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Introduction: The concept of embolic stroke of undetermined source (ESUS) has recently appeared to better characterise patients with cryptogenic stroke., Patients and Methods: A systematic review of studies published since 2014 was performed to evaluate the epidemiology, clinical features and prognosis of patients with ESUS and their proportion among patients with cryptogenic stroke., Results: Ten studies were identified with a total of 14,810 patients. The frequency of ESUS varied between 6% and 42%. We observed a high percentage of patients with cryptogenic stroke who met ESUS criteria (37-82%). The mean age of these patients was 65-68 years. The mean severity of the stroke, as measured using the National Institutes of Health Stroke Scale, was found to be 3-7 points. A high degree of variability was seen in the proportion of atrial fibrillation (detected during follow-up) related to the electrocardiogram monitoring technique. In five studies, some minor source of cardioembolism was observed in one out of every two patients, the most frequent being the persistence of patent foramen ovale. The risk of recurrence was 5-14.5%., Conclusion: The application of the new ESUS criteria provides a better definition of patients with cryptogenic stroke. Applying the concept of ESUS requires not only adequate electrocardiogram monitoring, but also routine complementary examinations to rule out the presence of minor sources of cardioembolism and other sources of embolism other than atrial fibrillation.

Introduction: Stroke is a recognized cause of disability among adults. However the impact that the deficits that occur after a moderate/severe stroke have on long-term disability, as well as the response of the resultant deficits to rehabilitation, are not completely understood., Patients and Methods: A total of 396 patients with a modified Rankin score >= 3 after an ischemic (n = 221) or hemorrhagic (n = 175) stroke were included in this study. All patients were assessed with cognitive, behavior, emotional, motor and functional domains. All patients were assessed at baseline and six months after inclusion in a multidisciplinary rehabilitation program., Results: Risk of falling (Berg Balance Scale < 45 in 83.1% of the sample at baseline and 49.5% at follow-up) and functional problems (82.8% with a Barthel Index < 75 at baseline and 53% at follow-up) were the most prevalent deficits. Emotional disturbances were those that most improved while behavioral problems were those that did less. Although global disability improved during treatment among most patients, only 11% of our patients, especially those with preserved cognitive function at baseline, could be classified as patients with mild disability at follow-up., Conclusions: Stroke consequences are multidimensional. The symptoms that the stroke can cause in multiple domains, as well as the pattern of recovery are widely diverse, with prevalence of behavioral long-term disturbances.

Aims: To describe the characteristics of cerebrovascular disease (CVD) in patients treated in a paediatric emergency department and to detect clinical differences, depending on whether the condition was ischaemic or haemorrhagic., Patients and Methods: An analytical, observation-based, retrospective study was conducted in the paediatric emergency department of a tertiary care hospital. The sample included patients aged between 1 month and 18 years who were treated in the service over a period of 10 years (January 2001 to December 2011) with a final diagnosis of CVD. Haemorrhages due to traumatic injury or secondary to tumours, thrombosis of the venous sinuses and patients who were not treated in the service were all excluded., Results: The final sample consisted of 61 patients, 39 (63.9%) of whom were males, with a mean age of 4.6 years (range: 1.3 months-17.5 years). Of them, 26 (42.6%) presented ischaemic CVD and 35 (57.4%) had haemorrhagic CVD. Headache (n = 20; 57.1%; p = 0.008) and vomiting (n = 25; 71.4%; p = 0.001) are more frequent in haemorrhagic CVD, and hemiparesis (n = 17; 65.4%; p < 0.001) and facial palsy (n = 7; 26.9%; p = 0.001) in ischaemic CVD. The main causes of haemorrhagic CVD are arteriovenous malformations (n = 17; 38.6%) and the ischaemic ones are triggered by arteriopathies (n = 6; 42.3%). On discharge from hospital, 27 (44.3%) presented different degrees of disability and 6 (9.8%) died., Conclusions: CVD is a rare entity, although it presents a high morbidity and mortality rate. Haemorrhagic CVD is seen to predominate slightly and it is observed how haemorrhagic CVD presents more often with signs of intracranial hypertension, while the ischaemic form tends to have more neurological focus.

