A García Pastor

Publications (16)12.47 Total impact

• Article: Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment.

  J Vivancos, F Gilo, R Frutos, J Maestre, A García-Pastor, F Quintana, J M Roda, A Ximénez-Carrillo, E Díez Tejedor, B Fuentes, [......], F Nombela, F Purroy, M Ribó, M Rodríguez-Yañez, J Roquer, F Rubio, T Segura, J Serena, P Simal, J Tejada
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  ABSTRACT: OBJECTIVE: To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment. MATERIAL AND METHODS: A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed. RESULTS: The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm. CONCLUSIONS: SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes.
  Neurologia 10/2012;
• Article: Efficacy of intravenous thrombolysis according to stroke subtypes: the Madrid Stroke Network Data.

  B Fuentes, P Martínez-Sánchez, M Alonso de Leciñana, J Egido, G Reig-Roselló, F Díaz-Otero, V Sánchez, P Simal, A Ximenez-Carrillo, A García-Pastor, G Ruiz-Ares, A García-García, J Masjuan, J Vivancos-Mora, A Gil-Nuñez, E Díez-Tejedor
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  ABSTRACT: OBJECTIVES: To identify possible differences in the early response to intravenous thrombolysis (IVT) or in stroke outcome at 3 months, based on stroke subtype in patients with acute ischaemic stroke (IS). METHODS: Multicenter stroke registry, with prospective inclusion of consecutive patients with acute IVT-treated IS in five acute stroke units. We compared clinical improvement (NIHSS) at 24 h and at day 7 as well as functional outcome at 3 months (Modified Rankin Scale, mRS) amongst the different stroke subtypes (ICD-10). RESULTS: One thousand four hundred and seventy-nine patients were included; 178 (12%) had large vessel disease (LVD) with carotid stenosis ≥ 50%, 175 (11.8%) had other LVD, 638 (43%) had cardioembolism, 60 (4.1%) had lacunar infarction, 72 (4.9%) were patients with IS of other/unusual cause and 356 (24.1%) were of unknown/multiple causes. Patients with lacunar infarction had lower stroke severity (median NIHSS 6) whilst cardioembolic IS was the most severe (median NIHSS 14) (P < 0.001). No differences in NIHSS improvement were found at 24 h. LVD patients with carotid stenosis (OR 0.544; 95% CI 0.383-0.772; P = 0.001) were less likely to improve at day 7 after adjustment for age, gender, vascular risk factors and stroke severity. However, adjusted multivariate analysis showed no influence of stroke subtype on stroke outcome (mRS) at 3 months. Age, systolic blood pressure on admission and stroke severity were independently associated with mRS > 2 at 3 months. CONCLUSION: Although LVD patients with arterial stenosis ≥ 50% improve less than the other aetiologies at day 7, stroke aetiological subtype does not determine differences in IS outcome at 3 months after IVT.
  European Journal of Neurology 06/2012; · 3.69 Impact Factor
• Article: Intravenous thrombolysis in capsular warning syndrome: is it beneficial?

  B Gutiérrez Ruano, A García Pastor, J A Villanueva Osorio, N Bravo Quelle, P Vázquez Alén, F Díaz Otero, A Gil Núñez
  Neurologia 05/2012;
• Article: Prediction of early stroke recurrence in transient ischemic attack patients from the PROMAPA study: a comparison of prognostic risk scores.

