RESUMO
RESUMO A oftalmologia fornece um campo vasto de conhecimentos necessários à medicina legal e às perícias médicas. O presente artigo objetivou revisar as informações na perícia criminal e cível, as repercussões da morte e os achados post-mortem que o exame ocular pode fornecer. Demonstrou-se que a perícia ocular é complexa e multifacetada, fornecendo ferramentas importantes para a classificação das lesões corporais, verificação da capacidade laboral, investigação da causa mortis e estimativa do tempo de morte.
ABSTRACT Ophthalmology provides a vast field of knowledge necessary for forensic medicine and medical expertise. The present article aimed to review the information on criminal and civil medical expertise, the repercussions of death, and the postmortem findings that the eye examination can provide. Ocular expertise has been shown to be complex and multifaceted, providing important tools to classify bodily injuries, verify work capacity, investigate the cause of death, and estimate the time of death.
Assuntos
Humanos , Oftalmologia/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Medicina Legal/legislação & jurisprudência , Legislação Médica , Mudanças Depois da Morte , Reflexo Pupilar , Fatores de Tempo , Piscadela , Morte Encefálica , Acuidade Visual , Tanatologia , Traumatismos Oculares , Causas de Morte , Morte , DiagnósticoRESUMO
En la Unidad de Cuidado Neurocrítico (UCN), el examen neurológico constituye un parámetro fundamental en la evaluación de la evolución de pacientes admitidos en esta unidad; uno de los principales elementos de esta inspección es la valoración de las pupilas, establecida por la estimulación del reflejo pupilar a la luz, ya sea de forma manual o mediante un pupilómetro para medir el diámetro pupilar y su reactividad, lo que se ha constituido como un primer y en algunos contextos casi que el único signo clínico que manifiestan los pacientes con traumas o lesiones encefálicas al momento que hay un empeoramiento del cuadro patológico, por lo que se ha propuesto como una herramienta eficaz para establecer un pronóstico y seguimiento en estos pacientes.
At the neuro-critical care units, the neurological examination constitutes a fundamental parameter in the evaluation of the evolution of patients admitted into these units. One of the main elements of this inspection is the assessment of the pupils, established by the pupillary light reflection stimulation, either manually or by means of a pupilometer to measure the pupillary diameter and its reactivity. It has been constituted as a first, and in some contexts, almost the only clinical sign manifested by patients with traumas or brain injuries at the time where there is a worsening of the pathological picture, so it has been proposed as an effective tool to establish a prognosis and follow-up in these patients.
Assuntos
Pupila , Reflexo Pupilar , Lesões Encefálicas , Cuidados Críticos , Exame NeurológicoRESUMO
A tiny structure, the pupil, attracts too much attention, since the antiquity. The pupil as part of the "'window of/to the soul", the eyes, it can demonstrate a clinical disorder sign, or simply a psychological expression. In this paper, it is studied the situation in which the pupillary reï¬ex to light is compromised, but the accommodation reï¬ex is preserved, what is named after Argyll Robertson, the frst Scottish ophthalmologist, who besides described the signal (1869), he also tried to defned its clinical signifcance. Afterwards, it was clearly demonstrated its relationship with tertiary neurosyphilis.
Uma estrutura minúscula, a pupila, atrai muita atenção, desde a antiguidade. A pupila como parte da "'janela da alma'", os olhos, poderia demonstrar um sinal de desordem clínica, ou, simplesmente, uma expressão psicológica. Neste trabalho, estuda-se a situação em que o reï¬exo pupilar à luz é comprometido, mas o reï¬exo de acomodação é preservado, o que leva o nome de Argyll Robertson, o primeiro oftalmologista escocês que além de descrever o sinal (1869), também tentou defniu seu signifcado clínico. Posteriormente, foi claramente demonstrada sua relação com a neurossíflis terciária.
