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1.
World Neurosurg ; 133: e281-e287, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31518739

RESUMO

BACKGROUND: The spot sign (SS) in spontaneous intracerebral hemorrhage has been reported to be a predictive factor of poor outcome; however, how SS is related with the clinical outcome remains unclear. We aimed to investigate how etiology associated with SS affects the clinical outcome of endoscopic surgery. METHODS: We retrospectively analyzed data from 104 patients (43 women and 61 men, mean age: 64.2 ± 11.0 years) who underwent endoscopic surgery for supratentorial intracerebral hemorrhage. The outcome variables analyzed were in-hospital mortality and modified Rankin scale score at 90 days from onset. RESULTS: The prevalence of intraventricular hemorrhage and the mean initial modified Graeb score were greater in SS-positive than in SS-negative patients (100% vs. 47.7%, P < 0.001, and 14.4 ± 5.4 vs. 10.6 ± 6.0, P = 0.03, respectively). Postoperative rebleeding occurred more frequently in SS-positive than -negative patients (25.0% vs. 6.8%, P = 0.045). The in-hospital mortality rate was 7.7% and was not significantly different between the groups (18.8% vs. 5.7%, P = 0.09). There was a significant unfavorable shift in modified Rankin scale scores at 90 days among SS-positive patients compared with SS-negative patients in an analysis with ordinal logistic regression (adjusted common odds ratio, 4.38; 95% confidence interval 0.06-0.79, P = 0.02). CONCLUSIONS: Intraventricular hemorrhage and postoperative rebleeding were considered to be associated with the poor outcome in patients with SS. The SS on computed tomography angiography may be valuable in predicting rebleeding and clinical outcome after surgery.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Hematoma/diagnóstico por imagem , Neuroendoscopia , Idoso , Dano Encefálico Crônico/etiologia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/cirurgia , Comorbidade , Feminino , Hematoma/complicações , Hematoma/cirurgia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
2.
World Neurosurg ; 133: e121-e128, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476469

RESUMO

BACKGROUND: Primary intraventricular hemorrhage (PIVH) is rare, and causes, characteristics, and outcomes remain unknown in children. METHODS: We retrospectively analyzed the clinical characteristics of patients 1 month to 21 years of age who were admitted to the hospital with PIVH over a 7-year period. PIVH was defined as bleeding confined to the ventricular system without parenchymal or subarachnoid hemorrhage involvement. RESULTS: Of 18 included patients, 55.6% were female, and mean age was 13.8 ± 6.0 years. The most common presenting symptoms were headache (77.8%) and vomiting (33.3%). In 15 patients (83.3%), known etiologies were diagnosed, including arteriovenous malformations (66.7%), moyamoya disease (11.1%), and aneurysms (5.6%). Idiopathic PIVH was the diagnosis in 3 patients (16.7%). Surgery was performed in 15 patients (83.3%), and 3 patients (16.7%) received conservative treatment. Four patients (28.6%) had an unfavorable outcome at discharge, and 3 patients (16.7%) had an unfavorable outcome at the 3-month follow-up. Higher Graeb score was associated with an unfavorable outcome in both short-term and long-term follow-up. CONCLUSIONS: Arteriovenous malformations were diagnosed in most pediatric patients with PIVH. Specific surgical treatment of underlying etiologies should be required to increase clinical improvement. Children with a higher Graeb score at admission tended to have poor early and late outcomes.


