RESUMEN
This study characterized the clinical, radiological, ultrasound, and necroscopic findings of a case of Arnold-Chiari type II malformation in a Gir breed calf from Brazil. The animal was hospitalized at sixty days of age, in permanent sternal recumbency, cutaneous appendix at the 4th lumbar vertebra and kyphoscoliosis of the caudal and lumbosacral thoracic spine. Radiographic examination of the spine and skull revealed spina bifida and suspected occipital hypoplasia. Upon examination of myelography with an injection of lumbar and atlantooccipital contrast, it was possible to visualize the meningocele at the 4th lumbar vertebra region and findings at the rhombencephalon level of increased regional pressure with failure to fill the contrast in the posterior fossa, in the presence of clear demarcation of the circumvolutions of the cerebral cortex and the subarachnoid space of the cervical spinal cord. Ultrasonographic examination of the cerebellum showed an insinuation of the cerebellar worm through the foramen magnum. The animal did not show changes in complete blood count, biochemical series, and cerebrospinal fluid and was negative for Pestivirus. There was a worsening of the clinical conditions and the animal died. This malformation of unknown etiology must be studied as a differential diagnosis of the nervous system disorders.(AU)
Este estudo caracterizou os achados clínicos, radiológicos, ultrassonográficos e necroscópicos de um caso de malformação de Arnold-Chiari tipo II em uma bezerra Gir no Brasil. O animal foi hospilatizado aos 60 dias de idade, apresentando decúbito esternal permanente, apêndice cutâneo na altura da quarta vértebra lombar e cifoescoliose da coluna vertebral torácica caudal e lombossacra. Ao exame radiográfico da coluna e do crânio, foram observadas espinha bífida e suspeita de hipoplasia occipital. Ao exame de mielografia com injeção de contraste lombar e atlanto-occipital, foi possivel visualizar a meningocele na altura da quarta vértebra lombar e achados em nível rombencefálico de aumento da pressão regional com falha de preenchimento do contraste na fossa posterior, na presença de nítida demarcação das circunvoluções do córtex cerebral e do espaço subaracnoide da medula espinhal cervical. Ao exame ultrassonográfico do cerebelo, foi observada insinuação do verme cerebelar através do forame magno. O animal não apresentou alterações em hemograma completo, série bioquímica e fluido cérebro-espinhal e foi negativo para Pestivirus. Houve uma piora do quadro clínico e o animal morreu. Essa malformação de etiologia desconhecida deve ser estudada como um diagnóstico diferencial.(AU)
Asunto(s)
Animales , Femenino , Bovinos , Malformación de Arnold-Chiari/veterinaria , Malformación de Arnold-Chiari/diagnóstico por imagen , Vermis Cerebeloso/diagnóstico por imagen , Anomalías Congénitas/veterinaria , Enfermedades del Sistema Nervioso/diagnóstico por imagenRESUMEN
A letter to the editor to discuss several uses of brain magnetic resonance imaging (MRI) in the investigation of neurological manifestations of covid-19. Described several situations in which the MRI is needed. Brain MRI is an important diagnostic method in the covid-19 scenario, to investigate possible neurological complications of the disease.
