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1.
Aging Clin Exp Res ; 35(8): 1741-1752, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37264166

RESUMEN

AIM: To explore associations of cerebrospinal fluid biomarkers of neurodegeneration and amyloidosis with caregiver burden, cognition and functionality in dementia with Lewy bodies (DLB) paired with late-onset Alzheimer's disease (AD) and healthy older people. METHODS: Consecutive outpatients with DLB were matched with outpatients with AD according to sex, cognitive scores and dementia stage, and with cognitively healthy controls according to age and sex to investigate associations of cerebrospinal fluid amyloid-ß (Aß42,Aß40,Aß38), tau, phospho-tau Thr181, ubiquitin, α-synuclein and neurofilament light with caregiver burden, functionality, reverse digit span, a clock drawing test, Mini-Mental State Examination (MMSE) and Severe MMSE, adjusted for sex, age, education, dementia duration and APOE-ε4 alleles. RESULTS: Overall, 27 patients with DLB (78.98 ± 9.0 years-old; eleven APOE-ε4 +) were paired with 27 patients with AD (81.50 ± 5.8 years-old; twelve APOE-ε4 +) and 27 controls (78.98 ± 8.7 years-old; four APOE-ε4 +); two-thirds were women. In AD, Aß42/Aß38 and Aß42 were lower, while tau/Aß42 and phospho-tau Thr181/Aß42 were higher; α-synuclein/Aß42 was lower in DLB and higher in AD. The following corrected associations remained significant: in DLB, instrumental functionality was inversely associated with tau/phospho-tau Thr181 and tau/Aß42, and reverse digit span associated with α-synuclein; in AD, instrumental functionality was inversely associated with neurofilament light, clock drawing test scores inversely associated with phospho-tau Thr181/Aß42 and α-synuclein/Aß42, and Severe MMSE inversely associated with tau/Aß42 and tau/phospho-tau Thr181. CONCLUSIONS: Cerebrospinal fluid phospho-tau Thr181 in DLB was similar to AD, but not Aß42. In associations with test scores, biomarker ratios were superior to isolated biomarkers, while worse functionality was associated with axonal degeneration only in AD.


Asunto(s)
Enfermedad de Alzheimer , Enfermedad por Cuerpos de Lewy , Humanos , Femenino , Anciano , Anciano de 80 o más Años , Masculino , Enfermedad de Alzheimer/líquido cefalorraquídeo , alfa-Sinucleína/líquido cefalorraquídeo , Enfermedad por Cuerpos de Lewy/complicaciones , Enfermedad por Cuerpos de Lewy/diagnóstico , Enfermedad por Cuerpos de Lewy/psicología , Proteínas tau , Fragmentos de Péptidos , Péptidos beta-Amiloides/líquido cefalorraquídeo , Biomarcadores/líquido cefalorraquídeo , Apolipoproteínas E/genética
2.
J Alzheimers Dis ; 81(3): 1295-1309, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33935098

RESUMEN

BACKGROUND: Behavioral features may reflect proteinopathies predicting pathophysiology in neurodegenerative diseases. OBJECTIVE: We aimed to investigate associations of cerebrospinal fluid biomarkers of amyloidogenesis and neurodegeneration with neuropsychiatric features in dementia with Lewy bodies (DLB) compared with late-onset Alzheimer's disease (AD) and cognitively healthy people. METHODS: Consecutive outpatients with DLB were paired with outpatients with AD according to sex, dementia stage, and cognitive scores, and with cognitively healthy controls according to sex and age to investigate associations of cerebrospinal fluid amyloid-ß (Aß)42, Aß40, Aß38, total tau, phospho-tau Thr181, α-synuclein, ubiquitin, and neurofilament light with neuropsychiatric features according to APOEɛ4 carrier status. RESULTS: Overall, 27 patients with DLB (78.48±9.0 years old, eleven APOEɛ4 carriers) were paired with 27 patients with AD (81.00±5.8 years old, twelve APOEɛ4 carriers) and 27 controls (78.48±8.7 years old, four APOEɛ4 carriers); two thirds were women. Behavioral burden was more intense in DLB. Biomarker ratios reflecting amyloidogenesis and neurodegeneration in DLB were more similar to those in AD when patients carried APOEɛ4 alleles. After corrections for false discovery rates, the following associations remained significant: in DLB, dysphoria was associated with tauopathy and indirect measures of amyloidogenesis, while in AD, agitation, and night-time behavior disturbances were associated with tauopathy, and delusions were associated with tauopathy and indirect measures of amyloidogenesis. CONCLUSION: Biomarker ratios were superior to Aß and tau biomarkers predicting neuropsychiatric symptoms when associations with isolated biomarkers were not significant. At the end, APOEɛ4 carrier status influenced amyloidogenesis and tau pathology in DLB and in AD, and axonal degeneration only in DLB.


