RESUMEN
BACKGROUND: Sexual dysfunction (SD) affects up to 80% of multiple sclerosis (MS) patients and pelvic floor muscles (PFMs) play an important role in the sexual function of these patients. OBJECTIVES: The objective of this paper is to evaluate the impact of a rehabilitation program to treat lower urinary tract symptoms on SD of women with MS. METHODS: Thirty MS women were randomly allocated to one of three groups: pelvic floor muscle training (PFMT) with electromyographic (EMG) biofeedback and sham neuromuscular electrostimulation (NMES) (Group I), PFMT with EMG biofeedback and intravaginal NMES (Group II), and PFMT with EMG biofeedback and transcutaneous tibial nerve stimulation (TTNS) (Group III). Assessments, before and after the treatment, included: PFM function, PFM tone, flexibility of the vaginal opening and ability to relax the PFMs, and the Female Sexual Function Index (FSFI) questionnaire. RESULTS: After treatment, all groups showed improvements in all domains of the PERFECT scheme. PFM tone and flexibility of the vaginal opening was lower after the intervention only for Group II. All groups improved in arousal, lubrication, satisfaction and total score domains of the FSFI questionnaire. CONCLUSION: This study indicates that PFMT alone or in combination with intravaginal NMES or TTNS contributes to the improvement of SD.
Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Esclerosis Múltiple Recurrente-Remitente/complicaciones , Esclerosis Múltiple Recurrente-Remitente/terapia , Músculo Esquelético/fisiopatología , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/terapia , Adulto , Femenino , Humanos , Persona de Mediana Edad , Neurorretroalimentación/métodos , Diafragma Pélvico , Proyectos Piloto , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: Seasonal variations of multiple sclerosis (MS) activity have been reported, however, most data come from studies in the northern hemisphere. METHODS: We reviewed medical records of MS patients living in Campinas region, Brazil. The first symptoms' date was defined as the relapse month. Climatic information included UV radiation index, median temperature, rainfall, and humidity. RESULTS: Two hundred and nine patients were included. The incidence of relapses was highest in January (11.2%) and December (10.4%) and lowest in November (5.7%) and October (7.0%) (P < 0.015). The months with highest incidence of relapses (December-January) had higher UV radiation index and humidity rates (P = 0.032 and 0.040, respectively). CONCLUSION: Most exacerbations were in the spring/summer transition, which also showed higher UV radiation index and humidity rate. Along with other environmental factors, seasonal fluctuation contributes to MS activity.
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Esclerosis Múltiple Recurrente-Remitente/epidemiología , Estaciones del Año , Adulto , Brasil/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Estudios Retrospectivos , Temperatura , Rayos Ultravioleta , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: TA is a branch of image processing that seeks to reduce image information by extracting texture descriptors from the image. TA of MR images of anatomic structures in mild AD and aMCI is not well-studied. Our objective was to attempt to find differences among patients with aMCI and mild AD and normal-aging subjects, by using TA applied to the MR images of the CC and the thalami of these groups of subjects. MATERIALS AND METHODS: TA was applied to the MR images of 17 patients with aMCI, 16 patients with mild AD, and 16 normal-aging subjects. The TA approach was based on the GLCM. MR images were T1-weighted and were obtained in the sagittal and axial planes. The CC and thalami were manually segmented for each subject, and 44 texture parameters were computed for each of these structures. RESULTS: TA parameters showed differences among the 3 groups for the CC and thalamus. A pair-wise comparison among groups showed differences for AD-control and aMCI-AD for the CC; and for AD-control, aMCI-AD, and aMCI-control for the thalamus. CONCLUSIONS: TA is a useful technique to aid in the detection of tissue alterations in MR images of mild AD and aMCI and has the potential to become a helpful tool in the diagnosis and understanding of these pathologies.
