RESUMO
Decompressive craniectomy (DC) has demonstrated efficacy in reducing mortality in hemispheric infarction of the middle cerebral artery. The aim of our study was to compare the outcome of patients submitted to DC to patients treated in a conservative way. Eighteen patients were submitted to DC and 14 received conservative treatment. Neurological status was assessed by the Glasgow Coma Score and National Institutes of Health Stroke Scale score. Mortality, modified Rankin Scale and Barthel Index scores were assessed at 90 days to evaluate outcome. We did not observe reduction in overall mortality and functional outcome in patients submitted to DC. The differences between our group and previously published series are probably related to the neurological status of the patients at the time of therapeutic decision.
Assuntos
Craniotomia/métodos , Descompressão Cirúrgica/métodos , Infarto da Artéria Cerebral Média/cirurgia , Adolescente , Adulto , Idoso , Seguimentos , Escala de Coma de Glasgow , Humanos , Infarto da Artéria Cerebral Média/mortalidade , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: Stroke is the leading cause of death in Brazil. This community-based study assessed lay knowledge about stroke recognition and treatment and risk factors for cerebrovascular diseases and activation of emergency medical services in Brazil. METHODS: The study was conducted between July 2004 and December 2005. Subjects were selected from the urban population in transit about public places of 4 major Brazilian cities: São Paulo, Salvador, Fortaleza, and Ribeirão Preto. Trained medical students, residents, and neurologists interviewed subjects using a structured, open-ended questionnaire in Portuguese based on a case presentation of a typical patient with acute stroke at home. RESULTS: Eight hundred fourteen subjects were interviewed during the study period (53.9% women; mean age, 39.2 years; age range, 18 to 80 years). There were 28 different Portuguese terms to name stroke. Twenty-two percent did not recognize any warning signs of stroke. Only 34.6% of subjects answered the correct nationwide emergency telephone number in Brazil (#192). Only 51.4% of subjects would call emergency medical services for a relative with symptoms of stroke. In a multivariate analysis, individuals with higher education called emergency medical services (P=0.038, OR=1.5, 95%, CI: 1.02 to 2.2) and knew at least one risk factor for stroke (P<0.05, OR=2.0, 95% CI: 1.2 to 3.2) more often than those with lower education. CONCLUSIONS: Our study discloses alarming lack of knowledge about activation of emergency medical services and availability of acute stroke treatment in Brazil. These findings have implications for public health initiatives in the treatment of stroke and other cardiovascular emergencies.
Assuntos
Educação em Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Neurologia/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Brasil/epidemiologia , Coleta de Dados , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
The Foix-Chavany-Marie syndrome (FCMS) is characterized by apraxia of speech associated to bilateral central facio-linguo-velo-pharyngeal paralysis, with automatic-voluntary dissociation. In Worster-Drought Syndrome (WDS), dysarthria is remarkable. We report an 18-year-old female, with clinical and radiological findings of intermediary form of FCMS/WDS, and showing involuntary movements, an unusual fact.
Assuntos
Transtornos de Deglutição/complicações , Paralisia Facial/complicações , Distúrbios da Fala/complicações , Adolescente , Apraxias/complicações , Apraxias/diagnóstico , Apraxias/tratamento farmacológico , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/tratamento farmacológico , Disartria/complicações , Disartria/diagnóstico , Disartria/tratamento farmacológico , Eletroencefalografia , Paralisia Facial/diagnóstico , Paralisia Facial/tratamento farmacológico , Feminino , Humanos , Imageamento por Ressonância Magnética , Testes Neuropsicológicos , Distúrbios da Fala/diagnóstico , Distúrbios da Fala/tratamento farmacológico , SíndromeRESUMO
Among the many infective causes of cerebral venous thrombosis (CVT), viral hepatitis is been regarded as a rare associated condition. We report on a 56-years-old man presenting CVT associated with hepatitis B and C coinfections outlining probable pathogenic mechanisms. We suggest that virus B and C serology should be performed in the cases of cerebral venous thrombosis with unknown etiology.