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1.
Dement Neuropsychol ; 18: e20230117, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39015553

RESUMEN

Despite the increasing knowledge in the past years, only minimal attention has been directed to the neuropsychological aspects and the prevalence of cognitive impairment associated with reversible cerebral vasoconstriction syndrome (RCVS). Objective: To describe the frequency and expand the understanding of cognitive dysfunction in RCVS. Methods: The neuropsychological evaluation was performed using a battery consisting of specific neuropsychological instruments that were administered to patients diagnosed with RCVS. A triage was conducted to exclude other potential causes of cognitive impairment. Performance on the tests was treated as a categorical variable, and a cutoff of -1.5 Z-score was adopted to indicate impaired performance. Results: Seven patients diagnosed with RCVS were evaluated, all of whom had a bachelor's degree and normal score in the Mini-Mental State Examination. The average time between diagnosis and neuropsychological evaluation was 1.8 years. Among the patients, 85.6% (n=6) exhibited performance below that of the normal population in at least two of the administered tests. Specifically, 71.4% (n=5) showed alterations in tests from the Psychological Battery for Attention Assessment, with impairment observed in concentrated (n=1), divided (n=3), or alternating (n=4) attention. Furthermore, 28.6% (n=2) demonstrated impairments in the Phonological Verbal Fluency Task, another 28.6% (n=2) exhibited difficulties copying elements of the Rey Complex Figure, and 14.3% (n=1) displayed lower performance in the Five-Digit test, all indicating executive dysfunction. Conclusion: This study provides evidence that cognitive impairment associated with RCVS is more prevalent than previously believed and has not received sufficient attention. Specifically, attention and executive functions are the cognitive domains most significantly impacted by RCVS.


Apesar do crescente conhecimento nos últimos anos, pouca atenção tem sido direcionada aos aspectos neuropsicológicos e à prevalência de declínio cognitivo associado à Síndrome de Vasoconstrição Cerebral Reversível (SVCR). Objetivo: Descrever a frequência e expandir o entendimento da disfunção cognitiva associada à SVCR. Métodos: A avaliação neuropsicológica foi realizada por meio de uma bateria composta de instrumentos neuropsicológicos específicos, que foram aplicados aos pacientes com SVCR. Uma triagem foi realizada para excluir outras potenciais causas de declínio cognitivo. O desempenho nos testes foi considerado como variável categórica, e o corte de −1,5 escore z foi adotado para indicar desempenho comprometido. Resultados: Sete pacientes com diagnóstico de SVCR foram avaliados, os quais tinham todos nível de ensino superior e pontuação normal no Miniexame do Estado Mental. A média de tempo entre o diagnóstico e a avaliação neuropsicológica foi de 1,8 ano. Dentre os pacientes, 85,6%(n=6) apresentaram desempenho comprometido em pelo menos dois dos testes aplicados. Especificamente, 71,4% (n=5) apresentaram alterações nos testes da Bateria Psicológica para Avaliação da Atenção, com comprometimento observado nas atenções concentrada (n=1), dividida (n=3), ou alternada (n=4). Além disso, 28,6% (n=2) demonstraram comprometimento na Fluência Verbal Fonológica, 28,6% (n=2) exibiram dificuldades na cópia da Figura Complexa de Rey e um paciente obteve desempenho alterado no Teste dos Cinco Dígitos, todos indicando disfunção executiva. Conclusão: Este estudo fornece evidência de que o declínio cognitivo associado à SVCR é mais prevalente do que se acreditava anteriormente. Especialmente, os domínios mais significativamente comprometidos foram a atenção e as funções executivas.

2.
Rheumatol Adv Pract ; 8(2): rkae060, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38800574

RESUMEN

Objective: Transcranial Doppler (TCD) and brain MRI may be useful in evaluating patients with APS, helping to stratify the risk of cerebrovascular ischaemic events in this population. This study aimed to assess the frequency of brain MRI abnormalities in patients with primary antiphospholipid syndrome, secondary antiphospholipid syndrome and SLE and correlate to TCD findings. Methods: The study, conducted over four years at two autoimmune disease referral centres, included 22 primary antiphospholipid syndrome patients, 24 secondary antiphospholipid syndrome patients, 27 SLE patients without APS and 21 healthy controls. All participants underwent TCD to assess cerebral haemodynamics, detect microembolic signals and evaluate right-to-left shunts, followed by brain MRI and magnetic resonance angiography. MRI scans were reviewed for acute microembolism, localized cortical infarctions, border infarctions, lacunar infarctions, ischaemic lesions, white matter hyperintensity, micro and macro haemorrhages and arterial stenosis ≥50% of the cervical carotid artery, by two neuroradiologists blinded to the clinical data. Results: Brain MRI findings were similar between the groups, except for lacunar infarction, more frequent in patients with secondary antiphospholipid syndrome (P = 0.022). Patients with intracranial stenosis detected by TCD had a higher frequency of territorial infarction (40% vs 7.5%, P = 0.02), lacunar (40% vs 11.3%, P = 0.075) and border zone infarcts (20% vs 1.9%, P = 0.034). Conclusions: Patients with intracranial stenosis presented a higher frequency of territorial, lacunar and border zone infarcts, suggesting that evaluating the intracranial vasculature should not be neglected in patients with APS and stroke.

