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las caracter&#237;sticas propias del sistema vascular&#44; hematol&#243;gico y los diversos estados de desarrollo cerebral del ni&#241;o no permiten extrapolar los resultados de las investigaciones o gu&#237;as de tratamiento del adulto a la poblaci&#243;n pedi&#225;trica<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Desde el a&#241;o 2003&#44; la secci&#243;n de neurolog&#237;a pedi&#225;trica de la Pontificia Universidad Cat&#243;lica de Chile &#40;PUC&#41; inici&#243; un registro de AVE desde reci&#233;n nacidos hasta 18 a&#241;os&#44; encontr&#225;ndose un n&#250;mero inusualmente alto de casos&#44; no descrito en la literatura nacional&#44; por lo que se estableci&#243; un programa de investigaci&#243;n del AVE pedi&#225;trico&#44; y en el a&#241;o 2005 se ingres&#243; al registro del International Pediatric Stroke Study &#40;IPSS&#41; Group<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; cuyo acceso permite consultar y recibir feedback en casos complejos&#44; y formar parte de este estudio multic&#233;ntrico&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo es describir los FR asociados a AVE isqu&#233;micos en una poblaci&#243;n pedi&#225;trica de un mes a 18 a&#241;os de edad y asociar los factores de riesgo a edad&#44; tipo de AVE y sexo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes y m&#233;todo</span><p id="par0040" class="elsevierStylePara elsevierViewall">Estudio observacional descriptivo de una cohorte de 114 ni&#241;os con AVE isqu&#233;mico&#44; ingresados en el estudio durante su hospitalizaci&#243;n o en el control ambulatorio en el Hospital Cl&#237;nico de la PUC durante enero del 2003-julio del 2012&#46; Este estudio fue aprobado por el Comit&#233; de &#201;tica&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Criterios de inclusi&#243;n&#58; lactantes de un mes hasta adolescentes de 18 a&#241;os al momento del AVE isqu&#233;mico diagnosticado por neuroim&#225;genes cerebrales &#40;resonancia magn&#233;tica cerebral &#91;RM&#93; o tomograf&#237;a computarizada &#91;TC&#93; cerebral&#41;&#46; Criterios de exclusi&#243;n&#58; AVE hemorr&#225;gico&#44; crisis isqu&#233;micas transitorias y pacientes con registros incompletos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La recolecci&#243;n de datos se realiz&#243; en una ficha cl&#237;nica dise&#241;ada que registra datos del cuadro cl&#237;nico inicial&#44; FR&#44; ex&#225;menes realizados&#44; evoluci&#243;n al alta y controles posteriores&#46; Las variables del estudio fueron las variables demogr&#225;ficas&#44; los factores de riesgo y el tipo de accidente isqu&#233;mico&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Definiciones</span><p id="par0055" class="elsevierStylePara elsevierViewall">AVE&#58; d&#233;ficit neurol&#243;gico agudo de duraci&#243;n mayor a 24 h&#44; sin otra explicaci&#243;n que la causa vascular confirmada con una imagen cerebral<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Infarto isqu&#233;mico arterial&#58; AVE&#44; con imagen cerebral&#44; TC del cerebro o RM que muestre infarto&#47;s de par&#233;nquima cerebral&#44; conforme a territorio arterial que corresponde a la presentaci&#243;n cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Trombosis de senos venosos&#58; AVE o cefalea con una neuroimagen &#40;TC o RM&#41; que muestre la trombosis venosa<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Arteriopat&#237;a&#58; cualquier anomal&#237;a estenosante de arterias intracraneanas o vasos cervicales&#44; la cual se categoriza despu&#233;s en grandes vasos&#44; medianos vasos o peque&#241;os vasos<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">FR&#58;</span> se asignaron en 6 categor&#237;as&#44; basadas en las definiciones del IPSS<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#58; <span class="elsevierStyleItalic">1&#41;</span> enfermedad aguda sist&#233;mica&#44; <span class="elsevierStyleItalic">2&#41;</span> enfermedad aguda de cabeza y cuello&#44; <span class="elsevierStyleItalic">3&#41;</span> enfermedad cr&#243;nica sist&#233;mica&#44; <span class="elsevierStyleItalic">4&#41;</span> enfermedad cr&#243;nica de cabeza y cuello&#44; <span class="elsevierStyleItalic">5&#41;</span> cardiopat&#237;a&#44; y 6&#41; arteriopat&#237;a&#46; Las categor&#237;as de FR no son excluyentes&#46; Se defini&#243; AVE isqu&#233;mico idiop&#225;tico cuando no se identific&#243; FR&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">An&#225;lisis de los datos&#58;</span> se describen las caracter&#237;sticas biodemogr&#225;ficas de la muestra al momento del AVE&#44; se estratifican grupos etarios &#40;&#60; 5 a&#241;os y 5 a&#241;os o m&#225;s&#41; en virtud de los mayores cambios en el neurodesarrollo previo a los 5 a&#241;os de edad&#44; tal como se ha realizado en la mayor&#237;a de los estudios multic&#233;ntricos<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Se compararon los factores de riesgo con el grupo etario&#44; sexo y tipo de AVE &#40;chi al cuadrado&#41; y el riesgo estimado se calcul&#243; a trav&#233;s de <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; con un intervalo de confianza del 95&#37;&#46; Los datos se analizaron con ayuda del paquete estad&#237;stico SPSS&#44; versi&#243;n 15&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">De los 114 pacientes&#44; 74 &#40;62&#44;2&#37;&#41; eran hombres&#44; con una mediana de edad de 2&#44;5 a&#241;os &#40;rango intercuartil de 0&#44;44-8&#46;8 a&#241;os&#41;&#44; 71 &#40;62&#44;3&#37;&#41; eran menores de 5 a&#241;os&#46; En 100 ni&#241;os &#40;84&#37;&#41;&#44; el AVE fue de origen arterial y la localizaci&#243;n comprometi&#243; la circulaci&#243;n anterior &#40;car&#243;tida interna&#44; cerebral media y anterior&#41; en el 67&#37; de ellos&#46; Las trombosis de senos venosos estuvieron presentes en 14 pacientes &#40;12&#37;&#41;&#44; con predominio de trombosis de sistemas superficiales &#40;seno sagital superior&#44; lateral y venas corticales&#41; en 9&#47;14 casos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En