Asunto(s)
Enfermedad de Alzheimer/psicología , Péptidos beta-Amiloides/líquido cefalorraquídeo , Cognición/fisiología , Enfermedad por Cuerpos de Lewy/psicología , alfa-Sinucleína/líquido cefalorraquídeo , Proteínas tau/líquido cefalorraquídeo , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/líquido cefalorraquídeo , Biomarcadores/líquido cefalorraquídeo , Diagnóstico Diferencial , Femenino , Humanos , Enfermedad por Cuerpos de Lewy/líquido cefalorraquídeo , Masculino , Fragmentos de Péptidos/líquido cefalorraquídeo , Fosforilación
3.
J Ophthalmol ; 2021: 1401609, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33575035

RESUMEN

PURPOSE: To correlate optical coherence tomography (OCT) measurements with clinical parameters in idiopathic intracranial hypertension (IIH). METHODS: A cross-sectional study was conducted with 22 patients with IIH and 11 controls. All participants underwent comprehensive ophthalmological examination followed by spectral-domain OCT (SD-OCT) and standard automated perimetry using the 30-2 program of the Humphrey visual field analyzer. Correlations between ganglion cell complex (GCC) thickness and retinal nerve fiber layer (RNFL) thickness, as measured by SD-OCT, and clinical parameters were assessed using generalized estimating equations. RESULT: The mean age of the participants was 35.0 ± 10.83 years. The groups were similar regarding age, but were significantly different regarding sex and visual acuity (p=0.001 and p=0.038, respectively). The GCC was significantly thinner in the IIH group, with a mean of 90.535 ± 9.766 µm compared to 98.119 ± 6.988 µm for the controls (p=0.023). There was a significant association between GCC thickness and optic disc pallor (p=0.016) and between edema and visual acuity (p=0.037). No significant difference was found in RNFL thickness between patients and controls. CONCLUSION: The GCC was thinner in the patients with IIH compared to the controls, and there was an association between GCC and optic disc pallor. This might suggest a role for OCT parameters when the structural changes that occur in IIH are investigated, possibly guiding clinical decision making.

4.
Arq Neuropsiquiatr ; 78(2): 63-69, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32022120

RESUMEN

OBJECTIVE: Investigate the auditory pathway in the brainstem of children with acute lymphoblastic leukemia submitted to chemotherapy (by intravenous or intrathecal infusion). METHODS: Fourteen children aged between 2 and 12 years with diagnosis of acute lymphoid leukemia were evaluated. The following procedures were used: meatoscopy, acoustic immitance measurements, tonal audiometry, vocal audiometry, transient otoacoustic emissions, and auditory brainstem response. RESULTS: From the 14 children with normal auditory thresholds, 35.71% showed an alteration in auditory brainstem response, with a predominance of hearing impairment in the lower brainstem. It was found that 80% of the children with alteration had used intrathecal methotrexate less than 30 days and that 40% had the highest cumulative intravenous methotrexate doses. CONCLUSION: Children with acute lymphoblastic leukemia submitted to chemotherapy, present auditory pathway impairment in the brainstem, with a predominance of a low brainstem.


Asunto(s)
Emisiones Otoacústicas Espontáneas , Leucemia-Linfoma Linfoblástico de Células Precursoras , Vías Auditivas , Umbral Auditivo , Tronco Encefálico , Niño , Preescolar , Potenciales Evocados Auditivos del Tronco Encefálico , Humanos , Metotrexato
5.
Arq. neuropsiquiatr ; 78(2): 63-69, Feb. 2020. tab
Artículo en Inglés | LILACS | ID: biblio-1089001

RESUMEN

Abstract Objective: Investigate the auditory pathway in the brainstem of children with acute lymphoblastic leukemia submitted to chemotherapy (by intravenous or intrathecal infusion). Methods: Fourteen children aged between 2 and 12 years with diagnosis of acute lymphoid leukemia were evaluated. The following procedures were used: meatoscopy, acoustic immitance measurements, tonal audiometry, vocal audiometry, transient otoacoustic emissions, and auditory brainstem response. Results: From the 14 children with normal auditory thresholds, 35.71% showed an alteration in auditory brainstem response, with a predominance of hearing impairment in the lower brainstem. It was found that 80% of the children with alteration had used intrathecal methotrexate less than 30 days and that 40% had the highest cumulative intravenous methotrexate doses. Conclusion: Children with acute lymphoblastic leukemia submitted to chemotherapy, present auditory pathway impairment in the brainstem, with a predominance of a low brainstem.


