Principais Dificuldades dos Cuidadores Informais da Pessoa com Doença Mental Grave / Main Difficulties of Informal Caregivers of People with Severe Mental Illness / Principales Dificultades de los Cuidadores Informales de la Persona con Enfermedad Mental Grave

Resumo Contexto: O processo de desinstitucionalização da pessoa com doença mental grave, trouxe uma nova realidade ao exigir uma adaptação das famílias, perante a necessidade dos seus membros assumirem o papel de cuidadores informais. Objetivo: Identificar as dificuldades dos cuidadores informais da pessoa com doença mental grave. Metodologia: Realizou-se um estudo descritivo transversal de base quantitativa. Foi constituída uma amostra probabilística aleatória simples de 27 cuidadores informais da pessoa adulta com doença mental grave, acompanhada na consulta externa de psiquiatria dum hospital da região Sul de Portugal. Como instrumento de colheita de dados foi aplicado o Índice de Avaliação das Dificuldades do Cuidador (CADI) e um questionário de caraterização sociodemográfica do cuidador informal. Resultados: Relativamente às características sociodemográficas dos participantes apurou-se que estas estão de acordo com o perfil que caracteriza os cuidadores informais em Portugal. Da aplicação do CADI, resulta que os fatores em que se verificaram mais dificuldades relacionadas com o cuidar foram os fatores relacionados com a falta de apoio familiar, com problemas financeiros, seguindo-se as reações à prestação de cuidados e a falta de apoio profissional. Conclusões: A função de cuidar causa dificuldades ao cuidador, que se vê perante um contexto diferente do habitual e a ter de desempenhar um novo papel. Assim, constatamos que os cuidadores familiares constituem um grupo com necessidades e dificuldades especificas, perante as quais o Enfermeiro Especialista Enfermagem Saúde Mental e Psiquiátrica tem um papel fundamental em termos de intervenção, na capacitação e empoderamento de quem cuida.

Abstract Context: The process of deinstitutionalization of the person with serious mental illness brought a new reality by requiring an adaptation of families, given the need for their members to assume the role of informal caregivers. Objective: To identify the difficulties of informal caregivers of people with severe mental illness. Methodology: A descriptive cross-sectional quantitative study was carried out. A simple random probabilistic sample of 27 informal caregivers of an adult person with severe mental illness was constituted, accompanied in the outpatient psychiatric clinic of a hospital in the south of Portugal. As a data collection instrument, the Caregiver's Difficulties Assessment Index (CADI) and a sociodemographic characterization questionnaire of the informal caregiver, were applied. Results: Regarding the sociodemographic characteristics of the participants, it was found that these are in line with the profile that characterizes informal caregivers in Portugal. From the application of the CADI, it appears that the factors in which there were more difficulties related to care were factors related to the lack of family support, financial problems, followed by reactions to the provision of care and the lack of professional support. Conclusions: The role of caring causes difficulties for the caregiver, who is faced with a different context than usual and having to play a new role. Thus, we found that family caregivers constitute a group with specific needs and difficulties, in view of which the Specialist Nurse Mental Health and Psychiatric Nursing has a fundamental role in terms of intervention, in the training and empowerment of those who care.

