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1.
Rev Med Suisse ; 16(705): 1646-1651, 2020 Sep 09.
Artigo em Francês | MEDLINE | ID: mdl-32914596

RESUMO

Diaphragmatic paresis/paralysis can be unilateral or bilateral. Its manifestations range from completely asymptomatically to global respiratory failure. Respiratory functional tests will reveal lowered respiratory pressures with a restrictive syndrome, and a decrease in vital capacity when lying in the supine position compared to sitting. Unilateral paresis is most often self-limited and mainly post-surgical. The bilateral dysfunction, observed in neuromuscular diseases, is often permanent. The treatment consists in the management of specific causes, the optimization of the treatment of comorbidities, and in some cases, diaphragmatic plication, ventilatory support or pacing of phrenic nerves.


Assuntos
Paresia , Paralisia Respiratória , Diafragma , Humanos , Nervo Frênico , Insuficiência Respiratória
2.
J Stroke Cerebrovasc Dis ; 29(10): 105074, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912559

RESUMO

Recent evidence has underlined the association between large-vessel stroke and COVID-19, probably due to a proinflammatory and prothrombotic microenvironment induced by SARS-CoV-2. Here, we report the case of a young fit woman affected by COVID-19 without any flu-like symptom, who suffered from speech disorder and left hemiparesis. Brain magnetic resonance evidenced two small acute brain infarctions in right perirolandic cortex without signs of previous ischemic lesions and hemorrhagic infarction. Diagnostic workup excluded cardiac embolic sources, acquired and inherited thrombophilia or autoimmune diseases. Two positive nasopharyngeal swab tests and high titers of serum specific IgA/IgM confirmed COVID-19 diagnosis. In our case stroke seems to be the only manifestation of SARS-COV-2 infection. Therefore the hypothesis of an underlying viral infection, as COVID-19, should be investigated in all the cases of small vessel cryptogenic stroke.


Assuntos
Doenças de Pequenos Vasos Cerebrais/etiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Acidente Vascular Cerebral/etiologia , Betacoronavirus/patogenicidade , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/virologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Interações entre Hospedeiro e Microrganismos , Humanos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital , Pandemias , Paresia/etiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Fatores de Risco , Distúrbios da Fala/etiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/virologia
3.
Medicine (Baltimore) ; 99(34): e21846, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846833

RESUMO

INTRODUCTION: Stroke often causes residual hemiparesis, and upper extremity motor impairment is usually more disabling than lower extremity in those who are suffering from post-stroke hemiparesis. Cell therapy is one of the promising therapies to reduce post-stroke disability. PATIENT CONCERNS: Three male participants were included in the study to investigate the feasibility and tolerability of autologous adipose tissue derived stromal vascular fraction. DIAGNOSIS: All participants had hemiparesis after 1st-ever stroke longer than 6 months previously. INTERVENTIONS: Under general anesthesia, liposuction of abdominal subcutaneous fat was performed. Stromal vascular fraction freshly isolated from the adipose tissue extract was injected into the muscles of paretic upper extremity. All participants received inpatient stroke rehabilitation consisted of physical and occupational therapy more than 3 hours a day for 2 months or more. OUTCOMES: The whole procedure did not produce any significant adverse event in all participants. Adipose tissue extracts yielded sufficient stromal cells. One participant showed clinically important change in upper extremity Fugl-Meyer assessment after the injection and it lasted up to 6 months. Functional magnetic resonance imaging showed concomitant increase in ipsilesional cortical activity. The other 2 participants did not show remarkable changes. LESSONS: Intramuscular injection of autologous adipose tissue derived stromal vascular fraction seems to be a safe and tolerable procedure in subjects with chronic stroke, and its utility in rehabilitation needs further investigation.


