Do Physically Active Patients Have Better Functional Outcome after Stroke? A Systematic Review.

BACKGROUND AND PURPOSE: Stroke is one of the major causes of mortality and, among survivors, disability. Physical activity has a protective effect maybe due to a major control of risk factors, such as hypertension, diabetes mellitus, and body weight. However, the effect of prestroke physical activity and the poststroke functional outcomes needs clarification. METHODS: We made a systematic review of the literature to elucidate this effect through electronic search in the MEDLINE/PubMed database. Prisma statement was used as a basis for this systematic review and analysis of the risk of bias was made according to the Grading of Recommendations, Assessment, Development and Evaluation. Three studies were finally analyzed in this review. RESULTS: The largest of the studies (Rist et al) revealed no association between prior physical activity and functional outcome after stroke. The second major study (Stroud et al) showed only a slight association. Only the smallest of the 3 studies (Krarup et al) showed a protective effect of physical activity. CONCLUSIONS: The evidence of the protective effect of physical activity is still conflicting. Better longitudinal studies are still needed to see the real effect of physical activity on functional outcome after stroke.

Systematic review of the effect of dynamic fixation systems compared with rigid fixation in the anterior cervical spine.

PURPOSE: Anterior cervical fixation is a procedure widely employed in medical practice, with different fixation systems in use. This study aimed to perform a systematic review of the literature comparing the use of rigid and dynamic cervical plates regarding the fusion rate and complications. METHODS: A search was conducted in PubMed, Lilacs, and Cochrane databases and selecting comparative studies on the use of rigid and dynamic cervical plates. Prospective randomized studies were selected to describe the final results regarding the clinical and radiological outcomes; comparative observational studies were also cited. Complications of using the dynamic cervical plate were also evaluated. RESULTS: Seven comparative studies were included in the review. Five of these were prospective and randomized studies that did not report significant differences in the clinical outcome. One study reported a faster fusion rate when dynamic cervical plate was used, and another study showed a higher fusion rate when a dynamic cervical plate was applied on multiple levels. Four studies investigated the complications of using a dynamic plate and reported that changes in the cervical curvature angle and material failure were the most frequent complications. CONCLUSIONS: There were no clinical differences between the two types of cervical fixation systems. A difference in the fusion rates could not be found at any follow-up time or in any of the studies. There was a loss of lordotic correction in the dynamic systems and a higher rate of complications in patients with a loss of lordotic correction.

A rare case of penetrating cranial trauma by knife with direct lesion to the anterior cerebral artery

Las lesiones penetrantes en el cráneo por lo general se asocian con alta mortalidad. Ellos pueden ser el resultado de numerosos eventos, la mayoría de ellos están causados por un trauma de alta energía. La perforación de un cráneo por los objetos de baja energía cinética es inusual en la práctica neuroquirúrgica. Un alto porcentaje de los casos con lesiones penetrantes craneales se asocian con lesiones vasculares, lo que requiere el estudio de la vascularización intracraneal para una conducta médica adecuada. Presentamos un caso de una paciente de 32 años de edad que sufrió un trauma penetrante en el cráneo con un cuchillo a través de los huesos del cráneo, con lesión directa a la arteria cerebral anterior, e incluimos una breve revisión de la literatura sobre el tema.

The penetrating injuries of the skull are usually associated with high mortality. They may be the result of numerous events, the majority of them being caused by high energy trauma. Penetrating brain injury by objects of low kinetic energy is unusual in the neurosurgical practice. A high percentage of the cases with penetrating injuries is associated with cranial vascular lesions, requiring study of the intracranial vasculature for proper management. We report on a case of a 32-year-old patient who suffered a head-penetrating trauma by a knife through the bones of the skull, with direct injury to the anterior cerebral artery, including a brief review of the literature on the theme.

Hemorragia subaracnoidea espontânea induzida por Warfarina / Spontenous subarachnoid hemorrhage indiced by warfarin use: case report and literature review

Introdução: A causa mais frequente de hemorragia subaracnoidea (HSA) espontânea é a ruptura de aneurisma cerebral. Em aproximadamente 5% dos casos de HSA espontânea não se observam alterações à angiografia ou ressonância magnética do sistema nervoso central que explique o sangramento. O objetivo deste trabalho é apresentar um caso de HSA espontânea induzida por warfarina, onde não foi evidenciado nenhuma malformação vascular no sistema nervoso central. Relato de Caso: Paciente do sexo masculino, com 59 anos, apresentou quadro súbito de cefaléia durante o banho. O paciente tinha história de valvulopatia mitral com troca de vávula há 23 anos e hipertensão arterial sistêmica acompanhado por cardiologista, em uso de warfarina sódica ( 5mg diários ). A tomografia computadorizada de crânio demonstrou HSA Fisher III. Os exames laboratoriais mostraram uma razão normalizada internacional (RNI) de 2.2 (normal 1 a 1,2). Foram realizadas ressonância magnética do neuroeixo e angiografia cerebral que não demonstraram aneurisma ou qualquer outra malformação vascular. Conclusão: A ocorrência de hemorragia cerebral associada ao uso de warfarina é um evento bem documentado na literatura. Entretanto a ocorrência de HSA isolada nesses pacientes rara. Para atribuir a hemorragia subaracnoidea ao uso de warfarina é necessário excluir a presença de aneurisma ou outras malformações vasculares pelos exames de imagem.