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1.
Genes Dev ; 32(13-14): 978-990, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29967292

RESUMO

The largest subunit of the origin recognition complex (ORC1) is essential for assembly of the prereplicative complex, firing of DNA replication origins, and faithful duplication of the genome. Here, we generated knock-in mice with LoxP sites flanking exons encoding the critical ATPase domain of ORC1. Global or tissue-specific ablation of ORC1 function in mouse embryo fibroblasts and fetal and adult diploid tissues blocked DNA replication, cell lineage expansion, and organ development. Remarkably, ORC1 ablation in extraembryonic trophoblasts and hepatocytes, two polyploid cell types in mice, failed to impede genome endoreduplication and organ development and function. Thus, ORC1 in mice is essential for mitotic cell divisions but dispensable for endoreduplication. We propose that DNA replication of mammalian polyploid genomes uses a distinct ORC1-independent mechanism.


Assuntos
Endorreduplicação/genética , Genoma/genética , Complexo de Reconhecimento de Origem/genética , Complexo de Reconhecimento de Origem/metabolismo , Adenosina Trifosfatases/genética , Animais , Divisão Celular/genética , Proliferação de Células/genética , Desenvolvimento Embrionário/genética , Ativação Enzimática , Feminino , Deleção de Genes , Hepatócitos/citologia , Regeneração Hepática/genética , Camundongos , Mitose/genética , Placenta/fisiologia , Gravidez
4.
Stroke ; 45(3): 781-7, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24425122

RESUMO

BACKGROUND AND PURPOSE: Hemicraniectomy and Durotomy Upon Deterioration From Infarction-Related Swelling Trial (HeADDFIRST) was a randomized pilot study to obtain information necessary to design a Phase III trial to evaluate the benefit of surgical decompression for brain swelling from large supratentorial cerebral hemispheric infarction. METHODS: All patients with stroke were screened for eligibility (age 18-75 years, National Institutes of Health Stroke Scale≥18 with Item 1a<2 [responsive to minor stimulation], and CT demonstrating unilateral, complete middle cerebral artery territory infarction by specific imaging criteria). All enrolled patients were treated using a standardized medical treatment protocol. Those with both≥4 mm of pineal shift and deterioration in level of arousal or ≥7.5 mm of anteroseptal shift within 96 hours of stroke onset were randomized to continued medical treatment only or medical treatment plus surgery. Death at 21 days was the primary outcome measure. RESULTS: Among 4909 screened patients, only 66 (1.3%) patients were eligible for HeADDFIRST. Forty patients were enrolled, and 26 patients developed the requisite brain swelling for randomization. All who failed to meet randomization criteria were alive at 21 days. Mortality at 21 and 180 days was 40% (4/10) in the medical treatment only and 21% (3/14) and 36% (5/14) in the medical treatment plus surgery arms, respectively. CONCLUSIONS: HeADDFIRST randomization criteria effectively distinguished low from high risk of death from large supratentorial cerebral hemispheric infarction. Lower mortality in the medical treatment only group than in other published trials suggests a possible benefit to standardizing medical management. These results can inform the interpretation of recently completed European trials concerning patient selection and medical management. CLINICAL TRIAL REGISTRATION: This trial was not registered because enrollment began before July 1, 2005.


Assuntos
Edema Encefálico/cirurgia , Infarto Cerebral/cirurgia , Craniectomia Descompressiva/métodos , Dura-Máter/cirurgia , Adulto , Idoso , Edema Encefálico/complicações , Edema Encefálico/mortalidade , Infarto Cerebral/complicações , Infarto Cerebral/mortalidade , Protocolos Clínicos , Cuidados Críticos , Interpretação Estatística de Dados , Feminino , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/cirurgia , Pressão Intracraniana/fisiologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Seleção de Pacientes , Projetos Piloto , Tamanho da Amostra , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
5.
Neurocrit Care ; 20(1): 106-10, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24002892

RESUMO

BACKGROUND: Macroglossia has been reported in patients undergoing posterior fossa neurosurgical procedures and is thought to be as a result of venous engorgement from intubation or mechanical positioning during these prolonged procedures. METHODS: We report three patients who developed macroglossia and dysautonomia of central neurogenic origin following brainstem injury. RESULTS: The three patients developed macroglossia and dysautonomia with wide hemodynamic fluctuations in the setting of posterior fossa injury of the lower brainstem structures, necessitating tracheostomy placement. Macroglossia was managed with dexamethasone and there was complete resolution of dysautonomia while treated with beta-blockers and gabapentin. CONCLUSIONS: Neurointensivists should be aware of macroglossia with dysautonomia complicating brainstem injury, which may have perilous consequences in the setting of cerebral edema or intracranial hypertension.


