RESUMEN
BACKGROUND: The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) have been previously studied as predictors of survival in different malignancies. OBJECTIVE: The aim of this study was to evaluate the predictive value of these hematologic inflammatory biomarkers for patients with brain metastases (BM). METHODS: We reviewed a consecutive cohort of patients at Instituto do Cancer do Estado de São Paulo (ICESP-FMUSP) from 2011 to 2016 with ≥ 1 BM treated primarily by surgical resection. The primary outcome was 1-year survival. We optimized the NLR, MLR, PLR, and RDW cutoff values, preserving robustness and avoiding overestimation of effect size. RESULTS: A total of 200 patients (mean age 56.1 years; 55.0% female) met inclusion criteria. Gross-total resection was achieved in 89.0%. The median (quartiles) preoperative and postoperative KPS scores were 60 (50-80) and 80 (60-90), respectively. Preoperative NLR was significantly associated with survival (HR 2.66, 95% CI: 1.17-6.01, p = 0.019). A NLR cutoff value of 3.83 displayed the most significant survival curve split. CONCLUSIONS: Preoperative NLR is an independent predictor of survival in newly diagnosed BM. We propose a cutoff value of 3.83 for preoperative NLR testing may be clinically useful as predictor of poor survival in this population. The wide accessibility of the NLR favors its inclusion in clinical decision-making processes for BM management.
ANTECEDENTES: Os neutrófilos para linfócitos (NLR), monócitos para linfócitos (MLR), proporção de plaquetas para linfócitos (PLR) e largura de distribuição de glóbulos vermelhos (RDW) foram previamente estudados como preditores de sobrevivência em diferentes malignidades. OBJETIVO: O objetivo deste estudo foi avaliar o valor preditivo desses biomarcadores inflamatórios hematológicos para pacientes com metástases cerebrais (MB). MéTODOS: Nós revisamos uma coorte consecutiva de pacientes no Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP) de 2011 a 2016 com ≥ 1 MB tratados principalmente por ressecção cirúrgica. O desfecho primário foi a sobrevida em 1 ano. Otimizamos os valores de corte de NLR, MLR, PLR e RDW, preservando a robustez e evitando superestimação do tamanho do efeito. RESULTADOS: Um total de 200 pacientes (idade média de 56,1 anos; 55,0% mulheres) preencheram os critérios de inclusão. A ressecção grosseira total foi obtida em 89,0%. A mediana (quartis) dos escores KPS pré-operatório e pós-operatório foram 60 (5080) e 80 (6090), respectivamente. O NLR pré-operatório foi significativamente associado à sobrevida (HR 2,66, IC 95%: 1,176,01, p = 0,019). Um valor de corte de NLR de 3,83 exibiu a divisão da curva de sobrevivência mais significativa. CONCLUSõES: O NLR pré-operatório é um preditor independente de sobrevida em MBs recém-diagnosticados. Propomos que um valor de corte de 3,83 para o teste de NLR pré-operatório pode ser clinicamente útil como preditor de baixa sobrevida nesta população. A ampla acessibilidade do NLR favorece sua inclusão nos processos de tomada de decisão clínica para o gerenciamento de BM.
Asunto(s)
Neoplasias Encefálicas , Neutrófilos , Humanos , Femenino , Persona de Mediana Edad , Masculino , Pronóstico , Estudios Retrospectivos , Brasil , Linfocitos/patología , Plaquetas/patología , Neoplasias Encefálicas/patologíaRESUMEN
Abstract Background The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) have been previously studied as predictors of survival in different malignancies. Objective The aim of this study was to evaluate the predictive value of these hematologic inflammatory biomarkers for patients with brain metastases (BM). Methods We reviewed a consecutive cohort of patients at Instituto do Cancer do Estado de São Paulo (ICESP-FMUSP) from 2011 to 2016 with ≥ 1 BM treated primarily by surgical resection. The primary outcome was 1-year survival. We optimized the NLR, MLR, PLR, and RDW cutoff values, preserving robustness and avoiding overestimation of effect size. Results A total of 200 patients (mean age 56.1 years; 55.0% female) met inclusion criteria. Gross-total resection was achieved in 89.0%. The median (quartiles) preoperative and postoperative KPS scores were 60 (50-80) and 80 (60-90), respectively. Preoperative NLR was significantly associated with survival (HR 2.66, 95% CI: 1.17-6.01, p = 0.019). A NLR cutoff value of 3.83 displayed the most significant survival curve split. Conclusions Preoperative NLR is an independent predictor of survival in newly diagnosed BM. We propose a cutoff value of 3.83 for preoperative NLR testing may be clinically useful as predictor of poor survival in this population. The wide accessibility of the NLR favors its inclusion in clinical decision-making processes for BM management.
