Aproximación al diagnóstico infarto cerebral isquémico en adultos jóvenes / Approach to the diagnosis of ischemic cerebral infarction in Young adults / Abordagem para o diagnóstico de infarto cerebral isquêmico em adultos jovens

Introducción: El infarto cerebral isquémico (ICI) en adultos jóvenes ha emergido como un relevante problema de salud debido al incremento de su incidencia, alta mortalidad, larga duración del tiempo de la discapacidad y consecuencias sociales. Objetivo: Describir una aproximación al diagnóstico del infarto cerebral isquémico en adultos jóvenes sobre la base de la clasificación etiopatogénica, historia e investigaciones complementarias. Método: Se realizó una extensa revisión bibliográfica con el buscador Google Académico, en las bases de datos bibliográficas PubMed, SciELO y Medline, y con la búsqueda de palabras claves; siendo escogidos 32 artículos cuyo título y resumen se relacionaron con el tema de la presente revisión. Desarrollo: Los subtipos etiopatogénicos del infarto cerebral isquémico en adultos jóvenes difieren al compararlo con adultos mayores, y sus causas etiológicas son más variadas y heterogéneas. Los factores de riesgo, antecedentes patológicos personales y familiares, manifestaciones clínicas no neurológicas y neurológicas, permiten un acercamiento al diagnóstico, mientras que las investigaciones complementarias facilitan la confirmación del diagnóstico, la localización y tamaño del infarto isquémico, el establecimiento de la causa etiológica y el sustento de las decisiones terapéuticas. Consideraciones finales: La historia y manifestaciones clínicas obtenidas mediante el interrogatorio y examen físico, unido a las investigaciones complementarias, posibilita la aproximación al diagnóstico del subtipo etiopatogénico y a la causa del infarto cerebral isquémico en adultos jóvenes, lo que mejora las posibilidades de tratamiento del mismo.(AU)

Introduction: Ischemic stroke in young adults has emerged as a relevant health problem today due to its increased incidence, high mortality, the duration of the disability and social consequences. Objective: To describe an approach in diagnosis of ischemic stroke in young adults based on etiopathogenic classification, history and complementary investigations. Method: A wide-ranging bibliographic review was carried out using Google Scholar, searching in bibliographic databases like PubMed, SciELO and Medline, and searching different keywords; 32 articles were chosen in the process with title and abstract were linked with the subject of this review. Development: The etiopathogenic subtypes of ischemic stroke in young adults differ with regard to older adults, and its etiologic causes are more diverse and heterogeneous. Risk factors, personal and family pathological history, non-neurological and neurological clinical manifestations, allow an approach to diagnosis, while complementary investigations facilitate the confirmation of diagnosis, the location and size of the ischemic infarction, definition of the etiological cause and the support of therapeutic decisions. Final considerations: The history and clinical manifestations obtained through interrogation and physical examination, in association with complementary investigations, made it possible an approach to diagnosis of etiopathogenic subtype and the cause of ischemic brain infarction in young adults improving treatment possibilities.(AU)

Introdução: O acidente vascular cerebral (AVC) isquêmico em adultos jovens emergiu como um problema de saúde relevante devido à sua crescente incidência, elevada mortalidade, longa duração da incapacidade e consequências sociais. Objetivo: Descrever uma abordagem ao diagnóstico do AVC isquêmico em adultos jovens baseada na classificação etiopatogénica, na história e em exames complementares. Método: Foi realizado uma extensa revisão bibliográfica utilizando o motor de busca Google Scholar, as bases de dados bibliográficas PubMed, SciELO e Medline, e uma pesquisa por palavras-chave; foram selecionados 32 artigos cujo título e resumo estavam relacionados com o tema desta revisão. Desenvolvimento: Os subtipos etiopatogênicos do AVC isquêmico em adultos jovens diferem quando comparados aos adultos mais velhos, e suas causas etiológicas são mais variadas e heterogêneas. Os fatores de risco, os antecedentes patológicos pessoais e familiares, as manifestações clínicas não neurológicas e neurológicas permitem uma aproximação ao diagnóstico, enquanto as investigações complementares facilitam a confirmação do diagnóstico, a localização e o tamanho do infarto isquêmico, o estabelecimento da causa etiológica e o apoio às decisões terapêuticas. Considerações finais: A história e as manifestações clínicas obtidas por meio de questionamento e exame físico, juntamente com investigações complementares, permitem abordar o diagnóstico do subtipo etiopatogênico e a causa do AVC isquêmico em adultos jovens, melhorando as possibilidades de seu tratamento.(AU)

Predictive value of serum initial brain natriuretic peptide and troponin on functional prognosis in noncardiogenic patients with anterior and posterior circulation cerebral infarction.