Resumo Objetivo: Investigar a via auditiva em tronco encefálico de crianças com leucemia linfoide aguda submetidas à quimioterapia (por infusão intravenosa ou por via intratecal). Métodos: Foram avaliadas 14 crianças com idade entre 2 e 12 anos, com diagnóstico de leucemia linfoide aguda. Foram utilizados os seguintes procedimentos: meatoscopia, medidas de imitância acústica, audiometria tonal, audiometria vocal, emissões otoacústicas transientes e potencial evocado auditivo de tronco encefálico. Resultados: Das 14 crianças com limiares auditivos normais, 35,71% demonstraram alteração no Potencial Evocado Auditivo de Tronco Encefálico, com predomínio de comprometimento de via auditiva em tronco encefálico baixo. Verificou-se que 80% das crianças com alteração haviam feito uso do metotrexato via intratecal a menos de 30 dias e que 40% tinham as maiores doses acumulativas de metotrexato por via endovenosa. Conclusão: Crianças com leucemia linfoide aguda submetidas à quimioterapia apresentam comprometimento na via auditiva em tronco encefálico, com predomínio em tronco encefálico baixo.


Asunto(s)
Humanos , Preescolar , Niño , Emisiones Otoacústicas Espontáneas , Leucemia-Linfoma Linfoblástico de Células Precursoras , Vías Auditivas , Umbral Auditivo , Tronco Encefálico , Metotrexato , Potenciales Evocados Auditivos del Tronco Encefálico
6.
Arq Neuropsiquiatr ; 77(10): 696-704, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31664345

RESUMEN

OBJECTIVE: The diagnosis of multiple sclerosis (MS) has changed over the last decade, but remains a composite of clinical assessment and magnetic resonance imaging to prove dissemination of lesions in time and space. The intrathecal synthesis of immunoglobulin may be a nonspecific marker and there are no plasma biomarkers that are useful in the diagnosis of MS, presenting additional challenges to their early detection. METHODS: We performed a preliminary untargeted qualitative lipidomics mass spectrometry analysis, comparing cerebrospinal fluid (CSF) and plasma samples from patients with MS, other inflammatory neurological diseases and idiopathic intracranial hypertension. RESULTS: Lipid identification revealed that fatty acids and sphingolipids were the most abundant classes of lipids in the CSF and that glycerolipids and fatty acids were the main class of lipids in the plasma of patients with MS. The area under the curve was 0.995 (0.912-1) and 0.78 (0.583-0.917), respectively. The permutation test indicated that this ion combination was useful for distinguishing MS from other inflammatory diseases (p < 0.001 and 0.055, respectively). CONCLUSION: This study concluded that the CSF and plasma from patients with MS bear a unique lipid signature that can be useful as a diagnostic biomarker.


Asunto(s)
Esclerosis Múltiple/sangre , Esclerosis Múltiple/líquido cefalorraquídeo , Adulto , Biomarcadores/sangre , Cromatografía Liquida , Femenino , Humanos , Lipidómica/métodos , Imagen por Resonancia Magnética , Masculino , Espectrometría de Masas/métodos , Persona de Mediana Edad , Esclerosis Múltiple/diagnóstico , Valores de Referencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto Joven
7.
Arq. neuropsiquiatr ; 77(10): 696-704, Oct. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1038736

RESUMEN

ABSTRACT The diagnosis of multiple sclerosis (MS) has changed over the last decade, but remains a composite of clinical assessment and magnetic resonance imaging to prove dissemination of lesions in time and space. The intrathecal synthesis of immunoglobulin may be a nonspecific marker and there are no plasma biomarkers that are useful in the diagnosis of MS, presenting additional challenges to their early detection. Methods We performed a preliminary untargeted qualitative lipidomics mass spectrometry analysis, comparing cerebrospinal fluid (CSF) and plasma samples from patients with MS, other inflammatory neurological diseases and idiopathic intracranial hypertension. Results Lipid identification revealed that fatty acids and sphingolipids were the most abundant classes of lipids in the CSF and that glycerolipids and fatty acids were the main class of lipids in the plasma of patients with MS. The area under the curve was 0.995 (0.912-1) and 0.78 (0.583-0.917), respectively. The permutation test indicated that this ion combination was useful for distinguishing MS from other inflammatory diseases (p < 0.001 and 0.055, respectively). Conclusion This study concluded that the CSF and plasma from patients with MS bear a unique lipid signature that can be useful as a diagnostic biomarker.


