Hipolito Nzwalo

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• MD MSc (Stroke Medicine | Sleep Sciences) PhD
• Professor at University of Algarve

Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is a rare form of nonhypertensive cerebral small-vessel disease caused by mutations in the HTRA1 gene. CARASIL is characterized by early adulthood onset of subcortical infarcts, cognitive impairment, alopecia, and spondylosis. Until recently, this...

Background There is scarce information on incidence and case fatality of spontaneous intracerebral hemorrhage (SICH) in certain regions of the world, including in Europe. There is no community-based data on SICH in Southern Portugal. Aim To determine the incidence and early case-fatality from SICH in Algarve, the southernmost region of Portugal....

Background: The short-term outcome from spontaneous intracerebral hemorrhage (SICH) is influenced by local quality of care and population specificities. There are no studies about the SICH mortality in southern Portugal. The objective of this study was to describe the predictors of 30-day in-hospital SICH mortality in Algarve, the southernmost reg...

Objectives: Spontaneous intracerebral hemorrhage (SICH) survivors are at risk of hospital readmissions. Data on readmissions after SICH is scarce. We aimed to study the frequency and predictors of readmissions after SICH in Algarve, Portugal. Patients and methods: Retrospective study of a community representative cohort of SICH survivors (2009-2...

Background: Complex regional pain syndrome (CRPS) is a rare, chronic, painful, neurological, debilitating disorder. Despite the substantial impact on quality of life, diagnosis remains challenging due to its complex pathophysiology and subjective clinical criteria. This integrative review aims to synthesize current research on potential diagnostic...

Complex Regional Pain Syndrome (CRPS) is a rare, chronic painful neurological debilitating disorder. Despite the substantial impact on quality of life, diagnosis remains challenging due to its complex pathophysiology and subjective clinical criteria. This integrative review aims to synthesize current research on potential diagnostic biomarkers for...

BACKGROUND Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk ind...

Background: Patients with functional neurological disorder presenting as stroke mimics or functional stroke mimics (FSMs) pose significant diagnostic challenges. In the acute phase, especially when patients are present within the therapeutic window for acute reperfusion treatments, a misdiagnosis of FSM can lead to unnecessary and costly interventi...

Background and Aims: The incidence of stroke increases with age and the population is aging worldwide. Despite the increasing number of veryold (⩾80) with stroke, few studies have addressed specifically vital prognosis in this age group. We aimed to describe the risk factors for short-term and long-term death after stroke in the very-old in souther...

Objectives: Cervical artery dissection (CeAD) accounts for 25% of ischemic strokes in young adults. This study evaluated the benefits and harms of intravenous thrombolysis (IVT) in patients presenting with spontaneous CeAD and acute ischemic stroke symptoms. Methods: This analysis used data from the retrospective STOP-CAD study and included pati...

Objective Patients with cervical artery dissection (CAD) are at increased ischemic stroke risk. We aimed to identify characteristics that are associated with increased risk of ischemic stroke following initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals. Me...

Superficial siderosis (SS) is an infrequent condition characterized by hemosiderin deposition in the central nervous system, resulting from chronic subarachnoid hemorrhage, often linked to dural mater diseases. Through a case report of a 50-year-old male with severe sensorineural hearing loss and newly diagnosed epilepsy, we explore SS triggered by...

Introduction: Toxoplasmosis, caused by the intracellular parasite Toxoplasma gondii, is diagnosed with clinical suspicion and supporting serological and imaging evidence. Early identification is crucial for life-saving interventions. We present a case illustrating the remarkable recovery from cerebral toxoplasmosis. Methods: A single case report. A...

Background and aims: Recurrent ischemic stroke (RIS) is associated with disability, higher case fatality, and increased health costs. Identifying preventable factors for RIS is therefore crucial. Our objective was to evaluate sociodemographic, clinical, and process of care risk factors for RIS in a consecutive case series of stroke survivors treate...

BACKGROUND Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation. METHODS This is a multicenter observational retrospective internationa...

Background Spontaneous intracerebral haemorrhage (SICH) is the most severe form of all stroke types. Stratification of SICH severity is important for group comparisons and treatment decisions. The existing prognostic scores for clinical prediction in SICH have not been specifically validated in the very old (≥75 years). Therefore, we aimed to evalu...

