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Hemos realizado un estudio retrospectivo partiendo de un registro prospectivo de pacientes<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>55 a&#241;os con el diagn&#243;stico final de ictus que ingresaron en nuestra Unidad de Ictus durante el a&#241;o 2014&#46; Se excluyeron las hemorragias traum&#225;ticas&#44; subdurales y subaracnoideas&#46; Los pacientes fueron atendidos seg&#250;n las recomendaciones de las gu&#237;as de pr&#225;ctica cl&#237;nica de la Sociedad Espa&#241;ola de Neurolog&#237;a y del Plan de Atenci&#243;n al Ictus II&#46; 2010<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#8211;13</span></a>&#46; El estudio fue aprobado por nuestro Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se recogieron las siguientes variables de acuerdo con un protocolo predefinido&#58; datos demogr&#225;ficos&#44; factores de riesgo vascular &#40;conocidos o descubiertos durante el ingreso&#44; como tabaquismo&#44; hipertensi&#243;n arterial&#44; diabetes mellitus&#44; dislipidemia&#44; obesidad&#44; fibrilaci&#243;n auricular y cardiopat&#237;as embol&#237;genas&#41;&#44; h&#225;bitos t&#243;xicos &#40;enolismo y consumo de drogas&#41;&#44; presencia de foramen oval permeable&#44; toma de anticonceptivos orales&#44; enfermedad oncol&#243;gica activa&#44; trastornos de la coagulaci&#243;n &#40;cong&#233;nitos o adquiridos&#41;&#44; migra&#241;a y estr&#233;s psicosocial&#46; El estr&#233;s psicosocial se defini&#243; como un estado de ansiedad&#44; tensi&#243;n&#44; irritabilidad o dificultad para conciliar el sue&#241;o relacionado con problemas externos&#44; especialmente familiares&#44; econ&#243;micos y laborales&#46; A los pacientes se les pregunt&#243; si se sent&#237;an o no estresados en la &#233;poca anterior al ictus y cumplimentaron la escala <span class="elsevierStyleItalic">Perceived Stress Scale &#40;</span>PSS&#41; para cuantificar el grado de estr&#233;s durante el mes previo<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; De las diferentes versiones validadas&#44; la original de 14 &#237;tems y 2 versiones breves de 10 y 4 &#237;tems&#44; se utiliz&#243; esta &#250;ltima &#40;PSS-4&#41; por su mayor aplicabilidad&#46; La escala&#44; que no utiliza puntos de corte&#44; punt&#250;a de 0 a 16 puntos&#58; el 0 es el m&#237;nimo y el 16 el m&#225;ximo grado de estr&#233;s &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Todos los pacientes fueron valorados de forma urgente por el neur&#243;logo de guardia &#40;con o sin activaci&#243;n del c&#243;digo ictus extrahospitalario&#41; y se les realiz&#243; una exploraci&#243;n general y neurol&#243;gica con la escala <span class="elsevierStyleItalic">National Institute of Health Stroke Scale</span>&#44; anal&#237;tica&#44; radiograf&#237;a de t&#243;rax&#44; electrocardiograma y tomograf&#237;a computarizada craneal&#46; Los pacientes que cumpl&#237;an criterios de tratamiento en fase aguda recibieron terapia de reperfusi&#243;n &#40;tromb&#243;lisis intravenosa&#44; tratamiento endovascular o ambos&#41;&#44; siguiendo las recomendaciones de las gu&#237;as cl&#237;nicas<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#44;16</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Durante el ingreso hospitalario se complet&#243; el estudio etiol&#243;gico con pruebas de imagen neurovascular &#40;angio-tomograf&#237;a computarizada o neurosonolog&#237;a&#41;&#44; resonancia magn&#233;tica craneal y test cardiol&#243;gicos &#40;ecocardiograma y holter-electrocardiograma de 24&#160;h&#41;&#46; En algunos casos se realizaron pruebas espec&#237;ficas para detectar enfermedades de la coagulaci&#243;n&#44; autoinmunes o infecciosas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los tipos de ictus se clasificaron de acuerdo con los criterios de la Organizaci&#243;n Mundial de la Salud &#40;infarto cerebral&#44; ictus transitorio&#44; hemorragia intracraneal y trombosis venosa cerebral&#41;&#46; Se utiliz&#243; la clasificaci&#243;n <span class="elsevierStyleItalic">Trial of Org 10172 in Acute Stroke Treatment</span> &#40;TOAST&#41; para dividir los subtipos de ictus isqu&#233;mico en aterotromb&#243;tico&#44; cardioemb&#243;lico&#44; lacunar&#44; de etiolog&#237;a infrecuente y de etiolog&#237;a indeterminada<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a>&#46; La evoluci&#243;n cl&#237;nica se determin&#243; con la escala de Rankin modificada &#40;eRm&#41;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#44; y se consider&#243; una evoluci&#243;n favorable la independencia funcional a los 3 meses &#40;eRm 0-2&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis estad&#237;stico se utiliz&#243; el programa SPSS en su versi&#243;n 21&#46;0 para Windows&#46; Se utilizaron los test