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1.
Artigo em Inglês | MEDLINE | ID: covidwho-381838

RESUMO

OBJECTIVE: To describe a novel case of coronavirus disease 2019 (COVID-19)-associated acute necrotizing encephalopathy (ANE) in a patient with aplastic anemia where there was early brain stem-predominant involvement. METHODS: Evaluation of cause, clinical symptoms, and treatment response. RESULTS: A 59-year-old woman with a background of transfusion-dependent aplastic anemia presented with seizures and reduced level of consciousness 10 days after the onset of subjective fever, cough, and headache. Nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus (SARS-CoV-2) was positive, and CT during admission demonstrated diffuse swelling of the brain stem. She required intubation and mechanical ventilation for airway protection, given her reduced level of consciousness. The patient's condition deteriorated, and MRI on day 6 demonstrated worsening brain stem swelling with symmetrical hemorrhagic lesions in the brain stem, amygdalae, putamina, and thalamic nuclei. Appearances were consistent with hemorrhagic ANE with early brain stem involvement. The patient showed no response to steroid therapy and died on the eighth day of admission. CONCLUSIONS: COVID-19 may be associated with an acute severe encephalopathy and, in this case, was considered most likely to represent an immune-mediated phenomenon. As the pandemic continues, we anticipate that the spectrum of neurologic presentation will broaden. It will be important to delineate the full clinical range of emergent COVID-19-related neurologic disease.


Assuntos
Anemia Aplástica/complicações , Infecções por Coronavirus/complicações , Leucoencefalite Hemorrágica Aguda/etiologia , Pneumonia Viral/complicações , Tonsila do Cerebelo/diagnóstico por imagem , Anemia Aplástica/terapia , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Edema Encefálico/fisiopatologia , Edema Encefálico/terapia , Tronco Encefálico/diagnóstico por imagem , Infecções por Coronavirus/terapia , Dexametasona/uso terapêutico , Imagem de Difusão por Ressonância Magnética , Evolução Fatal , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Leucoencefalite Hemorrágica Aguda/diagnóstico por imagem , Leucoencefalite Hemorrágica Aguda/fisiopatologia , Leucoencefalite Hemorrágica Aguda/terapia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Pandemias , Transfusão de Plaquetas , Pneumonia Viral/terapia , Hemorragia Putaminal/diagnóstico por imagem , Hemorragia Putaminal/etiologia , Hemorragia Putaminal/fisiopatologia , Respiração Artificial , Convulsões/etiologia , Núcleos Talâmicos/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
Artigo em Inglês | MEDLINE | ID: mdl-32457227

RESUMO

OBJECTIVE: To describe a novel case of coronavirus disease 2019 (COVID-19)-associated acute necrotizing encephalopathy (ANE) in a patient with aplastic anemia where there was early brain stem-predominant involvement. METHODS: Evaluation of cause, clinical symptoms, and treatment response. RESULTS: A 59-year-old woman with a background of transfusion-dependent aplastic anemia presented with seizures and reduced level of consciousness 10 days after the onset of subjective fever, cough, and headache. Nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus (SARS-CoV-2) was positive, and CT during admission demonstrated diffuse swelling of the brain stem. She required intubation and mechanical ventilation for airway protection, given her reduced level of consciousness. The patient's condition deteriorated, and MRI on day 6 demonstrated worsening brain stem swelling with symmetrical hemorrhagic lesions in the brain stem, amygdalae, putamina, and thalamic nuclei. Appearances were consistent with hemorrhagic ANE with early brain stem involvement. The patient showed no response to steroid therapy and died on the eighth day of admission. CONCLUSIONS: COVID-19 may be associated with an acute severe encephalopathy and, in this case, was considered most likely to represent an immune-mediated phenomenon. As the pandemic continues, we anticipate that the spectrum of neurologic presentation will broaden. It will be important to delineate the full clinical range of emergent COVID-19-related neurologic disease.


