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Síndromes do tronco cerebral em doentes seguidos no Hospital Pêro da Covilhã - ULS Cova da Beira
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Abstract(s)
Introdução: Os acidentes vasculares cerebrais (AVC) do tronco cerebral representam
entre 10-15% de todos os AVC. Apesar de menos frequentes, apresentam maior
morbimortalidade comparativamente com os AVC da circulação anterior. Fatores de
risco como diabetes mellitus, hipertensão arterial (HTA), dislipidemia, tabagismo e
fibrilhação ou flutter auricular são fatores de risco (FR) modificáveis que devem ser tidos
em conta. Este estudo propõe-se a caracterizar detalhadamente os doentes com AVC do
tronco cerebral seguidos no Hospital Pêro da Covilhã - Unidade Local de Saúde da Cova
da Beira (ULSCB - HPC), assim como analisar correlações entre informações clínicas e
as etiologias dos eventos com os achados imagiológicos.
Materiais e Métodos: Estudo observacional, transversal e retrospetivo de doentes
com diagnóstico definitivo de AVC isquémico do tronco cerebral, seguidos na Unidade
de AVC do ULSCB - HPC, entre 2021 e 2023. Da amostra selecionada de 36 doentes
foram analisadas múltiplas variáveis destacando: idade, sexo, FR, topografia da lesão,
classificação TOAST (Trial of ORG 10172 in Acute Stroke Treatment), identificação da
lesão em tomografia computadorizada (TC) ou ressonância magnética (RM), escala de
Rankin modificada, tratamento instituído, entre outras. A análise foi efetuada com
recurso ao SPSS, versão 28, utilizando-se a estatística descritiva para caracterização da
amostra, e na análise de correlação os testes do qui-quadrado, Exato de Fisher, Welch e
Kruskal-Wallis.
Resultados: Este estudo teve uma maior proporção de homens (63,9%) e apresentou
uma média de idades de 67,50 ± 12,13 anos. Destaca-se a presença de sintomas motores
em 63,9% dos doentes. A distribuição por topografia revelou predomínio de lesões
protuberanciais (47,2%). Entre os FR avaliados, a HTA foi o mais prevalente (80,6%;
n=29). Quanto à classificação TOAST, os AVC de etiologia indeterminada foram os mais
frequentes (41,7%; n=15). Salienta-se que 55,6% (n=20) dos doentes não apresentava
lesão numa TC mas apenas na RM realizada posteriormente. 26 casos foram passíveis de
correspondência com uma síndrome do tronco específica, sendo a Síndrome de
Wallenberg (22,2%; n=8) a mais prevalente. Não se verificou nenhuma correlação
positiva ou estatisticamente significativa entre a topografia da lesão e a classificação
TOAST (p = 0,500), os fatores de risco (p=0,607) ou a idade (p=0,072), nem entre a
classificação TOAST e a idade (p=0,367). Conclusão: As características sociodemográficas e clínicas da população em estudo são
semelhantes à maioria dos estudos descritos na literatura, com algumas discrepâncias
em certas variáveis, como os sintomas mais prevalentes, a distribuição percentual das
síndromes específicas e a prevalência de alguns FR e dos tratamentos instituídos. Este
estudo reforça a importância de uma avaliação minuciosa dos achados clínicos para um
diagnóstico e abordagem célere desta entidade. Além disso, o controlo dos FR mais
prevalentes deve ser o ponto-chave na prevenção primária desses doentes no que diz
respeito aos seus outcomes.
