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INTRODUCTION: Elevated flow velocity in the internal carotid artery or middle cerebral artery, detected by transcranial Doppler (TCD) ultrasonography, predicts an increased risk of stroke in children with sickle cell disease. OBJECTIVE: To describe the characteristics of TCD and to evaluate ischemic stroke risk in children with sickle cell anemia. METHODS: We prospectively studied 107 patients less than 16 years old remitted from Hematology and Immunology Institute of Havana with the diagnosis of sickle cell disease. The risk of stroke was classified according to the highest time averaged mean blood flow velocity (TAMM), according to STOP study. RESULTS: The mean age of patients was 9.6 years. An 86.9% have TAMM velocity in middle cerebral arteries below to 170 cm/s and 7% over 200 cm/s. There was an inverse correlation between the age and the level of the hemoglobin with the blood flow velocity in the studied arteries. We found inter-hemispheric asymmetry in the flow velocity of anterior cerebral artery in 38.3% of the cases, followed by the middle cerebral artery (30.8%) and the 15.9% of the extracraneal internal carotid artery. CONCLUSION: The risk of ischemic stroke in these patients appears to be lower than that described in the literature. The high flow velocity in cerebral arteries is uncommon. In contrast, hemispheric asymmetries between homologous vessels are frequent. [ABSTRACT FROM AUTHOR]

Objective: To describe clinical outcomes and costs of patient management in acute phase using Cuban clinical practice guidelines in two health institutions in Havana. Methods: We performed a descriptive observational study, and from the axis of an economic evaluation was a description of costs and consequences. The universe was all patients admitted with stroke in two hospitals: the Teaching Surgical Hospital "Dr. Salvador Allende" and General Teaching Hospital "Comandante Manuel Fajardo" in a period of 6 months between 2010 and 2011. (n=13 and n=23, respectively). Results: For both groups the mortality was low, while the disability of patients at discharge was high according to the mean Barthel Index (40.4 for the Hospital S. Allende and 37.7 for M. Fajardo Hospital). In the Hospital Manuel Fajardo were observed total costs and institutional slightly higher than Salvador Allende Hospital, but these differences will be statistically significant. The total cost per patient was between 2300 and about 2500 pesos. The institutional cost per patient was 1400 pesos and 1700 pesos. Although the institutional cost represented between 50 and 70% of the total, expenditure per patient was high, with values between 800 and nearly 1000 Cuban pesos. In both hospitals were high institutional cost and expense budgets. No significant differences were found in the direct medical cost in either cost or emergency stroke unit. Conclusions: The management of stroke patients, on the basis of Cuban clinical practice guidelines showed favourable clinical results in terms of lethality, not so much in levels of disability at discharge, which was accompanied by increased spending for both institutional and family resources. This was accentuated by being inserted the stroke unit in the neurology ward. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous intracerebral hemorrhage (SICH) constitutes a major problem for human and for public health worldwide. The surgical management of SICH is one of the most controversial issues in neurosurgery because of the shortage of evidence supporting this intervention. Objective: To assess the "Roberto Rodriguez" University Hospital experience with surgical treatment in patients with SICH. Method: We have carried out a descriptive study in the "Roberto Rodriguez" university hospital in Moron, Ciego de Avila, with all the patients which were operated on with the diagnosis of supratentorial SICH admitted in the period from January 2000 to December 2010. Results: 52 patients were included, more than half 31 (59.62%) were operated on in coma. Decompressive craniectomy with open evacuation of the clot was the surgical procedure used in 28 cases (53.85%) (p=0.000). The mortality rate was 34.62% and an overall unsatisfactory outcome was present in 59.61% of the patients. Conclusion: Because of the shortage of evidence supporting many of the medical and surgical intervention in SICH the statistical results should not define the treatment in this disease. The patients with CT scan criteria for surgical treatment should be operated on in the best possible neurological state. [ABSTRACT FROM AUTHOR]