3.
Dement. neuropsychol ; 18: e20230117, 2024. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1564434

RESUMEN

ABSTRACT. Despite the increasing knowledge in the past years, only minimal attention has been directed to the neuropsychological aspects and the prevalence of cognitive impairment associated with reversible cerebral vasoconstriction syndrome (RCVS). Objective: To describe the frequency and expand the understanding of cognitive dysfunction in RCVS. Methods: The neuropsychological evaluation was performed using a battery consisting of specific neuropsychological instruments that were administered to patients diagnosed with RCVS. A triage was conducted to exclude other potential causes of cognitive impairment. Performance on the tests was treated as a categorical variable, and a cutoff of −1.5 Z-score was adopted to indicate impaired performance. Results: Seven patients diagnosed with RCVS were evaluated, all of whom had a bachelor's degree and normal score in the Mini-Mental State Examination. The average time between diagnosis and neuropsychological evaluation was 1.8 years. Among the patients, 85.6% (n=6) exhibited performance below that of the normal population in at least two of the administered tests. Specifically, 71.4% (n=5) showed alterations in tests from the Psychological Battery for Attention Assessment, with impairment observed in concentrated (n=1), divided (n=3), or alternating (n=4) attention. Furthermore, 28.6% (n=2) demonstrated impairments in the Phonological Verbal Fluency Task, another 28.6% (n=2) exhibited difficulties copying elements of the Rey Complex Figure, and 14.3% (n=1) displayed lower performance in the Five-Digit test, all indicating executive dysfunction. Conclusion: This study provides evidence that cognitive impairment associated with RCVS is more prevalent than previously believed and has not received sufficient attention. Specifically, attention and executive functions are the cognitive domains most significantly impacted by RCVS.


RESUMO. Apesar do crescente conhecimento nos últimos anos, pouca atenção tem sido direcionada aos aspectos neuropsicológicos e à prevalência de declínio cognitivo associado à Síndrome de Vasoconstrição Cerebral Reversível (SVCR). Objetivo: Descrever a frequência e expandir o entendimento da disfunção cognitiva associada à SVCR. Métodos: A avaliação neuropsicológica foi realizada por meio de uma bateria composta de instrumentos neuropsicológicos específicos, que foram aplicados aos pacientes com SVCR. Uma triagem foi realizada para excluir outras potenciais causas de declínio cognitivo. O desempenho nos testes foi considerado como variável categórica, e o corte de −1,5 escore z foi adotado para indicar desempenho comprometido. Resultados: Sete pacientes com diagnóstico de SVCR foram avaliados, os quais tinham todos nível de ensino superior e pontuação normal no Miniexame do Estado Mental. A média de tempo entre o diagnóstico e a avaliação neuropsicológica foi de 1,8 ano. Dentre os pacientes, 85,6%(n=6) apresentaram desempenho comprometido em pelo menos dois dos testes aplicados. Especificamente, 71,4% (n=5) apresentaram alterações nos testes da Bateria Psicológica para Avaliação da Atenção, com comprometimento observado nas atenções concentrada (n=1), dividida (n=3), ou alternada (n=4). Além disso, 28,6% (n=2) demonstraram comprometimento na Fluência Verbal Fonológica, 28,6% (n=2) exibiram dificuldades na cópia da Figura Complexa de Rey e um paciente obteve desempenho alterado no Teste dos Cinco Dígitos, todos indicando disfunção executiva. Conclusão: Este estudo fornece evidência de que o declínio cognitivo associado à SVCR é mais prevalente do que se acreditava anteriormente. Especialmente, os domínios mais significativamente comprometidos foram a atenção e as funções executivas.

