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1.
Rev. panam. salud publica ; 6(5): 342-345, Nov. 1999. tab
Artigo em Inglês | MedCarib | ID: med-16921

RESUMO

A survey was done on the needs and resources available to control epilspsy in the countries of Latin America and the Caribbean. Responses came from ministries of health, prominent neurologists, and epilepsy advocacy organizations. A mailed questionnaire was used, and the response rate was excellent, 89 percent. The survey results showed that the private sector, in terms of both specialized personnel and access to a variety of drugs. Public policies are lacking, and linkages between medical personnel and social workers are almost nonexistent. Primary care doctors and nurses are somewhat able to diagnose some types of epilepsy but do less well with other types of the disorder. There is a strong justification for the new "Out of the Shadows" initiative, in which the International League Against Epilepsy, the International Bureau for Epilepsy, the World Health Organization, and the Pan American Health Organization are working to improve epilepsy health-care services, treatment, and social acceptance (AU)


Assuntos
Humanos , Epilepsia , Recursos em Saúde , América Latina , Região do Caribe , Doenças do Sistema Nervoso/diagnóstico , Atenção Primária à Saúde , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico
2.
In. University of the West Indies, Mona, Jamaica. Faculty of Medical Sciences. Eighth Annual Research Conference 1999. Kingston, s.n, 1999. p.1. (Annual Research Conference 1999, 8).
Monografia em Inglês | MedCarib | ID: med-1440

RESUMO

Neurological complications after open-heart surgery (OHS) constitute a broad spectrum of injury, and represents the leading cause of morbidity and mortality. The most serious injury is seen in those who remain comatose or never regain meaningful neurologic function. Stroke is another devastating complication that can leave the patient permanently disabled. The incidence of stroke has been documented as ranging from 0.8 - 5.2 percent. Much less information is available on the incidence of the less fatal complications such as delirium, confusion, encephalopathy, developmental delay or other neuropsychiatric disorders. During the period January, 1994 to August, 1999, a total of 360 paitents (adults and children) underwent OHS, at the University Hospital of the West Indies (UHWI), Mona, Jamaica. The types of surgeries performed were: ASD = 53; VSD = 40; valve replacement = 151 (100 MVR, 34 AVR, 17 DVR); valvuloplasty/annuloplasty = 5; CABG = 44; repair of congenital heart abnormalities = 65; other (atrial myxoma) = 2. About eight (8) patients (2.2 percent) developed severe neurological symptoms post-operatively. These ranged from short period (<24 hours) of seizure activities to severe encephalopathy and death, secondary to massive cerebral infarction. Four (4) of these patients died as a result of the neurologic complication. There is no need for avoidance and/or elimination of the factors that increase the risk of post-operative neurologic complications. Unfortunately not all of these can be eliminated. There is also the need for detailed, structured neurological and neuropsychiatric assessments, both pre- and post-operatively. These will enable the early detection of gross, but more importantly the subtle changes and hence prompt institution of counteractive/corrective measure. Detection of markers which will indicate the possible development of severe neurologic injury would also be useful.(AU)


Assuntos
Humanos , Adulto , Criança , Cirurgia Torácica/complicações , Transtornos Cerebrovasculares/etiologia , Complicações Pós-Operatórias , Doenças do Sistema Nervoso/complicações , Jamaica , Coma/etiologia , Doenças do Sistema Nervoso/mortalidade , Estudos de Casos e Controles
3.
WEST INDIAN MED. J ; 46(Suppl 2): 25, Apr. 1997.
Artigo em Inglês | MedCarib | ID: med-2302

RESUMO

In 1988, we reported on the neurological/neurosurgical referrals overseas in the period January 1984 to November 1987. The present study is a follow-up of the previous one and reviews overseas referrals over a 9 years period from November 1987 to November 1996. The pattern of referral, diagnoses, referral centres and costs were studied. All Queen Elizabeth Hospital patients transferred overseas between November 1987 and November 1996 under a government-aided scheme for neurological investigation or neurosurgical treatment were include. The Department of Social Services files were reviewed. No patients were transferred in November and December 1987 but 203 patient-transfers were arranged for neurological investigation and/or treatment overseas between January 1988 and November 1996. This includes 10 patients who were transferred twice and one patient three times. 191 patients, 69 males and 122 females, were included, with ages ranging from 1 to 80 (mean 37) years. Most patients were referred to Brooklyn Hospital, New York in 1988, Mount Sinai Medical Center (1989 - 94), and Hospital de Clinicas Caracas, Venezuela (1992 - 96). Twenty overseas centres were used during the study period. Sixty-five percent were referred for neurological management while 48 (25 percent) had MRI scans for diagnosis. The largest diagnostic category was central nervous system tumours (40 percent) followed by subarachnoid haemorrhage (25 percent). Through the government-aided scheme more than ten million BDS dollars were pledged during the study period. Actual costs were determined in only 38 percent of cases but there was a suggestion that the mean actual cost per patient of overseas neurosurgical management and investigation had shown little change over the nine years of the study, remaining at about Bds. $60,000.00(AU)


Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/tendências , Doenças do Sistema Nervoso/epidemiologia , Barbados
4.
Ann Neurol ; 35(5): 513-29, May 1994.
Artigo em Inglês | MedCarib | ID: med-3571

RESUMO

We present a synthesis of clinical, neuropatholgical, and biological details of the National Institutes of Health series of 300 experimentally transmitted cases of spongiform encephalopathy from among more than 1,000 cases of various neurological disorder inoculated into nonhuman primates during the past 30 years. The series comprises of 278 subjects with Creutzfeldt-Jakob disease, of whom 234 had sporadic, 36 familial, and 8 iatrogenic disease; 18 patients with kuru; and 4 patients with Gerstmann-Straussler-Scheinker syndrome. Sporadic Creutzfeldt-Jakob disease, numerically by far the most important representative, showed an average age at onset of 60 years, with the frequent early appearance of cerebellar and visual/oculomotor signs, and a broad spectrum of clinical features during the subsequent course of illness, which was usually fatal in less than 6 months. Characteristic spongiform neuropathology was present in all but 2 subjects. Microscopically visible kuru-type amyloid plaques were found in 5 percent of patients with Creutzfeldt-Jakob disease. 75 percent of those with kuru, and 100 percent of those with Gerstmann-Straussler-Scheinker syndrome; brain biopsy was diagnostic in 95 percent of cases later confirmed at autopsy, and proteinase-resistant amyloid protein was identified in Western blots of brain extracts from 88 percent of tested subjects. Experimental transmission rates were highest for iatrogenic Creutzfeldt-Jakob disease (100 percent), kuru (95 percent), and sporadic Creutzfeldt-Jakob disease (90 percent), and considerably lower for most familiar forms of disease (68 percent). Incubation periods as well as the durations and character of illness showed great variability, even in animals receiving the same inoculum, mirroring the spectrum of clinical profiles seen in human disease. Infectivity reached average levels of nearly 10(to the 5th power) median lethal doses/gm of brain tissue, but was only irregularly present (and at much lower levels) in tissues outside the brain, and, except for cerebrospinal fluid, was never detected in bodily secretions or excretions (AU)


Assuntos
Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Adulto , 21003 , Doenças Priônicas/epidemiologia , Doenças do Sistema Nervoso , Doença Iatrogênica , Kuru/epidemiologia , Doença de Gerstmann-Straussler-Scheinker , Fatores Etários , Encefalopatias , Doenças Priônicas/etiologia , Doenças Priônicas/patologia , Complexo AIDS Demência , Síndrome de Creutzfeldt-Jakob
5.
In. Anon. Prevalence and patterns of substance abusers: neurobehavioural and social dimensions: programme and abstracts. Kingston, University of the West Indies (Mona). Neuroscience, Adolescent and Drug Research Programme, 1994. p.16.
Monografia em Inglês | MedCarib | ID: med-3588

RESUMO

Major clinical disorders have been associated with fetal in utero exposure to cocaine and although factors such as prematurity, other drugs or alcohol used concomitantly, infections and a chaotic environment may all be contributory, the abuse of cocaine has been associated with several neurological complications. Perry et al. (1984) demonstrated a "down-regulation" of placental neurotransmitter receptors in infants with intrauterine exposure to drugs of abuse. Abnormalities or depletion of receptor sites in the fetal brain interfere with normal respiratory control, causing more frequent periods of apnea, and an increase in sudden infant death syndrome (SIDS) in infants of cocaine using mothers has been reported by some authors but not by others. Mahalik et al. (1980) proposed that vasoconstruction secondary to increased catecholamines, and the resulting hypoxia, was a probable contributing factor to the teratogenic potential of cocaine. Fetal vasoconstruction, hypoxia, placental vasoconstriction, abruptio placenta and teratogenicity of the drug itself all play a role in the pathogenesis of embryo-logical defects. The severity of problems is related to the time and extent of exposure. Intracerebral hemorrhages, cerebral infarctions and vasculitis have all been documented. We recently reported 3 infants with craniosynostosis. Other bony anomalies reported include skull defects exencephaly and encephalocele. We have also observed agenesis of the corpus callosum with porencephaly and Dandy-Walker variant malformation in one child. Neural tube defects and cortical atrophy have been observed. Small head circumferences, increased irritability with inability to calm the child, poor cuddling, hypertonicity, tremulousness, abnormal sleep patterns, overall poor stste regulation and attention deficit hyperactivity disorder with associated learning disability has been observed. Little is known of the potential long-term side effects of exposure to cocaine and more work in this area is needed. (AU)