Assuntos
Anemia Aplástica/complicações , Infecções por Coronavirus/complicações , Leucoencefalite Hemorrágica Aguda/etiologia , Pneumonia Viral/complicações , Tonsila do Cerebelo/diagnóstico por imagem , Anemia Aplástica/terapia , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Edema Encefálico/fisiopatologia , Edema Encefálico/terapia , Tronco Encefálico/diagnóstico por imagem , Infecções por Coronavirus/terapia , Dexametasona/uso terapêutico , Imagem de Difusão por Ressonância Magnética , Evolução Fatal , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Leucoencefalite Hemorrágica Aguda/diagnóstico por imagem , Leucoencefalite Hemorrágica Aguda/fisiopatologia , Leucoencefalite Hemorrágica Aguda/terapia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Pandemias , Transfusão de Plaquetas , Pneumonia Viral/terapia , Hemorragia Putaminal/diagnóstico por imagem , Hemorragia Putaminal/etiologia , Hemorragia Putaminal/fisiopatologia , Respiração Artificial , Convulsões/etiologia , Núcleos Talâmicos/diagnóstico por imagem , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 97(29): e11035, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30024496

RESUMO

It is not clear whether the fornix and cingulum are involved in cognition after putaminal hemorrhage (PH). We investigated structural changes and differences of the neural tracts, and the relationship between the integrity of the neural tracts and cognition not only at the affected but also at the unaffected side.Sixteen patients with left chronic putaminal hemorrhage and 20 healthy volunteers were enrolled. Using diffusion tensor tractography (DTT), we compared fiber number (FN), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of the neural tracts between patient and control groups. The relationship between the neural tract parameters and neuropsychological results was also analyzed.The left fornix FN was significantly lower than the right fornix FN in the patient group. Except for the cingulum FA, the neural tracts parameters for both the affected and unaffected hemispheres differed significantly between the groups. The fornix FA and ADC at the affected side were significantly correlated with intelligence quotient (IQ), mini-mental status examination (MMSE), and short-term memory. Interestingly, the fornix ADC at the unaffected side was significantly correlated with MMSE. However, none of the cingulum parameters was correlated with neuropsychological results.The fornix integrity is critical for cognitive impairment after putaminal hemorrhage.


Assuntos
Disfunção Cognitiva/etiologia , Fórnice/patologia , Giro do Cíngulo/patologia , Hemorragia Putaminal/complicações , Adulto , Idoso , Anisotropia , Doença Crônica , Cognição , Disfunção Cognitiva/patologia , Imagem de Tensor de Difusão/métodos , Feminino , Fórnice/diagnóstico por imagem , Giro do Cíngulo/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Testes Neuropsicológicos
5.
Eur Neurol ; 79(1-2): 33-37, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29130982

RESUMO

OBJECTIVE: We aimed to clarify the relationship between aphasia and hematoma type/volume in patients with left putaminal hemorrhage admitted to a rehabilitation facility. METHODS: We evaluated the relationship between the presence, type, and severity of aphasia and hematoma type/volume in 92 patients with putaminal hemorrhage aged 29-83 years. Hematoma type and volume were evaluated on the basis of CT images obtained at stroke onset. The Standard Language Test for Aphasia was conducted as part of the initial assessment. RESULTS: Aphasia was observed in 79 of 92 patients. A total of 31 patients had fluent aphasia, while 48 had non-fluent aphasia. Non-fluent aphasia often involved hematoma on the anterior limb of the internal capsule, while fluent aphasia often involved hematoma on the posterior limb of internal capsule. When the hematoma volume exceeded 20 mL, patients experienced difficulty in repeating spoken words. When hematoma volume exceeded 40 mL, non-fluent aphasia was observed in all patients. CONCLUSION: Our findings suggest that hematoma type and volume not only influence the development of aphasia following putaminal hemorrhage but also play a major role in determining the patient's fluency and repetition ability.


Assuntos
Afasia/epidemiologia , Afasia/etiologia , Hemorragia Putaminal/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma/complicações , Hematoma/patologia , Hospitais de Reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Hemorragia Putaminal/patologia
6.
Hum Brain Mapp ; 39(3): 1339-1353, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29239063

RESUMO

Novel methods that stimulate neuroplasticity are increasingly being studied to treat neurological and psychiatric conditions. We sought to determine whether real-time fMRI neurofeedback training is feasible in Huntington's disease (HD), and assess any factors that contribute to its effectiveness. In this proof-of-concept study, we used this technique to train 10 patients with HD to volitionally regulate the activity of their supplementary motor area (SMA). We collected detailed behavioral and neuroimaging data before and after training to examine changes of brain function and structure, and cognitive and motor performance. We found that patients overall learned to increase activity of the target region during training with variable effects on cognitive and motor behavior. Improved cognitive and motor performance after training predicted increases in pre-SMA grey matter volume, fMRI activity in the left putamen, and increased SMA-left putamen functional connectivity. Although we did not directly target the putamen and corticostriatal connectivity during neurofeedback training, our results suggest that training the SMA can lead to regulation of associated networks with beneficial effects in behavior. We conclude that neurofeedback training can induce plasticity in patients with Huntington's disease despite the presence of neurodegeneration, and the effects of training a single region may engage other regions and circuits implicated in disease pathology.