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Enfermedad de Alzheimer/patología , Amnesia/patología , Trastornos del Conocimiento/patología , Cuerpo Calloso/patología , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética/métodos , Tálamo/patología , Anciano , Anciano de 80 o más Años , Algoritmos , Enfermedad de Alzheimer/complicaciones , Amnesia/complicaciones , Trastornos del Conocimiento/complicaciones , Femenino , Humanos , Aumento de la Imagen/métodos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: To report the results from the Brazilian database on multiple sclerosis (MS) and pregnancy. METHODS: Retrospective data from MS patients who became pregnant at any time of their disease were sent to a Brazilian database, using a specific file for this purpose. RESULTS: Data on 128 women (142 pregnancies) from 30 neurologists working in 21 cities in Brazil were collected. Patients' average age at pregnancy was 29.8 years (range 16-42). EDSS at start of pregnancy was 1.5±1.4; and the relapse rate in the year preceding pregnancy was 1.2±1.5. Exposure to medication at any time during pregnancy was high (69.7%): 48.6% to interferon beta; 14.1% to glatiramer acetate; and 7% to other immunomodulatory and immunosuppressive drugs. There was a significant decrease in relapse rate during pregnancy. The prevalence of complications was relatively low, with 4.9% of obstetric and 1.4% neonatal unfavorable outcomes. CONCLUSIONS: Our patients had low degrees of disability, short histories of disease, high drug exposure, and relatively high relapse rate in the year previous to pregnancy. Obstetric and neonatal outcomes were successful in over 90% of our patients.
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Esclerosis Múltiple/epidemiología , Complicaciones del Embarazo/epidemiología , Adolescente , Adulto , Peso al Nacer/efectos de los fármacos , Brasil/epidemiología , Interpretación Estadística de Datos , Bases de Datos Factuales , Femenino , Acetato de Glatiramer , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Recién Nacido , Enfermedades del Recién Nacido/epidemiología , Interferón Tipo I/efectos adversos , Interferón Tipo I/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Péptidos/efectos adversos , Péptidos/uso terapéutico , Embarazo , Resultado del Embarazo , Proteínas Recombinantes , Recurrencia , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To establish whether vascular aphasic syndromes can predict stroke outcomes. METHOD: Thirty-seven adults were evaluated for speech and language within 72 hours after a single first-ever ischemic brain lesion, in blind association to CT and/or MR. RESULTS: Speech or language disabilities were found in seven (87.5 percent) of the eight deceased patients and twenty-six (89.7 percent) of the twenty-nine survivors. Global aphasia was identified in eleven patients, all with left hemisphere lesions (nine mute; five deceased), consisting on a risk factor for death in the acute stroke phase (ρ=0.022). Age (z=1.65; ρ>0.09), thrombolysis (ρ=0.591), infarct size (ρ=0.076) and side (ρ=0.649) did not significantly influence survival. Absence of aphasia did not predict a better evolution, regardless of the affected hemisphere. Prevalence of cardiovascular risk factors was similar for all patient groups. CONCLUSION: Global aphasia in acute stroke can adversely affect prognosis, translated into impairment of dominant perisylvian vascular territories, with mutism as an important semiological element.