estad&#237;sticos Chi-cuadrado de Pearson y test exacto de Fisher para la comparaci&#243;n de variables categ&#243;ricas y la <span class="elsevierStyleItalic">t</span> de Student para la comparaci&#243;n de medias&#46; Se consider&#243; significativa una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se hizo un an&#225;lisis de subgrupos dividiendo a los pacientes en tramos de edad &#40;&#8804;45 y &#62;45 a&#241;os&#41; y por sexo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">Durante el a&#241;o 2014&#44; 830 pacientes con un diagn&#243;stico final de ictus ingresaron en nuestra unidad&#46; De ellos&#44; 110 &#40;13&#44;3&#37;&#41; ten&#237;an &#8804;55 a&#241;os&#44; con predominio masculino &#40;60&#44;9&#37;&#41; y 35 pacientes &#40;4&#44;2&#37;&#41; ten&#237;an &#8804;45 a&#241;os&#44; con predominio en estos del sexo femenino &#40;19 vs&#46; 16&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El rango de edad estuvo entre 15 y 55 a&#241;os con una edad media de 46&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;1 a&#241;os y una mediana de 49 a&#241;os&#46; La edad media fue superior en los hombres &#40;47&#44;7 vs&#46; 44&#44;4 a&#241;os&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; La incidencia global fue aumentando exponencialmente con relaci&#243;n a la edad &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Un total de 92 pacientes &#40;83&#44;6&#37;&#41; tuvieron un ictus isqu&#233;mico&#58; 73 &#40;66&#44;4&#37;&#41; fueron infartos cerebrales y 19 &#40;17&#44;3&#37;&#41; ataques isqu&#233;micos transitorios&#46; Del total&#44; 14 pacientes &#40;12&#44;7&#37;&#41; presentaron una hemorragia intracraneal y 4 &#40;3&#44;6&#37;&#41; una trombosis de senos venosos cerebrales&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El 87&#44;6&#37; de los pacientes ten&#237;a al menos un factor de riesgo vascular cl&#225;sico y el 65&#37; 2 o m&#225;s factores de riesgo&#58; estos porcentajes fueron en el grupo de pacientes de &#8804;45 a&#241;os del 71&#44;4 y del 45&#44;7&#37;&#44; respectivamente&#46; De los factores cl&#225;sicos&#44; el tabaquismo fue el m&#225;s frecuente &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; La mayor&#237;a de los factores de riesgo fueron m&#225;s frecuentes en el grupo de<span class="elsevierStyleHsp" style=""></span>&#62;45 a&#241;os&#44; aunque solo la hipertensi&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y el consumo de alcohol &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; alcanzaron significaci&#243;n estad&#237;stica&#46; En los varones&#44; la hipertensi&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; el tabaquismo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41; y la diabetes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; fueron m&#225;s frecuentes que en las mujeres y en estas hubo mayor prevalencia de migra&#241;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; Muchos pacientes desconoc&#237;an sus factores de riesgo&#58; se descubrieron durante el ingreso un 64&#44;3&#37; de cardiopat&#237;as embol&#237;genas&#44; un 51&#44;1&#37; de dislipidemias&#44; un 25&#37; de diabetes y un 18&#44;2&#37; de hipertensiones arteriales&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">El 57&#44;2&#37; de los pacientes refer&#237;a estr&#233;s psicosocial en la etapa previa al ictus&#46; La puntuaci&#243;n media de la escala PSS fue de 5&#44;2&#44; cifra superior en los pacientes con estr&#233;s &#40;7&#44;3 vs&#46; 1&#44;9&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y en las mujeres &#40;6&#44;4 vs&#46; 4&#44;4&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Entre los diferentes tipos de ictus no existieron diferencias significativas en el porcentaje de pacientes con estr&#233;s ni en la puntuaci&#243;n de la escala PSS&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las proporciones de cada subtipo de ictus se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; Entre las causas infrecuentes de ictus isqu&#233;mico la m&#225;s prevalente fue la disecci&#243;n arterial &#40;7 pacientes&#44; 7&#44;6&#37; de los ictus isqu&#233;micos&#41;&#46; Otras causas infrecuentes fueron&#58; 3 ictus asociados a neoplasia por mecanismo procoagulante&#44; un s&#237;ndrome antifosfol&#237;pido&#44; un lupus eritematoso sist&#233;mico&#44; una vasculitis aislada del sistema nervioso central&#44; un ictus por embolia parad&#243;jica asociado al s&#237;ndrome de la clase turista<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> y un ictus hemodin&#225;mico en relaci&#243;n con un s&#237;ncope prolongado&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Hubo 14 hemorragias intracraneales&#44; de las cuales 12 &#40;85&#44;7&#37;&#41; ocurrieron en varones y 11 &#40;78&#44;6&#37;&#41; fueron