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Fuentes B, Alonso de Leciñana M, Rigual R, García-Madrona S, Díaz-Otero F, Aguirre C, Calleja P, Egido-Herrero JA, Carneado-Ruiz J, Ruiz-Ares G, Rodríguez-Pardo J, Rodríguez-López Á, Ximénez-Carrillo Á, de Felipe A, Ostos F, González-Ortega G, Simal P, Gómez Escalonilla CI, Gómez-Porro-Sánchez P, Cabal-Paz B, Reig G, Gil-Núñez A, Masjuán J, Díez Tejedor E. Fewer COVID-19-associated strokes and reduced severity during the second COVID-19 wave: The Madrid Stroke Network. Eur J Neurol 2021; 28:4078-4089. [PMID: 34528353 PMCID: PMC8653205 DOI: 10.1111/ene.15112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 12/15/2022]
Abstract
Background and purpose The experience gained during the first COVID‐19 wave could have mitigated the negative impact on stroke care in the following waves. Our aims were to analyze the characteristics and outcomes of patients with stroke admitted during the second COVID‐19 wave and to evaluate the differences in the stroke care provision compared with the first wave. Methods This retrospective multicenter cohort study included consecutive stroke patients admitted to any of the seven hospitals with stroke units (SUs) and endovascular treatment facilities in the Madrid Health Region. The characteristics of the stroke patients with or without a COVID‐19 diagnosis were compared and the organizational changes in stroke care between the first wave (25 February to 25 April 2020) and second wave (21 July to 21 November 2020) were analyzed. Results A total of 550 and 1191 stroke patients were admitted during the first and second COVID‐19 waves, respectively, with an average daily admission rate of nine patients in both waves. During the second wave, there was a decrease in stroke severity (median National Institutes of Health Stroke Scale 5 vs. 6; p = 0.000), in‐hospital strokes (3% vs. 8.1%) and in‐hospital mortality (9.9% vs. 15.9%). Furthermore, fewer patients experienced concurrent COVID‐19 (6.8% vs. 19.1%), and they presented milder COVID‐19 and less severe strokes. Fewer hospitals reported a reduction in the number of SU beds or deployment of SU personnel to COVID‐19 dedicated wards during the second wave. Conclusions During the second COVID‐19 wave, fewer stroke patients were diagnosed with COVID‐19, and they had less stroke severity and milder COVID‐19.
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Affiliation(s)
- Blanca Fuentes
- Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain
| | | | - Ricardo Rigual
- Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain
| | | | - Fernando Díaz-Otero
- Department of Neurology and Stroke Center, University Hospital Gregorio Marañón, Madrid, Spain
| | - Clara Aguirre
- Department of Neurology and Stroke Center, University Hospital La Princesa, Madrid, Spain
| | - Patricia Calleja
- Department of Neurology, University Hospital 12 de octubre, Madrid, Spain
| | | | | | - Gerardo Ruiz-Ares
- Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain
| | - Jorge Rodríguez-Pardo
- Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain
| | - Ángela Rodríguez-López
- Department of Neurology and Stroke Center, University Hospital Gregorio Marañón, Madrid, Spain
| | | | - Alicia de Felipe
- Department of Neurology and Stroke Center, University Hospital Ramón y Cajal, Madrid, Spain
| | - Fernando Ostos
- Department of Neurology, University Hospital 12 de octubre, Madrid, Spain
| | | | - Patricia Simal
- Department of Neurology, University Hospital Clinic San Carlos, Madrid, Spain
| | | | | | - Borja Cabal-Paz
- Department of Neurology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Gemma Reig
- Department of Neurology and Stroke Center, University Hospital La Princesa, Madrid, Spain
| | - Antonio Gil-Núñez
- Department of Neurology and Stroke Center, University Hospital Gregorio Marañón, Madrid, Spain
| | - Jaime Masjuán
- Department of Neurology and Stroke Center, University Hospital Ramón y Cajal, Madrid, Spain
| | - Exuperio Díez Tejedor
- Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain
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Díaz-Guzmán J, Egido-Herrero JA, Fuentes B, Fernández-Pérez C, Gabriel-Sánchez R, Barberà G, Abilleira S. [Incidence of strokes in Spain: the Iberictus study. Data from the pilot study]. Rev Neurol 2009; 48:61-65. [PMID: 19173202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION In a population-based study of the incidence of stroke conducted on a broad denominator, it is wise first to carry out a pilot study. AIM To present the results of the pilot phase of the study on stroke incidence in Spain, entitled Iberictus. PATIENTS AND METHODS Population of the study: all cases involving the first episode of acute cerebrovascular disease (stroke or transient ischaemic attack) diagnosed among residents over 17 years of age with their habitual place of abode registered in the areas of study between 15th and 31st October 2005 (total denominator: 1,440,997 inhabitants). SOURCE OF DATA prospective, hospital records (basic minimum data set, discharge abstracts) and casualty department registers. Standardised definitions: diagnostic categorisation and pathological, topographical and aetiological classification. Inter-observer agreement analysis among researchers (kappa). RESULTS A total of 128 cases were identified. Age range, 37-103 years; mean age, 75.7 +/- 13.4 years; 54% were females. In all, 71.1% of the cases were collected by means of a basic minimum data set. There were 91 ischaemic events (29.7% atherothrombotic and 29.7% cardioembolic). Of the 15 haemorrhagic strokes, 40% due to arterial hypertension, six were lobar hemispheric, six were deep basal ganglia, and there were three cerebellar haemorrhages. The incidence of stroke was seen to increase exponentially with age. Inter-observer agreement was good for the classifications that were employed (range of kappa indices, 0.57-0.78). Several problems were detected and corrected in the fieldwork. CONCLUSIONS The Iberictus pilot study yielded data that were consistent with the literature and provided us with the opportunity to detect and correct issues that would hinder us from conducting the main study.
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Affiliation(s)
- J Díaz-Guzmán
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España.
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Díaz-Guzmán J, Egido-Herrero JA, Gabriel-Sánchez R, Barberà G, Fuentes B, Fernández-Pérez C, Abilleira S. [Incidence of strokes in Spain. Methodological foundations of the Iberictus study]. Rev Neurol 2008. [PMID: 19085876 DOI: 10.33588/rn.4712.2008576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Epidemiological data on the incidence of cerebrovascular diseases in our country are scarce. A representative population-based study with a large denominator is required. AIM To present the design of the study on stroke incidence in Spain, entitled Iberictus. SUBJECTS AND METHODS We conducted a prospective, population-based study on the incidence of strokes and transient ischemic attacks, in which it is possible to distinguish: 1) population with a steady risk, which was well defined and had a broad denominator. We included all the cases in which the first episode of acute cerebrovascular disease was diagnosed among those over the age of 17 years (with no upper age limit) with their habitual residence in the areas of study between the 1st January and 31st December 2006: Lugo, Segovia, Talavera de la Reina, Mallorca and Almeria (total denominator, 1,440,997 inhabitants; minimum denominator per area, 100,000 inhabitants); 2) source of multiple and complementary data: hospital records (minimum basic data set, discharge abstracts), emergency and primary care records for the area with diagnostic codes 430-39 and 674.0 (International Classification of Diseases-9), population-based mortality records; 3) standardised definitions: diagnostic categorisation (MONICA-World Health Organisation, 1987), pathological classification (ischaemia, haemorrhagic), topography and aetiology; 4) presentation of data in suitable age groups, by sex and overall; 5) pilot study and analysis of inter-observer agreement among researchers. CONCLUSIONS With this design, the Iberictus study satisfies the methodological criteria as an 'ideal' study of the incidence of acute cerebrovascular diseases proposed by Malgrem, Sudlow and Warlow, and represents a unique opportunity to further our knowledge of the epidemiology of strokes in our country.
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Affiliation(s)
- J Díaz-Guzmán
- Hospital Universitario 12 de Octubre, Madrid, España.