As life expectancy continues to increase worldwide, age-related dysfunction will largely impact our societies in the future. Aging is well established to promote the deterioration of cognitive function and is the primary risk factor for the development of prevalent neurological disorders. Even in the absence of dementia, age-related cognitive decli...

Background Neurocysticercosis (NCC) is severe and leading global cause of morbidity and mortality. The disease presents with a variety of clinical presentations from focal to diffuse neurological symptoms. Despite being an endemic country, there are no studies describing the clinico-epidemiological characteristics of NCC in Mozambique. Herein, we d...

A myriad of neurological manifestations can occur in association with ketotic and non ketotic hyperglycaemic states. Contrary to diabetic coma, which is a universal complication under relatively established metabolic circumstances, the pathophysiology beyond hyperglycaemic-associated positive neurological manifestations, including seizures, remains...

Background: The incidence of spontaneous intracerebral hemorrhage (SICH) is highest in very old elderlies (≥75 years). The increasing use of antithrombotic drugs is shifting the epidemiology of SICH towards predominance of lobar subtype, suggesting an incremented propensity of bleeding associated with underlying cerebral amyloid angiopathy. With p...

The clinical presentation of acute stroke is pleomorphic. Very rarely, the clinical characteristics in the presenta-tion of the stroke of the anterior circu-lation can mimic the presentation of basilar artery thrombosis [1]. A 61- year-old-man was admitted with 12 hours evolution of left hemiparesis. Four hours after arriving he sudden got worse wi...

The World Health Organization predicts that by 2050, 2.1 billion people worldwide will be over 60 years old, a drastic increase from only 1 billion in 2019. Considering these numbers, strategies to ensure an extended “healthspan” or healthy longevity are urgently needed. The present study approaches the promotion of healthspan from an epigenetic pe...

Background: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stro...

Stroke presenting with predominant laryngeal dysfunction manifestations is often part of a clinical constellation of neurological signs associated with acute medullar lesion . Isolated laryngeal symptoms as a stroke presentation are extremely rare due to the intimal anatomical relation of swallowing-related structures with the ascending/descending...

Introduction Parkinson’s disease (PD) is associated with a progressive inability to accomplish essential activities of daily living (ADL) resulting in a loss of autonomy and quality of life. Accurate measurement of ADL in PD is important to monitor disease progression and optimize care. Despite its relevance, it is still unclear which measurement i...

Introduction Following the hyperacute phase of spontaneous intracerebral hemorrhage (SICH), the severest form of stroke, pneumonia emerges as the leading cause of morbidity and mortality. Prevention of stroke associated pneumonia (SAP) is fundamental to improve the prognosis of SICH patients. Aim Identify clinical, sociodemographic and process of...

Background: In non-valvular-associated atrial fibrillation (AF), direct oral anticoagulants (DOAC) are as effective as vitamin K antagonists (VKA) for the prevention of acute ischemic stroke (AIS). DOAC are associated with decreased risk and severity of intracranial hemorrhage. It is unknown if different pre-admission anticoagulants impact the pro...

Lemos com bastante satisfação o estudo de Dias et al publicado na Acta Médica Portuguesa que revelou as assimetrias nacionais no acesso ao tratamento endovascular (TEV) no acidente vascular cerebral (AVC) isquémico por oclusão de grande vaso proximal (OVP). Felizmente, no período em análise houve melhoria nacional das taxas de TEV, mais evidente no...

Introduction Patients with spontaneous intracerebral hemorrhage (SICH) face the worse functional and vital prognosis among all stroke subtypes. In cases of severe SICH, therapeutic inertia or nihilism complicates meaningful identification of outcome predictors. Therefore, we sought to investigate clinic-radiological and process of care predictors o...

Although more commonly seen in adult population, posterior reversible encephalopathy syndrome (PRES) can also be observed in pediatric patients. The etiopathogenesis of pediatric PRES is poorly understood, and the available evidence comes mostly from childhood cancer. Analysis of the sociodemographic and clinical characteristics of the different no...