Aims: The purpose of the current study is to analyze the labor trajectory, grade of disability and degree of dependence ecognized in a group of people with acquired brain injury with difference types and severity of injuries and with memory deficit as the main cognitive sequel, over a period of two years after the injury and to explore which premorbid clinical and demographic variables related to the brain injury are predictors of the return to work., Patients and Methods: 129 subjects (aged 18-80 years), who were attended by the Neuropsychology and Neuropsychiatry Department of Navarra's Hospital. Qualitative variables were compared using the Chi square test and means were compared using Student t test and to determine the correlation between continuing variables we used Pearson's correlation coefficient., Results: 17.7% returned to work one year after and 25% two years after. The return to work was related to high levels of education. Disability was recognized by 85% of applicants, to psychological factors or physical and psychological in 89% of them. In 77% of applicants was recognized the level of dependence., Conclusions: Results confirm the big impact of acquired brain injury on the career path two years later, in their interaction with their environment and in their level of independence. One of the factors that explain this impact is the memory deficits.

Introduction: There are few resources for acquired brain injury (ABI) in post-hospitalary phase in our country. At this level of carefulness, Personal Autonomy Promotion Center in Bergondo contemplates like a social and health care resource in order to facilitate community integration in subjects with ABI. AIMS. To describe clinical profile in the subjects admitted in our unit, and to assess intervention possibilities with clinico-functional recovery goals in the chronic phases in ABI., Patients and Method: . Sample of 105 subjects admitted in our center until December 2010. 86 men and 19 women, with a mean age of 32.16 years old and a most frequent evolution time of less than 5 years (64.76%). Variables collected were: sex, age, etiology, evolution time, personality changes diagnosis, admission FIM, previous participation in rehabilitation programmes and have recovery goals., Results: The main etiology was traumatic brain injury (62.5%). The 54.28% of the subjects was taking physical rehabilitation at the moment of admission, while the 49.52% had participated in neuropsychological interventions. Physical recovery goals were identified in the 42.85% of the subjects and the 78.09% had goals in neuropsychology field., Conclusion: The clinical profile observed was young man with sequelae caused by a traumatic brain injury suffered in last five years, who has received poor neuropsychological care and that still takes physiotherapy treatment.

Aim: The number of drivers and vehicles crossing our roads increases every year. Driving a car requires cognitive, psychomotor and psychological aptitudes and abilities that they should be assessed when the driving license is getting., Development: The current expectancy of life implies the increasing number of elderly people as drivers. The survival of brain injured people has increased because of scientific and technological improvements. The cognitive, emotional and behavioral sequelae of brain injury could influence in the ability to drive. However, the measures of this driving ability are not yet well established., Conclusion: Having in mind the legal dispositions, we would like to analyse the psychometric tests administering to get the driving licence and their sensitivity to assess brain injured people. It is also important to know how to manage cognitive deterioration drivers.

Background: Atrial fibrillation is present in 24% of the population over 60 and it increases the risk of stroke by 2,4% 3%/year. Antithrombotic treatment is considered as the treatment of choice for cardioembolic stroke prevention in this patients. As far as we know there are not relevant data about the influence of these treatments on the type of stroke that may develop in these patients., Aim: Analyze whether there are differences in the clinical profile and functional prognosis after stroke in patients with atrial fibrillation depending on the type of treatment they were on at the time of occurrence of the event., Patients and Methods: We identified 67 patients who were admitted consecutively to our stroke unit with a stroke and atrial fibrillation over a period of 2 years. Patients were classified according to the type of antithrombotic treatment they were on. Functional prognosis was estimated by Rankin score at discharge., Results: Treated patient showed a non significant tendency to suffer less severe strokes and present a better functional situation at discharge than those who were not on prophylactic treatment. Treated patients had a significant higher prevalence of previous TIA (44,2% vs 9,1%; p= 0,0042) and HBP (81,4% vs 52%; p= 0,041) than non treated patients. Embolic strokes were more frequent in non treated patients., Conclusion: Antithrombotic treatment not only prevents strokes but may also contribute to the development of less severe strokes with a better functional prognosis in patients with AF and does not contribute to increase complications in these group of patients.