Asunto(s)
COVID-19/complicaciones , COVID-19/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Enfermedades del Sistema Nervioso/etiología , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/etiología , Cefalea/diagnóstico por imagen , Cefalea/etiología , HumanosRESUMEN
Introducción. El hipoparatiroidismo es una enfermedad caracterizada por la ausencia o concentraciones inadecuadamente bajas de hormona paratiroidea (PTH), que conduce a hipocalcemia, hiperfosfatemia y excreción fraccional elevada de calcio en la orina. Las calcificaciones del sistema nervioso central son un hallazgo frecuente en estos pacientes. Caso clínico. Mujer de 56 años con antecedente de hipotiroidismo, que ingresó por un cuadro de 6 días de evolución caracterizado por astenia, parestesias periorales y movimientos anormales de manos y pies. Las pruebas de laboratorio demostraron hipocalcemia, hiperfosfatemia y niveles bajos de hormona paratiroidea. Se realizó una tomografía computarizada de cráneo que mostró áreas bilaterales y simétricas de calcificaciones en hemisferios cerebelosos, ganglios basales y corona radiata. No se evidenciaron trastornos en el metabolismo del cobre y hierro. Se estableció el diagnóstico del síndrome de Fahr secundario a hipoparatiroidismo y se inició tratamiento con suplementos de calcio y vitamina D con evolución satisfactoria. Discusión. El síndrome de Fahr es un trastorno neurológico caracterizado por el depósito anormal de calcio en áreas del cerebro que controlan la actividad motora. Se asocia a varias enfermedades, especialmente, hipoparatiroidismo. La suplementación con calcio y vitamina D con el objetivo de normalizar los niveles plasmáticos de estos cationes es el tratamiento convencional. (AU)
Introduction. Hypoparathyroidism is a disease characterized by absence or inappropriately low concentrations of circulating parathyroid hormone, leading to hypocalcaemia, hyperphosphataemia and elevated fractional excretion of calcium in the urine. Central nervous system calcifications are a common finding in these patients. Case report. 56-year-old woman with a history of hypothyroidism who was admitted for a 6-day course of illness characterized by asthenia, perioral paresthesias, and abnormal movements of the hands and feet. Laboratory tests showed hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels. A cranial computed tomography was performed. It showed bilateral and symmetrical areas of calcifications in the cerebellar hemispheres, basal ganglia, and radiata crown. No disorders of copper or iron metabolism were evident. The diagnosis of Fahr syndrome secondary to hypoparathyroidism was established and treatment with calcium and vitamin D supplements was started with satisfactory evolution. Discussion. Fahr's syndrome is a neurological disorder associated with abnormal calcium deposition in areas of the brain that control motor activity. It is associated with various diseases, especially hypoparathyroidism. The conventional treatment is supplementation with calcium and vitamin D, with the aim of normalizing their plasma levels. (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Calcinosis/diagnóstico por imagen , Hipoparatiroidismo/diagnóstico , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Hormona Paratiroidea/sangre , Calcinosis/complicaciones , Calcinosis/tratamiento farmacológico , Calcitriol/administración & dosificación , Carbonato de Calcio/administración & dosificación , Gluconato de Calcio/administración & dosificación , Calcio/administración & dosificación , Hiperfosfatemia/sangre , Hipocalcemia/sangre , Hipoparatiroidismo/etiología , Hipoparatiroidismo/tratamiento farmacológico , Enfermedades del Sistema Nervioso/complicaciones , Enfermedades del Sistema Nervioso/tratamiento farmacológicoRESUMEN
BACKGROUND: Congenital Zika syndrome causes a spectrum of neurological symptoms with varying effects on function that require different therapeutic strategies. To date, this spectrum of effects and its clinical implications have not been completely described. We describe the neurological examination findings in toddlers and preschoolers, including predominant symptom complexes and comorbidities. METHODS: This study is a case-series neurological evaluation of 75 children with congenital Zika syndrome in Campina Grande, Brazil. The study is part of a cohort of children with congenital Zika syndrome that started in 2015 and is still ongoing. Children with Zika virus infection detected during pregnancy (mothers exhibited rash and were followed and diagnosed by fetal ultrasound abnormalities or RT-PCR) or through microcephaly screening after birth, using Intergrowth 21 guidelines, were selected by laboratory and radiological criteria. Children were examined during a 10-day period in September, 2018, and underwent neurological interview, examination, and assessment of functional outcomes and comorbidities. Children were divided in groups of predominant corticospinal or neuromuscular clinical signs and the associations between these groups and clinical comorbidities were assessed. FINDINGS: All of the children recruited to the study from Nov 29, 2015 to Nov 30, 2017 had imaging correlates of congenital Zika syndrome. Children were assigned to groups depending on the signs exhibited, either corticospinal or neuromuscular, with or without dyskinetic signs. 