relaci&#243;n con los FR cerebrovascular&#44; en 9 ni&#241;os &#40;7&#44;9&#37;&#41; no se identificaron FR y 67 pacientes &#40;58&#44;7&#37;&#41; ten&#237;an m&#225;s de un FR &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Los FR m&#225;s frecuentes fueron la enfermedad aguda sist&#233;mica&#44; cardiopat&#237;as y enfermedades cr&#243;nicas sist&#233;micas con un 56&#44;1&#44; 35&#44;1 y 29&#44;8 respectivamente&#46; Las afecciones que tuvieron m&#225;s representaci&#243;n en el grupo de enfermedad sist&#233;mica aguda fueron sepsis&#44; insuficiencia renal aguda&#44; shock y anoxia-hipoxia con 16&#44; 10&#44; 9 y 5 casos&#44; respectivamente&#46; Las enfermedades sist&#233;micas agudas se asociaron significativamente al tramo de edad menor de 5 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; con una OR 4&#44;1 &#40;IC&#44; 1&#44;8-9&#44;2&#41;&#46; En el FR cardiopat&#237;as&#44; predominaron las cardiopat&#237;as cong&#233;nitas &#40;82&#44;5&#37;&#41;&#44; las que mostraron una tendencia a ser m&#225;s frecuentes en el menor de 5 a&#241;os vs&#46; &#8805; 5 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">La enfermedad cr&#243;nica sist&#233;mica se asoci&#243; en forma significativa a edad &#8805; 5 a&#241;os&#44; con OR de 2&#44;5 &#40;v&#233;ase la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Las arteriopat&#237;as representaron un 14&#37; del total de los factores de riesgo y fueron m&#225;s frecuentes en menores de 5 a&#241;os &#40;sin significaci&#243;n estad&#237;stica&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Las enfermedades agudas de cabeza y cuello tendieron a agruparse en los menores de un a&#241;o&#44; representadas principalmente por meningitis&#47;encefalitis &#40;12 casos&#41; e infecciones del tracto respiratorio superior &#40;7 casos&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">No existieron diferencias significativas entre FR cerebrovascular y sexo&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En relaci&#243;n con la asociaci&#243;n entre FR y tipo de AVE&#44; el FR cardiopat&#237;a tiene una asociaci&#243;n significativa con infarto isqu&#233;mico arterial &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; con un OR de 8&#44;3 &#40;IC&#44; 1&#44;05-66&#41; y el FR enfermedad aguda de cabeza y cuello se asoci&#243; a trombosis de senos venosos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;04 con OR 3&#44;5&#44; IC&#44; 1&#44;12-11&#44;19&#41; &#40;v&#233;ase la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran que el AVE pedi&#225;trico es m&#225;s frecuente en los primeros a&#241;os de vida &#40;mediana 2&#44;5 a&#241;os&#41; y en el sexo masculino&#44; igual a lo descrito en diferentes trabajos internacionales<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El FR m&#225;s frecuente es la enfermedad sist&#233;mica aguda &#40;56&#44;1&#37;&#41;&#44; que adem&#225;s est&#225; asociado con el estrato de edad menor de 5 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01 y OR &#61; 4&#44;1&#41;&#46; El FR enfermedades sist&#233;micas agudas integra enfermedades que llevan a alteraciones hemodin&#225;micas&#44; con deterioro de la perfusi&#243;n sist&#233;mica y cerebral&#44; concepto que Bladin y Chambers ya describ&#237;an en 1994<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; El segundo FR en frecuencia es la cardiopat&#237;a &#40;35&#44;1&#37;&#41;&#44; que est&#225; asociado a infarto isqu&#233;mico arterial&#44; seguido de las enfermedades cr&#243;nicas sist&#233;micas &#40;29&#44;8&#37;&#41;&#44; que se asocian significativamente a edades &#8805; 5 a&#241;os&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En Sudam&#233;rica&#44; las publicaciones sobre AVE en la poblaci&#243;n pedi&#225;trica son escasas&#44; a excepci&#243;n de las publicaciones en Brasil<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a>&#46; El reporte de 39 ni&#241;os entre 2 meses y 15 a&#241;os con AVE isqu&#233;mico de Noce et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> describe que el mayor n&#250;mero de casos con etiolog&#237;a definida &#40;8&#47;39&#41; correspondi&#243; a shock secundario a deshidrataci&#243;n &#40;7 de ellos bajo los 2 a&#241;os de edad&#41;&#44; lo que se puede homologar a una enfermedad sist&#233;mica aguda&#44; concordante con nuestro trabajo&#46; Igualmente&#44; las cardiopat&#237;as le siguen en frecuencia con 7 de 39 casos&#46; En este trabajo&#44; los autores destacan el alto porcentaje &#40;23&#44;1&#37;&#41; en el que no lograron reconocer un FR&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En relaci&#243;n con las cardiopat&#237;as&#44; segundo factor de riesgo en frecuencia en nuestro trabajo&#44; creemos que est&#225; subrepresentado y que probablemente existe falta de diagn&#243;stico&#46; En Chile existe un plan nacional de correcci&#243;n de cardiopat&#237;as cong&#233;nitas&#44; costeado &#237;ntegramente por el Estado&#44; pero desafortunadamente en este costo no est&#225;n incluidos los estudios de neuroim&#225;genes&#44; neurofisiol&#243;gicos ni gen&#233;ticos&#44; lo que dificulta el diagn&#243;stico&#44; tratamiento y pron&#243;stico del AVE en la etapa aguda&#46; No es infrecuente que en el estudio de convulsiones o retraso del desarrollo motor de ni&#241;os con cardiopat&#237;a encontremos un infarto cerebral antiguo &#40;observaci&#243;n personal del autor&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Las publicaciones europeas<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> describen hasta un 79&#37; de alteraciones en vasos cerebrales arteriales y en los estudios multic&#233;ntricos del IPSS Group las arteriopat&#237;as fueron el FR m&#225;s frecuente en Asia&#44; Europa&#44; Canad&#225; y Australia&#44; e infrecuentes en Sudam&#233;rica<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; En nuestro trabajo&#44; no se realiz&#243; estudio de vasos intracraneanos y cervicales a todos los pacientes&#44; por lo que solo se detect&#243; un 14&#37; de arteriopat&#237;as&#46; Creemos que tenemos un subdiagn&#243;stico de estas entidades&#44; por