ABSTRACT
OBJETIVOS: Os objetivos do estudo foram realizar uma versão brasileira da escala original de Fugl-Meyer e verificar a confiabilidade da aplicação inter e intra-observador desta versão em pacientes crônicos pós AVC. MÉTODO: Participaram do estudo 50 pacientes portadores de hemiparesia, os quais foram submetidos a duas avaliações (confiabilidade intra-observador), realizadas por três fisioterapeutas (confiabilidade interobservador), procedentes de três centros de reabilitação. RESULTADOS: Os resultados demonstraram alta confiabilidade inter e intra-observador da EFM total (IC = 0,99 e 0,98; respectivamente), assim como para todas as subescalas (interobservador IC = 0,99 a 0,94; intra-observador IC = 0,98 a 0,87). CONCLUSÃO: Conclui-se neste artigo que não foi verificado conflitos de interpretação na versão brasileira da escala de Fugl-Meyer. Obtivemos alto índice de confiabilidade, tanto intra como interobservador, permitindo assim seu uso como instrumento de avaliação clínica e de pesquisa no Brasil.
Subject(s)
Humans , Male , Female , Physical Therapy Modalities , Reproducibility of Results , StrokeABSTRACT
We evaluated the usefulness of seven cysticercal antigen extracts, four from Taenia solium cysticerci (whole parasite-TsoW, membrane-TsoMe, vesicular fluid-TsoVF and scolex-TsoSc) and three from T. crassiceps cysticerci (whole parasite-TcraW, membrane-TcraMe and vesicular fluid-TcraVF), for serodiagnosis of neurocysticercosis with an enzyme-linked immunosorbent assay (ELISA). Cysticercus-specific IgG were screened in serum samples from 23 patients with neurocysticercosis, 32 patients with other infections and 48 healthy persons. The best results were obtained with the TsoVF-ELISA (91.3% sensitivity; 96.2% specificity) and TcraVF-ELISA (91.3% sensitivity; 95% specificity). The ELISA done with whole parasite and membrane extracts from cysts of T. solium and T. crassiceps and the scolex extract from T. solium cysts showed a low performance in terms of sensitivity, ranging from 47.8% to 73.9%. None of the antigen preparations from T. solium and T. crassiceps cysticerci used in this study showed outstanding performance for the serodiagnosis of neurocysticercosis. However, considering the results obtained with the seven antigen preparations, vesicular fluid from T. solium and T. crassiceps cysticerci may be useful for detecting specific antibodies in sera from patients with neurocysticercosis.
Subject(s)
Antigens, Helminth/immunology , Neurocysticercosis/diagnosis , Taenia/immunology , Animals , Antigens, Helminth/blood , Cross Reactions , Enzyme-Linked Immunosorbent Assay/methods , Humans , Immunoglobulin G/blood , Immunoglobulin G/immunology , Sensitivity and Specificity , Serologic Tests , Taenia solium/immunologyABSTRACT
Laryngeal Electromyography (LEMG) is a diagnostic test commonly used in patients with vocal fold movement disorder. The aim of this study is to describe LEMG in patients with vocal fold immobility. A total of 55 dysphonic patients with vocal fold immobility diagnosed by laryngeal endoscopy were grouped according to probable clinical cause: 1) unknown; 2) traumatic; or 3) tumoral compression. They were submitted to LEMG by percutaneous insertion of concentric needle electrode. LEMG was conclusive in all patients and showed a majority with peripheral nerve injury. LEMG diagnosed peripheral nerve damage in 25 group 1, 12 group 2, and 11 group 3 patients. LEMG was normal in 4 patients, suggesting cricoarytenoid joint fixation. Central nervous system disorders was suggested in 2 and myopathic pattern in 1. As the major cause of vocal fold immobility is peripheral nerve damage, LEMG is an important test to confirm diagnosis.
Subject(s)
Electromyography , Vocal Cord Paralysis/diagnosis , Vocal Cord Paralysis/physiopathology , Adolescent , Adult , Aged , Endoscopy , Female , Humans , Laryngeal Nerves/physiopathology , Male , Middle Aged , Prognosis , Recurrent Laryngeal Nerve/physiopathologyABSTRACT
Quantitative analysis of normal values of motor unit action potentials duration and amplitude of muscles tireoaritenoideus (TA), cricotireoideus (CT), cricoaritenoideus lateralis (CAL), and cricoaritenoideus posterioris (CAP) was performed in 14 adult normal Brazilian volunteers. The recordings were obtained by percutaneously inserted concentric needle electrode. Different motor unit action potentials were manually selected in each muscle for quantitative computerized analysis of duration and amplitude. The mean values for duration and amplitude were respectively 3.8 ms and 413 microV for TA, 4.9 ms and 585 microV for CT 4.1 ms and 388 microV for CAL and 4.5 ms and 475 microV in CAP. There were no similar reports of normal values of motor unit action potentials in Brazilian subjects.
