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[Multidisciplinary study of cerebrovascular accidents: I. Definition, design, and general results]
1Departamento de Neurología, Hospital Clínico de la Pontificia Universidad Católica de Chile.
Insights
Cerebrovascular accidents (CVA) are common in Chile, with most strokes being cerebral infarcts, often cardiac-related. A multidisciplinary approach improves diagnosis and management of stroke patients, reducing high mortality rates.
Area of Science:
- Neurology
- Cardiology
- Public Health
Context:
- Cerebrovascular accidents (CVA) are a leading cause of mortality in Chile.
- A prospective study of 300 CVA patients was conducted over two years (July 1987-August 1989).
- The study employed a multidisciplinary approach for comprehensive patient evaluation.
Purpose:
- To investigate the incidence and etiology of cerebrovascular accidents in Chile.
- To evaluate the effectiveness of a multidisciplinary approach in diagnosing and managing CVA.
- To identify risk factors and outcomes associated with CVA.
Summary:
- Cerebral infarcts accounted for 62.3% of CVAs, with 33.5% being cardiac-related. Cerebral hemorrhages occurred in 28.3% of cases, strongly associated with hypertension (76%).
- Transient ischemic attacks represented 9.3% of cases.
- At two months, 16.3% of patients had severe handicaps, and the mortality rate was 19.3%.
Impact:
- The study confirmed cerebral infarcts as the most common CVA type, frequently linked to cardiac issues.
- Hypertension was identified as the primary cause of cerebral hemorrhages.
- A multidisciplinary approach facilitates precise diagnosis, leading to better therapeutic and preventive strategies for reducing CVA incidence and mortality.
Abstract:
Cerebrovascular accidents (CVA) constitute a major cause of adult cardiac cardiovascular mortality in Chile. From July 87 to August 89 we prospectively studied 300 patients with CVA utilizing a multidisciplinary approach. Besides clinical evaluation this included brain CT scan (48 hrs), glucidic and lipid profile. Occlusive CVA were additionally studied with 2D-Echocardiogram, 24 hr Holter, Cerebral Angiography and/or carotid Duplex Echotomograph, and a second brain CT scan was performed within the first week. We found a 62.3% incidence of cerebral infarcts, 28.3% of cerebral hemorrhages and 9.3% of transient ischemic attacks. Cerebral infarcts were found to be cardiac related in 33.5% of cases, whereas 13.2% were lacunar, 4.4% were atherothrombotic and 14% had no precise etiology. Hypertension was associated to cerebral hemorrhages in 76% of cases, 26% of which were intracranial. At 2 months of follow-up 16.3% of patients were severely handicapped and mortality was 19.3%. We have confirmed that cerebral infarcts constitute the most common cause of CVA and most of them are cardiac related. Hypertension appears to be the most important cause of cerebral hemorrhage. A multidisciplinary approach to cerebrovascular accidents allowed a more precise diagnosis and contributed to implement appropriate therapeutic and preventive strategies. Proper identification of high risk patients could contribute to decrease the high incidence and mortality of CVA in our community.