Adherence and barriers to drug therapy: relationship with the risk of falls in older adults / Adhesión y obstáculos con respecto a la terapia medicamentosa: relación con el riesgo de caídas en adultos mayores / Adesão e barreiras à terapêutica medicamentosa: relação com o risco de queda em idosos

ABSTRACT Objective: to verify the association of adherence and barriers to drug therapy with the risk of falls and the sociodemographic, clinical and economic variables. Method: a cross-sectional study, carried out with 117 aged individuals in a Medical Clinic of Specialties for Older Adults in the Southeast region of the city of São Paulo (SP), from March to November 2019. The following scales were applied: Downton Fall Risk, Morisky-Green Test and Brief Medication Questionnaire. Logistic regression was use to verify the association between adherence to the treatment and types of barriers to adherence and the risk of falls. A 5% significance level was used. Results: the older adults with low adherence to the drug treatment presented 5.57 times more chances of having a high risk of falling when compared to those with greater adherence, and those with a barrier in the recall domain had 22.75 times more chances of having a high risk of falling, in relation to the aged individuals without barriers in the recall domain. Conclusion: low and average adherence to drug therapy and the barrier related to the recall domain were associated with high risk of falls in the older adults.

RESUMEN Objetivo: verificar la asociación de la adhesión y los obstáculos con respecto a la terapia con el riesgo de caídas y las variables sociodemográficas, clínicas y económicas. Método: estudio transversal, realizado con 117 adultos mayores en una Clínica Médica Ambulatoria de Especialidades Geriátricas en la región sudeste de la ciudad de San Pablo (SP) entre marzo y noviembre de 2019. Se aplicaron las siguientes escalas: Riesgo de Caídas de Downton, prueba de Morisky-Green y Brief Medication Questionnaire. Se utilizó regresión logística para verificar la asociación entre la adhesión al tratamiento y los tipos de obstáculos con respecto a dicha adhesión y el riesgo de caídas. Se utilizó un nivel de significancia del 5%. Resultados: los adultos mayores con bajo nivel de adhesión al tratamiento medicamentoso presentaron 5,57 más probabilidades de tener un riesgo de caídas elevado en relación con los que presentaron más adhesión, y quienes tuvieron obstáculos en el dominio Recordatorio presentaron 22,75 más probabilidades de tener un riesgo de caídas elevado, en relación con los adultos mayores sin obstáculos en dicho dominio. Conclusión: los niveles bajo y medio de adhesión a la terapia medicamentosa y el obstáculo relacionado al dominio Recordatorio estuvieron asociados al riesgo de caída elevado en los adultos mayores.

RESUMO Objetivo: verificar a associação da adesão e das barreiras à terapêutica medicamentosa com o risco de quedas e as variáveis sociodemográficas, clínicas e econômicas. Método: estudo transversal, realizado com 117 idosos em um Ambulatório Médico de Especialidades do Idoso na Região Sudeste de cidade de São Paulo (SP), no período de março a novembro de 2019. Foram aplicadas as escalas: Risco de Queda de Downton, teste de Morisky-Green e Brief Medication Questionnaire. Para verificar a associação entre a adesão ao tratamento e tipos de barreiras a essa adesão e o risco de quedas, foi utilizada a regressão logística. Foi utilizado um nível de significância de 5%. Resultados: os idosos com baixa adesão ao tratamento medicamentoso apresentaram chance de 5,57 vezes de ter alto risco de queda em relação aos idosos com maior adesão, e aqueles com barreira no domínio recordação apresentaram chance de 22,75 vezes de ter alto risco de queda, em relação aos idosos sem barreira no domínio recordação. Conclusão: a baixa e média adesão à terapêutica medicamentosa e a barreira relacionada ao domínio recordação se associaram a alto risco de queda nos idosos.