Subject(s)
Action Potentials , Laryngeal Muscles/physiology , Adolescent , Adult , Brazil , Efferent Pathways/physiology , Electromyography , Female , Humans , Male , Middle Aged , Reference ValuesABSTRACT
Laryngeal Electromyography (LEMG) is an auxiliary diagnostic method used for the comprehension and diagnosis of different neurological diseases that compromise laryngeal function. The most common LEMG technique is the percutaneous insertion of needle electrodes guided by surface anatomical references. We describe techniques for inserting needle electrodes into the tireoaritenoideus (TA), cricotireoideus (CT), cricoaritenoideus lateralis (CAL) and cricoaritenoideus posterioris (CAP) muscles; these are used at UNICAMP laryngology ambulatory, we discuss difficulties found and their proposed solutions. All patients were submitted to otorhinolaryngological, phonoaudiological and laryngeal endoscopy before LEMG. The CAP approach, by digital rotation of the thyroid cartilage was found to be the most difficult, followed by the CAL approach. TA and CT approaches gave no major problems, except with some older and obese patients. A significant complication of the TA approach via thyroid cartilage was a hematoma in one patient which partially obstructed the laryngeal lumen.
Subject(s)
Electromyography/methods , Laryngeal Muscles/physiopathology , Adolescent , Adult , Aged , Electrodes , Female , Humans , Male , Middle Aged , Needles , Voice Disorders/physiopathologyABSTRACT
The National Consense abot Spasticity by Brazilian Society of Physical Medicine and Rehabilitation (SBMFR) and Brazilian Medical Association (AMB) was done based on critical analysis of epidemiological studies, showing that traditional terapeutic resources need more studies for posterior approving
Subject(s)
Muscle SpasticityABSTRACT
A missense G209A mutation of the alpha-synuclein gene was recently described in a large Contursi kindred with Parkinson's disease (PD). The objective of this study is to determine if the mutation G209A of the alpha-synuclein gene was present in 10 Brazilian families with PD. PD patients were recruited from movement disorders clinics of Brazil. A family history with two or more affected in relatives was the inclusion criterion for this study. The alpha-synuclein G209A mutation assay was made using polymerase chain reaction and the restriction enzyme Tsp45I. Ten patients from 10 unrelated families were studied. The mean age of PD onset was 42.7 years old. We did not find the G209A mutation in our 10 families with PD. Our results suggest that alpha-synuclein mutation G209A is uncommon in Brazilian PD families.
Subject(s)
Mutation/genetics , Nerve Tissue Proteins/genetics , Parkinson Disease/genetics , Adult , Age of Onset , Aged , Brazil , Female , Humans , Male , Middle Aged , Pedigree , Polymerase Chain Reaction , Restriction Mapping , Synucleins , alpha-SynucleinABSTRACT
OBJECTIVE: to evaluate the interrelationships between cerebral and systemic hemometabolic alterations in patients with severe traumatic brain injury managed according to a standardized therapeutic protocol. DESIGN: prospective, interventional study in patients with traumatic coma. SETTING: a general Intensive Care Unit in a teaching hospital. PATIENTS AND METHODS: twenty-seven patients (21M e 6F), aging 14 - 58 years, with severe acute brain trauma, presenting with three to eight points on the Glasgow Coma Scale, were prospectively evaluated according to a cumulative protocol for the management of acute intracranial hypertension, where intracranial pressure (ICP) and cerebral extraction of oxygen (CEO2) were routinely measured. Hemometabolic interrelationships involving mean arterial pressure (MAP), ICP, arterial carbon dioxide tension (PaCO2), CEO2, cerebral perfusion pressure (CPP) and systemic extraction of oxygen (SEO2) were analyzed. INTERVENTIONS: routine therapeutic procedures. RESULTS: no correlation was found between CEO2 and CPP (r = -0.07; p = 0.41). There was a significant negative correlation between PaCO2 and CEO2 (r = -0.24; p = 0.005) and a positive correlation between SEO2 and CEO2 (r = 0.24; p = 0.01). The mortality rate in this group of patients was 25.9% (7/27). CONCLUSION: 1) CPP and CEO2 are unrelated; 2) CEO2 and PaCO2 are closely related; 3) during optimized hyperventilation, CEO2 and SEO2 are coupled.