  F Purroy, P E Jiménez Caballero, A Gorospe, M J Torres, J Alvarez-Sabin, E Santamarina, P Martínez-Sánchez, D Cánovas, M M Freijo, J A Egido, [......], Y Silva, H Quesada, P Cardona, A Morales, N de la Ossa, A García-Pastor, J F Arenillas, T Segura, C Jiménez, J Masjuán
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  ABSTRACT: Several clinical scales have been developed for predicting stroke recurrence. These clinical scores could be extremely useful to guide triage decisions. Our goal was to compare the very early predictive accuracy of the most relevant clinical scores [age, blood pressure, clinical features and duration of symptoms (ABCD) score, ABCD and diabetes (ABCD2) score, ABCD and brain infarction on imaging score, ABCD2 and brain infarction on imaging score, ABCD and prior TIA within 1 week of the index event (ABCD3) score, California Risk Score, Essen Stroke Risk Score and Stroke Prognosis Instrument II] in consecutive transient ischemic attack (TIA) patients. Between April 2008 and December 2009, we included 1,255 consecutive TIA patients from 30 Spanish stroke centers (PROMAPA study). A neurologist treated all patients within the first 48 h after symptom onset. The duration and typology of clinical symptoms, vascular risk factors and etiological work-ups were prospectively recorded in a case report form in order to calculate established prognostic scores. We determined the early short-term risk of stroke (at 7 and 90 days). To evaluate the performance of each model, we calculated the area under the receiver operating characteristic curve. Cox proportional hazards multivariate analyses determining independent predictors of stroke recurrence using the different components of all clinical scores were calculated. We calculated clinical scales for 1,137 patients (90.6%). Seven-day and 90-day stroke risks were 2.6 and 3.8%, respectively. Large-artery atherosclerosis (LAA) was observed in 190 patients (16.7%). We could confirm the predictive value of the ABCD3 score for stroke recurrence at the 7-day follow-up [0.66, 95% confidence interval (CI) 0.54-0.77] and 90-day follow-up (0.61, 95% CI 0.52-0.70), which improved when we added vascular imaging information and derived ABCD3V scores by assigning 2 points for at least 50% symptomatic stenosis on carotid or intracranial imaging (0.69, 95% CI 0.57-0.81, and 0.63, 95% CI 0.51-0.69, respectively). When we evaluated each component of all clinical scores using Cox regression analyses, we observed that prior TIA and LAA were independent predictors of stroke recurrence at the 7-day follow-up [hazard ratio (HR) 3.97, 95% CI 1.91-8.26, p < 0.001, and HR 3.11, 95% CI 1.47-6.58, p = 0.003, respectively] and 90-day follow-up (HR 2.35, 95% CI 1.28-4.31, p = 0.006, and HR 2.20, 95% CI 1.15-4.21, p = 0.018, respectively). Conclusion: All published scores that do not take into account vascular imaging or prior TIA when identifying stroke risk after TIA failed to predict risk when applied by neurologists. Clinical scores were not able to replace extensive emergent diagnostic evaluations such as vascular imaging, and they should take into account unstable patients with recent prior transient episodes.
  Cerebrovascular Diseases 01/2012; 33(2):182-9. · 2.72 Impact Factor
• Source

  Available from: Sergio Calleja

  Article: Guidelines for the treatment of acute ischaemic stroke.

  M Alonso de Leciñana, J A Egido, I Casado, M Ribó, A Dávalos, J Masjuan, J L Caniego, E Martínez Vila, E Díez Tejedor, B Fuentes Secretaría, [......], F Nombela, F Purroy, M Rodríguez-Yañez, J Roquer, F Rubio, T Segura, J Serena, P Simal, J Tejada, J Vivancos
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  ABSTRACT: INTRODUCTION: Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies. DEVELOPMENT: Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105mmHg), treatment of hyperglycaemia over 155mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5°C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6hours, and mechanical thrombectomy within 8hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible. CONCLUSION: Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5hours from symptom onset. Intra-arterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated.
  Neurologia 12/2011;
• Article: Guidelines for the preventive treatment of ischaemic stroke and TIA (II). Recommendations according to aetiological sub-type.

  B Fuentes, J Gállego, A Gil-Nuñez, A Morales, F Purroy, J Roquer, T Segura, J Tejada, A Lago, E Díez-Tejedor, [......], P Martínez-Sánchez, E Martínez-Vila, C Molina, F Nombela, M Ribó, M Rodríguez-Yañez, F Rubio, J Serena, P Simal, J Vivancos
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  ABSTRACT: BACKGROUND AND OBJECTIVE: To update the ad hoc Committee of the Cerebrovascular Diseases Study Group of The Spanish Neurological Society guidelines on prevention of ischemic stroke (IS) and Transient Ischaemic Attack (TIA). METHODS: We reviewed the available evidence on ischaemic stroke and TIA prevention according to aetiological subtype. Levels of evidence and recommendation levels are based on the classification of the Centre for Evidence-Based Medicine. RESULTS: In atherothrombotic IS, antiplatelet therapy and revascularization procedures in selected cases of ipsilateral carotid stenosis (70-99%) reduce the risk of recurrences. In cardioembolic IS (atrial fibrillation, valvular diseases, prosthetic valves and myocardial infarction with mural thrombus) prevention is based on the use of oral anticoagulants. Preventive therapies for uncommon causes of IS will depend on the aetiology. In the case of cerebral venous thrombosis oral anticoagulation is effective. CONCLUSIONS: We conclude with recommendations for clinical practice in prevention of IS according to the aetiological subtype presented by the patient.
  Neurologia 09/2011;
• Article: Guidelines for the preventive treatment of ischaemic stroke and TIA (I). update of risk factors and life style.