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Carod-Artal FJ, González-Gutiérrez JL, Egido-Herrero JA, Varela de Seijas E. [The psychometric properties of the Spanish version of the stroke-adapted 30-item Sickness Impact Profile (SIP30-AI)]. Rev Neurol 2007; 45:647-654. [PMID: 18050095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM To assess the psychometric attributes of the stroke-adapted 30-item version of the Sickness Impact Profile, Spanish version (SA-SIP30), in stroke survivors. PATIENTS AND METHODS 79 patients were evaluated (mean age: 68.1 years) by means of the modified Rankin Scale (m-RS), Scandinavian Stroke Scale (SSS), Barthel Index (BI), and the modified 23-item Beck-Hamilton's Depression Rating Scale (HDRS). Health-related quality of life was evaluated using the MOS-Short Form 36 (SF-36) and the SA-SIP30. RESULTS SA-SIP30 mean score was 36.8. SA-SIP30 floor and ceiling effects were 3.8% and 0%. Regarding SA-SIP30 categories, floor effect ranged from 15.2% (social interaction) to 49.4% (alertness behavior), whereas ceiling effect ranged from 2.5% (social interaction) to 26.6% (household management). A floor effect was observed in seven SA-SIP30 categories. The internal consistency of SA-SIP30 (Cronbach's alpha = 0.87), physical (Cronbach's alpha = 0.89) and psychosocial (Cronbach's alpha = 0.75) dimensions were satisfactory. Standard error of measurement (SEM) values for each SA-SIP30 category ranged from 15.9 (household management) to 26.3 (ambulation). SEM values for overall SA-SIP30, physical and psychosocial dimensions were 8, 10 and 17.3, respectively. Corrected item-category correlations ranged from 0.17 (item 28) to 0.83 (item 23). A significant correlation (Spearman's correlation coefficient; p < 0.0001) between SA-SIP30 scores and BI (-0.71), m-RS (0.68), SSS (-0.67), HDRS (0.52), SF-36 physical (-0.67) and mental components (-0.51) was found. SA-SIP30 mean score significantly increased as m-RS increased (discriminative validity; Kruskal-Wallis, p < 0.0001). CONCLUSION The Spanish-version of the SA-SIP30 has satisfactory internal consistency, convergent validity and discriminative validity in stroke patients.
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Affiliation(s)
- F J Carod-Artal
- Servicio de Neurología, Hospital Sarah, Red Sarah de Hospitales de Rehabilitacion, Brasilia DF, Brasil.
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Caicoya AG, Barco-Nebreda L, González-Gutiérrez JL, Egido-Herrero JA. [Hashimoto's encephalopathy associated with scleromyxedema: coincidental or the overlapping of two syndromes with a possible autoimmune origin?]. Rev Neurol 2004; 39:723-6. [PMID: 15514899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION The encephalopathies that may accompany Hashimoto's thyroiditis and scleromyxedema, both of which are diseases that probably have an autoimmune origin, are clinically similar. The presence of both Hashimoto's thyroiditis and scleromyxedema in a patient with encephalopathy led us to compare the clinical symptoms and the different possible mechanisms accounting for the pathology. CASE REPORT We describe the case of a 54-year-old male who was admitted to hospital because of several occurrences of transient neurological focus that finally developed into a clinical picture of aphasia, acalculia and right homonymous hemianopsia. The patient had previously been diagnosed as suffering from scleromyxedema, which responded poorly to treatment, as well as IgG kappa paraproteinemia and, six months before admission to hospital, Hashimoto's thyroiditis. No abnormalities were found in the complementary tests, except for slightly high protein levels in the cerebrospinal fluid, a diffuse slowing of brain waves in the electroencephalogram and alterations due to thyroiditis and paraproteinemia. Neurological symptoms improved after a few days of corticoid therapy. CONCLUSIONS The presentation of encephalopathy as a stroke and its excellent response to treatment with corticoids pointed to a case of Hashimoto's encephalopathy, although we cannot completely rule out the possibility of it being a dermato-neuro syndrome, which is associated to scleromyxedema. In this paper we review the different pathological mechanisms proposed for the two clinical entities, as well as the clinical features that are similar in both syndromes and which could be an indication of some common mechanism shared by them.
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Affiliation(s)
- A G Caicoya
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain.
