RESUMO
Background: Dementia is one of the main problems in public health, affecting 5 to 10 percent of the eider population. The cost-effectiveness analysis of the ancillary tests is controversial. The object of this research is to make a review of the recent studies related to neuroimaging and dementia. Method and Results: English and Spanish studies published in the last ten years were searched in Medline, using evidence-based techniques. 13 systematic reviews were found and analysed. Conclusion: While reversible cases of dementia are rare once detected, most of the experts recommend the routine use of computerized tomography scanning. If the access to this test were restricted, there are some rules to select patients. Magnetic resonance imaging is better for the diagnosis of some subtypes of dementia like Creutzfeldt-Jakob, Huntington or CADASIL. Volumetric spectrometry PET and SPECT would be reserved to investigation protocols or special cases of diagnostic doubt.
Introducción: Las demencias constituyen uno de los principales problemas de salud pública, afectando al 5-10 por ciento de la población mayor de 65 años. Existe controversia respecto al costo-beneficio de los exámenes complementarios destinados a esclarecer el subtipo de demencia y la presencia de factores potencialmente reversibles. El objetivo de este estudio es revisar la literatura actualmente disponible respecto a las neuroimágenes y el diagnóstico de demencia. Métodos y Resultados: Se realizó una búsqueda sistemática en Medline, en inglés y español, restringida a los últimos 10 años. Se encontró y analizó 13 revisiones atingentes al tema. Conclusiones: Aunque los casos de demencia reversible son muy escasos, la mayoría de los expertos recomienda el uso rutinario de la tomografía computarizada. Si el acceso a este examen fuera restringido, se sugiere pautas de selección de pacientes. La resonancia magnética es de mayor ayuda ante la sospecha de patologías específicas como Creutzfeldt-]akob, Huntington o CADASIL. La volumetría, espectrometría, PET y SPECT deberían reservarse por el momento a protocolos de investigación o casos puntuales de duda diagnóstica.
Assuntos
Humanos , Demência/diagnóstico , Diagnóstico por Imagem/métodos , Imageamento por Ressonância Magnética , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Cérebro/patologiaRESUMO
Background: Stroke is the second cause of mortality and the first cause of morbidity in Chile and worldwide. Nowadays there is a major interest in introducing new therapies applying evidence based medicine for these patients. Aim: To describe the clinical profile of patients attended after a stroke, to determine stroke subtypes and their risk factors. Material and methods: Retrospective review of clinical records of 459 patients (mean age 65±48 years, 238 female) that were admitted to our unit during a period of 37 months. Results: Sixty three percent of patients had an ischemic stroke, 14% had an hemorrhagic stroke, 15% had a transient ischemic attack, 2% had a cerebral venous thrombosis and 6% a subarachnoidal hemorrhage. The global mortality was 1%. Seventy percent of patients had a history of high blood pressure. Conclusions: The most common type of stroke is ischemic and high blood pressure is the main risk factor.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/epidemiologia , Unidades Hospitalares/estatística & dados numéricos , Distribuição por Idade , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/etiologia , Distribuição de Qui-Quadrado , Chile/epidemiologia , Complicações do Diabetes , Hipertensão/complicações , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoRESUMO
BACKGROUND: Stroke is the second cause of mortality and the first cause of morbidity in Chile and worldwide. Nowadays there is a major interest in introducing new therapies applying evidence based medicine for these patients. AIM: To describe the clinical profile of patients attended after a stroke, to determine stroke subtypes and their risk factors. MATERIAL AND METHODS: Retrospective review of clinical records of 459 patients (mean age 65+/-48 years, 238 female) that were admitted to our unit during a period of 37 months. RESULTS: Sixty three percent of patients had an ischemic stroke, 14% had an hemorrhagic stroke, 15% had a transient ischemic attack, 2% had a cerebral venous thrombosis and 6% a subarachnoidal hemorrhage. The global mortality was 1%. Seventy percent of patients had a history of high blood pressure. CONCLUSIONS: The most common type of stroke is ischemic and high blood pressure is the main risk factor.
Assuntos
Unidades Hospitalares/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Chile/epidemiologia , Complicações do Diabetes , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/etiologiaRESUMO
The temporal crescent syndrome or half-moon syndrome is a rare mono ocular retrochiasmatic visual field defect that can be correlated to a lesion along the contralateral parieto-occipital sulcus. This field defect may be missed in automated perimetry. We report a 45 years old man, consulting for sudden loss of the peripheral temporal field in his right eye. The magnetic resonance imaging and the spectroscopy studies confirmed an ischemic lesion on the left anterior occipital cortex. Control imaging studies six months later did not show changes in the lesion.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Infarto Cerebral/complicações , Hemianopsia/etiologia , Córtex Visual , Campos Visuais , Testes de Campo Visual , Hemianopsia/diagnóstico , Imageamento por Ressonância Magnética , Síndrome , Visão MonocularRESUMO
El síndrome del "hombre en el barril" se refiere al cuadro clínico de paresia braquial proximal bilateral, que es habitualmente secundaria a una hipotensión arterial sistémica con hipoperfusión encefálica, resultando en una isquemia de zonas limítrofes. Reportamos el caso de un hombre de 57 años, con paresia braquial proximal bilateral después de una cirugía biliar debido a una colangitis. La difusión en resonancia magnética mostró lesiones hiperintensas en la zona correspondiente al límite entre los territorios de las arterias cerebrales media y anterior derechas.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Colangite/cirurgia , Isquemia/complicações , Paraparesia/etiologia , Paresia/etiologia , ColecistectomiaRESUMO
El síndrome de regresión espectacular de la isquemia encefálica (spectacular shrinking deficit) corresponde a la isquemia hemisférica encefálica que se resuelve en forma espontánea y deja un déficit neurológico residual mínimo o nulo. Reportamos el caso de una mujer de 86 años con un síndrome de isquemia hemisférica izquierda súbito y resolución clínica espontánea completa en pocas horas. El estudio con resonancia magnética de encéfalo y angiorresonancia mostró múltiples infartos pequeños en el territorio de la arteria cerebral media izquierda y oclusión completa de la arteria carótida interna izquierda.