RESUMO Embora o diagnóstico da EM tenha se modificado na última década, ainda tem como requisito básico a demonstração da disseminação no tempo e no espaço, através do quadro clínico e do exame de ressonância magnética. A síntese intratecal de imunoglobulina pode ser um marcador inespecífico e não há biomarcadores plasmáticos que sejam úteis no diagnóstico da EM, impondo desafios à sua detecção precoce. Métodos Realizamos uma análise lipidômica preliminar por espectrometria de massas, não direcionada, qualitativa, comparando amostras de LCR e plasma de pacientes com EM, outras doenças neurológicas inflamatórias e hipertensão intracraniana idiopática (HII). Resultados A identificação lipídica revelou que os ácidos graxos e esfingolipídios foram as classes mais abundantes de lipídios no LCR e que glicerolipídios e ácidos graxos foram a principal classe de lipídios no plasma de pacientes com EM. A AUC foi de 0,995 (0,912-1) e 0,78 (0,583-0,917), respectivamente. O teste de permutação indicou que essa combinação de íons foi útil para distinguir a EM de outras doenças inflamatórias (p < 0,001 e 0,055, respectivamente). Conclusão Este estudo sugere que o líquido cefalorraquidiano (LCR) e o plasma de pacientes com EM possuem uma assinatura lipídica única, pode ser útil como um biomarcador diagnóstico.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Esclerosis Múltiple/líquido cefalorraquídeo , Esclerosis Múltiple/sangre , Valores de Referencia , Espectrometría de Masas/métodos , Imagen por Resonancia Magnética , Biomarcadores/sangre , Reproducibilidad de los Resultados , Cromatografía Liquida , Sensibilidad y Especificidad , Lipidómica/métodos , Esclerosis Múltiple/diagnóstico
8.
Arq Neuropsiquiatr ; 76(11): 751-755, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30570018

RESUMEN

OBJECTIVE: To report cases of children and adolescents diagnosed with pseudotumor cerebri associated or not with rheumatic disease. METHODS: This was a retrospective study based on medical reports of 29 patients, up to 18 years of age and diagnosed with pseudotumor cerebri, followed up in the Pediatric Rheumatology and Neurology outpatient clinics of a tertiary hospital, until December 2016. RESULTS: Among the 29 patients diagnosed with pseudotumor cerebri, 51.7% were girls and the mean age at the disease onset was 12.3 years. In 18 patients (62%) where an etiology was found, four were associated with a rheumatic disease. The most common symptom was headache (69%) and acetazolamide was the most used medication (69%). Two patients developed blindness and 10 are still being followed up. CONCLUSION: Although rare, pseudotumor cerebri should be considered in children with headaches, especially in patients with rheumatic disease.


Asunto(s)
Seudotumor Cerebral/diagnóstico , Enfermedades Reumáticas/diagnóstico , Acetazolamida/uso terapéutico , Adolescente , Niño , Preescolar , Femenino , Cefalea/complicaciones , Humanos , Masculino , Papiledema/etiología , Seudotumor Cerebral/tratamiento farmacológico , Seudotumor Cerebral/etiología , Estudios Retrospectivos , Enfermedades Reumáticas/complicaciones , Adulto Joven
9.
Arq. neuropsiquiatr ; 76(11): 751-755, Nov. 2018. tab
Artículo en Inglés | LILACS | ID: biblio-973934

RESUMEN

ABSTRACT Objective: To report cases of children and adolescents diagnosed with pseudotumor cerebri associated or not with rheumatic disease. Methods: This was a retrospective study based on medical reports of 29 patients, up to 18 years of age and diagnosed with pseudotumor cerebri, followed up in the Pediatric Rheumatology and Neurology outpatient clinics of a tertiary hospital, until December 2016. Results: Among the 29 patients diagnosed with pseudotumor cerebri, 51.7% were girls and the mean age at the disease onset was 12.3 years. In 18 patients (62%) where an etiology was found, four were associated with a rheumatic disease. The most common symptom was headache (69%) and acetazolamide was the most used medication (69%). Two patients developed blindness and 10 are still being followed up. Conclusion: Although rare, pseudotumor cerebri should be considered in children with headaches, especially in patients with rheumatic disease.