hipertensivas&#46; En los otros pacientes la etiolog&#237;a fue una sobredosificaci&#243;n de acenocumarol&#44; un cavernoma cerebral y un feocromocitoma&#46; Los 4 casos de trombosis venosa cerebral sucedieron en mujeres&#58; 3 fumaban y tomaban anticonceptivos orales y 2 ten&#237;an adem&#225;s una trombofilia primaria&#46; En otra paciente no se encontr&#243; ning&#250;n factor asociado&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La hospitalizaci&#243;n media fue de 8 d&#237;as &#40;rango 1-60&#41;&#46; El 82&#44;9&#37; de los pacientes tuvo un pron&#243;stico favorable a los 3 meses&#44; el 14&#44;3&#37; qued&#243; con secuelas graves &#40;eRm 3-5&#41; y 3 pacientes &#40;2&#44;8&#37;&#41; fallecieron&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Un total de 17 pacientes &#40;23&#44;3&#37; de los infartos cerebrales&#41; se beneficiaron de terapias de reperfusi&#243;n en fase aguda&#58; 10 &#40;13&#44;7&#37;&#41; recibieron fibrin&#243;lisis intravenosa&#44; 3 &#40;4&#44;1&#37;&#41; tratamiento endovascular y 4 &#40;5&#44;5&#37;&#41; ambos tratamientos&#46; La gravedad del ictus medida con la escala <span class="elsevierStyleItalic">National Institute of Health Stroke Scale</span> fue superior en los pacientes tratados respecto a los no tratados &#40;12&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;5 vs&#46; 4&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;3&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; la hospitalizaci&#243;n media fue similar &#40;8&#44;6 vs&#46; 7&#44;9 d&#237;as&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;76&#41; y la proporci&#243;n de pacientes con pron&#243;stico favorable fue menor en los pacientes que se trataron &#40;62&#44;5 vs&#46; 86&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; No hubo ning&#250;n caso de mortalidad ni de transformaci&#243;n hemorr&#225;gica entre los que recibieron terapia de reperfusi&#243;n&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Este estudio muestra el perfil del ictus en pacientes j&#243;venes que ingresan en una unidad especializada en Espa&#241;a&#46; El l&#237;mite de edad para considerar que un ictus ocurre en una persona joven es variable y la mayor&#237;a de los estudios fija un l&#237;mite entre 45 y 55 a&#241;os&#44; sin un criterio determinado<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#8211;8</span></a>&#46; En este trabajo optamos por los 55 a&#241;os para comparar la proporci&#243;n de ictus en j&#243;venes con los datos mostrados en el estudio IBERICTUS&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En cuanto a la edad media y la distribuci&#243;n por sexos no existieron diferencias con respecto a otros estudios con similares intervalos de edad<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;8</span></a>&#46; Tanto en hombres como en mujeres los factores de riesgo vascular fueron m&#225;s frecuentes que los observados en la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#46; Los factores de riesgo fueron m&#225;s frecuentes en los hombres y en el grupo de &#62;45 a&#241;os&#44; lo que explicar&#237;a la preponderancia masculina y el incremento exponencial de ictus que se observa con la edad&#46; Es destacable que casi 3 de cada 4 pacientes del grupo de &#8804;45 a&#241;os presentaba alg&#250;n factor de riesgo vascular&#44; independientemente de la etiolog&#237;a del ictus&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En comparaci&#243;n con otros estudios&#44; la prevalencia de factores vasculares cl&#225;sicos fue globalmente superior&#44; con mayores tasas de tabaquismo&#44; hipertensi&#243;n&#44; obesidad y diabetes<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;8</span></a>&#46; Tambi&#233;n es destacable el elevado porcentaje de pacientes cuyos factores de riesgo se descubrieron durante el ingreso&#46; La elevada frecuencia de estos factores de riesgo&#44; inesperada en el grupo de &#8804;45 a&#241;os y en muchos casos desconocidos por los pacientes&#44; indica la necesidad de implementar estrategias intensivas de prevenci&#243;n en la poblaci&#243;n joven para evitar un primer evento vascular o una recurrencia&#46; Se ha demostrado que a mayor acumulaci&#243;n de factores de riesgo en adultos j&#243;venes&#44; mayor es el riesgo de recurrencia de eventos isqu&#233;micos<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Una de las novedades que se introducen en el estudio fue el an&#225;lisis del papel del estr&#233;s psicosocial en los pacientes con ictus&#44; que afectaba a 6 de cada 10 pacientes&#46; Existe una evidencia moderada de que el estr&#233;s relacionado con el trabajo &#40;exigencias psicol&#243;gicas excesivas&#44; falta de apoyo social&#44; presi&#243;n&#44; etc&#46;&#41;&#44; los conflictos&#44; las crisis y el estr&#233;s en