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.
Introduction: The classification of strokes subtypes is important, since they have different management and prognoses. This study aims to verify associations between the etiologies of the stroke according to the TOAST classification and the clinical presentation by the subtypes of the Oxfordshire scale. Methods: A descriptive cross-sectional study, with patients admitted to a stroke unit of a reference hospital in Salvador-BA between 11/2017 and 03/2020. We included patients over 18 years of age and didn’t include patients with inaccuracies in the filling of medical records or who didn’t meet the criteria for admission to the cohort. Results: 300 patients between 25 and 98 years old (mean: 64 years; SD: 13.34) were analyzed. Regarding cardioembolic etiology (CE), 34 patients (45.3%) had lacunar syndromes (LACS) and 25 (33.3%) Partial Anterior Circulation Syndrome (PACS). Patients with Large Artery Atherosclerosis (LAA) 24 (40.7%) had PACS while 21 (35.6%) of the LACS patients diagnosed with small vessel occlusion (SVO) 22 (62.9%) had LACS. Futhermore, patients with cryptogenic strokes (CS) had predominantly PACS and LACS, 27 (31%) and 40 (46%) respectively. Conclusion: Based on the results of acute strokes of CE, SVO and CS origin are related to LACS. The events originated by LAA are more associated with PACS. Events caused by SVO were related to lacunar syndromes, corroborating with findings in the literature.
Introduction: The etiologic classification of ischemic stroke according to TOAST is fundamental in stablishing the correct treatment to patients in order to prevent recurring strokes, besides helping to determine their prognosis. Objectives: To determine the relationship between TOAST and functional outcome 90 days after ischemic stroke, using the modified Rankin scale (mRS). Design and Setting: It’s a cross-sectional study with patients from HGRS – Salvador, Bahia. Methods: We classified all patients according to TOAST and stratified the mRS post-90 days in “functional independence” (mRs 0-2) and “functional dependence/death” (mRs 3-6). We included patients > 18 years old, admitted up to 72 hours from ictus, excluding those previously dependent (mRs ≥ 3). We used central tendency measures, chi- squared test and relative risk (RR). We considered IC = 95% and p <0,05 for statistical significance. Results: We included 268 patients. 59 had large-artery atherosclerosis (LAA), 39 small- vessel occlusion (SVO), 74 cardio embolism (CE) and 84 cryptogenic stroke (CS). There was no difference in gravity in admission between the groups nor in functional outcome in 90 days when the etiologies were grouped (p=0,07). Using CS as reference, CE had RR=1,34, LAA RR=1,31, SVO RR=0,99 for functional dependence (mRS ≥ 3) in 90 days. Conclusions: The RR analysis numerically shows that CE and LAA elevated the risk of functional dependence in 90 days in 30%. Bigger studies are required to sensitize the analysis.
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