Risultati per: Position paper della French Headache Society sul trattamento dell'emicrania

Stroke, Ahead of Print.

Stroke, Volume 53, Issue 3, Page 1043-1050, March 1, 2022. For more than a year, the SARS-CoV-2 pandemic has had a devastating effect on global health. High-, low, and middle-income countries are struggling to cope with the spread of newer mutant strains of the virus. Delivery of acute stroke care remains a priority despite the pandemic. In order to maintain the time-dependent processes required to optimize delivery of intravenous thrombolysis and endovascular therapy, most countries have reorganized infrastructure to optimize human resources and critical services. Low-and-middle income countries (LMIC) have strained medical resources at baseline and often face challenges in the delivery of stroke systems of care (SSOC). This position statement aims to produce pragmatic recommendations on methods to preserve the existing SSOC during COVID-19 in LMIC and propose best stroke practices that may be low cost but high impact and commonly shared across the world.

Stroke, Volume 53, Issue Suppl_1, Page ATP93-ATP93, February 1, 2022. Introduction:Compared to White patients, non-White minority populations are less likely to receive acute treatment for ischemic stroke, and when they do, it can be delayed.Hypothesis:To evaluate the interaction between arrival method (transfer vs. emergency medical services [EMS] vs. private vehicle) and race/ethnicity (non-Hispanic Black [NHB] vs. non-Hispanic White [NHW] vs. Hispanic) on door-to-arterial puncture (DTAP) time in thrombectomy.Methods:Multicenter retrospective cohort study of consecutive patients (≥18 years) treated with endovascular thrombectomy at 14 US Comprehensive Stroke Centers (1/1/2019-07/31/2020). Door (arrival) to arterial puncture (DTAP) was evaluated using a linear mixed model to estimate the effect of race/ethnicity and arrival mode on treatment time.Results:Of the 1,908 included patients, 356 (19%) of whom were Hispanic, stroke severity was similar between race/ethnicity groups, however Hispanic and NHB patients experienced significant delays in DTAP compared to NHWs (adjusted βHisp= 0.32, 95%CI 0.08-0.55; βNHB= 0.23, 95%CI 0.04-0.41). In the final linear mixed model, more severe neurologic deficits were associated with shorter DTAP (βNIHSSper point -0.03, 95%CI -0.04- -0.03), and arrival via EMS or private vehicle versus transfer were associated with longer delays (βEMS= 0.57, 95%CI 0.41-0.74; βPV= 1.27, 95%CI 0.85-1.70). There was a significant interaction between Hispanic ethnicity and arrival by EMS (p=0.03) or private vehicle (p=0.04) in a direction favoring shorter treatment delays.Conclusions:Endovascular therapy is delayed in Hispanic and NHBs when compared to NHWs. While arrival by EMS or private vehicle (vs. inter-hospital transfer) also contributed to treatment delays, Hispanic ethnicity modified this effect such that there was less delay in DTAP. This may be related to communication barriers between caregivers and healthcare providers when a patient is suddenly disabled from stroke.

Stroke, Volume 53, Issue Suppl_1, Page ATMP91-ATMP91, February 1, 2022. Introduction:Headache and anxiety are poorly described in children with moyamoya vasculopathy following revascularization.Hypothesis:Headache and anxiety in pediatric moyamoya patients are common co-morbidities and result in frequent healthcare utilization.Methods:In this single-center retrospective cohort study, children (

Stroke, Volume 53, Issue Suppl_1, Page ATP195-ATP195, February 1, 2022. Introduction:The prevalence of stroke is progressively increasing in developing countries owing to the increase in vascular risk factors in the population. Risk factors vary significantly in different population groups leading to variations in disease progression, management and outcomes. This study aims to describe the epidemiology, prevalent risk factors and outcomes in a multi ethnic society of Qatar.Methods:We conducted a retrospective cohort study that included all patients with suspected stroke admitted to Hamad General Hospital, Doha Qatar between April 30, 2014 till September 15, 2020.Results:A total of 11,892 patients were admitted during this period with suspected stroke. Of these, Ischemic stroke (IS; 48.8%), Transient ischemic attack (TIA; 10.3%), Intracerebral hemorrhage (ICH; 10.9%), Stroke mimics (28.6%) and Cerebral venous sinus thrombosis (CVST; 1.3%). Mean age was 53.1+14.1 and a male to female ratio of 3:1. Study population was majorly Asian (56.8%) and Arab (36%); while African (4.5%), Caucasian (2.6%) and Others (0.1%) formed minority of the population. Asian population (South Asian; 49.7+11.6 and Far Eastern; 47.4+9.9) were younger as compared to Arabs (58.9+15.9). Majority of the patients were hypertensive (66.8%), diabetic (47.9%) and dyslipidemic (45.9%) on admission, while cardiac diseases (14.7%) and DVT (0.3%) were observed in fewer patients. Patients with a history of prior stroke were 11.7%, while 0.9% had a prior TIA. In IS patients, 31.7% of the patients arrived ED within the 4.5-hour thrombolysis window, 12.5% received thrombolysis and 4.6% received thrombectomy. The average Door-to-Needle time for IS patients was 58.9+39.5 minutes. The average length of stay was 5.2+9.0 days with 71.5% discharged home, 13.8% transferred to rehabilitation, 9.3% to other specialties, 3% to long term care and 2.4% suffered in-hospital mortality.Conclusion:The patients suffering Stroke in Qatar are relatively younger than western population. Highly prevalent vascular risk factors could explain younger presentation and relatively high burden of stroke. Further analysis of epidemiological differences between ethnic subgroups can help tailoring effective preventive and management policies to reduce the burden of disease.