Resumen Contexto: El proceso de desinstitucionalización de la persona con enfermedad mental grave trajo una nueva realidad al exigir una adaptación de las familias, ante la necesidad de que sus miembros asuman el rol de cuidadores informales. Objetivo: Identificar las dificultades de los cuidadores informales de personas con enfermedad mental grave. Metodología: Se realizó un estudio cuantitativo descriptivo de corte transversal. Se constituyó una muestra probabilística aleatoria simple de 27 cuidadores informales de una persona adulta con enfermedad mental grave, acompañados en la consulta externa de psiquiatría de un hospital del sur de Portugal. Como instrumento de recolección de datos, se aplicó el Índice de Evaluación de Dificultades del Cuidador (CADI) y un cuestionario de caracterización sociodemográfica del cuidador informal. Resultados: En cuanto a las características sociodemográficas de los participantes, se constató que estas están en consonancia con el perfil que caracteriza a los cuidadores informales en Portugal. De la aplicación del CADI se desprende que los factores en los que hubo más dificultades relacionadas con el cuidado fueron los relacionados con la falta de apoyo familiar, los problemas económicos, seguidos de las reacciones a la prestación del cuidado y la falta de apoyo profesional. Conclusiones: El rol de cuidar genera dificultades para el cuidador, que se enfrenta a un contexto diferente al habitual y al tener que desempeñar un nuevo rol. Así, encontramos que los cuidadores familiares constituyen un grupo con necesidades y dificultades específicas, por lo que la Enfermera Especialista en Salud Mental y Enfermería Psiquiátrica tiene un papel fundamental en términos de intervención, en la formación y empoderamiento de quienes cuidan.

Intervenções De Enfermagem Promotoras De Esperança Na Reabilitação Psicossocial Orientada Para O Recovery - Revisão Integrativa Da Literatura / Nursing Interventions Promoting Hope in Recovery-Oriented Psychosocial Rehabilitation - Integrative Literature Review

Resumo Contexto: A esperança é um sentimento essencial à vida e é um elemento impulsionador do processo de reabilitação psicossocial orientada para o Recovery (PRPOR). Importa, pois, sintetizar e integrar o conhecimento existente acerca das intervenções de enfermagem especializadas e autónomas promotoras de esperança na população em PRPOR. Objetivo: Identificar as intervenções de enfermagem especializadas e autónomas promotoras de esperança na população em processo de reabilitação psicossocial orientado para o Recovery. Método: Revisão Integrativa de acordo com os critérios do Joanna Briggs Institute. Efetuada pesquisa nas plataformas Ebscohost, Google Académico e BMC Nursing, entre outubro e dezembro de 2021 utilizando os descritores "Esperança" AND "Enfermagem de Saúde Mental e Psiquiátrica" AND "(Recovery em saúde mental" OR "Reabilitação psicossocial"). Resultados: Incluímos sete estudos, referentes a diversos contextos de prestação de cuidados (comunitário, hospitalar, ambulatório). Apresentamos a forma de identificar a necessidade de atenção ao foco de enfermagem "Esperança", os diversos instrumentos de avaliação diagnóstica e as intervenções promotoras de esperança que apresentam resultados positivos. Conclusão: Os estudos incluídos identificam a relação terapêutica como contexto essencial para veicular as intervenções de enfermagem promotoras de esperança e o facto de os enfermeiros serem eles próprios fonte de instilação de esperança. É fundamental identificar os atributos da esperança, as emoções e experiências associadas e ter competência para formular objetivos realistas.

Abstract Context: Hope is an essential feeling in life and is a driving element in the recovery-oriented psychosocial rehabilitation process. It is therefore important to synthesize and integrate existing knowledge about specialized and autonomous nursing interventions that promote hope in the population living this process. Aim: To identify specialized and autonomous nursing interventions that promote hope in population in a recovery-oriented psychosocial rehabilitation process. Method: Integrative review according to Joanna Briggs Institute criteria. Research was carried out on the platforms Ebscohost, Google Academic and BMC Nursing, between October and December 2021 using the descriptors "Hope" AND "Mental Health and Psychiatric Nursing" AND "(Recovery in mental health" OR "Psychosocial rehabilitation"). Results: We included seven studies, referring to different care settings (community, hospital, outpatient). We present a way to identify the need for attention to the "Hope" nursing focus, the various diagnostic assessment instruments and hope-promoting interventions that present positive results. Conclusion: The included studies identify the therapeutic relationship as an essential context to convey nursing interventions that promote hope and the fact that nurses are themselves a source of hope. It is essential to identify the attributes of hope, the associated emotions and experiences and be competent to formulate realistic goals.