Assuntos
Humanos , História do Século XXI , Oftalmologia/história , Reflexo Pupilar , Distúrbios Pupilares/diagnóstico , Distúrbios Pupilares/fisiopatologia , Sistema Nervoso Autônomo , Acomodação Ocular/fisiologia , NeurossífilisRESUMO
ABSTRACT Purpose: We investigated parasympathetic innervation abnormalities of the iris sphincter and ciliary muscles in chronic Chagas disease by measuring pupillary diameter and intraocular pressure. Methods: A group of 80 patients with Chagas disease was compared with 76 healthy individuals without chagasic infection. The following procedures were performed: pupillometry, hypersensitivity test to pilocarpine 0.125%, intraocular pressure measurement (IOP), basal pupil diameter (BPD), absolute pupillary constriction amplitude (ACA), relative pupillary constriction amplitude (RCA) and the presence of anisocoria. Results: The prevalence of anisocoria was higher in chagasic patients (p<0.01). These patients had mean basal pupillary diameter, mean photopic pupillary diameter and mean value of absolute pupillary constriction amplitude significantly lower than non-chagasic ones (p<0.01, mean difference -0.50mm), (p=0.02, mean difference -0.20mm), (p<0.01, mean difference -0.29mm), respectively. The relative pupillary constriction amplitude did not differ between the two groups (p=0.39, mean difference -1.15%). There was hypersensitivity to dilute pilocarpine in 8 (10%) of the chagasic patients in the right eye and in 2 (2.5%) in the left eye and in 1 (1.25%) in both eyes. The mean value of intraocular pressure had a marginal statistical significance between the two groups (p=0.06, mean difference -0.91mmHg). Conclusions: Patients with chagasic infection may exhibit ocular parasympathetic dysfunction, demonstrable by pupillometry and the dilute pilocarpine hypersensitivity test.
RESUMO Introdução: Investigaram-se anormalidades da inervação parassimpática dos músculos esfíncter da íris e ciliar na doença de Chagas crônica, através de medidas pupilares e da pressão intraocular. Métodos: Foram estudados dois grupos, um com 80 chagásicos e outro com 76 indivíduos saudáveis sem infecção chagásica. Foram realizados os seguintes procedimentos: pupilometria, teste de hipersensibilidade à pilocarpina a 0,125%, medida da pressão intraocular (PIO), diâmetro basal da pupila (DBP), amplitude de constrição pupilar absoluta (ACA), amplitude de constrição pupilar relativa (ACR), e presença de anisocoria. Resultados: A prevalência de anisocoria foi maior nos chagásicos (p<0,01). Estes pacientes apresentaram diâmetro basal pupilar médio, diâmetro fotópico médio e valor médio da amplitude de constrição pupilar absoluta, significativamente menores que os não chagásicos, (p<0,01, diferença de média -0,50mm), (p=0.02, diferença de média -0,20mm), (p<0,01, diferença de média -0,29mm), respectivamente. A amplitude de constrição pupilar relativa não diferiu entre os dois grupos (p=0,39, diferença de média -1,15%). Houve hipersensibilidade à pilocarpina diluída em 8 (10%) chagásicos no olho direito em 2 (2,5%) no olho esquerdo e em 1 (1,25%) em ambos os olhos. O valor médio da pressão intraocular teve significância marginal entre os dois grupos (p=0,06, diferença de média -0,91mmHg). Conclusões: Pacientes com infecção chagásica podem apresentar disfunção parassimpática ocular, demonstrável pela pupilometria e pelo teste de hipersensibilidade à pilocarpina diluída.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Reflexo Pupilar/fisiologia , Anisocoria/etiologia , Doença de Chagas/complicações , Pressão Intraocular/fisiologia , Pilocarpina/farmacologia , Reflexo Pupilar/efeitos dos fármacos , Anisocoria/diagnóstico , Anisocoria/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Doença de Chagas/fisiopatologia , Mióticos/farmacologiaRESUMO
Viral encephalitis can lead to serious neurological sequelae and death among younger children. It is also known that the mortality rate in encephalitis with cerebral edema or transtentorial brain herniation is higher. A 4-year-old boy visited our emergency department exhibiting mental change. The patient had a high fever for four and a whole-body rash for three days prior to his visit. He had displayed irritable symptoms and been vomiting for six hours before his visit, accompanied by seizure. After 13 hours of admission, the patient's right pupil became fixed and fully dilated, and the left pupil also became fixed and fully dilated within 30 minutes. Brain computed tomography (CT) was performed immediately, and severe brain swelling with transtentorial brain herniation was found. The mannitol dose was increased and dexamethasone was also added. Hyperventilation was performed through intubation to reach PaCO₂ levels of 25 to 30mmHg. Fifteen hours later, pupillary reflex was observed and the cerebral edema and transtentorial brain herniation was found to be improving in follow-up brain CT. He was transferred to a general ward after 11 days and discharged on the thirteenth hospital day without any neurological sequelae. Human herpesvirus type 6 (HHV-6) was detected in the serological polymerase chain reaction (PCR) examination.