BACKGROUND: Brain natriuretic peptide (BNP) and troponin have a close relationship with cardiogenic cerebral embolism (CCE), but their relationship with noncardiogenic patients with anterior circulation ischemia (ACI) and posterior circulation ischemia (PCI) is not clear. OBJECTIVE: To explore the predictive value of serum initial BNP and troponin on the functional prognosis of patients with noncardiogenic ACI and PCI. METHODS: Consecutive patients with first-episode cerebral infarction within 12 hours of symptom onset were enrolled in the present 1-year prospective cohort study. Serum levels of BNP and troponin were collected within 12 hours of onset. Infarction location was classified as ACI and PCI by magnetic resonance imaging (MRI). According to the modified Rankin Scale (mRS) score at 90 days after onset, ACI and PCI cases were respectively divided into a good prognosis group (mRS score between 0 and 2) and a poor prognosis group (mRS score between 3 and 6). The general state of health and results of laboratory examinations and other auxiliary examinations of all patients were recorded. Single-factor analysis and multivariate logistic regression analysis were used to assess the relationship between serum levels of BNP, troponin, and functional outcome. RESULTS: The multivariate logistic regression found that higher levels of initial BNP (odds ratio [OR] = 1.024; 95% confidence interval [CI]: 1.006-1.041; p = 0.007) and C-reactive protein (CRP) (OR = 1.184; 95%CI: 1.024-1.369; p = 0.022) were independent predictors of poor functional prognosis of noncardiogenic PCI at 90 days after onset after adjusting for age, gender, ethnicity, history of hypertension and of diabetes. CONCLUSIONS: The levels of initial BNP and CRP were related to poor functional outcomes in noncardiogenic PCI patients at 3 months, independent of troponin.

ANTECEDENTES: O peptídeo natriurético cerebral (BNP, na sigla em inglês) e a troponina estão intimamente relacionados com a embolia cerebral cardiogênica (CCE, na sigla em inglês), mas a relação com pacientes não cardioembólicos com isquemia de circulação anterior (ICA) e isquemia de circulação posterior (ICP) não é clara. OBJETIVO: Investigar o valor preditivo dos níveis séricos iniciais do BNP e da troponina no prognóstico de pacientes com AVC isquêmico não cardiogênico. MéTODOS: Os níveis séricos de BNP e de troponina foram recolhidos de pacientes com primeiro episódio de acidente vascular cerebral (AVC) isquêmico dentro de 12 horas após o início dos sintomas, com localização classificada como ICA e ICP de acordo com exame de ressonância magnética (RM). De acordo com a pontuação modificada da escala de Rankin (mRS), aos 90 dias após o início dos sintomas, ICA e ICP foram divididas respectivamente em um grupo de bom prognóstico (mRS entre 0 e2) e em um grupo de mau prognóstico (mRS entre 3 e 6). Foram registrados exames laboratoriais e outros exames complementares de todos os pacientes. Foram utilizadas análise fatorial única e análise de regressão logística multivariada para investigar a relação entre os níveis séricos de BNP e de troponina e o resultado funcional. RESULTADOS: A regressão logística multivariada evidenciou que os níveis mais altos de BNP inicial (odds ratio [OR] = 1,024, intervalo de confiança [IC] de 95%: 1,006­1,041; p = 0,007) e proteína C reativa (CRP, na sigla em inglês) (OR = 1,184; 95%CI: 1,024­1,369; p = 0,022) foram preditores independentes de mau prognóstico funcional da ICP não cardiogênica aos 90 dias após o início dos sintomas. CONCLUSõES: Os níveis iniciais de BNP e CRP se associaram a maus resultados funcionais em pacientes com ICP não cardiogênica aos três meses, independentemente da troponina.