Assuntos
Hemorragia Cerebral/epidemiologia , Ventrículos Cerebrais/irrigação sanguínea , Adolescente , Malformações Arteriovenosas/complicações , Dano Encefálico Crônico/etiologia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Criança , Pré-Escolar , Feminino , Cefaleia/etiologia , Humanos , Lactente , Recém-Nascido , Aneurisma Intracraniano/complicações , Masculino , Doença de Moyamoya/complicações , Estudos Retrospectivos , Resultado do Tratamento , Vômito/etiologia , Adulto Jovem
3.
World Neurosurg ; 133: e135-e148, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31491576

RESUMO

BACKGROUND: Decompressive hemicraniectomy (DHC) is widely applied for patients with traumatic brain injury (TBI). Although previous studies have indicated that DHC can lead to similar or worse outcomes compared with medical treatment (MT) in patients with TBI, recent trials have suggested the benefit of DHC for neurologic function recovery. Therefore, we performed this meta-analysis to assess the efficacy and functional outcomes of DHC in patients with TBI. METHODS: In accordance with PRISMA guidelines, we searched English and Chinese databases to identify relevant randomized controlled trials (RCTs) reporting DHC for TBI. The outcomes measures included mortality, favorable outcome, unfavorable outcome, postoperative intracranial pressure (ICP), adverse events with hematoma, and hospital stay. RESULTS: Seven RCTs with a total of 779 patients with TBI were included in this meta-analysis. Compared with the MT group, the DHC group demonstrated significantly lower rates of mortality (P < 0.00001), postoperative ICP (P < 0.00001), and postoperative hematoma (P = 0.01), and significantly shorter hospital length of stay (P = 0.02). However, the rate of unfavorable outcomes was higher in the DHC group compared with the MT group (P = 0.0001). CONCLUSIONS: Our results indicate that DHC could be effective in reducing the mortality rate, incidence of ICP, and hospital length of stay in patients with TBI. However, the proportion of patients surviving with unfavorable outcomes was significantly higher in the DHC group compared with the MT group. Despite the limitations of the meta-analysis, our findings target extremely important topic and provide important evidence to facilitate clinical decision making.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Adulto , Dano Encefálico Crônico/etiologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Criança , Humanos , Hipertensão Intracraniana/etiologia , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
4.
Int Rev Neurobiol ; 147: 219-267, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607356

RESUMO

There are vast literatures on the neural effects of alcohol and the neural effects of exercise. Simply put, exercise is associated with brain health, alcohol is not, and the mechanisms by which exercise benefits the brain directly counteract the mechanisms by which alcohol damages it. Although a degree of brain recovery naturally occurs upon cessation of alcohol consumption, effective treatments for alcohol-induced brain damage are badly needed, and exercise is an excellent candidate from a mechanistic standpoint. In this chapter, we cover the small but growing literature on the interactive neural effects of alcohol and exercise, and the capacity of exercise to repair alcohol-induced brain damage. Increasingly, exercise is being used as a component of treatment for alcohol use disorders (AUD), not because it reverses alcohol-induced brain damage, but because it represents a rewarding, alcohol-free activity that could reduce alcohol cravings and improve comorbid conditions such as anxiety and depression. It is important to bear in mind, however, that multiple studies attest to a counterintuitive positive relationship between alcohol intake and exercise. We therefore conclude with cautionary notes regarding the use of exercise to repair the brain after alcohol damage.


Assuntos
Alcoolismo/complicações , Alcoolismo/terapia , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/terapia , Encéfalo/efeitos dos fármacos , Etanol/efeitos adversos , Terapia por Exercício/métodos , Humanos
5.
Pediatr Blood Cancer ; 66(11): e27947, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31418996

RESUMO

BACKGROUND: Survivors of childhood brain tumors are prone to sleep and neurocognitive problems. Effective interventions to improve neurocognitive functioning are largely lacking. In general, sleep problems are negatively related to neurocognitive functioning, but this relationship is unclear in survivors of childhood brain tumors. Therefore, the occurrence of sleep problems, potential risk factors, and the relation between sleep and executive functioning were evaluated. PROCEDURE: Baseline data of a randomized controlled trial on the effectiveness of neurofeedback were used. Childhood brain tumor survivors 8-18 years of age with parent-reported neurocognitive complaints ≥2 years after treatment were eligible. Parents completed the Sleep Disturbance Scale for Children. Executive functioning was assessed by parents and teachers (Behavior Rating Inventory of Executive Functioning). Multiple linear regression analyses were used to examine sociodemographic and medical characteristics and emotional difficulties and hyperactivity/inattention (Strength and Difficulties Questionnaire) as potential risk factors for sleep problems, and to assess the association between sleep and executive functioning. RESULTS: Forty-eight percent of survivors (n = 82, 7.0 ± 3.6 years post diagnosis, age 13.8 ± 3.2 years) had sleep problems and scored significantly worse than the norm on the subscales Initiating and Maintaining Sleep, Excessive Somnolence, and the total scale (effect sizes 0.58-0.92). Emotional problems and/or hyperactivity/inattention were independent potential risk factors. Sleep problems were associated with worse parent-reported executive functioning. CONCLUSIONS: Sleep problems occur among half of childhood brain tumor survivors with neurocognitive problems, and are associated with worse executive functioning. Future studies should focus on the development of sleep interventions for this population, to improve sleep as well as executive functioning.


