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.
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