etiology (TOAST): Cardioembolism 38%, Large Vessel Atherosclerosis 19%, Undetermined-negative evaluation 13%, Undetermined- incomplete evaluation 13%, Small vessel disease 11%. Symptom onset-to Needle and Door-to-Needle average time: 170 and 79 minutes respectively. Average stay in SU: 5 days. Complications: No complications: 70%, Asymptomatic intracranial hemorrhage (ICH): 13%, Symptomatic ICH: 11%, Systemic bleeding: 2%. Hospital mortality: 18.9% (80% Total MCA infarction, NIHSS average: 17). Causes of Death: Complications related to thrombolysis: 3 (Symptomatic ICH); Not related: Aspirative Pneumonia: 3, Sepsis: 3, Not reperfused total MCA infarction: 1. Incorporating SU neurology guard in the final seven months of the study quadrupled the average monthly thrombolysis and significantly decreased the door to needle time and complications (symptomatic ICH 3.3% vs 11%). At 6 months: 72% no or minor disabilities by Rankin 0-1; and 70% Barthel N 95. Survival at 36 months: 70%. Conclusions: Most patients with good outcome.Complications and times comparable to international data. Mortality mainly unrelated to treatment. The results were markedly better with the implementation of SU neurology guard. doi:10.1016/j.jns.2015.08.1343
1284 WFN15-0262 Stroke Stroke care organization in public health of Montevideo, Uruguay A. Gaye Saavedra, C. Camejo, R. Salamano, F. Brunet, S. Albisu. Instituto de Neurología Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay Background: The organization of stroke care is essential to achieve the best clinical outcome and cost-effective measures. Objective: To describe the process of organization in stroke care in the public health of Montevideo and to report results from the first year of operation. Materials and methods: Prospective description of the first year performance of this system in Montevideo from 10/03/2014 to 09/03/2015. Results: In accordance with the Ministry of Public Health and Medical School of Public University, public health of Montevideo was geographically divided into two Stroke Centers (250.000 users each). Educational courses to the population and prehospital care services were performed. A guard of neurology 7 x 24 h with Stroke Unit (SU) was established in one of the centers (Hospital de Clínicas {HC}). In the period, 172 patients were admitted to the HC, 97 in its SU. The number of patients in the SU was doubled compared to the previous year. SU patients mortality was 4 times lower compared to general ward (5.2 and 22,6%). The average hospital stay was reduced by 4 days. Admission to intensive care unit was reduced from 13.3 to 3.10%. Intravenous thrombolysis rate increased by 310% compared to previous year, with symptomatic intracranial hemorrhage rate of 3.2%.
e377
Conclusions: With this organization model, there was an increase in the number of patients benefiting from attention in SU and intravenous thrombolysis. There was an improvement in patients outcomes and cost indicators, such as admission to intensive care unit and length of in hospital stay decreased. doi:10.1016/j.jns.2015.08.1344
1285 WFN15-0790 Stroke Lacunar infarction (LI) in the hospital de clínicas stroke unit, Montevideo Uruguay F. Brunet, A. Gaye Saavedra, J. Gil, C. Camejo, S. Albisu, R. Salamano. Instituto de Neurología Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay Background and Objective: LI is a frequent type of stroke. We report and analyze a serie of patients with this disease. Population and methods: Descriptive and retrospective study. Patients: LI defined by Oxford clinical classification and Computed Tomography (CT). Place: Hospital de Clinicas, Montevideo from 1/7/ 2007 to 1/8/2014. Results: 198 patients analyzed. Prevalence of LI in all types of stroke: 20%. LACI Oxford classification showed a positive predictive value (PPV) for LI in CT of 87%. Median age: 66 yo, male 47%. NIHSS at admission and discharge respectively: 4 (0-18) and 2 (0-13). Higher NIHSS was associated with higher systolic blood pressure (SBP) or DBP (p = 0.016). Type of lacunar syndrome: Pure motor: 55%; Sensorimotor 31%; Ataxic hemiparesis: 3%; Pure sensitive: 2%, Dysarthria/clumsy hand: 1,5%, Others: 7,5%. Etiology: Small vessel disease (SVD) alone: 65%; Association with: ipsilateral carotid atherosclerotic plaque N70%: 11% and High risk cardioembolic source: 13,5%. CT localization: Internal Capsule (IC) rear limb: 23%, Lenticular: 13%, Deep cerebral white matter: 10%, Thalamus:8%, Caudate nucleus: 3.5%, IC anterior limb: 3%, IC knee: 3%, Pons: 2.5%, Cerebellum: Associated asymptomatic SVD: 39%. No hospital stay complications: 83%; Dysphagia: 21%. Aspirative pneumonia 8.6%. Hospital mortality: 2,5%. Conclusions: Prevalence, clinical presentation and topography was similar to previous reports. Oxford classification was a good predictor of LI in CT. Elevated blood pressure levels were associated with greater clinical severity. SVD alone was the most prevalent etiology but there was an important degree of association with large vessel atheromatosis and cardioembolic source. doi:10.1016/j.jns.2015.08.1345