RESUMO Relatar os casos de crianças e adolescentes com diagnóstico de pseudotumor cerebral com ou sem doença reumática. Métodos: Estudo retrospectivo através de revisão de prontuários, 29 pacientes com idade até 18 anos e diagnóstico de pseudotumor, atendidos nos ambulatórios de Reumatologia Pediátrica e Neurologia de um hospital terciário, registrados até dezembro de 2016. Resultados: Dentre os 29 pacientes com diagnóstico de pseudotumor cerebral, 51,7% eram meninas. A média de idade de aparecimento dos sintomas foi de 12,3 anos. Em relação à etiologia do pseudotumor cerebral, em 18 pacientes (62%) foi possível identificar uma causa, sendo o diagnóstico de doença reumática associada em quatro desses casos. Cefaléia foi o sintoma mais frequente (69%), e a medicação mais utilizada foi a acetazolamida (69%). Dois pacientes evoluíram para cegueira e 10 ainda se encontram em seguimento ambulatorial. Conclusão: Concluímos que, apesar de raro, o diagnóstico de pseudotumor cerebral deve ser considerado em crianças com cefaleia, principalmente nos pacientes com doença reumática.


Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto Joven , Seudotumor Cerebral/diagnóstico , Enfermedades Reumáticas/diagnóstico , Seudotumor Cerebral/etiología , Seudotumor Cerebral/tratamiento farmacológico , Papiledema/etiología , Enfermedades Reumáticas/complicaciones , Estudios Retrospectivos , Cefalea/complicaciones , Acetazolamida/uso terapéutico
10.
J Neurointerv Surg ; 9(2): 173-177, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27698231

RESUMEN

BACKGROUND AND PURPOSE: To assess the role of MR venography (MRV) for detecting transverse sinus stenosis, to determine the importance of this finding in idiopathic intracranial hypertension (IIH), and to propose an index that contributes to this diagnosis. MATERIALS AND METHODS: We retrospectively assessed consecutive intracranial MRV of patients aged >18 years diagnosed with IIH according to the diagnostic criteria, between January 2010 and July 2012. The assessments were randomly analyzed by three radiologists. Stenoses in the right and left transverse sinuses were independently classified according to the following scale: 0, normal; 1, stenosis <33%; 2, stenosis 33-66%; 3, stenosis >66%; and 4, hypoplasia or agenesis. We established an index based on multiplication of the stenosis scale values for each transverse sinus. A point and range estimate of the sensitivity, specificity, and the area under the receiver operating characteristic curve was performed to obtain cut-off points to differentiate between controls and patients. RESULTS: 63 individuals were included in this study: 32 (50.8%) diagnosed with IIH (31 (96.9%) women and 1 (3.1%) man) and 31 (49.2%) controls. According to all of the examiners, the IIH group showed a higher degree of stenosis than the control group. Index values ≥4 for a diagnosis of IIH had a sensitivity and specificity of 94.7% and 93.5%, respectively. CONCLUSIONS: MRV should be used to assess patients with suspected IIH, and bilateral transverse sinus stenosis should be considered for the diagnosis. The stenosis classifying index proposed here is a fast and accessible method for diagnosing IIH.


Asunto(s)
Hipertensión Intracraneal/diagnóstico por imagen , Senos Transversos/diagnóstico por imagen , Adulto , Área Bajo la Curva , Angiografía Cerebral , Constricción Patológica , Femenino , Humanos , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/etiología , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Flebografía , Estudios Retrospectivos , Adulto Joven
13.
Arq Neuropsiquiatr ; 71(9B): 681-4, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24141504

RESUMEN

Diagnostic lumbar puncture is essential to the diagnosis of central nervous system infections, subarachnoid haemorrhage and others neurological diseases. Myeloradicular involvement or life-threatening adverse events due to the procedure are rare, but less severe complications are more frequent. Post-lumbar puncture headache is the most common complication, by spinal fluid leakage due to delayed closure of a dural defect. Therefore, the development of fine needles, with differentiated atraumatic bevel, has contributed to minimize that problem. These generically called atraumatic needles cause less deformation of the dura mater then the Quincke(®) ones. So, why don't we use these atraumatic needles?


