Background Stroke is a major cause of disability worldwide and a neurological emergency. Intravenous thrombolysis and mechanical thrombectomy are effective in the reperfusion of the parenchyma in distress, but the impossibility to determine the exact time of onset was an important cause of exclusion from treatment until a few years ago. Objectives To review the clinical and radiological profile of patients with unknown-onset stroke, the imaging methods to guide the reperfusion treatment, and suggest a protocol for the therapeutic approach. Methods The different imaging methods were grouped according to current evidence-based treatments. Results Most studies found no difference between the clinical and imaging characteristics of patients with wake-up stroke and known-onset stroke, suggesting that the ictus, in the first group, occurs just prior to awakening. Regarding the treatment of patients with unknown-onset stroke, four main phase-three trials stand out: WAKE-UP and EXTEND for intravenous thrombolysis, and DAWN and DEFUSE-3 for mechanical thrombectomy. The length of the therapeutic window is based on the diffusion weighted imaging–fluid-attenuated inversion recovery (DWI-FLAIR) mismatch, core-penumbra mismatch, and clinical core mismatch paradigms. The challenges to approach unknown-onset stroke involve extending the length of the time window, the reproducibility of real-world imaging modalities, and the discovery of new methods and therapies for this condition. Conclusion The advance in the possibilities for the treatment of ischemic stroke, while guided by imaging concepts, has become evident. New studies in this field are essential and needed to structure the health care services for this new scenario.

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Este estudo teve como objetivo descrever a experiência da implementação da abordagem e tratamento do tabagismo na Atenção Primária à Saúde de um município nordestino, por meio de grupo operativo. Trata-se de um relato de experiência sobre as ações de controle tabágico, seguindo as etapas de (i) realização de busca ativa de fumantes no território, (ii) acolhimento e primeiro atendimento, (iii) estratificação quanto ao estágio motivacional para mudança, (iv) realização das sessões de grupo para cessação tabágica e (v) instituição da farmacoterapia. Durante os encontros, utilizou-se a abordagem ativa por meio da problematização, com ênfase nos principais conhecimentos que o fumante deve incorporar. A implementação da abordagem e tratamento do tabagismo no âmbito da APS permitiu, num primeiro passo, realizar o diagnóstico situacional de uma população específica e em território determinado, processo importante para o levantamento de problemas e construção de ações qualificadas e abrangentes.

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.