lo que necesitamos priorizar la pesquisa de esta afecci&#243;n realizando estudio angiogr&#225;fico convencional o angiorresonancia de vasos intracraneanos y cervicales&#44; idealmente en todos los ni&#241;os con AVE&#44; ya que la literatura internacional la menciona como el FR m&#225;s asociado a recurrencias<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Nuestro trabajo incluye una muestra significativa de ni&#241;os afectados&#44; que permite hacer asociaciones y seleccionar una poblaci&#243;n de mayor riesgo&#44; informaci&#243;n importante cuando se trata de prevenci&#243;n y tratamiento precoz&#46; Considerando que nuestro FR m&#225;s importante es la condici&#243;n sist&#233;mica aguda&#59; el riesgo de AVE debe ser considerado en las unidades de cuidados intensivos pedi&#225;tricos&#44; donde a la monitorizaci&#243;n de la funci&#243;n cardiaca&#44; renal y hep&#225;tica&#44; entre otras&#44; debiera agregarse en forma rutinaria la evaluaci&#243;n cerebral&#46; Igualmente&#44; creemos necesario instaurar un protocolo de evaluaci&#243;n neurol&#243;gica espec&#237;fica en pacientes con cardiopat&#237;as y agregar el estudio de vasos cerebrales y cervicales&#44; en todos los pacientes con AVE&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La detecci&#243;n de FR de AVE isqu&#233;mico en ni&#241;os permite el diagn&#243;stico y tratamiento precoz&#44; optimizar el manejo agudo y&#44; eventualmente&#44; la prevenci&#243;n de recurrencias a largo plazo&#46; La asociaci&#243;n entre FR y rango etario permite el estudio dirigido de poblaciones de riesgo&#46; La asociaci&#243;n entre FR y tipo de AVE isqu&#233;mico permite describir el riesgo espec&#237;fico&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Una de las limitaciones de nuestro trabajo es el sesgo de selecci&#243;n&#44; considerando que somos un centro de salud semiprivado&#44; de car&#225;cter terciario y centro de referencia para correcci&#243;n quir&#250;rgica de cardiopat&#237;as cong&#233;nitas&#44; lo que plantea la necesidad de integrar a hospitales estatales para lograr resultados generalizables a la poblaci&#243;n nacional&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los factores de riesgo &#40;FR&#41; para accidente vascular encef&#225;lico &#40;AVE&#41; pedi&#225;trico difieren del adulto e incluyen un amplio rango de enfermedades&#44; como pueden ser cardiopat&#237;as&#44; infecciones&#44; leucemias y errores cong&#233;nitos del metabolismo&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Describir FR en AVE isqu&#233;mico en poblaci&#243;n pedi&#225;trica y explorar asociaci&#243;n de los FR con edad&#44; sexo y tipo de AVE&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Pacientes y m&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 114 casos pedi&#225;tricos con AVE isqu&#233;mico ocurridos entre enero del 2003 y julio del 2012&#46; Los FR se estratificaron en 6 categor&#237;as&#44; los AVE isqu&#233;micos se clasificaron como arterial y venoso&#46; Se compararon los FR con edad&#44; sexo y tipo de infarto &#40;chi al cuadrado y <span class="elsevierStyleItalic">odds ratio&#41;&#46;</span></p> <span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La mediana de edad fue 2&#44;5 a&#241;os&#44; 74 &#40;62&#44;2&#37;&#41; hombres&#46; El 7&#44;9&#37; de los pacientes no ten&#237;a FR identificable y el 67&#37; ten&#237;a m&#225;s de uno&#46; La mayor frecuencia de FR fue&#58; enfermedades sist&#233;micas agudas &#40;56&#44;1&#37;&#41;&#44; cardiopat&#237;as &#40;35&#44;1&#37;&#41; y enfermedades cr&#243;nicas sist&#233;micas &#40;29&#44;8&#37;&#41;&#46; Hubo asociaci&#243;n estad&#237;sticamente significativa entre FR enfermedad sist&#233;mica aguda y edad menor de 5 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y entre enfermedad cr&#243;nica sist&#233;mica y edad mayor o igual a 5 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; El FR cardiopat&#237;a se asoci&#243; a infarto arterial &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y el FR enfermedad aguda de cabeza y cuello con infarto venoso &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los FR de AVE isqu&#233;mico en la poblaci&#243;n pedi&#225;trica son m&#250;ltiples y algunos de ellos se asocian a edades espec&#237;ficas y tipo de AVE&#46; La detecci&#243;n de estos factores permitir&#225; la prevenci&#243;n primaria en la poblaci&#243;n de riesgo as&#237; como un diagn&#243;stico y tratamiento precoz&#44; haciendo igualmente posible la prevenci&#243;n de recurrencias&#46;</p>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Risk factors &#40;RF&#41; in pediatric stroke differ from those of adults&#44; and they include a wide range of diseases such as heart disease&#44; infections&#44; leukemias&#44; and inborn errors of metabolism&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To describe RF for ischemic stroke in a pediatric population&#44; and to examine the relationship of RF with age&#44; sex and type of stroke&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Patients and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">An analysis was made of database of 114 children and adolescents with ischemic stroke from January 2003 to July 2012&#46; Risk factors were stratified into 6 categories and ischemic strokes were classified as arterial and venous&#46; We compared the RF with age&#44; sex&#44; and type of stroke &#40;chi2 and OR&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The median age was 2&#46;5 years&#44; with 74 &#40;62&#46;2&#37;&#41; males&#46; No RF was identified in 7&#46;9&#37; of patients&#44; and 67&#37; had more than one RF&#46; The most common RF were acute systemic diseases &#40;56&#46;1&#37;&#41;&#44; heart disease &#40;35&#46;1&#37;&#41;&#44; and chronic systemic diseases &#40;29&#46;8&#37;&#41;&#46; There was a statistically significant association between acute systemic disease and age less than 5 years <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;001&#41;&#44; and between chronic systemic disease and age 5 years or more <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;02&#41;&#46; The