Epidemiology of tension-type headache in Santiago, Chile: A prevalence study

Objective: To describe the importance of tension-type headache (TTH) in Santiago, Chile, by analyzing its prevalence, clinical features, and impact by age, gender, and socioeconomic status, using widely accepted international diagnostic criteria. Methods: In 1993, a representative sample of 1540 adults (older than 14) of the province of Santiago were interviewed using a standard questionnaire. A total of 1385 (89.9% response rate) subjects responded to the survey. Initially, a designated member of each household responded to the questionnaire. Subsequently, each household member with headache was asked to respond to questions about the severity, frequency, location, duration, associated symptoms, and impact in work and social activities of their most frequent headaches. TTH diagnoses were determined in accordance with the International Headache Society criteria of 1988. Results: Total prevalence was found to be 26.9% (95% CI: 24.6-29.3%); 35.2% in females (95% CI: 31.7- 38.8%) and 18.

Characterization of patients with embolic strokes of undetermined source in the navigate esus randomized trial

Background: The New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial vs. ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial is a randomized phase-III trial comparing rivaroxaban versus aspirin in patients with recent ESUS. Aims: We aimed to describe the baseline characteristics of this large ESUS cohort to explore relationships among key subgroups. Methods: We enrolled 7213 patients at 459 sites in 31 countries. Prespecified subgroups for primary safety and efficacy analyses included age, sex, race, global region, stroke or transient ischemic attack prior to qualifying event, time to randomization, hypertension, and diabetes mellitus. Results: Mean age was 66.9 +/- 9.8 years; 24% were under 60 years. Older patients had more hypertension, coronary disease, and cancer. Strokes in older subjects were more frequently cortical and accompanied by radiographic evidence of prior infarction. Women comprised 38% of participants and were older than men. Patients from East Asia were oldest whereas those from Latin America were youngest. Patients in the Americas more frequently were on aspirin prior to the qualifying stroke. Acute cortical infarction was more common in the United States, Canada, and Western Europe, whereas prior radiographic infarctions were most common in East Asia. Approximately forty-five percent of subjects were enrolled within 30 days of the qualifying stroke, with earliest enrollments in Asia and Eastern Europe. Conclusions: NAVIGATE-ESUS is the largest randomized trial comparing antithrombotic strategies for secondary stroke prevention in patients with ESUS. The study population encompasses a broad array of patients across multiple continents and these subgroups provide ample opportunities for future research.Bayer AG Janssen Research and Development Canadian Stroke Prevention Intervention Networ

Stroke units in Chile Unidades de tratamiento del ataque cerebrovascular (UTAC) en Chile

Stroke is a major public health problem in Chile, with an incidence similar to that of many industrialized nations, it accounts for 10% of all deaths and ranks 5 th in number of healthy years of life lost to a disease. Organized inpatient care for stroke patients has been shown in systematic reviews of randomized clinical trials to be effective in preventing death, disability and institutional care, without increasing length of stay compared to usual care. Organized stroke unit care is provided by multidisciplinary teams that exclusively manage stroke patients in a dedicated ward (stroke ward) of which there are various possible models; acute stroke units which accept patients acutely but discharge early (usually within 7 days). This could include an "intensive" model of care with continuous monitoring and high nurse staffing levels; comprehensive (i.e. combined acute and rehabilitation) stroke units which accept patients acutely but also provide rehabilitation for at least several we

Diagnostic accuracy of a simple clinical score to screen for vascular abnormalities in patients with intracerebral hemorrhage

© 2014 National Stroke Association.Background Patients with intracerebral hemorrhage may have vascular abnormalities. There is no consensus about which patients should be studied with angiographic methods. Our aim was to derive a simple clinical score to screen for vascular abnormalities in intracerebral hemorrhage (ICH) and test its accuracy.Results The performance of the scale in the derivation cohort showed the maximum operating point (MOP) at <5 (sensitivity.77, specificity.5). In the validation cohort, the MOP was a cutoff point of <5 (sensitivity.76, specificity.467). The positive and negative LRs were 2.1 and.6, respectively. The ROC showed similar AUC for both cohorts:.7. The probability of a vascular malformation was 23% with scores ≤5 and 83% with scores <9 in the validation cohort.Conclusions This simple clinical score can be used immediately on diagnosing an ICH to decide accurately whether to perform an angiographic study or not. Further studies using this simple score sh