Asunto(s)
Enfermedades del Sistema Nervioso Central/diagnóstico , Agujas , Punción Espinal/instrumentación , Enfermedades del Sistema Nervioso Central/líquido cefalorraquídeo , Diseño de Equipo , Humanos , Cefalea Pospunción de la Duramadre , Punción Espinal/efectos adversos
14.
Arq Neuropsiquiatr ; 71(9B): 685-8, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24141505

RESUMEN

The central nervous system demyelinating diseases are a group of disorders with different etiologies, characterized by inflammatory lesions that are associated with loss of myelin and eventually axonal damage. In this group the most studied ones are multiple sclerosis (MS), neuromyelitis optic (NMO) and acute disseminated encephalomyelitis (ADEM). The cerebrospinal fluid is essential to differentiate between these different syndromes and to define multiple sclerosis, helping to assess the probability of Clinical Isolated Syndrome turn into multiple sclerosis.


Asunto(s)
Encefalomielitis Aguda Diseminada/líquido cefalorraquídeo , Esclerosis Múltiple/líquido cefalorraquídeo , Neuromielitis Óptica/diagnóstico , Proteínas del Líquido Cefalorraquídeo/análisis , Diagnóstico Diferencial , Encefalomielitis Aguda Diseminada/diagnóstico , Humanos , Inmunoglobulinas/biosíntesis , Esclerosis Múltiple/diagnóstico , Neuromielitis Óptica/líquido cefalorraquídeo
15.
Arq. neuropsiquiatr ; 71(9B): 681-684, set. 2013.
Artículo en Inglés | LILACS | ID: lil-688519

RESUMEN

Diagnostic lumbar puncture is essential to the diagnosis of central nervous system infections, subarachnoid haemorrhage and others neurological diseases. Myeloradicular involvement or life-threatening adverse events due to the procedure are rare, but less severe complications are more frequent. Post-lumbar puncture headache is the most common complication, by spinal fluid leakage due to delayed closure of a dural defect. Therefore, the development of fine needles, with differentiated atraumatic bevel, has contributed to minimize that problem. These generically called atraumatic needles cause less deformation of the dura mater then the Quincke® ones. So, why don't we use these atraumatic needles?.


A punção lombar é essencial para o diagnóstico de infecções do sistema nervoso central, hemorragia subaracnoídea e outras doenças neurológicas. O comprometimento mielorradicular ou efeitos adversos que envolvam risco de vida como consequência do procedimento são raros, mas complicações leves são mais frequentes. Cefaléia pós-punção lombar é a complicação mais comum, secundária a escoamento do líquido cefalorraquiano por fechamento tardio de uma lesão dural. Consequentemente, o desenvolvimento de agulhas finas, com bisel atraumático, tem contribuído para minimizar o problema. Estas agulhas, chamadas genericamente de atraumáticas, causam menos deformação da dura-mater que as agulhas tipo Quincke®. Então, porque não usar estas agulhas atraumáticas?.


Asunto(s)
Humanos , Enfermedades del Sistema Nervioso Central/diagnóstico , Agujas , Punción Espinal/instrumentación , Enfermedades del Sistema Nervioso Central/líquido cefalorraquídeo , Diseño de Equipo , Cefalea Pospunción de la Duramadre , Punción Espinal/efectos adversos
16.
Arq. neuropsiquiatr ; 71(9B): 685-688, set. 2013.
Artículo en Inglés | LILACS | ID: lil-688522

RESUMEN

The central nervous system demyelinating diseases are a group of disorders with different etiologies, characterized by inflammatory lesions that are associated with loss of myelin and eventually axonal damage. In this group the most studied ones are multiple sclerosis (MS), neuromyelitis optic (NMO) and acute disseminated encephalomyelitis (ADEM). The cerebrospinal fluid is essential to differentiate between these different syndromes and to define multiple sclerosis, helping to assess the probability of Clinical Isolated Syndrome turn into multiple sclerosis.


As doenças desmielinizantes do sistema nervoso central são um grupo de desordens de diferentes etiologias, caracterizadas por lesões inflamatórias associadas a perda da mielina e eventualmente dano axonal. Neste grupo de doenças, as mais estudadas são a esclerose múltipla (EM), a neuromielite óptica e a encefalomielite aguda disseminada. O estudo de liquido cefalorraquiano é essencial para o diagnóstico diferencial entre as diferentes síndromes e para a definição de EM, ajudando a estimar a probabilidade da transformação da síndrome clínica isolada em EM.