Assuntos
Dano Encefálico Crônico/etiologia , Neoplasias Encefálicas/psicologia , Sobreviventes de Câncer/psicologia , Transtornos do Comportamento Infantil/etiologia , Transtornos Cognitivos/etiologia , Transtornos do Sono-Vigília/etiologia , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Dano Encefálico Crônico/psicologia , Neoplasias Encefálicas/terapia , Criança , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/psicologia , Transtornos Cognitivos/epidemiologia , Irradiação Craniana/efeitos adversos , Craniotomia/efeitos adversos , Emoções , Função Executiva , Humanos , Testes Neuropsicológicos , Prevalência , Psicologia , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/epidemiologia
6.
World Neurosurg ; 127: e162-e171, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30876994

RESUMO

OBJECTIVE: To develop and validate a risk-scoring model for predicting recurrent hypertensive cerebral hemorrhage (RHCH) occurring within 1 year after initial hypertensive cerebral hemorrhage and to facilitate preemptive clinical intervention for the prevention of secondary hemorrhage. METHODS: Patient gender, age, blood pressure, Glasgow Coma Scale (GCS) score, location of cerebral hemorrhage, surgery, past medical history, blood biochemical parameters, and Glasgow Outcome Scale score were analyzed using logistic regression analysis to determine independent predictors of RHCH. A risk-scoring model was constructed by assigning coefficients to each predictor and validating it in another independent cohort. The accuracy of the model was then assessed by the area under the receiver operating characteristic curve (AUC), and the calibration ability of the model was assessed by the Hosmer-Lemeshow test. RESULTS: Of 520 patients in the derivation cohort, 38 developed RHCH within 1 year after discharge. Independent risk factors of RHCH were age >60 years; stage 3 hypertension at admission; GCS score 9-12 (admission); GCS score 3-8 (discharge); history of cerebral ischemic stroke, smoking, alcoholism; and plasma homocysteine (Hcy) level ≥10 µmol/L. The recurrence rates for the low-risk (0-13 points), intermediate-risk (14-26 points), and high-risk (27-39 points) groups were 1.73%, 6.11%, and 57.14%, respectively (P < 0.001). The corresponding rates in the validation cohort, of whom 10/107 (9.35%) developed RHCH, were 3.45%, 7.14%, and 71.43%, respectively (P < 0.001). The risk-scoring model showed good discrimination in both the derivation and validation cohorts, with an AUC of 0.802 versus 0.863. The model also showed good calibration ability (the Hosmer-Lemeshow P values of the two cohorts were 0.532 vs. 0.724). CONCLUSIONS: This model will help identify high-risk groups for RHCH in order to facilitate and improve preemptive clinical intervention.