4.
Acta Neurol Taiwan ; 33(3): 122-126, 2024 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-37968850

RESUMEN

Fibromuscular dysplasia (FMD) is a rare non-atherosclerotic arterial disease that primarily affects middle-aged Caucasian women. Carotid web (CW) is a variant of FMD characterized by a nonatheromatous, membrane-like tissue protrusion into the carotid bulb. Reversible cerebral vasoconstriction syndrome (RCVS) is defined by severe headaches and reversible narrowing of cerebral arteries, which typically resolves within three months. While most RCVS cases have identifiable triggers, a significant portion occurs without known causes. Recent studies have reported a high prevalence of neurovascular abnormalities in RCVS patients. We present a case of a thirty-year-old woman with a sudden-onset severe headache, diagnosed with RCVS associated with carotid web. The patient had no ischemic involvement and responded well to flunarizine treatment. Follow-up imaging showed no stenosis. This case highlights a potential association between carotid web and RCVS, suggesting that FMD may contribute to vascular hyperreactivity and presents as a risk factor for RCVS. Further investigations are needed to understand the underlying mechanisms connecting these two vascular disorders. Keywords: reversible vasoconstriction syndrome; fibromuscular dysplasia; carotid web; structural abnormalities; vascular hyperreactivity.


Asunto(s)
Trastornos Cerebrovasculares , Displasia Fibromuscular , Cefaleas Primarias , Vasoespasmo Intracraneal , Persona de Mediana Edad , Humanos , Femenino , Adulto , Vasoconstricción , Displasia Fibromuscular/complicaciones , Trastornos Cerebrovasculares/complicaciones , Factores de Riesgo , Arterias Cerebrales , Vasoespasmo Intracraneal/etiología , Vasoespasmo Intracraneal/complicaciones , Cefaleas Primarias/complicaciones
6.
Front Neurol ; 14: 1165484, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37360333

RESUMEN

The effectiveness of endovascular thrombectomy in patients presenting low National Institutes of Health Stroke Scale (NIHSS) scores remains controversial, and the acquisition of additional evidence is required to refine the selection of candidates who may benefit the most from this therapeutic modality. In this study, we present the case of a 62-year-old individual, with left internal carotid occlusion stroke and low NIHSS, who had compensatory collateral flow from Willis polygon via the anterior communicating artery. The patient subsequently exhibited neurological deterioration and collateral flow failure from Willis polygon, indicating the need for urgent intervention. The study of collaterals in patients with large vessel occlusion stroke has garnered considerable attention, with research suggesting that individuals with low NIHSS scores and poor collateral profiles may be at a heightened risk of early neurological deterioration. We postulate that such patients may derive significant benefits from endovascular thrombectomy, and may posit that an intensive transcranial Doppler monitoring protocol could facilitate the identification of suitable candidates for such intervention.

7.
Arq Neuropsiquiatr ; 78(5): 277-281, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32490967

RESUMEN

BACKGROUND: Cerebral amyloid angiopathy (CAA) is a cerebrovascular disorder caused by progressive deposition of ß-amyloid peptides in the walls of small and medium-sized cortical and leptomeningeal vessels. Until today, the prevalence of CAA is unknown in our region. OBJECTIVE: This study aims to analyze the prevalence of this entity in a specific elderly population in a tertiary hospital in Northeastern Brazil. METHODS: A cross-sectional, retrospective study with the enrollment of patients aged 65 or older followed in the neurological outpatient service of the Universidade Federal do Piauí, Brazil, who underwent brain magnetic resonance imaging (MRI) from July 2016 to June 2018. RESULTS: One hundred and seventy-four patients were enrolled, of whom 100 were women (57.4%) and 74, men (42.6%), aged from 65 to 91 years old (median age 73.27). Nine patients were excluded from the study due to unavailability of MRI sequences needed for an appropriate analysis. Out of the 165 remaining patients, 12 (7.2%) had established the diagnosis of CAA, according to the modified Boston criteria. CONCLUSION: The prevalence of CAA in our study was like those of medical literature, with a progressive age-related increase.


