Background and Purpose: Delirium is an acute and fluctuating impairment of attention, cognition, and behavior. Although common in stroke, studies that associate the clinical subtypes of delirium with functional outcome and death are lacking. We aimed to evaluate the influence of delirium occurrence and its different motor subtypes over stroke patients’ prognosis. Methods: Prospective cohort of stroke patients with symptom onset within 72 hours before research admission. Delirium was diagnosed by Confusion Assessment Method for the Intensive Care Unit, and its motor subtypes were defined according to the Richmond Agitation-Sedation Scale. The main outcome was functional dependence or death (modified Rankin Scale>2) at 90 days comparing: delirium versus no delirium patients; and between motor subtypes. Secondary outcomes included modified Rankin Scale score >2 at 30 days and 90-day-mortality. Results: Two hundred twenty-seven patients were enrolled. Delirium occurred in 71 patients (31.3%), with the hypoactive subtype as the most frequent, in 41 subjects (57.8%). Delirium was associated with increased risk of death and functional dependence at 30 and 90 days and higher 90-day mortality. Multivariate analysis showed delirium (odds ratio, 3.28 [95% CI, 1.17–9.22]) as independent predictor of modified Rankin Scale >2 at 90 days. Conclusions: Delirium is frequent in stroke patients in the acute phase. Its occurrence—specifically in mixed and hypoactive subtypes—seems to predict worse outcomes in this population. To our knowledge, this is the first study to prospectively investigate differences between delirium motor subtypes over functional outcome three months poststroke. Larger studies are needed to elucidate the relationship between motor subtypes of delirium and functional outcomes in the context of acute stroke.

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Introduction Neuromyelitis optica spectrum disorders (NMOSD) is a rare inflammatory and demyelinating disease of the central nervous system (CNS) more frequent in women and Afro-descendants. No previous epidemiological or prognostic study has been conducted in the region of the state of Bahia, Brazilian Northeast. Objective To evaluate clinical and prognostic aspects in patients with NMOSD from a cohort in northeastern Brazil. Material and methods A single-center retrospective study was conducted with consecutive patients diagnosed with NMOSD. Clinical and epidemiological characteristics were described. The degree of disability was expressed by the Expanded Disability Status Scale (EDSS). Worsening disability were analyzed through negative binomial regression adjusted for disease duration. Results Ninety-one patients were included, 72 (79.1%) female and 67 (73.6%) afro descendants. Mean age at onset was 36 (± 14) years and 73.3% were anti-aquaporin-4 antibody positive. Isolated transverse myelitis (32.9%) and isolated optic neuritis (22.4%) were the most frequent initial clinical syndromes. After multivariate analysis, optic neuritis (RR = 0.45; 95% CI = 0.23 – 0.88; p = 0.020) and dyslipidemia (RR = 0.40; 95% CI = 0.20 – 0.83; p = 0.014) were associated with slower disease progression. Area postrema involvement (RR = 6.70; 95% CI = 3.31 – 13.54; p < 0.001) and age at onset (RR = 1.03; 95% CI = 1.01 – 1.05; p = 0.003) were associated with faster disease progression. Conclusions In the first clinical and prognostic study in northeastern Brazil, we identified area postrema involvement, age at onset, optic neuritis at fist syndrome and dyslipidemia as the main prognostic factors associated with disease progression.

Introduction: Neuromyelitis optic spectrum disorders (NMOSD) is a rare inflammatory and demyelinating disease of the central nervous system (CNS) more frequent in women and Afro-descendants. No previous epidemiological or prognostic study has been conducted in the region of the state of Bahia, Brazilian Northeast. Objective: To evaluate clinical and prognostic aspects in patients with NMOSD from a cohort in northeastern Brazil. Material and Methods: A single-center retrospective study was conducted with consecutive patients diagnosed with NMOSD. Clinical and epidemiological characteristics were described. The degree of disability was expressed by the Expanded Disability Status Scale (EDSS). Worsening disability were analyzed through negative binomial regression adjusted for disease duration. Results: Ninety-one patients were included, 72 (79.1%) female and 67 (73.6%) afro descendants. Mean age at onset was 36 (± 14) years and 73.3% were anti-aquaporin-4 antibody positive. Isolated transverse myelitis (32.9%) and isolated optic neuritis (22.4%) were the most frequent initial clinical syndromes. After multivariate analysis, optic neuritis (RR = 0.15; 95% CI=0.03 – 0.59; p = 0.008) and dyslipidemia (RR = 0.07; 95% CI=0.04 – 0.40; p < 0.001) were associated with slower disease progression. Area postrema involvement (RR = 29.69; 95% CI=3.40 – 226.07; p = 0.002) and age at onset (RR = 1.05; 95% CI=1.00 – 1.10; p = 0.037) were associated with faster disease progression. Conclusions: In the first clinical and prognostic study in northeastern Brazil, we identified area postrema involvement, age at onset, optic neuritis at fist syndrome and dyslipidemia as the main prognostic factors associated with disease progression.