Stroke, Volume 53, Issue Suppl_1, Page AWMP55-AWMP55, February 1, 2022. Introduction:When a stroke hospitalization follows soon after an Emergency Department (ED) treat-and-release visit for non-specific neurological complaints, a diagnostic error may have occurred. In this study, we sought to evaluate potential stroke misdiagnoses after ED treat-and-release headache visits.Methods:We conducted a retrospective cohort study using state-wide administrative claims data for all ED visits and admissions at nonfederal hospitals in Florida 2005-2018 and New York 2005-2016. Using standardICDcodes, we identified adult patients discharged home from the ED with a benign headache diagnosis (cohort of interest) as well as those with a diagnosis of back pain or renal colic (negative control cohorts). The primary study outcome was hospitalization within 30 days for stroke (ischemic or hemorrhagic), defined using validatedICDcodes. We used Cox proportional hazards modeling to assess the relationship between the index ED visit reason and stroke hospitalization adjusting for demographics and vascular risk factors.Results:We identified 1,458,904 patients with an ED treat-and-release headache visit; mean age was 41 (SD: 17) and 70% were female. A total of 2,636 (0.18%) headache patients were hospitalized for stroke within 30 days. Stroke risk was higher among headache patients compared to patients diagnosed with renal colic (HR: 2.7; 95% CI, 2.3-3.1) or back pain (HR: 3.8; 95% CI, 3.6-4.1; Figure). Among patients

Stroke, Volume 53, Issue Suppl_1, Page ATP111-ATP111, February 1, 2022. Background & Purpose:Severe headache is a hallmark of spontaneous subarachnoid hemorrhage (SAH), affecting nearly 90% of patients during index hospitalization. In addition, up to 25% of SAH-survivors experience chronic headaches. Despite its high prevalence, means of management of headaches are limited, largely reliant on opioids, and often ineffective. Urgent efforts to reduce opioid use require innovative treatment strategies for the management of post-SAH headaches.Methods:This is a retrospective cohort comprising 12 adults who received bilateral pterygopalatine fossa (PPF) blockade from 9/2018 to 3/2021 for refractory headaches after spontaneous SAH. We examined pain scores, analgesic requirements and transcranial doppler ultrasound (TCD) parameters before and after the block placement. Descriptive statistics were calculated for all variables.Results:Twelve patients (mean age 54 years, 66% females, nine aneurysmal and three non-aneurysmal SAH) received PPF-block on post-bleed day 2 to 11 (median 6.5) during hospitalization in the neurointensive care unit. Hunt and Hess scores ranged from 1-3. Pain scale scores from 24-hour period before the block (8.8 ±1.4; mean, SD) decreased significantly to a mean of 5.1 (SD ± 3.0) until 20 hours post-block (p = 0.0156). Opioid use also decreased significantly from median (range) oral morphine equivalent dose (mg) administered in the 24h before the block of 22.5 (0-75) vs. 7.5 (0-45) after PPF-block (p=0.0391). Five (41%) patients had radiographic (but not clinical) vasospasm by TCD criteria before PPF-block; in four of these patients, TCD velocities improved on the day after PPF-block, in one patient velocities were increased on the day after PPF-block. The block was well tolerated with no adverse events of bleeding, infection, pain, or numbness at the injection site.Conclusion:These results demonstrate that PPF-blockade might be a promising alternative for managing post-SAH headaches. Further prospective controlled randomized powered to address the safety and efficacy of the PPF-block are warranted.

Stroke, Volume 53, Issue Suppl_1, Page A63-A63, February 1, 2022. Background:Safety and efficacy of recanalization treatments,i.e.intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT), have to be refined in pediatric stroke.Methods:The French KIDCLOT multisourcing nationwide retrospective study (NCT03887143) collected data of consecutive children aged >28 days and