Introduction: Rupture of intracranial aneurysms causes nearly 80% of all spontaneous subarachnoid haemorrhages., Objective: To determine the variables with prognostic value in view of the results of patients operated on for intracranial aneurysms. Patients and methods. The sample was made up of 100 patients from whose clinical histories useful data was obtained. This data was then fed into a database using DBASE111 and discriminant analysis made to determine the variables of predictive value regarding mortality., Results: The average age was 45 years, with a predominance of women. Arterial hypertension was observed in 52.9% of the patients. The patients with the best pre operative evaluation on the WFNS scale obtained the best results. Correct evaluation of 97% of the cases was done on discriminant analysis of certain variables studied. Excellent results were obtained by 75% of the patients, 10% had a slight degree of disability, four patients had severe disability and 11 patients died, five of them of non neurological conditions., Conclusions: The application of discriminant analysis made it possible to determine amongst over 50 variables studied, a group which by themselves lead to the definite classification of our patients regarding survival. These were: the state of the brain during operation, number of post operative complications, difficulty in dissecting the sac of the aneurysm, early rupture of the aneurysm, pre operative neurological state and action on the aneurysm.

Introduction and Objective: Establishment of the prognosis after traumatic brain damage is an important question for doctors, patients and their families, as well as for health organizations and insurers. The precision of the prognosis varies markedly according to the final objective of the prediction (mortality, severity and type of residual defects, return to work), apart from consideration of the many factors which may affect the clinical course after this type of lesion. Our study considers the current state of this question., Development: We consider the main methodological difficulties in carrying out such studies and review the main variables affecting the prognosis in head injuries, divided into three general groups (severity and type of lesion, characteristics of the individual and variables depending on the context). Finally, we make general comments on the effect of multidisciplinary rehabilitation in relation to the functional prognosis and level of social and employment integration attained by the injured persons.

Introduction: Perinatal asphyxia (PA) and its neurologic manifestations are the most important cause of brain injury and neurologic sequelae in full-term infants. The objective of this study is to analyze the perinatal risk factors of neurologic sequelae in asphyctic term newborns., Patients and Methods: One hundred and fifty-six consecutive asphyctic term infants were studied prospectively during 40 months. PA was graded in two stages (severe and non-severe), hypoxic-ischemic encephalopathy classification was based on Levene's criteria, and neurologic sequelae was based on Finer and Amiel-Tisson's criteria. The perinatal variables were graded as prenatal (gestational and obstetrics), neonatal (resuscitation, general data of the newborn, and organic manifestations of asphyxia) and postneonatal (neurologic sequelae with at least 24 months of follow-up). The relationships between these variables are studied by univariant and multivariant analysis (Cox's regression)., Results: PA was graded as severe in 31 cases and non-severe in 125. Neurologic manifestations (hypoxic-ischemic encephalopathy) during neonatal period were present in 25.6%, and extraneurologic manifestations (hypoxic-ischemic disease) in 41.7% cases. The incidence of neurologic sequelae, in 115 asphyxiated full-term infants follow-up at least 24 months, was 16.5% (19 cases). The perinatal variables associated to risk of neurologic sequelae on univariate analysis are variables of neonatal resuscitation (1 minute Apgar score < or = 4, 5 minute Apgar score < or = 6, endotracheal intubation, severity of PA) and variables of systemic manifestations (hypoxic-ischemic encephalopathy, cardiovascular and multi-systemic dysfunction, and mechanical ventilation). But only two variables are independently associated on multivariate analysis: severe PA (RR = 2.82; IC = 1.07-7.39) and hypoxic-ischemic encephalopathy (RR = 4.17; IC = 1.48-11.75)., Conclusions: The best predictive risk factors for the neurological prognosis at follow-up are severe PA at birth and/or evidence of encephalopathy in neonatal period.

Introduction: Approximately 20% of all ischemic strokes are due to cardioembolism and occur more frequently in the younger patients. Our objective was to determine the clinical characteristics and course of cardioembolic infarcts (ICCE) comparing them with infarcts due to other aetiologies (ICNCE)., Patients and Methods: We made a prospective study of 354 patients admitted to hospital over a period of one year, after excluding transient ischaemia and parenchymatous/subarachnoid hemorrhage. Two groups were established: ICCE (29.4%) and ICNCE (70.6%), comparing age, sex, risk factors and course of the illness. Subsequently a study lasing two years was done to assess the recurrence rate., Results: The ICCE patients were older (75.89 compared with 72.58, p = 0.004), often know the exact time of onset of their symptoms (p = 0.015) and usually are admitted to hospital during the first six hours of their illness (p = 0.01). There was a significantly higher incidence of ischemic cardiopathy or auricular fibrillation (p = 0.0052); p = 0.005); more complications arose (p = 0.000); stay in hospital was longer (13.62 as compared to 11.8 days; p = 0.035), there was a lower weekly BI score (p = 0.0023) and higher mortality (p = 0.000). In the subgroup of 70 patients evaluated two years later 11 cases recurred, with no difference observed between the anticoagulant and anti-aggregant groups., Conclusion: The ICCE occurs in older patients, they develop worse neurological defects, have a worse short-term prognosis, develop more complications and have significantly greater mortality.

