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The reversible cerebral vasoconstriction syndrome, also known as Call-Fleming syndrome, was initially described in 1988, and is characterized by a clinical syndrome of headaches episodes, generally the “thunderclap” pattern, due to a deregulation of the vascular tonus, leading to segmentary cerebral vasoconstriction and secondary neurological deficits, including those by ischemic or hemorrhagic stroke. In this paper, we present two illustrative cases of this syndrome due to the use of sibutramine. To our knowledge, this situation hasn’t been described as related drug before.

Purpose – Remanufacturing is an essential strategy for implementing the concepts of the circular economy, but consumers must be willing to consume remanufactured products for this strategy to be successful. This study analyzes how the attitudinal factors environmental knowledge, environmental awareness, attitude towards sustainable products and perceived effectiveness by consumers influence the intention to purchase remanufactured products in the Brazilian market. Design/methodology/approach – A descriptive research with quantitative methodology was developed with a sample of 289 participants, the analysis of the results was made using the statistical method of multiple linear regression. As limitations of the study, we can mention the sampling for convenience that restricts the generalization of the results. Findings – The results indicate that the four attitudinal factors analyzed influence the intention to purchase remanufactured products. This article presents theoretical and practical contributions. Research limitations/implications – From a theoretical point of view, this study allows a better understanding of the factors related to the intention to purchase remanufactured products by Brazilian consumers; from a practical point of view, this study provides a better understanding of the characteristics of the consumer market for remanufactured products, and can assist in the development of sustainable actions by companies. Originality/value – This article is the first study that seeks to identify and analyze factors that influence the intention to purchase remanufactured products in Brazil and can assist organizations in implementing the circular economy more effectively.

Context: This case report describes a patient with bilateral dissection of the carotid and vertebral arteries after being immunized by the Astrazeneca vaccine against COVID-19. Case report: AVC, female, 55 years old, health professional, without previous illness, received ChAdOx1 nCov-19 AstraZeneca vaccine and evolved after one day with flu-like symptoms, headache, odynophagia, fever, myalgia for 5 days. On the 7th day, she sought hospital service complaining of sudden headache, and numbness in the left upper limb. A non-reactive Sars-Cov-2 RT-PCR test was performed. The patient was released after clinical improvement. She returned after 8 days, being diagnosed with migraine and was treated with sintomatic drugs. After more 7 days, during the neurologist appointment, she reported daily headaches of varying intensity and episodes of unverified fever, with no findings on physical examination. Laboratory tests, brain resonance with cranial and cervical angioresonance, which showed findings of bilateral carotid dissection, involving the supra-bulbar segments of both internal carotid arteries, notably in the right internal carotid artery, as well as degrees of dissection of both vertebral arteries. On admission, antiplatelet aggregation was chosen, with the patient showing good evolution and being discharged after 4 days for outpatient follow-up. Conclusion: The patient has no evident risk factor for arterial dissection. In addition, the post-vaccine adverse reaction and the temporal gap between the application of the vaccine and the development of multiple arterial dissections drew attention. A possible link between the patient’s immune response and vascular endothelial inflammatory reaction is suggested, resulting in multiple arterial dissections.

Introduction: Cerebrovascular accident (CVA) is the second cause of death in the world, and arterial hypertension (AH) is the main risk factor. Objectives: To evaluate the prevalence of AH and the epidemiological profile of patients who suffered CVA, first and recurrent events, registered at JOINVASC, between 2013 and 2019. Methodology: An observational, descriptive, retrospective study, analyzing demographic data and risk factors, in patients that suffered CVA, first or recurrent event, was done. Results: In the study period, 6057 CVA events were registered, 4402(72.6%) patients were classified as hypertensive, (122 were excluded due to incomplete data), 4387 registers were analyzed. In this group, 2149 (51.2%) were male, mean age was 68.4±14.7(18 a 102 years), BMI was 27.5±5.1(14 a 59), 4330(39.9%) with Diabetes, 2559(58.8%) were smokers or ex-smokers, 3174(7.42%) were sedentary, and 504(11.5%) had controlled AH. In the group with recurrent event (1392-31.7%) (52.3%, p

Background and Purpose— The incidence of stroke is on the rise in young adults in high-income countries. However, there is a gap of knowledge about trends in stroke incidence in young adults from low- and middle-income countries. We aimed to measure trends in incidence of ischemic stroke (IS) and intracerebral hemorrhage (IH) in young people from 2005 to 2015 in Joinville, Brazil. Methods— We retrospectively ascertained all first-ever IS subtypes and IH that occurred in Joinville in the periods of 2005 to 2006, 2010 to 2011, and 2014 to 2015. Poisson regression was used to calculate incidence rate ratios of all strokes, IS, and IH. We also compared the prevalence of risk factors and extension of diagnostic work-up across the 3 periods. Results— For 10 years, we registered 2483 patients (7.5% aged Conclusions— Stroke incidence is rising in young adults in Joinville, Brazil, because of increase in rates of ischemic but not hemorrhagic strokes. We urgently need better policies of cardiovascular prevention in the young.