Assuntos
Tecido Adiposo/irrigação sanguínea , Tecido Adiposo/transplante , Transplante de Células-Tronco Mesenquimais/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Células Estromais/transplante , Tecido Adiposo/citologia , Adulto , Hemorragia Cerebral/complicações , Humanos , Injeções Intramusculares , Lipectomia/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Células-Tronco Mesenquimais , Terapia Ocupacional/métodos , Paresia/fisiopatologia , Paresia/reabilitação , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Células Estromais/citologia , Extremidade Superior/fisiopatologia
4.
Medicine (Baltimore) ; 99(28): e20466, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664058

RESUMO

RATIONALE: Segmental zoster paresis (SZP) is a relatively rare neurologic complication of herpes zoster (HZ), and is characterized by focal asymmetric motor weakness in the myotome that corresponds to skin lesions of the dermatome. The upper extremities are the second most commonly involved regions after the face, and predominantly involve proximal muscles. The pathogenesis of SZP remains unclear; however, most of the reports indicate that it is the inflammation because of the spread of the herpes virus. PATIENT CONCERNS: A 72-year-old man without trauma history of the left shoulder joint developed weakness of the left proximal upper extremity 10 days after vesicular eruption of HZ. DIAGNOSES: His left shoulder girdle paresis was diagnosed with the upper truncus of the brachial plexus as a HZ complication according to a series of tests, including cervical magnetic resonance imaging (MRI), cerebral fluid analysis, sonography, and electrophysiological studies. INTERVENTIONS: Acyclovir and prednisolone were administered during hospitalization to treat SZP. Meanwhile, analgesics and gabapentin were administered to control the patient's neuralgic pain. He also received inpatient (daily) and outpatient (3 times per week) physical therapy along with range of motion and strengthening exercises. OUTCOMES: Partial improvement of the strength of the left shoulder girdle, and no improvement of the left deltoid muscle was observed 2 months after the interventions. LESSONS: This case emphasizes that HZ infections may be complicated by segmental paresis and they should be considered in the differential diagnosis of acute paresis in the upper limb. Awareness of this disorder is important because it avoids unnecessary invasive investigations and interventions, leading to suitable treatments with favorable prognosis.


Assuntos
Herpes Zoster/complicações , Paresia/virologia , Idoso , Humanos , Masculino , Extremidade Superior
5.
Medicine (Baltimore) ; 99(29): e20900, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702831

RESUMO

Cerebral venous sinus thrombosis (CVST) is a cause of secondary headache with substantial morbimortality. Headache dominates the clinical presentation, but no typical phenotype has been described. We aim to evaluate the presence of red flags in headache in patients with confirmed CVST at the moment of emergency department (ED) presentation.Retrospective STROBE compliant cohort study including patients with confirmed CVST that consulted because of headache at the ED. We analyzed presence and type of red flags at the moment of consult. We evaluated whether CVST was suspected at the moment of imaging request and analyzed delay in the diagnosis.Nineteen patients fulfilled inclusion and exclusion criteria. Mean age was 48.5 years, 47.4% were female. All the studied patients exhibited at least 1 red flag, being abnormal neurological examination the most frequent (79%), followed by the presence of other neurological symptoms (68%), alarm data related with headache phenotype (63%), or risk factors concerning prior medical history (47%). Temporal pattern of the headache was acute in 42.1%, thunderclap in 31.6%, and subacute in 26.3%. In none patient CVST was the specific suspicion when imaging was requested. Median time since headache onset and ED presentation was 84 hours, being different in patients with associated symptoms (48 hours) when compared with isolated headache patients (168 hours). Time since ED presentation and the diagnosis also differed between the 2 groups, being more prolonged in patients with an isolated headache at presentation.Headache attributed with CVST did not exhibit any distinctive phenotype, but all the patients presented some red flag, being abnormal neurological examination the most frequent.


Assuntos
Cefaleia/etiologia , Trombose dos Seios Intracranianos/diagnóstico , Afasia/etiologia , Comportamento , Estudos de Coortes , Transtornos da Consciência/etiologia , Serviço Hospitalar de Emergência , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/etiologia , Paresia/etiologia , Estudos Retrospectivos , Medição de Risco , Convulsões/etiologia , Transtornos das Sensações/etiologia , Distúrbios da Fala/etiologia , Manobra de Valsalva
7.
Medicine (Baltimore) ; 99(24): e20752, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541528

