Guia Neurologica Estrategias de Prevenci³n Secundaria ACV

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    GUR^@RGIA@UBG\^GZGHEAHUGEWHB@^A@GH@R@PWGEG^GN^CZ@UEWD@^ -@EZ!

    IW@ HGW^CDIAE@ =

    GHJG^OGB@B EG^GN^CZ@UEWD@^

    E@\RWDC 2

    CDI@ DWE@ \GB^@[@HGW^DCI@ EDHAE@( \^CJGUC^@ @UCEA@B@J@EWDR@B BG OGBAEAH@( MCU\AR@D WHAZG^UAR@^AC U@H AIH@EAC(\CHRAJAEA@ WHAZG^UAB@B K@ZG^A@H@( NCICR$ ECDCONA@

    ^AE@^BC B@[HGW^DCIC$ \^CJGUC^ @UCEA@BCJ@EWDR@BBG OGBAEAH@$ WHAZG^UAB@BBG E@DB@U$O@HA[@DGU$ ECDCONA@

    G^AEF UHEMG[ \(HGW^DCIC EDHAEC( \^CJGUC^ RARWD@^J@EWDR@B BG OGBAEAH@( MCU\AR@D WHAZG^UAR@^AC U@H AIH@EAC(\CHRAJAEA@ WHAZG^UAB@B K@ZG^A@H@( NCICR$ ECDCONA@

    @HIGD@ O@^@ A^@IC^^A^GUABGHRGBG HGW^CDCI@ EW@^RC @CJ@EWDR@B BG OGBAEAH@( MCU\AR@D WHAZG^UAR@^AC U@H AIH@EAC(\CHRAJAEA@ WHAZG^UAB@B K@ZG^A@H@( NCICR$ ECDCONA@

    EC^^GU\CHBGHEA@g/o`ad; cpgbr`z`Lk`vgra`h`(gbu(ec

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    \^GZGHEAHUGEWHB@^A@GH@EZ( \GB^@[@ CD$ B@[ ^$ UHEMG[ G$ A^@IC^^A @O / 29 /

    IWA@ HGW^CDCIAE@ =

    AHR^CBWEEAHGd @EZ gs d` tgregr` e`us` bg ougrtg gh WU@ `s ecoc d` praheap`d e`us` bg

    base`p`eab`b -0!( Gh Ecdcona` gs d` tgregr` e`us` bg ougrtg bgspus bg d` vacdghea`

    y bg d s ghjgrogb`bgs e`rb`e`s y gs uh` bg d`s praheap`dgs e`us`s bg base`p`eab`b y

    bg pgrbab` bg cs bg vab` s`dub`ndgs$ aheduyghbc p`rtaeud`roghtg d`s oukgrgs ghtrg dcs 07 y 22

    `cs ->!( Gh Ecdcona` sg m` ahjcro`bc uh` t`s` bg @EZ bg 5

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    / 2= / \^GZGHEAHUGEWHB@^A@GH@EZ( \GB^@[@ CD$ B@[ ^$ UHEMG[ G$ A^@IC^^A@O(

    IWA@ HGW^CDCIAE@ =

    bgougstr`h qug ` pgs`r bg tr`t`rsg d` MR@$ scdc ghtrg >9 y 22 pcr eaghtc bg p`eaghtgs `de`hz`h

    d`s ogt`s rgecoghb`b`s gh d`s iu`s bg o`hgkc ->2$>7!(

    GBWE@^@D\@EAGHRGDcs j`etcrgs qug `nrgh d` nrgem` ghtrg dc qug bgougstr` d` gvabghea` y dc qug sg m`eg gh gd

    o`hgkc gjgetavc bgd j`etcr bg ragsic aheduygh; uh` j`dt` bg echceaoaghtc bg dcs j`etcrgs bg ragsic

    p`r` @EZ y bg dcs shtco`s bgd @EZ pcr p`rtg bgd p`eaghtg(

    Ug m` bgocstr`bc qug scdc uh 79 pcr eaghtc bg d` pcnd`eah ighgr`d echceg dcs

    shtco`s bg uh @EZ(

    Gd p`eaghtg$ ecoc dc suiagrg d` dgy 01!(

    GBWE@^@D\G^UCH@DBGU@DWBUg echceg$ qug diuhcs oagonrcs bgd pgrsch`d bg s`dub$ ecoc ghjgrogr`s$ obaecs ighgr`dgs