Resumo Antecedentes Os neutrófilos para linfócitos (NLR), monócitos para linfócitos (MLR), proporção de plaquetas para linfócitos (PLR) e largura de distribuição de glóbulos vermelhos (RDW) foram previamente estudados como preditores de sobrevivência em diferentes malignidades. Objetivo O objetivo deste estudo foi avaliar o valor preditivo desses biomarcadores inflamatórios hematológicos para pacientes com metástases cerebrais (MB). Métodos Nós revisamos uma coorte consecutiva de pacientes no Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP) de 2011 a 2016 com ≥ 1 MB tratados principalmente por ressecção cirúrgica. O desfecho primário foi a sobrevida em 1 ano. Otimizamos os valores de corte de NLR, MLR, PLR e RDW, preservando a robustez e evitando superestimação do tamanho do efeito. Resultados Um total de 200 pacientes (idade média de 56,1 anos; 55,0% mulheres) preencheram os critérios de inclusão. A ressecção grosseira total foi obtida em 89,0%. A mediana (quartis) dos escores KPS pré-operatório e pós-operatório foram 60 (50-80) e 80 (60-90), respectivamente. O NLR pré-operatório foi significativamente associado à sobrevida (HR 2,66, IC 95%: 1,17-6,01, p = 0,019). Um valor de corte de NLR de 3,83 exibiu a divisão da curva de sobrevivência mais significativa. Conclusões O NLR pré-operatório é um preditor independente de sobrevida em MBs recém-diagnosticados. Propomos que um valor de corte de 3,83 para o teste de NLR pré-operatório pode ser clinicamente útil como preditor de baixa sobrevida nesta população. A ampla acessibilidade do NLR favorece sua inclusão nos processos de tomada de decisão clínica para o gerenciamento de BM.
RESUMEN
The Virchow-Robin spaces (VRSs), which are often incidentally observed in modern structural neuroimaging examinations, are small cystic cavities that usually surround the small arteries and arterioles at the level of basal ganglia, the anterior perforated substance and the thalamic-mesencephalic junction. Typically, they have similar physicochemical characteristics to cerebral spinal fluid (CSF) and there is no contrast enhancement on brain CT andMRI images. Its real meaning is unknown, although some contemporary studies have suggested that it might be related to certain traumatic brain injury or several other central nervous system (CNS) disorders, as degenerative diseases. Occasionally, some wide and atypical VRS may be mistaken for primary cystic brain tumors, especially in the context of large and symptomatic lesions, multiple clustered cysts, cortical lesions and if there is adjacent reactive gliosis. The present paper reports four patients who were affected by atypical VRS mimicking brain tumors that required imaging follow-up or even a biopsy to confirm the diagnosis or to indicate the correct approach. Although it is not so unusual, one of them occurred concomitantly and adjacent to a diffuse glioma (co-deleted 1p19q, WHO-GII).
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Humanos , Masculino , Femenino , Niño , Adulto , Persona de Mediana Edad , Dilatación Patológica , Sistema Glinfático/anomalías , Sistema Glinfático/cirugía , Sistema Glinfático/diagnóstico por imagen , Neoplasias del Sistema Nervioso Central/diagnóstico por imagen , Sistema Glinfático/patologíaRESUMEN
The present report describes the case of a male 17-year-old patient who progressively developed a hydrocephalus and polyradiculopathy due to involvement of central nervous system (CNS) by a diffuse leptomeningeal glioneuronal tumor (DLGNT). The tumor had partial remission in response to the treatment with radiotherapy plus procarbazine, lomustine, and vincristine (PCV) chemotherapy, and the patient had improvement in function and pain levels. The current knowledge about DLGNT, including its clinical manifestations, imaging findings, histological characteristics, and treatment are revised and discussed in the present paper.