Assuntos
Doença de Huntington/fisiopatologia , Imagem por Ressonância Magnética , Córtex Motor/fisiopatologia , Neurorretroalimentação/métodos , Plasticidade Neuronal , Adulto , Idoso , Mapeamento Encefálico , Cognição/fisiologia , Feminino , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Humanos , Doença de Huntington/diagnóstico por imagem , Doença de Huntington/patologia , Aprendizagem/fisiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Córtex Motor/diagnóstico por imagem , Córtex Motor/patologia , Neurorretroalimentação/fisiologia , Plasticidade Neuronal/fisiologia , Tamanho do Órgão , Estudo de Prova de Conceito , Hemorragia Putaminal/diagnóstico por imagem , Hemorragia Putaminal/fisiopatologia , Volição/fisiologia
7.
BMJ Case Rep ; 20172017 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-29269367

RESUMO

A 55-year-old right-handed man with a history of hypertension suddenly fell and developed right hemiparesis. Neurological examination revealed that he was alert, but did not appropriately respond to verbal questions and commands. Detailed examination revealed that he could correctly respond to written commands. His speech was almost fluent, showing no paraphasia and normal articulation. His written sentences were legible. Pure tone audiometry showed that his auditory acuity was relatively preserved. His brainstem auditory evoked potential components from I to V were recorded bilaterally with normal latency. Cerebral CT demonstrated fresh bleeding in the left putamen and an old haemorrhage on the opposite side. He was treated by antihypertensive therapy and rehabilitation. Although there remained mild sensory deficit on his right extremities and he felt a slight noise during conversation, he had little difficulty with verbal communication when he was transferred to another hospital on day 38.


Assuntos
Acidentes por Quedas , Agnosia/fisiopatologia , Anti-Hipertensivos/uso terapêutico , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Hipertensão/fisiopatologia , Hemorragia Putaminal/fisiopatologia , Agnosia/diagnóstico por imagem , Agnosia/reabilitação , Audiometria de Tons Puros , Percepção Auditiva/fisiologia , Angiografia por Tomografia Computadorizada , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Hemorragia Putaminal/complicações , Hemorragia Putaminal/diagnóstico por imagem , Fonoterapia , Resultado do Tratamento , Comportamento Verbal/fisiologia
8.
Technol Health Care ; 25(6): 1061-1071, 2017 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-28854525

RESUMO

OBJECTIVE: This study aims to compare the curative effect of different treatment methods of hypertensive putamen hemorrhage, in order to determine an ideal method of treatment; and to explore the curative effect of the application of soft channel technology-minimally invasive liquefaction and drainage of intracerebral hematoma in the treatment of hypertensive putamen hemorrhage. METHODS: Patients with hypertensive cerebral hemorrhage, who were treated in our hospital from January 2015 to January 2016, were included into this study. Patients were divided into three groups: minimally invasive drainage group, internal medical treatment group and craniotomy group. In the minimally invasive drainage group, puncture aspiration and drainage were performed according to different hematoma conditions detected in brain CT, the frontal approach was selected for putamen and intracerebral hemorrhage, and drainage was reserved until the hematoma disappeared in CT detection. Drug therapy was dominated in the internal medical treatment group, while surgery under general anesthesia was performed to remove the hematoma in the craniotomy group. RESULTS: Post-treatment neurological function defect scores in minimally invasive drainage group and internal medical group were 16.14 ± 11.27 and 31.43 ± 10.42, respectively; and the difference was remarkably significant (P< 0.01). Post-treatment neurological function defect scores in the minimally invasive drainage group and craniotomy group were 16.14 ± 11.27 and 24.20 ± 12.23, respectively; and the difference was statistically significant (P< 0.05). There was a remarkable significant difference in ADL1-2 level during followed-up in survival patients between the minimally invasive drainage group and internal medical treatment group (P< 0.01), and there was a significant difference in followed-up mortality between these two groups (P< 0.01). CONCLUSION: Clinical observation and following-up results revealed that minimally invasive drainage treatment was superior to internal medical treatment and craniotomy.