Assuntos
Lesões Encefálicas/complicações , Tronco Encefálico/lesões , Macroglossia/etiologia , Adolescente , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Aminas/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Lesões Encefálicas/etiologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Fossa Craniana Posterior/lesões , Ácidos Cicloexanocarboxílicos/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Gabapentina , Humanos , Macroglossia/tratamento farmacológico , Macroglossia/cirurgia , Masculino , Pessoa de Meia-Idade , Disautonomias Primárias/tratamento farmacológico , Disautonomias Primárias/etiologia , Traqueostomia/métodos , Resultado do Tratamento , Ácido gama-Aminobutírico/uso terapêutico
6.
Neurology ; 81(23): 2009-14, 2013 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-24198290

RESUMO

OBJECTIVE: To characterize the present state of brain death (BD) determination in actual practice relative to contemporary American Academy of Neurology (AAN) guidelines. METHODS: We reviewed the charts of all adult (16 years and older) BD organ donors during 2011 from 68 heterogeneous hospitals in the Midwest United States. Data were collected across 5 categories: guideline performance, preclinical testing, clinical examination, apnea testing, and use of ancillary tests. Practice within categories and overall adherence to AAN guidelines were assessed. RESULTS: Two hundred twenty-six BD organ donors were included. Practice exceeded recommendations in guideline performance but varied widely and deviated from AAN guidelines in all other categories. One hundred two (45.1%) had complete documentation of brainstem areflexia and absent motor response. One hundred sixty-six (73.5%) had completed apnea testing. Of the 60 without completed apnea testing, 56 (93.3%) had ancillary tests consistent with BD. Overall, 101 (44.7%) strictly and 84 (37.2%) loosely adhered to contemporary AAN guidelines. CONCLUSIONS: There is wide variability in the documentation of BD determination, likely reflecting similar variability in practice. This is a call for improved documentation, better uniformity of policies, and comprehensive and strategically targeted educational initiatives to ensure consistently contemporary approaches to BD determination in every patient.


Assuntos
Morte Encefálica/diagnóstico , Hospitais/normas , Guias de Prática Clínica como Assunto/normas , Doadores de Tecidos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Neurol Res ; 33(10): 1100-8, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22196764

RESUMO

OBJECTIVES: Acute liver failure (ALF) produces cerebral dysfunction and edema, mediated in part by elevated ammonia concentrations, often leading to coma and death. The pathophysiology of cerebral edema in ALF is incompletely understood. In vitro models of the cerebral effects of ALF have predominately consisted of dissociated astrocyte cultures or acute brain slices. We describe a stable long-term culture model incorporating both neural and glial elements in a three-dimensional tissue structure offering significant advantages to the study of astrocytic-neuronal interactions in the pathophysiology of cerebral edema and dysfunction in ALF. METHODS: We utilized chronic organotypic slice cultures from mouse forebrain, applying ammonium acetate in iso-osmolar fashion for 72 hours. Imaging of slice thickness to assess for tissue swelling was accomplished in living slices with optical coherence tomography, and confocal microscopy of fluorescence immunochemical and histochemical staining served to assess astrocyte and neuronal numbers, morphology, and volume in the fixed brain slices. RESULTS: Ammonia exposure at 1-10 mM produced swelling of immunochemically identified astrocytes, and at 10 mM resulted in macroscopic tissue swelling, with slice thickness increasing by about 30%. Astrocytes were unchanged in number. In contrast, 10 mM ammonia treatment severely disrupted neuronal morphology and reduced neuronal survival at 72 hours by one-half. DISCUSSION: Elevated ammonia produces astrocytic swelling, tissue swelling, and neuronal toxicity in cerebral tissues. Ammonia-treated organotypic brain slice cultures provide an In vitro model of cerebral effects of conditions relevant to ALF, applicable to pathophysiological investigations.