RF of heart disease was associated with arterial infarction <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;05&#41;&#44; and the acute head and neck disease RF was associated with venous infarction <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The RF for ischemic stroke are multiple in the pediatric population&#44; and some of them are associated with a specific age and type of stroke&#46; The detection of these factors may help in the primary prevention of people at risk&#44; an early diagnosis&#44; and treatment and prevention of recurrences&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficiencia renal aguda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipoxia-paro cardiaco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fiebre sin sepsis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficiencia cardiaca aguda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otras EAS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Cardiopat&#237;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cong&#233;nita&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adquirida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mesenquimopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Genetopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedades neurocut&#225;neas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Epilepsia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metab&#243;licas-neurodegenerativas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nefropat&#237;as&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neoplasia no SNC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colitis ulcerosa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">EA de cabeza y cuello</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;25&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;7-4&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Meningitis bacteriana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Encefalitis aguda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infecci&#243;n respiratoria alta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TEC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tumor cerebral descompensado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Arteriopat&#237;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8-11&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peque&#241;os vasos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grandes vasos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Enfermedad cr&#243;nica cabeza y cuello</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7 &#40;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Malformaci&#243;n del SNC&nbsp;\t\t\t\t\t\t\n
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                  """
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Frecuencia de factores de riesgo y asociaci&#243;n con grupo etario en poblaci&#243;n pedi&#225;trica con AVE isqu&#233;mico 2003-2012&#46; PUC&#44; Chile</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">AVE&#58; accidente vascular encef&#225;lico&#59; IC&#58; intervalo de confianza&#59; IIA&#58; infarto isqu&#233;mico arterial&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio&#59;</span> PUC&#58; Pontificia Universidad Cat&#243;lica&#59; TSV&#58; trombosis de senos venosos&#46;</p>"
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                  \t\t\t\t">E&#46; cr&#243;nica cabeza y cuello&nbsp;\t\t\t\t\t\t\n
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Original
Factores de riesgo para accidente vascular encefálico en un hospital universitario
Cerebrovascular risk factors seen in a university hospital
M. Hernández Chávez
Autor para correspondencia
mhernand@med.puc.cl

Autor para correspondencia.
, C. Samsó Zepeda, M. López Espejo, R. Escobar Henríquez, T. Mesa Latorre
Sección Neurología Pediátrica, División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero de factores de riesgo para AVE isqu&#233;mico en 114 pacientes&#46; PUC 2003-2012&#44; Chile&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0010" class="elsevierStylePara elsevierViewall">La Organizaci&#243;n Mundial de la Salud &#40;OMS&#41; define el accidente vascular encef&#225;lico &#40;AVE&#41; como &#171;el inicio abrupto de signos neurol&#243;gicos focales de origen vascular que dura m&#225;s de 24 h o que lleva a la muerte&#44; sin otra causa aparente&#187;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En la poblaci&#243;n pedi&#225;trica&#44; el AVE est&#225; emergiendo como una enfermedad grave y frecuente&#44; situ&#225;ndose internacionalmente entre las primeras 10 causas de muertes infantiles&#44; con una mortalidad cercana al 10&#37;&#44; secuelas neurol&#243;gicas en el 70&#37; y una recurrencia hasta 35&#37;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El AVE pedi&#225;trico no es una enfermedad reciente&#44; desde que Willis y Osler publicaron una serie de casos cl&#237;nicos&#44; en el siglo <span class="elsevierStyleSmallCaps">xvii</span> y <span class="elsevierStyleSmallCaps">xix</span>&#44; respectivamente&#44; los reportes de AVE pedi&#225;trico han aumentado en forma exponencial<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46; Hay estudios que han identificado un amplio rango de factores asociados&#44; com&#250;nmente denominados factores de riesgo &#40;FR&#41;&#44; que difieren de los FR del AVE adulto<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;11</span></a>&#46; Los FR del adulto&#44; como hipertensi&#243;n arterial&#44; ateromatosis&#44; tabaquismo y diabetes&#44; son infrecuentes en el ni&#241;o&#46; En estos predominan las enfermedades agudas infecciosas&#44; enfermedades cong&#233;nitas como cardiopat&#237;as y algunas enfermedades cr&#243;nicas sist&#233;micas y locales de cabeza y cuello&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Las diferencias en los FR&#44; las caracter&#237;sticas propias del sistema vascular&#44; hematol&#243;gico y los diversos estados de desarrollo cerebral del ni&#241;o