Correlation analysis of Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale score in acute cerebral infarction with risk factors.

OBJECTIVE: The aim of this study was to investigate the correlation between the Trial of Org 10172 in acute stroke treatment classification and the National Institutes of Health Stroke Scale score of acute cerebral infarction as well as acute cerebral infarction's risk factors. METHODS: The clinical data of 3,996 patients with acute cerebral infarction hospitalized in Hebei Renqiu Kangjixintu Hospital from January 2014 to November 2018 were analyzed retrospectively. According to Trial of Org 10172 in acute stroke treatment, they were divided into five groups: arteriosclerosis, cardio cerebral embolism, arterial occlusion, other causes, and unknown causes. Through questionnaire design, routine physical examination, and physical and chemical analysis of fasting venous blood samples, the risk factors were evaluated, and the correlation between Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale classification was analyzed using multivariate logistic regression. In addition, the relationship between National Institutes of Health Stroke Scale score and risk factors in different groups was compared, and the correlation between Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale score was analyzed. RESULTS: Multivariate logistic regression analysis showed that diabetes, atrial fibrillation or stroke history, age, and education level were related to Trial of Org 10172 in acute stroke treatment classification. In the National Institutes of Health Stroke Scale comparison, the scores of the cardio cerebral embolism group were significantly higher than those of the other four groups, and patients with diabetes, atrial fibrillation, or stroke history had a high share, especially atrial fibrillation (33.06%). CONCLUSIONS: The nerve function defect is more serious after acute cerebral infarction with cardiogenic cerebral embolism, indicating a poor prognosis.

Correlation analysis of Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale score in acute cerebral infarction with risk factors

SUMMARY OBJECTIVE: The aim of this study was to investigate the correlation between the Trial of Org 10172 in acute stroke treatment classification and the National Institutes of Health Stroke Scale score of acute cerebral infarction as well as acute cerebral infarction's risk factors. METHODS: The clinical data of 3,996 patients with acute cerebral infarction hospitalized in Hebei Renqiu Kangjixintu Hospital from January 2014 to November 2018 were analyzed retrospectively. According to Trial of Org 10172 in acute stroke treatment, they were divided into five groups: arteriosclerosis, cardio cerebral embolism, arterial occlusion, other causes, and unknown causes. Through questionnaire design, routine physical examination, and physical and chemical analysis of fasting venous blood samples, the risk factors were evaluated, and the correlation between Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale classification was analyzed using multivariate logistic regression. In addition, the relationship between National Institutes of Health Stroke Scale score and risk factors in different groups was compared, and the correlation between Trial of Org 10172 in acute stroke treatment classification and National Institutes of Health Stroke Scale score was analyzed. RESULTS: Multivariate logistic regression analysis showed that diabetes, atrial fibrillation or stroke history, age, and education level were related to Trial of Org 10172 in acute stroke treatment classification. In the National Institutes of Health Stroke Scale comparison, the scores of the cardio cerebral embolism group were significantly higher than those of the other four groups, and patients with diabetes, atrial fibrillation, or stroke history had a high share, especially atrial fibrillation (33.06%). CONCLUSIONS: The nerve function defect is more serious after acute cerebral infarction with cardiogenic cerebral embolism, indicating a poor prognosis.

Manejo da terapia antitrombótica em pacientes com acidentes vascular cerebral: onde estamos em 2018? / Management of antithrombotic therapy in estroke patients: where do we stand in 2018?

O acidente vascular cerebral (AVC) é a maior causa de incapacidade em todo mundo, e atualmente é também considerado como a segunda maior causa de morte no Brasil. O AVC isquêmico é o subtipo mais comum e pode ser subdividido etiologicamente em car-dioembólico, aterosclerótico de grandes ou pequenas artérias (lacunas), criptogênico ou de outras etiologias. Dependendo da etiologia encontrada, a profilaxia secundária de novos eventos deve ser feita através de medicações antitrombóticas específicas. Portanto, investigar adequadamente a etiologia do evento vascular isquêmico é fundamental para a instituição da profilaxia secundária apropriada. A terapia antitrombótica pós-AVC isquêmico evoluiu consideravelmente na última década. Especificamente para pacientes com AVC e fibrilação atrial, a incorporação de anticoagulantes de ação direta à prática clínica representa um grande avanço, já que tais medicações são mais eficazes e seguras para o tratamento de pacientes de alto risco. No presente artigo, discutiremos o uso de antitrombóticos em pacientes com AVC em diferentes momentos pós-icto vascular e nas distintas etiologias possíveis