Assuntos
Drenagem/métodos , Hematoma/etiologia , Hematoma/terapia , Hipertensão/complicações , Hemorragia Putaminal/etiologia , Idoso , Craniotomia/métodos , Feminino , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tomografia Computadorizada por Raios X
9.
World Neurosurg ; 107: 211-215, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28790006

RESUMO

OBJECTIVE: It is expected that anatomic variations in the circle of Willis have a direct effect on blood flow in the internal carotid artery. Rupture of the lenticulostriate artery of the middle cerebral artery 1st segment (M1) is the most common cause of putaminal intracerebral hemorrhage (ICH), and we hypothesized that this could be related to the anatomic variations of the circle of Willis and the predominance of the anterior cerebral artery 1st segment (A1). METHODS: We retrospectively reviewed the records of 544 patients who were treated for spontaneous ICH between 2013 and 2016 at Yeungnam University Hospital. Among them, 83 patients (49 men and 34 women; mean age, 60.38 years; range, 34-87 years) were admitted for the treatment of putaminal ICH. The circle of Willis was visualized on the basis of computed tomographic (CT) angiographic images with 3-dimensional (3D) reconstruction images. The number of putaminal ICH patients who showed differences in diameter between the right and left A1 segments, with a normal variation of the anterior cerebral artery (ACA), was analyzed. RESULTS: Among 83 patients with spontaneous ICH, 46 and 37 had left and right putaminal hemorrhages, respectively. Sixty-seven patients were treated conservatively, and 16 patients underwent surgery. The number of patients with a dominant A1 segment on either side was 58 (67.4%). Forty patients had a dominant A1 segment and putaminal ICH located in the same direction (P = 0.007). CONCLUSION: It was concluded that putaminal ICHs occur more frequently on the side of the dominant A1 segment. This information can help an understanding of the mechanism of putaminal spontaneous ICH development and may even assist in the treatment of ICH.


Assuntos
Artéria Cerebral Anterior/patologia , Círculo Arterial do Cérebro/patologia , Hemorragia Putaminal/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Circulação Cerebrovascular/fisiologia , Angiografia por Tomografia Computadorizada/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Hemorragia Putaminal/fisiopatologia , Estudos Retrospectivos
10.
Rinsho Shinkeigaku ; 57(8): 441-445, 2017 08 31.
Artigo em Japonês | MEDLINE | ID: mdl-28740065

RESUMO

A 45-year-old right-handed man with a past history (10 years) of putaminal hemorrage presented with auditory agnosia associated with left putaminal hemorrhage. It was suspected that the auditory agnosia was due to bilateral damage in the acoustic radiations. Generalized auditory agnosia, verbal and non-verbal (music and environmental), was diagnosed by neuropsychological examinations. It improved 4 months after the onset. However, the clinical assessment of attention remained poor. The cognition for speech sounds improved slowly, but once it started to improve, the progress of improvement was rapid. Subsequently, the cognition for music sounds also improved, while the recovery of the cognition for environmental sounds remained delayed. There was a dissociation in recovery between these cognitions. He was able to return to work a year after the onset. We also reviewed the literature for cases with auditory agnosia and discuss their course of recovery in this report.


Assuntos
Agnosia/psicologia , Agnosia/reabilitação , Hemorragia Putaminal/complicações , Retorno ao Trabalho , Agnosia/diagnóstico , Agnosia/etiologia , Atenção , Cognição , Humanos , Masculino , Pessoa de Meia-Idade , Música , Testes Neuropsicológicos , Fonética , Som , Fatores de Tempo
11.
Neurosci Lett ; 653: 163-167, 2017 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-28558977