75 children completed the evaluation, 38 (51%) girls and 37 (49%) boys. Median age was 33 months (range 26-40 months; IQR 29-34). Microcephaly was present at birth in 56 (75%) children, and 19 (25%) children were born with normal head circumference, 15 of whom later developed microcephaly. Neurological examination grouped four children as having isolated dyskinetic signs, 48 children were assigned to the corticospinal group and 23 into the neuromuscular group. Dyskinetic findings were present in 30 (40%) children, either alone (four [5%]) or combined with corticospinal (19 [40%] of 48) or neuromuscular (seven [30%] of 23) findings. Comorbidities were highly prevalent, and the neuromuscular group had worse functional outcomes, evaluated by gross motor function (p=0·026), manual abilities (p=0·0013), and communication function (p<0·0005) classification scales, than the corticospinal group, whereas pneumonia (p<0·0005) and urinary tract infections (p<0·0005) were more frequent in the corticospinal group. Cortical hyperexcitability was supported by several clinical correlates, such as early onset epilepsy, persistence of primitive reflexes, and dystonia. INTERPRETATION: We describe distinct neurological profiles in the congenital Zika syndrome spectrum, with functional outcomes tending to correlate with these groups. The clinical division of children based on the disease signs proposed here is supported by the literature on central and peripheral nervous system pathology in congenital Zika syndrome. The high prevalence of dyskinetic symptoms merits special attention. FUNDING: Brazilian National Council for Scientific and Technological Development and by the Coordination for the Improvement of Higher Education Personnel.
Asunto(s)
Discinesias/fisiopatología , Enfermedades Neuromusculares/fisiopatología , Infección por el Virus Zika/fisiopatología , Encéfalo/diagnóstico por imagen , Encefalopatías/diagnóstico por imagen , Encefalopatías/epidemiología , Brasil/epidemiología , Calcinosis/diagnóstico por imagen , Calcinosis/epidemiología , Preescolar , Comorbilidad , Trastornos de Deglución/epidemiología , Discinesias/epidemiología , Epilepsia/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Malformaciones del Desarrollo Cortical/diagnóstico por imagen , Malformaciones del Desarrollo Cortical/epidemiología , Malformaciones del Desarrollo Cortical/fisiopatología , Microcefalia/epidemiología , Microcefalia/fisiopatología , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/fisiopatología , Examen Neurológico , Enfermedades Neuromusculares/epidemiología , Neumonía/epidemiología , Tractos Piramidales/fisiopatología , Trastornos del Sueño-Vigilia/epidemiología , Tomografía Computarizada por Rayos X , Infecciones Urinarias/epidemiología , Infección por el Virus Zika/congénito , Infección por el Virus Zika/diagnóstico por imagen , Infección por el Virus Zika/epidemiologíaRESUMEN
Dendrimers are globular structures, presenting an initiator core, repetitive layers starting radially from the core and terminal groups on the surface, resembling tree architecture. These structures have been studied in many biological applications, as drug, DNA, RNA and proteins delivery, as well as imaging and radiocontrast agents. With reference to that, this review focused in providing examples of dendrimers used in nanomedicine. Although most studies emphasize cancer, there are others which reveal action in the neurosystem, reducing either neuroinflammation or protein aggregation. Dendrimers can carry bioactive compounds by covalent bond (dendrimer prodrug), or by ionic interaction or adsortion in the internal space of the nanostructure. Additionally, dendrimers can be associated with other polymers, as PEG (polyethylene glycol), and with targeting structures as aptamers, antibodies, folic acid and carbohydrates. Their products in preclinical/clinical trial and those in the market are also discussed, with a total of six derivatives in clinical trials and seven products available in the market.