Assuntos
Criança , Pré-Escolar , Humanos , Masculino , Encéfalo , Edema Encefálico , Dexametasona , Serviço Hospitalar de Emergência , Encefalite , Encefalite Viral , Exantema , Febre , Seguimentos , Hiperventilação , Intubação , Manitol , Mortalidade , Direitos do Paciente , Quartos de Pacientes , Reação em Cadeia da Polimerase , Pupila , Reflexo Pupilar , Convulsões , VômitoRESUMO
OBJECTIVE: To show the effect of dual monitoring including cardiac output (CO) and intracranial pressure (ICP) monitoring for severe traumatic brain injury (TBI) patiens. We hypothesized that meticulous treatment using dual monitoring is effective to sustain maintain minimal intensive care unit (ICU) complications and maintain optimal ICP and cerebral perfusion pressure (CPP) for severe TBI patiens. METHODS: We included severe TBI, below Glasgow Coma Scale (GCS) 8 and head abbreviation injury scale (AIS) >4 and performed decompressive craniectomy at trauma ICU of our hospital. We collected the demographic data, head AIS, injury severity score (ISS), initial GCS, ICU stay, sedation duration, fluid therapy related complications, Glasgow Outcome Scale (GOS) at 3 months and variable parameters of ICP and CO monitor. RESULTS: Thirty patients with severe TBI were initially selected. Thirteen patients were excluded because 10 patients had fixed pupillary reflexes and 3 patients had uncontrolled ICP due to severe brain edema. Overall 17 patients had head AIS 5 except 2 patients and 10 patients (58.8%) had multiple traumas as mean ISS 29.1. Overall complication rate of the patients was 64.7%. Among the parameters of CO monitoring, high stroke volume variation is associated with fluid therapy related complications (p=0.043) and low cardiac contractibility is associated with these complications (p=0.009) statistically. CONCLUSION: Combined use of CO and ICP monitors in severe TBI patients who could be necessary to decompressive craniectomy and postoperative sedation is good alternative methods to maintain an adequate ICP and CPP and reduce fluid therapy related complications during postoperative ICU care.
Assuntos
Humanos , Edema Encefálico , Lesões Encefálicas , Débito Cardíaco , Circulação Cerebrovascular , Craniectomia Descompressiva , Hidratação , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Cabeça , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva , Pressão Intracraniana , Monitorização Fisiológica , Traumatismo Múltiplo , Reflexo Pupilar , Volume SistólicoRESUMO
PURPOSE: We report a rare case of unilateral acute macular neuroretinoapthy in a young male. CASE SUMMARY: A 35-year-old male presented with a 2-day history of paracentral scotoma. He had suffered for 2 days from a flu-like illness, and his best corrected visual acuity was 20/20 OD and 20/20 OS. Pupillary reflex was normal and no relative afferent pupillary defects were not found. Ocular movement test was normal and pain on ocular movement was not noticed. Ophthalmoscopic examination of the left eye revealed multiple exudates lining the nasal macula toward the fovea. A Humphrey visual field study identified small paracentral scotoma. Spectral domain optical coherence tomography (SD-OCT, Heidelberg Engineering, Heidelberg, Germany) of the lesions showed a hyper-reflective lesion located in the outer plexiform layer and inflammatory cell infiltration. Fluorescent angiography was normal in the macula but showed late leak at the disc. The multifocal electroretinogram (mfERG) showed decreased foveal P1 amplitude in the left eye. The patient was diagnosed with acute macular neuroretinopathy and was treated with 60 mg of prednisolone. His subjective symptoms were improved, the paracentral scotoma disappeared, and the lesions appeared different upon SD-OCT; specifically, the hyper-reflective lesion disappeared and the outer plexiform layer showed thinning. CONCLUSIONS: Acute macular neuroretinopathy is a rare disease, and we report a case using SD-OCT and mfERG.