Assuntos
Amônia/toxicidade , Edema Encefálico/fisiopatologia , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Encefalopatia Hepática/fisiopatologia , Hiperamonemia/fisiopatologia , Animais , Animais Recém-Nascidos , Encéfalo/patologia , Edema Encefálico/induzido quimicamente , Edema Encefálico/patologia , Modelos Animais de Doenças , Encefalopatia Hepática/patologia , Hiperamonemia/complicações , Hiperamonemia/patologia , Camundongos , Camundongos Endogâmicos C57BL , Degeneração Neural/induzido quimicamente , Degeneração Neural/patologia , Degeneração Neural/fisiopatologia , Técnicas de Cultura de Órgãos
9.
Surg Neurol Int ; 2: 117, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21918732

RESUMO

BACKGROUND: Acute hydrocephalus (HCP) after aneurysmal subarachnoid hemorrhage (SAH) often persists. Our previous study described factors that singly and combined in a formula correlate with permanent CSF diversion. We now aimed to determine whether the same parameters are applicable at an institution with different HCP management practice. METHODS: We reviewed records of 181 consecutive patients who presented with SAH and received an external ventricular drain (EVD) for acute HCP. After exclusion and inclusion criteria were met, 71 patients were analyzed. Data included admission Fisher and Hunt and Hess grades, aneurysm location, treatment modality, ventricle size, CSF cell counts and protein levels, length of stay (LOS) in the hospital, and the presence of craniectomy. Outcome measures were: (1) initial EVD challenge outcome; (2) shunting within 3 months; and (3) LOS. RESULTS: Shunting correlated with Hunt and Hess grade, CSF protein, and the presence of craniectomy. The formula derived in our previous study demonstrated a weaker correlation with initial EVD challenge failure. Several parameters that correlated with shunting in the previous study were instead associated with LOS in this study. CONCLUSIONS: The decision to shunt depends on management choices in the context of a disease process that may improve over time. Based on the treatment strategy, the shunting rate may be lowered but LOS increased. Markers of disease severity in patients with HCP after SAH correlate with both shunt placement and LOS. This is the first study to directly evaluate the effect of different practice styles on the shunting rate. Differences in HCP management practices should inform the design of prospective studies.

10.
Epilepsy Behav ; 19(3): 278-83, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20817614

RESUMO

We investigated the potential neuroprotective effects of leptin (LEP) against cellular damage, long-term recurrent spontaneous seizures, and behavioral changes associated with kainate (KA)-induced status epilepticus (SE). Adult Sprague-Dawley rats were sacrificed 24 hours after KA injections, and hippocampi were subjected to histological analysis. In the acute condition, one group received 12 mg/kg KA intraperitoneally (KAac group), and another group received 12 mg/kg KA intraperitoneally, followed by two intraperitoneal LEP injections of 4 mg/kg each, 1 and 13 hours after KA (KALEPac group). For long-term outcomes, one group received KA (KA group), and the other group received three intraperitoneal LEP injections (4 mg/kg at 1 hour, and 2mg/kg at 13 and 24 hours) after KA (KALEP group). Controls were sham manipulated. Behavioral tests started 6 weeks after SE. All rats that received KA underwent behavioral seizures of comparable severity. Compared with the KAac group, the KALEPac group had significantly larger pyramidal cell surface areas and fewer black-stained degenerating neurons with silver stain. The KALEP and KA groups were comparable with respect to recurrent spontaneous seizures, aggression, hyperactivity, and impaired memory. We show that leptin reduces cellular injury associated with KA-induced SE, but does not prevent long-term recurrent spontaneous seizures and behavioral deficits.


Assuntos
Ácido Caínico , Leptina/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Estado Epiléptico/induzido quimicamente , Análise de Variância , Animais , Contagem de Células , Modelos Animais de Doenças , Interações Medicamentosas , Hipocampo/patologia , Masculino , Células Piramidais/efeitos dos fármacos , Células Piramidais/patologia , Ratos , Ratos Sprague-Dawley , Estado Epiléptico/patologia
12.
J Clin Neurosci ; 16(2): 333-5, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19091571

RESUMO

Locked-in syndrome (LIS) is often caused by ventral pontine injury involving the perforating pontine vessels of the basilar artery and recovery is rarely reported. We report a patient who developed LIS acutely after aneurysmal subarachnoid haemorrhage and rostro-caudal herniation from hydrocephalus. The patient's clinical course and diagnostic studies suggest that the likely mechanism of this patient's LIS is mechanical compression of the ventral pons anteriorly against the clivus. The patient's slow but full recovery allowed us to further differentiate this clinical entity from the more common LIS due to ischaemic mechanisms.