la vida familiar aumentan el riesgo de enfermedad cardiovascular<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a>&#46; Recientemente diferentes estudios han observado una asociaci&#243;n entre el estr&#233;s y la enfermedad cerebrovascular&#44; que es independiente del resto de los factores de riesgo<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15&#44;23&#44;24</span></a>&#46; Es conocido que el estr&#233;s influye en una serie de mecanismos biol&#243;gicos y fomenta h&#225;bitos y estilos de vida poco saludables&#58; consumo de tabaco&#44; alimentaci&#243;n poco equilibrada&#44; sedentarismo o mala adherencia a tratamientos<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a>&#46; Existe evidencia de que los programas de intervenci&#243;n psicol&#243;gica basados en el tratamiento del estr&#233;s como la terapia cognitivo-conductual pueden contribuir a mejorar el perfil de riesgo vascular y promover estilos de vida saludables<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a>&#59; y consideramos que aquellos pacientes que han sufrido un ictus en edad laboral y asocian un alto grado de estr&#233;s psicosocial podr&#237;an beneficiarse de un tratamiento psicoterap&#233;utico dirigido al control del estr&#233;s como parte del programa de prevenci&#243;n secundaria del ictus&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Con relaci&#243;n a los tipos de ictus&#44; la proporci&#243;n de isqu&#233;micos y hemorr&#225;gicos fue similar a la descrita en la literatura<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a>&#46; El ictus criptog&#233;nico es el m&#225;s frecuente en la mayor&#237;a de las series de ictus en sujetos j&#243;venes&#44; y representa entre un tercio y la mitad de los casos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a>&#46; Sin embargo&#44; la clasificaci&#243;n TOAST tiene unos criterios estrictos para poder clasificar algunos ictus como aterotromb&#243;ticos &#40;se requiere una estenosis mayor del 50&#37; de la arteria responsable&#41;&#44; lo que explica que muchos ictus se clasifiquen como criptog&#233;nicos&#44; aunque ocurran en pacientes con ateromatosis carot&#237;dea y presenten otros factores de riesgo vascular cuya relaci&#243;n con el ictus est&#225; bien documentada&#46; La proporci&#243;n de los subtipos de ictus isqu&#233;micos var&#237;a en cada estudio<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a>&#46; En nuestra serie&#44; a los ictus criptog&#233;nicos les siguieron en frecuencia los infartos lacunares&#44; hallazgo observado &#250;nicamente en otro registro<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a>&#59; esto se explica por la elevada prevalencia de hipertensi&#243;n arterial en ausencia de estenosis arteriales&#46; Los ictus de etiolog&#237;a cardioemb&#243;lica fueron relativamente infrecuentes&#44; aunque se sabe que tras algunos ictus criptog&#233;nicos puede subyacer una fibrilaci&#243;n auricular oculta<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a>&#46; En el grupo de &#8804;45 a&#241;os&#44; a pesar de la elevada prevalencia de factores de riesgo&#44; solo un tercio de los ictus se atribuy&#243; a aterotrombosis&#44; cardioembolia o enfermedad de peque&#241;o vaso&#44; lo que indica que la presencia de factores de riesgo vascular podr&#237;a contribuir a la aparici&#243;n de ictus por otros mecanismos&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Debe resaltarse que la causa m&#225;s frecuente de las hemorragias intracraneales fue la hipertensiva &#40;78&#44;6&#37;&#41; y solo 3 casos se produjeron por otras causas&#46; En general&#44; la etiolog&#237;a de la hemorragia intracraneal es similar a la de los pacientes mayores&#44; con una mayor representaci&#243;n de malformaciones arteriovenosas y enfermedades de la coagulaci&#243;n en detrimento de aquellas relacionadas con la toma de anticoagulantes o la angiopat&#237;a amiloide<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En cuanto a la evoluci&#243;n cl&#237;nica&#44; en el 82&#44;9&#37; de los pacientes fue favorable a los 3 meses&#44; dato similar a lo observado en otros estudios que muestran tasas de independencia funcional entre el 78 y el 94&#37;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a>&#46; Debe tenerse en cuenta que este porcentaje tambi&#233;n incluye los ataques isqu&#233;micos transitorios y los ictus menores&#44; de mejor pron&#243;stico general&#46; Considerando &#250;nicamente los ictus isqu&#233;micos tratados con terapias de reperfusi&#243;n &#40;en su mayor parte ictus graves&#41;&#44; cerca de 2&#47;3 de los pacientes fueron independientes a los 3 meses&#44; resultado que confirma que los sujetos j&#243;venes tienen generalmente mejor pron&#243;stico respecto a los pacientes de mayor