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Humanos , Masculino , Adulto Joven , Oligodendroglioma/patología , Oligodendroglioma/tratamiento farmacológico , Oligodendroglioma/radioterapia , Neoplasias Meníngeas , Oligodendroglioma/diagnóstico por imagen , Polirradiculopatía/complicaciones , Derivación Ventriculoperitoneal/métodos , Hidrocefalia/complicacionesRESUMEN
OBJECTIVE: Despite advances in systemic therapy and radiotherapy (RT), neurosurgical resection (NSR) remains a mainstay of the treatment of brain metastases (BMs). Although it is unequivocal in instances of diagnostic doubt, radioresistance, and risk of death due to neurologic causes, NSR may be controversial in other situations. Many aspects related to NSR have not yet been well established, and the primary prognostic indices were proposed only in the last decade. This study evaluates the survival and the morbidity, causes of death, prognostic factors, and the impact of RT in patients with BMs treated by NSR in the current era. METHODS: A total of 200 patients with BMs who were treated by NSR were evaluated sequentially and followed prospectively. We used logistic regression and Cox regression models to identify independent factors associated with mortality at 4 weeks and at 1 year, respectively. Clinical features, morbidity, recurrence, and causes of death were also studied. RESULTS: Lung cancer was the most prevalent cancer (36.5%); the median Karnofsky Performance Status (KPS) score was 60. Total resection was achieved in 89%, and adjuvant RT was applied in 63% of the cases. The rates of surgical mortality, morbidity, and mortality at 4 weeks were 1.5%, 17%, and 7.5%, respectively. Systemic infections were the leading cause of death in 62.5% of the cases. The median survival was 5 months, and 34.5% of patients lived > 1 year. The postoperative KPS (KPSpo) score remained unchanged or improved in 94.5% of the cases. In the multivariate analysis, a KPSpo score ≥ 80 and the application of adjuvant RT were associated with a lower risk of death at 12 weeks and at 1 year. Interestingly, the variables of primary tumor site, number of BMs, and presence of carcinomatous meningitis were not significant. CONCLUSION: Morbidity and mortality were high, a third of the patients lived > 1 year, and the KPS score improved or remained unchanged in most cases. Prognostic indices and health conditions were important predictive factors, but the KPSpo score and adjuvant RT were independent variables for survival at 12 weeks and at 1 year. Therefore, new studies are needed to assess the influence of new therapies and specific molecular profiles.
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Neoplasias Encefálicas/cirugía , Encéfalo/cirugía , Procedimientos Neuroquirúrgicos , Adulto , Anciano , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/secundario , Estudios de Cohortes , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Pronóstico , Radioterapia Adyuvante , Estudios RetrospectivosRESUMEN
BACKGROUND: The goals of treating a cerebral metastasis (CM) are to achieve local control of the disease and to improve patient quality of life. The aim of this study was to analyze the effect of conventional surgery supported by intraoperative ultrasound (IOUS) to approach a CM. To perform this analysis, we determined the postoperative Karnofsky Performance Status Scale (KPS) scores and tumor resection grades. METHODS: Patients with a CM diagnosis were included in this study. Surgical treatment was either supported or not by IOUS. Pre- and postoperative KPS scores were determined by the oncology team, and cerebral tumor volume was estimated through pre- and postoperative magnetic resonance imaging. The surgical team determined whether it was possible to perform a total CM resection. RESULTS: There were 78 patients treated using surgical management (35 with and 43 without IOUS). In the IOUS group, the postoperative KPS scores were higher (80 vs. 70, respectively; P = 0.045) and the KPS evolution was superior (P = 0.036), especially in the following subgroups: difficulty of tumor resection ranking score <4 (P = 0.037), tumor in an eloquent area (P = 0.043), tumor not associated with vessels or nerves (P = 0.007), and solitary lesions (P = 0.038). The residual tumor volume was lower in the IOUS group (9.5% and 1.6 mm3 vs. 30.8% and 9 mm3, respectively; P = 0.05). In patients with a KPS score ≥70, 62% of them had <10% residual tumors (76% in the IOUS group and 45% in the non-IOUS group; P = 0.032; odds ratio, 3.8). CONCLUSIONS: IOUS may improve postoperative KPS scores and decrease residual tumor volumes in CM surgeries. These findings should be confirmed in future studies.