RESUMO

INTRODUCTION: Repetitive peripheral magnetic stimulation (rPMS) therapy is an innovative and minimally invasive neurorehabilitative technique and has been shown to facilitate neural plasticity. However, there is at present no research that clarifies the dose-response of rPMS therapy on the recovery of upper limb hemiparesis after stroke. This trial aims to clarify the dose-response of rPMS therapy combined with intensive occupational therapy (OT) for chronic stroke patients with moderate to severe upper limb hemiparesis. METHODS AND ANALYSIS: This multicenter, prospective, assessor-blinded, randomized controlled study with 3 parallel groups will be conducted from January 20, 2020 to September 30, 2022. Fifty patients will be randomly assigned in a ratio of 1:2:2 to the control group, the group receiving daily 2400 pulses of rPMS, or the group receiving daily 4800 pulses of rPMS, respectively. From the day after admission (Day 1), rPMS therapy and intensive OT will be initiated. The primary outcome is the change in the motor function of the affected upper extremity (Fugl-Meyer Assessment) between the time of admission (Day 0) and the day after 2 weeks of treatment (Day 14). Secondary outcomes will include the changes in spasticity, active range of motion, motor evoked potential, and activity of daily living. ETHICS AND DISSEMINATION: The study was approved by the Jikei University Certified Review Board for all institutions (reference number: JKI19-020). Results of the primary and secondary outcomes will be published in a peer-reviewed journal and presented at international congresses. The results will also be disseminated to patients. TRIAL REGISTRATION NUMBER: jRCTs032190191.


Assuntos
Terapia de Campo Magnético/métodos , Terapia Ocupacional , Paresia/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Extremidade Superior , Terapia Combinada , Humanos , Estudos Multicêntricos como Assunto , Paresia/etiologia , Estudos Prospectivos , Método Simples-Cego , Acidente Vascular Cerebral/complicações
8.
Stud Health Technol Inform ; 270: 163-167, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570367

RESUMO

Identifying adverse events in clinical documents is demanded in retrospective clinical research and prospective monitoring of treatment safety and cost-effectiveness. We proposed and evaluated a few methods of semi-automated muscle weakness detection in preoperative clinical notes for a larger project on predicting paresis by images. The combination of semi-expert and machine learning methods demonstrated maximized sensitivity = 0.860 and specificity = 0.919, and largest AUC = 0.943 with a 95% CI [0.874; 0.991], outperforming each method used individually. Our approaches are expected to be effective for autoshaping a well- verified training dataset for supervised machine learning.


Assuntos
Debilidade Muscular , Processamento de Linguagem Natural , Registros Eletrônicos de Saúde , Humanos , Paresia , Estudos Prospectivos , Estudos Retrospectivos
9.
Phys Ther ; 100(9): 1557-1567, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32529236

RESUMO

OBJECTIVE: A loss of balance poststroke from externally induced perturbations or during voluntary movements is often recovered by stepping. The purpose of this study was to characterize stepping behavior during lateral induced waist-pull perturbations and voluntary steps in community-dwelling fallers and nonfallers with chronic stroke. METHODS: This study used a cohort design. Thirty participants >6 months poststroke were exposed to 24 externally triggered lateral waist-pull perturbations and 20 voluntary steps. Balance tolerance limit (BTL) (transition from single to multiple steps) and first step type were determined for the waist-pull perturbations. Step parameters of initiation time, velocity, first step length, and clearance were calculated at and above BTL and for the voluntary steps. Hip abductor/adductor torque, foot cutaneous sensation, and self-reported falls that occurred 6 months prior were evaluated. RESULTS: Twelve participants were classified retrospectively as fallers and 18 as nonfallers. Fallers had a reduced BTL and took more medial first steps than nonfallers. Above BTL, no between-group differences were found in medial steps. At BTL, the nonparetic step clearance was reduced in fallers. Above BTL, fallers took longer to initiate a paretic and nonparetic step and had a reduced nonparetic step length and clearance compared with nonfallers. There was a between-group difference in step initiation time for voluntary stepping with the paretic leg (P < .05). Fallers had a reduced paretic abductor torque and impaired paretic foot cutaneous sensation. CONCLUSION: A high fall rate poststroke necessitates effective fall prevention strategies. Given that more differences were found during perturbation-induced stepping between fallers and nonfallers, further research assessing perturbation-induced training on reducing falls is needed. IMPACT: Falls assessments should include both externally induced perturbations along with voluntary movements in determining the fall risk.