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Carod-Artal FJ, González-Gutiérrez JL, Egido-Herrero JA, Varela de Seijas E. [Post stroke depression: predictive factors at one year follow up]. Rev Neurol 2002; 35:101-6. [PMID: 12221617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION The presence of depression constitutes one of the treatable complications in stroke survivors. Its long term prevalence and the triggering factors are unknown in our community. Moreover, its presence can interfere in the process of rehabilitating the patient and in family dynamics. PATIENTS AND METHODS A sample of 118 patients from the Stroke Unit at the Hospital Universitario San Carlos in Madrid were studied. After one year follow up, 90 survivors (41 females and 49 males; average age: 68 years) were evaluated, with their informed consent, with the Hamilton depression and Beck s melancholia scale, the Barthel index, the Rankin scale, Psychosocial Dimension of Sickness Impact Profile and the Scandinavian neurological scale. A factorial ANOVA model was used to conduct the statistical analysis. RESULTS On discharge, a third of the patients presented symptoms of depression, while a year after the stroke the figure had risen to 67%. The average score on the Hamilton scale at one year follow up was 13.1 and was rated as mild depression. The variables related with depression one year after the stroke were of a socio demographic nature (female, women working in the home, long lasting occupational disability; p< 0.0001), whereas biological variables (cortical/subcortical distribution, laterality, aetiology and subtype of the stroke) were not statistically significant. Subjects suffering from serious disabilities that affected the performance of their daily activities (Barthel< 60) scored significantly worse (p= 0.005). Motor deficit, according to the Scandinavian scale, was of no use as a predictor of depression one year after the stroke (p= 0.0617). CONCLUSIONS Post stroke depression is highly prevalent in our community and, late on in the follow up, is associated with socio demographic variables and with the degree of disability.
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Affiliation(s)
- F J Carod-Artal
- Unidad de Patología Cerebrovascular, Servicio de Neurología, Hospital Universitario San Carlos, Madrid, España.
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Rojo-Sebastián A, González-Gutiérrez JL, Egido-Herrero JA, Fernández-Pérez C. [Comparative clinico-radiological study of lacunar infarcts of the cerebral hemispheres and brain stem in 110 cases]. Rev Neurol 1999; 28:643-7. [PMID: 10363286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Lacunar infarcts (LI) are small deep infarcts due to occlusion of perforating branches. OBJECTIVE Our objective was to outline the clinical and epidemiological characteristics which differentiate hemispherical lacunar infarcts (HLI) from those of the brain stem (SLI). PATIENTS AND METHODS We present 110 cases of LI (80 HLI, 30 SLI) analysing risk factors, clinical syndromes, findings on neurological examination (dysarthria, gravity, distribution and proportional paresia), form of clinical presentation, evolution whilst in hospital, site and results of carotid duplex. Diagnosis was made in 72 patients using magnetic resonance (MR) and in 38 patients using computerized axial tomography (CT). RESULTS The commonest characteristics of SLI, as compared with HLI, with statistical significance (p < 0.05) was the appearance of supranuclear facial paresia (OR = 2.68), severe motor involvement (OR = 4.23), form of presentation with previous TIA (OR = 6.33), fluctuating evolution of the symptoms (OR = 5.78) and progression of the paresia (OR = 6.41). Also, in the pontine LI there was significant correlation between site and gravity: the lower the site of the lesion, the more serious was the paresia. Patients with multiple LI presented with no previous risk factors significantly more frequently than those with a single LI. CONCLUSION The different clinical profiles may help to establish the subgroups of IL, according to where they occur.
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Affiliation(s)
- A Rojo-Sebastián
- Unidad de Patología Cerebrovascular, Hospital Clinico San Carlos, Madrid, España
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Egido-Herrero JA, González JL. [Pontine hemorrhage after abuse of cocaine. Letter]. Rev Neurol 1997; 25:137-8. [PMID: 9091200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Castro del Río M, Egido-Herrero JA, González-Gutiérrez JL. [Capsular alarm syndrome as a sign of unilateral pontine infarct. Letter]. Rev Neurol 1997; 25:140-1. [PMID: 9091203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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