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Dendrímeros/administración & dosificación , Dendrímeros/química , Nanomedicina/métodos , Nanoestructuras/química , Antineoplásicos/administración & dosificación , Química Farmacéutica , Ensayos Clínicos como Asunto , Medios de Contraste/administración & dosificación , Medios de Contraste/química , Humanos , Nanoestructuras/administración & dosificación , Neoplasias/diagnóstico por imagen , Neoplasias/tratamiento farmacológico , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Enfermedades del Sistema Nervioso/tratamiento farmacológico , Enfermedades del Sistema Nervioso/inmunología , Polietilenglicoles/química , Profármacos/administración & dosificación , Profármacos/química , Agregación Patológica de Proteínas/diagnóstico por imagen , Agregación Patológica de Proteínas/tratamiento farmacológicoRESUMEN
The use of echocardiography is very useful in the evaluation, treatment, and follow-up of the patient in critical condition. Along with clinic and the stethoscope, it is a tool that complements the act of the physician faced with the diversity of etiologies that determine the state of shock and increase morbidity and mortality, especially in post-cardiac surgery patients, in whom there are no management emergency post-surgical algorithms. In view of this situation, at the National Institute of Cardiology Ignacio Chávez, a management algorithm has been made and improved in cardiac post-surgical patients: through focused ultrasonography, including transthoracic echography, pulmonary ultrasound, optic nerve ultrasound, and renal ultrasound by evaluating renal resistive indices. Several societies have created their protocols for addressing patients in critical condition, so in the institute, specifically in cardiovascular intensive therapy, has created the cardiac, cerebral, renal, optic nerve, and lung ultrasound study (CCROSS) protocol for the initial approach of these patients, and a study is currently taking place for its validation, reproducibility, and efficacy.
El uso de ecocardiografía enfocada es de gran utilidad en la valoración, tratamiento y seguimiento del paciente en estado crítico. Es, junto con la clínica y el estetoscopio, una herramienta que complementa el actuar del médico ante las diversas etiologías que determinan un estado de choque o aumentan la morbimortalidad, especialmente en pacientes posquirúrgicos de cirugía cardíaca, en quienes no se tiene algoritmos de manejo emergente en el posquirúrgico. Ante tal situación, en el Instituto Nacional de Cardiología Ignacio Chávez se ha realizado y propuesto un algoritmo de manejo en los pacientes posquirúrgicos cardíacos: mediante ultrasonografía enfocada, abarcando ecoscopia transtorácica, ultrasonido pulmonar, ultrasonido del nervio óptico y renal mediante la valoración de índices resistivos renales. Diversas sociedades han creado sus protocolos de abordaje en pacientes en estado crítico, por lo que en el Instituto, específicamente en la terapia intensiva cardiovascular, ha creado el protocolo CCROSS (Cardiac, Cerebral, Renal, Optic nerve, lung ultraSound Study) para el abordaje inicial de estos pacientes y se encuentra en marcha actualmente un estudio para su validación, reproducibilidad y eficacia.
Asunto(s)
Algoritmos , Procedimientos Quirúrgicos Cardíacos , Protocolos Clínicos , Cardiopatías/diagnóstico por imagen , Enfermedades Renales/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Ultrasonografía , Encéfalo/diagnóstico por imagen , Ecocardiografía , Humanos , Nervio Óptico/diagnóstico por imagenRESUMEN
Positron-emission tomography (PET) is a medical diagnostic technique by means of which functional images are obtained by recording the spatio-temporal biodistribution of specific radiopharmaceuticals targeted at specific molecular objectives, which provides biochemical information at the molecular level. Early in the first decade of this 21st century, the Faculty of Medicine of the National Autonomous University of Mexico acquired the technology to implement this diagnostic technique in Mexico, thus becoming a pioneer in PET applications in the country and in Latin America. Almost two decades after its implementation in Mexico, PET has become an essential tool in medical clinics. This article describes the background, current state and perspectives of PET molecular imaging in Mexico, and the impact it has had on the management of patients with oncological, neurological and heart diseases.