A visita domiciliária na transição hospital-domicílio à pessoa com doença mental: uma revisão integrativa da literatura / The home visit in the hospital-domicile transition of the person with a mental disorder: an integrative review of the literature / La visita a domicilio em la transición hospital-domicilio a la persona com enfermedad mental: una revisión integrativa de la literatura

CONTEXTO: A mudança de um paradigma hospitalocêntrico para um de raiz comunitária vem sendo desde há vários anos contemplada como prioritário. No entanto, continua a existir uma escassa resposta de estruturas necessárias de apoio às pessoas com doença mental e seus cuidadores. O processo de vivência da transição hospital-domicílio pode expor a pessoa a um risco potencial de desenvolver um processo de adaptação desajustado, pelo que a visita domiciliária pode ser um recurso interessante, na medida em que promove a acessibilidade e a aceitabilidade, podendo influenciar positivamente o envolvimento das pessoas e dos seus cuidadores no tratamento destas patologias. OBJETIVO: Identificar os benefícios da visita domiciliária às pessoas com doença mental na continuidade de cuidados hospital-domicílio. MÉTODO: Realizou-se uma revisão integrativa da literatura, recorrendo-se a pesquisa nas bases de dados EBSCO e B-ON e no RCAAP, tendo resultado em cinco artigos compreendidos no horizonte temporal 2013-2018. RESULTADOS: A visita domiciliária permite manter o contacto da pessoa com doença mental e os cuidados de saúde, assegura a continuidade de cuidados, demonstrando ter benefícios quer a nível da sintomatologia, da funcionalidade ou da qualidade e vida das pessoas e das suas famílias, reduzindo o desperdício de recursos consumidos durante os reinternamentos por causa das recaídas, além de promover igualmente a sua inserção na comunidade. CONCLUSÕES: A visita domiciliária deve ser explorada no que concerne aos cuidados a pessoas com doença mental, por ser um recurso que pode diminuir algumas das barreiras identificadas na continuidade de cuidados pós-hospitalar e pelos benefícios que acarreta.

BACKGROUND: Changing the hospital-centered to a community-based care paradigm has been seen as a priority for a long time. However, there still is a limited response from all the organizations needed to help and support patients with Mental Illnesses and their caretakers. The hospital-home transition and how the patients cope with it might lead to maladjusted adaptation mechanisms. As such, home visits are an important tool that promote accessibility and acceptability, positively influencing patients’ and their caretakers’ involvment in the treatment of the underlying disease. AIM: To understand the benefits that home visits can have in promoting the continuity of hospital-home care for the patients with mental illness. METHODS: An integrative literature review was conducted using the EBSCO and B-ON databases and RCAAP, resulting in five articles included in the 2013-2018 time horizon. RESULTS: The home visit allows the person with mental illness to maintain contact with the health care system, ensures continuity of care, demonstrating benefits in terms of symptoms, functionality or quality of life and life of individuals and their families, reducing the waste of resources consumed during readmissions due to relapses, and also promoting their integration into the community. CONCLUSIONS: Home visits should be explored with regard to the care of people with mental illness, as this is a resource that can reduce some of the barriers identified in the continuity of post-hospital care and the benefits it brings.

CONTEXTO: El cambio de un paradigma centrado en el hospital a uno basado en la comunidad ha sido considerado una prioridad durante varios años. Todavía hay poca respuesta de las estructuras de apoyo necesarias para las personas con enfermedades mentales y sus cuidadores. El proceso de experimentar la transición entre el hospital y el domicilio puede exponer a la persona a un riesgo potencial de desarrollar un proceso de adaptación inapropiado, por lo que la visita a domicilio puede ser un recurso interesante, ya que promueve la accesibilidad, la aceptabilidad y la participación de las personas y sus cuidadores en el tratamiento de estas patologías. OBJETIVO: Identificar los beneficios de las visitas domiciliarias a personas con enfermedades mentales en la continuidad de la atención hospitalaria domiciliaria. METODOLOGÍA: Se llevó a cabo una revisión integrativa de la literatura utilizando las bases de datos de EBSCO y B-ON y RCAAP, lo que resultó en la inclusión de cinco artículos en el horizonte temporal 2013-2018. RESULTADOS: La visita domiciliaria asegura la continuidad de la atención, demuestra beneficios en términos de síntomas, funcionalidad o calidad de vida de las personas y sus familias, reduce el derroche de recursos consumidos, y también promueve su integración en la comunidad. CONCLUSIONES: Se deben explorar las visitas domiciliarias en relación con la atención de las personas con enfermedades mentales, ya que se trata de un recurso que puede reducir algunas de las barreras identificadas en la continuidad de la atención poshospitalaria y los beneficios que aporta.