Asunto(s)
Angiopatía Amiloide Cerebral , Anciano , Anciano de 80 o más Años , Péptidos beta-Amiloides/química , Péptidos beta-Amiloides/metabolismo , Boston , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Estudios Retrospectivos
8.
Arq. neuropsiquiatr ; 78(5): 277-281, May 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1131706

RESUMEN

ABSTRACT Background: Cerebral amyloid angiopathy (CAA) is a cerebrovascular disorder caused by progressive deposition of β-amyloid peptides in the walls of small and medium-sized cortical and leptomeningeal vessels. Until today, the prevalence of CAA is unknown in our region. Objective: This study aims to analyze the prevalence of this entity in a specific elderly population in a tertiary hospital in Northeastern Brazil. Methods: A cross-sectional, retrospective study with the enrollment of patients aged 65 or older followed in the neurological outpatient service of the Universidade Federal do Piauí, Brazil, who underwent brain magnetic resonance imaging (MRI) from July 2016 to June 2018. Results: One hundred and seventy-four patients were enrolled, of whom 100 were women (57.4%) and 74, men (42.6%), aged from 65 to 91 years old (median age 73.27). Nine patients were excluded from the study due to unavailability of MRI sequences needed for an appropriate analysis. Out of the 165 remaining patients, 12 (7.2%) had established the diagnosis of CAA, according to the modified Boston criteria. Conclusion: The prevalence of CAA in our study was like those of medical literature, with a progressive age-related increase.


RESUMO Introdução: A angiopatia amiloide cerebral (AAC) é uma desordem vascular causada pela deposição progressiva de peptídeos β-amiloides nas paredes de pequenos e médios vasos corticais e leptomeníngeos. Até a presente data, a epidemiologia da AAC é desconhecida em nossa região. Objetivos: Avaliar a prevalência da AAC em uma população específica de pacientes idosos de um hospital terciário no nordeste brasileiro. Métodos: Estudo transversal, retrospectivo, com seleção de pacientes com idade igual ou superior a 65 anos, acompanhados no serviço de Neurologia do Hospital Universitário da Universidade Federal do Piauí, Brasil, e que foram submetidos a exame de ressonância nuclear magnética entre julho de 2016 e junho de 2018. Resultados: Foram recrutados 174 pacientes, dos quais 100 eram mulheres (57,4%) e 74 homens (42,6%), com idades entre 65 e 91 anos (média de 73,27). Nove pacientes foram excluídos devido à indisponibilidade de sequências de ressonância magnética necessárias para uma análise apropriada. Dos 165 pacientes restantes, 12 (7,2%) foram diagnosticados com AAC de acordo com os critérios de Boston modificados. Conclusão: A prevalência da AAC em nosso estudo foi semelhante ao resultado encontrado na literatura médica, com um aumento progressivo relacionado à idade.


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Angiopatía Amiloide Cerebral , Brasil , Boston , Estudios Transversales , Estudios Retrospectivos , Péptidos beta-Amiloides/metabolismo , Péptidos beta-Amiloides/química
9.
Arq. bras. neurocir ; 38(1): 73-76, 15/03/2019.
Artículo en Inglés | LILACS | ID: biblio-1362680

RESUMEN

Intracranial hypertension (ICH) is a life-threatening condition that can be observed in several diseases. Its clinical presentation is variable, with headache, nausea, vomiting, visual disturbances, papilledema, and alterations in the level of consciousness. The gold standard for the diagnosis of ICHis still the intracranial implantation of invasive devices. Non-invasive techniques, such as ultrasonography of the optic nerve sheath (USONS), have emerged in recent years with promising clinical results. The authors report the case of a patient with progressive headache associated with visual impairment and papilledema, and the eventual diagnosis of idiopathic intracranial hypertension using USONS.


Asunto(s)
Humanos , Masculino , Adulto , Nervio Óptico/diagnóstico por imagen , Seudotumor Cerebral/tratamiento farmacológico , Seudotumor Cerebral/diagnóstico por imagen , Presión Intracraneal , Papiledema/diagnóstico por imagen , Retina , Ultrasonografía
10.
J Stroke Cerebrovasc Dis ; 24(9): e271-3, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26198371

RESUMEN

BACKGROUND: Vasospasm has been rarely described as a complication associated with craniopharyngioma surgery. Herein we describe a patient who developed symptomatic vasospasm and delayed cerebral ischemia after transsphenoidal surgery for a craniopharyngioma. CASE REPORT: A 67-year-old woman became drowsy 2 weeks after a transsphenoidal resection of a craniopharyngioma. A head computed tomography (CT) was unremarkable except for postoperative findings. Electroencephalogram and laboratory studies were within the normal limits. A repeated CT scan 48 hours after the initial symptoms showed bilateral infarcts in the territory of the anterior cerebral arteries (ACA). Transcranial Doppler (TCD) showed increased blood flow velocities in both anterior cerebral arteries (169 cm/second in the left ACA and 145 cm/second in the right ACA) and right middle cerebral artery (164 cm/second) compatible with vasospasm. A CT angiography confirmed the findings. She was treated with induced hypertension and her level of consciousness improved. TCD velocities normalized after 2 weeks. CONCLUSION: Cerebral vasospasm should be considered in the differential diagnosis of patients with altered neurologic status in the postoperative period following a craniopharyngioma resection.