La tomografía por emisión de positrones (PET) es una técnica de diagnóstico médico mediante la cual se obtienen imágenes funcionales a partir de registrar la biodistribución espacio-temporal de radiofármacos específicos dirigidos a blancos moleculares específicos, proveyendo información bioquímica a nivel molecular. A principios de la primera década de este siglo XXI, la Facultad de Medicina de la Universidad Nacional Autónoma de México implementó esta técnica de diagnóstico en México, convirtiéndose en pionera en aplicaciones PET en el país y Latinoamérica. Casi dos décadas después, la PET se ha convertido en una herramienta esencial en la clínica médica. En este artículo se describen los antecedentes, el estado actual, las perspectivas de la imagen molecular PET en México y el impacto que ha tenido en el manejo de pacientes con enfermedades oncológicas, neurológicas y cardiológicas.
Asunto(s)
Tomografía de Emisión de Positrones/métodos , Radiofármacos/administración & dosificación , Cardiopatías/diagnóstico por imagen , Humanos , México , Neoplasias/diagnóstico por imagen , Enfermedades del Sistema Nervioso/diagnóstico por imagenRESUMEN
Resumen La tomografía por emisión de positrones (PET) es una técnica de diagnóstico médico mediante la cual se obtienen imágenes funcionales a partir de registrar la biodistribución espacio-temporal de radiofármacos específicos dirigidos a blancos moleculares específicos, proveyendo información bioquímica a nivel molecular. A principios de la primera década de este siglo XXI, la Facultad de Medicina de la Universidad Nacional Autónoma de México implementó esta técnica de diagnóstico en México, convirtiéndose en pionera en aplicaciones PET en el país y Latinoamérica. Casi dos décadas después, la PET se ha convertido en una herramienta esencial en la clínica médica. En este artículo se describen los antecedentes, el estado actual, las perspectivas de la imagen molecular PET en México y el impacto que ha tenido en el manejo de pacientes con enfermedades oncológicas, neurológicas y cardiológicas.
Abstract Positron-emission tomography (PET) is a medical diagnostic technique by means of which functional images are obtained by recording the spatio-temporal biodistribution of specific radiopharmaceuticals targeted at specific molecular objectives, which provides biochemical information at the molecular level. Early in the first decade of this 21st century, the Faculty of Medicine of the National Autonomous University of Mexico acquired the technology to implement this diagnostic technique in Mexico, thus becoming a pioneer in PET applications in the country and in Latin America. Almost two decades after its implementation in Mexico, PET has become an essential tool in medical clinics. This article describes the background, current state and perspectives of PET molecular imaging in Mexico, and the impact it has had on the management of patients with oncological, neurological and heart diseases.