Satisfação pessoal e atividades de lazer em idosos acompanhados ambulatorialmente / Personal satisfaction and leisure activities in elderly outpatients

Objetivo: avaliar a associação da satisfação de vida com a atitude face ao lazer de idosos. Método: Estudo transversal e analítico realizado com 100 idosos. Para relacionar as escalas de Satisfação de Vida e Atitudes Face ao Lazer utilizou-se o coeficiente de correlação de Spearman. Resultados: Quanto maior o escore nos domínios saúde física e saúde mental, da escala de Satisfação com a Vida, maiores os escores no domínio afetivo e total da escala de Atitudes Face ao Lazer. Quanto maior o escore nos domínios capacidade física e envolvimento social, maiores os escores nos domínios afetivo, comportamental e total da escala de Atitudes Face ao Lazer. Conclusão: quanto maior os escores da escala de Satisfação com a Vida, maior os scores da escala de Atitudes Face ao Lazer, o que pode demonstrar que o idoso com mais satisfação com a vida apresenta atitude mais positiva em relação ao lazer.

Objectives: to evaluate the association of life satisfaction with attitude towards leisure among the elderly. Method: This is a cross-sectional and analytical study conducted with 100 elderly outpatients. Spearman's correlation coefficient was used to relate the Satisfaction with Life Scale and the Leisure Attitude Measurement Scale. Results: The higher the score in the physical health and mental health domains of the Satisfaction with Life Scale, the higher the affective domain and total scores of the Leisure Attitude Measurement Scale. The higher the score in the physical capacity and social involvement domains, the higher the scores in the affective and behavioral domains as well as the total score of the Leisure Attitude Measurement Scale. Conclusion: It was concluded that the higher the scores of the Satisfaction with Life Scale, the higher the scores of the Leisure Attitude Measurement Scale, which demonstrates that elderly people with greater life satisfaction have a more positive attitude towards leisure

Brazilian Academy of Neurology (2006 - 2016).

Brazil is a heterogeneous country with continental dimensions. The different characteristics of cultural, socioeconomic, and demographic status of the population drive different strategies for neurological care. This knowledge helps the understanding of the current scenario with the consequent possibility of preparing for future challenges. We used data from annual internal forms of the Brazilian Academy of Neurology (BAN) since 2006 and the survey for all BAN members (3,240) in 2016. The geographic distribution of BAN members in Brazil follows the demographic concentration of the population. Participation of members from big cities was the most prevalent, 18.7% of participants were young neurologists, and 36.7% of neurologists had more than of 20 years of neurological practice. The improvement of knowledge of neurological practice in Brazil will be useful for BAN leadership in planning future actions. The BAN must make an effort to aggregate a greater number of neurologists, offering updating support contributing to health policies to disseminate neurological care in Brazil.

Brazilian Academy of Neurology (2006 - 2016) / Academia Brasileira de Neurologia (2006 - 2016)

ABSTRACT Brazil is a heterogeneous country with continental dimensions. The different characteristics of cultural, socioeconomic, and demographic status of the population drive different strategies for neurological care. This knowledge helps the understanding of the current scenario with the consequent possibility of preparing for future challenges. We used data from annual internal forms of the Brazilian Academy of Neurology (BAN) since 2006 and the survey for all BAN members (3,240) in 2016. The geographic distribution of BAN members in Brazil follows the demographic concentration of the population. Participation of members from big cities was the most prevalent, 18.7% of participants were young neurologists, and 36.7% of neurologists had more than of 20 years of neurological practice. The improvement of knowledge of neurological practice in Brazil will be useful for BAN leadership in planning future actions. The BAN must make an effort to aggregate a greater number of neurologists, offering updating support contributing to health policies to disseminate neurological care in Brazil.

RESUMO O Brasil é um país heterogêneo com dimensões continentais. As diferentes características culturais, do padrão socioeconômico e demográfico da população direcionam diferentes estratégias de atenção neurológica. Este conhecimento ajuda a entender o cenário atual para consequente preparação para os desafios futuros. Utilizamos informações dos relatórios anuais de Academia Brasileira de Neurologia (ABN) desde 2006, além de dados de uma pesquisa para os membros da ABNr ealizada em 2016. A distribuição geográfica dos membros da ABN no Brasil segue a concentração demográfica da população. A participação na pesquisa dos membros das grandes cidades foi a mais prevalente. 18,7% eram neurologistas jovens e 36,7% tinham mais de 20 anos de prática neurológica. O aperfeiçoamento do conhecimento da prática neurológica no Brasil será útil para a liderança da ABN planejar ações futuras. A ABN deve se esforçar para agregar um maior número de neurologistas, oferecendo constante atualização e apoio profissional contribuindo para políticas de saúde para disseminar o conceito de doenças neurológicas no Brasil.

