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Introduction: Obstructive sleep apnea (OSA) is highly prevalent after stroke and associated with stroke recurrence. Several clinical scales have been used to predict OSA, but their relevance for functional outcomes are unknown. Objective: We aimed to determine if a sleep apnea risk score is associated with functional outcome in stroke patients. Methods: Consecutive patients with imaging-confirmed ischemic stroke were recruited from a public hospital in Salvador, Brazil. Demographic and cerebrovascular risk factor data were collected prospectively. We used NIH stroke scale (NIHSS) to quantify stroke severity and STOP-BANG questionnaire to quantify risk of OSA on admission (0 to 8, higher scores indicating higher risk). Patients were followed for 90 days and functional outcome was assessed by modified Rankin Scale (mRS). Poor outcome was defined as a mRS = 3 to 6. Results: We recruited 382 patients with ischemic stroke between October, 2018 and November, 2019, mean age 64 +/- 13 years, 189 (49.5%) female, median NIHSS 8 (interquartile range - IQR - 6 to 14) and median STOP-BANG score 5 (IQR 4 to 5). After 90 days, 216 (56.5%) had poor outcomes. Median STOP-BANG score was higher in patients with poor, when compared to good outcomes (4 vs 3, respectively, p=0.001). In multivariable logistic regression, STOP-BANG score was independently associated with poor outcome (odds ratio 1.56, 95% confidence interval 1.02 to 2.63, p=0.003), after adjustment for age, sex, NIHSS, cerebrovascular risk factors and stroke etiology. When STOP-BANG score was stratified by OSA risk, patients with mild, moderate and high OSA risk reached poor outcomes in 38.2%, 58.7% and 62.1%, respectively (p=0.004). Conclusions: A simple sleep apnea risk score (STOP-BANG) is independently associated with poor functional outcome in ischemic stroke patients.

Introduction: The ankle-brachial index (ABI) is the ratio between systolic blood pressure of the upper and lower limbs. A low ABI ( < 0.9) is associated with increased risk of cardiovascular and stroke outcomes. However, ABI relevance for functional outcomes is unknown. Objective: We aimed to investigate if low ABI is associated with functional outcome in stroke patients. Methods: Consecutive patients with imaging-confirmed ischemic stroke were recruited from a public hospital in Salvador, Brazil. Demographic and cerebrovascular risk factor data were collected prospectively. We used NIH stroke scale to quantify stroke severity and ABI was measured on admission. Patients were followed for 90 days and functional outcome was assessed by modified Rankin Scale (mRS). Poor outcome was defined as a mRS = 3 to 6. Logistic regression was used to adjust for potential confounders of poor outcome. Results: We recruited 376 patients with ischemic stroke between October 2018 and October 2019, mean age 64 +/- 13 years, 189 (49%) female. Median ABI was 1.06 (interquartile range - IQR 0.93 to 1.13). After 90 days, 209 (56%) patients had poor outcome. Low ABI was more frequent in patients with poor outcome (38% vs 18%, p=0.0001). After adjustment for age, sex and cerebrovascular risk factors, low ABI remained a significant predictor of poor outcome (odds ratio 2.10; 95% confidence interval 1.24 - 3.55, p=0.006). Conclusions: Low ABI is an independent predictor of poor outcome in acute stroke patients. Assessment of ABI on admission is clinically useful as a prognostic tool and should be more routinely implemented.

SinopseO neuroblastoma origina-se freqüentemente na medula adrenal. As metástases do neuroblastoma são comuns e quando localizadas no crânio surgem, geralmente, ao longo das suturas, provocando disjunção destas pelo aumento da pressão intracraniana. Ocasionalmente, apresenta diagnóstico diferencial com hematoma subdural. Os autores descrevem um caso de metástase craniana em criança portadora de neuroblastoma com localização primária na medula supra-renal que apresentou hipertensão intracraniana e disjunção da sutura coronária e que simulava tomograficamente um hematoma subdural. Palavras-chaveNeuroblastoma, metástase craniana, hematoma subdural. ABSTRACT Metastatic neuroblastoma simulating subdural hematoma. Report of a caseNeuroblastomas grow up in the adrenal medulla. Metastasis are frequent and when localized in the skull may compromise the cranial sutures, inducing disjunction due to high intracranial pressure. Sometimes differential diagnosis with subdural hematoma is made. The authors report a case of cranial vault metastasis in a child with neuroblastoma with primary localization in the adrenal gland, presenting with intracranial hypertension and disjunction of coronal suture. CT image suggested a subdural hematoma but further investigation disclosed a metastatic lesion. KeywordsNeuroblastoma, cerebral metastasis, subdural hematoma. FIGURA 1Tomografia computadorizada craniana sem contraste demonstrando disjunção da sutura coronária e lesão hiperdensa na região frontoparietal bilateral, mais acentuada do lado esquerdo. J Bras Neurocirurg 14(1): 25-28, 2003 PEREIRA CU, MORAIS DCR, TAVARES GA, DANTAS MC -Neuroblastoma metastático simulando hematoma subdural -Relato de caso J Bras Neurocirurg 14(1): 25-28, 2003 PEREIRA CU, MORAIS DCR, TAVARES GA, DANTAS MC -Neuroblastoma metastático simulando hematoma subdural -Relato de caso Endereço para correspondência: