Browsing by Author "Cárcamo, Daniel"

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Accuracy of diffusion-weighted imaging in the diagnosis of stroke in patients with suspected cerebral infarct
    (American Heart Association, 2013) Brunser, Alejandro; Hoppe, Arnold; Illanes, Sergio; Díaz, Violeta; Muñoz, Paula; Cárcamo, Daniel; Olavarría, Verónica; Valenzuela, Marcela; Lavados, Pablo
    BACKGROUND AND PURPOSE: The accuracy of diffusion-weighted imaging (DWI) for the diagnosis of acute cerebral ischemia among patients with suspected ischemic stroke arriving to an emergency room has not been studied in depth. METHODS: DWI was performed in 712 patients with acute or subacute focal symptoms that suggested an acute ischemic stroke (AIS), 609 of them with AIS. RESULTS: DWI demonstrated a sensitivity of 90% and specificity of 97%, a positive likelihood ratio of 31 and a negative likelihood ratio of 0.1 for detecting AIS. The overall accuracy was 95%. Of those patients who demonstrated abnormal DWI studies, 99.5% were AIS patients, and of those patients with normal DWI studies 63% were stroke mimics. CONCLUSIONS: DWI is accurate in detecting AIS in unselected patients with suspected AIS; a negative study should alert for nonischemic conditions.
  • Thumbnail Image
    Item
    Accuracy of Power Mode TranscranialDoppler in the Diagnosis of Brain Death
    (2015) Brunser, Alejandro; Lavados, Pablo; Cárcamo, Daniel; Hoppe, Arnold; Olavarría, Verónica; López, Javiera; Muñoz, Paula; Rivas, Rodrigo
    Background:The diagnosis of brain death (BD) is complex. For this reason, we aimed toevaluate the accuracy of power mode transcranial Doppler (PMD-TCD) in diagnosing BD.Patients and methods:Patients admitted to an intensive care unit between December 2003and January 2012 were included in this study if they were in a structural coma, had nocraniectomy, and were evaluated blind by a neurologist using PMD-TCD. The diagnosis of BDwas based on an evaluation that took into consideration the absence of sedative drugs, amedian blood pressure>60 mmHg, a body temperature>35 C, and the absence of brainstemreflexes. A neurosonologist followed a protocol using PMD-TCD that considered the examina-tion as positive for brain circulatory arrest given the presence of reverberating, small systolicpeaks or the disappearance of a previous signal present in both middle cerebral arteries andintracranial vertebral arteries.Results:A total of 74 patients were evaluated. In 61 (82.4%) patients the interval betweenboth evaluations was less than 1 hour. The sensitivity and specificity for the diagnosis of BD with PMD-TCD were 100% and 98%, respectively. The positive and negative likelihood ratios forBD were 45 and 0, respectively.Conclusion:PMD-TCD is accurate for the diagnosis of BD.
  • Thumbnail Image
    Item
    Breaking Down Barriers: Easter Island's First Telestroke Thrombolysis Experience and Case Report
    (2022) Mazzon, Enrico; Arévalo, Mirya; Mirelis, Samuel; Delfino, Carlos; Rojas, Diego; Lara, Luis; Cárcamo, Daniel; Jurado, Felipe; Rocha, Diego; Muñoz, Paula; Mansilla, Eloy
    Easter Island (Rapa Nui), Chile, is remote, located in the Polynesian Triangle in Oceania. The closest continental point is Chile, 3,512 km east. It has a population of 7,750 inhabitants, who are Chilean citizens, and receives more than 60,000 tourists a year. For this entire population, there is a medium complexity hospital without a neurology specialist. In 2019, local professionals were trained in a Telestroke program with remote clinical support conducted by neurologists located on mainland Chile. We present a 50-year-old native male, with unknown medical history, who suddenly presented right-half-body weakness and aphasia. He was evaluated via Telestroke consultation, and thrombolysis with tenecteplase was indicated. The patient improved rapidly and 45 min later the NIHSS score was 0 points. To our knowledge, this is the first reported case of Telestroke treatment in such a remote area, highlighting the importance of telemedicine to overcome geographical and technological stroke care barriers and to improve patients' outcome, no matter where they live.