Assuntos
Adulto , Humanos , Masculino , Angiografia , Exsudatos e Transudatos , Prednisolona , Distúrbios Pupilares , Doenças Raras , Reflexo Pupilar , Escotoma , Tomografia de Coerência Óptica , Acuidade Visual , Campos VisuaisRESUMO
PURPOSE: To determine the normal ranges of various indexes of the pupillary light reflex measured by automated pupillometry in Koreans. METHODS: We retrospectively analyzed 90 healthy adults who did not have any ocular diseases other than refractive errors. The direct pupillary light reflex was measured with an automated dynamic pupillometer (PLR-200, NeurOptics Inc., Irvine, CA, USA). A total of 7 indices were measured as follows; the maximum and minimum pupil diameters, constriction latency, constriction ratio, maximum constriction velocity, average constriction velocity and average dilation velocity. RESULTS: There were no significant differences in quantitative indexes of the pupillary light reflex between fellow eyes. A significant decrease in maximum pupil diameter, minimum pupil diameter, maximum constriction velocity, average constriction velocity and average dilation velocity were observed with aging. In contrast, a significant increase in constriction latency was observed with aging. There were no differences in quantitative pupil measurements according to gender (p<0.001). CONCLUSIONS: Quantitative measurements of the pupillary light reflex by dynamic pupillometry showed no significant differences between fellow eyes. A significant decrease in pupil size, constriction velocity and dilation velocity, and an increase in pupil constriction latency were observed with aging.
Assuntos
Adulto , Humanos , Envelhecimento , Constrição , Pupila , Valores de Referência , Reflexo , Reflexo Pupilar , Erros de Refração , Estudos RetrospectivosRESUMO
A 46-year-old female patient was admitted to the intensive care unit (ICU) after liver transplantation. About an hour later after the ICU admission, she had no pupillary light reflex. Both pupils were also fixed at 5 mm. Patients who undergo liver transplantation are susceptible to neurologic disorders including hepatic encephalopathy, thromboembolism and intracranial hemorrhage. Abnormal pupillary light reflex usually indicates a serious neurologic emergency in these patients; however, benign neurologic disorders such as peripheral autonomic neuropathy or Holmes-Adie syndrome should also be considered. We experienced a case of fixed pupillary light reflex after liver transplantation diagnosed as peripheral autonomic neuropathy.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Síndrome de Adie , Emergências , Encefalopatia Hepática , Unidades de Terapia Intensiva , Hemorragias Intracranianas , Transplante de Fígado , Fígado , Doenças do Sistema Nervoso , Doenças do Sistema Nervoso Periférico , Pupila , Reflexo , Reflexo Pupilar , TromboemboliaRESUMO
PURPOSE: To report a case of rhino-orbital mucormycosis successfully treated by posaconazole salvage therapy after a surgical intervention combined with amphotericin B treatment. CASE SUMMARY: A 57-year-old female with uncontrolled diabetes mellitus presented to our department with left periorbital swelling and pain for 3 days. At initial presentation, complete ptosis, complete external ophthalmoplegia, and exophthalmos of 6 mm were observed in the left eye. Pupillary reflex was absent in the left eye. Orbital magnetic resonance imaging showed left focal maxillary sinusitis and left posterior orbital inflammatory infiltration with left optic nerve involvement. Nasal endoscopic examination showed black eschar in both nasal