Asunto(s)
Isquemia Encefálica/etiología , Craneofaringioma/cirugía , Procedimientos Neuroquirúrgicos/efectos adversos , Neoplasias Hipofisarias/cirugía , Complicaciones Posoperatorias/fisiopatología , Vasoespasmo Intracraneal/etiología , Anciano , Angiografía Cerebral , Femenino , Humanos , Tomografía Computarizada por Rayos X
11.
J Stroke Cerebrovasc Dis ; 24(9): e275-8, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26198372

RESUMEN

BACKGROUND: Subarachnoid hemorrhage (SAH) associated with anticoagulation is a rare event. About 30% of in-hospital patients with aneurysmal SAH develop delayed cerebral ischemia (DCI); however, the occurrence of vasospasm and DCI in patients with nonaneurysmal SAH is still controversial. METHODS: This study is a case report of a patient experiencing an anticoagulation-induced SAH complicated by vasospasm and DCI. RESULTS: A 38-year-old woman presented to our hospital with a sudden onset of severe headache. Head computed tomography (CT) showed bleeding in the posterior fossa subarachnoid space. There was no aneurysm in the CT angiography. The International Normalized Ratio at hospital admission was 9. Anticoagulation was held, and she was treated with fresh frozen plasma (15 mg/kg) and parenteral vitamin K. The patient remained in the intensive care unit and had daily transcranial Doppler (TCD) monitorization. TCD examination detected increased blood flow velocities in the basilar and vertebral arteries, meeting criteria for definitive vasospasm. CT angiography confirmed the presence of posterior circulation vasospasm. Magnetic resonance (MR) imaging 2 weeks after the bleeding showed a small area of restricted diffusion in the left superior cerebellar artery territory. MR angiography showed resolution of the vasospasm at this time point and TCD velocities normalized. CONCLUSIONS: In conclusion, this case report suggests that vasospasm and consequent DCI is a possible mechanism of secondary lesion after anticoagulation-induced SAH. To our knowledge, this is the first report of vasospasm and DCI due to warfarin-associated SAH.


Asunto(s)
Isquemia Encefálica/etiología , Hemorragia Subaracnoidea/complicaciones , Vasoespasmo Intracraneal/etiología , Adulto , Anticoagulantes/efectos adversos , Femenino , Humanos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Hemorragia Subaracnoidea/inducido químicamente , Ultrasonografía Doppler Transcraneal , Warfarina/efectos adversos
12.
Arq. neuropsiquiatr ; 72(12): 938-941, 02/12/2014. tab
Artículo en Inglés | LILACS | ID: lil-731036

RESUMEN

Little is known about stroke patients’ awareness about the warning signs of stroke and its therapeutic time window in Brazil. Method We interviewed consecutive patients with acute stroke admitted to a terciary public hospital in Brazil. Data collected included demographics, mode of arrival, National Institutes of Health Stroke Scale (NIHSS) scores and knowledge of stroke warning signs and therapeutic time window. Early arrival was defined as within 4.5 hours of symptoms onset. Results Although 66.2% of patients knew the warning signs of stroke, only 7.8% reported to know that stroke had a limited therapeutic time window. Stroke severity measured by the NIHSS was independently associated with early arrival, but not knowledge of stroke signs and symptoms. Conclusion Knowledge about stroke symptoms was not a predictor of early arrival. .


Pouco se sabe sobre o conhecimento dos pacientes com acidente vascular cerebral (AVC) acerca dos sinais de alarme da doença e sua janela terapêutica no Brasil. Método Foram entrevistados consecutivamente os pacientes com AVC agudo internados em um hospital público terciário no Brasil. Os dados coletados incluíram dados demográficos, o modo de chegada, escala de AVC do National Institute of Health (NIH) e conhecimento sobre a janela de tempo terapêutica e os sinais de alerta do AVC através de um questionário padronizado. Chegada precoce foi definida como aquela dentro de 4,5 horas do início dos sintomas. Resultados Embora 66,2% dos pacientes sabiam os sinais de alerta do AVC , apenas 7,8% relataram saber que a doença tinha uma janela de tempo terapêutica limitada. A gravidade do AVC avaliada pela escala do NIH foi preditora de chegada precoce, mas conhecimento acerca dos sinais e sintomas do AVC não foram. Conclusão O conhecimento acerca dos sintomas do AVC não foi preditivo de chegada precoce ao hospital. .


