Introduction Acute spinal cord injury is associated with an increased risk of thromboembolic events. Low-molecular-weight heparins are first-line medications for both the treatment and prevention of venous thromboembolism. Pharmacological prophylaxis may be indicated for high-risk patients and low-risk patients may be managed with non-pharmacological measures. Case presentation We report two cases of gluteal hematomas that occurred in patients with chronic spinal cord injury who were under prophylactic doses of enoxaparin at a tertiary rehabilitation hospital. There was no local trauma. The patients needed multiple surgical interventions and rehabilitation treatment was delayed. Discussion There is a lack of evidence to correctly estimate the thromboembolic risk in chronic spinal cord injury and the duration of prophylaxis. Over-prescription of pharmacological prophylaxis may expose patients to unnecessary risks. These patients frequently present with polypharmacy and reducing the amount of prescribed medication may begin with reducing prophylactic treatments for venous thromboembolism, which may be an overtreatment based on risk overestimation.
Introduction: Stroke is the leading cause of disability worldwide, not only due to motor impairment, but to many sequelae in other domains. Fatigue is one of the most impacting symptoms in the quality of life in post stroke patients, with estimated prevalence around 30%. Objectives and methods: We present a cross-sectional study that aimed to determine the prevalence of fatigue in patients with ischemic stroke followed in the neurovascular outpatient clinic of a tertiary hospital in São Paulo, Brazil, using the Fatigue Assessment Scale (FAS) questionnaire. It can range from 0-50 points, proportional to symptom intensity; scores equal or over 24 points indicate fatigue in such individuals. Casuistics and results: One hundred and fifty seven questionnaires were analyzed and classified according to the FAS. Mean age was 58 years, 74 (47.13%) individuals were men and median FAS score was 21 points (interquartile range: 18–29). Of the interviewees, 64 individuals (40.76%) were classified as having fatigue by the established cut-off; in this subgroup, mean age was 55 years and 28 (43.75%) were men. Discussion and conclusion: In this study, around 40% of post-stroke patients have fatigue, indicating a high prevalence in our population. Fatigue has a high impact on the quality of life of patients, also worsening in functionality and mortality, due to lesser participation in rehabilitation and physical activities. Thus, the health professional dealing with post-stroke patients must be aware and prepared to help patients in coping with fatigue.
Introduction: Sequelae are frequent in patients with a history of ischemic stroke and result in decreased quality of life, increase in morbidity, mortality and healthcare costs. One often overlooked complication of ischemic stroke is its association with depression and depressive symptoms. Objectives and methods: This cross-sectional study aims to assess the prevalence of depression and depressive symptoms in patients with previous ischemic stroke followed in the neurovascular outpatient clinic of a tertiary hospital in São Paulo, Brazil, through the application of the Patient Health Questionnaire-9 (PHQ-9) filled in by the patients. Casuistics and results: A total of 173 participated in the study, but only 154 answered all PHQ-9 questions. Mean age was 52 years; 56.82% were women; 44 patients (28.6%) had a score ≥ 10, resulting in sensitivity and specificity for post-stroke depression of 86 and 79% respectively; 118 (68.2%) did not present depression or depressive symptoms before the stroke, 33 (19.1%) had previous symptoms and 22 (12.7%) did not answer this specific question. Discussion and conclusion: The results indicate that depression is an important comorbidity in patients with ischemic stroke. In this cohort, most patients did not have depressive symptoms before the stroke. Further studies are important to better assess this association as well as to determine strategies to prevent and to manage this condition.