Assuntos
Movimentos Oculares/fisiologia , Hérnia , Quadriplegia/etiologia , Transtornos Cognitivos/complicações , Transtornos Cognitivos/etiologia , Fossa Craniana Posterior/irrigação sanguínea , Fossa Craniana Posterior/patologia , Feminino , Hérnia/complicações , Hérnia/etiologia , Hérnia/patologia , Humanos , Hidrocefalia/complicações , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Ponte/irrigação sanguínea , Ponte/patologia , Hemorragia Subaracnóidea/complicações , Tomografia Computadorizada por Raios X
13.
J Neurol Sci ; 268(1-2): 190-2, 2008 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-18164729

RESUMO

Brain herniation from hemispheric mass lesions injures mainly the upper brainstem around the tentorial incisura. While mechanical tissue compression is usually the process of deterioration and injury, the primary injury mechanism in some patients is early brainstem ischemia from arterial compromise as demonstrated by this patient's magnetic resonance imaging (MRI) and pathology.


Assuntos
Isquemia Encefálica/etiologia , Isquemia Encefálica/patologia , Tronco Encefálico/patologia , Hematoma Subdural Agudo/complicações , Adulto , Isquemia Encefálica/cirurgia , Tronco Encefálico/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Neurocirurgia/métodos
14.
J Neurosurg ; 107(2): 253-60, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17695377

RESUMO

OBJECT: Prophylactic use of antiepileptic drugs (AEDs) in patients admitted with aneurysmal subarachnoid hemorrhage (SAH) is common practice; however, the impact of this treatment strategy on in-hospital complications and outcome has not been systematically studied. The goal in this study was twofold: first, to describe the prescribing pattern for AEDs in an international study population; and second, to delineate the impact of AEDs on in-hospital complications and outcome in patients with SAH. METHODS: The authors examined data collected in 3552 patients with SAH who were entered into four prospective, randomized, double-blind, placebo-controlled trials conducted in 162 neurosurgical centers and 21 countries between 1991 and 1997. The prevalence of AED use was assessed by study country and center. The impact of AEDs on in-hospital complications and outcome was evaluated using conditional logistic regressions comparing treated and untreated patients within the same study center. RESULTS: Antiepileptic drugs were used in 65.1% of patients and the prescribing pattern was mainly dependent on the treating physicians: the prevalence of AED use varied dramatically across study country and center (intraclass correlation coefficients 0.22 and 0.66, respectively [p < 0.001]). Other predictors included younger age, worse neurological grade, and lower systolic blood pressure on admission. After adjustment, patients treated with AEDs had odds ratios of 1.56 (95% confidence interval [CI] 1.16-2.10; p = 0.003) for worse outcome based on the Glasgow Outcome Scale; 1.87 (95% CI 1.43-2.44; p < 0.001) for cerebral vasospasm; 1.61 (95% CI 1.25-2.06; p < 0.001) for neurological deterioration; 1.33 (95% CI 1.01-1.74; p = 0.04) for cerebral infarction; and 1.36 (95% CI 1.03-1.80; p = 0.03) for elevated temperature during hospitalization. CONCLUSIONS: Prophylactic AED treatment in patients with aneurysmal SAH is common, follows an arbitrary prescribing pattern, and is associated with increased in-hospital complications and worse outcome.


Assuntos
Anticonvulsivantes/uso terapêutico , Padrões de Prática Médica , Pregnatrienos/uso terapêutico , Convulsões/etiologia , Convulsões/prevenção & controle , Hemorragia Subaracnóidea/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Seguimentos , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
J Neurosurg ; 107(2): 261-5, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17695378

RESUMO

OBJECT: In this study the authors analyzed the relationship of intraventricular hemorrhage (IVH) to in-hospital complications and clinical outcome in a large population of patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: Data from 3539 patients with aneurysmal SAH were evaluated, and these data were obtained from four prospective, randomized, double-blind, placebo-controlled trials of tirilazad that had been conducted between 1991 and 1997. Clinical characteristics, in-hospital complications, and outcome at 3 months post-SAH (Glasgow Outcome Scale score) were analyzed with regard to the presence or absence of IVH. RESULTS: Patients with SAH and IVH differ in demographic and admission characteristics from those with SAH but without IVH and are more likely to suffer in-hospital complications and a worse outcome at 3 months post-SAH. CONCLUSIONS: The presence of IVH in patients with SAH has an important predictive value with regard to these aspects.


