Background: Intravenous thrombolysis is the standard medical treatment for acute ischemic stroke (AIS) within 4.5 hours of symptom onset, and symptomatic hemorrhagic transformation (sHT) is the most feared complication of this treatment. Objective: To describe the prevalence, risk factors, treatment and outcome of sHT. Design and setting: This is a retrospective cross-sectional study in a quaternary care hospital in Sao Paulo, Brazil. Methods: We reviewed 90 records of patients with AIS submitted to thrombolysis from March 2018 to February 2020. Evaluation of brain imaging after thrombolysis and the treatment initiated after detection of hemorrhage were made. Results: The overall prevalence of HT was 18.9% (n = 17, mean age 69.4±14.6 years, 58.8% males) and 8.9% (n = 8) of sHT. The most prevalent comorbidities were renal impairment (82%), hypertension (76.4%), diabetes mellitus (35.2%), atrial fibrillation (35.2%) and smoking (35.2%). The median baseline NIHSS score was 17. The most prevalent radiological classification of post-thrombolysis HT was class 2 (41.1%) from the Heidelberg Bleeding Classification. Cryoprecipitate and tranexamic acid were administered in 11.8% (n = 2). The mortality rate for HT was 35.3% (n = 6). Antiplatelet or anticoagulant therapy was initiated after a mean of 24.6 days from HT diagnosis and there was no stroke recurrence at 90 days. Conclusion: We showed a prevalence of sHT and related risk factors aligned with other studies, but with high mortality rates, despite being a stroke service. The late initiation of antiplatelets or anticoagulants did not lead to stroke recurrence at 90 days.
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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: Stroke is characterized by the acute onset of one or more neurologic deficits that persist for at least 24 hours, and is the result of a vascular disorder in a defined territory, being the leading cause of disability. Late complications, such as sexual dysfunction, have a direct impact on psychological and emotional aspects and directly affect the quality of life of these patients. Objectives and methods: Cross-sectional study that aimed to determine the prevalence of sexual dysfunction in patients with ischemic stroke followed in the neurovascular outpatient clinic of a tertiary hospital in São Paulo, Brazil, using the Female Sexual Quotient (FSQ) questionnaire. The FSQ can range from 0-100 points. Higher values indicate better sexual performance/satisfaction and a score of 60 points or less was considered as having sexual dysfunction. Casuistics and results: Sixty-five questionnaires were analyzed and classified according to the FSQ score. Mean age was 52 years and median FSQ score was 54 points. Of the interviewees, 30.7% had their sexual performance classified as poor-null, 13.85% of patients had poor-unfavorable sexual performance, 15.38% as unfavorable-regular. Regular-good and good-great sexual performance were found in 21.54% and 18.46%, respectively. Discussion: In this study, only 40% of post-stroke women have regular-good and good-great sexual performance. The impact of the stroke on the sexual life of these patients is high, because most of the interviewees had sexual dysfunction according to FSQ. Conclusion: The health professional must be aware of the non-motor sequelae caused by the stroke and be prepared to help these patients in coping with sexual dysfunctions.
Introduction: Stroke is the leading cause of disability worldwide. Late complications, such as sexual dysfunction, have a direct impact on psychological and emotional aspects and directly affect the quality of life of these patients. Objectives and methods: We present a cross-sectional study that aimed to determine the prevalence of sexual dysfunction in patients with ischemic stroke followed in the neurovascular outpatient clinic of a tertiary hospital in São Paulo, Brazil, using the Male Sexual Quotient (MSQ) questionnaire. The MSQ can range from 0-100 points. Higher values indicate better sexual performance/satisfaction and a score of 60 points or less was considered as having sexual dysfunction. Casuistics and results: Fifty eight questionnaires were analyzed and classified according to the MSQ score. Mean age was 60 years and median MSQ score was 64 points. Of the interviewees, 24.14% had their sexual performance classified as poor-null, 17.24% of patients had poorunfavorable sexual performance, 6.90% as unfavorable-regular; regulargood and good-great sexual performance were equally found in 25.86% of the subjects. Discussion and conclusion: In this study, almost half of post-stroke men have sexual dysfunction according to MSQ, indicating a high impact of such a condition in the quality of life of our patients due to its prevalence. Thus, the health professional dealing with post-stroke patients must be aware and prepared to help patients in coping with sexual dysfunctions.
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.
Background: Depression is the most common psychiatric complication in stroke patients. Its impact is relevant and implies greater functional impairment, delays in the rehabilitation process and recurrence of cardiovascular events. Objectives: To investigate the prevalence of depression and its association with other comorbidities in post-stroke patients. Design and setting: A cross-sectional, observational study conducted at a specialized outpatient clinic in Sao Paulo, Brazil. Methods: The Patient Health Questionnaire-9 (PHQ-9), a 9-item summed scale, with scores ranging from 0 (no depressive symptoms) to 27 (all symptoms occurring daily), was applied to 134 stroke survivors between September 2019 and February 2020. Demographic and clinical data were obtained using the same structured questionnaire by neurologists. Results: Moderate to severe depression (PHQ-9 ≥10) was present in 40 (29.9%) patients, of whom 55% were female, 70% were overweight or obese (BMI ≥25) and only 27.5% were over 60 years. 80% of patients had some comorbidity: systemic arterial hypertension in 57.5%, diabetes in 32.5%, cardiac arrhythmias in 22.5% and history of heart attack in 5%. Current and past tobacco smoking was found in 67.5% of patients and half of them were current smokers. Conclusions: The prevalence of depression among stroke patients was high in our study and mostly associated with other comorbidities. Our data show the need to actively search for symptoms related to this condition, aiming for early diagnosis and appropriate treatment.
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