Asunto(s)
Humanos , Encefalomielitis Aguda Diseminada/líquido cefalorraquídeo , Esclerosis Múltiple/líquido cefalorraquídeo , Neuromielitis Óptica/diagnóstico , Proteínas del Líquido Cefalorraquídeo/análisis , Diagnóstico Diferencial , Encefalomielitis Aguda Diseminada/diagnóstico , Inmunoglobulinas/biosíntesis , Esclerosis Múltiple/diagnóstico , Neuromielitis Óptica/líquido cefalorraquídeo
17.
Arq Neuropsiquiatr ; 68(4): 528-34, 2010 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-20730304

RESUMEN

UNLABELLED: Multiple sclerosis (MS) is an inflammatory, demyelinating disease that can affect several areas of the central nervous system. Damage along the auditory pathway can alter its integrity significantly. Therefore, it is important to investigate the auditory pathway, from the brainstem to the cortex, in individuals with MS. OBJECTIVE: The aim of this study was to characterize auditory evoked potentials in adults with MS of the remittent-recurrent type. METHOD: The study comprised 25 individuals with MS, between 25 and 55 years, and 25 age- and gender-matched healthy controls (research and control groups). Subjects underwent audiological and electrophysiological evaluations. RESULTS: Statistically significant differences were observed between the groups regarding the results of the auditory brainstem response and the latency of the Na and P300 waves. CONCLUSION: Individuals with MS present abnormalities in auditory evoked potentials indicating dysfunction of different regions of the central auditory nervous system.


Asunto(s)
Vías Auditivas/fisiopatología , Potenciales Relacionados con Evento P300/fisiología , Potenciales Evocados Auditivos/fisiología , Esclerosis Múltiple Recurrente-Remitente/fisiopatología , Adulto , Estudios de Casos y Controles , Femenino , Pruebas Auditivas , Humanos , Masculino , Persona de Mediana Edad , Tiempo de Reacción , Adulto Joven
18.
Arq. neuropsiquiatr ; 68(4): 528-534, Aug. 2010. tab
Artículo en Inglés | LILACS | ID: lil-555229

RESUMEN

Multiple sclerosis (MS) is an inflammatory, demyelinating disease that can affect several areas of the central nervous system. Damage along the auditory pathway can alter its integrity significantly. Therefore, it is important to investigate the auditory pathway, from the brainstem to the cortex, in individuals with MS. OBJECTIVE: The aim of this study was to characterize auditory evoked potentials in adults with MS of the remittent-recurrent type. METHOD: The study comprised 25 individuals with MS, between 25 and 55 years, and 25 age- and gender-matched healthy controls (research and control groups). Subjects underwent audiological and electrophysiological evaluations. RESULTS: Statistically significant differences were observed between the groups regarding the results of the auditory brainstem response and the latency of the Na and P300 waves. CONCLUSION: Individuals with MS present abnormalities in auditory evoked potentials indicating dysfunction of different regions of the central auditory nervous system.


A esclerose múltipla é uma doença inflamatória desmielinizante que pode se desenvolver em diversas regiões do sistema nervoso central. O comprometimento da via auditiva central pode alterar significativamente a integridade desta e, portanto, a investigação desta região em indivíduos com esclerose múltipla, desde o tronco encefálico até o córtex, torna-se importante. OBJETIVO: Caracterizar os resultados dos potenciais evocados auditivos em adultos com esclerose múltipla do tipo remitente-recorrente. MÉTODO: Foram submetidos às avaliações audiológica e eletrofisiológica 25 indivíduos pertencentes ao grupo controle e 25 ao grupo pesquisa, com idades entre 25 e 55 anos. RESULTADOS: Verificou-se diferença estatisticamente significante entre os grupos quanto à ocorrência de resultados normais e alterados no potencial evocado auditivo de tronco encefálico e latências das ondas Na e P300. CONCLUSÃO: Indivíduos com esclerose múltipla apresentam alterações nos potenciais evocados auditivos, indicando comprometimento de diferentes regiões do sistema nervoso auditivo central.


Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Vías Auditivas/fisiopatología , /fisiología , Potenciales Evocados Auditivos/fisiología , Esclerosis Múltiple Recurrente-Remitente/fisiopatología , Estudios de Casos y Controles , Pruebas Auditivas , Tiempo de Reacción , Adulto Joven
19.
Pró-fono ; 21(4): 285-291, out.-dez. 2009. tab
Artículo en Inglés, Portugués | LILACS | ID: lil-536787