Stroke is the leading cause of disability worldwide, and is currently also considered the second leading cause of death in Brazil. Ischemic stroke is the most common subtype and can be subdivided etiologically into cardioembolic, atherosclerotic (large artery atherosclero-sis or small vessel disease-lacunae), cryptogenic or strokes of other etiologies. Depending on the etiology, secondary prophylaxis of new events should be undertaken with specific antithrombotic medications. Therefore, a thorough investigation of ischemic vascular event etiology is essential for the introduction of appropriate secondary prophylaxis. Antithrombotic therapy after ischemic stroke has evolved considerably in the last decade. The incorporation of direct-acting anticoagulants into clinical practice represents a major advance, particularly for stroke and atrial fibrillation patients, since such medications are safer and more effective for the treatment of high-risk patients. In this article, we will discuss the use of antithrombo-tics in stroke patients at different post-stroke stages and in the distinct possible etiologies

Distinguishing Intracerebral Hemorrhage from Acute Cerebral Infarction through Metabolomics.

BACKGROUND: Acute cerebral infarction (ACI) and intracerebral hemorrhage (ICH) are potentially lethal cerebrovascular diseases that seriously impact public health. ACI and ICH share several common clinical manifestations but have totally divergent therapeutic strategies. A poor diagnosis can affect stroke treatment. OBJECTIVE: To screen for biomarkers to differentiate ICH from ACI, we enrolled 129 ACI and 128 ICH patients and 65 healthy individuals as controls. METHODS: Patients with stroke were diagnosed by computed tomography/magnetic resonance imaging, and their blood samples were obtained by fingertip puncture within 2-12 h after stroke initiation. We compared changes in metabolites between ACI and ICH using dried blood spot-based direct infusion mass spectrometry technology for differentiating ICH from ACI. RESULTS: Through multivariate statistical approaches, 11 biomarkers including 3-hydroxylbutyrylcarnitine, glutarylcarnitine (C5DC), myristoylcarnitine, 3-hydroxypalmitoylcarnitine, tyrosine/citrulline (Cit), valine/phenylalanine, C5DC/3-hydroxyisovalerylcarnitine, C5DC/palmitoylcarnitine, hydroxystearoylcarnitine, ratio of sum of C0, C2, C3, C16, and C18:1 to Cit, and propionylcarnitine/methionine were screened. An artificial neural network model was constructed based on these parameters. A training set was evaluated by cross-validation method. The accuracy of this model was checked by an external test set showing a sensitivity of 0.8400 (95% confidence interval [CI], 0.7394-0.9406) and specificity of 0.7692 (95% CI, 0.6536-0.8848). CONCLUSION: This study confirmed that metabolomic analysis is a promising tool for rapid and timely stroke differentiation and prediction based on differential metabolites.

Etiología de infarto cerebral en adultos jóvenes de una serie de pacientes del Instituto Nacional de Ciencias Neurológicas en el periodo 2010 al 2013 / Etiology of stroke in young adults from a series of patients at the Instituto Nacional de CienciasNeurológicas in the period 2010 to 2013

Objetivos: Precisar la etiología del infarto cerebral en adultos jóvenes hospitalizados en el Departamento de Enfermedades Neurovasculares del Instituto Nacional de Ciencias Neurológicas (INCN) durante el periodo 2010 al 2013. Material y métodos: Estudio descriptivo, retrospectivo, de corte transversal; en paciente jóvenes con diagnóstico de infarto cerebral, hospitalizados en el INCN, en el periodo de estudio que tuvieron tomografía y/o imagen de resonancia magnética cerebral. Resultados: Un total de 43 pacientes cumplieron los criterios de inclusión. El 55,8% fueron mujeres. La media de edad fue 37,6+/-6,4 años. El 69,8% provenían de Lima. El 44,2% de los casos fueron de etiología indeterminada, 23,3% cardioembólica. La media de edad para la etiología atero-trombótica fue de 41,8 años, y para la etiología indeterminada de 34,7 años. El territorio vascular mayormente comprometido fue el de la circulación anterior con 65,1%.Conclusiones: Se describen las características clínicas, sociodemográficas y la etiología del infarto cerebral en adultos jóvenes. Los más frecuentes fueron: indeterminada y cardioembólica. Las enfermedades metabólicas y el uso de anticonceptivos orales fueron los factores asociados más frecuentes. No hubo mortalidad. El territorio vascular cerebral mayormente comprometido fue la circulación anterior.

