De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study

Background and aim Headache attributed to intracranial endovascular procedures is described in the ICHD-3. Our aim was to study the frequency and characteristics of headache specifically related to thrombectomy in patients with ischemic stroke. Methods Prospective evaluation of clinical features of headache after thrombectomy using an ad hoc questionnaire. Results One hundred seventeen patients were included (52.1% females). Most had an anterior circulation artery occlusion (91.5%). 93 (79.5%) received general anaesthesia. 111 (94.9%) required stent retriever, 21 (24.4%) angioplasty and 19 (16.2%) aspiration thrombectomy. 31 (26.5%; 95% CI 18.8?35.5%) had headache related to thrombectomy, and it was associated with a history of primary headache (p =?0.004). No differences about sex, initial NIHSS score, or the type or complexity of the procedure were observed. Headache was usually moderate and oppressive, ipsilateral to the artery occlusion and usually lasted less than 48?hours. Conclusions Almost one-third of patients with ischemic stroke who undergo endovascular thrombectomy experience headache in the first 24?hours, occurring more frequently in patients who had a previous history of headaches regardless of the procedure complexity.Acknowledgments: The authors received no financial suppor

Dislipidemias y prevención del ictus: recomendaciones del Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología

Objective: We present an update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. Development: We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. Conclusions: In primary prevention, the patient's vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value <55 mg/dL is recommended; in non-atherothombotic ischaemic strokes, given the unclear relationship with dyslipidaemia, target value should be established according to the vascular risk group of each patient. In both primary and secondary prevention, statins are the drugs of first choice, and ezetimibe and/or PCSK9 inhibitors may be added in patients not achieving the target value.Objetivo: Actualizar las recomendaciones de la Sociedad Española de Neurología para la prevención del ictus, tanto primaria como secundaria en pacientes con dislipidemia. Desarrollo: Se ha realizado una revisión sistemática en Pubmed evaluando los principales aspectos relacionados con el manejo de las dislipidemias en la prevención primaria y secundaria del ictus, elaborándose una serie de recomendaciones relacionadas con los mismos. Conclusiones: En prevención primaria se recomienda determinar el riesgo vascular del paciente con el fin de definir los objetivos de LDLc. En prevención secundaria tras un ictus de origen aterotrombótico se recomienda un objetivo de LDLc < 55 mg/dl, mientras que en ictus isquémicos de origen no aterotrombótico dado que su relación con dislipidemias es incierta se establecerán los objetivos en base al grupo de riesgo vascular de cada paciente. Tanto en prevención primaria como secundaria las estatinas son los fármacos de primera elección, pudiendo asociarse ezetimiba y/o inhibidores de PCSK9 en aquellos casos que no alcancen los objetivos terapéuticos

Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry

Introduction: We aimed to evaluate if prior oral anticoagulation (OAC) and its type determines a greater risk of symptomatic hemorrhagic transformation in patients with acute ischemic stroke (AIS) subjected to mechanical thrombectomy. Materials and Methods: Consecutive patients with AIS included in the prospective reperfusion registry NORDICTUS, a network of tertiary stroke centers in Northern Spain, from January 2017 to December 2019 were included. Prior use of oral anticoagulants, baseline variables, and international normalized ratio (INR) on admission were recorded. Symptomatic intracranial hemorrhage (sICH) was the primary outcome measure. Secondary outcome was the relation between INR and sICH, and we evaluated mortality and functional outcome at 3 months by modified Rankin scale. We compared patients with and without previous OAC and also considered the type of oral anticoagulants. Results: About 1.455 AIS patients were included, of whom 274 (19%) were on OAC, 193 (70%) on vitamin K antagonists (VKA), and 81 (30%) on direct oral anticoagulants (DOACs). Anticoagulated patients were older and had more comorbidities. Eighty-one (5.6%) developed sICH, which was more frequent in the VKA group, but not in DOAC group. OAC with VKA emerged as a predictor of sICH in a multivariate regression model (OR, 1.89 [95% CI, 1.01-3.51], p = 0.04) and was not related to INR level on admission. Prior VKA use was not associated with worse outcome in the multivariate regression model nor with mortality at 3 months. Conclusions: OAC with VKA, but not with DOACs, was an independent predictor of sICH after mechanical thrombectomy. This excess risk was associated neither with INR value by the time thrombectomy was performed, nor with a worse functional outcome or mortality at 3 months

Biología de los anfibios y reptiles en el bosque seco tropical del norte de Colombia.

Los anfibios y reptiles son animales asombrosos y su biología es mucho más Fascinante y variada de lo que originalmente se consideraba. Esta afirmación se soporta fácilmente en múltiples aspectos, entre los cuales sobresale, su reproducción (Duellman &amp; Trueb 1994; Wells 2007; Balshine 2012; Gómez-Mestre et al. 2012; Vitt &amp; Caldwell 2014; Pough et al. 2016). En los anfibios, por ejemplo, muchas especies no dejan sus huevos en charcas y lagunas, como tradicionalmente ha creído el común de las personas, sino que las hembras los depositan en ambientes terrestres, tales como la superficie de hojas o en ambientes húmedos que se dan a nivel del suelo entre hojarasca y bajo troncos caídos, piedras o raíces de árboles (Duellman &amp; Trueb 1994; Crump 2015). Más aún, hay especies cuya reproducción es tan especializada que los padres o madres transportan a los renacuajos en diferentes partes de su cuerpo , ya sea, por pocas horas o días, mientras los depositan en ambientes específicos, o hasta que las crías terminan su ciclo de metamorfosis y se desarrollen como un adulto, pero en miniatura  (Noble 1927; Mendelson et al. 2000; Castroviejo-Fisher et al. 2015). Con respecto a los reptiles, hay ejemplos de especies, donde, - las hembras no requieren que un gameto masculino fertilice sus óvulos para producir crías, o especies, donde el sexo de la progenie no está determinado genéticamente, sino por la temperatura ambiental, lo cual, permiten la incubación de huevos (Tinkle &amp; Gibbons 1977; Shine 1995; Vitt &amp; Caldwell 2014). Los factores o procesos asociados a la evolución de este último aspecto en la reproducción de reptiles, es todo un enigma para los científicos (BlacNburn 2006; Shine 2015). Estos y muchos más ejemplos, que se encuentran a lo largo de este libro, contradicen la imagen que durante décadas se tuvo de los anfibios y reptiles, incluso, por científicos y naturalistas tan prestigiosos como, Carlos Linneo, quien afirmó que estos vertebrados eran animales repulsivos, en los cuales el creador no había ejercido toda su sabiduría y poder (Halliday &amp; Adler 1986)