Asunto(s)
Humanos , Tomografía de Emisión de Positrones/métodos , Radiofármacos/administración & dosificación , Cardiopatías/diagnóstico por imagen , México , Neoplasias/diagnóstico por imagen , Enfermedades del Sistema Nervioso/diagnóstico por imagenRESUMEN
IMPORTANCE: United States government personnel experienced potential exposures to uncharacterized directional phenomena while serving in Havana, Cuba, from late 2016 through May 2018. The underlying neuroanatomical findings have not been described. OBJECTIVE: To examine potential differences in brain tissue volume, microstructure, and functional connectivity in government personnel compared with individuals not exposed to directional phenomena. DESIGN, SETTING, AND PARTICIPANTS: Forty government personnel (patients) who were potentially exposed and experienced neurological symptoms underwent evaluation at a US academic medical center from August 21, 2017, to June 8, 2018, including advanced structural and functional magnetic resonance imaging analytics. Findings were compared with imaging findings of 48 demographically similar healthy controls. EXPOSURES: Potential exposure to uncharacterized directional phenomena of unknown etiology, manifesting as pressure, vibration, or sound. MAIN OUTCOMES AND MEASURES: Potential imaging-based differences between patients and controls with regard to (1) white matter and gray matter total and regional brain volumes, (2) cerebellar tissue microstructure metrics (eg, mean diffusivity), and (3) functional connectivity in the visuospatial, auditory, and executive control subnetworks. RESULTS: Imaging studies were completed for 40 patients (mean age, 40.4 years; 23 [57.5%] men; imaging performed a median of 188 [range, 4-403] days after initial exposure) and 48 controls (mean age, 37.6 years; 33 [68.8%] men). Mean whole brain white matter volume was significantly smaller in patients compared with controls (patients: 542.22 cm3; controls: 569.61 cm3; difference, -27.39 [95% CI, -37.93 to -16.84] cm3; P < .001), with no significant difference in the whole brain gray matter volume (patients: 698.55 cm3; controls: 691.83 cm3; difference, 6.72 [95% CI, -4.83 to 18.27] cm3; P = .25). Among patients compared with controls, there were significantly greater ventral diencephalon and cerebellar gray matter volumes and significantly smaller frontal, occipital, and parietal lobe white matter volumes; significantly lower mean diffusivity in the inferior vermis of the cerebellum (patients: 7.71 × 10-4 mm2/s; controls: 8.98 × 10-4 mm2/s; difference, -1.27 × 10-4 [95% CI, -1.93 × 10-4 to -6.17 × 10-5] mm2/s; P < .001); and significantly lower mean functional connectivity in the auditory subnetwork (patients: 0.45; controls: 0.61; difference, -0.16 [95% CI, -0.26 to -0.05]; P = .003) and visuospatial subnetwork (patients: 0.30; controls: 0.40; difference, -0.10 [95% CI, -0.16 to -0.04]; P = .002) but not in the executive control subnetwork (patients: 0.24; controls: 0.25; difference: -0.016 [95% CI, -0.04 to 0.01]; P = .23). CONCLUSIONS AND RELEVANCE: Among US government personnel in Havana, Cuba, with potential exposure to directional phenomena, compared with healthy controls, advanced brain magnetic resonance imaging revealed significant differences in whole brain white matter volume, regional gray and white matter volumes, cerebellar tissue microstructural integrity, and functional connectivity in the auditory and visuospatial subnetworks but not in the executive control subnetwork. The clinical importance of these differences is uncertain and may require further study.
Asunto(s)
Encéfalo/patología , Empleados de Gobierno , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Adulto , Encéfalo/anatomía & histología , Encéfalo/diagnóstico por imagen , Estudios de Casos y Controles , Cuba , Imagen de Difusión por Resonancia Magnética , Femenino , Sustancia Gris/anatomía & histología , Sustancia Gris/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades del Sistema Nervioso/etiología , Ruido/efectos adversos , Tamaño de los Órganos , Valores de Referencia , Estados Unidos , Sustancia Blanca/anatomía & histología , Sustancia Blanca/diagnóstico por imagenRESUMEN
Resumen El uso de ecocardiografía enfocada es de gran utilidad en la valoración, tratamiento y seguimiento del paciente en estado crítico. Es, junto con la clínica y el estetoscopio, una herramienta que complementa el actuar del médico ante las diversas etiologías que determinan un estado de choque o aumentan la morbimortalidad, especialmente en pacientes posquirúrgicos de cirugía cardíaca, en quienes no se tiene algoritmos de manejo emergente en el posquirúrgico. Ante tal situación, en el Instituto Nacional de Cardiología Ignacio Chávez se ha realizado y propuesto un algoritmo de manejo en los pacientes posquirúrgicos cardíacos: mediante ultrasonografía enfocada, abarcando ecoscopia transtorácica, ultrasonido pulmonar, ultrasonido del nervio óptico y renal mediante la valoración de índices resistivos renales. Diversas sociedades han creado sus protocolos de abordaje en pacientes en estado crítico, por lo que en el Instituto, específicamente en la terapia intensiva cardiovascular, ha creado el protocolo CCROSS (Cardiac, Cerebral, Renal, Optic nerve, lung ultraSound Study) para el abordaje inicial de estos pacientes y se encuentra en marcha actualmente un estudio para su validación, reproducibilidad y eficacia.
