Search

Introduction: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009., Material and Methods: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine., Results: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7 days a week in 2009). There were 3 hospitals offering clinical telemedicine services., Conclusions: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS., (Copyright © 2010 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Proliferative granulomatous arachnoiditis is an infrequent manifestation of central nervous system tuberculosis. The mortality rate is 30%, and there are functional sequels in almost all patients. We present the case of a 22-year-old woman, immunocompetent that suffered form tuberculous radiculo-myelopathy with fatal evolution, which allowed us to confront neuroimaging and neuropathological findings. Although serial MR imaging illustrated evolution of lesions, autopsy revealed more extensive lesions that those observed in neuroimaging studies. The characteristic pathological lesion was an intradural inflammatory exudate with a global medullar necrosis. Even through duration of medical treatment is still discussed, early diagnosis, complete antituberculous drug regimen and prolonged corticosteroid therapy are essential to avoid fatal evolution as occurred in this case.