Keywords ► bithalamic infarct ► the artery of Percheron ► ischemic stroke ► paramedian thalamic infarct Abstract The artery of Percheron (AOP) is an abnormal variant of the arterial supply of the thalamus. Stroke caused by AOP occlusion is seldom reported. AOP leads to bilateral thalamic and rostral midbrain infarct presenting with unspecific manif...

Viral infections are frequently present before the clinical manifestation of Guillain-Barre syndrome (GBS). Multiple studies on coronaviruses have shown that these viruses have neurotropic characteristics, and their molecular mimicry can induce inflammatory demyelinating neuropathy. Herein, we describe a case of a GBS in an 85-year-old patient infe...

Introduction: the perception of Quality of Life (QoL) has been used to evaluate the treatment and evolution of several pathologies. QoL evaluation allows a better understanding of the patient and his adaptation to the disease. An observational, community-based and descriptive correlational study was carried out to analyze stroke survivors’ percepti...

Background and aims: Spontaneous intracerebral hemorrhage (SICH) is the most devastating type of stroke. Full medical treatment improves short-term prognosis. Factors that determine poor outcome in patients with mild to moderate SICH can clarify which areas of intervention are necessary to mitigate the associated negative impact. Our aim was to exa...

Background: Stroke is the leading cause of cortical deafness (CD), the most severe form of central hearing impairment. CD remains poorly characterized and perhaps underdiagnosed. We perform a systematic review to describe the clinical and radiological features of stroke-associated CD. Methods: PubMed and the Web of Science databases were used to id...

Background and aims: Pneumonia is a leading cause of death after spontaneous intracerebral hemorrhage (SICH). Pneumonia increases the length of hospital stay and is associated with both poor functional outcome and mortality. We sought to identify predictors of pneumonia in patients with SICH in Algarve. Methods: Observational, retrospective study...

Background and Aims: There is a paucity of information regarding in�hospital mortality of patients admitted with territorial middle cerebral artery acute stroke in the region of Algarve, Portugal. We sought to identify the risk factors of in-hospital mortality after territorial MCA stroke. Methods: Retrospective study of consecutive patients with M...

Introduction Neuromyelitis optica spectrum disorder (NMOSD) is a rare disorder in which astrocyte damage and/or demyelination often cause severe neurological deficits. Objective To identify Portuguese patients with NMOSD and assess their epidemiological/clinical characteristics. Methods This was a nationwide multicenter study. Twenty-four Portugu...

Background and Aims: Survivors of territorial middle cerebral artery stroke (MCA) are at risk of hospital readmissions. Data on hospital readmissions after ischemic stroke is scarce. We aimed to study the predictors of unplanned hospital readmissions after territorial MCA stroke in Algarve, Portugal. Methods: Retrospective study of a consecutive ca...

Introduction: the prognosis of spontaneous intracerebral hemorrhage (SICH) remains poor. Understanding gender differences can clarify the clinico-epidemiological and process of care related factors that influence SICH prognosis. We analyzed the long-term gender differences of mortality after SICH in Algarve, southern Portugal. Patients and method...

Aim The incidence of spontaneous intracerebral hemorrhage (SICH) increases with age. Data on SICH mortality in the very old are sparse. We aimed to describe the predictors of 30-day SICH mortality in the very elderly in southern Portugal. Methods A total of 256 community representative SICH patients aged ≥ 75 years (2009–2016) were included. Multip...

Background: Diffuse midline glioma (DMG) is one of the most aggressive pediatric tumors. Approximately 60% of pediatric DMG patients die within the first year of diagnosis. Complete clinical and radiological remission of DMG is extremely rare. The objective of this study was to describe a case of remission of pediatric DMG and to compare with simi...

A 70‐year‐old right‐hand man sought consultation because of left‐hand involuntary movements that started abruptly 2 weeks prior. Left‐hand alien limb syndrome (AHS) (Figure 1/Video S1) involving ipsilateral ideomotor apraxia and right‐sided infarct involving the corpus callosum (genu, anterior body, splenium) and centrum ovale were documented. Symp...

The epidemiological link between inflammation, infection, and acute ischemic stroke (AIS) is well known. 1 Transient prothrombotic status and vasculitis are possible explanatory factors. 1 Aneurysm formation in association with central nervous system infections is occasionally reported. 2 Ischemic or hemorrhagic complication in relation to neurotro...