Introduction: Brainstem strokes account for 10-15% of all strokes. Despite being less frequent, they are associated with higher morbidity and mortality compared to anterior circulation strokes. Modifiable risk factors such as diabetes mellitus, hypertension (HTN), dyslipidemia, smoking, and atrial fibrillation or atrial flutter should be considered. This study aims to provide a detailed characterization of patients with brainstem stroke followed at Hospital Pêro da Covilhã – Unidade de Saúde local da Cova da Beira (ULSCB - HPC) and to analyze correlations between clinical data, stroke etiologies, and imaging findings. Materials and Methods: This is an observational, cross-sectional, and retrospective study that included patients with definitive diagnosis of ischemic brainstem stroke admitted to the Unidade de AVC of ULSCB - HPC between 2021 and 2023. A selected sample of 36 patients was analyzed based on multiple variables, including: age, sex, risk factors, lesion topography, TOAST classification, lesion identification on CT or MRI, modified Rankin Scale score, and treatment administered. Statistical analysis was performed using SPSS, version 28, using descriptive statistics for sample characterization, and correlation analysis with chi-square, Fisher’s exact, Welch’s, and Kruskal-Wallis tests. Results: This study had a higher proportion of male patients (63.9%) and a mean age of 67.50 ± 12.13 years. Motor symptoms were present in 63.9% of patients. Lesion topography analysis showed a predominance of pontine lesions (47.2%). Among the evaluated risk factors, HTN was the most prevalent (80.6%; n=29). Regarding TOAST classification, strokes of undetermined etiology were the most frequent (41.7%; n=15). Notably, 55.6% (n=20) of patients had no visible lesion on CT but only on subsequent MRI. A total of 26 cases matched a specific brainstem stroke syndrome, with Wallenberg syndrome being the most prevalent (22.2%; n=8). No significant positive correlation was found between lesion topography and TOAST classification (p = 0.500), risk factors (p = 0.607), or age (p = 0.072), nor between TOAST classification and age (p = 0.367). Conclusion: The sociodemographic and clinical characteristics of the studied population are similar to most of the literature, although some discrepancies were noted in specific variables, such as the most prevalent symptoms, the proportional distribution of specific syndromes, and the prevalence of certain risk factors and treatments. This study reinforces the importance of a detailed clinical assessment for the timely diagnosis and management of this condition. Additionally, controlling the most prevalent risk factors should be a key focus in the primary prevention of these patients to improve their outcomes.
Introduction: Brainstem strokes account for 10-15% of all strokes. Despite being less frequent, they are associated with higher morbidity and mortality compared to anterior circulation strokes. Modifiable risk factors such as diabetes mellitus, hypertension (HTN), dyslipidemia, smoking, and atrial fibrillation or atrial flutter should be considered. This study aims to provide a detailed characterization of patients with brainstem stroke followed at Hospital Pêro da Covilhã – Unidade de Saúde local da Cova da Beira (ULSCB - HPC) and to analyze correlations between clinical data, stroke etiologies, and imaging findings. Materials and Methods: This is an observational, cross-sectional, and retrospective study that included patients with definitive diagnosis of ischemic brainstem stroke admitted to the Unidade de AVC of ULSCB - HPC between 2021 and 2023. A selected sample of 36 patients was analyzed based on multiple variables, including: age, sex, risk factors, lesion topography, TOAST classification, lesion identification on CT or MRI, modified Rankin Scale score, and treatment administered. Statistical analysis was performed using SPSS, version 28, using descriptive statistics for sample characterization, and correlation analysis with chi-square, Fisher’s exact, Welch’s, and Kruskal-Wallis tests. Results: This study had a higher proportion of male patients (63.9%) and a mean age of 67.50 ± 12.13 years. Motor symptoms were present in 63.9% of patients. Lesion topography analysis showed a predominance of pontine lesions (47.2%). Among the evaluated risk factors, HTN was the most prevalent (80.6%; n=29). Regarding TOAST classification, strokes of undetermined etiology were the most frequent (41.7%; n=15). Notably, 55.6% (n=20) of patients had no visible lesion on CT but only on subsequent MRI. A total of 26 cases matched a specific brainstem stroke syndrome, with Wallenberg syndrome being the most prevalent (22.2%; n=8). No significant positive correlation was found between lesion topography and TOAST classification (p = 0.500), risk factors (p = 0.607), or age (p = 0.072), nor between TOAST classification and age (p = 0.367). Conclusion: The sociodemographic and clinical characteristics of the studied population are similar to most of the literature, although some discrepancies were noted in specific variables, such as the most prevalent symptoms, the proportional distribution of specific syndromes, and the prevalence of certain risk factors and treatments. This study reinforces the importance of a detailed clinical assessment for the timely diagnosis and management of this condition. Additionally, controlling the most prevalent risk factors should be a key focus in the primary prevention of these patients to improve their outcomes.
Description
Keywords
Acidentevascularcerebral Clínica Etiologia Fatoresderisco Síndromesdotroncocerebral Topografia