Electrical stimulation of the posterior tibialis nerve improves symptoms of poststroke neurogenic overactive bladder in men: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of electrical stimulation of the posterior tibialis nerve in men with neurogenic overactive bladder secondary to ischemic stroke at 45 days and 12 months after treatment. MATERIALS AND METHODS: We studied 24 patients older than 18 years, with ischemic stroke that occurred between 6 months and 3 years previously and with no prior urinary symptoms. These patients were randomly allocated to receive electrical stimulation of the posterior tibialis nerve twice weekly for 6 weeks (treatment group, n = 12) or general advice and stretching sessions 1 to 3 times monthly for 6 weeks (control group, n = 12). Each session lasted 30 minutes in both groups. The primary outcomes were reduction in urinary frequency, reduction in urinary urgency, and overall improvement in voiding diary variables. RESULTS: Patients in the electrical stimulation group, in relation to baseline and to control group, experienced improvement in urinary symptoms, reducing urinary urgency and frequency, and reported subjective improvement after treatment. This effect persisted after 12 months of follow-up. The patients with lesion in right hemisphere, advanced age, and with higher body mass index presented more chance to develop urinary symptoms. CONCLUSION: Electrical stimulation of the posterior tibialis nerve is a safe and effective option for the treatment of poststroke neurogenic overactive bladder in men, reducing urinary frequency and urgency.

Vestibular function in carotid territory stroke patients.

UNLABELLED: Stroke patients may present otoneurological symptoms. OBJECTIVE: To assess the vestibular function of subjects with a history of carotid territory stroke. METHOD: This historical cohort cross sectional study enrolled 40 patients; subjects answered the Dizziness Handicap Inventory, were interviewed and submitted to ENT examination and vectorelectronystagmography. RESULTS: Mild saccadic movement anomalies were seen in 20 patients (50.0%); nine complained of imbalance and dizziness. Abnormal smooth pursuit gain was seen in 17 cases (42.5%); six subjects reported imbalance and one complained of dizziness. Abnormal directional preponderance during rotational nystagmus was seen in two cases (5.0%), who also reported imbalance. Three patients (7.5%) and two subjects (5.0%) were found to have abnormal labyrinthine predominance and abnormal nystagmus directional preponderance respectively; all five individuals reported imbalance. Ten of the 11 patients without complaints of disordered balance had altered saccadic and smooth pursuit eye movements, while one had unaltered vestibular function. CONCLUSION: Patients with a history of carotid territory stroke may suffer from dizziness or imbalance and present signs of compromised eye motility and vestibular function.

Função vestibular no acidente vascular cerebral do território carotídeo / Vestibular function in carotid territory stroke patients

Pacientes após Acidente Vascular Cerebral (AVC) podem apresentar sintomas otoneurológicos. OBJETIVO: Avaliar a função vestibular de pacientes com antecedente pessoal de AVC no território carotídeo. Desenho científico: estudo de coorte histórica com corte transversal. MÉTODO: Quarenta pacientes foram submetidos à anamnese, exame otorrinolaringológico, Dizziness Handicap Inventory e vectoeletronistagmografia. RESULTADOS: Anormalidades discretas dos movimentos sacádicos foram encontradas em 20 pacientes (50,0%); nove referiram desequilíbrio e um tontura. O ganho do rastreio pendular foi anormal em 17 casos (42,5%); seis referiram desequilíbrio e um tontura. Preponderância direcional anormal do nistagmoperrotatório ocorreu em dois casos (5,0%), que referiram desequilíbrio. A prova calórica identificou três casos (7,5%) com predomínio labiríntico anormal e dois (5,0%) com preponderância direcional anormal do nistagmo; os cinco casos relataram desequilíbrio. Dos 11 pacientes que não referiram manifestações de alteração do equilíbrio corporal, 10 apresentaram alterações nos movimentos sacádicos e no rastreio pendular e um apresentou exame vestibular normal. CONCLUSÃO: Pacientes com antecedente pessoal de AVC no território carotídeo podem apresentar tontura ou desequilíbrio corporal e sinais de comprometimento da motilidade ocular e da função vestibular.