There is little knowledge on the pathophysiology of pediatric stroke associated with radiation-induced occlusive cerebral vasculopathy (RIOCV). Herein, we present an extremely rare case of a child with multiple ischemic strokes in association with progressive RIOCV. The possibility of hemodynamic compromise and artery-to-artery embolism as a cause...

Cortical deafness is an extremely rare clinical manifestation that originates mainly from bilateral cortical lesions in the primary auditory cortex. Its main clinical manifestation is the bilateral sudden loss of hearing. Diagnosis is difficulty due to its rarity and similarity with other language and communication disorders, such as Wernicke's aph...

A 44-year-old woman presented with headache and delirium. Brain tomography indicated pneumocephalus, while blood and cerebrospinal fluid cultures revealed Streptococcus pneumoniae. Despite antibiotic treatment and admission to the intensive care unit, the patient died 3 days later. Pneumocephalus in association with meningitis is very rare and may...

Objectives: The case fatality from spontaneous ICH (SICH) remains high. The quality and intensity of early treatment is one of the determinants of the outcome. We aimed to study the association of early intensive care, using the Intracerebral Hemorrhage-Specific Intensity of Care Quality Metrics (IHSICQM) with the 30-day in-hospital mortality in A...

Background Plexiform neurofibromas (PN) are the most frequent tumors associated with Neurofibromatosis type 1 (NF-1). PN can cause significant complications, including pain, functional impairment, and disfigurement. There is no efficient medical treatment and, surgical resection of large PN is frequently infeasible. Selumetinib (AZD6244/ARRY-142886...

Introduction The primary function of palliative care is to improve quality of life. The recognition and treatment of symptoms causing suffering is central to the achievement of this goal. Insomnia reduces quality of life of patients under palliative care. Knowledge about prevalence, associated factors, and treatment of insomnia in palliative care i...

The authors report the case of a classic phenotype of Fabry disease in a 60-year-old male patient presenting with left ventricular hypertrophy and stroke. Genetic analysis revealed 2 GLA-gene variants, i.e., p.R356Q and p.G360R. This clinical case highlights that the finding of 2 or more GLA gene variants in a Fabry patient should lead to a careful...

Herpes simplex virus encephalitis (HSVE) usually presents as a monophasic disease. Symptomatic HSVE relapsing with seizures, encephalopathy, or involuntary movements associated with anti- N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis have been recently reported. We report 2 cases of adult post-HSVE anti-NMDAR encephalitis from Portugal. T...

Introdução: Aproximadamente 15% do total de AVC são hemorrágicos sendo as hemorragias talâmicas um tipo frequente mas cujas características enquanto grupo individual foram escassamente reportadas na literatura. Pretendemos avaliar as características clinicas deste tipo de hemorragias bem como identificar factores que se relacionam com o prognóstico...

Introdução: A hiperglicemia à admissão associa-se a maior morbilidade e mortalidade nos doentes com hemorragia intracraniana espontânea (HIC). A dissecção intraventricular tem-se revelado como um dos principais fatores pior prognóstico nesta população. Neste estudo pretendemos avaliar a relação entre o valor da glicemia à admissão hospitalar e a oc...

Objectives: The association between short-term ambient particulate matter ≤ 2.5 μm diameter (PM2.5) and spontaneous intracerebral hemorrhage (SICH) occurrence is unclear. We aimed to study the association of ambient PM2.5 with occurrence of SICH in an area of low air pollution in southern Portugal. Patients and methods: PM2.5 levels from the 3 d...

Background: Delayed hospital arrival remains the main reason for the low rates of thrombolysis in eligible acute ischemic stroke (AIS) patients. The role of socioeconomic and clinical factors for the prehospital delay of AIS remains poor and has never been studied in Portugal. Objectives: Describe the socioeconomic and clinical factors leading to d...

This systematic review explores the frequency of complications associated with nasogastric tube (NGT) placement in patients with acute stroke. The unique condition of the dysphasic, immobile, confused immunosuppressed patient who has had an acute stroke hampers any consistent inference from other neurological or nonneurological condition in which N...

Combining the IHSICQM score with the ICH score increased accuracy of prediction of the 30-day in-hospital mortality. Although many prognosis scales are useful for predicting mortality and helpful for clinicians in making decisions about treatment of ICH it is important to have in account that the intensity and quality of care may have an important...