1286 WFN15-1255 Stroke Report of 4 cases of acute basilar thrombosis treated with IV rTPA in hospital de clínicas stroke unit, Uruguay F. Preve Cocco, M. Legnani, J. Higgie, F. Brunet, S. Albisu, A. Gaye Saavedra. Instituto de Neurología Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay Background: Stroke is the second cause of death and first cause of disability in Uruguay. Acute basilar thrombosis is one of the most
Cardiovascular Universitario Hospital de Clínicas Facultad de Medicina UdelaR Montevideo Uruguay, Montevideo, Uruguay Background: Although intravenous thrombolysis is the most effective treatment for Cerebral Infarction (CI) it is under used in Uruguay Objective: To report the largest registry of intravenous thrombolysis for CI in Uruguay. Material and Method: Descriptive retroprospective design. Population: Patients with thrombolyzed CI in the Stroke Unit (SU) of Clinicas Hospital, Montevideo from 1/7/2010 to 1/8/2014. Results: 53 patients thrombolyzed. Average age: 66; Oxford Classification: TACI 34%, PACI 32%, LACI 26%, POCI 8%; NIHSS at admission and discharge: 11 (3-24) and 3 (0-20). Etiology (TOAST): Cardioembolism 38%, Large Vessel Atherosclerosis 19%, Undetermined-negative evaluation 13%, Undetermined- incomplete evaluation 13%, Small vessel disease 11%. Symptom onset-to Needle and Door-to-Needle average time: 170 and 79 minutes respectively. Average stay in SU: 5 days. Complications: No complications: 70%, Asymptomatic intracranial hemorrhage (ICH): 13%, Symptomatic ICH: 11%, Systemic bleeding: 2%. Hospital mortality: 18.9% (80% Total MCA infarction, NIHSS average: 17). Causes of Death: Complications related to thrombolysis: 3 (Symptomatic ICH); Not related: Aspirative Pneumonia: 3, Sepsis: 3, Not reperfused total MCA infarction: 1. Incorporating SU neurology guard in the final seven months of the study quadrupled the average monthly thrombolysis and significantly decreased the door to needle time and complications (symptomatic ICH 3.3% vs 11%). At 6 months: 72% no or minor disabilities by Rankin 0-1; and 70% Barthel N 95. Survival at 36 months: 70%. Conclusions: Most patients with good outcome.Complications and times comparable to international data. Mortality mainly unrelated to treatment. The results were markedly better with the implementation of SU neurology guard. doi:10.1016/j.jns.2015.08.1343
1284 WFN15-0262 Stroke Stroke care organization in public health of Montevideo, Uruguay A. Gaye Saavedra, C. Camejo, R. Salamano, F. Brunet, S. Albisu. Instituto de Neurología Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay Background: The organization of stroke care is essential to achieve the best clinical outcome and cost-effective measures. Objective: To describe the process of organization in stroke care in the public health of Montevideo and to report results from the first year of operation. Materials and methods: Prospective description of the first year performance of this system in Montevideo from 10/03/2014 to 09/03/2015. Results: In accordance with the Ministry of Public Health and Medical School of Public University, public health of Montevideo was geographically divided into two Stroke Centers (250.000 users each). Educational courses to the population and prehospital care services were performed. A guard of neurology 7 x 24 h with Stroke Unit (SU) was established in one of the centers (Hospital de Clínicas {HC}). In the period, 172 patients were admitted to the HC, 97 in its SU. The number of patients in the SU was doubled compared to the previous year. SU patients mortality was 4 times lower compared to general ward (5.2 and 22,6%). The average hospital stay was reduced by 4 days. Admission to intensive care unit was reduced from 13.3 to 3.10%. Intravenous thrombolysis rate increased by 310% compared to previous year, with symptomatic intracranial hemorrhage rate of 3.2%.