Stroke patients may present otoneurological symptoms. OBJECTIVE: To assess the vestibular function of subjects with a history of carotid territory stroke. METHOD: This historical cohort cross sectional study enrolled 40 patients; subjects answered the Dizziness Handicap Inventory, were interviewed and submitted to ENT examination and vectorelectronystagmography. RESULTS: Mild saccadic movement anomalies were seen in 20 patients (50.0%); nine complained of imbalance and dizziness. Abnormal smooth pursuit gain was seen in 17 cases (42.5%); six subjects reported imbalance and one complained of dizziness. Abnormal directional preponderance during rotational nystagmus was seen in two cases (5.0%), who also reported imbalance. Three patients (7.5%) and two subjects (5.0%) were found to have abnormal labyrinthine predominance and abnormal nystagmus directional preponderance respectively; all five individuals reported imbalance. Ten of the 11 patients without complaints of disordered balance had altered saccadic and smooth pursuit eye movements, while one had unaltered vestibular function. CONCLUSION: Patients with a history of carotid territory stroke may suffer from dizziness or imbalance and present signs of compromised eye motility and vestibular function.

Swallowing disorders after ischemic stroke.

OBJECTIVE: To investigate occurrences of swallowing disorders after ischemic stroke. METHOD: This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days. RESULTS: 50.5% were men and 49.5% women; mean age 65.3 years (SD= ± 11.7) (p ≤ 0.001). Among the risk factors, 79.4% had hypertension, 36.7% had diabetes (p ≤ 0.001) and 42.7% were smokers. 13.3% of the patients died. Swallowing disorders occurred in 19.6%, among whom 91.5% had mild difficulty and 8.5% had severe difficulty. 87.1% had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8% (p ≤ 0.001). CONCLUSION: Swallowing disorders occurred in almost 20% of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.

Swallowing disorders after ischemic stroke / Alteração da deglutição após acidente cerebrovascular isquêmico

OBJECTIVE: To investigate occurrences of swallowing disorders after ischemic stroke. METHOD: This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days. RESULTS: 50.5 percent were men and 49.5 percent women; mean age 65.3 years (SD=±11.7) (p<0.001). Among the risk factors, 79.4 percent had hypertension, 36.7 percent had diabetes (p<0.001) and 42.7 percent were smokers. 13.3 percent of the patients died. Swallowing disorders occurred in 19.6 percent, among whom 91.5 percent had mild difficulty and 8.5 percent had severe difficulty. 87.1 percent had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8 percent (p<0.001). CONCLUSION: Swallowing disorders occurred in almost 20 percent of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.

OBJETIVO: Verificar alteração da deglutição após acidente cerebrovascular isquêmico (AVCI). MÉTODO: Estudo retrospectivo de 596 prontuários. Critérios de inclusão: pacientes hospitalizados com diagnóstico de AVCI. Critérios de exclusão: pacientes com problemas cardíacos associados e com mais de 14 dias de internação. RESULTADOS: 50,5 por cento homens e 49,5 por cento mulheres, idade média 65,3 anos (DP=±11,7) (p<0,001). Entre os fatores de risco, 79,4 por cento hipertensão arterial, 36,7 por cento diabetes (p<0,001), 42,7 por cento tabagismo. Óbito ocorreu em 13,3 por cento dos pacientes. Alteração de deglutição ocorreu em 19,6 por cento, sendo 91,5 por cento com dificuldade leve e 8,5 por cento com dificuldade grave; 87,1 por cento tiveram recuperação espontânea com tempo médio de 2,4 meses. A lesão em região de tronco encefálico ocorreu em 6,8 por cento (p<0,001). CONCLUSÃO: A alteração da deglutição ocorreu em quase 20 por cento da população e a dificuldade de deglutição mais encontrada foi a leve. Os fatores preditores para alteração de deglutição foram aumento da idade, diabetes mellitus e lesão em região de tronco encefálico.