Subject(s)
Brain Injuries/blood , Brain/metabolism , Coma/blood , Adolescent , Adult , Blood Pressure , Brain Injuries/physiopathology , Brain Injuries/therapy , Carbon Dioxide/metabolism , Cerebrovascular Circulation , Clinical Protocols , Coma/physiopathology , Coma/therapy , Female , Humans , Hyperventilation/blood , Hyperventilation/physiopathology , Intracranial Pressure/physiology , Male , Middle Aged , Oxygen/blood , Partial Pressure , Prospective StudiesABSTRACT
A quantitative enzyme-linked immunosorbent assay (ELISA) for the immunodiagnosis of neurocysticercosis is described. The ELISA was standardized using a purified Taenia solium cysticerci fraction (PCF) obtained by ion exchange chromatography. The ELISA using PCF (PCF-ELISA) and a qualitative ELISA using a whole extract from T. solium cysticerci (WEC-ELISA) were used to screen for cysticercus-specific IgG antibodies in cerebrospinal fluid (CSF) samples from 57 patients with neurocysticercosis and 50 patients with other neurologic disorders. The sensitivity of both assays was 95%, whereas the specificities of PCF-ELISA and WEC-ELISA were 100% and 92%, respectively. The excellent sensitivity and specificity of the PCF-ELISA make this assay a potentially useful tool in screening for antibodies against T. solium cysticerci.
Subject(s)
Antibodies, Helminth/cerebrospinal fluid , Antigens, Helminth/immunology , Cysticercus/immunology , Enzyme-Linked Immunosorbent Assay/methods , Neurocysticercosis/diagnosis , Animals , Antibodies, Helminth/blood , Chromatography, Ion Exchange , Humans , Sensitivity and SpecificityABSTRACT
Intracranial pressure (ICP) monitoring was carried out in 100 patients with severe acute brain trauma, primarily by means of a subarachnoid catheter. Statistical associations were evaluated between maximum ICP values and: 1) Glasgow Coma Scale (GCS) scores; 2) findings on computed tomography (CT) scans of the head; and 3) mortality. A significant association was found between low GCS scores (3 to 5) and high ICP levels, as well as between focal lesions on CT scans and elevated ICP. Mortality was significantly higher in patients with ICP > 40 mm Hg than in those with ICP < or = 20 mm Hg.
Subject(s)
Brain Injuries/physiopathology , Intracranial Pressure/physiology , Acute Disease , Adolescent , Adult , Aged , Brain Injuries/diagnosis , Cerebrovascular Circulation , Chi-Square Distribution , Child , Coma/physiopathology , Female , Glasgow Coma Scale , Humans , Male , Middle Aged , Monitoring, Physiologic , Oxygen Consumption , Prospective Studies , Subarachnoid SpaceABSTRACT
A 57 year-old man developed a spasmodic torticollis with involuntary deviation of the head to the right-side. He had a left paramedian frontal meningioma. The association of spasmodic torticollis and other movement disorders has been reported with contralateral lesions in the basal ganglia. Its occurrence in association to a frontal lesion appears to be much less frequent suggesting a possible disorder of frontostriatal connections.
Subject(s)
Frontal Lobe , Meningeal Neoplasms/complications , Meningioma/complications , Torticollis/etiology , Humans , Male , Middle AgedABSTRACT
Sao apresentados 4 casos da forma tumoral de neurocisticercose com cistos cerebrais gigantes, de localizacao supratentorial em 3 e infratentorial em um. Em 2 pacientes a sindrome predominante era de hipertensao intracraniana, ocorrendo nos outros 2 sinais focais deficitarios, num deles con instalacao aguda.A tomografia computadorizada cerebral revelou, em um dos pacientes lesao cistica unica supratentorial, levando a diagnostico diferencial com varias outras patologias. O resultado cirurgico obtido foi bom, sugerindo-se a indicacao desse procedimento para diagnostico e tratamento das lesoes cisticas extensas