    y gspgea dast`s bgd rg` edhae`$ aheduyghbc hgurdcics qug tr`t`h p`eaghtgs ech @EZ bgsechcegh$

    ech rgd`tav` jrgeughea`$ dcs j`etcrgs bg ragsic y ouem`s vgegs erggh qug hc gs su rgspchs`nadab`b

    d` gbue`eah bgd p`eaghtg scnrg gstg tgo`(

    Gs uh bgngr bg d`s j`eudt`bgs bg s`dub y bg dcs mcspat`dgs uhavgrsat`racs$ m`egr echseaghtgs `

    dcs gstuba`htgs bg prgir`bc y pcsir`bc$ bgd p`pgd qug gddcs bgngh bgsgopg`r gkgopd`raz`hbc

    y gbue`hbc gh gstg tgo` ->7!(

    GBWE@^@D@ECOWHAB@BBgsbg dcs sastgo`s bg gbue`eah y s`dub sg bgngh bgs`rrcdd`r prcir`o`s p`r` d` ecouhab`b

    gh tcbcs dcs irupcs bg gb`b$ ghe`oah`bcs ` ighgr`r gh d`s pgrsch`s mnatcs y gstadcs s`hcs bg

    vab`$ qug aheduy`h n`d`heg ghtrg d` bagt`$ gd gkgreaeac y d` `etavab`b jsae`( Ug bgngh bgs`rrcdd`r

    prcir`o`s ahbavabu`daz`bcs qug sg craghtgh ` ogkcr`r gd echceaoaghtc bg dcs j`etcrgs bg

    ragsic y su prgvgheah ->9/>1!(

    \^CI^@O@GHGDUAURGO@BGU@DWBGd sastgo` bg s`dub bgng tr`n`k`r `opda`oghtg gh gd euopdaoaghtc bg dcs cnkgtavcs bg

    prcoceah y prgvgheah gh s`dub$ b`hbc pracrab`b ` d` gbue`eah scnrg d`s p`tcdci`s bg

    `dt` prgv`dghea`$ aheabghea` y ocrt`dab`b ecoc sch d` ghjgrogb`b ecrch`ra` y d` ghjgrogb`b

    egrgnrcv`seud`r ->1!(

    MA\G^RGHUAH@^RG^A@DD` mapgrtghsah rtgra`d gs uh j`etcr bg ragsic p`r` @EZ asquoaec y mgocrriaec -mgocrr`ia`

    ahtr`p`rghquao`tcs` y sun`r`ehcabg`!$ y j`vcrgeg gd bgs`rrcddc bg `tgrcsedgrcsas$ dapcma`dahcsas

    `scea`b` ` ghjgrogb`b egrgnrcv`seud`r bg pgqugc v`sc$ y j`dd` e`rb`e` -5

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    \^GZGHEAHUGEWHB@^A@GH@EZ( \GB^@[@ CD$ B@[ ^$ UHEMG[ G$ A^@IC^^A @O / 21 /

    IWA@ HGW^CDCIAE@ =

    Raghg uh ocbgdc bg mgrghea` ecopdgk` y dcs oge`hasocs ightaecs ahvcduer`bcs aheduygh;

    mgrghea` pcdaihae`$ mgtgrcighaeab`b ightae`$ ahtgr`eeah ghtrg ighgs$ ahtgr`eeah ighgs/j`etcrgs

    `onaght`dgs y gxprgsah bg dcs ighgs tagopc/bgpghbaghtgs -50!(

    Rr`baeach`doghtg sg `egpt` qug 1< / 17 pcr eaghtc bg dcs p`eaghtgs mapgrtghscs prgsght`h uh`jcro` bg mapgrtghsah rtgra`d gh d` eu`d hc gs pcsandg abghtajae`r uh` e`us` crihae` qug gxpdaqug

    d` gdgv`eah bg d` prgsah( Uah gon`ric$ sg m`h bgseratc v`racs oge`hasocs qug echtranuygh ` d`