RESUMO

OBJECTIVES: We investigated differences in recovery course of motor weakness according to the state of the corticospinal tract (CST) in putaminal hemorrhage, using diffusion tensor tractography (DTT). METHODS: We recruited 36 patients with complete weakness of the affected extremities at onset. The patients were classified into two groups according to the findings of DTT for the CST at chronic stage: group A- preserved integrity of the CST around the lesion, and group B- discontinued integrity of the CST. Motor function of the affected extremities was measured over a six month period using the Motricity Index (MI). RESULTS: The MI scores differed significantly each month, except at the onset, between group A and group B (p<0.05). In both groups, we observed significant increases between onset and one month, between one month and two months, between two month and three months, and between three months and four months (p<0.05). However, there were no significant increases after four months (p>0.05). The degree of difference between months was as follows: onset ∼1 month, 1 month ∼2months, 2 months ∼3months, and 3 months ∼4months. CONCLUSIONS: Patients with preserved integrity of the CST showed better motor function than patients with discontinued integrity of the CST. In both groups, significant motor recovery was achieved during the first four months after onset. In addition, the most rapid motor recovery occurred during the first month and then decreased gradually with the passage of time.


Assuntos
Movimento , Hemorragia Putaminal/fisiopatologia , Tratos Piramidais/fisiopatologia , Recuperação de Função Fisiológica , Adulto , Idoso , Imagem de Tensor de Difusão , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Putaminal/patologia , Tratos Piramidais/patologia
12.
J Stroke Cerebrovasc Dis ; 26(7): 1541-1546, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28285089

RESUMO

BACKGROUND: Chronic expanding intracerebral hematoma is a well-known complication of spontaneous intracerebral hemorrhage. However, because chronic expanding intracerebral hematoma is relatively rare, it has not been studied systemically. The purpose of this study was to characterize a patient population with chronic expanding intracerebral hematoma, and to identify the predictive factors for it. METHODS: We retrospectively evaluated 112 patients with spontaneous putaminal hemorrhage who were treated at our institution between January 1, 2010 and December 31, 2015. Data on age, sex, Glasgow Coma Scale score, presence of intraventricular hemorrhage, and intracerebral hemorrhage volume were collected, and their predictive values for chronic expanding intracerebral hematoma were investigated. We also evaluated the predictive value of a characteristic radiological finding at onset called the "layer sign," which was represented as a fluid level adjacent to the clot. RESULTS: Chronic expanding intracerebral hematoma was observed in 4 patients (4.9%) with spontaneous intracerebral hemorrhage. Only the layer sign was significantly related to chronic expanding intracerebral hematoma (P = .003), and was found to be independently associated with chronic expanding intracerebral hematoma in a multivariate analysis (odds ratio, 18.6; 95% confidence interval, 1.19-291.0; P = .037). CONCLUSIONS: The frequency of chronic expanding intracerebral hematoma in those with spontaneous intracerebral hemorrhage was estimated at 4.9%. The layer sign was a useful factor for predicting chronic expanding intracerebral hematoma.


Assuntos
Hematoma/etiologia , Hemorragia Putaminal/complicações , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Doença Crônica , Angiografia por Tomografia Computadorizada , Feminino , Hematoma/diagnóstico por imagem , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Hemorragia Putaminal/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X
14.
Turk Neurosurg ; 27(4): 500-508, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27593801

RESUMO

AIM: To identify whether neuronavigation-assisted aspiration (NA) combined with electro-acupuncture (EA) provides better motor recovery in events of hypertensive putaminal hematoma (HPH) sized 30 to 50 ml. This study aims to examine whether neuronavigation-assisted aspiration and electro-acupuncture have additional value to cerebral hemorrhage motor rehabilitation. MATERIAL AND METHODS: 240 patients with HPH sized 30 to 50 ml and admitted within 6 to 10 hours after stroke ictus were included in this study. Group 1 contained 60 patients who underwent neuronavigation-assisted aspiration and electro-acupuncture (NAEA), group 2 contained 60 patients who underwent neuronavigation-assisted aspiration (NA), group 3 contained 60 patients who underwent electro-acupuncture (EA), and group 4 contained 60 patients who received conservative therapy consisting solely of medications. All the patients received the same therapeutic plan on admission and functional exercises three days after stroke onset. Electro-acupuncture was performed on the third day of admission; motor recovery was examined on weeks zero and eight by blinded assessors. Outcome measures included Fugl-Meyer assessment, modified Ashworth Scale and Functional Independence Measure. RESULTS: Group one showed significantly improved motor outcomes compared to group four (p < 0.01). Group one also showed significant motor improvement when pre-and post- therapy functioning was examined (p < 0.01). Cerebral edema and ischemia were significantly decreased in group one compared to group 3 and 4 (p < 0.05). While not as effective as group one treatment, group two and group three patients had significant motor recovery after intervention when compared to group four (p < 0.05). Muscular tension secondary to stroke was considerably improved between group one and group four, group two and group four, group three and group four respectively (p < 0.05). Activities of daily living (ADL) improved a lot with EA together with NA. CONCLUSION: Neuronavigation-assisted aspiration and electro-acupuncture of HPH at the early stage can provide improved motor recovery with fewer complications. Significant motor recovery can be achieved by neuronavigation-assisted aspiration with acupuncture. Based on our findings, we recommend early intervention with NA and EA in order to promote early rehabilitation of hemiplegia secondary to HPH.


