Acute Fulminant Cerebral Edema in a Child With Suspected Meningoencephalitis.

Acute fulminant cerebral edema (AFCE) is a recently identified encephalitis type associated with significant morbimortality. Described as rare, limited data exists on its early detection and treatment. This paper describes a case of AFCE that progressed to unresponsive intracranial hypertension. A previously healthy four-year-old boy presented with fever, myalgias, and neurological symptoms. Diagnostic assessments showed cerebrospinal fluid abnormalities, and despite medical interventions, his condition deteriorated rapidly and developed severe cerebral edema and herniation within 24 hours. A decompressive craniectomy was attempted to decrease intracranial pressure, without success. This case emphasizes the urgency of early AFCE recognition and effective management strategies given its severe prognosis, aiming to improve understanding and spur further research.

Circadian activity rhythm and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke.

BACKGROUND: Activity levels and disturbances of the sleep-wake pattern affect health and quality of life and need to be further explored in patients with stroke. OBJECTIVE: To evaluate activity levels and their association with sleep-wake patterns in patients with stroke. METHODS: Ten adults with (51±6 years) and 10 without stroke (52±7 years) participated in the study; they were matched on age, sex and educational level. Neurological status, motor function, sleep quality, and activity levels were measured. The groups were compared using Student t-tests and the association between the measures was assessed using Pearson's correlation. RESULTS: Compared to people without stroke, those with stroke had worse sleep quality (p = 0.044), twice lower 24h-activity levels (p < 0.0001), higher interdaily stability and intradaily variability, lower activity during the most active 10 h and during the least active 5 h. Sleep quality was associated with activity level (r= -0.72) and with within-day activity variability (r= 0.53). CONCLUSIONS: Activity level and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke.

Vivências do cuidador informal de doentes após AVC: um desafio à gestão de serviços/cuidados de saúde / Experiences of the informal caregiver of stroke patients: a challenge to health services/care management

A ocorrência de um Acidente Vascular Cerebral pode provocar, no indivíduo, alterações funcionais, sociais, emocionais e comunitárias que, de um modo geral, atingem toda a família. Muitas vezes surge a necessidade da presença de um cuidador Informal. Quando se fala em gestão de cuidados / serviços de saúde, em contexto de proximidade, é fundamental conhecer as necessidades, tanto dos doentes como dos seus cuidadores; As exigências inerentes ao cuidar requerem do cuidador um esforço físico e emocional, assim como capacitação para desempenhar este papel. A prestação de cuidados de enfermagem tem como função auxiliar estes cuidadores, proporcionando apoio, ensino e educação, no sentido de promover o desenvolvimento de habilidades e competências. Deste modo, pretende-se que a prestação de cuidados no domicílio, não só seja uma realidade crescente, mas também, garanta a qualidade a que os cidadãos têm direito. O presente estudo tem como objetivo principal analisar as vivências do cuidador informal de doentes, após acidente vascular cerebral, como um contributo à gestão de cuidados / serviços de saúde, em particular no que se refere à criação/implementação de uma Equipa de Cuidados Continuados Integrados. O estudo insere-se no paradigma qualitativo, de carácter exploratório e descritivo. Os dados foram obtidos através de entrevista e análise documental. A entrevista foi elaborada exclusivamente para esta investigação, efetuada a cuidadores informais de pessoas que sofreram de Acidente Vascular Cerebral, oito dias após alta de uma unidade de convalescença da região do norte do país. Da análise documental do processo clínico obteve-se informação relativa à dependência dos utentes. A recolha de informação decorreu no período de Maio a Julho de 2011, tendo sido entrevistadas 8 cuidadoras informais. Estas cuidam, maioritariamente, de homens, idosos, com graus de dependência elevados e moderados. São todas mulheres, maioritariamente com idades entre os 40 e 50 anos, filhas e noras, domésticas e com escolaridade básica incompleta. A partir das respostas das nossas entrevistadas, esta investigação coloca em debate as experiências das cuidadoras informais, as suas necessidades, as necessidades dos doentes e os contributos para a prática de cuidados. Analisando os resultados parece que estes cuidadores estão interessados em cuidar dos seus familiares, mas necessitam dos enfermeiros para ajudar a gerir todo o processo de adaptação e integração na comunidade. As ECCI pretendem proporcionar as respostas mais adequadas aos cuidadores e às pessoas que sofreram AVC.

The occurrence of a stroke may cause changes on the individual at the social, functional, emotional and community levels that generally affect all the family. On many cases there is a need for the presence of an informal caregiver. When talking about management of health care and services in a proximity context it's necessary to know the needs of both the patients and their caregivers. The requirements relating to the care demand a physical and emotional effort of the caregiver, as well as the ability to play that role. The provision of nursing care has the function of helping those caregivers, providing support, education and learning to promote the development of skills and competences. Thus the provision of care at home is intended to be not only a growing reality but also the warrant of the quality rightly deserved by the citizens. The main objective of this study is to analyze the experiences of the post-stroke patient informal caregivers as a contribute to health services and care management, particularly regarding the creation / implementation of long turn care. The study falls within the qualitative paradigm, exploratory and descriptive. Data were obtained through interviews and document analysis. The interview was prepared exclusively for this research, made to informal caregivers of individuals who suffered strokes, eight days after being discharged from a convalescent unit in the northern region of the country. Information related to the dependence of the users was obtained from the document analysis of the clinical process. Information collection occurred between May and July 2011, with interviews to 8 informal caregivers. They mostly take care of elder men, with high and moderate dependence degrees. Caregivers are mostly women, aged around 40 or 50, daughters and daughters-in-law, domestic workers with incomplete compulsory education. This research puts under discussion, from the speeches of our interviewees, the experiences of the informal caregivers, their needs, the needs of the patients and the contribute for the care practice. An analysis of the results seems to indicate these caregivers are interested in taking care of their family, but need nurses to help manage all the adaptation and integration into the community process. The ICCT are intended to provide the most adequate answers to caregivers and stroke patients