Assuntos
Acidentes por Quedas/prevenção & controle , Equilíbrio Postural/fisiologia , Posição Ortostática , Acidente Vascular Cerebral/complicações , Fenômenos Biomecânicos , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Paresia/complicações , Paresia/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Torque , Caminhada/fisiologia
10.
Rinsho Shinkeigaku ; 60(7): 479-484, 2020 Jul 31.
Artigo em Japonês | MEDLINE | ID: mdl-32536665

RESUMO

A 48-year-old woman with a right-sided headache beginning a month prior to admission presented with sudden-onset right hemiparesis. On admission, she had weakness of the right lower extremity, which disappeared 3 hours after onset. Contrast enhanced brain MRI revealed no parenchymal lesion, while indicated thrombi in the superior sagittal sinus and the right side of the transverse sinus, sigmoid sinus, and internal jugular vein, leading to the diagnosis of cerebral venous sinus thrombosis. Brain perfusion single photon emission computed tomography presented slightly decreased blood flow in the bilateral frontal lobes (left-sided dominant) and the right occipitotemporal lobe. Electroencephalogram showed no abnormal finding. After anticoagulant therapy, thrombi in the venous sinuses decreased and brain blood flow improved. We should consider cerebral venous sinus thrombosis in the case of a patient presenting with symptoms of a transient ischemic attack accompanied with headache. Moreover, the etiology of transient neurological deficits remains controversial.


Assuntos
Trombose dos Seios Intracranianos/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Diagnóstico Diferencial , Eletroencefalografia , Feminino , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Cefaleia/etiologia , Humanos , Ataque Isquêmico Transitório/diagnóstico por imagem , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Paresia/etiologia , Imagem de Perfusão , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/tratamento farmacológico , Lobo Temporal/irrigação sanguínea , Lobo Temporal/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
11.
Int J Rehabil Res ; 43(3): 247-254, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32459669

RESUMO

This study aimed to determine the efficacy of using real-time visual feedback during overground walking training to improve walking function in patients with post-stroke hemiparesis. Twenty-four patients with post-stroke hemiparesis who were able to walk independently under less impact of synergy pattern on the affected lower limbs (Brunnstrom stage IV or V) were randomly assigned to either the experimental group or the control group. All subjects performed overground walking for 30 min, three times a week for 6 weeks, with real-time visual feedback (weight load to the affected lower limb) provided during training for subjects in the experimental group. Outcome measures comprised the timed up-and-go test and gait parameters (step length, stride length, single and double support times, step and stride length ratios, and single support time ratio). In between-group comparison, the changes between pre-test and post-test scores in all parameters were significantly greater in the experimental group than in the control group (P < 0.05), except for double support time and step length ratio. Furthermore, post-test values of all parameters were significantly more improved in the experimental group than in the control group (P < 0.05). Our findings suggest that real-time visual feedback may be an advantageous therapeutic adjunct to reinforce the effects of overground walking training in patients with post-stroke hemiparesis.


Assuntos
Transtornos Neurológicos da Marcha/fisiopatologia , Marcha , Paresia/terapia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/complicações , Retroalimentação Sensorial , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Método Simples-Cego
12.
Cochrane Database Syst Rev ; 5: CD005950, 2020 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-32449959