Abstract The use of echocardiography is very useful in the evaluation, treatment and follow-up of the patient in critical condition. Along with clinic and the stethoscope, it is a tool that complements the act of the physician faced with the diversity of etiologies that determine the state of shock and increase morbidity and mortality, especially in post cardiac surgery patients, in whom there are no management emergency postsurgical algorithms. In view of this situation, at the National Institute of Cardiology Ignacio Chávez, a management algorithm has been made and improved in cardiac postsurgical patients: through focused ultrasonography, including transthoracic echography, pulmonary ultrasound, optic nerve ultrasound, and renal ultrasound by evaluating renal resistive indices. Several societies have created their protocols for addressing patients in critical condition, so in the Institute, specifically in cardiovascular intensive therapy, has created the CCROSS protocol (Cardiac, Cerebral, Renal, Optic nerve, lung UltraSound Study) for the initial approach of these patients, and it is being carried out a study for its validation, reproducibility and efficacy.
Asunto(s)
Humanos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Algoritmos , Protocolos Clínicos , Ultrasonografía , Cardiopatías/diagnóstico por imagen , Procedimientos Quirúrgicos Cardíacos , Enfermedades Renales/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Nervio Óptico/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , EcocardiografíaRESUMEN
BACKGROUND: With application of 3T magnetic resonance imaging (MRI) to functional neurosurgery procedures and given the inherent requirement of millimetric precision, the need to develop a method for correction of geometric image distortion emerged. The aim of this study was to demonstrate clinical safety and practical viability of a correction protocol in patients scheduled to undergo stereotactic procedures using 3T MRI. METHODS: This prospective study comprised 20 patients scheduled to undergo computed tomography (CT) stereotactic functional procedures or encephalic brain lesion biopsies. The CT images were references for MRI geometric accuracy calculations. For each scan, 2 images were obtained: normal and reversed images. Eight distinct points on CT and MRI were selected summing 152 points that were based on a power analysis calculation value >0.999. One patient was excluded because of the inability to find reliable common landmark points on CT and MRI. RESULTS: The distortion range was 0-5.6 mm and increased proportionally with stereotactic isocenter distance, meaning the distortion was greater in the periphery. After correction, the minimum and maximum distortion found was 0 mm and 3.5 mm, respectively. There was no significant difference between CT and MRI corrected x-coordinates (P > 0.05). CONCLUSIONS: The proposed method can satisfactorily correct geometric distortions in clinical 3T MRI studies. Clinical use of the technique can be practical and efficient after software automation of the process. The method can be applied to all spin-echo MRI sequences.
