ABSTRACT Background: Migraine is a major cause of disability, which affects many areas of life, including productivity at work. Measuring absenteeism and presenteeism resulting from migraine with the use of appropriate tools is essential for better understanding the impact of this disease. Objective: The aim of the present study was to assess the work impact of migraine using the Brazilian Portuguese version of Work Productivity and Activity Impairment (WPAI) questionnaire. Methods: This survey was carried out with the aid of a smartphone app (Dr Cefaleia for Doctors) containing the questionnaires: ID-Migraine, Headache Impact Test (HIT-6), and WPAI. The data were collected during a headache awareness event. Correlations were assessed between migraine impact (HIT-6) with WPAI parameters: a) work time missed (absenteeism), b) impairment at work (presenteeism), c) overall work productivity loss (absenteeism+presenteeism), and d) activity impairment outside work. Results: Overall, 305 subjects with headache were interviewed and 167 were classified as having migraine. No significant differences in migraine impact according to sex (p=0.8) and modality of work were registered (p=0.8). Females had significantly higher absenteeism score (p<0.001), but presenteeism score was not significantly different between genders (p=0.3). WPAI absenteeism and presenteeism scores significantly correlated with migraine impact (HIT-6). Conclusions: The results suggest WPAI Brazilian Portuguese version was efficient in assessing migraine related work impact. The use of an app with validated questionnaires facilitates the conduction of migraine impact research in different populations, allowing a better understanding of the burden of this disease.

Introduction: Stroke is the leading cause of disability worldwide, not only due to motor impairment, but to many sequelae in other domains. Fatigue is one of the most impacting symptoms in the quality of life in post stroke patients, with estimated prevalence around 30%. Objectives and methods: We present a cross-sectional study that aimed to determine the prevalence of fatigue in patients with ischemic stroke followed in the neurovascular outpatient clinic of a tertiary hospital in São Paulo, Brazil, using the Fatigue Assessment Scale (FAS) questionnaire. It can range from 0-50 points, proportional to symptom intensity; scores equal or over 24 points indicate fatigue in such individuals. Casuistics and results: One hundred and fifty seven questionnaires were analyzed and classified according to the FAS. Mean age was 58 years, 74 (47.13%) individuals were men and median FAS score was 21 points (interquartile range: 18–29). Of the interviewees, 64 individuals (40.76%) were classified as having fatigue by the established cut-off; in this subgroup, mean age was 55 years and 28 (43.75%) were men. Discussion and conclusion: In this study, around 40% of post-stroke patients have fatigue, indicating a high prevalence in our population. Fatigue has a high impact on the quality of life of patients, also worsening in functionality and mortality, due to lesser participation in rehabilitation and physical activities. Thus, the health professional dealing with post-stroke patients must be aware and prepared to help patients in coping with fatigue.

Introduction: Sequelae are frequent in patients with a history of ischemic stroke and result in decreased quality of life, increase in morbidity, mortality and healthcare costs. One often overlooked complication of ischemic stroke is its association with depression and depressive symptoms. Objectives and methods: This cross-sectional study aims to assess the prevalence of depression and depressive symptoms in patients with previous ischemic stroke followed in the neurovascular outpatient clinic of a tertiary hospital in São Paulo, Brazil, through the application of the Patient Health Questionnaire-9 (PHQ-9) filled in by the patients. Casuistics and results: A total of 173 participated in the study, but only 154 answered all PHQ-9 questions. Mean age was 52 years; 56.82% were women; 44 patients (28.6%) had a score ≥ 10, resulting in sensitivity and specificity for post-stroke depression of 86 and 79% respectively; 118 (68.2%) did not present depression or depressive symptoms before the stroke, 33 (19.1%) had previous symptoms and 22 (12.7%) did not answer this specific question. Discussion and conclusion: The results indicate that depression is an important comorbidity in patients with ischemic stroke. In this cohort, most patients did not have depressive symptoms before the stroke. Further studies are important to better assess this association as well as to determine strategies to prevent and to manage this condition.

Introduction: Chorea is a movement disorder characterized by involuntary, random and irregular movements. In the emergency department, the most common causes of chorea are cerebrovascular disorders, but other conditions may also play an important role. The aim is to present a rare case of acquired hemichorea secondary to hyponatremia by reviewing the patient’s records. Case report: A 73-year-old female patient with a history of arterial hypertension, dyslipidemia, active smoking, and heart failure, taking enalapril, hydrochlorothiazide, furosemide and simvastatin, was admitted to the emergency department after falling from standing height and hitting her head, also presenting choreic movements in the right side of her body. The patient started amitriptyline for chronic low back pain in the last month and had been experiencing apathy and weight loss since; the choreic movements had started a week before admission and had progressively worsened. On admission, the patient presented with fluctuating level of consciousness and hemichorea. Complementary evaluation showed leukocytosis and hyponatremia (117 mg/ dL); magnetic resonance imaging of the brain showed diffuse brain atrophy without any other findings compatible with hemichorea and the lumbar puncture did not reveal any additional findings; a pulmonary infection was detected by the chest computed tomography. The patient was treated for pulmonary infection and hyponatremia. Haloperidol was started, but the chorea was fully solved after hyponatremia correction over the next few days and did not return after haloperidol weaning. Discussion: We presented the case of a 73-year-old woman with acquired hemichorea secondary to hyponatremia, which resolved completely after the metabolic disorder was corrected. Although this condition has been described, its incidence remains unclear, as few cases have been reported.

Introduction: Stroke is the leading cause of disability worldwide. Late complications, such as sexual dysfunction, have a direct impact on psychological and emotional aspects and directly affect the quality of life of these patients. Objectives and methods: We present a cross-sectional study that aimed to determine the prevalence of sexual dysfunction in patients with ischemic stroke followed in the neurovascular outpatient clinic of a tertiary hospital in São Paulo, Brazil, using the Male Sexual Quotient (MSQ) questionnaire. The MSQ can range from 0-100 points. Higher values indicate better sexual performance/satisfaction and a score of 60 points or less was considered as having sexual dysfunction. Casuistics and results: Fifty eight questionnaires were analyzed and classified according to the MSQ score. Mean age was 60 years and median MSQ score was 64 points. Of the interviewees, 24.14% had their sexual performance classified as poor-null, 17.24% of patients had poorunfavorable sexual performance, 6.90% as unfavorable-regular; regulargood and good-great sexual performance were equally found in 25.86% of the subjects. Discussion and conclusion: In this study, almost half of post-stroke men have sexual dysfunction according to MSQ, indicating a high impact of such a condition in the quality of life of our patients due to its prevalence. Thus, the health professional dealing with post-stroke patients must be aware and prepared to help patients in coping with sexual dysfunctions.