Predictive factors for spasticity among ischemic stroke patients / Fatores preditivos para espasticidade após acidente vascular cerebral

Spasticity is a determining for functional loss following ischemic stroke. OBJECTIVE: To detect possible predictive factors for its occurrence. METHOD: Demographic, clinical and tomographic data on 146 stroke patients were analyzed. RESULTS: Spasticity was noted more frequently among patients who underwent physiotherapy (p<0.0001; OR=19.4; 95 percent CI: 4.4-84.5), those who underwent such treatment for long periods (p=0.028; OR=4.80; 95 percent CI: 1.1-8.3) and those with manual work (p=0.041; OR=2.2; 95 percent CI: 1.02-4.6), lower income (p=0.038), pain complaints (p<0.0001; OR=107.0; 95 percent CI: 13.5-847.3), appearance of pain at the same time as spasticity (p<0.0001), previous vascular disease (p=0.001; OR=4.2; 95 percent CI: 1.7-10.3), muscle weakness (p<0.0001; OR=91.9; 95 percent CI: 12.0-699.4), extensive lesions as seen on tomography (p=0.01) and lesions affecting more than one cerebral lobe (p=0.018). Manual work had a relative risk of 2.9; previous stroke 3.9, and extensive lesion 3.6. CONCLUSION: Spasticity affected 25 percent of the patients, and was associated with: manual work, previous stroke, extensive lesions, decrease in individual income, underwent physiotherapy, underwent physiotherapy for longer period, pain complaints, the pain started simultaneously with the spasticity, presented changes in strength.

A espasticidade é fator determinante para perda funcional após o acidente vascular cerebral isquêmico (AVCI). OBJETIVO: Detectar possíveis fatores preditivos para a ocorrência da espasticidade. MÉTODO: Foram analisados dados demográficos, clínicos e tomográficos de 146 pacientes pós-AVCI. RESULTADOS: Na análise univariada a espasticidade foi notada com maior freqüência em pacientes que realizaram fisioterapia (p<0,0001; OR=19,4; 95 por cento CI: 4,4-84,5), com maior tempo de duração desse tratamento (p=0,028; OR=4,80; 95 por cento CI: 1,1-8,3) e que realizavam trabalho braçal (p=0,041; OR=2,2; 95 por cento CI: 1,02-4,6), renda menor (p=0,038), referência de dor (p<0,0001; OR=107,0; 95 por cento CI: 13,5-847,3) e seu aparecimento simultâneo à espasticidade (p<0,0001), acidente vascular cerebral (AVC) pregresso (p=0,001; OR=4,2; 95 por cento CI: 1,7-10,3), fraqueza muscular (p<0,0001; OR=91,9; 95 por cento CI: 12,0-699,4), lesão tomográfica extensa (p=0,01) e lesão afetando mais de um lobo cerebral (p=0,018). Na análise de regressão multivariada a atividade braçal apresentou risco relativo de 2,9; acidente vascular cerebral prévio com risco relativo de 3,9 e lesão tomográfica extensa risco relativo de 3,6. CONCLUSÃO: A espasticidade afetou um quarto da população estudada e esteve associada ao trabalho braçal, AVC pregresso, lesões tomográficas extensas, diminuição da renda individual, realização de fisioterapia, realização de fisioterapia por um período maior, presença de dor, surgimento da dor simultânea à espasticidade e alteração da força.

Verbal language spontaneous recovery after ischemic stroke.