OBJETIVO: Determinar se síndromes afásicas na fase aguda do infarto cerebral influenciam o prognóstico. MÉTODO: Avaliação para fala e linguagem de 37 adultos dentro de 72 horas após um primeiro infarto cerebral, em associação topográfica cega com TC e/ou RM. RESULTADOS: Detectaram-se afasias ou disartria em 7 (87,5 por cento) dos 8 pacientes falecidos, e em 26 (89,7 por cento) dos 29 sobreviventes. Afasia global foi identificada em 11 pacientes, todos com lesões no hemisfério esquerdo (cinco óbitos; mutismo em nove), consistindo em fator de risco para mortalidade na fase aguda do acidente vascular cerebral isquêmico (ρ=0,022). Idade (z=1,65; ρ>0,09), trombólise (ρ=0,591), dimensões da lesão (ρ=0,076) e lado (ρ=0,649) não afetaram significativamente a sobrevivência. Ausência de afasia não prenunciou melhor evolução. Fatores de risco cardiovascular tiveram similar prevalência para todos os grupos de pacientes. CONCLUSÃO: Afasia global na fase aguda do infarto cerebral pode aumentar mortalidade, demonstrando envolvimento de território vascular perisylviano dominante, tomando-se mutismo como importante elemento semiológico.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Afasia/etiología , Accidente Cerebrovascular/complicaciones , Enfermedad Aguda , Afasia/diagnóstico , Escolaridad , Imagen por Resonancia Magnética , Pronóstico , Estudios Prospectivos , Análisis de Supervivencia , Accidente Cerebrovascular/mortalidad , Tomografía Computarizada por Rayos XRESUMEN
Microemulsão (ME) é um sistema que foi descoberto por Hoar e Schulman no ano de 1943 e que é termodinamicamente estável e isotropicamente translúcido de dois líquidos imiscíveis (óleo/água), estabilizados por um filme interfacial de tensoativos. O estudo de sistemas microemulsionados se baseia nas suas três teorias de formação: (1) teoria da solubilização, (2) teoria da tensão interfacial e (3) teoria termodinâmica. A estrutura formada é influenciada pelas propriedades físico-químicas dos componentes utilizados e da razão entre os componentes. O objetivo desta revisão foi avaliar o estado da arte de sistemas microemulsionados enfatizando uma abordagem teórica. Além disso, os recentes avanços sobre a aplicabilidade clínca e utilização como carreador de moléculas insolúveis foram discutidas.
Microemulsions (ME) are thermodynamically stable and isotropic systems of two immiscible liquids (oil/water), stabilized by an interfacial film of surfactants, discovered by Hoar and Schulman in 1943. The study of ME formation is based on three areas of theory: (1) solubilization, (2) interfacial tension and (3) thermodynamics. ME structures are influenced by the physicochemical properties and proportions of their ingredients. The goal of this review is to assess the state of the art of microemulsified systems, from a theoretical viewpoint. Also, recent progress on their clinical application and use as carriers for insoluble compounds is discussed.
Asunto(s)
Proteínas Portadoras , Emulsiones/química , Aceites/químicaRESUMEN
O desenvolvimento de formulações para aplicação na pele é uma estratégia interessante para transportar fármacos cuja ação é a própria pele, representando uma alternativa para superar aspectos indesejados relacionados às características farmacocinéticas e farmacodinâmicas dos fármacos. No entanto, a pele apresenta camadas que formam uma barreira à penetração de fármacos. Desse modo, estratégias têm sido pesquisadas e os modernos estudos farmacêuticos apontam para o uso de métodos físicos e químicos, norteados no desenvolvimento de novas formas farmacêuticas, as quais devem apresentar propriedades físico-químicas e parâmetros farmacotécnicos adequados para o uso transdérmico.
The development of formulations for skin application is a good strategy for the delivery of drugs whose target is the skin itself, which avoids some unwanted effects of treatment arising from the pharmacokinetic and pharmacodynamic properties of drugs. However, the skin has layers that resist the penetration of drugs. Thus, new strategies have been researched and the latest pharmaceutical studies point to the use of physical and chemical methods aimed at the development of new drug delivery systems, exhibiting physicochemical properties and pharmaceutical parameters suitable for transdermal administration.