no permiten extrapolar los resultados de las investigaciones o gu&#237;as de tratamiento del adulto a la poblaci&#243;n pedi&#225;trica<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Desde el a&#241;o 2003&#44; la secci&#243;n de neurolog&#237;a pedi&#225;trica de la Pontificia Universidad Cat&#243;lica de Chile &#40;PUC&#41; inici&#243; un registro de AVE desde reci&#233;n nacidos hasta 18 a&#241;os&#44; encontr&#225;ndose un n&#250;mero inusualmente alto de casos&#44; no descrito en la literatura nacional&#44; por lo que se estableci&#243; un programa de investigaci&#243;n del AVE pedi&#225;trico&#44; y en el a&#241;o 2005 se ingres&#243; al registro del International Pediatric Stroke Study &#40;IPSS&#41; Group<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; cuyo acceso permite consultar y recibir feedback en casos complejos&#44; y formar parte de este estudio multic&#233;ntrico&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo es describir los FR asociados a AVE isqu&#233;micos en una poblaci&#243;n pedi&#225;trica de un mes a 18 a&#241;os de edad y asociar los factores de riesgo a edad&#44; tipo de AVE y sexo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes y m&#233;todo</span><p id="par0040" class="elsevierStylePara elsevierViewall">Estudio observacional descriptivo de una cohorte de 114 ni&#241;os con AVE isqu&#233;mico&#44; ingresados en el estudio durante su hospitalizaci&#243;n o en el control ambulatorio en el Hospital Cl&#237;nico de la PUC durante enero del 2003-julio del 2012&#46; Este estudio fue aprobado por el Comit&#233; de &#201;tica&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Criterios de inclusi&#243;n&#58; lactantes de un mes hasta adolescentes de 18 a&#241;os al momento del AVE isqu&#233;mico diagnosticado por neuroim&#225;genes cerebrales &#40;resonancia magn&#233;tica cerebral &#91;RM&#93; o tomograf&#237;a computarizada &#91;TC&#93; cerebral&#41;&#46; Criterios de exclusi&#243;n&#58; AVE hemorr&#225;gico&#44; crisis isqu&#233;micas transitorias y pacientes con registros incompletos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La recolecci&#243;n de datos se realiz&#243; en una ficha cl&#237;nica dise&#241;ada que registra datos del cuadro cl&#237;nico inicial&#44; FR&#44; ex&#225;menes realizados&#44; evoluci&#243;n al alta y controles posteriores&#46; Las variables del estudio fueron las variables demogr&#225;ficas&#44; los factores de riesgo y el tipo de accidente isqu&#233;mico&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Definiciones</span><p id="par0055" class="elsevierStylePara elsevierViewall">AVE&#58; d&#233;ficit neurol&#243;gico agudo de duraci&#243;n mayor a 24 h&#44; sin otra explicaci&#243;n que la causa vascular confirmada con una imagen cerebral<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Infarto isqu&#233;mico arterial&#58; AVE&#44; con imagen cerebral&#44; TC del cerebro o RM que muestre infarto&#47;s de par&#233;nquima cerebral&#44; conforme a territorio arterial que corresponde a la presentaci&#243;n cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Trombosis de senos venosos&#58; AVE o cefalea con una neuroimagen &#40;TC o RM&#41; que muestre la trombosis venosa<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Arteriopat&#237;a&#58; cualquier anomal&#237;a estenosante de arterias intracraneanas o vasos cervicales&#44; la cual se categoriza despu&#233;s en grandes vasos&#44; medianos vasos o peque&#241;os vasos<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">FR&#58;</span> se asignaron en 6 categor&#237;as&#44; basadas en las definiciones del IPSS<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#58; <span class="elsevierStyleItalic">1&#41;</span> enfermedad aguda sist&#233;mica&#44; <span class="elsevierStyleItalic">2&#41;</span> enfermedad aguda de cabeza y cuello&#44; <span class="elsevierStyleItalic">3&#41;</span> enfermedad cr&#243;nica sist&#233;mica&#44; <span class="elsevierStyleItalic">4&#41;</span> enfermedad cr&#243;nica de cabeza y cuello&#44; <span class="elsevierStyleItalic">5&#41;</span> cardiopat&#237;a&#44; y 6&#41; arteriopat&#237;a&#46; Las categor&#237;as de FR no son excluyentes&#46; Se defini&#243; AVE isqu&#233;mico idiop&#225;tico cuando no se identific&#243; FR&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">An&#225;lisis de los datos&#58;</span> se describen las caracter&#237;sticas biodemogr&#225;ficas de la muestra al momento del AVE&#44; se estratifican grupos etarios &#40;&#60; 5 a&#241;os y 5 a&#241;os o m&#225;s&#41; en virtud de los mayores cambios en el neurodesarrollo previo a los 5 a&#241;os de edad&#44; tal como se ha realizado en la mayor&#237;a de los estudios multic&#233;ntricos<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Se compararon los factores de riesgo con el grupo etario&#44; sexo y tipo de AVE &#40;chi al cuadrado&#41; y el riesgo estimado se calcul&#243; a trav&#233;s de <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; con un intervalo de confianza del 95&#37;&#46; Los datos se analizaron con ayuda del paquete estad&#237;stico SPSS&#44; versi&#243;n 15&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0085" class="elsevierStylePara elsevierViewall">De los 114 pacientes&#44; 74 &#40;62&#44;2&#37;&#41; eran hombres&#44; con una mediana de edad de 2&#44;5 a&#241;os &#40;rango intercuartil de 0&#44;44-8&#46;8 a&#241;os&#41;&#44; 71 &#40;62&#44;3&#37;&#41; eran menores de 5 a&#241;os&#46; En 100 ni&#241;os &#40;84&#37;&#41;&#44; el AVE fue de origen arterial y la localizaci&#243;n comprometi&#243; la circulaci&#243;n anterior &#40;car&#243;tida interna&#44; cerebral media y anterior&#41; en el 67&#37; de ellos&#46; Las trombosis de senos venosos estuvieron presentes en 14 pacientes &#40;12&#37;&#41;&#44; con predominio de trombosis de sistemas superficiales &#40;seno sagital superior&#44; lateral y venas corticales&#41; en 9&#47;14 casos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En relaci&#243;n con los FR cerebrovascular&#44; en 9 ni&#241;os &#40;7&#44;9&#37;&#41; no se identificaron FR y 67 pacientes &#40;58&#44;7&#37;&#41; ten&#237;an