    v`ra`eah bg d`s eajr`s bg tghsah `rtgra`d gh uh ahbavabuc -5>!(

    Z`racs gstubacs suiagrgh uh aon`d`heg ghtrg gd sastgo` rghah`/`hiactghsah` y d` v` bg

    prcbueeah bg xabc htraec gh d` p`tcihgsas bg d` mapgrtghsah `rtgra`d$ pugs gd bgs`rrcddc bg

    d` ghjgrogb`b ahvcduer` trgs j`etcrgs praheap`dgs; `dtgr`eah bgd tchc v`seud`r$ `hcro`dab`b gh d`

    rgiud`eah bgd vcduogh y d` s`d y rgocbgd`eah v`seud`r(

    Ctr` maptgsas prcpugst` supchg d` gxastghea` bg uh bgjgetc gh d` ogonr`h` egdud`r$

    ech o`ycr prgbadgeeah pcr d`s edud`s bgd oseudc dasc$ qug prcbueg `dtgr`eachgs gh dcsoge`hasocs bg tr`hspcrtg bg scbac( Gstc ddgv`r` ` `euoud`eah gxegsav` bg e`deac gh gd

    ahtgracr bg d` edud` ouseud`r$ dc qug dg echjagrg uh` o`ycr e`p`eab`b bg rgspugst` `htg

    gd gstoudc v`scprgscr(

    Ctr`s mcroch`s qug pcbr`h p`rtaeap`r gh d` jasacp`tcdci` bg d` mapgrtghsah `rtgra`d sch

    -50$5>!; gd pptabc h`traurtaec uraeud`r qug dangr`bc gh d`s edud`s e`rb`e`s$ ecoc rgspugst` d`

    bastghsah `uraeud`r pcr `uoghtc bg vcduogh ahtr`v`seud`r6 prcbueg v`scbad`t`eah y h`traurgsas$

    g ahmang d` dangr`eah bg rghah` y ghbctgdah`$ d` sgergeah bg `dbcstgrch` y d` prcdajgr`eah egdud`r(

    D` nr`baeahah` qug `etav` d` shtgsas bg prcst`eaedah` y gstaoud` d` dangr`eah bg xabc htraec y d`

    `brghcogbudah`$ uh` mcroch` sgergt`b` pcr d` obud` supr`rrgh`d qug rgbueg d` prgsah rtgra`d

    pcr v`scbad`t`eah y gxergeah bg scbac y `iu`(Ug m` bgseratc qug pcr e`b` >< oo Mi bg ahergoghtc gh d` prgsah `rtgra`d sastdae`$ c

    0< oo Mi gh d` prgsah `rtgra`d ba`stdae`$ gd ragsic e`rbacv`seud`r sg bupdae` gh p`eaghtgs

    bg 2< ` 9< `cs bg gb`b -5

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    / 7< / \^GZGHEAHUGEWHB@^A@GH@EZ( \GB^@[@ CD$ B@[ ^$ UHEMG[ G$ A^@IC^^A@O(

    IWA@ HGW^CDCIAE@ =

    Bgsbg 011=$ sg m`h ecopdgt`bc `diuhcs gstubacs `opdacs ecop`r`hbc hugv`s ed`sgs bg

    ogbae`oghtcs$ aheduyghbc e`deac`ht`ichast`s$ AGE@ y @^@ AA$ ech dcs `htaiucs baurtaecs

    y/ndcqug`bcrgs -55$57!(

    Gh gd gstubac \^CI^GUU -\grahbcprad \rctgetach `i`ahst ^geurrght Utrcfg Utuby!$ sgaheduygrch :' 2>=' 7==6 ^^^ 05'

    praheap`d

    ^gbueeah bg eajr`s bg 5#> oo Mi 1#2 oo Mi R@U; Dcs`rth 5 oo Mi6

    tghsah `rtgra`d `tghcdcd >1(0 oo Mi(

    R@B; dcs`rth 0:(: oo Mi$

    `tghcdcd 0:(= oo Mi

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    \^GZGHEAHUGEWHB@^A@GH@EZ( \GB^@[@ CD$ B@[ ^$ UHEMG[ G$ A^@IC^^A @O / 70 /