Assuntos
Humanos , Feminino , Criança , Cocaína/efeitos adversos , Exposição Materna , Doenças do Sistema Nervoso/etiologia , Doenças do Recém-Nascido/etiologia , Efeitos Tardios da Exposição Pré-Natal
8.
West Indian med. j ; 41(Suppl. 1): 21, Apr. 1992.
Artigo em Inglês | MedCarib | ID: med-6474

RESUMO

A survey of the spectrum of neurological syndromes encountered in Barbados was carried out to determine the pathogenic role of human T-lymphotropic virus (HTLV-I) infection in affected patients. Since 1989, patients with chronic neurological disorders were either recalled or were selected from new referrals to the neurology clinic at the Queen Elizabeth Hospital, Barbados. With the consent of patients, serum and CSF samples were tested for IgG antibodies to HTLV-I, using an enzyme-linked immunosorbent assay method. Positive results were confirmed by Western Immunoblotting at the CAREC Laboratories, in Trinidad. Only patients native to Barbados and the Eastern Caribbean were included in the survey. Twenty-nine (29) of 170 patients tested were serpositive for HTLV-I antibodies 18(62 percent) of the HTLV-I-positive patients had tropical spastic paraparesis (TSP). Of 21 seropositive patients who also had CFS-positive antibodies status, 16(76 percent) had TSP, 2(9.5 percent) adult T-cell leukaemia/lymphoma (ATLL), and 3 (14 percent) polymyositis, including 2 with an atypical clinical profile. HTLV-I seronegative patients included 12 (8.5 percent) with ataxia, 19(13.5 percent) with a relapsing/remitting sydrome characteristic of multiple sclerosis, 8(5.5 percent) with idiopathic intracranial hypertension and 8(5.5 percent) with stroke. HTLV-I positive associated neurological diseases in Barbados consist primarily of myelopathy (TSP). Some cases present more complex patterns of neurlogical dysfunction, associated with polymyositis. (AU)


Assuntos
Humanos , Infecções por HTLV-I , Doenças do Sistema Nervoso/etiologia , Barbados/epidemiologia
9.
Int J Gynaecol Obstet ; 32(4): 335-44, Aug. 1990.
Artigo em Inglês | MedCarib | ID: med-12471

RESUMO

Neonatal morbidity, in particular neurological morbidity is a more relevant measure of the effectiveness of obstetrical care than perinatal mortality. Neurological morbidity was assessed in a birth cohort in Grenada, and appeared to be lower than in a reference group examined in Groningen, the Netherlands, in 1975-1978. Perinatal mortality, however, was higher. The results support the thesis that some children may have died who, if they would have survived, would have been neurologically abnormal. It is concluded that whereas a decrease in perinatal deaths is an essential goal in Grenada, a concomitant increase in morbidity should be carefully avoided. (AU)


Assuntos
Humanos , Gravidez , Recém-Nascido , Adolescente , Adulto , Feminino , Doenças do Sistema Nervoso/epidemiologia , Mortalidade Infantil , Complicações do Trabalho de Parto , Países Baixos/epidemiologia , Complicações na Gravidez , Fatores Socioeconômicos , Granada/epidemiologia
10.
West Indian med. j ; 39(Suppl. 1): 65, Apr. 1990.
Artigo em Inglês | MedCarib | ID: med-5242

RESUMO

The only report in the literature of heredofamilial neurological syndromes (HNS) in Trinidad and Tobago was Beaubrun's study of Huntington's chorea (Beaubrun, 1965). This study of HNS in Trinidad and Tobago comprised all patients seen at the Port-of-Spain General Hospital (1980 - mid 1985), the San Fernando General Hospital (mid 1985 - 1989), together with those seen in private practice. The diagnosis and genealogy were verified. A wide variety of HNS was encountered and included amyotrophic lateral sclerosis [4 cases in 2 generations] olivopontocerebellar degeneration [9 in 3 generations], multiple sclerosis [2 in 2 generations], neurofibromatosis [3 in 3 generations], Crouzon's syndrome [2 in 3 generations], biparietal foramina [17 in 3 generations], a neurological syndrome referred to as "ptosis plus syndrome" [9 in 3 generations] and familial tremor [4 in 2 generations]. In addition there were 2 siblings each with cerebral gliomas and intracranial meningioma with familial occurrence of seizures, many cases of carpal tunnel syndrome in 1 family, and familial cases of Huntington's chorea. Mode of genetic transmission seemed to be autosomal dominant in all pedigrees, sometimes with incomplete penetrance or expressivity (AU)