RESUMEN

BACKGROUND: cognitive potential - P300 assessment in individuals with right hemisphere ischemic lesion due to ischemic stroke. AIM: to characterize the cognitive potential - P300 in right-handed individuals with right hemisphere ischemic lesion, and to compare such data to those obtained in normal individuals. METHOD: anamnesis, conventional audiologic assessment and cognitive potential (P300) were carried out in 17 subjects with right hemisphere lesions (research group) and in 25 normal individuals (control group), aged between 20 and 70 years. RESULTS: in the qualitative analysis of the P300 data, there was no statistically significant difference between groups for the normal result. In the quantitative analysis, there was a statistically significant difference between groups in terms of P300 wave latency, with the research group presenting higher latencies. In addition, there was a trend for a statistically significant difference between the right and left ears in the research group - increased P300 wave latency in the right ear. CONCLUSION: right-handed individuals with right hemisphere lesion and normal hearing presented electrophysiological hearing results indicative of central auditory nervous system deficits. Alterations were observed in regions generating this potential (cortical and subcortical areas). Hearing difficulties were not perceived by these individuals, suggesting that this signal can probably be related to an auditory heminegligence. Further studies that evaluate the central auditory pathway of individuals with right hemisphere ischemic lesion are needed in order to better characterize the electrophysiological findings.


TEMA: avaliação do potencial cognitivo P300 em indivíduos com lesão de hemisfério direito provocada por acidente vascular cerebral isquêmico. OBJETIVO: caracterizar os achados do potencial cognitivo P300 em indivíduos destros com lesão isquêmica do hemisfério cerebral direito, bem como comparar seus resultados aos obtidos em indivíduos normais. MÉTODO: foram realizadas anamnese, avaliação audiológica convencional e potencial cognitivo (P300), em 17 indivíduos com lesão do hemisfério direito (grupo pesquisa) e 25 normais (grupo controle), com idades entre 20 e 70 anos. RESULTADOS: na análise dos dados qualitativos do P300, não houve diferença estatisticamente significante entre os grupos para o resultado normal. Para a análise dos dados quantitativos, ocorreu diferença estatisticamente significante entre os grupos com relação à latência da onda P300, sendo que o grupo pesquisa apresentou latência maior. Além disso, houve uma tendência estatisticamente significante entre as orelhas direita e esquerda dentro do grupo pesquisa, mostrando aumento de latência da onda P300 na orelha direita. CONCLUSÃO: Indivíduos destros com lesão de hemisfério direito e limiares auditivos normais, apresentaram resultados eletrofisiológicos da audição indicativos de déficit no sistema nervoso auditivo central. Foram observados comprometimentos nas regiões geradoras deste potencial (áreas subcorticais e corticais). Dificuldades auditivas não foram percebidas pelos indivíduos, sugerindo que, provavelmente tal sinal possa estar relacionado à uma heminegligência auditiva. Tornam-se necessários mais estudos que avaliem a via auditiva central destes indivíduos para uma melhor caracterização dos achados eletrofisiológicos.


Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Isquemia Encefálica/fisiopatología , /fisiología , Métodos Epidemiológicos , Lateralidad Funcional/fisiología , Adulto Joven
20.
Pro Fono ; 21(4): 285-90, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-20098945

RESUMEN

BACKGROUND: Cognitive potential--P300 assessment in individuals with right hemisphere ischemic lesion due to ischemic stroke. AIM: To characterize the cognitive potential--P300 in right-handed individuals with right hemisphere ischemic lesion, and to compare such data to those obtained in normal individuals. METHOD: Anamnesis, conventional audiologic assessment and cognitive potential (P300) were carried out in 17 subjects with right hemisphere lesions (research group) and in 25 normal individuals (control group), aged between 20 and 70 years. RESULTS: In the qualitative analysis of the P300 data, there was no statistically significant difference between groups for the normal result. In the quantitative analysis, there was a statistically significant difference between groups in terms of P300 wave latency, with the research group presenting higher latencies. In addition, there was a trend for a statistically significant difference between the right and left ears in the research group--increased P300 wave latency in the right ear. CONCLUSION: Right-handed individuals with right hemisphere lesion and normal hearing presented electrophysiological hearing results indicative of central auditory nervous system deficits. Alterations were observed in regions generating this potential (cortical and subcortical areas). Hearing difficulties were not perceived by these individuals, suggesting that this signal can probably be related to an auditory heminegligence. Further studies that evaluate the central auditory pathway of individuals with right hemisphere ischemic lesion are needed in order to better characterize the electrophysiological findings.


Asunto(s)
Isquemia Encefálica/fisiopatología , Potenciales Relacionados con Evento P300/fisiología , Adulto , Anciano , Métodos Epidemiológicos , Femenino , Lateralidad Funcional/fisiología , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
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