Characterization of acute ischemic cerebrovascular accidents at the emergency department
Caracterización del ataque cerebrovascular isquémico agudo en el servicio de urgencias
Show authors biography
Introduction: cerebrovascular disease (CVD) is ranked as the second leading cause of death worldwide. In Colombia, there is scarce data to distinguish the risk factors and clinical course among men and women. Objective: to characterize inpatients with a diagnosis of ischemic cerebrovascular disease (ICVD) treated at Hospital de San José in Bogotá from March 1, 2019, to January 31, 2020. Methodology: a prospective, descriptive, cohort study in inpatients older than 18 years, diagnosed with ICVD, treated at Hospital de San José in Bogotá. Results: 106 patients with mean age 69 years, were included. Risk factors included physical inactivity 87.1%; overweight 40.6%, hypertension 41.5 % and tobacco smoke exposure 22.7%. A CT angiogram scan evidenced some degree of carotid stenosis in 18% and atrial fibrillation was identified in 5.6%. Most patients received acetylsalicylic acid and atorvastatin (83.6%); 8.1% received anticoagulation therapy and most of them presented a mild stroke (62.6%); 19% of patients received thrombolytic therapy. Atherosclerosis was established as the cause in 41.8%. Discussion and conclusions: cerebrovascular events mostly occur in the seventh decade of life and above, in the active population, causing significant disabilities with functional limitation. The proper management of risk factors that are modifiable can reduce the risk of a stroke.
Article visits 507 | PDF visits 449
Downloads
- Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-2089. https://doi.org/10.1161/STR.0b013e318296aeca.
- Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, et al. Heart disease and stroke statistics—2022 update: a report from the American Heart Association. Circulation. 2022;145(8):e153-e639. https://doi.org/10.1161/CIR.0000000000001052.
- Pinilla-Monsalve GD, Vergara-Aguilar JP, Machado-Noguera B, Gutiérrez-Baquero J, Cabezas-Vargas Z, Bejarano-Hernández, J. Estudio de la epidemiología neurológica en Colombia a partir de información administrativa (ESENCIA). Resultados preliminares 2015-2017. Rev Univ Ind Santander Salud. 2021;53:e21025. https://doi.org/10.18273/saluduis.53.e:21025.
- Hankey GJ. Stroke. Lancet. 2017;389(10069):641-54. https://doi.org/10.1016/S0140-6736(16)30962-X.
- Furie, K. Epidemiology and primary prevention of stroke. Continuum (Minneap Minn). 2020;26(2):260-267. https://doi.org/10.1212/CON.0000000000000831.
- Pan B, Jin X, Jun L, Qiu S, Zheng Q, Pan M. The relationship between smoking and stroke: a meta-analysis. Medicine (Baltimore). 2019;98(12):e14872. https://doi.org/10.1097/MD.0000000000014872.
- Hill VA, Towfighi A. Modifiable Risk Factors for Stroke and Strategies for Stroke Prevention. Semin Neurol. 2017;37(3):237-258. https://doi.org/10.1055/s-0037-1603685.
- Yousufuddin M, Young N. Aging and ischemic stroke. Aging (Albany NY). 2019;11(9):2542-2544. https://doi.org/10.18632/aging.101931.
- Miller EC, Leffert L. Stroke in pregnancy: a focused update. Anesth Analg. 2020;130(4):1085-1096. https://doi.org/10.1213/ANE.0000000000004203.
- O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388(10046):761-775. https://doi.org/10.1016/S0140-6736(16)30506-2.
- Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Cir Res. 2020;127(1):4-20. https://doi.org/10.1161/CIRCRESAHA.120.316340.
- Okumura K, Tomita H, Nakai M, Kodani E, Akao M, Suzuki S, et al. Risk Factors Associated With Ischemic Stroke in Japanese Patients With Nonvalvular Atrial Fibrillation. JAMA Netw Open. 2020;3(4):e202881. https://doi.org/10.1001/jamanetworkopen.2020.2881.
- Zilberman JM. Menopausia: Hipertension arterial y enfermedad vascular. Hipertensión y riesgo vascular. 2018;35(2):77-83. https://doi.org/10.1016/j.hipert.2017.11.001.
- Palacios Sánchez E, Triana JD, Gómez AM, Ibarra Quiñones M. Ataque cerebrovascular isquémico: Caracterización demográfica y clínica. Hospital de San José de Bogotá DC, 2012-2013. Repert Med Cir. 2014;23(2):127-33. https://doi.org/10.31260/RepertMedCir.v23.n2.2014.727.
- Howard VJ, Madsen TE, Kleindorfer DO, Judd SE, Rhodes JD, et al. Sex and race differences in the association of incident ischemic stroke with risk factor. JAMA Neurol. 2019;76(2):179-186. https://doi.org/10.1001/jamaneurol.2018.3862.
- Otite FO, Liaw N, Khandelwal P, Malik AM, Romano JG, Rundek T, et al. Increasing prevalence of vascular risk factors in patients with stroke: A call to action. Neurology. 2017;89(19):1985–1994. https://doi.org/10.1212/WNL.0000000000004617.
- Etminan N, Chang HS, Hackenberg K, De Rooij NK, Vergouwen Rinkel GJ, Algra A. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurol. 2019;76(5):588-597. https://doi.org/10.1001/jamaneurol.2019.0006.
- Epstein KA, Viscoli CM, Spence JD, Young LH, Inzucchi SE, Gorman M, et al. Smoking cessation and outcome after ischemic stroke or TIA. Neurology. 2017;89(16):1723–1729. https://doi.org/10.1212/WNL.0000000000004524.
- Kleindorfer D.O, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467. https://doi.org/10.1161/STR.0000000000000375.
- Zhang XH, Liang H M. Systematic review with network meta-analysis: Diagnostic values of ultrasonography, computed tomography, and magnetic resonance imaging in patients with ischemic stroke. Medicine. 2019;98(30):e16360. https://doi.org/10.1097/MD.0000000000016360.
- Thomalla G, Simonsen C. Z, Boutitie F, Andersen G, Berthezene Y, et al. MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med. 2018;379(7):611-622. https://doi.org/10.1056/NEJMoa1804355.
- Feske SK. Ischemic stroke. Am J Med. 2021;134(12):1457-1464. https://doi.org/10.1016/j.amjmed.2021.07.027.
- Sposato LA, Chaturvedi S, Hsieh CY, Morillo CA, Kamel H. Atrial fibrillation detected after stroke and transient ischemic attack: a novel clinical concept challenging current views. Stroke. 2022;29(2):e94-e103. https://doi.org/10.1161/STROKEAHA.121.034777.
- Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-e99. https://doi.org/10.1161/STR.0000000000000158.
- Radu RA, Terecoasă EO, Băjenaru OA, Tiu C. Etiologic classification of ischemic stroke: Where do we stand?. Clin Neurol Neurosurg. 2017;159:93-106. https://doi.org/10.1016/j.clineuro.2017.05.019.
- Gittler M, Davis AM. Guidelines for adult stroke rehabilitation and recovery. JAMA. 2018;319(8):820-821. https://doi.org/10.1001/jama.2017.22036.
- Berge E, Whiteley W, Audebert H, De Marchis GM, Fonseca AC, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021;6(1):I-LXII. https://doi.org/10.1177/2396987321989865.