Among ischemic strokes, cardioembolic (CE) stroke has the worst outcome. We measured the incidence of atrial fibrillation (AF) and non-AF related CE strokes, previous anticoagulant use, and the 90-day functional outcome. Using multiple overlapping sources, we included all CE strokes that occurred in 2015 in Joinville, Brazil. Of the 374 ischemic strokes, 23% (84) were CE. The CE age-adjusted incidence, per 1,000 person-years, was 0.14 (0.11–0.17). Of the 26 patients with known prior AF, 73% (19) were not anticoagulated, 77% (20) had a CHA2DS2VASc score ≥ 3 and 81% (21) had a HAS-BLED score < 3. After three months, approximately one third of those 26 patients died or became disabled. The incidence of CE stroke in our sample was lower than in other population-based studies. The opportunity for anticoagulation was missed in one third of cases. RESUMO Entre todos os subtipos de AVC isquêmico, os eventos cardioembólicos (CE) apresentam os piores prognósticos. Determinamos a incidência de AVC isquêmico CE, associada ou não à fibrilação atrial (FA), o uso prévio de anticoagulantes e os desfechos funcionais em Joinville, Brasil. Utilizando múltiplas e sobrepostas fontes de informação, registramos todos os primeiros eventos CE ocorridos em 2015. Entre 374 eventos isquêmicos, 23% (84) foram CE. A incidência ajustada, para qualquer fonte cardioembólica, foi 0.14 (0.11–0.17) por 1000 pessoas-ano. Entre 26 pacientes com FA previamente conhecida, 73% (19) não estavam anticoagulados, 77% (20) tinham ≥ 3 pontos na escala CHA2DS2VASc e 81 % (21) < 3 pontos na escala HAS-BLED. Após 3 meses, um terço destes 26 pacientes morreram ou ficaram dependentes. A incidência de AVC I CE em Joinville é menor do que em outros estudos de base populacional. Um terço dos casos de AVC I CE com FA previamente conhecida perderam a oportunidade de anticoagulação.

Background: Temporal trends on the incidence of stroke and its subtypes could help assess on-going public health policies and point to further targets for action among middle- and low-income countries, where the stroke burden is very high. This study aimed at evaluating longitudinal trends of stroke incidence in Joinville, Brazil. Methods: We ascertained the incidence of all first-ever strokes occurred in 1995, 2005-2006 and 2012-2013, which were extracted from Joinville Stroke Registry, a prospective epidemiological data bank, launched in 1995. Results: From 1995 to 2013, the age-adjusted incidence of all strokes decreased 37% (95% CI 32-42). From 2005 to 2013, the haemorrhagic stroke (HS) incidence decreased 60% (95% CI 13-86), ischemic stroke (IS) incidence decreased 15% (95% CI 1-28), and subarachnoid haemorrhage incidence remained stable. The proportion of IS and HS patients with regularly treated hypertension increased by 60% (p = 0.01) and 33% (p = 0.01), respectively. The proportion of IS and HS patients that quit smoking increased 8% (p = 0.03) and 17% (p = 0.03), respectively. Conclusions: Stroke incidence has been decreasing in Joinville over the last 18 years, more so for HS than IS. Better control of hypertension and tobacco use might explain these findings.

Aiming to contribute to studies that use detailed clinical and genomic information of biobanks, we present the initial results of the first Latin American Stroke Biobank. Methods: Blood samples were collected from patients included in the Joinville Stroke Registry and four Brazilian cities. Demographic socio-economic data, cardiovascular risk factors, Causative Classification System for Ischemic Stroke, Trial of Org 10172 in Acute Stroke Treatment and National Institutes of Health scores, functional stroke status (modified Rankin) and brain images were recorded. Additionally, controls from both geographic regions were recruited. High-molecular-weight genomic DNA was obtained from all participants. Results: A total of 2,688 patients and 3,282 controls were included. Among the patients, 76% had ischemic stroke, 12% transient ischemic attacks, 9% hemorrhagic stroke and 3% subarachnoid hemorrhage. Patients with undetermined ischemic stroke were most common according the Trial of Org 10172 in Acute Stroke Treatment (40%) and Causative Classification System for Ischemic Stroke (47%) criteria. A quarter of the patients were under 55 years of age at the first-ever episode. Conclusions: We established the Joinville Stroke Biobank and discuss its potential for contributing to the understanding of the risk factors leading to stroke.

Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the unaffected hemisphere can enhance function of the paretic hand in patients with mild motor impairment. Effects of low-frequency rTMS to the contralesional motor cortex at an early stage of mild to severe hemiparesis after stroke are unknown. In this pilot, randomized, double-blind clinical trial we compared the effects of low-frequency rTMS or sham rTMS as add-on therapies to outpatient customary rehabilitation, in 30 patients within 5–45 days after ischemic stroke, and mild to severe hand paresis. The primary feasibility outcome was compliance with the interventions. The primary safety outcome was the proportion of intervention-related adverse events. Performance of the paretic hand in the Jebsen–Taylor test and pinch strength were secondary outcomes. Outcomes were assessed at baseline, after ten sessions of treatment administered over 2 weeks and at 1 month after end of treatment. Baseline clinical features were comparable across groups. For the primary feasibility outcome, compliance with treatment was 100% in the active group and 94% in the sham group. There were no serious intervention-related adverse events. There were significant improvements in performance in the Jebsen–Taylor test (mean, 12.3% 1 month after treatment) and pinch force (mean, 0.5 Newtons) in the active group, but not in the sham group. Low-frequency rTMS to the contralesional motor cortex early after stroke is feasible, safe and potentially effective to improve function of the paretic hand, in patients with mild to severe hemiparesis. These promising results will be valuable to design larger randomized clinical trials.