edad<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">7&#44;31</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Las limitaciones principales de este trabajo son su car&#225;cter retrospectivo y la baja especificidad de la escala de estr&#233;s&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0140" class="elsevierStylePara elsevierViewall">En este estudio la proporci&#243;n de ictus en sujetos j&#243;venes fue un 30&#37; superior a la del estudio IBERICTUS&#44; lo que indica que la incidencia del ictus podr&#237;a estar aumentando en esta poblaci&#243;n&#46; Este aumento parece deberse a una elevada tasa de factores de riesgo vascular en un segmento de la poblaci&#243;n que desconoce su perfil de riesgo o no lo controla adecuadamente&#46; La mayor&#237;a de los factores de riesgo vascular son modificables&#44; y entre ellos se debe considerar el estr&#233;s psicosocial&#44; lo que hace necesario fomentar estrategias de prevenci&#243;n adecuadas para evitar eventos vasculares&#46; Por &#250;ltimo&#44; cabe resaltar que casi 2&#47;3 de los ictus isqu&#233;micos tratados con terapias de reperfusi&#243;n fueron funcionalmente independientes a los 3 meses&#44; lo que subraya la importancia de la detecci&#243;n temprana de los s&#237;ntomas de ictus tambi&#233;n en la poblaci&#243;n joven&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">Este trabajo ha sido financiado con una beca de la Fundaci&#243;n Alberto Contador&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2016-03-05"
    "fechaAceptado" => "2016-05-06"
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          "palabras" => array:6 [
            0 => "Ictus"
            1 => "Ictus en adultos j&#243;venes"
            2 => "Infarto cerebral"
            3 => "Hemorragia cerebral"
            4 => "Factores de riesgo vascular"
            5 => "Estr&#233;s"
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            0 => "Stroke"
            1 => "Stroke in young adults"
            2 => "Cerebral infarction"
            3 => "Cerebral haemorrhage"
            4 => "Cardiovascular risk factors"
            5 => "Stress"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar la incidencia&#44; los factores de riesgo&#44; la etiolog&#237;a&#44; el tratamiento y la evoluci&#243;n cl&#237;nica de pacientes j&#243;venes con ictus&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Registro retrospectivo de pacientes &#8804; 55 a&#241;os ingresados en una Unidad de Ictus durante el a&#241;o 2014&#46; Se recogi&#243; la incidencia sobre el total de ictus y se analizaron datos demogr&#225;ficos&#44; factores de riesgo&#44; grado de estr&#233;s&#44; tipo y etiolog&#237;a del ictus&#44; tratamientos de reperfusi&#243;n y evoluci&#243;n cl&#237;nica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 110 pacientes&#44; la mayor&#237;a hombres &#40;60&#44;9&#37;&#44; ratio 1&#44;6&#58;1&#41;&#46; La incidencia fue del 13&#44;3&#37; &#40;110 de 830 ictus&#41;&#46; La mayor&#237;a de los pacientes ten&#237;a factores de riesgo vascular&#46; El tabaquismo fue el m&#225;s frecuente &#40;56&#44;4&#37;&#41;&#44; seguido de la hipertensi&#243;n arterial &#40;50&#37;&#41;&#44; dislipidemia &#40;42&#44;7&#37;&#41;&#44; obesidad &#40;33&#37;&#41;&#44; diabetes &#40;18&#44;2&#37;&#41; y cardiopat&#237;as embol&#237;genas &#40;12&#44;7&#37;&#41;&#46; El 64&#44;3&#37; de las cardiopat&#237;as y el 51&#44;1&#37; de las dislipidemias se descubrieron durante el ingreso&#46; El 57&#44;2&#37; de los pacientes presentaban estr&#233;s psicosocial en la etapa previa al ictus&#46; El 83&#44;6&#37; de los ictus fueron isqu&#233;micos&#44; el 12&#44;7&#37; hemorr&#225;gicos y el 3&#44;6&#37; trombosis de senos venosos&#46; De los ictus isqu&#233;micos&#44; el 30&#44;4&#37; fueron criptog&#233;nicos&#44; el 23&#44;9&#37; lacunares&#44; el 16&#44;3&#37; por causas infrecuentes&#44; el 15&#44;2&#37; aterotromb&#243;ticos y el 14&#44;1&#37; cardioemb&#243;licos&#46; El 78&#44;6&#37; de las hemorragias cerebrales fueron hipertensivas&#46; El 23&#44;3&#37; de los ictus isqu&#233;micos recibieron tratamientos de reperfusi&#243;n en fase aguda y se consiguieron niveles de independencia funcional a los 3 meses del 62&#44;5&#37;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La mayor&#237;a de los ictus en pacientes &#8804; 55 a&#241;os parecen relacionarse con una elevada prevalencia de factores de riesgo vascular cl&#225;sicos y posiblemente de estr&#233;s psicosocial&#46;</p></span>"