Asunto(s)
Humanos , Administración Cutánea , Preparaciones Farmacéuticas , FarmacocinéticaRESUMEN
The immunomodulador glatiramer acetate (GA) has been shown to significantly reduce the severity of symptoms during the course of multiple sclerosis and in its animal model--experimental autoimmune encephalomyelitis (EAE). Since GA may influence the response of non-neuronal cells in the spinal cord, it is possible that, to some extent, this drug affects the synaptic changes induced during the exacerbation of EAE. In the present study, we investigated whether GA has a positive influence on the loss of inputs to the motoneurons during the course of EAE in rats. Lewis rats were subjected to EAE associated with GA or placebo treatment. The animals were sacrificed after 15 days of treatment and the spinal cords processed for immunohistochemical analysis and transmission electron microscopy. A correlation between the synaptic changes and glial activation was obtained by performing labeling of synaptophysin and glial fibrillary acidic protein using immunohistochemical analysis. Ultrastructural analysis of the terminals apposed to alpha motoneurons was also performed by electron transmission microscopy. Interestingly, although the GA treatment preserved synaptophysin labeling, it did not significantly reduce the glial reaction, indicating that inflammatory activity was still present. Also, ultrastructural analysis showed that GA treatment significantly prevented retraction of both F and S type terminals compared to placebo. The present results indicate that the immunomodulator GA has an influence on the stability of nerve terminals in the spinal cord, which in turn may contribute to its neuroprotective effects during the course of multiple sclerosis.
Asunto(s)
Encefalomielitis Autoinmune Experimental/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Plasticidad Neuronal/efectos de los fármacos , Péptidos/uso terapéutico , Médula Espinal/efectos de los fármacos , Animales , Astrocitos/efectos de los fármacos , Astrocitos/metabolismo , Astrocitos/ultraestructura , Encefalomielitis Autoinmune Experimental/metabolismo , Femenino , Acetato de Glatiramer , Microscopía Electrónica de Transmisión , Neuronas Motoras/efectos de los fármacos , Neuronas Motoras/fisiología , Esclerosis Múltiple/metabolismo , Plasticidad Neuronal/fisiología , Ratas , Ratas Endogámicas Lew , Médula Espinal/metabolismo , Médula Espinal/ultraestructura , Transmisión Sináptica/efectos de los fármacos , Transmisión Sináptica/fisiología , Sinaptofisina/análisisRESUMEN
The immunomodulador glatiramer acetate (GA) has been shown to significantly reduce the severity of symptoms during the course of multiple sclerosis and in its animal model - experimental autoimmune encephalomyelitis (EAE). Since GA may influence the response of non-neuronal cells in the spinal cord, it is possible that, to some extent, this drug affects the synaptic changes induced during the exacerbation of EAE. In the present study, we investigated whether GA has a positive influence on the loss of inputs to the motoneurons during the course of EAE in rats. Lewis rats were subjected to EAE associated with GA or placebo treatment. The animals were sacrificed after 15 days of treatment and the spinal cords processed for immunohistochemical analysis and transmission electron microscopy. A correlation between the synaptic changes and glial activation was obtained by performing labeling of synaptophysin and glial fibrillary acidic protein using immunohistochemical analysis. Ultrastructural analysis of the terminals apposed to alpha motoneurons was also performed by electron transmission microscopy. Interestingly, although the GA treatment preserved synaptophysin labeling, it did not significantly reduce the glial reaction, indicating that inflammatory activity was still present. Also, ultrastructural analysis showed that GA treatment significantly prevented retraction of both F and S type terminals compared to placebo. The present results indicate that the immunomodulator GA has an influence on the stability of nerve terminals in the spinal cord, which in turn may contribute to its neuroprotective effects during the course of multiple sclerosis.