Longitudinal diffusion-weighted imaging in infants with hydrocephalus: decrease in tissue water diffusion after cerebrospinal fluid diversion.

OBJECT: Progressive hydrocephalus may lead to edema of the periventricular white matter and to damage of the brain parenchyma because of compression, stretching, and ischemia. The aim of the present study was to investigate whether cerebral edema can be quantified using diffusion-weighted imaging in infants with hydrocephalus and whether CSF diversion could decrease cerebral edema. METHODS: Diffusion-weighted MR imaging was performed in 24 infants with progressive hydrocephalus before and after CSF diversion. Parametric images of the trace apparent diffusion coefficients (ADCs) were obtained. The ADCs of 5 different cortical and subcortical regions of interest were calculated pre- and postoperatively in each patient. The ADC values were compared with age-related normal values. Mean arterial blood pressure and anterior fontanel pressure were measured immediately after each MR imaging study. RESULTS: After CSF diversion, the mean ADC decreased from a preoperative value of 1209 +/- 116 x 10(-6) mm(2)/second to a postoperative value of 928 +/- 64 x 10(-6) mm(2)/second (p < 0.005). Differences between pre- and postoperative ADC values were most prominent in the periventricular white matter, supporting the existence of preoperative periventricular edema. Compared with age-related normal values, the preoperative ADC values were higher and the postoperative ADC values were lower, although within normal range. The decrease in ADC after CSF drainage was more rapid than the more gradual physiological decrease that is related to age. The preoperative ICP was elevated in all patients. After CSF diversion the ICP decreased significantly to within the normal range. A linear correlation between ADC values and ICP was found (correlation coefficient 0.496, p < 0.001). In all patients the mean arterial blood pressure was within physiological limits both pre- and postoperatively. CONCLUSIONS: This study shows a rapid and more extensive decrease in ADC values after CSF diversion than is to be expected from physiological ADC decrease solely due to increasing patient age. The preoperative ADC increase can be explained by interstitial edema caused by transependymal CSF leakage or by vasogenic edema caused by capillary compression and stretching of the brain parenchyma. This study population of infants with (early recognized) hydrocephalus did not suffer from cytotoxic edema. These findings may help to detect patients at risk for cerebral damage by differentiating between progressive and compensated hydrocephalus.

Recurrent perimesencephalic subarachnoid hemorrhage during antithrombotic therapy.

INTRODUCTION: In patients with non-aneurysmal perimesencephalic hemorrhage, spontaneous rebleeding does not occur. The lack of reported recurrences may lead to less cautious administration of antithrombotic therapy. METHODS: Case report. RESULTS: A 57-year-old woman with a perimesencephalic pattern of hemorrhage and negative CT angiography was treated with carbasalate calcium and intravenous heparin because of an acute coronary syndrome. Three days after installment of this antithrombotic therapy she experienced a recurrent perimesencephalic hemorrhage leading to hydrocephalus and a decrease in consciousness. She died the same day as a result of ventricular fibrillation. CONCLUSION: In the early phase after perimesencephalic hemorrhage, anticoagulant therapy may lead to rebleeding. The risks and benefits of antithrombotic therapy should be carefully weighed in patients with a perimesencephalic pattern of hemorrhage and negative CT angiography.

Pneumocephalus Following Severe Head Trauma.