OBJECTIVE: To analyze the spontaneous recovery of the verbal language on patients who have had an ischemic stroke. METHOD: Retrospective analysis of 513 medical records. We characterize referring aspects for data identification, language deficit, spontaneous recovery and speech therapy. RESULTS: The average age was 62.2 years old (SD= +/-12.3), the average time of academic experience was 4.5 years (SD=+/-3.9), 245 (47.7%) patients presented language disturbance, 166 (54.0%) presented spontaneous recovery, from which 145 (47.2%) had expression deficit (p=0.001); 12 (3.9%) had comprehension deficit and 9 (2.9%) had both expression and comprehension deficit. Speech therapy was carried with 15 patients (4.8%) (p=0.001). CONCLUSION: The verbal language spontaneous recovery occurred in most of the patients being taken care of at the stroke out clinic, and expression disturbance was the most identified alteration. As expected, the left hemisphere was associated with the deficit and smoking and pregressive stroke were the language alteration primary associated factors.

Verbal language spontaneous recovery after ischemic stroke / Recuperação espontânea da linguagem verbal após acidente cerebrovascular isquêmico

OBJECTIVE: To analyze the spontaneous recovery of the verbal language on patients who have had an ischemic stroke. METHOD: Retrospective analysis of 513 medical records. We characterize referring aspects for data identification, language deficit, spontaneous recovery and speech therapy. RESULTS: The average age was 62.2 years old (SD= ±12.3), the average time of academic experience was 4.5 years (SD=±3.9), 245 (47.7 percent) patients presented language disturbance, 166 (54.0 percent) presented spontaneous recovery, from which 145 (47.2 percent) had expression deficit (p=0.001); 12 (3.9 percent) had comprehension deficit and 9 (2.9 percent) had both expression and comprehension deficit. Speech therapy was carried with 15 patients (4.8 percent) (p=0.001). CONCLUSION: The verbal language spontaneous recovery occurred in most of the patients being taken care of at the stroke out clinic, and expression disturbance was the most identified alteration. As expected, the left hemisphere was associated with the deficit and smoking and pregressive stroke were the language alteration primary associated factors.

OBJETIVO: Analisar a recuperação espontânea da linguagem verbal em pacientes que sofreram acidente cerebrovascular isquêmico (AVCI). MÉTODO: Análise retrospectiva de 513 prontuários. Caracterizamos aspectos referentes aos dados de identificação, déficit de linguagem, recuperação espontânea, realização de tratamento fonoaudiológico. RESULTADOS: A média de idade foi 62,2 anos (DP=±12,3), o nível de escolaridade teve média de 4,5 anos (DP=±3,9), 245 (47,7 por cento) pacientes apresentaram alteração de linguagem, 166 (54,0 por cento) apresentaram recuperação espontânea sendo 145 (47,2 por cento) do déficit de expressão (p=0,001), 12 (3,9 por cento) de compreensão e 9 (2,9 por cento) misto. A realização de tratamento fonoaudiológico foi encontrada em 15 (4,8 por cento) (p=0,001). CONCLUSÃO: A recuperação espontânea da linguagem verbal ocorreu na maioria dos pacientes atendidos no ambulatório de AVCI e a alteração mais encontrada foi de expressão. Como esperado o hemisfério esquerdo associou-se ao déficit, sendo o tabagismo e AVC pregresso fatores preditores de alteração de linguagem.

Factors relating to depressive symptoms among elderly people with chronic vestibular dysfunction.

OBJECTIVE: To identify factors relating to depressive symptoms among elderly people with chronic vestibular dysfunction. METHOD: This was a cross-sectional study in which 120 elderly people with chronic vestibular dysfunction answered the Geriatric Depression Scale questionnaire. Multivariate linear regression analysis was performed (p<0.05 and 95% CI). RESULTS: The patients presented a mean score of 12.86 +/- 6.39 points on the Geriatric Depression Scale, and 67 of them (55.8%) scored above the cutoff of 11 points. The predictive model for worsening of depressive symptoms was composed of female gender, memory and concentration disorders, insomnia, hearing disorders, poor sight, nonuse of walking aids and greater emotional impact of dizziness. CONCLUSION: Greater numbers of depressive symptoms among elderly people with chronic vestibular disease were related to the presence of memory and concentration disorders, insomnia, hearing disorders, very poor sight, greater emotional impact of dizziness, female gender and nonuse of walking aids.