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Imagenología Tridimensional/normas , Imagen por Resonancia Magnética/normas , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Técnicas Estereotáxicas/normas , Tomografía Computarizada por Rayos X/normas , Adolescente , Adulto , Anciano , Femenino , Humanos , Imagenología Tridimensional/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tomografía Computarizada por Rayos X/métodos , Adulto JovenAsunto(s)
Encéfalo/diagnóstico por imagen , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Paracoccidioidomicosis/diagnóstico por imagen , Pliegues Vocales/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Paracoccidioidomicosis/patología , Pliegues Vocales/patologíaAsunto(s)
Anomalías Congénitas/virología , Feto/anomalías , Leche Humana/virología , Enfermedades del Sistema Nervioso/virología , Virus Zika/aislamiento & purificación , Adulto , Líquidos Corporales/virología , Brasil , Anomalías Congénitas/diagnóstico por imagen , Femenino , Feto/diagnóstico por imagen , Feto/virología , Genotipo , Humanos , Recién Nacido , Madres , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Filogenia , Embarazo , ARN Viral/análisis , ARN Viral/orina , Ultrasonografía , Virus Zika/genéticaRESUMEN
When the first suspected cases of neurologic disorders associated with the Zika virus were noticed in Brazil in late 2015, several studies had been conducted to understand the pathophysiology of the disease and its associated complications. In addition to its well-established association with microcephaly in neonates, the Zika virus infection has also been suggested to trigger other severe neurologic complications in adults, such as Guillain-Barré syndrome, radiculomyelitis, and meningoencephalitis. Hence, the Zika virus should be deemed a global threat that can cause devastating neurologic complications among individuals in all age ranges. The aim of this review was to further describe neuroimaging findings of Zika virus infection and associated neurologic complications found in adults.
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Enfermedades del Sistema Nervioso/diagnóstico por imagen , Enfermedades del Sistema Nervioso/virología , Complicaciones Infecciosas del Embarazo/diagnóstico por imagen , Infección por el Virus Zika/complicaciones , Infección por el Virus Zika/diagnóstico por imagen , Adulto , Brasil , Femenino , Humanos , Recién Nacido , Neuroimagen , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Virus ZikaRESUMEN
Vitamins and minerals have essential functions in the body, from signal transduction to acting as cofactors for numerous enzymatic processes. Nutritional deficiencies and excess of certain vitamins and minerals can have profound effects on the central and peripheral nervous systems from early development into adulthood. This article summarizes the role of various nutritional factors in the nervous system and the neurological symptoms that can arise from deficiency or excess.
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Enfermedades del Sistema Nervioso/complicaciones , Trastornos Nutricionales/complicaciones , Animales , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Humanos , Micronutrientes/deficiencia , Micronutrientes/toxicidad , Enfermedades del Sistema Nervioso/diagnóstico por imagen , Enfermedades del Sistema Nervioso/fisiopatología , Trastornos Nutricionales/diagnóstico por imagen , Trastornos Nutricionales/fisiopatología , Médula Espinal/diagnóstico por imagen , Médula Espinal/fisiopatologíaRESUMEN
PURPOSE: To assess the diagnostic impact of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome (PNS) based on our own pre-test risk classification (PRC). METHODS: A multicenter retrospective longitudinal study was conducted from 2006 to 2014. We designed a seven-point scoring system using the clinical syndrome characteristics [classical (CS) and non-classical syndromes (NCS)] and its location (central, peripheral, in the neuromuscular junction or combined), onconeural antibodies and tumor markers. Patients were classified as low (score 0-2), intermediate (3-4) and high (5-7) pre-test risk of PNS. FDG-PET/CT was classified as negative or positive. Final diagnosis according Graus' criteria (definite, possible or no PNS) was established. Relations between clinical and metabolic variables with the final diagnosis were studied. RESULTS: 73 patients were included, with a follow-up time of 33 months. Eleven (15 %) patients were finally diagnosed with neoplasm (8 invasive cancers). Ultimately, 13 (18 %) and 24 (33 %) subjects were diagnosed as definite or possible PNS. All the patients with final diagnosis of neoplasm had a CS (p = 0.005). PET/CT was helpful to diagnose 6/8 (75 %) invasive cancers. PET/CT findings were associated with the final diagnosis of neoplasm (p = 0.003) and the diagnosis of PNS attending to Graus' criteria (p = 0.019). PRC showed significant association with the final diagnosis of neoplasm and PET/CT results. A majority of patients (10/11) diagnosed of neoplasm had intermediate/high-risk. CONCLUSIONS: Our PRC seems to be a valid tool to select candidates for PET/CT imaging in this setting. PET/CT detected malignancy in a significant proportion of patients with invasive cancer.