Objectives: Clarify the etiology of cerebral infarction in young adults hospitalized in the Department of Neurovascular Diseases at the National Institute of Neurological Sciences (INCN), during the period 2010 to 2013. Material and Methods: Descriptive, retrospective, cross-sectional study in a sample of young patients diagnosed with cerebral infarction, hospitalized during the study period and who underwent tomography and / or magnetic resonance imaging brain tests. Results: A total of 43 patients, 55.8 % of them female, met the inclusion criteria. The mean age was 37.6 +/- 6.4 years, 69.8% came from Lima, and 44.2% of the cases were of undetermined etiology and 23.3%, cardioembolic. The average age for artery occlusive disease was 41.8 years, and for undetermined etiology, 34.7 years. The vascular territory mostly compromised was that of the anterior circulation with 65.1%. Conclusions: Sociodemographic, clinical characteristics, and etiological factors of cerebral infarction in young adults were described. The most frequent etiologieswerecardioembolic and undeterminated. Metabolic diseases and the use of oral contraceptives were the most frequently associated factors. The cerebral vascular territory mostlyaffected was that of the anterior circulation. No deaths occurred.

Type I persistent proatlantal artery associated with fusiform subclavian artery aneurysm: Report of one case.

We report a 61 years old male presenting with a right cerebral infarction, along with a type I persistent left proatlantal artery (PA), which is a form of primitive carotid-basilar anastomosis. The patient had an absence of the ipsilateral vertebral artery (VA) and hypoplasia of the contralateral VA, while the basilar artery was supplied by the PA. Other vascular anomalies present were a fusiform aneurysm of the right subclavian artery, and an A1 segment aplasia of the hypoplastic anterior right cerebral artery, which originated from the anterior communicating artery. To our knowledge these anomalies were not described previously.

Type I persistent proatlantal artery associated with fusiform subclavian artery aneurysm: Report of one case / Arteria proatlántica persistente tipo I asociada a un aneurisma fusiforme de la arteria subclavia: Presentación de un caso

We report a 61 years old male presenting with a right cerebral infarction, along with a type I persistent left proatlantal artery (PA), which is a form of primitive carotid-basilar anastomosis. The patient had an absence of the ipsilateral vertebral artery (VA) and hypoplasia of the contralateral VA, while the basilar artery was supplied by the PA. Other vascular anomalies present were a fusiform aneurysm of the right subclavian artery, and an A1 segment aplasia of the hypoplastic anterior right cerebral artery, which originated from the anterior communicating artery. To our knowledge these anomalies were not described previously.

[Intracranial sinus venous thrombosis in ulcerative colitis. Report of one case]. / Trombosis de senos venosos intracraneales: una complicación infrecuente y grave de la colitis ulcerosa. Primera comunicación de un caso en Uruguay.

Intracranial sinus venous thrombosis (ICSVT) is a rare complication of ulcerative colitis that affects from 1.7 to 7.5% of patients. We report a 22 year-old male with ulcerative colitis in treatment with mesalazine and prednisone presenting with headache and speech disturbances. A magnetic resonance imaging of the brain showed a left temporal hemorrhagic infarct with thrombosis of the ispilateral superficial vein and sigmoid venous sinus. No cause of thrombophilia was detected. Anticoagulation with heparin was started which was changed to oral anticoagulation with warfarin. The patient was discharged ten days after admission.

Why Can't This Patient Look Up? Bilateral Vertical Gaze Palsy.