    IWA@ HGW^CDCIAE@ =

    ^GECOGHB@EACHGU -55!D` ogt` bgd tr`t`oaghtc$ sgih d`s iu`s bgd ZAA ecoat echkuhtc p`r` gd o`hgkc bg

    mapgrtghsah `rtgra`d$ gs dcir`r eajr`s bg tghsah `rtgra`d oghcrgs bg 02

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    / 7> / \^GZGHEAHUGEWHB@^A@GH@EZ( \GB^@[@ CD$ B@[ ^$ UHEMG[ G$ A^@IC^^A@O(

    IWA@ HGW^CDCIAE@ =

    Dcs eabcs ir`scs cogi` 5( Dcs ahvgsta/

    i`bcrgs gstao`h qug dcs gjgetcs scnrg d`s

    echeghtr`eachgs bg dpabcs s`hiuhgcs dcir`b`s

    ech gd supdgoghtc bg gstg tapc bg eabcs ir`scsprcvghaghtgs bg `egatg bg pgse`bc prcbueg

    uh` basoahueah bg >9 pcr eaghtc gh gd ragsic

    bg ghjgrogb`b e`rbacv`seud`r( ^gechcegh hc

    cnst`htg$ d` hgegsab`b bg v`dab`r gstcs m`dd`zics

    ech gstubacs edhaecs ` d`ric pd`zc gh dcs qug

    sg vgrajaqug qug d` rgbueeah bg dcs j`etcrgs bg

    ragsic sg tr`bueg gh gjgetc gh uh` basoahueah

    bg dcs gvghtcs e`rbacv`seud`rgs gh baemc irupc

    bg d` pcnd`eah -2

    D` bagt` bgd ogbatgrrhgc( Gd gstadc bgvab` bg d` rgiah aheduyg gd echsuoc bg gdgv`b`s

    e`htab`bgs bg pgse`bc$ `egatg bg cdav`$ vgigt`dgs$ jrut`s y egrg`dgs$ kuhtc ech uh` n`k` utadaz`eah

    bg detgcs y e`rhgs rck`s y uh echsuoc ocbgr`bc bg vahcs rckcs( Gst` bagt` prcpcreach`

    ir`hbgs e`htab`bgs bg janr`$ vat`oah`s bgd ecopdgkc N y `htacxab`htgs h`tur`dgs( Ech gddc$ gs

    pcsandg basoahuar dcs havgdgs bg ecdgstgrcd uhabc ` dapcprctgh`s bg n`k` bghsab`b y sg ahmangh dcs

    oge`hasocs ahjd`o`tcracs y cxab`htgs rgspchs`ndgs bg d` tgrcsedgrcsas(

    Gh gd Gstubac bg Ecr`zh y Bagt` bg Dych$ dcs eaghtjaecs ecoprcn`rch qug baem` bagt`

    rgbue` m`st` 9< pcr eaghtc d` rgeurrghea` bg ecopdae`eachgs e`rbacv`seud`rgs ecoc ougrtg

    snat`$ ghjgrogb`b egrgnrcv`seud`r$ ahj`rtc `iubc bg oace`rbac$ goncdasoc pudoch`r y

    j`dd` e`rb`e` sgvgr` -20!(

    Rr`t`oaghtc bg d` mapgrecdgstgrcdgoa` DBD( D`s gst`tah`s m`h echsgiuabc d` rgvcdueah

    j`ro`ecdiae` bg d` prgvgheah sgeuhb`ra`( Gstubacs edhaecs ecoc gd \D@E 0 -\r`v`st`tah

    Daoat`tach cj @tmgrcsedgrcsas ah tmg Ecrch`ry @rtgrags! -2>!$ gd ^GI^GUU -^girgssach Ircwtm

    Gv`du`tach Ut`tah Utuby Ircup! -25! y gd E@^G -Emcdgstgrcd `hb ^geurrght Gvghts Rra`d! -22!$

    m`h bgocstr`bc ech sujaeaghea` d` e`p`eab`b qug taghgh gstcs ogbae`oghtcs p`r` basoahuar

    d` aheabghea` bg hugvcs gvghtcs ecrch`racs `iubcs y p`r` e`us`r d` rgirgsah bg d` pd`e`

    `tgrcgsedgrt