Low dose vs standard dose alteplase for patients with acute ischemic stroke secondary analysis of the Enchanted randomized clinical trial

IMPORTANCE: A lower dose of intravenous alteplase appears to be a safer treatment option than the standard dose, reducing the risk of symptomatic intracerebral hemorrhage. There is uncertainty, however, over how this effect translates into an overall clinical benefit for patients with acute ischemic stroke (AIS). OBJECTIVE: To assess whether older, Asian, or severely affected patients with AIS who are considered at high risk of thrombolysis may benefit more from low-dose rather than standard-dose alteplase treatment. DESIGN, SETTING, AND PARTICIPANTS: This study is a prespecified secondary analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), an international, randomized, open-label, blinded, end-point clinical trial of low-dose vs standard-dose intravenous alteplase for patients with AIS. From March 1, 2012, to August 31, 2015, a total of 3310 patients who had a clinical diagnosis of AIS as confirmed by brain imaging and who fulfilled the local criteria for thrombolysis treatment were included in the alteplase-dose arms. Patients were randomly assigned to receive low-dose (0.6 mg/kg; 15% as bolus and 85% as infusion over 1 hour) or standard-dose (0.9 mg/kg; 10% as bolus and 90% as infusion over 1 hour) alteplase. Of the 3310 randomized patients, 13 patients were excluded for missing consent, mistaken randomization, and duplicate randomization numbers. This secondary analysis was conducted between May 1, 2016, and April 28, 2017. MAIN OUTCOMES AND MEASURES: The primary end point was a poor outcome defined by the combination of death and any disability as scored by the modified Rankin Scale (scores range from 2 to 6, with the highest score indicating death) at 90 days. RESULTS: Of the 3297 patients included in the analysis, 1248 (37.9%) were women, and the mean (SD) age was 67 (13) years. No significant differences in the treatment effects were observed between low- and standard-dose alteplase for poor outcomes (death or disability) by age, ethnicity, or severity (all P > .37 for interaction). Similarly, the treatment effects of low-vs standard-dose alteplase on function outcome (ordinal shift of the modified Rankin Scale) in Asians (odds ratio, 1.05; 95% CI, 0.90-1.22) was consistent with non-Asians (odds ratio, 0.93; 95% CI, 0.76-1.14) (P = .32 for interaction). There were generally consistent reductions in rates of symptomatic intracerebral hemorrhage with low-dose alteplase, although this reduction was not statistically significant by age, ethnicity, or severity. CONCLUSIONS AND RELEVANCE: This analysis found that the effects of low-dose alteplase were not clearly superior to the effects of standard-dose alteplase on death or disability in key demographic subgroups of patients with AIS. Further investigation is required to identify patients with AIS who may benefit from low-dose alteplase.National Health and Medical Research Council of Australia Stroke Association of the United Kingdom National Council for Scientific and Technological Development of Brazil Ministry for Health, Welfare and Family Affairs of the Republic of Kore

Performance of an abbreviated mini mental examination to detect dementia in older people

Background: The usefulness of the abbreviated Mini-Mental State Examination included in the Chilean Functional assessment of elderly people (MMSE- EFAM) to detect Dementia has not been determined. Aim: To assess the performance of the MMSE-EFAM to detect dementia. Material and Methods: We studied a non-probabilistic sample of subjects older than 65 years who had been assessed by the MMSE-EFAM in a Chilean primary care center during a period of 6 months. Patients underwent clinical evaluation by a neurologist blinded to MMSE-EFAM score, to establish the diagnosis of dementia using DSM-IV-TR criteria. Besides, the full Mini-Mental State Examination (MMSE) was applied. Results: The clinical diagnosis of Dementia was established in 13 of the 54 peoples evaluated. MMSE-EFAM had a sensitivity of 30.8% (95% confidence intervals (CI); 9-61.4) and a specificity of 90.2% (95% CI; 76.9%-97.3%), while MMSE had a sensitivity of 84.6% (95% CI; 54.6-98.1) and a specificity of 58.5% (95% CI; 42.1-73.7). In a receiver operating characteristic (ROC) curve analysis, the areas under the curve (AUC) were 0.77 (95% CI; 0.61-0.93) and 0.82 (95% CI; 0.70-0.95) for MMSE-EFAM and MMSE, respectively. Socio-demographic variables did not influence test performance in both cases. Conclusions: MMSE- EFAM has a low sensitivity to detect patients with Dementia and it is not an effective screening tool. These results are in agreement with the evidence and international guidelines that do not support the use of cognitive screening tools to detect dementia in the older general population