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            "titulo" => "Pacientes y m&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyse the incidence&#44; risk factors&#44; aetiology&#44; treatment and clinical evolution of young patients with stroke&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective registry of patients aged 55 years or younger hospitalised in a stroke unit during 2014&#46; We recorded the incidence rate for all strokes and analysed demographic data&#44; risk factors&#44; degree of stress&#44; stroke type and aetiology&#44; reperfusion treatments and clinical evolution&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 110 patients&#44; the majority of whom were men &#40;60&#46;9&#37;&#44; 1&#46;6&#58;1 ratio&#41;&#46; The incidence rate was 13&#46;3&#37; &#40;110 of 830 strokes&#41;&#46; Most of the patients had cardiovascular risk factors&#46; Smoking was the most common risk factor &#40;56&#46;4&#37;&#41;&#44; followed by arterial hypertension &#40;50&#37;&#41;&#44; dyslipidaemia &#40;42&#46;7&#37;&#41;&#44; obesity &#40;33&#37;&#41;&#44; diabetes &#40;18&#46;2&#37;&#41; and emboligenic heart disease &#40;12&#46;7&#37;&#41;&#46; Some 64&#46;3&#37; of the heart disease cases and 51&#46;1&#37; of the dyslipidaemia cases were discovered during hospitalisation&#46; Some 57&#46;2&#37; of the patients experienced psychosocial stress in the stage prior to the stroke&#46; Some 83&#46;6&#37; of the stroke cases were ischaemic&#44; 12&#46;7&#37; were haemorrhagic and 3&#46;6&#37; were venous sinus thrombosis&#46; Of the ischaemic stroke cases&#44; 30&#46;4&#37; were cryptogenic&#44; 23&#46;9&#37; were lacunar&#44; 16&#46;3&#37; were from uncommon causes&#44; 15&#46;2&#37; were atherothrombotic and 14&#46;1&#37; were cardioembolic&#46; Some 78&#46;6&#37; of the cerebral haemorrhage cases were hypertensive&#46; Some 23&#46;3&#37; of the ischaemic stroke cases underwent reperfusion treatments in the acute phase&#44; achieving levels of functional independence at 3 months of 62&#46;5&#37;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The majority of stroke events in patients 55 years of age or younger appear to be related to a high prevalence of classical cardiovascular risk factors and possibly to psychosocial stress&#46;</p></span>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">En el &#250;ltimo mes&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nunca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">De vez en cuando&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Muy a menudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46; &#191;Con qu&#233; frecuencia se ha sentido incapaz de controlar las cosas importantes en su vida&#63;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>110&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Varones &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mujeres &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#8804;45 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#62;45 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Edad&#44; a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67 &#40;60&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;39&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">V 16 &#40;45&#44;7&#41;<br>M 19 &#40;54&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">V 51 &#40;68&#41;<br>M 24 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Altura&#44; cm</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">168&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">173&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">161&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">167&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">169&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Peso&#44; kg</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tabaquismo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;56&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;67&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;39&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;42&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;62&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hipertensi&#243;n arterial&#44; n &#40;&#37;&#41;</span><br><span class="elsevierStyleHsp" style=""></span>Conocida<br><span class="elsevierStyleHsp" style=""></span>Desconocida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;50&#41;<br>45 &#40;81&#44;8&#41;<br>10 &#40;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;65&#44;7&#41;<br>37 &#40;84&#44;1&#41;<br>7 &#40;15&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;25&#44;6&#41;<br>8 &#40;72&#44;7&#41;<br>3 &#40;27&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#44;001<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;31&#44;4&#41;<br>9 &#40;81&#44;8&#41;<br>2 &#40;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;58&#44;7&#41;<br>36 &#40;81&#44;8&#41;<br>8 &#40;18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;01<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes mellitus&#44; n &#40;&#37;&#41;</span><br><span