IntroductionAcute stroke interventions, such as stroke units and reperfusion therapy, have the potential to improve outcomes. However, there are many disparities in patient characteristics and access to the best stroke care. Thus, we aim to compare patient-reported outcome measures (PROMs) after stroke in two stroke centers representing the public and private healthcare systems in Brazil.MethodsPROMs through the International Consortium for Health Outcomes Measures (ICHOM) were assessed at 90 days after the stroke to compare two Brazilian hospitals in southern Brazil: a public university and a private stroke center, both with stroke protocols and stroke units.ResultsWhen compared with the private setting (n = 165), patients from the public hospital (n = 175) were younger, had poorer control of risk factors, had more frequent previous strokes, and arrived with more severe strokes. Both hospitals had a similar percentage of IV thrombolysis treatment. Only 5 patients received mechanical thrombectomy (MT), all in the private hospital. Public hospital patients presented significantly worse outcomes at 3 months, including worse quality of life and functional dependence (60 vs. 48%, p = 0.03). Poor outcome, as measured by the mRS score, was significantly associated with older age, higher NIHSS score, and the presence of heart failure. However, the public practice was a strong predictor of any self-reported disability.ConclusionPatients assisted at a good quality public stroke center with the same protocol used in the private hospital presented worse disability as measured by mRS and patient-reported outcome measures, with greater inability to communicate, dress, toilet, feed, and walk.
Context: Primary central nervous system angeitis (APSNC) is a vasculitis confined to the central nervous system (CNS). Its incidence rate is 2.4 cases per 1,000,000 person-years. It affects predominantly small and medium sized arteries of the cerebral parenchyma, spinal cord and leptomeninges. The most common manifestations are headache, cognitive impairment, stroke and transient ischemic attack. The fact that it results in multifocal inflammation of the arteries and veins can lead to ischemic or hemorrhagic infarctions in multiple vascular territories, more common in the subcortical white matter. Case report: A woman with a past of epilepsy and headache present to us with acute intraparenchymal hemorrhagic stroke, after extensive investigation, arrived at the presumed diagnosis of APSNC. Conclusion:Tests such as MRI and arteriography have low sensitivity and specificity for APSNC and brain biopsy is still the gold standard method for diagnosis, but in practice it is performed in less than half of the cases in clinical practice, this is due to several factors. Next, it is important to note that the biopsy efficiency is around 53-74% in unselected areas, reaching 80% if the site is selected affected by non-invasive exams. The literature specifies brain biopsy as a procedure with relatively low morbidity and mortality, however, it was not performed in more than a half of cases.
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