Factors relating to depressive symptoms among elderly people with chronic vestibular dysfunction / Fatores relacionados aos sintomas depressivos de idosos com disfunção vestibular crônica

OBJECTIVE: To identify factors relating to depressive symptoms among elderly people with chronic vestibular dysfunction. METHOD: This was a cross-sectional study in which 120 elderly people with chronic vestibular dysfunction answered the Geriatric Depression Scale questionnaire. Multivariate linear regression analysis was performed (p<0.05 and 95 percent CI). RESULTS: The patients presented a mean score of 12.86 ± 6.39 points on the Geriatric Depression Scale, and 67 of them (55.8 percent) scored above the cutoff of 11 points. The predictive model for worsening of depressive symptoms was composed of female gender, memory and concentration disorders, insomnia, hearing disorders, poor sight, nonuse of walking aids and greater emotional impact of dizziness. CONCLUSION: Greater numbers of depressive symptoms among elderly people with chronic vestibular disease were related to the presence of memory and concentration disorders, insomnia, hearing disorders, very poor sight, greater emotional impact of dizziness, female gender and nonuse of walking aids.

OBJETIVO: Identificar os fatores relacionados aos sintomas depressivos de idosos com disfunção vestibular crônica. MÉTODO: Estudo transversal, em que 120 idosos com disfunção vestibular crônica submeteram-se ao questionário Geriatric Depression Scale. Realizou-se análise de regressão linear multivariada (p<0,05 e IC de 95 por cento). RESULTADOS: Os pacientes apresentaram média de 12,86 ± 6,39 pontos no GDS, sendo que 67 idosos (55,8 por cento) pontuaram acima da nota de corte 11. O modelo preditivo para piora dos sintomas depressivos foi composto por gênero feminino, distúrbios de memória e da concentração, insônia, hipoacusia, visão péssima, não utilização de dispositivo de auxílio à marcha e maior impacto da tontura no aspecto emocional. CONCLUSÃO: O maior número de sintomas depressivos de idosos vestibulopatas crônicos está relacionado à presença de distúrbios de memória e da concentração, insônia, hipoacusia, visão péssima, maior impacto da tontura no aspecto emocional, gênero feminino e não utilização de dispositivo de auxílio à marcha.

Predictive factors for spasticity among ischemic stroke patients.

UNLABELLED: Spasticity is a determining for functional loss following ischemic stroke. OBJECTIVE: To detect possible predictive factors for its occurrence. METHOD: Demographic, clinical and tomographic data on 146 stroke patients were analyzed. RESULTS: Spasticity was noted more frequently among patients who underwent physiotherapy (p<0.0001; OR=19.4; 95% CI: 4.4-84.5), those who underwent such treatment for long periods (p=0.028; OR=4.80; 95% CI: 1.1-8.3) and those with manual work (p=0.041; OR=2.2; 95% CI: 1.02-4.6), lower income (p=0.038), pain complaints (p<0.0001; OR=107.0; 95% CI: 13.5-847.3), appearance of pain at the same time as spasticity (p<0.0001), previous vascular disease (p=0.001; OR=4.2; 95% CI: 1.7-10.3), muscle weakness (p<0.0001; OR=91.9; 95% CI: 12.0-699.4), extensive lesions as seen on tomography (p=0.01) and lesions affecting more than one cerebral lobe (p=0.018). Manual work had a relative risk of 2.9; previous stroke 3.9, and extensive lesion 3.6. CONCLUSION: Spasticity affected 25% of the patients, and was associated with: manual work, previous stroke, extensive lesions, decrease in individual income, underwent physiotherapy, underwent physiotherapy for longer period, pain complaints, the pain started simultaneously with the spasticity, presented changes in strength.

Cerebral venous thrombosis and hepatitis: case report / Trombose venosa cerebral e hepatite: relato de caso

Among the many infective causes of cerebral venous thrombosis (CVT), viral hepatitis is been regarded as a rare associated condition. We report on a 56-years-old man presenting CVT associated with hepatitis B and C coinfections outlining probable pathogenic mechanisms. We suggest that virus B and C serology should be performed in the cases of cerebral venous thrombosis with unknown etiology.