Assuntos
Humanos , Doenças do Sistema Nervoso/genética , Trinidad e Tobago/epidemiologia
11.
In. Cruickshank, J. Kennedy; Beevers, D. G. Ethnic factors in health and disease. London, Wright, 1989. p.170-5.
Monografia em Inglês | MedCarib | ID: med-10204
13.
Muscle Nerve ; 11(4): 380-5, Apr. 1988.
Artigo em Inglês | MedCarib | ID: med-12357

RESUMO

Jamaican neuropathy (JN) is a common disorder in Jamaica and has characteristics similar to neurological diseases found in other tropical areas. JN is a clinical syndrome and occurs in two forms: spastic and ataxic. This is the first known electrophysiological study of this disease. In the spastic group of JN, peripheral electrophysiological findings were mostly normal, suggesting a central cause for their symptoms. The only patient with the ataxic form of JN had a chronic axonal peripheral neuropathy. (AU)


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/fisiopatologia , Paraparesia Espástica Tropical/fisiopatologia , Potenciais de Ação , Ataxia/etiologia , Ataxia/fisiopatologia , Eletromiografia , Jamaica , Neurônios Motores/fisiologia , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Doenças do Sistema Nervoso/classificação , Doenças do Sistema Nervoso/complicações , Condução Nervosa , Neurônios Aferentes/fisiologia
14.
South Med J ; 81(4): 452-4, Apr. 1988.
Artigo em Inglês | MedCarib | ID: med-12408

RESUMO

Clinical features of 74 patients with neurosyphilis and 38 syphilitic patients with nonsyphilitic neurologic disorders were correlated with results of their serum and cerebrospinal fluid (CSF) VDRL and FTA tests, and with the WBC count and total protein level in the CSF. The most common clinical features in those having neurosyphilis were reflex changes (53.9 percent), peripheral neuropathy (44.5 percent), ataxia (38 percent), and cranial nerve palsies (24.3 percent). In 27 percent of the patients with neurosyphilis the CSF was VDRL-reactive, while in 77 percent the CSF was FTA-reactive. The frequency of elevated WBC counts in various serologic categories ranged from 23 percent to 27 percent; neither the mean WBC count nor the protein level differed significantly among the different serologic categories (P less than .05). Only two of the 74 patients with neurosyphilis and elevation of both the WBC and protein level. None of the syphilitic patients without neurosyphilis had an elevated WBC or protein level, though the CSF was FTA-reactive in all 38. Among the neurosyphilis patients whose CSF was VDRL-nonreactive but FTA-reactive, 21 percent had an elevated protein level and 26 percent had an elevated WBC count. These results support the view that patients having neurosyphilis will not necessarily have either VDRL-reactive CSF or the other expected CSF abnormalities. (AU)


Assuntos
Humanos , Neurossífilis/diagnóstico , Sorodiagnóstico da Sífilis/métodos , Doenças do Sistema Nervoso/diagnóstico , Neurossífilis , Tabes Dorsal , Tabes Dorsal/diagnóstico
15.
West Indian med. j ; 37(Suppl): 15, 1988.
Artigo em Inglês | MedCarib | ID: med-6633

RESUMO

Neurological/neurosurgical cases (NNC) requiring overseas investigation and treatment have become an increasingly difficult problem for Barbados in recent years. All overseas referrals from Queen Elizabeth Hospital (QEH) between January 1, 1984 and November 1, 1987 have been reviewed. Ninety one NNCs were referred; there were 48 males and 43 females, aged 32ñ7 years (meanñSD, range 4 months to 69 years). Only five were older than 60 years. Eleven centres were used. In 1984 referrals to the University Hospital of the West Indies (UHWI), Jamaica, ceased; for the next two years, most NNCs were sent to Port-of-Spain, Trinidad. Several factors, chiefly bureaucratic delays in approval for transfer, forced new lines of referral, outside of the Caribbean. In 1986 and 1987, 63 percent of new cases were referred to North America, chiefly to Mount Sinai Hospital New York. This was made possible by a Government aid scheme. During 1984 - 1986, there were non-surgical than surgical cases. In January 1987, a CAT Scan was installed at QEH and there was a marked fall (by over 60 percent) in referrals in 1987. Each of the 13 NNCs referred in this year was correctly diagnosed as needing surgery. This represents a huge savings in non-surgical referrals for investigation. Lack of neurological/neurosurgical facilities for investigation and treatment has placed an inordinate burden on finances, social services and internists, as well as severely compromising the outcome of NNCs (AU)