Assuntos
Hemorragia Intracraniana Hipertensiva/epidemiologia , Modelos Cardiovasculares , Medição de Risco/métodos , Adulto , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Área Sob a Curva , Glicemia/análise , Dano Encefálico Crônico/etiologia , Estudos de Coortes , Comorbidade , Feminino , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Transtornos Hemorrágicos/epidemiologia , Humanos , Hiper-Homocisteinemia/epidemiologia , Hemorragia Intracraniana Hipertensiva/sangue , Hemorragia Intracraniana Hipertensiva/complicações , Lipídeos/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Curva ROC , Recidiva , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fumar/epidemiologia , Tomografia Computadorizada por Raios X
7.
Arterioscler Thromb Vasc Biol ; 39(3): 360-372, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30700129

RESUMO

Objectives- The prediction of patients at risk for poor clinical outcome after acute ischemic stroke remains challenging. An imbalance of coagulation factors may play an important role in progression and prognosis of these patients. In this systematic review, we assessed the current literature on hemostasis biomarkers and the association with poor clinical outcome in acute ischemic stroke. Approach and Results- A systematic search of Embase, Medline, Cochrane Library, Web of Science, and Google Scholar was performed on studies reporting on hemostasis biomarkers and clinical outcome after acute ischemic stroke. Studies were considered eligible if blood samples were collected within 72 hours after symptom onset. Additionally, clinical outcome should be assessed using a disability score (Barthel Index or modified Rankin scale). Methodological quality of included studies was assessed with an adapted version of the Quality Assessment of Diagnostic Accuracy Studies questionnaire. A total of 80 articles were read full text, and 41 studies were considered eligible for inclusion, reporting on 37 different hemostasis biomarkers. No single biomarker appeared to be effective in predicting poor clinical outcome in acute ischemic stroke patients. Conclusions- Based on current literature, no clear recommendations can be provided on which hemostasis biomarkers are a predictor of clinical outcome after acute ischemic stroke. However, some biomarkers show promising results and need to be further investigated and validated in large populations with clear defined study designs.


Assuntos
Biomarcadores/sangue , Isquemia Encefálica/sangue , Hemostasia , Doença Aguda , Anticorpos Antifosfolipídeos/sangue , Proteínas Sanguíneas/análise , Dano Encefálico Crônico/sangue , Dano Encefálico Crônico/etiologia , Isquemia Encefálica/complicações , Estudos de Casos e Controles , Ensaios Clínicos como Assunto , Estudos de Coortes , Avaliação da Deficiência , Humanos , Inibidor de Coagulação do Lúpus/sangue , Prognóstico , Reprodutibilidade dos Testes , Resultado do Tratamento
8.
Med Law Rev ; 27(2): 318-329, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30597098

RESUMO

In Darnley v Croydon Health Services NHS Trust [2018] UKSC 50, the Supreme Court held that a hospital receptionist's misleading statement about A&E waiting times constituted a breach of duty and that the claimant's decision, based on this misinformation, to leave the hospital did not break the chain of causation when he was left paralysed as a result of a head injury. In this commentary, I argue that while the Supreme Court's treatment of duty of care and breach is, for the most part, a model of doctrinal clarity, its treatment of the causation issue is problematic as it elides the test of whether there has been a break in the chain of causation with that for remoteness. I then comment on the Supreme Court's construction of the patient in medical negligence cases.


Assuntos
Causalidade , Serviços de Saúde/legislação & jurisprudência , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Dano Encefálico Crônico/etiologia , Comunicação , Tomada de Decisões , Serviço Hospitalar de Emergência/normas , Serviços de Saúde/normas , Hematoma Epidural Craniano/complicações , Humanos , Pacientes Internados , Recepcionistas de Consultório Médico/normas , Paralisia/etiologia , Padrão de Cuidado/legislação & jurisprudência , Reino Unido
9.
J Craniofac Surg ; 29(5): 1341-1343, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29863569

RESUMO

BACKGROUND: Autologous fat injection is a procedure aimed at eliminating grave defects in the skin surface by subcutaneous injection of the patient's fatty tissue. Fat embolism is a rare but severe complication of this procedure, especially cerebral infarction. It is first reported by Thaunat in 2004. METHODS: were presented to the hospital with sudden unconsciousness and left limb weakness in 24 hours after facial fat injection. Brain computed tomography and magnetic resonance imaging were performed immediately after admission. Frontal temporoparietal decompressive craniectomy plus multiple treatments scheduled for patients. Pictures and videos were taken during follow-up. Figures are edited with Adobe Photograph CS6. RESULTS: Patients were diagnosed with extensive cerebral infarction of the right hemisphere through the middle cerebral artery or facial-intracranial branches. CONCLUSION: Routine cosmetic procedures of facial fat injections could cause devastating and even fatal complications to patients. The small volume of fat grafts can be inserted through the internal carotid artery or go through the communicating branches between the facial artery and the intracranial artery into the brain.


