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ICTUS, EPIDEMIOLOGIA

 

El infarto cerebral, o ICTUS, es una de las mayores tragedias sanitarias que nos afectan.

Tanto desde el punto de vista personal, como de la repercusión personal, social, y sanitaria – económica.

Es la causa principal de invalidez o discapacidad grave a largo plazo en el adulto y la segunda causa de demencia.

Permanentemente se están realizando estudios para evaluar los casos que se producen, en todos los países desarrollados. De todos ellos podemos extraer cifras de su incidencia en la población.

La edad media fue de 70 años para los varones, y 75 para las mujeres.

La edad de inicio es de 55 años, este dato debe hacernos pensar que no es una enfermedad exclusiva de la persona mayor.

Una constante de todos los estudios es que con cada década de vida más, el incremento en la posibilidad de sufrir un ictus se incrementa de una manera acelerada.

En Europa, por ejemplo, los datos indican una mayor incidencia en los países del Norte de Europa:

· Finlandia: 270 casos por cada 100.000 habitantes, al año.

· Italia o Portugal: 100 casos por cada 100.000 habitantes, al año.

En relación a la edad, y como demostración de su mayor incidencia al aumentar esta, podemos citar estudios en diferentes regiones, con diferencias significativas en los porcentajes de edades. Ateniéndose a estudios en personas de más de 85 años:

· Oxfordshire (Reino Unido) : 1.647 casos por cada 100.000 habitantes, al año.

· Población escocesa : 2.400 casos por cada 100.000 habitantes, al año.

· Chile : 1.000 casos por cada 100.000 habitantes, al año.

Estas diferencias tan significativas es por la diferencia de envejecimiento de la población, los estudios Europeos indican que el 18,8 % de la población es mayor de 65 años, y en cambio en Chile esta cifra disminuye a 4,5 – 6 %.

 

ICTUS CARDIOEMBOLICO

 

Si diferenciamos el infarto cerebral hemorrágico, del isquémico y dentro de este grupo valoramos el de origen cardioembólico, las cifras de los estudios nos demuestran:

La Fibrilación Auricular es su causa más frecuente.

El riesgo de Ictus es independiente del tipo de F.A. ( de novo, paroxística, persistente, permanente).

Afecta 2 a 7 veces mas que los que no la padecen (5%) , y aumenta al 23 % en mayores de 80 años.

La mortalidad, es este tipo de ictus, es del 45 % a dos años y del 80 % a los 5 años.

Se calcula que la F.A. es la responsable del 20 & de todos los ictus isquémicos.

Por tanto la complicación más devastadora, personal, social y sanitariamente es la F.A. en este grupo de ictus isquémico.

 

Existe un problema añadido: la no determinación de la causa del infarto cerebral.

El estudio español DIAPRESIC demostró que un 46 % de los ictus no tenían un estudio exhaustivo de demostración de su causa.

Al menos un 30 % de los ictus, de las series publicadas, indican un origen no certero, por estudio incompleto.

 

Seria por tanto de enorme utilidad, tener formas de diagnostico de certeza, o al menos orientativas, precoces y previos a la instauración del ictus.

 

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