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- Isolated vocal cord paresis as a presentation of acute ischemic strokePublication . Valente, Diana; Gil, InĆŖs; Jacinto, Filipe; Freitas, LuĆs; Nzwalo, HipĆ³lito; Felix, CatarinaStroke presenting with predominant laryngeal dysfunction manifestations is often part of a clinical constellation of neurological signs associated with acute medullar lesion [1]. Isolated laryngeal symptoms as a stroke presentation are extremely rare due to the intimal anatomical relation of swallowing-related structures with the ascending/descending tracts in the lateral medulla [2]. Herein we present a case with isolated vocal cord paresis as the sole manifestation of acute ischemic stroke.
- Ischemic stroke and subarachnoid hemorrhage following Epstein-Barr virus infectionPublication . Rios, Jonathan; FĆ©lix, Catarina; ProenƧa, Paula; Malaia, LuĆs; Nzwalo, HipĆ³litoThe epidemiological link between inflammation, infection, and acute ischemic stroke (AIS) is well known.1 Transient prothrombotic status and vasculitis are possible explanatory factors.1 Aneurysm formation in association with central nervous system infections is occasionally reported.2 Ischemic or hemorrhagic complication in relation to neurotropic virus infections, including Epstein-Barr Virus (EBV) are rarely reported in adults. Thus, we report here an extremely rare case of ischemic and hemorrhagic cerebrovascular complications in the context of EBV neuroinfection.
- Non-ketotic hyperglycaemia induced occipital reflex focal seizuresPublication . Buque, Helena; Catamo, Deise; Felix, Catarina; AndrĆ©, Ana; Gil, InĆŖs; Nzwalo, HipĆ³litoA myriad of neurological manifestations can occur in association with ketotic and non ketotic hyperglycaemic states. Contrary to diabetic coma, which is a universal complication under relatively established metabolic circumstances, the pathophysiology beyond hyperglycaemicassociated positive neurological manifestations, including seizures, remains to be elucidated. The occurrence of symptomatic focal epilepsy as a manifestation of diabetes-related hyperglycaemia is seldom reported. Herein, we present a case of focal epilepsy with alternating positive and negative neurological manifestations as the initial manifestation of diabetes-related hyperglycaemia. The electroencephalogram confirmed the diagnosis of focal occipital seizures, and the brain magnetic resonance imaging depicted the associated typical transient imaging findings in the occipital lobe. Seizures were refractory to antiepileptics, and symptomatic control was achieved after achieving normoglycemia. On follow-up, complete clinical and imaging recovery occurred. Reflex focal epilepsy in the context of hyperglycaemic states is a rare condition, and the possibility of misdiagnosis is likely high. As reported in similar cases, seizures can be resistant to antiepileptics. An important message to highlight is that seizures associated with hyperglycaemic status can be resistant to antiepileptic treatment and only cease with glycaemic control.
- Prediction of short-term prognosis in elderly patients with spontaneous intracerebral hemorrhagePublication . Batista, AntĆ³nio; OsĆ³rio, Rui; Varela, Ana; Guilherme, PatrĆcia; Marreiros, Ana; Pais, Sandra; Nzwalo, HipĆ³litoAim The incidence of spontaneous intracerebral hemorrhage (SICH) increases with age. Data on SICH mortality in the very old are sparse. We aimed to describe the predictors of 30-day SICH mortality in the very elderly in southern Portugal. Methods A total of 256 community representative SICH patients aged >= 75 years (2009-2016) were included. Multiple logistic regression was used to identify predictors of 30-day mortality. Results Mean age was 82.1 years; 57.4% males. The 30-day case fatality was 38.7%. The frequency of patients taking anticoagulants (29.3% vs. 11.5%); comatose (46.9% vs. 2.5%); with hematoma volume >= 30 mL (64.6% vs. 13.4%); intraventricular dissection (78.8% vs. 27.4%) was higher in deceased patients (p < 0.05). Survivors were more often admitted to stroke unit (SU) (68.2 vs. 31.3%) and had lower mean admission glycaemia values (p < 0.05). The likelihood of death was increased in patients with higher admission hematoma volume (>= 30 mL) (OR: 8.817, CI 1.753-44.340, p = 0.008) and with prior to SICH history of >= 2 hospitalizations OR = 1.022, CI 1.009-1.069, p = 0.031). Having higher Glasgow coma scale score, OR: 0.522, CI 0.394-0.692, p < 0.001, per unit was associated with reduced risk of death. Age was not an independent risk factor of short-term death. Conclusions The short-term mortality is high in very elderly SICH. Prior to SICH history of hospitalization, an indirect and gross marker of coexistent functional reserve, not age per se, increases the risk of short-term death. Other predictors of short-term death are potentially manageable reinforcing the message against any defeatist attitude toward elderly patients with SICH. Key summary pointsAim Identification of predictors of short-term death after spontaneous intracerebral hemorrhage (SICH) in the elderly. Findings The short-term case fatality (38.7%) after SICH is high in the elderly. Hematoma volume, decreased level of consciousness and functional reserve, but not age per se, increase the risk of short-term death. Message Age per se should not justify any decision of withholding best treatment in elderly SICH patients. Offering the best acute treatment can potentially improve the clinical outcome.