Asunto(s)
Animales , Femenino , Ratas , Encefalomielitis Autoinmune Experimental/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Plasticidad Neuronal/efectos de los fármacos , Péptidos/uso terapéutico , Médula Espinal/efectos de los fármacos , Astrocitos/efectos de los fármacos , Astrocitos/metabolismo , Astrocitos/ultraestructura , Encefalomielitis Autoinmune Experimental/metabolismo , Microscopía Electrónica de Transmisión , Neuronas Motoras/efectos de los fármacos , Neuronas Motoras/fisiología , Esclerosis Múltiple/metabolismo , Plasticidad Neuronal/fisiología , Ratas Endogámicas Lew , Médula Espinal/metabolismo , Médula Espinal/ultraestructura , Transmisión Sináptica/efectos de los fármacos , Transmisión Sináptica/fisiología , Sinaptofisina/análisisRESUMEN
BACKGROUND: Grey matter (GM) atrophy has been demonstrated in amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD), but the role of white matter (WM) atrophy has not been well characterized. Despite these findings, the validity of aMCI concept as prodromal AD has been questioned. METHODS: We performed brain MRI with voxel-based morphometry analysis in 48 subjects, aiming to evaluate the patterns of GM and WM atrophy amongst mild AD, aMCI and age-matched normal controls. RESULTS: Amnestic mild cognitive impairment GM atrophy was similarly distributed but less intense than that of mild AD group, mainly in thalami and parahippocampal gyri. There were no difference between aMCI and controls concerning WM atrophy. In the mild AD group, we found WM atrophy in periventricular areas, corpus callosum and WM adjacent to associative cortices. DISCUSSION: We demonstrated that aMCI might be considered a valid concept to detect very early AD pathology, since we found a close proximity in the pattern of atrophy. Also, we showed the involvement of WM in mild AD, but not in aMCI, suggesting a combination of Wallerian degeneration and microvascular ischaemic disease as a plausible additional pathological mechanism for the discrimination between MCI and AD.
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Enfermedad de Alzheimer/patología , Amnesia/patología , Encéfalo/patología , Trastornos del Conocimiento/patología , Fibras Nerviosas Mielínicas/patología , Anciano , Envejecimiento , Amnesia/complicaciones , Atrofia , Trastornos del Conocimiento/complicaciones , Humanos , Imagenología Tridimensional , Imagen por Resonancia MagnéticaRESUMEN
Mesial temporal lobe epilepsy (MTLE) is usually accompanied by memory deficits due to damage to the hippocampal system. In most studies, however, the influence of hippocampal atrophy (HA) is confounded with other variables, such as: type of initial precipitating injury and pathological substrate, effect of lesion (HA) lateralization, history of febrile seizures, status epilepticus, age of seizure onset, duration of epilepsy, seizure frequency, and antiepileptic drugs (AEDs). To investigate the relationship between memory deficits and these variables, we studied 20 patients with MTLE and signs of HA on MRI and 15 MTLE patients with normal high-resolution MRI. The findings indicated that (1) HA, earlier onset of seizures, longer duration of epilepsy, higher seizure frequency, and AEDs (polytherapy) are associated with memory deficits; and (2) there is a close relationship between deficits of verbal memory and left HA, but not between visual memory and right HA.
Asunto(s)
Epilepsia del Lóbulo Temporal/fisiopatología , Hipocampo/patología , Memoria/fisiología , Adolescente , Adulto , Anticonvulsivantes/uso terapéutico , Atrofia/patología , Atrofia/fisiopatología , Electroencefalografía , Epilepsia del Lóbulo Temporal/patología , Femenino , Lateralidad Funcional , Humanos , Inteligencia/fisiología , Pruebas de Inteligencia/estadística & datos numéricos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas/estadística & datos numéricos , Convulsiones Febriles/fisiopatología , Estado Epiléptico/tratamiento farmacológico , Estado Epiléptico/fisiopatologíaRESUMEN
We studied the clinical, EEG and MRI findings in 19 patients with epilepsy secondary to congenital destructive hemispheric insults. Patients were divided in two groups: 10 with cystic lesions (group 1), and 9 with atrophic lesions (group 2). Seizure and EEG features, as well as developmental sequelae were similar between the two groups, except for the finding that patients of group 2 more commonly presented seizures with more than one semiological type. MRI showed hyperintense T2 signal extending beyond the lesion in almost all patients of both groups, and it was more diffuse in group 2. Associated hippocampal atrophy (HA) was observed in 70% of group 1 patients and 77.7% of group 2, and it was not correlated with duration of epilepsy or seizure frequency. There was a good concordance between HA and electroclinical localization. The high prevalence of associated HA in both groups suggests a common pathogenesis with the more obvious lesion. Our findings indicate that in some of these patients with extensive destructive lesions, there may be a more circumscribed epileptogenic area, particularly in those with cystic lesions and HA, leading to a potential rationale for effective surgical treatment.