Asunto(s)
Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud , Accidente Cerebrovascular/diagnóstico , Brasil , Estudios Transversales , Escolaridad , Hospitales Públicos , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Centros de Atención Terciaria , Factores de Tiempo
13.
Arq Neuropsiquiatr ; 72(12): 938-41, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25410321

RESUMEN

UNLABELLED: Little is known about stroke patients' awareness about the warning signs of stroke and its therapeutic time window in Brazil. METHOD: We interviewed consecutive patients with acute stroke admitted to a terciary public hospital in Brazil. Data collected included demographics, mode of arrival, National Institutes of Health Stroke Scale (NIHSS) scores and knowledge of stroke warning signs and therapeutic time window. Early arrival was defined as within 4.5 hours of symptoms onset. RESULTS: Although 66.2% of patients knew the warning signs of stroke, only 7.8% reported to know that stroke had a limited therapeutic time window. Stroke severity measured by the NIHSS was independently associated with early arrival, but not knowledge of stroke signs and symptoms. CONCLUSION: Knowledge about stroke symptoms was not a predictor of early arrival.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Accidente Cerebrovascular/diagnóstico , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Escolaridad , Femenino , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Centros de Atención Terciaria , Factores de Tiempo
14.
J Stroke Cerebrovasc Dis ; 23(5): 1229-31, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24103672

RESUMEN

Foot drop syndrome is a frequent neurologic condition usually caused by peroneal nerve damage. On rare occasions, foot drop may present as the single neurologic manifestation of intracranial lesions. We presented a 43-year-old man admitted to our hospital with acute weakness in the dorsiflexion of his right foot that appeared 3 days before admission. Brain magnetic resonance imaging diffusion-weighted sequence revealed a small area of restricted diffusion in the left frontal cortex. Three months later, his motor deficit had completely improved (modified Rankin scale score = 0). To our knowledge, this is the second report of sudden isolated foot drop caused by a cortical infarction.


Asunto(s)
Isquemia Encefálica/complicaciones , Pie/inervación , Trastornos Neurológicos de la Marcha/etiología , Traumatismos de los Nervios Periféricos/diagnóstico , Nervio Peroneo/lesiones , Accidente Cerebrovascular/complicaciones , Enfermedad Aguda , Adulto , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatología , Diagnóstico Diferencial , Imagen de Difusión por Resonancia Magnética , Evaluación de la Discapacidad , Trastornos Neurológicos de la Marcha/diagnóstico , Trastornos Neurológicos de la Marcha/fisiopatología , Humanos , Masculino , Traumatismos de los Nervios Periféricos/fisiopatología , Nervio Peroneo/fisiopatología , Valor Predictivo de las Pruebas , Recuperación de la Función , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Síndrome , Factores de Tiempo
16.
Arq Neuropsiquiatr ; 71(6): 345-8, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23828538

RESUMEN

Autosomal recessive cerebellar ataxias are a heterogeneous group of neurological disorders. In 1981, a neurological entity comprised by early onset progressive cerebellar ataxia, dysarthria, pyramidal weakness of the limbs and retained or increased upper limb reflexes and knee jerks was described. This disorder is known as early onset cerebellar ataxia with retained tendon reflexes. In this article, we aimed to call attention for the diagnosis of early onset cerebellar ataxia with retained tendon reflexes as the second most common cause of autosomal recessive cerebellar ataxias, after Friedreich ataxia, and also to perform a clinical spectrum study of this syndrome. In this data, 12 patients from different families met all clinical features for early onset cerebellar ataxia with retained tendon reflexes. Dysarthria and cerebellar atrophy were the most common features in our sample. It is uncertain, however, whether early onset cerebellar ataxia with retained tendon reflexes is a homogeneous disease or a group of phenotypically similar syndromes represented by different genetic entities. Further molecular studies are required to provide definitive answers to the questions that remain regarding early onset cerebellar ataxia with retained tendon reflexes.


