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Item type:Publication, Clinical and Radiological Differences between Patients Diagnosed with Acute Ischemic Stroke and Chameleons at the Emergency Room: Insights from a Single-Center Observational Study(S. Karger AG, 2024-07-18); ; ; ; Gabriel Cavada<jats:p><b><i>Introduction:</i></b> Scarce data exist about clinical/radiological differences between acute ischemic strokes diagnosed in the emergency room (AISER) and stroke chameleons (SCs). We aimed at describing the differences observed in a comprehensive stroke center in Chile. <b><i>Methods:</i></b> Prospective observational study of patients with ischemic stroke syndromes admitted to the emergency room (ER) of Clínica Alemana between December 2014 and October 2023. <b><i>Results:</i></b> 1,197 patients were included; of these 63 (5.2%, 95% CI: 4.1–6.6) were SC; these were younger (<i>p</i> &lt; 0.001), less frequently hypertensive (<i>p</i> = 0.03), and they also had lower systolic (SBP) (<i>p</i> &lt; 0.001), diastolic blood pressures (DBP) (<i>p</i> = 0.011), and NIHSS (<i>p</i> &lt; 0.001). Clinically, they presented less frequently gaze (<i>p</i> = 0.008) and campimetry alterations (<i>p</i> = 0.03), facial (<i>p</i> &lt; 0.001) and limb weakness (left arm [<i>p</i> = 0.004], right arm (<i>p</i> = 0.041), left leg (<i>p</i> = 0.001), right leg <i>p</i> = 0.0029), sensory abnormalities (<i>p</i> &lt; 0.001), and dysarthria (<i>p</i> &lt; 0.001). Neuroradiological evaluations included less frequently large vessel occlusions (<i>p</i> = 0.01) and other stroke locations (<i>p</i> = 0.005); they also differed in their etiologies (<i>p</i> &lt; 0.001). Brainstem strokes (<i>p</i> &lt; 0.001) and extinction/inattention symptoms (<i>p</i> &lt; 0.001) were only seen in AISER. In multivariate analysis, younger age (OR: 0.945; 95% CI: 0.93–0.96), DBP (OR: 0.97; 95% CI, 0.95–0.99), facial weakness (OR: 0.39; 95% CI: 0.19–0.78), sensory abnormities (OR: 0.16.18; 95% CI, 0.05–0.4), infratentorial location (OR: 0.36; 95% CI, 0.15–0.78), posterior circulation involvement (OR: 3.02; 95% CI, 1.45–6.3), cardioembolic (OR: 3.5; 95% CI, 1.56–7.99), and undetermined (OR: 2.42; 95% CI, 1.22–4.7; 95%) etiologies, remained statistically significant. A stepwise analysis including only clinical elements present on the patient’s arrival to the ER, demonstrates that age (OR: 0.95; 95% CI: 0.94–0.97), DBP (OR: 0.97; 95% CI, 0.95–0.99), the presence of atrial fibrillation (OR: 2.22; 95% CI, 1.04–4.75, NIHSS (OR: 0.88; 95% CI, 0.71–0.89) and the presence in NIHSS of 1a level of consciousness (OR: 5.66; CI: 95% 1.8–16.9), 1b level of consciousness questions (OR: 3.023; 95% CI, 1.35–6.8), facial weakness (OR: 0.3; CI: 95% 0.17–0.8), and sensory abnormalities (OR: 0.27; 95% CI, 0.1–0.72) remained statistically significant. <b><i>Conclusion:</i></b> SC had clinical and radiological differences compared to AISER. An additional relevant finding is that neurological symptoms in a patient with atrial fibrillation, even with a negative diffusion-weighted imaging, should be carefully evaluated as a potential stroke until other causes are satisfactorily ruled out. </jats:p>Scopus© Citations 1 6 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Clinical Profile of Stroke Chameleons Receiving Intravenous Thrombolysis: Insights from a Single-Center Experience(S. Karger AG, 2024-11-13); ; ; ; Eloy Mansilla<jats:p>Introduction: In emergency rooms (ERs), 5% of patients experiencing an acute ischemic stroke (AIS) receive an alternative diagnosis; these cases are known as stroke chameleons (SC). The percentage of SC treated with intravenous thrombolysis (IVT) and the characteristics have not been well described. We aimed at investigating the variables associated with the probability receiving IVT. Methods: In this prospective study, we included consecutive patients with SC admitted at the ER of Clínica Alemana between September 2014 and October 2023. Results: Among 1,193 stroke patients; sixty-three (5.2%) corresponded to SC. Ten of these cases (15.8%, 95% CI: 8.8–26.8) were treated with IVT, mean door-to-needle (DTN) time of 85.7 (SD 35) min, median of 73.5 (IQR 62–113) min. SCs who underwent IVT were younger (p = 0.01), with higher NIHSS (p = 0.05). They presented more frequently with altered level of consciousness in the NIHSS (p = 0.01), language abnormities (p = 0.001), and dysarthria (p = 0.01). In multivariate analysis, none of the variables were significantly associated with IVT. A secondary analysis showed that only time to brain imaging was significantly associated with IVT (OR: 0.99; 95% CI: 0.98–0.99; p = 0.01). Conclusions: Almost 1 out of every 7 SC could be treated with IVT but with a prolonged DTN time; the chance of being treated is associated with time to brain imaging. <p>Introduction: In emergency rooms (ERs), 5% of patients experiencing an acute ischemic stroke (AIS) receive an alternative diagnosis; these cases are known as stroke chameleons (SC). The percentage of SC treated with intravenous thrombolysis (IVT) and the characteristics have not been well described. We aimed at investigating the variables associated with the probability receiving IVT. Methods: In this prospective study, we included consecutive patients with