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Quistes del Sistema Nervioso Central/complicaciones , Epilepsia/congénito , Hipocampo/anomalías , Adolescente , Adulto , Atrofia/complicaciones , Atrofia/congénito , Distribución de Chi-Cuadrado , Niño , Preescolar , Electroencefalografía , Femenino , Hipocampo/patología , Humanos , Lactante , Imagen por Resonancia Magnética , MasculinoRESUMEN
Autoimmune T cells play a key role as regulators and effectors of organ-specific autoimmune disease. In multiple sclerosis (MS), activated T cells specific for myelin components produce a plethora of inflammatory cytokines and mediators that contribute to myelin damage. The production of proinflammatory and regulatory cytokines by peripheral blood cells from patients with active and stable MS and healthy controls were examined. The results show that TNF alpha production was somewhat elevated in active MS with no significant increase in the level IFN gamma, whereas in the chronic phase the anti-inflammatory cytokines IL-10 and TGF beta increased, accompanied by a reduction in IFN gamma when stimulated by myelin basic protein. Multiple Sclerosis (2000) 6 293 - 299
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Citocinas/inmunología , Citocinas/metabolismo , Esclerosis Múltiple Recurrente-Remitente/inmunología , Linfocitos T/metabolismo , Adulto , Brasil , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Interferón gamma/inmunología , Interferón gamma/metabolismo , Interleucina-10/inmunología , Interleucina-10/metabolismo , Masculino , Linfocitos T/inmunología , Factor de Crecimiento Transformador beta/inmunología , Factor de Crecimiento Transformador beta/metabolismo , Factor de Necrosis Tumoral alfa/inmunología , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
The occurrence of de novo psychogenic seizures after epilepsy surgery is rare, and is estimated in 1.8% to 3.6%. Seizures after epilepsy surgery should be carefully evaluated, and de novo psychogenic seizures should be considered especially when there is a change in the ictal semiology. We report a patient with de novo psychogenic seizures after anterior temporal lobe removal for refractory temporal lobe epilepsy. Once psychogenic seizures were diagnosed and psychiatric treatment was started, seizures stopped.
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Epilepsia del Lóbulo Temporal/cirugía , Complicaciones Posoperatorias/psicología , Convulsiones/psicología , Trastornos Somatomorfos/psicología , Adolescente , Depresión/diagnóstico , Depresión/terapia , Femenino , Humanos , Factores de Riesgo , Convulsiones/terapia , Trastornos Somatomorfos/terapiaRESUMEN
OBJECTIVE: To describe the role of magnetic resonance imaging (MRI) in the evaluation of patients with chronic and recurrent aseptic meningitis. METHOD: A retrospective study of five patients with aseptic meningoencefalitis diagnosed by clinical and CSF findings. CT scans showed without no relevant findings. RESULTS: MRI showed small multifocal lesions hyperintense on T2 weighted images and FLAIR, with mild or no gadolinium enhancement, mainly in periventricular and subcortical regions. Meningoencephalitis preceded the diagnosis of the underlying disease in four patients (Behçet's disease or systemic lupus erythematosus). After the introduction of adequate treatment for the rheumatic disease, they did not present further symptoms of aseptic meningoencephalitis. CONCLUSION: Aseptic meningoencephalitis can be an early presentation of an autoimmune disease. It is important to emphasize the role of MRI in the diagnosis and follow-up of these patients.