Assuntos
Aneurisma Roto/complicações , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico , Adulto , Idoso , Hemorragia Cerebral/tratamento farmacológico , Estudos de Coortes , Método Duplo-Cego , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuroprotetores/uso terapêutico , Pregnatrienos/uso terapêutico , Prognóstico , Hemorragia Subaracnóidea/tratamento farmacológico
17.
Surg Neurol ; 66(1): 82-5; discussion 85, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16793452

RESUMO

BACKGROUND: Carotid cavernous sinus fistulae are abnormal communications between the carotid circulation and cavernous sinus that may arise spontaneously or develop after craniocerebral trauma. They may present with a constellation of signs and symptoms characteristic of raised cavernous sinus pressure, including orbital or retro-orbital pain, pulsatile proptosis, chemosis, ocular or cranial bruit, deterioration of visual acuity, or ophthalmoplegia. Visual loss is likely the result of multiple insults to the visual system, including reversal of venous drainage from the fistula, arterial flow into the superior ophthalmic vein, increased intraocular venous pressure, venous stasis retinopathy, and eventually ischemic optic neuropathy [Brodsky MC, Hoyt WF, Halbach VV, et al. Recovery from total monocular blindness after balloon embolization of carotid-cavernous fistula. Am J Ophthalmol 1987;104:86-87; Sanders MD, Hoyt WF. Hypoxic ocular sequelae of carotid-cavernous fistulae: study of the causes of visual failure before and after neurosurgical treatment in a series of 25 cases. Br J Ophthalmol 1969;53:82-97]. CASE DESCRIPTION: With few exceptions, the literature is replete with evidence of persistent blindness despite successful treatment of the CCF [Albuquerque FC, Heinz GW, McDougall CG. Reversal of blindness after transvenous embolization of a carotid-cavernous fistula: case report. Neurosurgery 2003;52:233-237; Brodsky MC, Hoyt WF, Halbach VV, et al. Recovery from total monocular blindness after balloon embolization of carotid-cavernous fistula. Am J Ophthalmol 1987;104:86-87; Weinstein JM, Rufenacht DA, Partington CR, et al. Delayed visual loss due to trauma of the internal carotid artery. Arch Neurol. 1991;48:490-497]. Here, we report a patient who experienced recovery of vision after endovascular obliteration of the offending CCF. DISCUSSION: To our knowledge, this is the second reported case of recovery of visual function in a patient presenting with loss of light perception after treatment of a direct CCF.


Assuntos
Cegueira/etiologia , Cegueira/cirurgia , Fístula Carótido-Cavernosa/complicações , Fístula Carótido-Cavernosa/cirurgia , Olho/irrigação sanguínea , Olho/fisiopatologia , Cegueira/fisiopatologia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Fístula Carótido-Cavernosa/fisiopatologia , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/patologia , Seio Cavernoso/cirurgia , Angiografia Cerebral , Embolização Terapêutica/instrumentação , Humanos , Hipóxia-Isquemia Encefálica/etiologia , Hipóxia-Isquemia Encefálica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Artéria Oftálmica/patologia , Artéria Oftálmica/fisiopatologia , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/fisiopatologia , Recuperação de Função Fisiológica , Doenças Retinianas/etiologia , Doenças Retinianas/fisiopatologia , Veia Retiniana/patologia , Veia Retiniana/fisiopatologia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/instrumentação , Procedimentos Cirúrgicos Vasculares/métodos
18.
Neurocrit Care ; 3(2): 139-45, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16174883

RESUMO

INTRODUCTION: Primary cervical and oromandibular dystonia (CD and OMD, respectively) are well-recognized movement disorders, often treated with botulinum toxin (BTx). In contrast, dystonia related to acute brain injuries is not well delineated. Our objective was to define in neurocritically ill patients the clinical characteristics of CD and OMD and to investigate the safety of BTx. METHODS: All acutely brain-injured patients admitted to a neurocritical care unit over a 10-month period were prospectively screened for CD and OMD. Clinical characteristics, etiology of brain injury, and pattern of dystonia were analyzed. Patients with clinically significant CD and OMD were treated with BTx and followed for 12 weeks. RESULTS: Of 165 patients screened, 33 had new-onset CD or OMD. Of 21 patients enrolled, 14 had CD, 5 had OMD, and 2 had both. The pattern of brain injury included 13 cerebral hemorrhages, 6 ischemic strokes, 1 status epilepticus, and 1 unclear etiology. Improvement after BTx was seen in four of seven patients with CD and two of four with OMD; no adverse effects occurred. Spontaneous improvement was recorded in 7 of 11 nontreated patients with CD or OMD. CONCLUSIONS: Acute secondary CD or OMD, associated with a variety of causes, was identified in 20% of acutely brain-injured patients. The temporal profile of dystonia onset and resolution in these patients was variable. Treatment with BTx in the neurocritical care setting seems to be safe. Future, larger scale randomized studies should evaluate the effectiveness of BTx treatment in this patient population.