Introduction Solitary fibrous tumor (SFT) is rarely diagnosed in clinical practice. Since its initial descriptions in the central nervous system (CNS) and the orbits, very few case reports and small case series have expanded their clinical and pathological characterization. We sought to describe a cases series of SFT from a single laboratory of neu...

Background: The long-term prognosis of spontaneous intracerebral hemorrhage (SICH) is poor. Frequent emergency department (ED) visits can signal increased risk of hospitalization and death. There are no studies describing the risk of frequent ED visits after SICH. Methods: Retrospective cohort study of a community representative consecutive SICH s...

Introdução: A Fibrilhação Auricular (FA) é um fator de risco major para a ocorrência de Acidente Isquémico Vascular (AVC). Atualmente está recomendada a anticoagulação em doentes com risco intermédio/alto de AVC (CHA2DS2-VASc score ≥2). A sobrevalorização das complicações hemorrágicas da anticoagulação em detrimento do risco isquémico é uma realida...

Background Intracerebral hemorrhage (ICH) in the context of cerebral hyperperfusion syndrome (CHS) is an uncommon but potentially lethal complication after carotid revascularization for carotid occlusive disease. Information about its incidence, risk factors and fatality is scarce. Therefore, we aimed to perform a systematic review and meta-analys...

Introduction: Cerebrovascular diseases are the most frequent risk factor for epilepsy in the elderly, and epileptic phenomenon following stroke is known to worsen the prognosis. Although electroencephalography is the gold standard epilepsy biomarker, it is rarely used in post-stroke studies, and the frequency of post-stroke epileptiform activity is...

Background and aims: Cerebrovascular disease is the most frequent risk factor for epilepsy, and epileptic phenomena following stroke are known to worsen prognosis. Electroencephalography (EEG) is the gold standard biomarker for epilepsy, but it is seldom used, and there is uncertainty about the frequency post stroke epileptiform activity as detecte...

Purpose Hypoalbuminemia and systemic inflammatory response syndrome (SIRS) are reported in critically-ill patients, but their relationship is unclear. We sought to determine the association of admission serum albumin and SIRS with outcomes in patients with intracerebral hemorrhage (ICH). Methods We used a multicenter, multinational registry of ICH...

Background Limbic autoimmune encephalitis (LE) should be considered in any patient with acute or subacute neuropsychiatric manifestations, without other common causes of encephalitis. Y-Aminobutyric-acid-B-receptor (anti-GABABR) antibodies are rarely encountered in association with LE. Case report A 74-year-old patient presented with a progressive...

Background and Aims: Posterior fossa malformations, Hemangioma, Arterial anomalies, Cardiac defects, Eye anomalies Syndrome (PHACES) is rare but should be considered in any newborn with a large segmental facial hemangioma. Method: Single center case-series description. Results: Four cases were identified during 17 years. Table 1 describes demograph...

Amyotrophic lateral sclerosis (ALS) is a relatively rare disease with a significant phenotypic variation often leading to misdiagnosis. Bilateral flail arm syndrome also known as ‘manin-barrel syndrome’ (MIBS) is one of the rarest and atypical presentation of regional ALS. Progressive weakness and atrophy of upper limbs and absent of bulbar signs is...

Background and purpose: Intracerebral hemorrhage (ICH) volume, particularly if ≥30 mL, is a major determinant of poor outcome. We used a multinational ICH data registry to study the characteristics, course, and outcomes of supratentorial hematomas with volumes <30 mL. Methods: Basic characteristics, clinical and radiological course, and 30-day o...

Background: With the expected growth and aging of the population of primary central nervous system tumours (PCNST) survivors, attention to the radiation-induced late brain injury is fundamental. Late focal hemosiderin de-position (FHD) lesions, namely microbleeds and cavernomas, are among the presumable late cerebrovascular complications associated...

Background: With the expected growth and aging of the population of primary central nervous system tumours (PCNST) survivors, attention to the radiation-induced late brain injury is fundamental. Late focal hemosiderin deposition (FHD) lesions, namely microbleeds and cavernomas, are among the presumable late cerebrovascular complications associated...