Asunto(s)
Enfermedades del Tejido Conjuntivo/diagnóstico , Meningitis Aséptica/diagnóstico , Meningoencefalitis/diagnóstico , Adulto , Síndrome de Behçet/complicaciones , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamiento farmacológico , Enfermedad Crónica , Enfermedades del Tejido Conjuntivo/complicaciones , Enfermedades del Tejido Conjuntivo/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Meningitis Aséptica/tratamiento farmacológico , Meningitis Aséptica/etiología , Meningoencefalitis/tratamiento farmacológico , Meningoencefalitis/etiología , Recurrencia , Estudios RetrospectivosRESUMEN
INTRODUCTION: Several recent studies have analyzed a possible effect of thrombophilia risk factors such as factor V Leiden, the prothrombin variant (allele 20210 A), and homozygosity for thermolabile methylenetetrahydrofolate reductase (MTHFR-T) on the development of ischemic stroke (IS). In the present study, we determined the role of these prothrombotic polymorphisms in the early onset of arterial IS or cerebral venous thrombosis (CVT) in a group of young Brazilian adults of Caucasian and African descent. MATERIALS AND METHODS: We conducted a cross-sectional study of 167 survivors of IS (153 patients with arterial IS and 14 cases of CVT; 66 men: 101 women; 124 of Caucasian and 43 of African origin; median age: 32.6 years; range: 15 to 45 years) and compared the prevalence of inherited thrombophilia risk factors with a control group of 225 sex and age matched individuals of the same ethnic background. To determine the interaction with atherogenic risk factors, the following diagnoses were considered: hypertension, hyperlipoproteinemia, diabetes mellitus, smoking status and use of oral contraceptives. RESULTS: In the arterial IS group, no significant variation was found between patients and controls of Caucasian origin regarding the prevalence of factor V Leiden (P = 0.92), the prothrombin variant (P = 0.13) or homozygosity for MTHFR-T (P = 0.61). Among Brazilians of African descent, 10.3% were homozygous for MTHFR-T, which was significantly elevated, odds ratio of 5.9 (95% CI: 0.88 to 49.15). In the CVT group, two Caucasian patients (20%) were heterozygous for the prothrombin variant, odds ratio of 9.7 (95% CI: 0.95 to 89.71) and one patient was carrier of factor V Leiden (P = 0.49). No prothrombotic polymorphism was identified in patients with CVT of African descent. All women in the CVT group were in use of oral contraceptives or in the post-partum state. DISCUSSION: Inherited thrombophilia risk factors were not found to increase the risk of arterial IS among young patients of Caucasian descent. However, a potential role of homozygosity for MTHFR-T was observed in a small group of patients of African origin. The analysis of patients with CVT revealed an increased risk due to the prothrombin gene variant or oral contraceptive use. Further studies including all incoming patients with IS are necessary to evaluate the impact of inherited thrombophilia risk factors on early mortality.
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Isquemia/genética , Accidente Cerebrovascular/genética , Trombofilia/genética , Adolescente , Adulto , África/etnología , Alelos , Arterias/patología , Brasil/epidemiología , Anticonceptivos Orales/efectos adversos , Estudios Transversales , Factor V/genética , Salud de la Familia , Femenino , Frecuencia de los Genes , Variación Genética , Homocigoto , Humanos , Isquemia/epidemiología , Masculino , Metilenotetrahidrofolato Reductasa (NADPH2) , Persona de Mediana Edad , Oxidorreductasas actuantes sobre Donantes de Grupo CH-NH/genética , Mutación Puntual , Periodo Posparto , Embarazo , Prevalencia , Protrombina/genética , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Trombofilia/epidemiología , Enfermedades Vasculares/epidemiología , Enfermedades Vasculares/genética , Población Blanca/genéticaRESUMEN
The author reports three cases of pseudodementia and discuss the difficulties in establishing limits between normality and illness in the elderly. The mental and neuropathological changes that accompany the normal ageing of the brain are similar to those of early Alzheimer's dementia (AD). These similarities often lead to difficulties in the differential diagnosis, hence the search for consensus criteria. The decline of working and secondary memory is greater than that of primary and tertiary memory, as is found in AD. On the other hand, tests of delayed recall of 10 to 15 unrelated words, logical memory, categorical thinking, visuo-motor-spatial skills, and Boston Naming Test have been pointed out as the most discriminative. Neuroimaging findings of atrophy or hypoperfusion in the entorhinal-hippocampal or temporo-parietal regions are suggestive of DA, but they can be lacking in the early stages of this disease. In the conclusion, the author suggests the diagnostic process should be based on a comprehensive neuropsychological and behavioral evaluation (including a survey of the subject's premorbid level of cognitive and socio-occupational functioning), supplemented by neuroimaging and laboratory tests. If inconclusive, the whole evaluation can be repeated after 4 to 6 months, to check the consistency of the findings.