Asunto(s)
Reflejo de Estiramiento , Degeneraciones Espinocerebelosas/diagnóstico , Adulto , Edad de Inicio , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Reflejo de Estiramiento/genética , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Degeneraciones Espinocerebelosas/genética , Degeneraciones Espinocerebelosas/fisiopatología , Síndrome , Adulto Joven
17.
Arq. neuropsiquiatr ; 71(6): 345-348, jun. 2013. tab, graf
Artículo en Inglés | LILACS | ID: lil-677612

RESUMEN

Autosomal recessive cerebellar ataxias are a heterogeneous group of neurological disorders. In 1981, a neurological entity comprised by early onset progressive cerebellar ataxia, dysarthria, pyramidal weakness of the limbs and retained or increased upper limb reflexes and knee jerks was described. This disorder is known as early onset cerebellar ataxia with retained tendon reflexes. In this article, we aimed to call attention for the diagnosis of early onset cerebellar ataxia with retained tendon reflexes as the second most common cause of autosomal recessive cerebellar ataxias, after Friedreich ataxia, and also to perform a clinical spectrum study of this syndrome. In this data, 12 patients from different families met all clinical features for early onset cerebellar ataxia with retained tendon reflexes. Dysarthria and cerebellar atrophy were the most common features in our sample. It is uncertain, however, whether early onset cerebellar ataxia with retained tendon reflexes is a homogeneous disease or a group of phenotypically similar syndromes represented by different genetic entities. Further molecular studies are required to provide definitive answers to the questions that remain regarding early onset cerebellar ataxia with retained tendon reflexes.

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As ataxias cerebelares autossômicas recessivas são um grupo heterogêneo de doenças neurológicas. Em 1981, foi descrita uma entidade neurológica incluindo ataxia cerebelar progressiva de início precoce, disartria, liberação piramidal e manutenção ou aumento dos reflexos tendíneos nos membros superiores e inferiores. Essa síndrome é conhecida como ataxia cerebelar de início precoce com reflexos mantidos. Neste artigo, o objetivo foi chamar a atenção para o diagnóstico de ataxia cerebelar de início precoce com reflexos mantidos como a segunda causa mais comum de ataxia cerebelar autossômica recessiva, após a ataxia de Friedreich, e também realizar um estudo do espectro clínico da síndrome. Doze pacientes de diferentes famílias preencheram os critérios clínicos para ataxia cerebelar de início precoce com reflexos mantidos. Disartria e atrofia cerebelar foram as características mais frequentes. No entanto, não há consenso se a ataxia cerebelar de início precoce com reflexos mantidos é uma doença homogênea ou um grupo de síndromes com fenótipos semelhantes representadas por diferentes entidades genéticas. Estudos moleculares futuros são necessários para fornecer respostas definitivas para as questões pendentes em relação à ataxia cerebelar de início precoce com reflexos mantidos.

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Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Reflejo de Estiramiento , Degeneraciones Espinocerebelosas/diagnóstico , Edad de Inicio , Imagen por Resonancia Magnética , Estudios Retrospectivos , Reflejo de Estiramiento/genética , Índice de Severidad de la Enfermedad , Síndrome , Degeneraciones Espinocerebelosas/genética , Degeneraciones Espinocerebelosas/fisiopatología
18.
J Stroke Cerebrovasc Dis ; 22(8): e628-9, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22995380

RESUMEN

Cerebral infarcts can be overlooked or grossly underestimated in the second and third week after an ischemic stroke. We report a patient who presented with a vanishing stroke on a follow-up brain computed tomography scan, a condition known as the "fogging effect" phenomenon.


Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Errores Diagnósticos , Femenino , Humanos , Valor Predictivo de las Pruebas , Índice de Severidad de la Enfermedad , Factores de Tiempo
19.
Arq. bras. cardiol ; 95(2): 192-199, ago. 2010. graf, tab
Artículo en Portugués | LILACS | ID: lil-557826