Assuntos
Eletroacupuntura/métodos , Hemiplegia/terapia , Neuronavegação , Paracentese/métodos , Hemorragia Putaminal/terapia , Atividades Cotidianas , Edema Encefálico/complicações , Edema Encefálico/terapia , Terapia por Exercício , Feminino , Hemiplegia/complicações , Hemiplegia/reabilitação , Humanos , Isquemia/complicações , Isquemia/terapia , Masculino , Pessoa de Meia-Idade , Hemorragia Putaminal/complicações , Hemorragia Putaminal/tratamento farmacológico , Hemorragia Putaminal/reabilitação , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
15.
Medicine (Baltimore) ; 96(50): e9123, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29390312

RESUMO

RATIONALE: A 50-year-old man presented with complete paralysis at the onset of a putaminal hemorrhage. PATIENT CONCERNS: The patient presented with complete paralysis of the left upper and lower extremities (Medical Research Council:0/5). DIAGNOSES: Spontaneous intra crebral hemorrhage on putamen. INTERVENTION: He underwent comprehensive rehabilitative therapy from 3 weeks after onset. At 3weeks after onset, he presented with severe weakness of the left extremities. The weakness of his left extremities had recovered as follows at 3 months after onset. Consequently, he was able to walk independently on an even floor. OUTCOMES: On 3-week and 3-month diffusion tensor tractography (DTTs), the right corticospinal tract (CST) and the corticoreticulospinal tract (CRT) showed discontinuations below the lesion. On 3-month DTT, the left CST had become thinner; however, the left CRT had become thicker compared with 3-week DTT (Fig. 1). LESSONS: To the best of our knowledge, this is the first study to demonstrate the activation process of the CRT in the unaffected hemisphere in relation to gait recovery from early to chronic stage of stroke.


Assuntos
Transtornos Neurológicos da Marcha/reabilitação , Paralisia/reabilitação , Hemorragia Putaminal/complicações , Imagem de Tensor de Difusão , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia/etiologia , Recuperação de Função Fisiológica
16.
World Neurosurg ; 98: 140-145, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27810452

RESUMO

BACKGROUND: The appropriate amount of transfused fluids, and which types of fluids should be transfused during the peri-operative period, is a matter of controversy among neurosurgeons. Thus, a retrospective study was conducted to assess whether crystalloid transfusion is associated with better outcomes after spontaneous hypertensive putamen hemorrhage (HPH). METHODS: Data from acute spontaneous HPH surgeries performed between December 2013 and June 2016 were collected in a multi-center chart. The primary outcome was prognosis, with better outcome defined as a Glasgow outcome score (GOS) of 4 or greater. The secondary outcome was survival, with survival defined as a GOS score of 2 or greater. Univariate analysis and bivariate logistic regression were performed to account for the association between perioperative HPH and different outcomes. We also used Spearman rank correlation and linear regression to determine the correlation between length of stay (LOS) and the univariate analysis significant factors in patients with a GOS score of 4 or greater. RESULTS: Bivariate logistic regression showed a marked correlation between better outcome and age (odds ratio [OR], 0.927; 95% confidence interval [CI], 0.851-0.995), Glasgow Coma Scale (GCS; OR, 1.162; 95% CI, 1.049-1.356), and crystalloid transfusion (OR, 1.083; 95% CI, 1.005-1.142). In addition, bivariate logistic regression also revealed a significant correlation between survival and GCS score (OR, 1.097; 95% CI, 1.056-1.199). In patients with a GOS of 4 or greater, Spearman rank correlation and linear regression suggested that a higher GCS score was more likely to prolong the LOS. CONCLUSION: Increased perioperative crystalloid transfusion was independently associated with better outcome across a spectrum of surgical risk profiles after spontaneous HPH.


