RESUMO
BACKGROUND: Traumatic brain injury (TBI) can induce long-term severe disorders of consciousness. Evidence suggests an underlying dopaminergic deficit. Dopamine agonists may therefore play an important role in recovery of consciousness. OBJECTIVE: To explore the response to continuous subcutaneous administration of apomorphine in a patient who had remained in minimally conscious state for 104 days and to evaluate the anatomical substrate of the effect. DESIGN: A prospective, open-label, daily treatment, dose-escalation single case clinical study, with retrospective diffusion tensor image (DTI) evaluation. RESULTS: On the fist day of treatment, the patient was able to move his limbs on command and answer yes/no questions which had not been the case prior to apomorphine administration. Subsequently there was a full recovery of consciousness and substantial functional recovery that was sustained even after apomorphine discontinuation. At the highest dose, mild dyskinesias were observed. These resolved with a lowering of the dose. DTI demonstrated a decrease of thalamocortical and corticothalamic projections in this MCS patient compared to normal volunteers. CONCLUSION: Although this is an open-label single-patient case report, the data are consistent with the theory that a dopaminergic deficit underlies MCS and that it may be overcome with apomorphine administration.
Assuntos
Apomorfina/uso terapêutico , Lesões Encefálicas/tratamento farmacológico , Agonistas de Dopamina/uso terapêutico , Estado Vegetativo Persistente/tratamento farmacológico , Recuperação de Função Fisiológica/efeitos dos fármacos , Atividades Cotidianas , Adulto , Lesões Encefálicas/fisiopatologia , Humanos , Masculino , Estado Vegetativo Persistente/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Resultado do TratamentoRESUMO
Monovoxel magnetic resonance spectroscopy (MRS) is a technique extensively used for the study of brain tumors in many imaging centers. However, given the fact that monovoxel spectrum quality depends upon voxel size, region of acquisition and the presence of metal and/or blood residue after surgery can make the comparison of MRS brain tumor spectra more difficult than that of other pathologies. This study was conducted in order to evaluate whether it is possible to predict in which cases a tumor spectrum will be quantifiable from acquisitions obtained without water suppression, allowing comparison to other spectra. Three different methods were employed: a qualitative, clinical method and two quantitative ones (Amares and Quest). It was found that by using Quest, it is possible to estimate the number of acquisitions needed to obtain a quantifiable spectrum before its acquisition, something which was not feasible with Amares (given the base used). On examining the spectra as physicians would, it was found that after a certain number of acquisitions, they did not change. The study shows that it is possible to optimize MRS acquisition time in brain tumors and guarantee spectrum quantification for comparison of different MRS studies, obtained both from a single patient or different patients.
Assuntos
Neoplasias Encefálicas/diagnóstico , Espectroscopia de Ressonância Magnética/métodos , Água , Humanos , Hidrogênio , Modelos TeóricosRESUMO
O objetivo deste estudo foi analisar o consumo de triglicerídeos intra (IT) e extracelulares (ET) nos músculos sóleo, tibial anterior e vasto medial após uma prova de quatro horas de ciclismo de estrada. Esta pesquisa caracterizou-se por ser um estudo de caso de um ciclista que participa de competicões internacionais. Os estudos de ressonância magnética utilizaram os seguintes parâmetros espectrais impostos para o ajuste no domínio do tempo, como a distância das freqüências entre os sinais de IT e ET. Os valores de amplitudes dos triglicerídeos intra e extracelulares foram divididos pela ressonância de água. Concluímos que o músculo vasto medial do ciclista apresentou maior consumo de triglicerídeos depois de quatro horas de ciclismo em estrada. Portanto, constatou-se que um trabalho com intensidade de 80 por cento da freqüência cardíaca máxima permitiu consumo de triglicerídeos intramusculares durante o exercício.