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Adenocarcinoma/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Ecoencefalografía/métodos , Melanoma/diagnóstico por imagen , Metastasectomía/métodos , Procedimientos Neuroquirúrgicos/métodos , Sarcoma/diagnóstico por imagen , Cirugía Asistida por Computador/métodos , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , Neoplasias de la Mama/patología , Neoplasias del Colon/patología , Femenino , Humanos , Cuidados Intraoperatorios , Estado de Ejecución de Karnofsky , Neoplasias Pulmonares/patología , Masculino , Melanoma/patología , Melanoma/secundario , Melanoma/cirugía , Persona de Mediana Edad , Neoplasia Residual , Oportunidad Relativa , Estudios Retrospectivos , Sarcoma/patología , Sarcoma/secundario , Sarcoma/cirugía , Neoplasias Cutáneas/patología , Neoplasias Gástricas/patología , Resultado del Tratamiento , Carga Tumoral , Adulto JovenRESUMEN
UNLABELLED: Brain metastases (BM) are one of the most common intracranial tumors and surgical treatment can improve both the functional outcomes and patient survival, particularly when systemic disease is controlled. Image-guided BM resection using intraoperative exams, such as intraoperative ultrasound (IOUS), can lead to better surgical results. METHODS: To evaluate the use of IOUS for BM resection, 20 consecutive patients were operated using IOUS to locate tumors, identify their anatomical relationships and surgical cavity after resection. Technical difficulties, complications, recurrence and survival rates were noted. RESULTS: IOUS proved effective for locating, determining borders and defining the anatomical relationships of BM, as well as to identify incomplete tumor resection. No complications related to IOUS were seen. CONCLUSION: IOUS is a practical supporting method for the resection of BM, but further studies comparing this method with other intraoperative exams are needed to evaluate its actual contribution and reliability.
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Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/secundario , Adulto , Anciano , Neoplasias Encefálicas/cirugía , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Ultrasonografía IntervencionalRESUMEN
Brain metastases (BM) are one of the most common intracranial tumors and surgical treatment can improve both the functional outcomes and patient survival, particularly when systemic disease is controlled. Image-guided BM resection using intraoperative exams, such as intraoperative ultrasound (IOUS), can lead to better surgical results. METHODS: To evaluate the use of IOUS for BM resection, 20 consecutives patients were operated using IOUS to locate tumors, identify their anatomical relationships and surgical cavity after resection. Technical difficulties, complications, recurrence and survival rates were noted. RESULTS: IOUS proved effective for locating, determining borders and defining the anatomical relationships of BM, as well as to identify incomplete tumor resection. No complications related to IOUS were seen. CONCLUSION: IOUS is a practical supporting method for the resection of BM, but further studies comparing this method with other intraoperative exams are needed to evaluate its actual contribution and reliability.