We report a case of a patient with profound bilateral vertical gaze palsy resulting from a unilateral thalamic lesion-one of only a handful of such cases ever reported. The patient had significant symptomatic vertical diplopia that was disabling functionally and vocationally. We discuss pathways whereby a unilateral lesion can cause bilateral gaze palsy. We also report on the successful functional and vocational rehabilitation of the patient's vertical diplopia. To our knowledge, this is the first report of successful rehabilitation of a patient with bilateral vertical diplopia due to a central lesion.

Trombosis de senos venosos intracraneales: una complicación infrecuente y grave de la colitis ulcerosa. Primera comunicación de un caso en Uruguay / Intracranial sinus venous thrombosis in ulcerative colitis: Report of one case

Intracranial sinus venous thrombosis (ICSVT) is a rare complication of ulcerative colitis that affects from 1.7 to 7.5% of patients. We report a 22 year-old male with ulcerative colitis in treatment with mesalazine and prednisone presenting with headache and speech disturbances. A magnetic resonance imaging of the brain showed a left temporal hemorrhagic infarct with thrombosis of the ispilateral superficial vein and sigmoid venous sinus. No cause of thrombophilia was detected. Anticoagulation with heparin was started which was changed to oral anticoagulation with warfarin. The patient was discharged ten days after admission.

Stroke and pineal gland calcification: lack of association. Results from a population-based study (The Atahualpa Project).

OBJECTIVE: It has been suggested that pineal gland calcifications (PGC) represent a risk factor for stroke; however, information comes from a single retrospective hospital-based registry. We aimed to validate this association in a population-based study conducted in rural Ecuador. METHODS: Atahualpa residents aged ≥60 years were identified during a door-to-door survey and invited to undergo neuroimaging studies (CT/MRI) for identification and rating PGC and lesions consistent with cerebral infarcts and hemorrhages. Cardiovascular health (CVH) status was assessed according to the American Heart Association criteria, and clinical strokes were identified by the use of a validated field instrument and confirmed by neurologists. RESULTS: Out of 248 participants (mean age 70±8 years, 59% women, 73% with poor CVH), 137 (55%) had PGC and 39 (16%) had strokes (silent in 28 cases). PGC were noted in 61% versus 54% persons with and without stroke, respectively. After adjusting for age, sex and cardiovascular health, logistic and ordinal logistic regression models showed no association between any evidence (p=0.916) or severity (p=0.740) of PGC and stroke. CONCLUSION: PGC is not associated with stroke in this population of community-dwelling elders, where prevalence of PGC and stroke are similar to those found in other regions.

Headache and migraine in children with sickle cell disease are associated with lower hemoglobin and higher pain event rates but not silent cerebral infarction.

OBJECTIVE: To identify risk factors for headache and migraine in children with sickle cell disease and test the hypothesis that either or both are independently associated with silent cerebral infarcts. STUDY DESIGN: In this cross-sectional study, we evaluated the health history, laboratory values, and brain magnetic resonance imaging findings of participants with sickle cell disease (hemoglobinSS or hemoglobinSß°-thalassemia) with no history of overt stroke or seizures. Participants characterized headache severity and quality. Migraine was defined by International Headache Society criteria modified for increased sensitivity in children. Neuroradiology and neurology committees adjudicated the presence of silent cerebral infarction by review of magnetic resonance imaging and standardized examination by pediatric neurologists. RESULTS: The cohort included 872 children (51.1% males), ranging in age from 5 to 15 years (mean age, 9.1 years). Of these children, 317 (36.4%) reported recurrent headaches, and 132 (15.1%) reported migraines. In multivariable logistic regression analyses, both were associated with lower steady-state hemoglobin (P = .01 for headaches; P < .01 for migraines) and higher pain rate (P < .01 for headaches; P < .01 for migraines), defined as the number of admissions requiring opioids in the previous 3 years. The presence of silent cerebral infarction was not associated with recurrent headaches or migraines. Only 1.9% (6 of 317) of children with recurrent headaches received medication for headache prophylaxis. CONCLUSION: Recurrent headaches and migraines are common and undertreated in children with sickle cell disease. Low hemoglobin levels and high pain rates are associated with recurrent headaches and migraines; whereas, silent cerebral infarction is not.