class="elsevierStyleHsp" style=""></span>Conocida<br><span class="elsevierStyleHsp" style=""></span>Desconocida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;18&#44;2&#41;<br>15 &#40;75&#41;<br>5 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;25&#44;4&#41;<br>12 &#40;70&#44;6&#41;<br>5 &#40;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;7&#41;<br>3 &#40;100&#41;<br>-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;02<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;11&#44;4&#41;<br>2 &#40;50&#41;<br>2 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;21&#44;3&#41;<br>13 &#40;81&#44;3&#41;<br>3 &#40;18&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;29<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Dislipidemia&#44; n &#40;&#37;&#41;</span><br><span class="elsevierStyleHsp" style=""></span>Conocida<br><span class="elsevierStyleHsp" style=""></span>Desconocida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;42&#44;7&#41;<br>23 &#40;48&#44;9&#41;<br>24 &#40;51&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;44&#44;8&#41;<br>14 &#40;47&#44;7&#41;<br>16 &#40;53&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;39&#44;5&#41;<br>9 &#40;52&#44;9&#41;<br>8 &#40;47&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;95<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;31&#44;4&#41;<br>6 &#40;54&#44;5&#41;<br>5 &#40;45&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;48&#41;<br>17 &#40;47&#44;2&#41;<br>19 &#40;52&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;15<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Obesidad &#40;IMC &#62;30&#41;&#44; n&#47;total &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#47;100 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#47;60 &#40;36&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;40 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;32 &#40;21&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#47;68 &#40;38&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cardiopat&#237;as embol&#237;genas &#40;FA</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">otras&#41;&#44; n &#40;&#37;&#41;</span><br><span class="elsevierStyleHsp" style=""></span>Conocida<br><span class="elsevierStyleHsp" style=""></span>Desconocida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;12&#44;7&#41;<br><br>5 &#40;35&#44;7&#41;<br>9 &#40;64&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;11&#44;9&#41;<br><br>3 &#40;37&#44;5&#41;<br>5 &#40;62&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;13&#44;9&#41;<br><br>2 &#40;33&#44;3&#41;<br>4 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;99<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;8&#44;6&#41;<br><br>3 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;14&#44;7&#41;<br><br>4 &#40;36&#44;4&#41;<br>7 &#40;63&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;54<br><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Consumo de alcohol &#62;40</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">g&#47;d&#237;a&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;13&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Foramen oval permeable&#44; n&#47;total &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#47;30 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;14 &#40;28&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;16 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;10 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;20 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anticonceptivos hormonales&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;16&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Consumo de drogas&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enfermedad oncol&#243;gica&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Enfermedades de la coagulaci&#243;n&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Migra&#241;a&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;18&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Estr&#233;s psicosocial&#44; n&#47;total &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#47;57 &#40;56&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#47;39 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#47;29 &#40;55&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;82&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;20&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Etiolog&#237;a infrecuente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;16&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;10&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;24&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Etiolog&#237;a