m&#225;s de un FR &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Los FR m&#225;s frecuentes fueron la enfermedad aguda sist&#233;mica&#44; cardiopat&#237;as y enfermedades cr&#243;nicas sist&#233;micas con un 56&#44;1&#44; 35&#44;1 y 29&#44;8 respectivamente&#46; Las afecciones que tuvieron m&#225;s representaci&#243;n en el grupo de enfermedad sist&#233;mica aguda fueron sepsis&#44; insuficiencia renal aguda&#44; shock y anoxia-hipoxia con 16&#44; 10&#44; 9 y 5 casos&#44; respectivamente&#46; Las enfermedades sist&#233;micas agudas se asociaron significativamente al tramo de edad menor de 5 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; con una OR 4&#44;1 &#40;IC&#44; 1&#44;8-9&#44;2&#41;&#46; En el FR cardiopat&#237;as&#44; predominaron las cardiopat&#237;as cong&#233;nitas &#40;82&#44;5&#37;&#41;&#44; las que mostraron una tendencia a ser m&#225;s frecuentes en el menor de 5 a&#241;os vs&#46; &#8805; 5 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">La enfermedad cr&#243;nica sist&#233;mica se asoci&#243; en forma significativa a edad &#8805; 5 a&#241;os&#44; con OR de 2&#44;5 &#40;v&#233;ase la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Las arteriopat&#237;as representaron un 14&#37; del total de los factores de riesgo y fueron m&#225;s frecuentes en menores de 5 a&#241;os &#40;sin significaci&#243;n estad&#237;stica&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Las enfermedades agudas de cabeza y cuello tendieron a agruparse en los menores de un a&#241;o&#44; representadas principalmente por meningitis&#47;encefalitis &#40;12 casos&#41; e infecciones del tracto respiratorio superior &#40;7 casos&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">No existieron diferencias significativas entre FR cerebrovascular y sexo&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En relaci&#243;n con la asociaci&#243;n entre FR y tipo de AVE&#44; el FR cardiopat&#237;a tiene una asociaci&#243;n significativa con infarto isqu&#233;mico arterial &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; con un OR de 8&#44;3 &#40;IC&#44; 1&#44;05-66&#41; y el FR enfermedad aguda de cabeza y cuello se asoci&#243; a trombosis de senos venosos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;04 con OR 3&#44;5&#44; IC&#44; 1&#44;12-11&#44;19&#41; &#40;v&#233;ase la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran que el AVE pedi&#225;trico es m&#225;s frecuente en los primeros a&#241;os de vida &#40;mediana 2&#44;5 a&#241;os&#41; y en el sexo masculino&#44; igual a lo descrito en diferentes trabajos internacionales<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El FR m&#225;s frecuente es la enfermedad sist&#233;mica aguda &#40;56&#44;1&#37;&#41;&#44; que adem&#225;s est&#225; asociado con el estrato de edad menor de 5 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01 y OR &#61; 4&#44;1&#41;&#46; El FR enfermedades sist&#233;micas agudas integra enfermedades que llevan a alteraciones hemodin&#225;micas&#44; con deterioro de la perfusi&#243;n sist&#233;mica y cerebral&#44; concepto que Bladin y Chambers ya describ&#237;an en 1994<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; El segundo FR en frecuencia es la cardiopat&#237;a &#40;35&#44;1&#37;&#41;&#44; que est&#225; asociado a infarto isqu&#233;mico arterial&#44; seguido de las enfermedades cr&#243;nicas sist&#233;micas &#40;29&#44;8&#37;&#41;&#44; que se asocian significativamente a edades &#8805; 5 a&#241;os&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En Sudam&#233;rica&#44; las publicaciones sobre AVE en la poblaci&#243;n pedi&#225;trica son escasas&#44; a excepci&#243;n de las publicaciones en Brasil<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a>&#46; El reporte de 39 ni&#241;os entre 2 meses y 15 a&#241;os con AVE isqu&#233;mico de Noce et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> describe que el mayor n&#250;mero de casos con etiolog&#237;a definida &#40;8&#47;39&#41; correspondi&#243; a shock secundario a deshidrataci&#243;n &#40;7 de ellos bajo los 2 a&#241;os de edad&#41;&#44; lo que se puede homologar a una enfermedad sist&#233;mica aguda&#44; concordante con nuestro trabajo&#46; Igualmente&#44; las cardiopat&#237;as le siguen en frecuencia con 7 de 39 casos&#46; En este trabajo&#44; los autores destacan el alto porcentaje &#40;23&#44;1&#37;&#41; en el que no lograron reconocer un FR&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En relaci&#243;n con las cardiopat&#237;as&#44; segundo factor de riesgo en frecuencia en nuestro trabajo&#44; creemos que est&#225; subrepresentado y que probablemente existe falta de diagn&#243;stico&#46; En Chile existe un plan nacional de correcci&#243;n de cardiopat&#237;as cong&#233;nitas&#44; costeado &#237;ntegramente por el Estado&#44; pero desafortunadamente en este costo no est&#225;n incluidos los estudios de neuroim&#225;genes&#44; neurofisiol&#243;gicos ni gen&#233;ticos&#44; lo que dificulta el diagn&#243;stico&#44; tratamiento y pron&#243;stico del AVE en la etapa aguda&#46; No es infrecuente que en el estudio de convulsiones o retraso del desarrollo motor de ni&#241;os con cardiopat&#237;a encontremos un infarto cerebral antiguo &#40;observaci&#243;n personal del autor&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Las publicaciones europeas<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> describen hasta un 79&#37; de alteraciones en vasos cerebrales arteriales y en los estudios multic&#233;ntricos del IPSS Group las arteriopat&#237;as fueron el FR m&#225;s frecuente en Asia&#44; Europa&#44; Canad&#225; y Australia&#44; e infrecuentes en Sudam&#233;rica<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; En nuestro trabajo&#44; no se realiz&#243; estudio de vasos intracraneanos y cervicales a todos los pacientes&#44; por lo que solo se detect&#243; un 14&#37; de arteriopat&#237;as&#46; Creemos que tenemos un subdiagn&#243;stico de estas entidades&#44; por lo que necesitamos priorizar la pesquisa de esta afecci&#243;n realizando estudio angiogr&#225;fico convencional o angiorresonancia de vasos