cavities. Histopathological examination of the involved nasal cavities showed non-septated fungal hyphae with blunt-angle branching, thus rhino-orbital mucormycosis was diagnosed. The patient underwent a lid-sparing subtotal exenteration, wide endonasal debridement of the nasal necrotic tissues, and intravenous injections of amphotericin B for 7 weeks. The patient continued to receive oral posaconazole salvage therapy for 6 months and was successfully treated. At the 44-month follow-up, recurrence was not observed, and the patient is wearing a new type of silicone oculofacial prosthesis. CONCLUSIONS: Rhino-orbital mucormycosis is an aggressive, opportunistic fungal infection that is life-threatening despite exenteration and amphotericin B treatment. Sequential use of oral posaconazole as salvage therapy may be helpful for a successful treatment.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Anfotericina B , Desbridamento , Diabetes Mellitus , Exoftalmia , Seguimentos , Hifas , Injeções Intravenosas , Imageamento por Ressonância Magnética , Seio Maxilar , Sinusite Maxilar , Mucormicose , Cavidade Nasal , Oftalmoplegia , Nervo Óptico , Órbita , Próteses e Implantes , Recidiva , Reflexo Pupilar , Terapia de Salvação , SiliconesRESUMO
A 46-year-old female patient was admitted to the intensive care unit (ICU) after liver transplantation. About an hour later after the ICU admission, she had no pupillary light reflex. Both pupils were also fixed at 5 mm. Patients who undergo liver transplantation are susceptible to neurologic disorders including hepatic encephalopathy, thromboembolism and intracranial hemorrhage. Abnormal pupillary light reflex usually indicates a serious neurologic emergency in these patients; however, benign neurologic disorders such as peripheral autonomic neuropathy or Holmes-Adie syndrome should also be considered. We experienced a case of fixed pupillary light reflex after liver transplantation diagnosed as peripheral autonomic neuropathy.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Síndrome de Adie , Emergências , Encefalopatia Hepática , Unidades de Terapia Intensiva , Hemorragias Intracranianas , Transplante de Fígado , Fígado , Doenças do Sistema Nervoso , Doenças do Sistema Nervoso Periférico , Pupila , Reflexo , Reflexo Pupilar , TromboemboliaRESUMO
PURPOSE: Identify ideal profiles in patients undergoing to photorefractive laser surgery with the aid of an automated pupillometry and psychometric analysis of patients with visual function questionnaire (VQF 25). METHODS: Seventy-seven patients undergoing photorefractive laser surgery laser (LASIK) were analyzed with the aid of an automated digital pupillometer based on an infrared camera coupled to the optical head of a videokeratography system. Patients underwent complete ophthalmic evaluation and documentation of the pupillary behavior under different intensities of illumination, simulating situations of everyday life. Visual quality function questionnaire, translated to Portuguese was assessed. RESULTS: All patients, regardless of pupillary change under varying conditions of illumination (scotopic, mesopic and photopic) showed improvement in all sub-groups of the VQF 25. Pupil diameter was not the primary determinant of patients' visual satisfaction. CONCLUSION: Despite digital pupillometer has proven to be a useful tool in documenting and understanding of pupil behavior, a set of factors such as psycho-social profile, preoperative ametropy and final residual ametropy, contributed decisively to determine the degree of satisfaction of patients undergoing LASIK.