e377
Conclusions: With this organization model, there was an increase in the number of patients benefiting from attention in SU and intravenous thrombolysis. There was an improvement in patients outcomes and cost indicators, such as admission to intensive care unit and length of in hospital stay decreased. doi:10.1016/j.jns.2015.08.1344
1285 WFN15-0790 Stroke Lacunar infarction (LI) in the hospital de clínicas stroke unit, Montevideo Uruguay F. Brunet, A. Gaye Saavedra, J. Gil, C. Camejo, S. Albisu, R. Salamano. Instituto de Neurología Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay Background and Objective: LI is a frequent type of stroke. We report and analyze a serie of patients with this disease. Population and methods: Descriptive and retrospective study. Patients: LI defined by Oxford clinical classification and Computed Tomography (CT). Place: Hospital de Clinicas, Montevideo from 1/7/ 2007 to 1/8/2014. Results: 198 patients analyzed. Prevalence of LI in all types of stroke: 20%. LACI Oxford classification showed a positive predictive value (PPV) for LI in CT of 87%. Median age: 66 yo, male 47%. NIHSS at admission and discharge respectively: 4 (0-18) and 2 (0-13). Higher NIHSS was associated with higher systolic blood pressure (SBP) or DBP (p = 0.016). Type of lacunar syndrome: Pure motor: 55%; Sensorimotor 31%; Ataxic hemiparesis: 3%; Pure sensitive: 2%, Dysarthria/clumsy hand: 1,5%, Others: 7,5%. Etiology: Small vessel disease (SVD) alone: 65%; Association with: ipsilateral carotid atherosclerotic plaque N70%: 11% and High risk cardioembolic source: 13,5%. CT localization: Internal Capsule (IC) rear limb: 23%, Lenticular: 13%, Deep cerebral white matter: 10%, Thalamus:8%, Caudate nucleus: 3.5%, IC anterior limb: 3%, IC knee: 3%, Pons: 2.5%, Cerebellum: Associated asymptomatic SVD: 39%. No hospital stay complications: 83%; Dysphagia: 21%. Aspirative pneumonia 8.6%. Hospital mortality: 2,5%. Conclusions: Prevalence, clinical presentation and topography was similar to previous reports. Oxford classification was a good predictor of LI in CT. Elevated blood pressure levels were associated with greater clinical severity. SVD alone was the most prevalent etiology but there was an important degree of association with large vessel atheromatosis and cardioembolic source. doi:10.1016/j.jns.2015.08.1345
1286 WFN15-1255 Stroke Report of 4 cases of acute basilar thrombosis treated with IV rTPA in hospital de clínicas stroke unit, Uruguay F. Preve Cocco, M. Legnani, J. Higgie, F. Brunet, S. Albisu, A. Gaye Saavedra. Instituto de Neurología Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay Background: Stroke is the second cause of death and first cause of disability in Uruguay. Acute basilar thrombosis is one of the most