RESUMO

BACKGROUND: Stroke is caused by the interruption of blood flow to the brain (ischemic stroke) or the rupture of blood vessels within the brain (hemorrhagic stroke) and may lead to changes in perception, cognition, mood, speech, health-related quality of life, and function, such as difficulty walking and using the arm. Activity limitations (decreased function) of the upper extremity are a common finding for individuals living with stroke. Mental practice (MP) is a training method that uses cognitive rehearsal of activities to improve performance of those activities. OBJECTIVES: To determine whether MP improves outcomes of upper extremity rehabilitation for individuals living with the effects of stroke. In particular, we sought to (1) determine the effects of MP on upper extremity activity, upper extremity impairment, activities of daily living, health-related quality of life, economic costs, and adverse effects; and (2) explore whether effects differed according to (a) the time post stroke at which MP was delivered, (b) the dose of MP provided, or (c) the type of comparison performed. SEARCH METHODS: We last searched the Cochrane Stroke Group Trials Register on September 17, 2019. On September 3, 2019, we searched the Cochrane Central Register of Controlled Trials (the Cochrane Library), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Web of Science, the Physiotherapy Evidence Database (PEDro), and REHABDATA. On October 2, 2019, we searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. We reviewed the reference lists of included studies. SELECTION CRITERIA: We included randomized controlled trials (RCTs) of adult participants with stroke who had deficits in upper extremity function (called upper extremity activity). DATA COLLECTION AND ANALYSIS: Two review authors screened titles and abstracts of the citations produced by the literature search and excluded obviously irrelevant studies. We obtained the full text of all remaining studies, and both review authors then independently selected trials for inclusion. We combined studies when the review produced a minimum of two trials employing a particular intervention strategy and a common outcome. We considered the primary outcome to be the ability of the arm to be used for appropriate tasks, called upper extremity activity. Secondary outcomes included upper extremity impairment (such as quality of movement, range of motion, tone, presence of synergistic movement), activities of daily living (ADLs), health-related quality of life (HRQL), economic costs, and adverse events. We assessed risk of bias in the included studies and applied GRADE to assess the certainty of the evidence. We completed subgroup analyses for time since stroke, dosage of MP, type of comparison, and type of arm activity outcome measure. MAIN RESULTS: We included 25 studies involving 676 participants from nine countries. For the comparison of MP in addition to other treatment versus the other treatment, MP in combination with other treatment appears more effective in improving upper extremity activity than the other treatment without MP (standardized mean difference [SMD] 0.66, 95% confidence interval [CI] 0.39 to 0.94; I² = 39%; 15 studies; 397 participants); the GRADE certainty of evidence score was moderate based on risk of bias for the upper extremity activity outcome. For upper extremity impairment, results were as follows: SMD 0.59, 95% CI 0.30 to 0.87; I² = 43%; 15 studies; 397 participants, with a GRADE score of moderate, based on risk of bias. For ADLs, results were as follows: SMD 0.08, 95% CI -0.24 to 0.39; I² = 0%; 4 studies; 157 participants; the GRADE score was low due to risk of bias and small sample size. For the comparison of MP versus conventional treatment, the only outcome with available data to combine (3 studies; 50 participants) was upper extremity impairment (SMD 0.34, 95% CI -0.33 to 1.00; I² = 21%); GRADE for the impairment outcome in this comparison was low due to risk of bias and small sample size. Subgroup analyses of time post stroke, dosage of MP, or comparison type for the MP in combination with other rehabilitation treatment versus the other treatment comparison showed no differences. The secondary outcome of health-related quality of life was reported in only one study, and no study noted the outcomes of economic costs and adverse events. AUTHORS' CONCLUSIONS: Moderate-certainty evidence shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity activity. Moderate-certainty evidence also shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity impairment after stroke. Low-certainty evidence suggests that ADLs may not be improved with MP in addition to other treatment versus the other treatment. Low-certainty evidence also suggests that MP versus conventional treatment may not improve upper extremity impairment. Further study is required to evaluate effects of MP on time post stroke, the volume of MP required to affect outcomes, and whether improvement is maintained over the long term.


Assuntos
Braço , Imaginação/fisiologia , Paresia/reabilitação , Prática Psicológica , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Paresia/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica
13.
Medicine (Baltimore) ; 99(19): e20144, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384499