Introduction: Delirium is a common disorder in patients after stroke. We designed a study to evaluate the incidence of delirium and risk factors for its occurrence after stroke. Design and setting: Prospective cohort study at Hospital Geral Roberto Santos. Methods: Patients were admitted within 72h of ictus. Delirium was assessed using the Confusion Assessment Method in an Intensive Care Unit scale. Results: 279 patients were enrolled, with a mean age of 61.08 (± 13.05) years, 54.0% of whom were men. The incidence of delirium was 28% (n = 78). Delirium patients were older (68.9 ± 12.6 vs 58.8 ± 12.5; p <0.001) and had a higher NIHSS on admission [11 (7-15) vs 8 (5-12); p <0.001]. The occurrence of delirium was associated with a previous diagnosis of hypertension [RR = 2.62 (1.13-6.09)], hemorrhagic stroke [RR 1.94 (1.13-2.86)], cardioembolic etiology [RR 2.21 (1.22-3.97)] and infection during hospitalization [RR 5.27 (3.54-7.84)]. Independent predictors of delirium: age ≥ 65 years [OR 1.06 (1.02 -1.10)], epileptic seizures in ictus [OR 6.28 (1.65 - 23.91)], infection [OR 14.17 (6.39 - 31.43)] and hemorrhagic stroke [OR 4.04 (1.51-10.78)]. Conclusion: Delirium is a common complication after acute stroke, affecting 28% of patients. In view of the importance of identifying risk factors in the acute setting of stroke, further studies are needed to elucidate the association of the findings with the occurrence of delirium.

Background: Hemorrhagic transformation (HT) is a complication of stroke described as cause of early neurologic deterioration. Previous studies are discordant about the real impact of HT on stroke prognosis. Objectives: to describe the impact of HT in patient prognosis. Design and setting: Prospective cohort with acute ischemic stroke patients from a Stroke Unit, admitted between 2017 to 2020. Methods: All patients performed a brain computer tomography (CT) scan on their arrival and 24 hours later. Patients with or without HT were compared regarding functional 90-day outcome using the modified rankin scale (mRS). Functional disability was considered as mRS < 2. Results: 383 patients were included, mean age was 62,2 (±13,8), which 54,3% were male, 80,9% hypertensive, 33,1% diabetics and 27,2% were dyslipidemic. HT occurred in 11,5% patients (n= 44) increasing the risk of poorer functional outcome in discharge [RR= 1,47; (IC95% 1,25–1,72), in 30 days [RR = 1,54; (IC95% 1,01-1,92)], and in 90 days [RR= 1,39; (IC95% 1,01-1,92)]. Multivariate analysis HT was not associated with worse outcome in 90 days (mRS>2) [OR= 1,01; (IC95% 0,44–2,33) p= 0,987], when adjusted to age, sex, NIHSS, ASPECTS, trombolysis and other relevant variables. Conclusion: Although the occurrency of HT had been associated with worse short-term outcomes, patients seems to recover from disability over time.

Background: Hemorrhagic transformation (HT) is an aggravating factor to patients with ischemic stroke. For patients’ best care, it’s essential to know its predictors. Objective: To describe HT in patients with ischemic stroke. Design and setting: Prospective cohort with ischemic stroke patients from a Stroke Unit, admitted between 2017 to 2019. Methods: All patients performed a brain computer tomography (CT) scan on arrival and 24-hours later. Patients with or without HT were compared for predictors. Results: 363 patients were included, with a mean age of 63,14 (±13,92), 53,1% were male and 9,9% (n= 38) had HT. Thrombolysis didn’t increase the risk of HT [(55,3% vs 42,5%); p= 0,132]. Patients with atrial fibrillation [(31,6% vs 12,6%); p= 0,002], and cardioembolic etiology according with TOAST classification [(57,6% vs 21,7%); p< 0,001] had higher risk of HT. Patients with HT had lower ASPECTS scores on their initial CT [8 (6-9) vs 9 (8-10); p< 0,001] and higher NIHSS scores [12 (9-15) vs 8 (5-12); p< 0,001]. Cardioembolic strokes [OR= 4,67; (IC95% 2,01-10,84)] and higher NIHSS [OR= 1,11; (IC95% 1,01-1,22)] were independently associated with HT after multivariate adjustments, considering ASPECTS and thrombolysis. Conclusion: Cardioembolic etiology and higher NIHSS score were independently associated with HT. It’s essential to know HT predictors due to worse outcomes associated with its occurrence.

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