Socioeconomic and cardiovascular variables explaining regional variations in stroke mortality in Chile: An ecological study

Background: Regional differences in stroke mortality rates have been described in Chile. These could be related to the distribution of cardiovascular risk factors, the quality of medical care or socioeconomic status influencing incidence or case fatality rates. Our objective was to investigate variables explaining the variability in stroke mortality rates in the different regions of Chile. Methods: Adjusted stroke mortality rates in different regions were calculated for the year 2003. Variables were added from three sources: the National Death Certificate Database, the National Socioeconomic Characterization Survey and the National Health Survey. A logistic regression model was used to investigate regions, demographic variables and socioeconomic variables associated with the risk of death from stroke. A linear regression model was used to study the association of socioeconomic variables and cardiovascular risk factors with the standardized mortality rate by region and the contributio

Validity of the NIHSS in predicting arterial occlusion in cerebral infarction is time-dependent

Background: The NIH Stroke Scale (NIHSS) is used to assess acute ischemic stroke severity and outcome. High NIHSS scores are usually associated with arterial occlusion but it is unknown what the effect of time to clinical evaluation (TTCE) in this association is. We tested the NIHSS scores as an instrument to determine vessel occlusion (VO) at different time points from symptom onset. Methods: Patients were selected from our prospective stroke database if they had admission NIHSS scores and intracranial vessel neuroimaging studies. We dichotomized patients according to VO and TTCE. Receiver operating curves, c statistics, and odds ratios were calculated to study the validity of the NIHSS score. Results: Among 463 patients (mean age 70.2 years, 53.1% male, median NIHSS 4, median TTCE 3.3 hours), 22.5% had arterial occlusion. Median NIHSS scores were higher in patients with VO, 10.5 (interquartile range 5-18) vs 3 (2-7), p < 0.001, and in those with TTCE <6 hours, 15 (interquartile rang

Additional information given to a multimodal imaging stroke protocol by transcranial doppler ultrasound in the emergency room: A prospective observational study

Background: Transcranial Doppler (TCD) ultrasound can demonstrate dynamic information. We aimed to evaluate whether TCD generates useful additional information in the emergency room after a multimodal stroke imaging protocol and also whether this modified the management of patients with cerebral infarction. Methods: Patients admitted between April 2006 and June 2007 with ischemic stroke of less than 24 h were subjected to a protocol consisting of noncontrast brain CT, computed tomography angiography, diffusion- weighted magnetic resonance imaging and then TCD within the following 6 h by an observer blinded to the results of imaging studies. Results: Seventy-nine patients were included. The imaging protocol was performed 457 ( 8 346) min after stroke symptoms and TCD after 572 ( 8 376) min. TCD provided additional information in 28 cases (35.4%, 95% CI 25.7–46.4). More that one piece of additional information was obtained in 6 patients. The most frequent additional information was collateral pathways. Multivariate analysis demonstrated that intracranial vessel occlusion was the variable most associated with additional information. In 7 patients (8.8%, 95% CI 4.3–17.1), additional information changed management: in 4 an additional angiography was performed, in 2 patients angiography was suspended and in 1 aggressive neurocritical care was indicated. Patients with NIHSS 1 10 were significantly more likely to have their initial treatment changed (p = 0.004). Conclusions: TCD can provide additional information to a multimodal acute ischemic stroke imaging protocol in a third of patients. This can result in changes in the management in some of these patients