It is important to be alert to the possibility of pneumocephalus in patients with head injury. Pneumocephalus is a potentially lethal complication in patients with craniofacial fractures following severe head trauma. A patient presented with intracranial air after he fell down from a height of 4 m. The patient recovered without any neurological deficits after conservative treatment. A time sequence of cerebral CT scans shows how the pneumocephalus developed and finally resolved without surgical intervention. The etiology, diagnosis, treatment and possible complications of this injury are discussed briefly.

Magnetic resonance imaging for quantitative flow measurement in infants with hydrocephalus: a prospective study.

OBJECT: Raised intracranial pressure (ICP) that is associated with hydrocephalus may lead to alterations in cerebral hemodynamics and ischemic changes in the brain. In infants with hydrocephalus, defining the right moment for surgical intervention based on clinical signs alone can sometimes be a difficult task. Clinical signs of raised ICP are known to be unreliable and sometimes even misleading. Furthermore, when sutures are closed, ICP does not always correlate with the size of the ventricles or with the clinical signs or symptoms. In this study the authors investigated whether cerebral blood flow (CBF) can be measured by using quantitative MR angiography in infants with progressive hydrocephalus. In addition, the authors investigated the relationship between CBF and ICP, before and after cerebrospinal fluid (CSF) diversion. METHODS: Fifteen infants with progressive hydrocephalus (age range 1 day-7 months) were examined. All patients underwent anterior fontanel pressure measurement, MR angiography, and mean arterial blood pressure measurements before and after CSF diversion. Brain volume was measured to compensate for the physiological increase in CBF during brain maturation in infants. RESULTS: The mean preoperative ICP was 19.1 +/- 8.4 cm H(2)O (+/- standard deviation). The mean postoperative ICP was 6.7 +/- 4.0 cm H(2)O (p < 0.005). The mean preoperative CBF was 25.7 +/- 11.3 ml/100 cm(3) brain/min. After CSF diversion, CBF increased to 50.1 +/- 12.1 ml/100 cm(3) brain/min (p < 0.005). The mean arterial blood pressure did not change after surgical intervention. CONCLUSIONS: Magnetic resonance imaging can be used to measure CBF in infants with hydrocephalus. Raised ICP was related to a decrease in CBF. After CSF diversion, CBF and ICP improved to values within the normal range.

Altered flow territories after extracranial-intracranial bypass surgery.

OBJECTIVE: To prevent stroke after carotid sacrifice and to augment cerebral perfusion in patients with internal carotid artery (ICA) occlusion, high-flow extracranial-intracranial (EC-IC) bypass operations are performed. Although the function and efficacy of the bypass is monitored during surgery, the postoperative flow through the bypass is significantly lower than the flow in the contralateral ICA. Thus far, it is unknown whether decreased bypass flow is caused by a low tissue perfusion or by a relatively small flow territory. METHODS: Seven patients, four with an atherosclerotic ICA occlusion and three with a giant aneurysm of the ICA, were investigated; each underwent a high-flow EC-IC bypass and permanent occlusion of the ICA. Cerebral blood flow was measured with arterial spin labeling perfusion magnetic resonance imaging. Separate flow territory mapping of the EC-IC bypass, contralateral ICA, and posterior circulation was performed with selective arterial spin labeling magnetic resonance imaging. RESULTS: No significant difference was found in cerebral blood flow between the hemisphere ipsilateral to the EC-IC bypass (70.9 +/- 11.3 ml/min/100 g tissue), contralateral to the EC-IC bypass (71.9 +/- 14.3 ml/min/100 g tissue), and comparable findings in 50 healthy control participants (69.1 +/- 17.5 ml/min/100 g tissue). Paired analysis of the individual flow territories demonstrated a 15% volume reduction (P = 0.018) in flow territory of the EC-IC bypass compared with the contralateral side. CONCLUSION: In the present study, we demonstrate the feasibility of selective arterial spin labeling magnetic resonance imaging for clinical follow-up of patients after high-flow EC/IC bypass surgery, providing both information on flow territories and the level of regional cerebral blood flow.

