RESUMO
OBJECTIVE: To investigate whether caloric vestibular stimulation, a non-invasive form of neuro-modulation, alters the level of awareness in people residing in a minimally conscious state. DESIGN: Single-case ( n = 2), prospective, controlled (ABAB) efficacy study. SETTING: Tertiary, neuro-rehabilitation inpatient ward within a university hospital. PARTICIPANTS: Two individuals in a minimally conscious state. INTERVENTION: Left ear caloric vestibular stimulation was performed in two four/five-week blocks interleaved with two four/five-week blocks of sham stimulation. Session duration and frequency gradually increased within each block from once per day for 10 minutes (Week 1) to once per day for 20 minutes (Week 2) to 20 minutes twice per day in the remaining weeks. MEASURES: Wessex Head Injury Matrix, JFK Coma Recovery Scale - Revised. RESULTS: Both participants' Wessex Head Injury Matrix scores indicated a transition from involuntary (i.e. mechanical vocalization) to voluntary (i.e. gesture making, selective responses to family members) behaviour that was time-locked to the onset of active stimulation. In one participant, this improvement persisted for at least four weeks after active stimulation, while in the other it diminished two weeks after stimulation. Allied, although less dramatic, changes were seen on the arousal and auditory subscales of the JFK Coma Recovery Scale - Revised. CONCLUSION: The data provide the first evidence that vestibular stimulation may help improve outcome in a low awareness state, although further studies are needed to replicate effect and determine longer-term benefit.
Assuntos
Testes Calóricos/métodos , Infarto Cerebral/complicações , Parada Cardíaca/complicações , Meningioma/cirurgia , Estado Vegetativo Persistente/reabilitação , Tálamo/cirurgia , Idoso , Testes Calóricos/instrumentação , Infarto Cerebral/etiologia , Estudos Cross-Over , Escala de Coma de Glasgow , Parada Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/etiologia , Complicações Pós-Operatórias , Tálamo/patologia , Resultado do Tratamento , Fibrilação Ventricular/complicaçõesRESUMO
We sought to determine whether cognitive function in stable outpatients with heart failure (HF) is affected by HF severity. A retrospective, cross-sectional analysis was performed using data from 2, 043 outpatients with systolic HF and without prior stroke enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial. Multivariable regression analysis was used to assess the relationship between cognitive function measured using the Mini-Mental Status Exam (MMSE) and markers of HF severity (left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, and 6-minute walk distance). The mean (SD) for the MMSE was 28.6 (2.0), with 64 (3.1%) of the 2,043 patients meeting the cut-off of MMSE <24 that indicates need for further evaluation of cognitive impairment. After adjustment for demographic and clinical covariates, 6-minute walk distance (ß-coefficient 0.002, p<0.0001), but not LVEF or NYHA functional class, was independently associated with the MMSE as a continuous measure. Age, education, smoking status, body mass index, and hemoglobin level were also independently associated with the MMSE. In conclusion, six-minute walk distance, but not LVEF or NYHA functional class, was an important predictor of cognitive function in ambulatory patients with systolic heart failure.
Assuntos
Aspirina/uso terapêutico , Cognição , Fibrinolíticos/uso terapêutico , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Varfarina/uso terapêutico , Fatores Etários , Idoso , Índice de Massa Corporal , Estudos Transversais , Escolaridade , Tolerância ao Exercício , Feminino , Insuficiência Cardíaca Sistólica/diagnóstico , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pacientes Ambulatoriais , Estudos Retrospectivos , Índice de Gravidade de Doença , Fumar/fisiopatologia , Volume Sistólico , Função Ventricular Esquerda , CaminhadaAssuntos
Ensaios Clínicos como Assunto/ética , Células-Tronco Embrionárias , Ética Médica , Doenças do Sistema Nervoso/cirurgia , Transplante de Células-Tronco/ética , Participação da Comunidade/tendências , Humanos , Comunicação Interdisciplinar , Neurologia/ética , Neurologia/métodos , Política , Opinião PúblicaAssuntos
Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Endarterectomia das Carótidas/métodos , Anestesia/efeitos adversos , Estenose das Carótidas/fisiopatologia , Causalidade , Ensaios Clínicos como Assunto/estatística & dados numéricos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/estatística & dados numéricos , Doença da Artéria Coronariana/fisiopatologia , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/estatística & dados numéricos , Humanos , Mortalidade/tendências , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco , Fatores de Risco , Stents/estatística & dados numéricos , Stents/tendências , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/prevenção & controleAssuntos
Clonagem de Organismos/ética , Clonagem de Organismos/métodos , Pesquisas com Embriões , Embrião de Mamíferos/citologia , Oócitos/citologia , Células-Tronco Pluripotentes , Pesquisas com Embriões/ética , Desenvolvimento Embrionário , Humanos , Técnicas de Transferência Nuclear , Células-Tronco Totipotentes , ZigotoRESUMO
Nucleus pulposus (NP) embolism is an extremely rare cause of spinal cord infarction. To our knowledge, it has not been reported in pregnancy in the English literature. A 41-year-old pregnant woman presented with clinical symptoms initially attributed to a transverse myelitis. After a complicated clinical course, she expired, and was found at autopsy to have NP embolism to the spinal cord. In conclusion NP embolism is a rare cause of spinal cord infarction, and should be considered in the differential of a patient presenting with symptoms compatible with spinal cord infarction in the pregnant as well as nonpregnant state.
Assuntos
Embolia/patologia , Infarto/etiologia , Disco Intervertebral/patologia , Complicações Cardiovasculares na Gravidez/etiologia , Medula Espinal/irrigação sanguínea , Adulto , Autopsia , Encéfalo/patologia , Diagnóstico Diferencial , Embolia/complicações , Evolução Fatal , Feminino , Humanos , Infarto/patologia , Mielite Transversa/patologia , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Medula Espinal/patologiaRESUMO
A 71-year-old man experienced sudden onset of hemiparesis and aphasia. He had a 4-month history of gallbladder cholangiocarcinoma, complicated with a postoperative deep-vein thrombosis (DVT) that necessitated a vena caval filter placement. Diffusion-weighted magnetic resonance imaging of the brain showed multiple hyperintense foci. Magnetic resonance spectroscopy was compatible with cerebral infarction. Abdominal computed tomography showed a thrombus in the inferior vena cava extending through the filters. A transcranial Doppler bubble study revealed the presence of a right-to-left shunt. Paradoxical cerebral embolism must be considered in patients with DVT who have new onset neurologic deficits even in the presence of a caval filter.
Assuntos
Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Tromboembolia/complicações , Filtros de Veia Cava/efeitos adversos , Idoso , Colangiocarcinoma/complicações , Diagnóstico Diferencial , Diagnóstico por Imagem , Neoplasias da Vesícula Biliar/complicações , Humanos , Masculino , Tromboembolia/etiologiaRESUMO
An 84-year-old man presented with acute confusion, global aphasia, and fever. Magnetic resonance imaging (MRI) showed hyperintense lesions on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images predominantly affecting the cortical gray matter of the left mesial temporal and inferior frontal lobes, and insula. Acyclovir was prescribed for presumed viral encephalitis. Clinical and MRI worsening prompted a left temporal lobe biopsy that revealed primary central nervous system lymphoma (PCNSL). This case adds to the MRI spectrum of PCNSL and illustrates that it may mimic the clinical and MRI presentation of herpes simplex encephalitis.