Craniotomia descompressiva: análise crítica baseada em relatos de caso / Decompressive cranotomy: critical analysis based on case reports

Entende-se por infarto maligno aquele que acomete mais da metade do território da artéria cerebral média, atingindo níveis de mortalidade de até 80%. A craniotomia descompressiva tem se mostrado como técnica operatória capaz de reduzir significativamente essas taxas. No entanto, persistem na literatura muitas dúvidas quanto à indicação do procedimento relacionadas a idade, hemisfério cerebral acometido, time cirúrgico e status neurológico pré-operatório. Analisamos 10 pacientes vítimas de acidente vascular cerebral (AVC) isquêmicos extensos, tratados no hospital SEMPER-BH, levando-se esses fatores em consideração. Concluímos que a idade e o quadro neurológico prévio ao momento cirúrgico são os dois fatores mais importantes no prognóstico do paciente submetido à craniotomia descompressiva.

It is understood that malignant infarction affects more than half of the middle cerebral artery territory and reaches mortality rates up to 80%. A decompressive craniotomy has been recommended as the surgical technique that can significantly reduce these rates. However, many questions persist in the literature as the indication of the procedure related to age, hemisphere affected, surgical time and preoperative neurological status. We analyzed 10 patients who suffered extensive ischemic stroke treated in hospital SEMPER-BH taking these factors into consideration. We conclude that age and neurological status prior to the surgical time are the two most important factors in the prognosis of patients undergoing decompressive craniotomy.

Accuracy of diffusion-weighted imaging in the diagnosis of stroke in patients with suspected cerebral infarct.

BACKGROUND AND PURPOSE: The accuracy of diffusion-weighted imaging (DWI) for the diagnosis of acute cerebral ischemia among patients with suspected ischemic stroke arriving to an emergency room has not been studied in depth. METHODS: DWI was performed in 712 patients with acute or subacute focal symptoms that suggested an acute ischemic stroke (AIS), 609 of them with AIS. RESULTS: DWI demonstrated a sensitivity of 90% and specificity of 97%, a positive likelihood ratio of 31 and a negative likelihood ratio of 0.1 for detecting AIS. The overall accuracy was 95%. Of those patients who demonstrated abnormal DWI studies, 99.5% were AIS patients, and of those patients with normal DWI studies 63% were stroke mimics. CONCLUSIONS: DWI is accurate in detecting AIS in unselected patients with suspected AIS; a negative study should alert for nonischemic conditions.

Vestibulo-ocular reflex and the head impulse test / Reflexo vestíbulo-ocular e o teste do impulso da cabeça

The authors highlights the importance of the vestibulo-ocular reflex examination through the head impulse test as a diagnostic method for vestibular dysfunction as well as, and primarily, a bedside semiotic resource capable of differentiating between acute peripheral vestibulopathy and a cerebellar or brainstem infarction in emergency rooms.

Os autores ressaltam a importância do exame do reflexo vestíbulo-ocular por meio do teste do impulso da cabeça como método diagnóstico de hipofunção vestibular. Este método é também - e principalmente - um instrumento semiótico de beira do leito capaz de auxiliar no diagnóstico diferencial entre a vestibulopatia periférica aguda e o infarto cerebelar ou do tronco cerebral na sala de emergência.

Communicative clusters after a right-hemisphere stroke: are there universal clinical profiles?.

OBJECTIVE: The current research aimed at classifying communication profiles among right-brain-damaged adults with an intercultural perspective, and so begins to fill in a long-standing gap in the literature. METHOD: The sample was made up of 112 right-brain-damaged individuals from three nationalities (Canadians, Brazilians and Argentineans). They were assessed using 13 language tasks from the Protocol MEC in Spanish, Brazilian Portuguese and French. RESULTS: A hierarchical cluster analysis led to four distinct clinical profiles of communication. Since only a few distinctions between nationalities were observed, the results suggest that there probably is a partial universality of clinical profiles of communication impairments after a right brain damage. CONCLUSIONS: This study proposes a preliminary taxonomy of communication disorders among right-brain-damaged individuals with cross-cultural implications. The exploration of associated stroke sites and neuropsychological concomitant deficits would contribute to the eventual development of a more accurate clinical intervention.