Objective: To identify the frequency of congenital anomalies located in Middle Cerebral Artery (MCA) in patients with aneurism in this vessel. Methods: The investigation was based on the evaluation of angiographic studies of 156 patients with Subarachnoid Hemorrhage admitted to Stroke Unit, in Hermanos Ameijeiras Hospital, between January 2006 and December 2008. Cerebral aneurysms were present in 118 patients, 31 aneurysms were localized in MCA in 27 patients. A total of 312 MCA were examined in 156 patients searching for the following MCA anomalies: duplication, hypoplasia or aplasia, accessory artery, fenestration, isolated branch and cuadrifurcation. Results: There were two cases with MCA anomalies in 31 MCA with aneurysms (6.5%), whereas the anomalies considered were not present in 281 non aneurysmal MCA examined. The abnormalities detected were duplication of MCA and fenestration of segment M1, both cases have a giant aneurysm of the affected MCA. Conclusions: Anomalies of MCA are very unusual, although can be associated with an aneurysm of the involved vessel. [ABSTRACT FROM AUTHOR]

Objective: To study the changes of stroke management in a tertiary center of Havana, after the introduction of a Stroke Unit with multidisciplinary team approach. Methods: We compare stroke patients assisted in Hermanos Ameijeiras Hospital in two separate periods characterized by different strategies of care. In the first period (2002-2003) stroke care was not specialized and multidisciplinary team does not exist, while in the second period (2006-2007), stroke care was organized, centralized in a Stroke Unit and headed by a specialized multidisciplinary team. Information collected from hospital records included date of birth and sex of patient, admission and discharge dates, discharge status, length of hospital stay, and diagnosis. Results: In the period 2002-2003, 656 stroke patients were admitted to the hospital and 598 in the period 2006-2007. In the second period there was an increment of patients with subarachnoid hemorrhage (110 to 156 patients), but a decrement of patients with cerebral hemorrhage (114 to 66 patients), and stroke of undetermined cause (91 to 13 patients). Specialized stroke care reduce hospital mortality (17.4 % to 11.0 %), the major impact was in ischemic stroke. The total duration of the hospital stay was inferior in patients managed in Stroke Unit with multidisciplinary stroke team (13.9 days), in contrast with those managed with a non-specialized approach (15.7 days), but the difference was not significant. Conclusions: Specialized stroke care increased tertiary functions of the hospital. In the new context, hospital mortality and hospital stay decreased. [ABSTRACT FROM AUTHOR]

Introduction: Cerebrovascular disease is the third-leading cause of death and the second-leading cause of disability and dementia., Objective: Determine stroke incidence and risk factors in a population of adults aged 65 and over in Cuba (Havana and Matanzas)., Material and Methods: This prospective longitudinal study, completed between April 2008 and Abril 2011, re-evaluated 2916 elderly adults with an average follow-up time of 4 years. Cases included 2316 living subjects and 600 verbal autopsies. Study variables were age, sex, educational level, self-reported health, and description of chronic diseases and substance abuse. Laboratory tests included genotyping APOE. Stroke was diagnosed based on the World Health Organization definition. We calculated the global incidence rate for stroke, broken down by sex, age group, and risk factors for incident stroke., Results: Stroke incidence was 786.2 in 100000 persons/year (95% CI: 672.3-906.4). History of alcohol consumption (HR: 3.5; 95% CI: 3.3-3.7), dementia (HR: 3.0; 95% CI, 1.6-5.5) and male sex (HR: 1.8; 95% CI, 1.2-2.8) were shown to be risk factors for incident stroke., Conclusions: Stroke incidence was similar to rates reported in developed countries and lower than that in low- to middle-income countries. Given that diabetes mellitus, heart disease, arterial hypertension, smoking, APOE4, etc. are associated with higher mortality rates, they will require separate analysis in a study of stroke risk factors., (Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)