  B Fuentes, J Gállego, A Gil-Nuñez, A Morales, F Purroy, J Roquer, T Segura, J Tejada, A Lago, E Díez-Tejedor, [......], P Martínez-Sánchez, E Martínez-Vila, C Molina, F Nombela, M Ribó, M Rodríguez-Yañez, F Rubio, J Serena, P Simal, J Vivancos
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  ABSTRACT: OBJECTIVE: To update the ad hoc Committee of the Cerebrovascular Diseases Study Group of The Spanish Neurological Society guidelines on prevention of ischaemic stroke (IS) and transient ischaemic attack (TIA). METHODS: We reviewed available evidence on risk factors and the measures for their modification to prevent ischaemic stroke and TIA. Levels of evidence and recommendation grades are based on the classification of the Centre for Evidence-Based Medicine. RESULTS: In this first part the recommendations for action on the following factors are summarised: blood pressure, diabetes, lipids, tobacco and alcohol consumption, diet and physical activity, cardio-embolic diseases, asymptomatic carotid stenosis, hormone replacement therapy and contraceptives, hyperhomocysteinemia, prothrombotic states and sleep apnea syndrome. CONCLUSIONS: The change in lifestyle and pharmacological treatment of hypertension, diabetes mellitus and dyslipidemia, according to criteria of primary and secondary prevention, are recommended in preventing ischemic stroke.
  Neurologia 09/2011;
• Article: [Feen report on epilepsy in Spain].

  R García-Ramos, A García Pastor, J Masjuan, C Sánchez, A Gil
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  ABSTRACT: Epilepsy is a very common disease in Spain. There is a great lack of information on real epidemiological data and the patient impact of this disease. The objective of the Spanish Foundation for Neurological Diseases (FEEN) report is to collect epidemiological data, morbidity, mortality and costs of this disease in Spain. A search was carried out in Medline on publications up to 2010, as well as a review of data published by the Spanish National Statistics Institute (INE). There are about 400,000 patients with epilepsy in Spain. Approximately 5 -10% of the population will experience a seizure in their lifetime, and up to 20% of these will have recurrent seizures. Using hospital discharge report data, hospital admissions for epilepsy are around 35 patients per 100,000 patients. Mortality risk in epileptic patients is two or three times higher than in non-epileptics. The mean total annual cost of drug resistant epilepsy patient in Spain is 6,935 Euros. The total cost of epilepsy according to data from the year 2000 could be around 5% of the total health budget. It is very important to maintain disease registers. This initiative should be encouraged by the patient associations and scientific societies. This report confirms that epilepsy has a great social and health impact on the population.
  Neurologia 07/2011; 26(9):548-55.
• Source

  Available from: Sergio Calleja

  Article: Clinical practice guidelines in intracerebral haemorrhage.

  M Rodríguez-Yáñez, M Castellanos, M M Freijo, J C López Fernández, J Martí-Fàbregas, F Nombela, P Simal, J Castillo, E Díez-Tejedor, B Fuentes, [......], C Molina, A Morales, F Purroy, M Ribó, J Roquer, F Rubio, T Segura, J Serena, J Tejada, J Vivancos
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  ABSTRACT: Intracerebral haemorrhage accounts for 10-15% of all strokes, however it has a poor prognisis with higher rates of morbidity and mortality. Neurological deterioration is often observed during the first hours from onset, and determines the poor prognosis. Intracerebral haemorrhage, therefore, is a neurological emergency which must be diagnosed and treated properly as soon as possible. In this guide we review the diagnostic procedures and factors that influence the prognosis of patients with intracerebral haemorrhage and we establish recommendations for the therapheutic strategy, systematic diagnosis, acute treatment and secondary prevention for this condition.
  Neurologia 05/2011;
• Article: [The use of a pro-forma improves the quality of the emergency medical charts of patients with acute stroke].