intracraneanos y cervicales&#44; idealmente en todos los ni&#241;os con AVE&#44; ya que la literatura internacional la menciona como el FR m&#225;s asociado a recurrencias<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Nuestro trabajo incluye una muestra significativa de ni&#241;os afectados&#44; que permite hacer asociaciones y seleccionar una poblaci&#243;n de mayor riesgo&#44; informaci&#243;n importante cuando se trata de prevenci&#243;n y tratamiento precoz&#46; Considerando que nuestro FR m&#225;s importante es la condici&#243;n sist&#233;mica aguda&#59; el riesgo de AVE debe ser considerado en las unidades de cuidados intensivos pedi&#225;tricos&#44; donde a la monitorizaci&#243;n de la funci&#243;n cardiaca&#44; renal y hep&#225;tica&#44; entre otras&#44; debiera agregarse en forma rutinaria la evaluaci&#243;n cerebral&#46; Igualmente&#44; creemos necesario instaurar un protocolo de evaluaci&#243;n neurol&#243;gica espec&#237;fica en pacientes con cardiopat&#237;as y agregar el estudio de vasos cerebrales y cervicales&#44; en todos los pacientes con AVE&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La detecci&#243;n de FR de AVE isqu&#233;mico en ni&#241;os permite el diagn&#243;stico y tratamiento precoz&#44; optimizar el manejo agudo y&#44; eventualmente&#44; la prevenci&#243;n de recurrencias a largo plazo&#46; La asociaci&#243;n entre FR y rango etario permite el estudio dirigido de poblaciones de riesgo&#46; La asociaci&#243;n entre FR y tipo de AVE isqu&#233;mico permite describir el riesgo espec&#237;fico&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Una de las limitaciones de nuestro trabajo es el sesgo de selecci&#243;n&#44; considerando que somos un centro de salud semiprivado&#44; de car&#225;cter terciario y centro de referencia para correcci&#243;n quir&#250;rgica de cardiopat&#237;as cong&#233;nitas&#44; lo que plantea la necesidad de integrar a hospitales estatales para lograr resultados generalizables a la poblaci&#243;n nacional&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            1 => "Introducci&#243;n"
            2 => "Objetivos"
            3 => "Pacientes y m&#233;todo"
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          "titulo" => array:6 [
            0 => "Abstract"
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          "titulo" => "Conflicto de intereses"
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    "fechaRecibido" => "2013-01-12"
    "fechaAceptado" => "2013-11-14"
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          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Accidente vascular encef&#225;lico"
            1 => "Factores de riesgo"
            2 => "Pediatr&#237;a"
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          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Stroke"
            1 => "Risk factors"
            2 => "Childhood"
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los factores de riesgo &#40;FR&#41; para accidente vascular encef&#225;lico &#40;AVE&#41; pedi&#225;trico difieren del adulto e incluyen un amplio rango de enfermedades&#44; como pueden ser cardiopat&#237;as&#44; infecciones&#44; leucemias y errores cong&#233;nitos del metabolismo&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Describir FR en AVE isqu&#233;mico en poblaci&#243;n pedi&#225;trica y explorar asociaci&#243;n de los FR con edad&#44; sexo y tipo de AVE&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Pacientes y m&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 114 casos pedi&#225;tricos con AVE isqu&#233;mico ocurridos entre enero del 2003 y julio del 2012&#46; Los FR se estratificaron en 6 categor&#237;as&#44; los AVE isqu&#233;micos se clasificaron como arterial y venoso&#46; Se compararon los FR con edad&#44; sexo y tipo de infarto &#40;chi al cuadrado y <span class="elsevierStyleItalic">odds ratio&#41;&#46;</span></p> <span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La mediana de edad fue 2&#44;5 a&#241;os&#44; 74 &#40;62&#44;2&#37;&#41; hombres&#46; El 7&#44;9&#37; de los pacientes no ten&#237;a FR identificable y el 67&#37; ten&#237;a m&#225;s de uno&#46; La mayor frecuencia de FR fue&#58; enfermedades sist&#233;micas agudas &#40;56&#44;1&#37;&#41;&#44; cardiopat&#237;as &#40;35&#44;1&#37;&#41; y enfermedades cr&#243;nicas sist&#233;micas &#40;29&#44;8&#37;&#41;&#46; Hubo asociaci&#243;n estad&#237;sticamente significativa entre FR enfermedad sist&#233;mica aguda y edad menor de 5 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y entre enfermedad cr&#243;nica sist&#233;mica y edad mayor o igual a 5 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; El FR cardiopat&#237;a se asoci&#243; a infarto arterial &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y el FR enfermedad aguda de cabeza y cuello con infarto venoso &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los FR de AVE isqu&#233;mico en la poblaci&#243;n pedi&#225;trica son m&#250;ltiples y algunos de ellos se asocian a edades espec&#237;ficas y tipo de AVE&#46; La detecci&#243;n de estos factores permitir&#225; la prevenci&#243;n primaria en la poblaci&#243;n de riesgo as&#237; como un diagn&#243;stico y tratamiento precoz&#44; haciendo igualmente posible la prevenci&#243;n de recurrencias&#46;</p>"
      ]