Dentre as várias causas infecciosas de trombose venosa cerebral (TVC), a hepatite viral tem sido reconhecida como causa rara de TVC. Relatamos sobre um homem de 56 anos com TVC associada a coinfecção pelos vírus B e C da hepatite, ressaltando possíveis mecanismos patogênicos. Sugerimos que sorologia para vírus da hepatite B e C deveria ser solicitado em todos os casos de TVC de origem indeterminada.

Cerebral venous thrombosis and hepatitis: case report.

Among the many infective causes of cerebral venous thrombosis (CVT), viral hepatitis is been regarded as a rare associated condition. We report on a 56-years-old man presenting CVT associated with hepatitis B and C coinfections outlining probable pathogenic mechanisms. We suggest that virus B and C serology should be performed in the cases of cerebral venous thrombosis with unknown etiology.

Transesophageal echocardiography discloses unexpected cardiac sources of embolus in stroke patients aged more than 45 years

Embolia cerebral de fonte cardíaca é frequentemente relacionada a acidente vascular cerebral (AVC) em jovem.OBJETIVO: Descrever achados ecocardiográficos em jovens e não jovens com AVC isquêmico, sem suspeita de fonte cardíaca.MÉTODO: Estudo transversal; 523 pacientes (267 homens e 256 mulheres) com AVC isquêmico sem evidência de fonte cardíaca submeteram-se ao ecocardiograma transesofágico (ECOTE). RESULTADOS: 10% dos pacientes tinha 45 anos; ou menos. Hipertrofia do ventrículo esquerdo, aumento do átrio esquerdo, contraste espontâneo na aorta, aneurisma do septo interatrial, calcificação da válvula mitral e aórtica, insuficiência aórtica e placas de ateroma na aorta foram significantemente mais frequentes nos pacientes com mais que 45 anos; 2.8% dos não-jovens apresentaram trombo nas câmaras esquerdas.CONCLUSÃO: ECOTE é amplamente sugerido na investigação de embolia em pacientes jovens, porém parece ser tão importante também no grupo de pacientes mais velhos, nos quais o risco de embolia cerebral é subestimado; etiologia cardioembólica e aterosclerótica coexistem, e ambas devem ser identificadas e tratadas para melhor prognóstico.

[Management of carotid disease in acute phase of stroke: national opinion]. / Abordagem da doença carotídea na fase aguda do acidente vascular cerebral: opinião nacional.

The Brazilian Stroke Society constituted a committee composed by specialists from different areas of Brazil that emitted a viewpoint called "National Opinion", in a consensus pattern. The study purpose is to guide and offer subsidies for diagnosis and therapeutical plans for different situations in cerebrovascular disease The present article analyzes "carotid disease in the acute phase of stroke", approaching separately the following topics: methods for detection of carotid stenosis in acute phase; when and how intervene on the carotid during the acute phase; clinical treatment and inflammatory markers. Comments based on literature and participants personal opinion are described, and conclusion are the group opinion.

Abordagem da doença carotídea na fase aguda do acidente vascular cerebral: opinião nacional / Management of carotid disease in acute phase of stroke: national opinion

Com finalidade de orientar e oferecer subsídios para a conduta diagnóstica e terapêutica em diferentes situações dentro das doenças cerebrovasculares, a Sociedade Brasileira de Doenças Cerebrovasculares constituiu um comitê composto por especialistas de diferentes áreas do Brasil, que emitiram um parecer, denominado "Opinião Nacional", redigido nos moldes dos consensos. O presente artigo analisa a "Doença Carotídea na Fase Aguda do AVC", abordando separadamente os seguintes tópicos: métodos de detecção de estenose carotídea na fase aguda; quando e como intervir sobre a carótida na fase aguda; tratamento clínico e marcadores de inflamação. São apresentados os comentários, baseados na literatura e na opinião pessoal dos participantes, e é descrito, como conclusão em cada item, a opinião do grupo.