Björk-Shiley convexoconcave valves: susceptibility artifacts at brain MR imaging and mechanical valve fractures.

PURPOSE: To assess the relationship between heart valve history and susceptibility artifacts at magnetic resonance (MR) imaging of the brain in patients with Björk-Shiley convexoconcave (BSCC) valves. MATERIALS AND METHODS: MR images of the brain were obtained in 58 patients with prosthetic heart valves: 20 patients had BSCC valve replacements, and 38 had other types of heart valves. Two experienced neuroradiologists determined the presence or absence of susceptibility artifacts in a consensus reading. Artifacts were defined as characteristic black spots that were visible on T2*-weighted gradient-echo MR images. The statuses of the 20 explanted BSCC valves-specifically, whether they were intact or had an outlet strut fracture (OSF) or a single-leg fracture (SLF)-had been determined earlier. Number of artifacts seen at brain MR imaging was correlated with explanted valve status, and differences were analyzed with nonparametric statistical tests. RESULTS: Significantly more patients with BSCC valves (17 [85%] of 20 patients) than patients with other types of prosthetic valves (18 [47%] of 38 patients) had susceptibility artifacts at MR imaging (P =.005). BSCC valve OSFs were associated with a significantly higher number of artifacts than were intact BSCC valves (P =.01). No significant relationship between SLF and number of artifacts was observed. CONCLUSION: Susceptibility artifacts at brain MR imaging are not restricted to patients with BSCC valves. These artifacts can be seen on images obtained in patients with various other types of fractured and intact prosthetic heart valves.

Direction of flow in posterior communicating artery on magnetic resonance angiography in patients with occipital lobe infarcts.

BACKGROUND AND PURPOSE: In some people the blood supply to the posterior cerebral artery occurs partly or even exclusively via the carotid system. This anatomic configuration may influence the risk of occipital lobe infarction. We studied the presence and direction of flow in the posterior communicating artery (PCoA) in patients with an occipital lobe infarct and in healthy controls. METHODS: Forty-seven patients with an occipital lobe infarct were studied by MR angiography, as well as 50 young healthy controls. Special attention was paid to the presence of a PCoA and, if present, to the direction of flow. RESULTS: Significantly fewer patients than controls had an exclusive blood supply to the posterior cerebral artery via the carotid system, in both the affected (4% versus 17%; 95% CI of difference, 4% to 22%) and unaffected hemispheres (5% versus 17%; 95% CI of difference, 3% to 22%). Patients also less often had a patent PCoA with anteroposterior flow than controls (affected hemisphere, 8% versus 22%; unaffected hemisphere, 12% versus 22%; 95% CI of differences, 3% to 25% and -2% to 23%, respectively). With analysis at the level of individuals, significantly more patients showed no anteroposterior flow through the PCoA in either hemisphere than controls (79% versus 42%; 95% CI of difference, 19% to 55%). CONCLUSIONS: Supply of the posterior cerebral artery by the carotid system occurs less often in patients with an occipital lobe infarct than in healthy controls. The same was true for the unaffected hemisphere of patients, which suggests that the anatomic difference represents a causal factor (fewer collateral pathways after occlusion of the posterior cerebral artery or its branches) rather than a consequence (redistribution of blood flow after occipital infarction).

Hemodynamic compensation via an excimer laser-assisted, high-flow bypass before and after therapeutic occlusion of the internal carotid artery.