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Risk factors &#40;RF&#41; in pediatric stroke differ from those of adults&#44; and they include a wide range of diseases such as heart disease&#44; infections&#44; leukemias&#44; and inborn errors of metabolism&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To describe RF for ischemic stroke in a pediatric population&#44; and to examine the relationship of RF with age&#44; sex and type of stroke&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Patients and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">An analysis was made of database of 114 children and adolescents with ischemic stroke from January 2003 to July 2012&#46; Risk factors were stratified into 6 categories and ischemic strokes were classified as arterial and venous&#46; We compared the RF with age&#44; sex&#44; and type of stroke &#40;chi2 and OR&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The median age was 2&#46;5 years&#44; with 74 &#40;62&#46;2&#37;&#41; males&#46; No RF was identified in 7&#46;9&#37; of patients&#44; and 67&#37; had more than one RF&#46; The most common RF were acute systemic diseases &#40;56&#46;1&#37;&#41;&#44; heart disease &#40;35&#46;1&#37;&#41;&#44; and chronic systemic diseases &#40;29&#46;8&#37;&#41;&#46; There was a statistically significant association between acute systemic disease and age less than 5 years <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;001&#41;&#44; and between chronic systemic disease and age 5 years or more <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;02&#41;&#46; The RF of heart disease was associated with arterial infarction <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;05&#41;&#44; and the acute head and neck disease RF was associated with venous infarction <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The RF for ischemic stroke are multiple in the pediatric population&#44; and some of them are associated with a specific age and type of stroke&#46; The detection of these factors may help in the primary prevention of people at risk&#44; an early diagnosis&#44; and treatment and prevention of recurrences&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fiebre sin sepsis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Enfermedad cr&#243;nica sist&#233;mica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Epilepsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metab&#243;licas-neurodegenerativas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nefropat&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neoplasia no SNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colitis ulcerosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">EA de cabeza y cuello</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;25&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7-4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Meningitis bacteriana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Encefalitis aguda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infecci&#243;n respiratoria alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TEC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tumor cerebral descompensado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8-11&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peque&#241;os vasos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grandes vasos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Malformaci&#243;n del SNC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tumor intracraneano&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otras&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  """
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">AVE&#58; accidente vascular encef&#225;lico&#59; IC&#58; intervalo de confianza&#59; IIA&#58; infarto isqu&#233;mico arterial&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio&#59;</span> PUC&#58; Pontificia Universidad Cat&#243;lica&#59; TSV&#58; trombosis de senos venosos&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">IIA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">TSV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Cardiopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">E&#46; aguda sist&#233;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">E&#46; cr&#243;nica sist&#233;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">E&#46; aguda cabeza y cuello&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;12-11&#44;19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">E&#46; cr&#243;nica cabeza y cuello&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 16954033
Idioma original: Español
DOI:10.1016/j.anpedi.2013.11.010
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2023 Septiembre 41 25 66
2023 Agosto 37 16 53
2023 Julio 50 25 75
2023 Junio 55 33 88
2023 Mayo 71 24 95
2023 Abril 58 11 69
2023 Marzo 65 18 83
2023 Febrero 59 19 78
2023 Enero 63 16 79
2022 Diciembre 69 41 110
2022 Noviembre 82 49 131
2022 Octubre 72 50 122
2022 Septiembre 63 38 101
2022 Agosto 73 43 116
2022 Julio 53 40 93
2022 Junio 70 40 110
2022 Mayo 80 36 116
2022 Abril 113 35 148
2022 Marzo 129 48 177
2022 Febrero 109 23 132
2022 Enero 111 44 155
2021 Diciembre 64 35 99
2021 Noviembre 101 51 152
2021 Octubre 75 48 123
2021 Septiembre 48 44 92
2021 Agosto 68 51 119
2021 Julio 89 43 132
2021 Junio 48 35 83
2021 Mayo 46 22 68
2021 Abril 116 64 180
2021 Marzo 110 27 137
2021 Febrero 59 19 78
2021 Enero 31 26 57
2020 Diciembre 42 22 64
2020 Noviembre 29 24 53
2020 Octubre 43 24 67
2020 Septiembre 36 62 98
2020 Agosto 26 13 39
2020 Julio 43 11 54
2020 Junio 25 8 33
2020 Mayo 42 14 56
2020 Abril 33 8 41
2020 Marzo 31 17 48
2020 Febrero 40 11 51
2020 Enero 34 13 47
2019 Diciembre 49 20 69
2019 Noviembre 31 14 45
2019 Octubre 36 12 48
2019 Septiembre 54 12 66
2019 Agosto 42 19 61
2019 Julio 61 22 83
2019 Junio 37 39 76
2019 Mayo 105 49 154
2019 Abril 82 24 106
2019 Marzo 30 12 42
2019 Febrero 50 10 60
2019 Enero 39 23 62
2018 Diciembre 50 22 72
2018 Noviembre 93 32 125
2018 Octubre 126 19 145
2018 Septiembre 75 13 88
2018 Agosto 5 0 5
2018 Julio 7 0 7
2018 Junio 7 0 7
2018 Mayo 10 0 10
2018 Abril 104 0 104
2018 Marzo 33 0 33
2018 Febrero 18 0 18
2018 Enero 22 0 22
2017 Diciembre 27 1 28
2017 Noviembre 32 0 32
2017 Octubre 19 0 19
2017 Septiembre 25 0 25
2017 Agosto 17 0 17
2017 Julio 21 1 22
2017 Junio 27 20 47
2017 Mayo 34 16 50
2017 Abril 22 19 41
2017 Marzo 23 10 33
2017 Febrero 25 8 33
2017 Enero 20 3 23
2016 Diciembre 36 7 43
2016 Noviembre 52 8 60
2016 Octubre 68 22 90
2016 Septiembre 50 11 61
2016 Agosto 61 10 71
2016 Julio 35 6 41
2016 Mayo 1 0 1
2016 Enero 1 0 1
2015 Diciembre 3 0 3
2015 Noviembre 1 12 13
2015 Octubre 4 14 18
2015 Agosto 3 11 14
2015 Mayo 1 13 14
2015 Abril 1 10 11
2014 Diciembre 1 0 1
2014 Noviembre 3 1 4
2014 Septiembre 7 0 7
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