Assuntos
Tecido Adiposo/transplante , Infarto Cerebral/etiologia , Técnicas Cosméticas/efeitos adversos , Embolia Gordurosa/etiologia , Face/irrigação sanguínea , Face/cirurgia , Artéria Cerebral Média , Adulto , Dano Encefálico Crônico/etiologia , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/cirurgia , Craniectomia Descompressiva , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/cirurgia , Feminino , Seguimentos , Humanos , Injeções Subcutâneas , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
PLoS One ; 13(6): e0199001, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29924823

RESUMO

OBJECTIVES: Pediatric brain damage is associated with various cognitive deficits. Cognitive rehabilitation may prevent and reduce cognitive impairment. In recent years, home-based computerized cognitive training (CCT) has been introduced in clinical practice to increase treatment opportunities for patients (telerehabilitation). However, limited research has been conducted thus far on investigating the effects of remote CCT for the juvenile population in contexts other than English-speaking countries. The aim of the present study was to investigate the feasibility of a home-based CCT in a group of Italian adolescents with brain damage. A commercially available CCT (Lumosity) developed in the English language was used due to the lack of telerehabilitation programs in the Italian language that allow stimulation of multiple cognitive domains and, at the same time, remote automatic collection of data. Thus, this investigation provides information on the possibility of introducing CCT programs available in foreign languages in countries with limited investment in the telerehabilitation field. METHODS: 32 adolescents aged 11-16 with a diagnosis of congenital or acquired (either traumatic or non-traumatic) brain damage participated in the study. They received 40 training sessions (5 days/week for 8 weeks). Before starting the training program, they received face-to-face demonstration of training exercises and written instructions in their mother tongue. The feasibility of both training and study design and procedures was assessed through 9 criteria taken from extant literature. RESULTS: All 9 feasibility criteria were met. 31 out of the 32 participants demonstrated adherence to the training program. 94.2% of training sessions were completed in the recommended timeframe. No significant technical issue was found. CONCLUSIONS: Telerehabilitation seems to be a feasible practice for adolescents with brain damage. A training program developed in a foreign language can be used to counter the unavailability of programs in patients' mother tongue. TRIAL REGISTRATION: The trial is registered with the ISRCTN registry with study ID ISRCTN59250807.


Assuntos
Dano Encefálico Crônico/reabilitação , Disfunção Cognitiva/reabilitação , Telerreabilitação/métodos , Terapia Assistida por Computador , Adolescente , Dano Encefálico Crônico/congênito , Dano Encefálico Crônico/etiologia , Lesões Encefálicas/complicações , Lesões Encefálicas/reabilitação , Criança , Disfunção Cognitiva/etiologia , Estudos de Viabilidade , Feminino , Humanos , Itália , Linguagem , Masculino , Projetos de Pesquisa , Terapia Assistida por Computador/métodos , Jogos de Vídeo
11.
Rev Neurol ; 66(12): 409-414, 2018 06 16.
Artigo em Espanhol | MEDLINE | ID: mdl-29897608