OBJETIVO: Identificar perfis ideais em pacientes submetidos à cirurgia fotorrefrativa a laser com o auxílio de um pupilômetro automatizado e análise psicométrica de pacientes com o questionário de função visual (VQF 25). MÉTODOS: Setenta e sete pacientes submetidos à cirurgia fotorrefrativa a laser (LASIK) foram analisados com o auxílio de um pupilômetro digital automatizado baseado em uma câmera de infravermelho acoplado à cabeça óptica de um sistema de videoceratografia. Os pacientes foram submetidos à avaliação oftalmológica completa e documentação do comportamento pupilar em diferentes intensidades de iluminação, simulando situações da vida cotidiana. O questionário de qualidade da função visual, traduzido para o Português, foi avaliado. RESULTADOS: Todos os pacientes, independentemente da mudança pupilar em diferentes condições de iluminação (escotópica, mesópica e fotópica) apresentaram melhora em todos os subgrupos do VQF 25. O diâmetro pupilar não foi o principal determinante da satisfação visual dos pacientes. CONCLUSÃO: Apesar do pupilômetro digital ter provado ser uma ferramenta útil na documentação e compreensão do comportamento da pupila, um conjunto de fatores, tais como o perfil psicossocial, ametropia pré-operatória e ametropia residual final, contribuiu de forma decisiva para determinar o grau de satisfação dos pacientes submetidos a LASIK.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Ceratomileuse Assistida por Excimer Laser In Situ/psicologia , Reflexo Pupilar/fisiologia , Acuidade Visual/fisiologia , Ceratomileuse Assistida por Excimer Laser In Situ , Psicometria , Ceratectomia Fotorrefrativa/psicologia , Ceratectomia Fotorrefrativa , Inquéritos e QuestionáriosRESUMO
We report a case of bilateral loss of pupillary light reflex and accommodation following 360° peripheral retinal laser therapy. A 24 years old male underwent prophylactic laser barrage for peripheral retinal lattice degenerations. Soon after the procedure, he developed bilateral loss of pupillary light reflex and accommodation. The patient faced difficulty while doing near work. On instillation of 0.125% pilocarpine, both pupils demonstrated the phenomenon of denervation supersensitivity. Damage to the short ciliary nerves was the most likely mechanism responsible for this adverse outcome
Assuntos
Humanos , Masculino , Adulto , Sistema Nervoso Parassimpático/efeitos da radiação , Degeneração Retiniana/cirurgia , Corpo Ciliar/inervação , Acomodação Ocular/efeitos dos fármacos , Denervação Muscular , Reflexo Pupilar/efeitos dos fármacos , Resultado do TratamentoRESUMO
Context: Pupil cycle time (PCT) has been widely used for examination of ocular diabetic autonomic neuropathy (DAN). Aims: The primary aim of this study was to evaluate the difference of contrast sensitivity according to PCT results, and the secondary aim was to determine the factors associated with PCT difference for type II diabetes patients. Settings and Design: A clinical pilot study that included a total of 60 eyes of 60 type II diabetes patients. Materials and Methods: We divided all patients into three groups according to PCT results. Group A and Group C were composed of patients who had upper one third PCT and lower one third PCT, respectively. We analyzed difference of age, diabetes duration, hypertension duration, mean best corrected visual acuity (BCVA), mean spherical equivalent (SE), HbA1C, glomerular filtration rate (GFR), stage of diabetic retinopathy, and Cardiac Autonomic Function Score (CAFS). Contrast sensitivity and decrease of visual acuity by glare were also estimated and analyzed for 28 eyes of 28 non-proliferative diabetic retinopathy (NPDR) patients. Group [NPDR] A and Group [NPDR] C were defined as those who had lower one third PCT and upper one third PCT, respectively. Statistical Analysis: Statistical analysis was done using SPSS 17.0 software. Results and Conclusions: Each group contained 20 eyes. Significant differences between Group A and Group C were observed in duration of diabetes and CAFS (P ≤ 0.001 and P <0.001, respectively). Contrast sensitivity in Group [NPDR] A was significantly more than in Group [NPDR] C at all cpds (all P ≤ 0.001). We found that PCT can influence contrast sensitivity or glare in diabetes patients and also confirmed a significant correlation of PCT with CAFS and duration of diabetes.
Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Sensibilidades de Contraste , Diabetes Mellitus Tipo 2/fisiopatologia , Retinopatia Diabética/fisiopatologia , Ofuscação , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Reflexo Pupilar , Fatores de TempoRESUMO
Este trabalho tem por objetivo apresentar o teste do reflexo vermelho ao pediatra , ao medico generalista e ao estudante de medicina , demonstrando o seu papel no rastreamento de patologias oculares neonatais e sua importância na prevenção da cegueira infantil.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Cegueira/prevenção & controle , Oftalmopatias/diagnóstico , Reflexo PupilarRESUMO
OBJECTIVE: Stroke is the most prevalent disease involving the central nervous system. Since medical modalities are sometimes ineffective for the acute edema following massive infarction, surgical decompression may be an effective option when medical treatments fail. The present study was undertaken to assess the outcome and prognostic factors of decompressive surgery in life threatening acute, severe, brain infarction. METHODS: We retrospectively analyzed twenty-six patients (17 males and 9 females; average age, 49.7yrs) who underwent decompressive surgery for severe cerebral or cerebellar infarction from January 2003 to December 2006. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). RESULTS: Of the 26 patients, 5 (19.2%) showed good recovery, 5 (19.2%) showed moderate disability, 2 (7.7%) severe disability, 6 (23.1%) persistent experienced vegetative state, and 8 (30.8%) death. In this study, the surgical decompression improved outcome for cerebellar infarction, but decompressive surgery did not show a good result for MCA infarction (30.8% overall mortality vs 100% mortality). The dominant-hemisphere infarcts showed worse prognosis, compared with nondominant-hemisphere infarcts (54.5% vs 70%). Poor prognostic factors were diabetes mellitus, dominant-hemisphere infarcts and low preoperative Glasgow Coma Scale (GCS) score. CONCLUSION: The patients who exhibit clinical deterioration despite aggressive medical management following severe cerebral infarction should be considered for decompressive surgery. For better outcome, prompt surgical treatment is mandatory. We recommend that patients with severe cerebral infarction should be referred to neurosurgical department primarily in emergency setting or as early as possible for such prompt surgical treatment.
Assuntos
Feminino , Humanos , Masculino , Edema Encefálico , Infarto Encefálico , Encéfalo , Sistema Nervoso Central , Infarto Cerebral , Descompressão , Descompressão Cirúrgica , Diabetes Mellitus , Edema , Emergências , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Infarto , Infarto da Artéria Cerebral Média , Mortalidade , Estado Vegetativo Persistente , Prognóstico , Reflexo Pupilar , Estudos Retrospectivos , Acidente Vascular CerebralAssuntos
Humanos , Feminino , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/diagnóstico por imagem , Sedimentação Sanguínea , Abscesso Encefálico/terapia , Tomografia Computadorizada por Raios X , Imageamento por Ressonância Magnética , Reflexo Pupilar , Rigidez Muscular , Escala de Coma de GlasgowRESUMO
Background: Anoxic-ischemic coma has a poor outcome with a high rate of mortality and morbidity. Therefore, clinical predictors of prognosis are needed for therapeutic decision-making. Patients and methods: Prospective analysis of 46 patients, 31 male, age range 19-85 years, with anoxic-ischemic coma following cardiac arrest. All the patients included in our study remained comatose with a Glasgow Coma Scale (GCS) score of six or less points, after their stabilization in the Intensive Care Unit. They were evaluated clinically using the pupillary light reflex, corneal reflex and vestibulo-ocular reflex testing, induced by caloric stimulation with cold water. Survival was evaluated using life tables. All patients were followed until the thirtieth day after the anoxic-ischemic event. Results: Thirty five patients (76%) died within the next twenty-nine days, 8 patients (18%) reached the vegetative state, 2 patients (4%) achieved a recovery with disability, and only 1 patient (2%) was discharged without sequelae. One day, five and 30 days survival rates were 89, 53 and 29%, respectively. The abolition of all brainstem reflexes was not a predictor of mortality. Conclusion: Thirty day survival in this group of patients was 29% and the absence of brainstem reflexes was not a predictor of mortality.