RESUMO
Vertical one-and-a-half syndrome (VOHS) is an uncommon presentation resulting from a unilateral thalamomesencephalic stroke with involvement of the rostral interstitial nucleus of the medial longitudinal fasciculus and posterior commissure. The artery of Percheron (aPe) is a branch of the posterior cerebral artery (PCA) and it is a variant that arises as a solitary trunk supplying both medial thalami and upper midbrain. A 78-year-old female patient, presented at the hospital emergency with approximately 12 hours of sudden onset of diplopia, associated with dizziness. Neurological exam revealed torsional nystagmus associated with bilateral upgaze palsy with limitation of infraduction on the left. We describe a rare case of VOHS associated with ischemic alterations at the MRI suggesting an aPe impairment. The conjugate gaze control lies anatomically at the midbrain at the central nervous system (CNS). This report describes a rare type of VOHS and brings a new insight on a possible aPe topography possibly causing this clinical presentation.
RESUMO
JUSTIFICATIVA E OBJETIVOS: A criança internada, na maioria das vezes, é submetida à punção venosa e talvez essa seja a experiência mais estressante percebida no decorrer da sua internação. O objetivo deste estudo foi avaliar a intensidade da dor da criança em idade escolar quando submetida á punção venosa periférica.MÉTODO: Após aprovação pelo Comitê de Ética em Pesquisa da Instituição, usando a escala de faces e a escala visual numérica para a avaliação da dor no momento da punção venosa, foram estudadas 31 crianças em idade escolar submetidas à punção venosa, sendo que 67,74% delas já haviam sido internadas e vivenciadas o procedimento anteriormente.RESULTADOS: Em relação à intensidade da dor 48,39% das crianças informaram que foi de intensidade leve, 32,27% sentiram dor moderada, 9,67% dor insuportável, sendo que 9,67% das crianças informaram não ter sentido nenhuma dor no momento da punção venosa. Analisando as etapas do procedimento verificou-se que o uso do garrote causou mais desconforto em 32,28% das crianças, a introdução da agulha foi responsável pelo maior desconforto em 29,03% e a infusão de medicamentos foi a causa do maior desconforto para 16,12% das crianças.CONCLUSÃO: Embora o procedimento de punção venosa periférica seja bastante comum na unidade pediátrica, a dor e o desconforto não estão relacionados apenas à punção propriamente dita, mas também ao uso do torniquete para melhor expor a veia e a infusão do liquido.
BACKGROUND AND OBJECTIVES: Hospitalized children are very often submitted to venous puncture and this might be the most stressing experience perceived by them throughout their hospital stay. This study aimed at assessing pain intensity in school-age children submitted to peripheral venous puncture.METHOD: After the Institution?s Research Ethics Committee approval and using the faces scale and the numeric scale visual to evaluate pain at venous puncture, 31 school-age children submitted to venous puncture were evaluated, being that 67.74% of them had already been hospitalized and experienced the venous puncture procedure.RESULTS: With regard to pain intensity, 48.39% of children informed that it was mild, 32.27% felt moderate pain, 9.67% unbearable pain and 9.67% of children said they had no pain during venous puncture. Analyzing the stages of the procedure we have observed that tourniquet has caused greater discomfort to 32.28% of children, needle introduction was responsible for greater discomfort to 29.03% and drug infusion was the cause of greater discomfort to 16.12% of children.CONCLUSION: Although peripheral venous puncture is very common in pediatric units, pain and discomfort are not related only to the puncture itself, but also to the use of tourniquet to better expose the vein and to the drug infusion.