Little is known about stroke patients' awareness about the warning signs of stroke and its therapeutic time window in Brazil. Method: We interviewed consecutive patients with acute stroke admitted to a terciary public hospital in Brazil. Data collected included demographics, mode of arrival, National Institutes of Health Stroke Scale (NIHSS) scores and knowledge of stroke warning signs and therapeutic time window. Early arrival was defined as within 4.5 hours of symptoms onset. Results: Although 66.2% of patients knew the warning signs of stroke, only 7.8% reported to know that stroke had a limited therapeutic time window. Stroke severity measured by the NIHSS was independently associated with early arrival, but not knowledge of stroke signs and symptoms. Conclusion: Knowledge about stroke symptoms was not a predictor of early arrival.Keywords: stroke, public awareness, knowledge. RESUMOPouco se sabe sobre o conhecimento dos pacientes com acidente vascular cerebral (AVC) acerca dos sinais de alarme da doença e sua janela terapêutica no Brasil. Método: Foram entrevistados consecutivamente os pacientes com AVC agudo internados em um hospital público terciário no Brasil. Os dados coletados incluíram dados demográficos, o modo de chegada, escala de AVC do National Institute of Health (NIH) e conhecimento sobre a janela de tempo terapêutica e os sinais de alerta do AVC através de um questionário padronizado. Chegada precoce foi definida como aquela dentro de 4,5 horas do início dos sintomas. Resultados: Embora 66,2% dos pacientes sabiam os sinais de alerta do AVC , apenas 7,8% relataram saber que a doença tinha uma janela de tempo terapêutica limitada. A gravidade do AVC avaliada pela escala do NIH foi preditora de chegada precoce, mas conhecimento acerca dos sinais e sintomas do AVC não foram. Conclusão: O conhecimento acerca dos sintomas do AVC não foi preditivo de chegada precoce ao hospital.Palavras-chave: acidente vascular cerebral, sensibilização pública, conhecimento.Stroke is a major public health problem and the leading cause of mortality in Brazil. In 2005, 10% of all deaths in the country (90,006 deaths) as well as 10% of all public hospital admissions were due to stroke 1,2 . Intravenous thrombolytic therapy for ischemic stroke was approved in Brazil in 2001 but the number of patients who have access to stroke reperfusion therapies remains low, despite the advances in stroke treatment in the country 3 . Early hospital presentation is a prerequisite for successful management of acute ischemic stroke 4 . Many factors contribute to delays in seeking for treatment for acute stroke. However, the most important is lack of public awareness regarding stroke symptoms and the need for a rapid response 5 . A previous community-based study has shown alarming lack of awareness about stroke in Brazil. Most of the studies evaluating knowledge about stroke symptoms in the country have been conducted in the general population 6,7,8 . Little is known about stroke patients' awareness about stroke warning signs and i...

-We performed a cross-sectional study of stroke type frequency at a local emergency hospital, in Natal, Brazil. The sample consisted of all patients who were admitted to an emergency hospital with a presumptive diagnosis of stroke. Of the 416 patients, 328 were studied, 88 were excluded for not meeting inclusion criteria, 74.7% (n= 245) had ischemic stroke 17.7% (n=58) had intracerebral hemorrhage, 7.6% (n=25) had subarachnoid hemorrhage; 173 were men (52.7%). Mean age was 64.1 years. The intrahospital mortality rate was 10.2%, 17.2% and 36% for ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage, respectively. The most prevalent modifiable risk factor was hypertension for ischemic stroke (67.6%) and hemorrhage stroke (57.8%). Logistic regression analysis identified diabetes (OR=3.70; CI=1.76-7.77) as independent risk factor for ischemic stroke. The ischemic stroke was most common type of stroke. Hypertension and diabetes were important risk factors for stroke.KEY WORDS: stroke, Brazil, hypertension. Freqüência dos tipos de acidente vascular cerebral em hospital de emergência, Natal, BrasilRESUMO -Realizamos um estudo de prevalência para determinar a freqüência dos tipos de acidente vascular cerebral (AVC) num hospital de urgência de Natal. Estudaram-se todos os pacientes que foram admitidos no hospital de urgência com diagnóstico presuntivo de AVC. Dos 416 pacientes, 328 foram estudados, 88 foram excluídos por não cumprirem os critérios de inclusão, 74,7% (n= 245) tiveram AVC isquêmi-co, 17,7% (n=58) hemorragia intracerebral e 7,6% (n=25) hemorragia subaracnóidea. O gênero mais prevalente foi o masculino (52,7%). A média de idade foi 64,1 anos. A letalidade intra-hospitalar foi de 10,2%, 17,2% e 36% para o tipo isquêmico, hemorrágico e hemorragia subaracnóide, respectivamente. O principal fator de risco modificável foi a hipertensão arterial sistêmica (HAS) para AVC isquêmico (67,6%) e AVC hemorrágico (57,8%). A regressão logística identificou diabetes como fator de risco independente para AVC isquêmico (OR=3,70; IC=1,77 Dr. Mario E. Dourado -Rua Marcílio Furtado 2042 -59063-360 Natal RN -Brasil. E-mail: medourado@digi.com.br Stroke has become an increasingly important health problem worldwide. There are about 5.5 million yearly deaths and an estimated loss of 49 million disability-adjusted life years worldwide 1-4 . Hypertension and age are the main risk factors for the different types of stroke, which include ischemic (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). The management strategies of these ailments are distinct, since they are heterogenous diseases 5 . There has been a decreasing trend in incidence and mortality from stroke in the USA and Europe 6,7 . In contrast, its incidence has increased in developing countries, which may be due to the rapid aging of the population, and increased prevalence of stroke risk factors resulting from change in diet, sedentary lifestyle and diabetes 2 . Lavados et al. showed a raw annual stroke incidence of 95.8 p...