  • Thumbnail Image
    Item
    Socioeconomic and Cardiovascular Variables Explaining Regional Variations in Stroke Mortality in Chile: An Ecological Study
    (2011) Lavados, Pablo; Díaz, Violeta; Jadue, Liliana; Olavarría, Verónica; Delgado, Iris; Cárcamo, Daniel
    Background: Regional differences in stroke mortality rates have been described in Chile. These could be related to the distribution of cardiovascular risk factors, the quality of medical care or socioeconomic status influencing incidence or case fatality rates. Our objective was to investigate variables explaining the variability in stroke mortality rates in the different regions of Chile. Methods: Adjusted stroke mortality rates in different regions were calculated for the year 2003. Variables were added from three sources: the National Death Certificate Database, the National Socioeconomic Characterization Survey and the National Health Survey. A logistic regression model was used to investigate regions, demographic variables and socioeconomic variables associated with the risk of death from stroke. A linear regression model was used to study the association of socioeconomic variables and cardiovascular risk factors with the standardized mortality rate by region and the contribution of these to the variability. Results: A twofold increase was found in adjusted stroke mortality rates among regions. Greater risk was associated with older age, female gender and residence in regions V, VII, VIII and IX. Sixty-two percent of the regional variability rate was explained by the combined prevalence of poverty (34%), diabetes (17%), sedentarism (8%) and overweight (3%). Conclusion: The risk of death from stroke in Chile is associated with age, sex and living in four specific regions of the country. The majority of the increased risk in these regions is explained by the prevalence of poverty, diabetes, a sedentary lifestyle and overweight. Copyright (C) 2011 S. Karger AG, Basel
  • Thumbnail Image
    Item
    Sonotrombolisis en el ataque cerebrovascular isquémico: once años de experiencia en Clínica Alemana de Santiago
    (Sociedad Médica de Santiago, 2014) Brunser, Alejandro; Hoppe, Arnold; Muñoz, Paula; Cárcamo, Daniel; Lavados, Pablo; Gaete, Javier; Roldán, Andrés; Rivas, Rodrigo
    Background: Sonothrombolysis (ST) is an emerging modality for the treatment of stroke. Aim: To assess the feasibility to perform ST in a Chilean hospital. Material and Methods: Patients attended at a private clinic with an acute ischemic stroke, between September 2002 and May 2013 and eligible for endovenous thrombolysis, were studied with a transcranial Doppler (Spencer PMD 100 or 150®). Those with an adequate sonographic window and a demonstrated arterial occlusion were monitored continuously with transcranial Doppler at the site of worst residual flow following the CLOTBUST study protocol. Results: One thousand twenty six patients were studied, of whom 136 received intravenous thrombolysis (rt-PA) and 61, aged 66 ± 18 years (59% males), were subjected to ST (7% of total). Their median National Institutes of Health Stroke Scale score was 14, the lapse from symptom onset to rt-PA was 127 minutes (43-223). Middle cerebral artery (MCA) occlusion was found in 88.5% of patients. Complete recanalization was achieved in 44.3% of patients. Sixty percent had Modified Rankin Scale of 0 to 2 at 3 months (95% confidence intervals (CI) 48.1 to 72). Case fatality was 9.8% and asymptomatic intracranial hemorrhage occurred in 9.8% (95% CI: 4.3 to 20.2). Conclusions: ST can be carried out in a complex medical center and is safe.
  • Thumbnail Image
    Item
    Validez del Doppler transcraneal en el diagnóstico de muerte encefálica
    (2010) Brunser, Alejandro; Hoppe, Arnold; Cárcamo, Daniel; Lavados, Pablo; Roldán, AndrésS; Rivas, Rodrigo; Valenzuela, Marcela; Montes, José Miguel
    The clinical diagnosis of brain death is complex. Aim: To evaluate the diagnostic accuracy of transcranial Doppler (TCD) for brain death. Patients and Methods: Patients seen on the intensive care unit of a private hospital between January 2004 to December 2008, were included if they were in structural coma, had no craniectomy and had a blind evaluation by a neurologist and TCD done in less than three hours. The diagnosis of brain death was based on a clinical evaluation that considered the absence of sedative drugs, median blood pressure >60 mmHg, body temperature over 35º Celsius and complete absence of brainstem reflexes. An expert neurosonologist, with a TCD-PMD-100, 2 Mhz transducer, used an institutional protocol that considers the examination as positive for brain circulatory arrest when there is presence of reverberating, small systolic peaks or the disappearance of a previous signal present on both middle cerebral arteries and intracranial vertebral arteries. Results: Fifty three patients were evaluated, 25 with clinical brain death. On 45 cases (84.9%), the interval between both evaluations was less than one hour. The sensitivity, specificity, positive and negative predictive values for the diagnosis of brain death with TCD were 100, 96, 96.1 and 100% respectively. Positive and negative likelihood ratios for brain death were 28 and 0, respectively. Conclusions: TCD is a valid and useful technique for the diagnosis of brain death and can be used on complicated cases.
  • Thumbnail Image
    Item
    Validity of the NIHSS in predicting arterial occlusion in cerebral infarction is time-dependent
    (2011) Delgado, Iris; Hoppe, Arnold; Brunser, Alejandro; Cárcamo, Daniel; Lavados, Pablo; Olavarría, Verónica; Díaz Tapia, V.
    Background: The NIH Stroke Scale (NIHSS) is used to assess acute ischemic stroke severity and outcome. High NIHSS scores are usually associated with arterial occlusion but it is unknown what the effect of time to clinical evaluation (TTCE) in this association is. We tested the NIHSS scores as an instrument to determine vessel occlusion (VO) at different time points from symptom onset. Methods: Patients were selected from our prospective stroke database if they had admission NIHSS scores and intracranial vessel neuroimaging studies. We dichotomized patients according to VO and TTCE. Receiver operating curves, c statistics, and odds ratios were calculated to study the validity of the NIHSS score. Results: Among 463 patients (mean age 70.2 years, 53.1% male, median NIHSS 4, median TTCE 3.3 hours), 22.5% had arterial occlusion. Median NIHSS scores were higher in patients with VO, 10.5 (interquartile range 5-18) vs 3 (2-7), p < 0.001, and in those with TTCE < 6 hours, 15 (interquartile range 7-19) vs 4 (2-8) if >= 6 hours, p < 0.001. Receiver operating characteristic curves showed that the validity of NIHSS in predicting VO was higher in patients with TTCE < 6 hours, p = 0.03. The best cutoff point in patients evaluated before 6 hours was an NIHSS of 7 (76.2% sensitivity, specificity 70.1%), while in patients evaluated after 6 hours the best cutoff point was 4 (sensitivity 65.4%, specificity 62.0%). Conclusions: Our study shows that the validity of NIHSS scores in predicting arterial occlusion is time-dependent, decreasing with increasing time from symptom onset to clinical evaluation. Neurology (R) 2011; 76:62-68

Implementado por OpenGeek Services