OBJECTIVE: High-flow, extracranial-intracranial (EC-IC) bypass operations are performed to prevent strokes among patients with giant aneurysms who cannot tolerate internal carotid artery (ICA) occlusion. However, the volume flow through the bypass, compared with preoperative ICA flow, has not been evaluated for any type of bypass. We describe a prospective case study that tested the ability of the high-flow EC-IC bypass to replace the volume flow of the ipsilateral ICA after deliberate ICA occlusion. METHODS: Seven consecutive patients with giant aneurysms of the ICA who experienced test occlusion failure underwent nonocclusive, excimer laser-assisted, EC-IC bypass surgery before permanent ICA occlusion. Volume flow values in the ICAs, the basilar artery, the EC-IC bypass, and the middle cerebral arteries were measured with magnetic resonance angiography. RESULTS: No significant changes in volume flow to the ipsilateral and contralateral hemispheres were observed after bypass surgery and therapeutic ICA occlusion. Before bypass surgery, the volume flow through the ipsilateral ICA was 243 +/- 74 ml/min, that through the contralateral ICA was 264 +/- 32 ml/min, and that through the basilar artery was 141 +/- 43 ml/min. After bypass surgery and therapeutic occlusion of the ipsilateral ICA, the volume flow through the bypass was 199 +/- 72 ml/min, that through the contralateral ICA was 303 +/- 82 ml/min, and that through the basilar artery was 153 +/- 72 ml/min. No significant preoperative versus postoperative changes in middle cerebral artery flow were observed on either side. CONCLUSION: The flow through the high-flow EC-IC bypass was able to replace the volume flow of the ipsilateral ICA after deliberate ICA occlusion for the treatment of giant aneurysms.

Blood supply of the posterior cerebral artery by the carotid system on angiograms.

BACKGROUND AND PURPOSE: Occipital lobe infarcts are traditionally attributed to vertebrobasilar disease. However, anatomical studies indicate that in some people the supply of the posterior cerebral artery is via the carotid system. We investigated how often such a developmental variant in the cerebral blood supply was present during life. METHODS: We retrospectively studied 212 conventional four-vessel cerebral angiograms. Eighteen subjects were excluded beforehand, because of vascular abnormalities causing important hemodynamic changes. We determined whether a fetal variant was present, and in other cases whether there was a functioning posterior communicating artery. RESULTS: In 11 % of hemispheres the posterior cerebral artery was exclusively supplied by the internal carotid artery; in a further 46 % of hemispheres the internal carotid artery might contribute, via a patent posterior communicating artery. In 75 % of subjects the internal carotid artery contributed in at least one hemisphere to the blood flow of the posterior cerebral artery. CONCLUSIONS: The implication of our findings is that an occipital lobe infarct can be caused by ipsilateral carotid disease in a proportion of cases between 10 and 60 %. This implies that carotid endarterectomy might be beneficial in some patients with severe carotid stenosis and infarction in the territory of the posterior cerebral artery.

Electrode positioning in thoracic percutaneous partial rhizotomy: an anatomical study.

The present study was undertaken to clarify if needle positioning in percutaneous partial rhizotomy in the thoracic area based on bony landmarks and guided by fluoroscopic control leads to adequate placement in or at the targeted nervous tissue, i.e., the dorsal root ganglion (DRG), and to determine if needle localization by CT is more reliable than by fluoroscopic control. An investigation was performed in 2 cadavers, simulating the clinical setting as much as possible. At the levels T1-T8 a drill hole was made in the vertebral arc with a Kirschner wire. At the levels T9-T12 the "classic" dorsolateral technique was used. In 46 procedures the position of the needle tips was compared using hard copies of the fluoroscopic images, CT images at 1.5 mm intervals, surface photographs, and stained 25 microns sections obtained by a multirange heavy duty cryomicrotome. The position of the DRG in the foramen, and its size, were measured. In the sections, considered as the "golden standard", in 28 cases (60.9%) the needle tip was found in the DRG and in the extradural dorsal root in 14 cases (30.4%). In 4 cases (8.7%) no nervous tissue was encountered. In 8 of 32 "drill hole procedures" the facet joint was pierced. No accidental pleural puncture occurred in any of the procedures. The needle position was imaged more accurately by fluoroscopy. It is concluded that fluoroscopic control is a reliable guide to needle placement in percutaneous partial rhizotomy and permits standardization of the technique with the help of bony landmarks.