As metástases cerebrais (MC) são os tumores intracranianos mais frequentes e seu tratamento cirúrgico pode melhorar a sobrevida e a funcionalidade do paciente, especialmente quando a doença sistêmica está controlada. A ressecção das MC guiada por imagens de exames intraoperatórios, como ultrassom intraoperatório (USIO), pode levar a melhores resultados cirúrgicos. MÉTODOS: Avaliar o uso do USIO nas ressecções de MC de 20 pacientes para localizar os tumores, avaliar suas relações anatômicas e a cavidade cirúrgica após o procedimento. As dificuldades técnicas, complicações, recorrência e taxa de sobrevivência foram anotadas em cada caso. RESULTADOS: USIO foi eficaz para localizar, delinear e definir as relações anatômicas das MC, assim como a ocorrência de ressecção incompleta. Não foram encontradas complicações relacionadas ao uso do USIO. CONCLUSÃO: USIO é um método auxiliar prático para as ressecções de MC, porém outros estudos ainda se fazem necessários para avaliar sua real contribuição nesses procedimentos.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas , Neoplasias Encefálicas/cirugía , Periodo Intraoperatorio , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Ultrasonografía IntervencionalRESUMEN
Os gliomas representam 30%-40% de todas as neoplasias intracranianas e aproximadamente 50% são glioblastomas. São classificados em graus pela OMS, de acordo com sua patologia. Apresentam altas taxas de mortalidade. Existem marcadores tumorais que podem auxiliar na detecção precoce e avaliar prognóstico. Realizada revisão sobre o tema marcadores tumorais por meio do site PubMed. MGMT é uma proteína que restaura o DNA, impedindo a sua alquilação. A metilação do MGMT por meio de fenômeno epigenético impede sua transcrição inibindo sua ação, tornando o tumor suscetível a fármacos. IDH e codeleção cromossômica 1p19q são marcadores tumorais e estão associados a melhor prognóstico. As neoplasias intracranianas apresentam altas taxas de mortalidade e sua detecção precoce por meio de marcadores e o conhecimento de alterações que conferem bom prognóstico podem auxiliar no tratamento dessa doença. A análise molecular auxilia na detecção e no tratamento de tumores.
Gliomas represent 30%-40% of all intracranial tumors and approximately 50% are glioblastomas. They are classified by the WHO in degrees, according to their pathology. Have high mortality rates. There are tumor markers may help in early detection and assess prognosis. Was performed a review about the topic tumor markers through PubMed. MGMT is a protein that restores the DNA, preventing its alkylation. Methylation of MGMT through epigenetic phenomenon prevents their transcription and inhibits its action, making the tumor susceptible to drugs. IDH and chromosomal deletion 1p19q are tumor markers and are associated with better prognosis. The intracranial tumors have high rates of mortality and early detection through biomarkers and knowledge of changes that confer a good prognosis can help in treating this disease. Molecular analysis allows the detection and treatment of tumors.
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Humanos , Persona de Mediana Edad , Glioma/diagnóstico , Glioma/terapia , Biomarcadores de Tumor/química , Biomarcadores de Tumor/uso terapéutico , Isocitrato DeshidrogenasaRESUMEN
UNLABELLED: Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is effective in the treatment of chronic pain patients, but the analgesic effect of repeated sessions is still unknown. We evaluated the effects of rTMS in patients with refractory pain due to complex regional pain syndrome (CRPS) type I. Twenty-three patients presenting CRPS type I of 1 upper limb were treated with the best medical treatment (analgesics and adjuvant medications, physical therapy) plus 10 daily sessions of either real (r-) or sham (s-) 10 Hz rTMS to the motor cortex (M1). Patients were assessed daily and after 1 week and 3 months after the last session using the Visual Analogical Scale (VAS), the McGill Pain Questionnaire (MPQ), the Health Survey-36 (SF-36), and the Hamilton Depression (HDRS). During treatment there was a significant reduction in the VAS scores favoring the r-rTMS group, mean reduction of 4.65 cm (50.9%) against 2.18 cm (24.7%) in the s-rTMS group. The highest reduction occurred at the tenth session and correlated to improvement in the affective and emotional subscores of the MPQ and SF-36. Real rTMS to the M1 produced analgesic effects and positive changes in affective aspects of pain in CRPS patients during the period of stimulation. PERSPECTIVE: This study shows an efficacy of repetitive sessions of high-frequency rTMS as an add-on therapy to refractory CRPS type I patients. It had a positive effect in different aspects of pain (sensory-discriminative and emotional-affective). It opens the perspective for the clinical use of this technique.