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Envejecimiento/fisiología , Encéfalo/patología , Encéfalo/fisiología , Demencia/diagnóstico , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Pruebas NeuropsicológicasRESUMEN
Acute disseminated encephalomyelitis (ADEM) is a widespread monophasic inflammatory disease affecting the central nervous system, that usually follows an infection or vaccination. In this study, we present an analysis of magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) and clinical aspects in four patients with clinical diagnosis of ADEM. The presence of MRI demyelinating lesions was crucial, but not in itself sufficient for definitive diagnosis. Clinical and MRI follow up, in order to exclude new lesions and to reevaluate the former ones, as well as CSF, were important for the differential diagnosis with other demyelinating diseases, particularly multiple sclerosis. In addition, we have shown that early treatment with methylprednisolone after the initial symptoms was effective for improving clinical manifestations as well as for reducing MRI lesions.
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Enfermedades Desmielinizantes/diagnóstico , Encefalomielitis Aguda Diseminada/diagnóstico , Enfermedad Aguda , Adulto , Enfermedades Desmielinizantes/líquido cefalorraquídeo , Enfermedades Desmielinizantes/tratamiento farmacológico , Diagnóstico Diferencial , Encefalomielitis Aguda Diseminada/líquido cefalorraquídeo , Encefalomielitis Aguda Diseminada/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Metilprednisolona/uso terapéutico , Esclerosis Múltiple/diagnóstico , Estudios RetrospectivosRESUMEN
Eighteen patients (mean age of 66.5 years) with normal pressure hydrocephalus (NPH) underwent a ventriculo-peritoneal shunt surgery. Prior to operation a cerebrospinal fluid tap-test (CSF-TT) was performed with measurements of gait pattern and psychometric functions (memory, visuo-motor speed and visuo-constructive skills) before and after the removal of 50 ml CSF by lumbar puncture (LP). Fifteen patients improved and 3 were unchanged after surgery. Short duration of disease, gait disturbance preceding mental deterioration, wide temporal horns and small sulci on CT-scan were associated with good outcome after shunting. There was a good correlation between the results of CSF-TT and shunt surgery (chi 2 = 4.11, phi = 0.48, p < 0.05), with gait test showing highest correlation (r = 0.99, p = 0.01). In conclusion, this version of CSF-TT proved to be an effective test to predict improvement after shunting in patients with NPH.
Asunto(s)
Líquido Cefalorraquídeo , Hidrocéfalo Normotenso/cirugía , Derivación Ventriculoperitoneal , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Valor Predictivo de las Pruebas , Punción EspinalRESUMEN
The authors present considerations about death and brain death concepts, as well the legal aspects for its diagnosis in Brazil. They also present the UNICAMP Protocol for the Diagnosis of Brain Death, revised and according with the current law, with standard techniques for the diagnostic exam. They emphasize the importance of a mature ethical position for this frequent and challenging situation.