Indeterminada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;30&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;29&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;32&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;26&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hemorragia cerebral&#44; n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hipertensiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;78&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;83&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;71&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;85&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Relacionada con anticoagulaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Malformaci&#243;n vascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otras etiolog&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Trombosis de senos venosos&#44; n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tabaquismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Enfermedades coagulaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anticonceptivos hormonales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ning&#250;n factor de riesgo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Tipos de ictus y etiolog&#237;a</p>"
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          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Instituto Nacional de Estad&#237;stica Defunciones seg&#250;n la causa de muerte&#46; 2013 &#91;consultado 15 Feb 2016&#93;&#46; Disponible en&#58; <a id="intr0005" class="elsevierStyleInterRef" href="http://www.ine.es/prensa/np896.pdf">http&#58;&#47;&#47;www&#46;ine&#46;es&#47;prensa&#47;np896&#46;pdf</a>"
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                    0 => array:2 [
                      "titulo" => "Stroke and transient ischemic attack incidence rate in Spain&#58; The IBERICTUS study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; D&#237;az-Guzm&#225;n"
                            1 => "J&#46;A&#46; Egido"
                            2 => "R&#46; Gabriel-S&#225;nchez"
                            3 => "G&#46; Barber&#225;-Comes"
                            4 => "B&#46; Fuentes-Gimeno"
                            5 => "C&#46; Fern&#225;ndez-P&#233;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000342652"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cerebrovasc Dis&#46;"
                        "fecha" => "2012"
                        "volumen" => "34"
                        "paginaInicial" => "272"
                        "paginaFinal" => "281"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23095851"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
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            2 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of 1008 consecutive patients aged 15&#8211;49 with first-ever ischemic stroke&#58; The Helsinki young stroke registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Putaala"
                            1 => "A&#46;J&#46; Metso"
                            2 => "T&#46;M&#46; Metso"
                            3 => "N&#46; Konkola"
                            4 => "Y&#46; Kraemer"
                            5 => "E&#46; Haapaniemi"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1161/STROKEAHA.108.529883"
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                        "tituloSerie" => "Stroke&#46;"
                        "fecha" => "2009"
                        "volumen" => "40"
                        "paginaInicial" => "1195"
                        "paginaFinal" => "1203"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19246709"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term prognosis of ischemic stroke in young adults&#46; Study of 272 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;F&#46; Varona"
                            1 => "F&#46; Bermejo"
                            2 => "J&#46;M&#46; Guerra"
                            3 => "J&#46;A&#46; Molina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00415-004-0583-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurol&#46;"
                        "fecha" => "2004"
                        "volumen" => "251"
                        "paginaInicial" => "1507"
                        "paginaFinal" => "1514"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15645352"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
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            4 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "5"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiology of first-ever ischaemic stroke in European young adults&#58; The 15 cities young stroke study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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