OBJECTIVE:Atrial fibrillation is a common arrhythmia that increases the risk of stroke by four- to five-fold. We aimed to establish a profile of patients with atrial fibrillation from a population of patients admitted with acute ischemic stroke or transient ischemic attack using clinical and echocardiographic findings.METHODS:We evaluated patients consecutively admitted to a tertiary hospital with acute ischemic stroke or transient ischemic attack. Subjects were divided into an original set (admissions from May 2009 to October 2010) and a validation set (admissions from November 2010 to April 2013). The study was designed as a cohort, with clinical and echocardiographic findings compared between patients with and without atrial fibrillation. A multivariable model was built, and independent predictive factors were used to produce a predictive grading score for atrial fibrillation (Acute Stroke AF Score-ASAS).RESULTS:A total of 257 patients were evaluated from May 2009 to October 2010 and included in the original set. Atrial fibrillation was diagnosed in 17.5% of these patients. Significant predictors of atrial fibrillation in the multivariate analysis included age, National Institutes of Health Stroke Scores, and the presence of left atrial enlargement. These predictors were used in the final logistic model. For this model, the area under the receiver operating characteristic curve was 0.79. The score derived from the logistic regression analysis was The model developed from the original data set was then applied to the validation data set, showing the preserved discriminatory ability of the model (c statistic = 0.76).CONCLUSIONS:Our risk score suggests that the individual risk for atrial fibrillation in patients with acute ischemic stroke can be assessed using simple data, including age, National Institutes of Health Stroke Scores at admission, and the presence of left atrial enlargement.

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Introduction: Distal hyperintense vessels (DHV) detected by FLAIR imaging are not uncommon in patients with acute ischemic stroke. The presence of DHV and its predictors has been scarcely evaluated in patients with transient ischemic attack (TIA), being associated to the presence of large vessel occlusion in such patients. We assessed the hypothesis that DHV are frequent in patients with TIA and do correlate with relevant clinical and neuroimaging characteristics. Methods: We evaluated a database of consecutive patients admitted with TIA from February 2009 to June 2012 who had undergone magnetic resonance imaging within 30 h of symptoms onset and intracranial and extracranial vascular imaging. We analyzed the relationship between DHV, clinical presentation, risk factors, neuroimaging characteristics and large artery stenosis or occlusion. DHV signals were defined on FLAIR images as focal, linear or serpentine, hyperintense signals relative to gray matter. Two neuroradiologists blinded to clinical information reached consensus regarding the presence of DHV. Results: Seventy-two TIA patients were enrolled. The median time from symptoms onset to MRI was 8:39 h [4:21, 14:13]. DHV signals on FLAIR images were present in 12 (16.7 %) patients. The overall agreement between examiners was good (k 0.67). Patients with DHV had more atrial fibrillation (AF) than those without (41.7% versus 21.7%, p=0.05) and a trend towards more congestive heart failure (CHF) (8.3% versus 1.7%, p=0.2) and diabetes (41.7% versus 21.7%, p=0.1). There were no differences in the frequency of intracranial or cervical arterial stenosis, cerebral microbleeds and white matter abnormalities in patients with and without DHV. In a multivariate logistic regression analysis, only AF had a trend to be a predictor of DHV (OR=4.24, p=0.1). The statistical model to predict DHV including AF, diabetes, and CHF had a moderate fit in terms of discrimination (c statistic=0.62) Conclusion: DHV signals on FLAIR images occur in patients with TIA and might correlate with clinical variables like AF and not only with large vessel occlusion as previously described. The presence of DVH in patients with TIA and AF might be a surrogate marker for a previous large vessel occlusion spontaneously recanalized.

A 27-year-old woman presented with sudden onset left-sided numbness and double vision. In the last 10 years, she developed diabetes mellitus, cataract, osteoarthritis, osteoporosis, benign neoplasm of the skull, epilepsy, and nonscarring alopecia. Her parents were first-degree relatives and there were no relatives with similar disease. On examination there were right internuclear ophthalmoplegia, short stature, tight skin, hyperkeratosis (figure 1), cataract, and mild cognitive impairment. Brain MRI disclosed acute brainstem ischemic infarct and severe leukoaraiosis with multiple old lacunar infarcts secondary to small-vessel disease (figure 2). Antinuclear antibodies and anticardiolipin and lupus anticoagulant antibodies were normal or negative. Genetic testing was not available.The patient presents with 5 cardinal and 3 minor features of Werner syndrome, which is an unusual autosomal recessive inherited disorder caused by mutations in the WRN gene on chromosome 8.1 It encodes a protein with helicase and exonuclease activities, absence of which leads to abnormalities in several DNA repair and processing pathways. Werner syndrome is the most common adult-onset progeria. The disease is characterized by premature aging and propensity for cancer.