Background Stroke is a leading cause of disability and death worldwide. The best estimates of local, national, and global burden of stroke are derived from prospective population-based studies. We aimed to investigate the incidence, risk factors, long-term prognosis, care, and quality of life after stroke in the Ñuble region of Chile. MethodsWe did a prospective community-based study with use of multiple overlapping sources of hospitalised, ambulatory, and deceased cases. Standardised diagnostic criteria were used to identify and follow up all cases occurring in the resident population of the Ñuble region, Chile (in a low-income rural-urban population including predominantly people of Indigenous-European heritage), for 1 year. Participants were included if they had a clinical diagnosis of stroke confirmed according to the study criteria. All cases were adjudicated by vascular neurologists. Incidence rates of first-ever stroke were calculated from the population of Ñuble according to the 2017 national census. FindingsFrom April 1, 2015, to March 31, 2016, we ascertained 1103 stroke cases, of which 890 (80•7%) were first-ever incident cases. The mean age of patients with first-ever stroke was 70•3 years (SD 14•1) and 443 (49•8%) were women. A CT scan was obtained in 801 (90%) of 890 patients (mean time from symptom onset to scan of 13•4 h (SD 29•8). The incidence of first-ever stroke age-adjusted to the world population was 121•7 (95% CI 113•7-130•1) per 100 000. The age-adjusted incidence rates, per 100 000 inhabitants, by main pathological subtypes were as follows: ischaemic stroke (101•5 [95% CI 90•9-113•0]); intracerebral haemorrhage (17•9 [13•5-23•4]), and subarachnoid haemorrhage (4•2 [2•1-7•3]). The 30-day case-fatality rate was 24•6% (21•9-27•6). At 6 months after the stroke, 55•9% (432 of 773) of cases had died or were disabled, which increased to 61•0% (456 of 747) at 12 months. Health-related quality of life in survivors was low at 6 months, improving slightly at 12 months after the stroke.Interpretation The incidence of stroke in this low-resource population was higher than our previous finding in northern Chile and within the mid-range of most population-based stroke studies. This result was due mainly to a higher incidence of ischaemic stroke, probably associated with increasing age and a high prevalence of cardiometabolic risk factors in the population studied. Our findings suggest that more should be done for the prevention and care of stroke in communities like the Ñuble population.

Results: Dural Arteriovenous fistulas were found in patients at age ranging from 32-74 years old. They are mostly found at cavernous sinus (40%), transverse-sigmoid sinus (35%) respectively. At these locations patients usually present with headache, exophthalmos and opthalmoparesis (70%, 65%, and 38% respectively) which are resemble with other common neurological diseases. CT brain, MRI or MRA brain were selected to examine in every patients. Average delayed time before definite diagnosis is 1.5 months. Factors involved in delayed diagnosis are unrecognizing symptoms mimicking common neurological diseases (60%), choosing improper neuroimaging (60%) and overlooking subtle abnormalities in those neuroimaging (45%). Conclusions: Keeping in mind that headache, exophthalmos and opthalmoparesis can be presentation of dural arteriovenous fistulas particularly in middle-age to elderly patients and selecting proper initial neuroimaging as well as meticulous interpreting would help to achieve correct diagnosis and be able to start treatment in timely fashion.

No abstract

No abstract

No abstract