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Analgésicos/uso terapéutico , Dimensión del Dolor , Distrofia Simpática Refleja/clasificación , Distrofia Simpática Refleja/tratamiento farmacológico , Estimulación Magnética Transcraneal/métodos , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Dimensión del Dolor/métodos , Distrofia Simpática Refleja/diagnóstico , Síndrome , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Introdução e objetivos: Estudos recentes sugerem que a estimulação magnética transcraniana repetitiva (EMTr) aplicada sobre o córtex motor é eficaz no tratamento analgésico de doentes com dor crônica. O objetivo deste estudo foi avaliar os efeitos da aplicação da EMTr sobre o córtex motor, utilizada como co-intervenção terapêutica no tratamento de pacientes com síndrome complexa de dor regional (SCDR) refratária aos tratamentos convencionais. Métodos: Vinte e três doentes com SCDR na mão foram distribuídos aleatoriamente em dois grupos de tratamentos para receberem o tratamento padrão (analgésicos, medicações adjuvantes e terapia física) associado a dez sessões diárias e consecutivas de EMTr rápida ou estimulação magnética placebo (EMTp), aplicadas sobre a região correspondente ao córtex motor da mão acometida. Os grupos foram comparados em relação aos aspectos epidemiológicos, apresentação clínica da doença, intensidade da dor, alterações do humor, qualidade de vida e função do membro acometido até noventa dias após a conclusão do tratamento, utilizando-se de entrevistas estruturadas, da escala visual analógicas de dor (EVA), do questionário de dor de McGuill (QM), do questionário PIQ-6 (Pain Inpact Questionnaire), do questionário DASH (Disabilities of Arm, Shoulder and Hand), do questionário SF-36 e dos questionários Hamilton para ansiedade e depressão. Resultados: Ocorreu redução significativa dos escores da EVA no grupo tratado com EMTr durante o tratamento, que durou até o sétimo dia após o encerramento das aplicações (p<0.05). A redução média da EVA no grupo tratado com EMTr foi de 4.65 cm (redução de 50.9% dos escores de dor), estatisticamente superior ao grupo tratado com placebo, no qual a redução foi de 2.18 cm (redução de 24.7%). A diminuição dos escores de dor na EVA foi independente de outras variáveis em estudo, exceto pela melhora no domínio sete do questionário SF-36 (aspectos emocionais). Conclusões: A aplicação de EMTr rápida sobre a...
Background and aims: There are many evidences that repetitive transcranial magnetic stimulation (r-TMS) of the motor cortex is effective in relief of chronic pain. The aim of this study was to evaluate the analgesic effects of r-TMS in patients with refractory CRPS. Methods: Twenty-three patients presenting with complex regional pain syndrome (CRPS) of the hand were randomly selected and treated with conventional treatment (analgesics, adjuvant medications and physical therapy) plus sham-TMS or r-TMS to the motor cortex opposite the affected limb: 100% MT, 10 hz, 10 s trains, 25 trains daily, 10 daily sessions. The Visual Analogical Scale of Pain (VAS), McGill Questionnaire, Pain Impact Questionnaire (PIQ-6), Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Hamilton Depression and Anxiety Rating Scales and SF-36 Questionnaire were the instruments used for the evaluation. The groups were comparable with regards to socio-demographics, mood and pain intensity. Evaluations were performed before, during TMS treatment and up to three months the end of the treatment. Results: There was a significant reduction in VAS scores favoring the r-TMS group up to the seventh follow-up day (p <0.05). The mean reduction in the rTMS group was of 4.65 cm (fall of 50.9%) against 2.18 cm (fall of 24.7%) in sham group during treatment. Improvement in VAS scores was independent of other variables, except for improvement in emotional aspects in the SF-36. Conclusions: During r-TMS sessions there was significant and positive improvement in pain experience of CRPS patients regardless of mood, function or quality of life effects.