SC admitted at the ER of Clínica Alemana between September 2014 and October 2023. Results: Among 1,193 stroke patients; sixty-three (5.2%) corresponded to SC. Ten of these cases (15.8%, 95% CI: 8.8–26.8) were treated with IVT, mean door-to-needle (DTN) time of 85.7 (SD 35) min, median of 73.5 (IQR 62–113) min. SCs who underwent IVT were younger (p = 0.01), with higher NIHSS (p = 0.05). They presented more frequently with altered level of consciousness in the NIHSS (p = 0.01), language abnormities (p = 0.001), and dysarthria (p = 0.01). In multivariate analysis, none of the variables were significantly associated with IVT. A secondary analysis showed that only time to brain imaging was significantly associated with IVT (OR: 0.99; 95% CI: 0.98–0.99; p = 0.01). Conclusions: Almost 1 out of every 7 SC could be treated with IVT but with a prolonged DTN time; the chance of being treated is associated with time to brain imaging. </p></jats:p>1 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 3 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Who is in the emergency room matters when we talk about door-to-needle time: a single-center experience(2023); 5Scopus© Citations 1 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A Chilean Experience of Telestroke in a COVID-19 Pandemic Year(2022); ; <jats:p><b><i>Background and Purpose:</i></b> Telemedicine for stroke patients’ care (telestroke [TS]) has grown notably in recent decades and may offer advantages during health crisis. Hospital admissions related to stroke have decreased globally during the COVID-19 pandemic, but scarce information is available regarding the effect of COVID-19 in TS. Using a population-based TS registry, we investigated the impact of the first year of the COVID-19 pandemic throughout our TS network in Santiago, Chile. <b><i>Methods:</i></b> Stroke codes evaluated after the onset of COVID-19 restrictions in Chile (defined as March 15, 2020) were compared with those evaluated in 2019. We analyzed differences between number of stroke codes, thrombolysis rate, stroke severity, and time from the stroke onset to hospital admission. <b><i>Results:</i></b> We observed that the number of stroke codes and the number of patients undergoing reperfusion therapy did not change significantly (<i>p</i> = 0.669 and 0.415, respectively). No differences were found with respect to the median time from the stroke onset to admission (<i>p</i> = 0.581) or in National Institutes of Health Stroke Scale (NIHSS) scores (<i>p</i> = 0.055). The decision-making-to-needle time was significantly shorter in the COVID-19 period (median 5 min [IQR 3–8], <i>p</i> &#x3c; 0.016), but no significant changes were found at the other times. <b><i>Conclusions:</i></b> This study demonstrates the potential of adapting TS to extreme situations such as the COVID-19 pandemic, as well as the importance of establishing networks that facilitate patient access to quality treatments. </jats:p>Scopus© Citations 7 1 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Diffusion-weighted imaging as predictor of acute ischemic stroke etiology(2022); ; Alexis Rojo<jats:p>Abstract Background: Topographic patterns may correlate with causes of ischemic stroke. Objective: To investigate the association between diffusion-weighted imaging (DWI) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Methods: We included 1019 ischemic stroke patients. DWI were classified as: i) negative; ii) DWI single lesion (cortico-subcortical, cortical, subcortical ≥20 mm, or subcortical <20 mm); iii) scattered lesions in one territory (small scattered lesions or confluent with additional lesions); and iv) multiple lesions (multiple unilateral anterior circulation [MAC], multiple posterior circulation [MPC], multiple bilateral anterior circulation [MBAC], and multiple anterior and posterior circulations [MAP]). Results: There was a relationship between DWI patterns and TOAST classification (p<0.001). Large artery atherosclerosis was associated with small, scattered lesions in one vascular territory (Odds Ratio [OR] 4.22, 95% confidence interval [95%CI] 2.61–6.8), MPC (OR 3.52; 95%CI 1.54–8.03), and subcortical lesions <20 mm (OR 3.47; 95%CI 1.76–6.85). Cardioembolic strokes correlated with MAP (OR 4.3; 95%CI 1.64–11.2), cortico-subcortical lesions (OR 3.24; 95%CI 1.9–5.5) and negative DWI (OR 2.46; 95%CI 1.1–5.49). Cryptogenic strokes correlated with negative DWI (OR 4.1; 95%CI 1,84–8.69), cortical strokes (OR 3.3; 95%CI 1.25–8.8), MAP (OR 3.33; 95%CI 1.25–8.81) and subcortical lesion ≥20 mm (OR 2.44; 95%CI 1,04–5.73). Lacunar strokes correlated with subcortical lesions diameter <20 mm (OR 42.9; 95%CI 22.7–81.1) and negative DWI (OR 8.87; 95%CI 4.03–19.5). Finally, MBAC (OR 9.25; 95%CI 1.12–76.2), MAP (OR 5.54; 95%CI 1.94–15.1), and MPC (OR 3.61; 95%CI 1.5–8.7) correlated with stroke of other etiologies. Conclusions: A relationship exists between DWI and stroke subtype.</jats:p>Scopus© Citations 7 2 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Scopus© Citations 8 1 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience(2020); ; Scopus© Citations 2 2 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 3Scopus© Citations 9 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 2Scopus© Citations 26