  A García Pastor, C Alarcón Morcillo, F Cordido Henriquez, F Díaz Otero, P Vázquez Alén, J A Villanueva, A Gil Núñez
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  ABSTRACT: The information obtained from the Emergency Medical Chart (EMC) is a key factor for the correct management of acute stroke. Our aim is to determine if the use of a pro-forma (PF) for filling in the EMC improves the quality of the clinical information. A PF was created from a list of 26 key-items considered important to be recorded in an EMC. We compared the number of items recorded in the EMC of patients admitted to our Stroke Unit (SU) in January-February 2009 (before PF was introduced) with the data obtained with the PF (April-May, 2009). We also analysed the agreement with the final diagnosis on discharge from the SU. A total of 128 EMC were analysed, and the PF was used in 48 cases. The mean number of recorded items was 20.5 for the PF group and 13.7 for the non-PF charts (P<.001). Sixteen of the 26 items were recorded significant more frequently (P<.05) in the PF Group. The most notable scores being: previous baseline situation (100% vs. 51%), previous Modified Rankin scale score (94% vs. 1%), time of symptom onset (100% vs. 85%), time of neurological evaluation (100% vs. 39%), NIHSS score (92% vs. 30%), ECG results (88% vs. 59%), time of perform brain scan (60% vs. 1%). Diagnostic agreement: nosological/syndromic diagnosis: PF group: 94%, Non-PF group: 60% (P<.001), topographic diagnosis: PF: 71%, Non-PF: 53% (P=.03), aetiological diagnosis: PF: 25%, Non-PF: 9% (P=.01). The use of a PF improves the quantity and quality of the information, and offers a better diagnostic accuracy.
  Neurologia 03/2011; 26(9):533-9.
• Article: [Neurovascular intervention in the acute phase of cerebral infarction].

  A Cruz Culebras, A García-Pastor, G Reig, B Fuentes, P Simal, J C Méndez-Cendón, J L Caniego, E Castro, R Frutos, A Gil, J Vivancos, A Gil-Núñez, E Díez-Tejedor, J A Egido, M Alonso de Leciñana, J Masjuan
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  ABSTRACT: Endovascular therapies in acute ischaemic stroke may offer benefits to patients that are not eligible for standard use of intravenous tissue activator plasminogen (iv t-PA) or when this is not effective. Our aim is to present the initial experience in with endovascular techniques in the Community of Madrid. We present data from our registry of acute ischaemic strokes treated with endovascular re-perfusion therapies in five University Hospitals in Madrid (Spain) during the period 2005-2009. We recorded demographic data, vascular risk factors, risk severity with the NIHSS (National Institute of Health Stroke Scale), endovascular techniques, complications and mortality rates. Functional outcome and neurological disability at 90 days was defined by the modified Rankin scale (mRs). A total of 41 patients were treated with endovascular therapies. Mean age was 58.6 ± 19.9, and 56.1% were males. Of those 22 patients had an anterior circulation stroke and 19 had a posterior circulation stroke. Baseline NIHSS score was: median, 17 [range, 2-34]; 7 patients had previously received iv t-PA. The following endovascular techniques were performed: mechanical disruption (26 patients), intra-arterial infusion of t-PA (26 patients), angioplasty and stenting (5 patients), mechanical use of MERCI device (3 patients). Partial or total re-canalization was achieved in 32 patients (78%). Only one patient had a symptomatic cerebral haemorrhage. Three months after stroke, 53.6% of the patients were independent (mRs ≤ 2) and overall mortality rate was 19.5%. Acute ischaemic stroke is a potentially treatable medical emergency within the first hours after the onset of symptoms. Stroke endovascular procedures constitute an alternative for patients with iv t-PA exclusion criteria or when this is not effective.
  Neurologia (Barcelona, Spain) 06/2010; 25(5):279-86. · 0.79 Impact Factor
• Article: Fusiform aneurysm of the scalp: an unusual cause of focal headache in Marfan syndrome.

  A García-Pastor, A Guillem-Mesado, J Salinero-Paniagua, S Giménez-Roldán
  Headache The Journal of Head and Face Pain 11/2002; 42(9):908-10. · 2.52 Impact Factor
• Article: [Acute encephalopathy and myoclonic status induced by vigabatrin monotherapy] .