- Predictors of pneumonia in patients with acute spontaneous intracerebral hemorrhage in Algarve, Southern PortugalPublication . Soares, Rita; Fernandes, Adriana; Taveira, Isabel; Marreiros, Ana; Nzwalo, HipĆ³litoIntroduction: Following the hyperacute phase of spontaneous intracerebral hemorrhage (SICH), the severest form of stroke, pneumonia emerges as the leading cause of morbidity and mortality. Prevention of stroke associated pneumonia (SAP) is fundamental to improve the prognosis of SICH patients. Aim: Identify clinical, sociodemographic and process of care factors associated with occurrence of SAP after SICH in Algarve, southern Portugal. Methods: Observational, retrospective study of community representative consecutive case series of patients with SICH admitted to the sole public hospital in the region. Logistic regression was used to identify predictors of SAP after SICH. Results: A total of 525 patients were included. The mean age was 71 ( +/- 13) years and 64% were men. SAP occurred in 165 (31.5%). Lower Glasgow Coma Scale score (GCS score): <= 8 (OR= 2.087; 95% CI= [1.027;4.424]; p = 0.042) and GCS 9-12 (OR= 1.775; 95% CI= [1.030;3.059]; p = 0.039); prolonged emergency room stay (OR= 8.066; 95%CI=[3.082;21.113]; p < 0.001) and hyperactive delirium (OR=2.860; 95% CI= [1.661;4.925]; p < 0.001) increased the likelihood of SAP. Being younger, = 59 years (OR= 0.391; 95% CI= [0.168; 0.911]; p = 0.029) and 60-71 years (OR= 0.389; 95% CI= [0.185; 0.818]; p = 0.013); and having less severe SICH/intracerebral hemorrhage score (ICH score) <= 2 (OR=0.601; 95% CI= [0.370; 0.975]; p = 0.039), decreased the risk of SAP. Conclusion: After SICH, SAP occurs in approximately a third of patients. Non preventable (admission severity, ageing) and potentially preventable (prolonged emergency room stay, hyperactive delirium) determine the occurrence of SAP. Intensification of preventive intervention in high-risk patients, delirium prevention and improvement of the process of care can potentially reduce the occurrence of SAP after SICH.
- Internuclear ophthalmoplegia, skew deviation and nystagmus from facial colliculus infarction: small lesion big troublePublication . Valente, Diana Vilares; de Almeida, TomĆ”s Duarte; Gil, InĆŖs; Nzwalo, HipĆ³lito; FĆ©lix, Ana CatarinaIsolated internuclear ophthalmoplegia (INO) is an extremely rare presentation of stroke [1ā3]. INO is defned by the presence of ipsilateral adduction paresis with contralateral dissociated nystagmus on horizontal gaze and is caused by strategic brainstem lesions involving the medial longitudinal fasciculus (MLF) [2, 3].
- Stroke-associated cortical deafness: a systematic review of clinical and radiological characteristicsPublication . Silva, Gracinda; GonƧalves, Rita; Taveira, Isabel; Mouzinho, Maria; OsĆ³rio, Rui; Nzwalo, HipĆ³litoBackground: Stroke is the leading cause of cortical deafness (CD), the most severe form of central hearing impairment. CD remains poorly characterized and perhaps underdiagnosed. We perform a systematic review to describe the clinical and radiological features of stroke-associated CD. Methods: PubMed and the Web of Science databases were used to identify relevant publications up to 30 June 2021 using the MeSH terms: ādeafnessā and āstrokeā, or āhearing lossā and āstrokeā or āauditory agnosiaā and āstrokeā. Results: We found 46 cases, caused by bilateral lesions within the central auditory pathway, mostly located within or surrounding the superior temporal lobe gyri and/or the Heschlās gyri (30/81%). In five (13.51%) patients, CD was caused by the subcortical hemispheric and in two (0.05%) in brainstem lesions. Sensorineural hearing loss was universal. Occasionally, a misdiagnosis by peripheral or psychiatric disorders occurred. A few (20%) had clinical improvement, with a regained oral conversation or evolution to pure word deafness (36.6%). A persistent inability of oral communication occurred in 43.3%. A full recovery of conversation was restricted to patients with subcortical lesions. Conclusions: Stroke-associated CD is rare, severe and results from combinations of cortical and subcortical lesions within the central auditory pathway. The recovery of functional hearing occurs, essentially, when caused by subcortical lesions.