RESUMEN

FUNDAMENTO: A hipertensão arterial, o excesso de peso e o sedentarismo são importantes fatores de risco para doenças cardiovasculares e estão fortemente associados. OBJETIVO: Avaliar o estado nutricional, o nível de atividade física e os níveis de pressão arterial de estudantes da Universidade Federal do Piauí, em Teresina. MÉTODOS: Estudo transversal com amostra de 605 estudantes (46,1 por cento do sexo masculino e 53,9 por cento do feminino), com média de idade de 21,7 ± 3,7 anos. O estado nutricional global foi classificado pelo índice de massa corporal (IMC) e a adiposidade central pela circunferência da cintura (CC). O nível de atividade física foi avaliado utilizando-se o Questionário Internacional de Atividade Física (IPAQ) na versão curta. A pressão arterial aumentada foi definida como uma pressão sistólica > 140 mmHg e/ou diastólica > 90 mmHg. RESULTADOS: A prevalência de pressão arterial aumentada foi de 9,7 por cento, sendo maior em homens. Excesso de peso (IMC > 25 kg/m²) foi encontrado em 18,2 por cento dos estudantes, sendo as proporções de sobrepeso e obesidade de 15,2 por cento e 3 por cento, respectivamente. Obesidade abdominal foi encontrada em 2,4 por cento dos estudantes, independentemente do gênero, e o sedentarismo em 52 por cento. A pressão arterial média aumentou com o incremento do IMC e da CC. Não houve associação entre os níveis de atividade física e pressão arterial. CONCLUSÃO: Houve associação entre aumento do peso corporal e da circunferência da cintura com maiores níveis de pressão arterial entre os pesquisados. É necessário estabelecer instrumentos de avaliação precoce do risco cardiovascular e promover orientação preventiva para esses jovens.


BACKGROUND: High blood pressure, excess weight and sedentary lifestyle are important risk factors for cardiovascular diseases, and they are closely associated. OBJECTIVE: To evaluate the nutritional status, level of physical activity and blood pressure levels of students of Universidade Federal do Piauí, Teresina, Brazil. METHODS: Cross-sectional study with a sample of 605 students (46.1 percent males and 53.9 percent females), with a mean age of 21.7 ± 3.7 years. The nutritional status was classified according to body mass index (BMI), and central adiposity according to waist circumference (WC). The level of physical activity was evaluated using the short version of the International Physical Activity Questionnaire (IPAQ). Elevated blood pressure was defined as systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg. RESULTS: The prevalence of elevated blood pressure was 9.7 percent, and was higher among men. Excess weight (BMI > 25 kg/m²) was found in 18.2 percent of the students, with overweight and obesity rates of 15.2 percent and 3 percent, respectively. Abdominal obesity was found in 2.4 percent of the students regardless of gender, and sedentary lifestyle in 52 percent. The mean blood pressure increased with increasing BMI and WC. No association was found between the levels of physical activity and blood pressure. CONCLUSION: An association of increased body weight and waist circumference with higher blood pressure levels was observed among the participants. Instruments for an early assessment of the cardiovascular risk and preventive advice should be established for these young individuals.


Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Presión Sanguínea/fisiología , Ejercicio Físico/fisiología , Estado Nutricional/fisiología , Obesidad/epidemiología , Conducta Sedentaria , Índice de Masa Corporal , Brasil/epidemiología , Estudios Transversales , Enfermedades Cardiovasculares/etiología , Hipertensión/epidemiología , Obesidad/complicaciones , Factores de Riesgo , Distribución por Sexo
20.
Arq Bras Cardiol ; 95(2): 192-9, 2010 Aug.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-20549132

RESUMEN

BACKGROUND: High blood pressure, excess weight and sedentary lifestyle are important risk factors for cardiovascular diseases, and they are closely associated. OBJECTIVE: To evaluate the nutritional status, level of physical activity and blood pressure levels of students of Universidade Federal do Piauí, Teresina, Brazil. METHODS: Cross-sectional study with a sample of 605 students (46.1% males and 53.9% females), with a mean age of 21.7 ± 3.7 years. The nutritional status was classified according to body mass index (BMI), and central adiposity according to waist circumference (WC). The level of physical activity was evaluated using the short version of the International Physical Activity Questionnaire (IPAQ). Elevated blood pressure was defined as systolic blood pressure > 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. RESULTS: The prevalence of elevated blood pressure was 9.7%, and was higher among men. Excess weight (BMI > 25 kg/m(2)) was found in 18.2% of the students, with overweight and obesity rates of 15.2% and 3%, respectively. Abdominal obesity was found in 2.4% of the students regardless of gender, and sedentary lifestyle in 52%. The mean blood pressure increased with increasing BMI and WC. No association was found between the levels of physical activity and blood pressure. CONCLUSION: An association of increased body weight and waist circumference with higher blood pressure levels was observed among the participants. Instruments for an early assessment of the cardiovascular risk and preventive advice should be established for these young individuals.


Asunto(s)
Presión Sanguínea/fisiología , Ejercicio Físico/fisiología , Estado Nutricional/fisiología , Obesidad/epidemiología , Conducta Sedentaria , Adolescente , Adulto , Índice de Masa Corporal , Brasil/epidemiología , Enfermedades Cardiovasculares/etiología , Estudios Transversales , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Factores de Riesgo , Distribución por Sexo , Adulto Joven
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