Assuntos
Antidiscinéticos/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Lesões Encefálicas/fisiopatologia , Distúrbios Distônicos/diagnóstico , Torcicolo/diagnóstico , Adulto , Lesões Encefálicas/complicações , Pré-Escolar , Cuidados Críticos , Distúrbios Distônicos/epidemiologia , Distúrbios Distônicos/terapia , Feminino , Humanos , Masculino , Doenças Mandibulares/diagnóstico , Doenças Mandibulares/tratamento farmacológico , Doenças Mandibulares/epidemiologia , Doenças Mandibulares/terapia , Pessoa de Meia-Idade , Doenças da Boca/diagnóstico , Doenças da Boca/tratamento farmacológico , Doenças da Boca/epidemiologia , Doenças da Boca/terapia , Postura , Torcicolo/tratamento farmacológico , Torcicolo/epidemiologia , Torcicolo/terapia , Resultado do Tratamento
19.
J Neurosurg ; 103(1): 18-24, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16121968

RESUMO

OBJECT: Few studies have focused on the impact of racial differences in demographics, clinical characteristics, acute complications, and outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to examine this issue. METHODS: The authors evaluated prospectively collected data on 1711 adult patients with aneurysmal SAH who were entered into two randomized, double-blind, placebo-controlled trials conducted at neurosurgical centers in North America between 1991 and 1997. Admission characteristics, treatment modalities, in-hospital complications, and 3-month outcomes assessed by application of the Glasgow Outcome Scale were compared using the chi-square test, a t-test, the Wilcoxon rank-sum test, and multiple logistic regressions based on a significance level of 0.05 in 241 African-American, 1342 Caucasian, and 128 other racial minority patients. Caucasian patients were significantly older than patients of other races (p < 0.0001). African-American patients more frequently had a history of hypertension (p < 0.0001) and an elevated blood pressure at the time of admission (p < 0.0001). African-Americans and other racial minorities were more likely to have internal carotid artery aneurysms and Caucasians were more likely to have posterior circulation aneurysms (p = 0.0002). Rates of in-hospital complications were not significantly different except that pulmonary edema occurred more commonly in Caucasians (p = 0.036). After an adjustment was made for significant admission characteristics, the 3-month outcome was not significantly different among the races. CONCLUSIONS: Race was not found to be a prognostic factor for outcome after aneurysmal SAH. The higher SAH mortality rate previously observed in African-American patients is likely a result of a higher incidence of SAH in this group. These findings highlight the importance of primary prevention programs aimed at modifying risk factors for SAH.


Assuntos
Negro ou Afro-Americano , Grupos Minoritários , Hemorragia Subaracnóidea/etnologia , População Branca , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuroprotetores/uso terapêutico , Admissão do Paciente , Pregnatrienos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
20.
Neurosurgery ; 56(4): E872; discussion E871, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15792531

RESUMO

OBJECTIVE AND IMPORTANCE: Acute disseminated encephalomyelitis (ADEM) varies widely in symptoms and severity. Some cases are associated with massive life-threatening cerebral edema refractory to conventional medical management. CLINICAL PRESENTATION: A 51-year-old woman with ADEM who developed severe brain swelling and herniation despite aggressive medical management is described. INTERVENTION: A decompressive hemicraniectomy and durotomy led to rapid improvement and an excellent outcome. CONCLUSION: This case report reinforces the place of this procedure in the armamentarium of treatment options for patients with medically refractory brain swelling and elevated intracranial pressure caused by ADEM. The potential for an increase in the incidence of ADEM with more frequent smallpox vaccinations emphasizes the significance of redefining the full range of management options for this treatable disease.


Assuntos
Craniotomia/métodos , Descompressão Cirúrgica/métodos , Encefalomielite Aguda Disseminada/cirurgia , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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