Introduction: Perinatal asphyxia and its neurological signs are the most important cause of brain damage and neurological sequelae in full term newborn babies. Neuroprotection treatments currently being investigated promise to reduce such sequelae, but these treatments are not without risk and the patients involved should be selected., Objective: To analyze a scale composed of variables recorded from the start of delivery until the fourth hour of life, comparing the neurological evolution of the patients. By means of this scale we aim to establish a criterion for the selection of neonates with acute perinatal asphyxia, who would benefit from neuroprotector treatment., Patients and Methods: A retrospective study was made of 50 patients with the diagnosis of perinatal asphyxia. Our scale was formed of the following variables: intrauterine meconiorrhexis, pathological cardiotocographic recordings, resuscitation at birth, Apgar score at five minutes, pH of the umbilical artery blood, neurological examination, multisystemic involvement, seizures, persistent metabolic acidosis and need for mechanical ventilation during the first hours of life. The patients were followed up for at least one year by means of periodical studies (neurological examination and evaluation of psychomotor development according to the Brunnet Lezinne test). For statistical analysis we used the chi squared test, Fisher's exact test, Kruskal-Wallis test and the area beneath the ROC curve., Results and Conclusions: The scale presented constitutes a rapid, easy method which is statistically significant for the selection of perinatal asphyxia of high neurological risk which would benefit from neuroprotector treatment after the event.

Introduction: The relationship between brief loss of consciousness, subsequent cognitive and emotional complaints, and impact on daily functioning continues to be hotly debated., Development: In this paper the strong variability about prevalence of the postconcussional syndrome found in several studies is outstanding and the main issues of this disagreement are suggested. Recent neuroimaging techniques are discussed and some neuropsychological measures are suggested., Conclusions: Currents models (organic/psychogenic) of postconcussional symptoms are reviewed, and a multifactorial model which integrates biological factors with the relevance of neuropsychological deficits--attention, memory, speed of information processing--and coping process is proposed. Finally, according with this model, we conclude with some suggestions to improve neuropsychological intervention and medical treatment of these patients.

Introduction: The obstetric and neonatal technological advances have changed the frequency and syndromic classification of perinatal brain lesions., Objective: To study all prevalent patients during 1996, with perinatal or late intrauterine brain lesions, in the outpatient neuropediatric clinic at our hospital., Methods: Selection of patients according to neuroimaging findings, and/or neurological sequela with documented perinatal antecedent., Exclusion Criteria: a normal MRI, brain lesions of doubtful origin, or uncertain sequela with normal CT or echography studies. Descriptive study, and also analytical, using logistic regression to study the relationship between antecedents and sequela., Results: A total of 111 patients with: brain lesions due to hypoxic-ischemic encephalopathy (22 cases), lesions due to prematurity (29), late intrauterine infection or neonatal meningitis as the only cause of fixed neurological impairment (12), unexpected vascular brain lesions during the neonatal period (11), late intrauterine brain lesions (37). The neurological sequela observed were: cerebral palsy (68%), epilepsy (47%), mental retardation (45%), learning disorders in (34%) of those of school age and free from mental retardation, strabism (26%), microcephaly (19%), visual impairment (14%), hyperkinesis (10%). The neuroimaging findings were: focal lesions (45%), hydrocephaly (28%), intraventricular haemorrhage (22%), white matter lesions (24%), venous thrombosis (2%). The multivariable analysis showed, as the most noticeable finding, the relationship between the antecedent of mechanical ventilation and late development of hyperkinesis (OR: 10), in this sample of patients with severe sequela. Three patients should be noted: a case of late-onset dystonia secondary to a late intrauterine brain lesion, a child with exclusively cerebellar symptoms due to a destructive cerebellar lesion of prenatal onset, and a patient with an acquired perinatal biopercular lesion and pseudobulbar palsy as the only long-term sequelae.