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Encaminhamento e Consulta , Doenças do Sistema Nervoso , Barbados , Transferência de Pacientes/estatística & dados numéricos , Trinidad e Tobago , Jamaica , América do Norte
16.
Ann Neurol ; 23(suppl): S174-80, 1988.
Artigo em Inglês | MedCarib | ID: med-12478

RESUMO

Human T-lymphotropic virus type I (HTLV-I) has been associated with adult T-cell leukemia/lymphoma (ATL), a malignancy of mature CD4-positive lymphocytes, and tropical spastic paraparesis (TSP), a demyelinating neurological syndrome. This article describes the clinical and pathological features of ATL and reviews the epidemiology of this disease and of its putative etiological agent, HTLV-I. From what is known about the molecular biology and epidemiology of HTLV-I, hypotheses on the etiology of TSP are proposed, and strategies for studying the neurological syndrome are suggested. (AU)


Assuntos
Humanos , Adulto , Masculino , Feminino , Infecções por Deltaretrovirus/complicações , Leucemia/complicações , Infecções por Retroviridae , Ásia , Doença Crônica , Doenças Hematológicas/etiologia , Infecções por Deltaretrovirus/epidemiologia , Infecções por Deltaretrovirus/fisiopatologia , Deltaretrovirus/fisiologia , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Índias Ocidentais , Paraparesia Espástica Tropical
17.
West Indian med. j ; 35(Suppl): 54, April 1986.
Artigo em Inglês | MedCarib | ID: med-5911

RESUMO

The clinical neurophysiological techniques available in Trinidad and Tobago are electroencephalography (EEG) nerve conduction studies (NCS) and electromyography (EMG). Two hundred consecutive EEGs and 100 consecutive NCS and 27 EMGs were retrospectively evaluated to determine the usefulness of these studies. EMGs were done on a Grass model 8/10 D, 8 channel recorder. The commonest symptoms investigated were seizures (78), headaches (42), post concussion syndrome (41), cerebral contusion (19), blackouts (17), dizziness (7) and stroke syndrome (7). Seizure were confirmed in 27:18, generalised; 7, focal, and 2, focal spreading to generalised. One showed the petit mal pattern of 3 per second spike and wave and another hypsarrhythmia. Eight out of 16 with febrile convulsions had paroxysmal activity. Of patients with headaches, 8 were abnormal, showinf focal slowing (6) and diffuse slowing (2). All patients with blackouts had normal tracings. Slow activity eas seen in 2 cases of dizziness and in 5 of stroke syndrome. In post concussion, 5 showed slowing and 1 sharp activity. NCS and EMG were done on a TECA model B6 machine. NCS were most commonly done on median nerve (75), ulnar (48), radial (15), and peroneal (20). EMG most frequently tested the biceps and deltoid. NCS confirmed compression of the median nerve (carpal tunnel syndrome) in 23, ulnar in 1, peroneal in 2 and medial plantar (tarsal tunnel syndrome) in 1. NCS also confirmed injury in the median nerve (6), ulnar (1), radial (4), multiple upper extremity nerves (2), brachial plexus 1, sciatic (1) and peroneal (1). Four cases of peripheral neuropathy indicated Guillan-Barre in 2 and motor neurone disease was suggested in another 4. EMG confirmed nerve injury and various stages of recovery in 9, motor neurone disease in 5 and myasthenia gravis in 1. EEG was useful in selecting patients for further studies. NCS identified specific nerve compression or injury and further evaluated cases of generalised neuropathy. EMG served to clarify and determine prognosis in nerve injury and compression and was valuable in the evaluation of generalised nerve and primary muscle disease (AU)


Assuntos
Humanos , Eletroencefalografia , Eletromiografia , Doenças do Sistema Nervoso/diagnóstico , Trinidad e Tobago
19.
West Indian med. j ; 33(4): 272-4, Dec. 1984.
Artigo em Inglês | MedCarib | ID: med-11454

RESUMO

A case of lithium toxicity is reported even though very close monitoring of blood lithium levels was maintained. Blood lithium levels continued to rise after oral medication was discontinued. Regular clinical assessments and facilities for forced alkaline diuresis are as important as facilities for blood lithium levels (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/tratamento farmacológico , Lítio/efeitos adversos , Doenças do Sistema Nervoso/induzido quimicamente , Transtornos Psicomotores/induzido quimicamente
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