Assuntos
Transfusão de Sangue/métodos , Descompressão Cirúrgica/métodos , Hipotensão Intracraniana/complicações , Soluções Isotônicas/uso terapêutico , Assistência Perioperatória/métodos , Hemorragia Putaminal/etiologia , Adulto , Idoso , Soluções Cristaloides , Feminino , Escala de Coma de Glasgow , Humanos , Hipotensão Intracraniana/diagnóstico por imagem , Hipotensão Intracraniana/mortalidade , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomógrafos Computadorizados , Resultado do Tratamento
17.
Neurocase ; 22(6): 518-525, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27925501

RESUMO

A 63-year-old, right-handed professional chorus conductor developed right putaminal hemorrhage, and became unable to experience emotion while listening to music. Two years later, neurological examination revealed slight left hemiparesis. Neuromusicological assessments revealed impaired judgment of "musical sense," and the inability to discriminate the sound of chords in pure intervals from those in equal temperament. Brain MRI and tractography identified the old hemorrhagic lesion in the right putamen and impaired fiber connectivity between the right insula and superior temporal lobe. These findings suggest that musical anhedonia might be caused by a disconnection between the insula and auditory cortex.


Assuntos
Anedonia/fisiologia , Córtex Auditivo/patologia , Córtex Cerebral/patologia , Lateralidade Funcional/fisiologia , Música , Hemorragia Putaminal , Córtex Auditivo/diagnóstico por imagem , Percepção Auditiva , Córtex Cerebral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiologia , Neuroimagem , Exame Neurológico , Hemorragia Putaminal/diagnóstico por imagem , Hemorragia Putaminal/patologia , Hemorragia Putaminal/fisiopatologia , Hemorragia Putaminal/psicologia
18.
Acta Neurochir Suppl ; 123: 17-23, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27637624

RESUMO

BACKGROUND: Conventionally, patients suffering a massive intraventricular hemorrhage have undergone external ventricular drainage. However, long-term or repeated drainage increases the risk of complications due to infections or shunt dependency. Neuroendoscopic surgery may offer some advantages over more conventional procedures. METHODS: Thirteen patients suffering intraventricular hematoma associated with intracerebral hemorrhage, treated in our hospital between April 2011 and March 2014, were reviewed retrospectively. Casting hematomas in the ventricles were manually aspirated using a flexible endoscope. The timing of the operation, period of post-endoscopic ventricular drainage, additional internal shunt surgery, 3-month post-surgical outcome, and critical complications were evaluated. RESULTS: Two patients (treated during our earliest use of endoscope) who underwent surgery on the 7th and 16th day post-onset required subsequent cerebrospinal shunt surgery. In contrast, of the 11 patients who underwent endoscopic surgery on the day of onset, only 1 patient required an additional, third ventriculostomy due to a secondary obstruction of the aqueduct by adhesive fibrous membranes. After 3 months, all six patients with mRS scores of 2-3 satisfied all the following criteria: initial Glasgow Coma Scale scores higher than 8, flexible endoscopic surgeries performed on the day of onset, and period of ventricular drainage of less than 4 days. CONCLUSIONS: Early surgical intervention using a flexible endoscope and short period of post-surgical drainage can be highly effective for patients suffering from casting intraventricular hematomas associated with intracerebral hemorrhage. The advantages of this treatment may be a less invasive procedure, ICP control in the acute phase, breaking away from ventricular drainage in the early stage, and prevention of hydrocephalus or intracranial infectious complications in the long term.


Assuntos
Hemorragia Cerebral/cirurgia , Ventrículos Cerebrais/cirurgia , Hematoma/cirurgia , Neuroendoscopia/métodos , Ventriculostomia/métodos , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/complicações , Drenagem , Intervenção Médica Precoce , Feminino , Escala de Coma de Glasgow , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Putaminal/complicações , Hemorragia Putaminal/cirurgia , Estudos Retrospectivos , Tálamo , Resultado do Tratamento
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