RESUMO
BACKGROUND: Clinical and experimental evidence suggests that a localized decrease in oxygen brain tissue availability contributes to the neurological deficit in patients with cerebrovascular disease (CVD) who also present with frontal leukoaraiosis (LA) (periventricular hypodensity on CT scan) and lacunar infarcts. In a prospective controlled trial blinded to patients but not to investigators, we tested the effect of HBO2 on this group of patients. METHODS: Selected patients with symptomatic CVD, LA and lacunar infarcts received daily exposures of 45 minutes for 10 days to hyperbaric oxygen (n=18, HBO2 group) or hyperbaric air (n=8, control group). The control group subsequently received HBO2. Scores of conventional scales for motor and cognitive functions were obtained and videotaped before and after exposure. After the exposures, participants were followed on a monthly basis with systematic clinical neurological examination for up to 6 months. Results. There was a statistically significant improvement in all scales for the HBO2 group compared with the placebo group and in the placebo group after receiving HBO2 (p<0.05). Neurological improvement persisted in the majority of patients for up to 6 months. Repetition of the HBO2 protocol in 9 patients in whom symptoms recurred after 6 months resulted in improvement of symptoms. CONCLUSIONS: These data provide evidence consistent with the notion that HBO2 improves neurological function in patients with CVD, lacunar infarcts and frontal LA. Because of the lack of investigator blinding and a relatively small sample size in this study, larger, randomized controlled studies are needed to further test this hypothesis and to further define the role of oxygen therapy for brain repair in chronic brain disease.
Assuntos
Doenças dos Gânglios da Base/terapia , Transtornos Cerebrovasculares/complicações , Transtornos Cognitivos/terapia , Transtornos Neurológicos da Marcha/terapia , Oxigenoterapia Hiperbárica , Transtornos Urinários/terapia , Idoso , Doenças dos Gânglios da Base/etiologia , Infarto Cerebral/complicações , Transtornos Cognitivos/etiologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Leucoaraiose , Masculino , Pessoa de Meia-Idade , Oxigênio/metabolismo , Estudos Prospectivos , Método Simples-Cego , Transtornos Urinários/etiologiaRESUMO
INTRODUCTION: Frontal leukoaraiosis (LA) is a common finding in patients with subcortical small-vessel disease and currently its pathogenesis is attributed to ischemic-hypoxic mechanisms. It associates to a vascular subcortical frontal syndrome (VSFS) for which an effective treatment does not exist. CLINICAL CASES: We present four subjects from a prospective patient-blind controlled pilot trial to study efficacy and safety of hyperbaric oxygen therapy (HBO) vs hyperbaric air in VSFS with LA. All of them had frontal or extended LA on computed tomography scan and lacunes in basal ganglia and centrum ovale, with moderate to severe gait disorders, urinary dysfunction, cognitive impairment, and dependence in the daily living activities. Deficits had begun two to ten years before and had remained stable three months previous to the treatment. Patients were assessed with validated scales and tests one week before and after being administrated ten daily sessions of HBO at 2.5 atmospheres absolute for 45 minutes with a multiplace chamber. Serious adverse effects did not occur. After treatment a noticeable gait, urinary and cognitive improvement was observed in all subjects, increasing their independence. They remained clinically improved during four to five months, after which the previous deficits reappeared. Then, three patients received ten daily sessions of air at 1.1 atmospheres absolute for 45 minutes (controls) and the other a new HBO regimen, which improved as the first time. From the controls, there were no changes in two, while the other did only improve cognitively. CONCLUSION: These patients show that HBO is effective and safety in reversing, at least partially, although at great length, chronic neurological deficits associated to vascular frontal LA, highlighting that a functional reserve therapeutically useful exists.
Assuntos
Arteriopatias Oclusivas/complicações , Isquemia Encefálica/etiologia , Isquemia Encefálica/terapia , Lobo Frontal/irrigação sanguínea , Lobo Frontal/metabolismo , Oxigenoterapia Hiperbárica/métodos , Oxigênio/metabolismo , Atividades Cotidianas , Idoso , Isquemia Encefálica/diagnóstico , Transtornos Cognitivos/diagnóstico , Lobo Frontal/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Incontinência Urinária/diagnósticoRESUMO
Se comunican 2 casos de infarto en el territorio de la Arteria Coroidea Anterior. Ambas pacientes, mujeres de 19 y 47 años, fueron admitidas por clínica y tomografía computada (TC) de hemorragia subaracnoidea. En el postquirúrgico inmediato, de ectasia pediculada carotídea, vimos: desviación de cabeza y ojos a derecha,disartria,negligencia, así como hemiparesia con disestesias a izquierda. La angiografía (AG) verificadora de vasos de cuello y cerebro, mostró la correcta aplicación del clip en el cuello de sendos aneurismas. Ambas completaron la recuperación clínica antes del séptimo día y meses más tarde padecieron la primera crisis parcial compleja. Se observaron imágenes hipodensas temporales profundas y posteriores en TC. Nuestras pacientes continúan asintomáticas con carbamazepina. De 80 casos reportados, 38 fueron por cirugía adrede, ninguno casual y el resto ictales. Nuestros casos serían los únicos impensados. Consideramos que estos infartos tienen la suficiente categoría como para conformar una entidad clínica independiente
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infarto Cerebral/etiologia , Plexo Corióideo/patologia , Hemorragia Subaracnóidea/complicações , Aneurisma Intracraniano/complicações , Complicações Pós-Operatórias/diagnóstico , Artérias Carótidas/cirurgia , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/terapia , Infarto Cerebral/diagnóstico , Infarto Cerebral/terapia , Tomografia Computadorizada por Raios X , Hemiplegia/etiologia , Hemianopsia/etiologia , Afasia/etiologia , Disartria/etiologia , Carbamazepina/administração & dosagemRESUMO
Se comunican 2 casos de infarto en el territorio de la Arteria Coroidea Anterior. Ambas pacientes, mujeres de 19 y 47 años, fueron admitidas por clínica y tomografía computada (TC) de hemorragia subaracnoidea. En el postquirúrgico inmediato, de ectasia pediculada carotídea, vimos: desviación de cabeza y ojos a derecha,disartria,negligencia, así como hemiparesia con disestesias a izquierda. La angiografía (AG) verificadora de vasos de cuello y cerebro, mostró la correcta aplicación del clip en el cuello de sendos aneurismas. Ambas completaron la recuperación clínica antes del séptimo día y meses más tarde padecieron la primera crisis parcial compleja. Se observaron imágenes hipodensas temporales profundas y posteriores en TC. Nuestras pacientes continúan asintomáticas con carbamazepina. De 80 casos reportados, 38 fueron por cirugía adrede, ninguno casual y el resto ictales. Nuestros casos serían los únicos impensados. Consideramos que estos infartos tienen la suficiente categoría como para conformar una entidad clínica independiente