RESUMO

RATIONALE: Limb-kinetic apraxia (LKA), a kind of apraxia, means the inability to perform precise and voluntary movements of extremities resulting from injury of the premotor cortex (PMC) or the corticofugal tract (CFT) from the PMC. Diagnosis of LKA is made by observation of movements without specific assessment tools. PATIENT CONCERNS: A 44-year-old male underwent conservative management for traumatic intracerebral hemorrhage in the left basal ganglia and subarachnoid hemorrhage due to a pedestrian-car crash. When he was admitted to the rehabilitation department of a university hospital after 41 months after onset, he presented with right hemiparesis (Medical Research Council (MRC): shoulder abductor; 3, elbow flexor; 3, finger extensor; 0, hip flexor; 2- [range: 30°], knee extensor; 1 and ankle dorsiflexor; 3-). In addition, he exhibited slow, clumsy, and mutilated movements when performing movements of his right ankle. DIAGNOSES: The patient was diagnosed as traumatic brain injury (TBI). INTERVENTIONS: Clinical assessments and DTI were performed at 41 and 44 months after onset. During three months, rehabilitative therapy was performed including dopaminergic drugs (pramipexole 2.5 mg, ropinirole 2.5 mg, and amantadine 300 mg, and carbidopa/levodopa 75 mg/750 mg). OUTCOMES: The right leg weakness slowly recovered during 3 months, until 44 months after the initial injury (MRC: shoulder abductor, 3; elbow flexor, 3; finger extensor, 0; hip flexor, 3; knee extensor, 3; and ankle dorsiflexor, 3+). The fiber number of the right corticospinal tract (CST) was decreased on 44-month diffusion tensor tractography (DTT) (1319) compared with 41-month DTT (1470) and the left CST was not reconstructed on both DTTs. The fiber number of both CRTs were decreased on 44-month DTT (right: 1547, left: 698) than 41-month DTT (right: 3161, left: 1222). LESSONS: A chronic patient with TBI showed motor recovery of the hemiparetic leg by improvement of LKA after rehabilitation. This results have important implications for neurorehabilitation.


Assuntos
Apraxia Ideomotora/tratamento farmacológico , Apraxia Ideomotora/etiologia , Hemorragia Encefálica Traumática/complicações , Agonistas de Dopamina/uso terapêutico , Paresia/tratamento farmacológico , Paresia/etiologia , Adulto , Apraxia Ideomotora/reabilitação , Lesões Encefálicas Traumáticas/complicações , Hemorragia Cerebral/complicações , Doença Crônica , Agonistas de Dopamina/administração & dosagem , Humanos , Masculino , Córtex Motor/lesões , Paresia/reabilitação , Recuperação de Função Fisiológica , Hemorragia Subaracnóidea/complicações
14.
J Med Vasc ; 45(2): 62-66, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32265016

RESUMO

Basilar artery fenestration is the second most commonly observed fenestration of the cerebral arteries. In addition to our case, we reviewed the clinical, imaging findings, treatment, and prognosis of 9 other reported cases. Patients' mean age was 45.1 years. Half of them had cardiovascular risk factors. Mean time to diagnosis was 9.4 days. The main symptoms were right hemiparesis and dysarthria. Basilar artery fenestration was found in all patients, as well as ours, in addition to a thrombus, found in 2 cases. One patient was treated by IV thrombolysis and thrombectomy. In other cases, antiplatelet drugs or anticoagulants were used. A favorable outcome was observed in most cases with one reported death.


Assuntos
Artéria Basilar/anormalidades , Isquemia Encefálica/etiologia , Malformações Vasculares do Sistema Nervoso Central/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Artéria Basilar/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Malformações Vasculares do Sistema Nervoso Central/terapia , Criança , Pré-Escolar , Disartria/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia
17.
Ann Phys Rehabil Med ; 63(4): 376-378, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32315800
18.
Medicine (Baltimore) ; 99(14): e19495, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243365