Introduction: Chorea is a movement disorder characterized by involuntary, random and irregular movements. In the emergency department, the most common causes of chorea are cerebrovascular disorders, but other conditions may also play an important role. The aim is to present a rare case of acquired hemichorea secondary to hyponatremia by reviewing the patient’s records. Case report: A 73-year-old female patient with a history of arterial hypertension, dyslipidemia, active smoking, and heart failure, taking enalapril, hydrochlorothiazide, furosemide and simvastatin, was admitted to the emergency department after falling from standing height and hitting her head, also presenting choreic movements in the right side of her body. The patient started amitriptyline for chronic low back pain in the last month and had been experiencing apathy and weight loss since; the choreic movements had started a week before admission and had progressively worsened. On admission, the patient presented with fluctuating level of consciousness and hemichorea. Complementary evaluation showed leukocytosis and hyponatremia (117 mg/ dL); magnetic resonance imaging of the brain showed diffuse brain atrophy without any other findings compatible with hemichorea and the lumbar puncture did not reveal any additional findings; a pulmonary infection was detected by the chest computed tomography. The patient was treated for pulmonary infection and hyponatremia. Haloperidol was started, but the chorea was fully solved after hyponatremia correction over the next few days and did not return after haloperidol weaning. Discussion: We presented the case of a 73-year-old woman with acquired hemichorea secondary to hyponatremia, which resolved completely after the metabolic disorder was corrected. Although this condition has been described, its incidence remains unclear, as few cases have been reported.
Introduction: Acute stroke is the second most prevalent cause of death in the world and an important cause of disability in adults. Urinary incontinence (UI) is a complication present in the acute and chronic phases of stroke and is a strong predictor of mortality and need for institutional care. Objectives and methods: Cross-sectional study that aimed to evaluate the presence of UI through the International Consultation Questionnaire on Incontinence - Short Form (ICIQ-UI SF) in patients with ischemic stroke followed in the neurovascular outpatient clinic of a tertiary hospital in São Paulo, Brazil. The ICIQ-SF assesses the impact of UI on quality of life and qualifies degrees of urinary loss. The final score ranges from 0 to 21, with higher values representing greater impact. Casuistics and results: A total of 141 patients adequately answered the questionnaire, among which 75 were female and 66 were male. As for symptoms, 36.87% reported some degree of UI, 40.00% among women and 33.33% among men. The mean ICIQ-UI SF score across all patients was 9.90. For males the mean score was 10.36 and for females it was 9.56. Among symptomatic patients, only 9.21% reported urinary symptoms before the stroke. Discussion: Almost 40% of the patients in the study acquired UI after stroke. This condition prevailed in women, but with less impact compared to men. Urinary incontinence can affect the quality of life of patients, causing psychological, social, physical, economic, personal and sexual relationships. Conclusion: New studies are needed to evaluate prevention and treatment strategies for incontinence in these patients.
Introduction: Stroke is the second most prevalent cause of death in the world and an important cause of disability in adults. Obstructive sleep apnea (OSA) is an independent risk factor for stroke and is associated with poor poststroke functional outcome if left untreated. Objectives and methods: In this cross-sectional study, we aimed to determine the prevalence of OSA in ambulatory stroke patients using the STOPBang (snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck size, gender) questionnaire. Casuistic and results: A total of 149 patients completed the clinical assessment. Mean age was 57.47 years, 75 (50.34%) were men and 74 (49.66%) were female. Among the patients, 56.37% were smokers or former smokers, and mean body mass index was 27.01 kg/m2 . The median STOP-Bang score was 3 (interquartile range: 2–4). 69.12% were considered moderate to severe risk for OSA (STOP-Bang score ≥3). For the identification of OSA, the questionnaire demonstrated sensitivity of 83.5%, accuracy of 75.2% and specificity of 45.5%. Among the 84 patients who answered the question about the presence of previous OSA symptoms, 59.53% had a negative answer. Discussion: Approximately two out of three stroke patients were classified as moderate to high risk for OSA, reinforcing the need for screening for the disease in this population. In addition, almost 60% reported no symptoms prior to cerebrovascular disease. Finally, the high sensitivity in this study confirms the usefulness of the tool in screening patients for diagnosis and therapeutic intervention. Conclusion: New studies are needed to evaluate OSA prevention and treatment strategies, as this measure will help in the global clinical recovery of the patient after the stroke.
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