  A García Pastor, E García-Zarza, R Peraita Adrados
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  ABSTRACT: Vigabatrin (VGB) is a new antiepileptic drug useful in refractOry partial seizures. Psychosis as a secondary effect of VGB is well known. This drug may even induce new epileptic seizures. We report a 69-year-old hypertensive patient with multiple cerebral infarcts. She was diagnosed as having late onset symptomatic partial epilepsy (complex partial seizures and generalized secondary motor partial seizures). She had been receiving VGB 3 g/day in monotherapy. She came to the emergency room in a psychotic state with new epileptic seizures. We performed an EEG and video during the ictal phase. The patient was awake, conscious and partially oriented. The video showed generalized myoclonic jerks involving facial and limb muscles, separated by non-convulsive intervals lasting three minutes. The EEG showed spike and wave discharges over a diffuse slow-wave background activity. The patient was conscious throughout the recording. The electroclinical picture was considered as an encephalopathy-associated generalized myoclonic status. VGB was replaced by phenytoin. Two weeks later, and after a clinical improvement, a new recording showed the disappearance of signs of encephalopathy and the myoclonic status. Epileptic seizures induced by VGB are well reported. Several pathogenic mechanisms have been suggested. In our case the myoclonic status was related to a non-dose dependent encephalopathy induced by VGB. The electroclinical improvement after withdrawal of the drug supports this possibility.
  Neurologia (Barcelona, Spain) 11/2000; 15(8):370-4. · 0.79 Impact Factor
• Article: [Transient ischemic attacks: risk factors, duration and neuroimaging in a series of 173 patients].

  A García-Pastor, F Díaz-Otero, B Castaño-García, M L Martínez-Ginés, A Asúnsolo-Del Barco, A Gil-Nuñez, J A Villanueva-Osorio
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  ABSTRACT: The appearance of transient ischemic attacks (TIA) is an important sign of vascular risk. The maximum time the deficit lasts has been set arbitrarily at 24 hours. It is assumed that TIA does not entail permanent vascular lesions. A retrospective review of the clinical records of patients diagnosed as suffering from TIA in our centre between 1996 and 1997. Analysis of associated risk factors (RF), duration and findings in neuroimaging. The clinical records of 173 patients (106 males) were examined. The RF identified were similar to those described for ischemic strokes. 45.6% of patients with a history of vascular pathologies received no preventative treatment. 58% of the TIA were resolved within the first 30 minutes and 71% within the first hour. Cranial CT was normal in 69%, showed old lesions in 26% and lesions that were compatible with the clinical signs of TIA in 5% (in the latter case the duration of the episodes was greater). TIA shares the same RF and aetiopathogenic mechanisms as ischemic stroke and should, therefore, be considered as such. There is a need to revise the concept of TIA paying special attention to the findings of neuroimaging or to establish duration limits that are better matched to the practical reality. TIA maintains a practical interest since it provides a simple method of identifying patients with a high vascular risk.
  Revista de neurologia 35(2):107-10. · 0.65 Impact Factor
• Article: [Urinary retention as the first sign of rhombencephalitis due to Listeria monocytogenes].

  A García-Pastor, M Valderrama, E Lozano, J Rodríguez-Gorostiza, L A Alvarez-Sala
  Revista de neurologia 31(10):999-1000. · 0.65 Impact Factor
• Article: [Intracranial tumors simulating transient ischemic attacks].

  A García Pastor, I Iniesta López, C de Andrés
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  ABSTRACT: Occasionally intracranial tumors present a clinical picture similar to that seen with transient ischemic attacks (TIA). The mechanism for this is not clear. The differential diagnosis of these two disorders is important since their treatment is quite different. Two men and two women aged between 53 and 72 years of age, with no known cardiovascular risk factors, complained of one or several episodes of neurological deficit (hemisensitive deficits, transient blindness and isolated aphasia), lasting between 3 minutes and 6 hours. Neuroimaging investigations (CT and MR) showed images compatible with space occupying lesions localized to the convexity (parietal, frontotemporal and frontoparietal) and in one case at the edge of the sphenoid bone. Three patients were operated on. The lesions were confirmed as tumors (two cases of meningiomas and one of glioblastoma). Symptoms did not recur after a mean follow up period of nine months. Various mechanisms have been suggested to explain this phenomenon: vascular compression due to pressure from the mass, changes in intracranial pressure, vascular steal phenomenon, negative focal seizures, Leao s cortical depression and others. The absence of risk factors which would justify a vascular cause, the correlation between localization of the tumour and the clinical signs, and the disappearance of symptoms following surgery would seem to support the hypothesis that in our cases the symptoms observed were due to intracranial space occupying lesions. The presence of an intracranial tumour should be ruled out by using neuroradiological investigations in patients complaining of transient episodes of neurological deficits.
  Revista de neurologia 33(9):839-42. · 0.65 Impact Factor