- Determinants of quality of life after stroke in Southern Portugal: a cross sectional community-based studyPublication . LourenƧo, Eva; Sampaio, MĆ”rio Rui dos MĆ”rtires; Nzwalo, HipĆ³lito; Costa, EmĆlia Isabel; Ramos, JosĆ© Luis SĆ”nchez: Introduction: the perception of Quality of Life (QoL) has been used to evaluate the treatment and evolution of several pathologies. QoL evaluation allows a better understanding of the patient and his adaptation to the disease. An observational, community-based and descriptive correlational study was carried out to analyze stroke survivorsā perception of QoL. Methods: consecutive caseseries of stroke survivors (ā„3 months) followed in a single public primary health center (āTavira Primary Health Centreā) from Algarve, southern Portugal. The Portuguese version of the World Health Organization Quality of life instrument was administered in 102 stroke survivors. Results: Perception of QoL was associated (p < 0.05) with specific sociodemographic (age, sex, marital status, academic training), economic (monthly family income) and clinical factors (number of vascular risk factors, type of stroke, evolution, chronic mRankin score). On multivariate analysis, chronic mRankin score on physical (R2 = 0.406; F = 8.757; p < 0.001), psychological (R2 = 0.286; F = 5.536; p < 0.001) and general domain (R2 = 0.357; F = 7.287; p < 0.001); and family income (R2 = 0.160; F = 3.156; p < 0.005) on environmental domain, emerged as predictors of QoL. Conclusion: Different socio-demographic, economic and health factors are associated with post-stroke QoL. Description of QoL contributes to the overall evaluation of the impact of stroke on health and should be a priority for health professionals.
- Cortical deafness of following bilateral temporal lobe strokePublication . Silva, Julia; Sousa, Marisa; Mestre, Susana; Nzwalo, Isa; Nzwalo, HipĆ³litoCortical deafness is an extremely rare clinical manifestation that originates mainly from bilateral cortical lesions in the primary auditory cortex. Its main clinical manifestation is the bilateral sudden loss of hearing. Diagnosis is difficulty due to its rarity and similarity with other language and communication disorders, such as Wernicke's aphasia, auditory agnosia or verbal deafness. Herein, we present a case report of a young woman with a sudden bilateral loss of auditory comprehension. Initially, a psychiatric nature of the disorder was considered, but the persistence of the symptoms, lead to the diagnosis of cortical deafness secondary to bilateral ischemic lesions in both temporal lobes. Progressive improvement occurred and three months after the initial manifestations she manifested pure verbal deafness. Cortical deafness usually has a poor functional prognosis, with limited therapeutic options. Rehabilitation and speech therapy is recommended to improve the chance of patients achieving communication skills.
- Tratamento Endovascular no Acidente Vascular Cerebral IsquĆ©mico: āUrgĆŖncia na ReduĆ§Ć£o das AssimetriasāPublication . Nzwalo, HipĆ³lito; Botelho, Ana; Gil, InĆŖs; Baptista, Alexandre; Fidalgo, Ana PaulaLemos com bastante satisfaĆ§Ć£o o estudo de Dias et al1 publicado na Acta MĆ©dica Portuguesa que revelou as assimetrias nacionais no acesso ao tratamento endovascular (TEV) no acidente vascular cerebral (AVC) isquĆ©mico por oclusĆ£o de grande vaso proximal (OVP). Felizmente, no perĆodo em anĆ”lise houve melhoria nacional das taxas de TEV, mais evidente nos distritos prĆ³ximos de hospitais com TEV (HCTEV), tendo-se demonstrado a disparidade regional nos tempos de atraso da TEV. Nesse sentido, realƧamos que a mediana do tempo AVC - primeira porta de entrada na via verde foi 13 minutos inferior nos doentes transferidos num hospital sem TEV (HSTEV) em comparaĆ§Ć£o com os doentes cuja primeira porta foi um HCTEV. Ć um dado que possivelmente reflete a pressĆ£o de seleĆ§Ć£o com prejuĆzo dos doentes que chegam no limite temporal para TEV nos HSTEV.