RESUMO

INTRODUCTION: Upper extremity motor impairment is one of the major sequelae of stroke, resulting in limitations of activities of daily living. Recently, contralesional cortical activation has been reported to be important for motor recovery in stroke patients with severe upper extremity hemiparesis due to the extensive corticospinal tract involvement. We therefore designed this study to investigate the effects of contralesional anodal transcranial direct current stimulation (tDCS), which induces cortical activation, in stroke patients with severe upper extremity motor impairment. METHODS AND ANALYSIS: We will recruit patients with subacute stroke (<3 months after onset) with unilateral upper extremity weakness who meet the following criteria: Shoulder Abduction and Finger Extension (SAFE) score below 8, Fugl-Meyer Assessment for upper extremity (FMA-UE) score ≤25, and absent motor evoked potential (MEP) response on the affected extensor carpi radialis muscle. Subjects will be randomly allocated to either the intervention (n = 18) or the control group (n = 18). The intervention group will undergo 10 sessions of robotic arm rehabilitation with simultaneous anodal tDCS over the contralesional premotor area, whereas the control group will receive sham tDCS during the same sessions. One daily session consists of 25 minutes.The primary outcome measure of this study is the Fugl-Meyer Assessment score of the upper extremity; the secondary outcome measures are the Korean version of the Modified Barthel Index, the Brunnstrom stage of the affected arm and hand, the Box and Block Test, the Modified Ashworth Scale, the Manual Muscle Power Test, and the patient's encephalographic laterality index. DISCUSSION: Findings of this study will help to establish an individualized tDCS protocol according to the stroke severity and to find out the EEG parameters to predict the better recovery in subacute stroke patients with severe upper extremity hemiparesis. ETHICS AND DISSEMINATION: The study was approved by the Seoul National University Bundang Hospital Institutional Review Board (IRB No. B-1806-475-006) and will be carried out in accordance with the approved guidelines. The results of the trial will be submitted for publication in a peer-reviewed journal.


Assuntos
Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Extremidade Superior , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Potencial Evocado Motor , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Recuperação de Função Fisiológica , Adulto Jovem
19.
Int J Infect Dis ; 95: 265-267, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32272261

RESUMO

Histoplasmosis is the most common endemic mycosis in the United States and is caused by the organism Histoplasma capsulatum. Infection is often asymptomatic or self-limited, but when symptomatic it usually presents in the form of pulmonary histoplasmosis. In its most severe form, H. capsulatum can spread to extrapulmonary sites causing disseminated infection. Here we present a peculiar case of central nervous system (CNS) histoplasmosis wherein multiple focal spinal cord lesions were the only manifestation of CNS infection, causing bilateral lower extremity paresis and loss of sensation. Although uncommon, CNS histoplasmosis should be included in the differential diagnosis when a patient presents with meningitis, encephalitis, or isolated brain or spinal cord lesions in endemic areas.


Assuntos
Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Histoplasma , Histoplasmose/diagnóstico , Paresia/diagnóstico , Idoso de 80 Anos ou mais , Encéfalo/patologia , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Diagnóstico Diferencial , Histoplasma/isolamento & purificação , Histoplasmose/fisiopatologia , Humanos , Extremidade Inferior , Masculino , Paresia/etiologia
20.
Medicine (Baltimore) ; 99(10): e19517, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150113

RESUMO

INTRODUCTION: Radiotherapy is a valid treatment option for nasopharyngeal carcinoma. However, complications can occur following irradiation of the closest anatomical structures, including brainstem radionecrosis (BRN). The rehabilitation is poorly described in patients with BRN, despite its usefulness in improving functional independence in patients with brain tumors. We aimed at testing the usefulness of intensive, robot-assisted neurorehabilitation program to improve functional independence in a 57-year-old male with BRN. PATIENT CONCERNS: A 57-year-old male diagnosed with a nasopharyngeal carcinoma, received a radiation total dose of 72 Gy. Owing to the appearance of a severe symptomatology characterized by dysphagia, hearing loss, and left sided hemiparesis, the patient was hospitalized to be provided with intensive pharmacological and neurorehabilitation treatment. DIAGNOSIS: Follow-up brain magnetic resonance imaging disclosed no residual cancer, but some brainstem lesions compatible with BRN areas were appreciable. INTERVENTION: The patient underwent a 2-month conventional, respiratory, and speech therapy. Given that the patient only mildly improved, he was provided with intensive robot-aided upper limb and gait training and virtual reality-based cognitive rehabilitation for other 2 months. OUTCOMES: The patient reported a significant improvement in functional independence, spasticity, cognitive impairment degree, and balance. CONCLUSION: Our case suggests the usefulness of neurorobotic intensive rehabilitation in BRN to reduce functional disability. Future studies should investigate whether an earlier, even multidisciplinary rehabilitative treatment could lead to better functional outcome in patients with BRN.


Assuntos
Tronco Encefálico/lesões , Terapia por Exercício , Neoplasias Nasofaríngeas/radioterapia , Lesões por Radiação/reabilitação , Robótica , Tronco Encefálico/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paresia/reabilitação , Lesões por Radiação/diagnóstico por imagem
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