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Humanos , Masculino , Femenino , Distrofia Simpática Refleja/terapia , Dolor Intratable/terapia , Síndromes de Dolor Regional Complejo/terapia , Estimulación Magnética TranscranealRESUMEN
Relatamos o caso de um homemde 49 anos, com episódio convulsivo único, portador de um tumor na convexidade parietal direita, implantado na dura-máter, que foi submetido a tratamento cirúrgico com remoção radical da lesão. O exame anatomopatológico foi compatível com menongioma papilar e o tratamento foi complementado com radioterapia externa. Após cinco anos, o paciente apresenta-se assintomático, sem sinais de recidiva local ou a distância.
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Humanos , Masculino , Persona de Mediana Edad , MeningiomaRESUMEN
Accidental induction of convulsions by using repetitive transcranial magnetic stimulation (rTMS) has been reported to have occurred in 6 normal voluntary subjects, in 1 patient with depression and in 1 patient who had temporal lobe epilepsy, with secondary generalization. In addition, 3 other cases have been published relating its use with seizure induction and in 1 case, using 1-Hz stimulation. In this paper, we report a patient who was participating in a protocol for the use of rTMS in chronic pain, with stimulation in the motor cortex, who developed a generalized seizure in the fifth application. Intertrain interval was within safety guidelines, but the combination of 10 Hz for 10 seconds was excessive and must be considered the main cause for the episode. No further complication has been noted after she was withdrawn from the study protocol.
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Corteza Motora/fisiopatología , Convulsiones/etiología , Estimulación Magnética Transcraneal/efectos adversos , Adulto , Femenino , Humanos , Convulsiones/fisiopatologíaRESUMEN
Os autores escrevem o resultado dos achados anatomopatológicos e correlacionam-os com dados do exame clínico de 48 doentes com dor facial decorrente de lesões expansivas intracranianas. Observaram que ocorreu predomínio das condições em indivíduos do sexo feminino (72,9%), as idades variaram de 23 a 71 anos (média das idades = 42,9 anos), o neurinoma do VIII nervo craniano (64,5%) ou do nervo trigêmeo (14,0%) foi o achado mais freqüênte, seguido pelo meningioma do ângulo pontocerebelar (11,3%) e por outras condições, incluindo a invasão do gânglio trigeminal por carcinoma do nasofarígeo, ou o angioma do ângulo potocerebelar, a tomografia computadorizada do crânio revelou-se mais sensível e específica para o diagnóstico que a ventriculografia, a cintilografia encefálica, a arteriografia encefálica e o exame do líquido cefalorraquidiano. Nos doentes com neurinoma, meningioma, angioma ou carcinoma infiltrativo do gânglio trigeminal; a hipoestesia da face e o déficit funcional do VIII nervo craniano foram as anormalidades mais freqüentemente observadas (69,0%), seguindo-se o edema de papila (29,3%), o déficit funcional do nervo facial (40,5%), a síndrome cerebelar (23,8%) e outras anormalidades, como paralisia de nervo abducente ou do nervo motor do nervo trigêmeo (7,1%), ou déficit funcional do nervo glossofaríngeo e vago (4,7%). Concluem que exames complementares, especialmente de imagem, são recomendados para avaliar todos os dentes com dor facial sem causa aparente
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Adulto , Persona de Mediana Edad , Anciano , Humanos , Femenino , Edema Encefálico , Dolor Facial , Neuralgia del Trigémino , Trastornos Cerebrovasculares , Neuralgia Facial , Vías Nerviosas , NeurilemomaRESUMEN
Dor, especialmente nos membros superiores relacionada as atividades laborais, e condicao comum. Decorre geralmente de anormalidades musculo-esqueleticas e neurais. Alem das condicoes mecanicas admite-se que ...
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Humanos , Dolor , Síndromes del Dolor Miofascial/historia , Trastornos de Traumas Acumulados/historia , Riesgos Laborales , Trastornos de Traumas Acumulados/diagnóstico , Trastornos de Traumas Acumulados/epidemiología , Trastornos de Traumas Acumulados/fisiopatología , Trastornos de Traumas Acumulados/rehabilitaciónRESUMEN
Dor e comum nos membros superiores. Varias sao as razoes de sua ocorrencia quer em afeccoes musculo-esqueleticas, dermatologicas, vasculares, neuropaticas ou viscerais toracicas e cervicais concorrem...