RESUMO

AIM: Retrospective analysis of the neurodevelopment in the first two years of life in patients with severe congenital heart disease. PATIENTS AND METHODS: Out of 89 patients with severe congenital heart disease 19 were excluded due to a history of prematurity and/or chromosomopathy, four due to a history of ischemic stroke and two due to lack of medical history. Denver Test (DT) results at 2, 6, 12, 15 and 18 months, and results in motor, language and social interaction fields were achieved. RESULTS: 59.4% were male and 40.6% female. The mean age of patients undergoing extracorporeal membrane oxygenation with pathological DT at 18 months was 3 months, compared to 11.88 months in those with normal DT. DT at 2 months was normal in 98.4% of patients, 87.5% at 6 and 12 months, 81.3% at 15 months and 85% at 18 months. Two patients with abnormal neurodevelopment normalized the DT before 24 months. The field of neurodevelopment most affected was language (15.6%), followed by motor (10.9%) and social interaction (8%). CONCLUSIONS: Psychomotor development delay, especially in the area of language, is more frequent in patients with severe congenital heart disease. The presence of cyanosis and the need for extracorporeal membrane oxygenation were the variables that are most associated with this type of pathology.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Cardiopatias Congênitas/epidemiologia , Transtornos Psicomotores/epidemiologia , Dano Encefálico Crônico/etiologia , Transtornos do Comportamento Infantil/epidemiologia , Transtornos do Comportamento Infantil/etiologia , Comorbidade , Cianose , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/etiologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/terapia , Humanos , Hipóxia Encefálica/etiologia , Lactente , Recém-Nascido , Transtornos do Desenvolvimento da Linguagem/epidemiologia , Transtornos do Desenvolvimento da Linguagem/etiologia , Masculino , Testes Neuropsicológicos , Transtornos Psicomotores/diagnóstico , Estudos Retrospectivos
12.
Rev. neurol. (Ed. impr.) ; 66(12): 409-414, 16 jun., 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-174865

RESUMO

Objetivo. Analizar los hitos motores alcanzados en los dos primeros años de vida en pacientes con cardiopatía congénita grave. Pacientes y métodos. De 89 pacientes con cardiopatía congénita grave, 19 fueron excluidos por antecedentes de prematuridad o cromosomopatía, cuatro por antecedente de ictus isquémico y dos por ausencia de historia clínica. Se obtuvieron resultados del test de Denver (TD) a los 2, 6, 12, 15 y 18 meses, y resultados en los campos motor, del lenguaje y de interacción social. Resultados. El 59,4% fueron varones, y el 40,6%, mujeres. La edad media de los pacientes sometidos a oxigenación con membrana extracorpórea con TD patológico a los 18 meses fue de 3 meses, frente a 11,88 meses de los que presentaban un TD normal. El TD a los 2 meses resultó normal en el 98,4% de los pacientes, en el 87,5% a los 6 y 12 meses, en el 81,3% a los 15 meses, y en el 85% a los 18 meses. Dos de los pacientes con alteración en el neurodesarrollo normalizaron el TD antes de los 24 meses. El campo del neurodesarrollo más afectado fue el del lenguaje (15,6%), seguido del motor (10,9%) y de la interacción social (8%). Conclusiones. El retraso en el desarrollo psicomotor, especialmente en el área del lenguaje, es más frecuente en pacientes con cardiopatías congénitas graves, y la presencia de cianosis y la necesidad de circulación con membrana extracorpórea son las variables que más se asocian con este tipo de patología


Aim. Retrospective analysis of the neurodevelopment in the first two years of life in patients with severe congenital heart disease. Patients and methods. Out of 89 patients with severe congenital heart disease 19 were excluded due to a history of prematurity and/or chromosomopathy, four due to a history of ischemic stroke and two due to lack of medical history. Denver Test (DT) results at 2, 6, 12, 15 and 18 months, and results in motor, language and social interaction fields were achieved. Results. 59.4% were male and 40.6% female. The mean age of patients undergoing extracorporeal membrane oxygenation with pathological DT at 18 months was 3 months, compared to 11.88 months in those with normal DT. DT at 2 months was normal in 98.4% of patients, 87.5% at 6 and 12 months, 81.3% at 15 months and 85% at 18 months. Two patients with abnormal neurodevelopment normalized the DT before 24 months. The field of neurodevelopment most affected was language (15.6%), followed by motor (10.9%) and social interaction (8%). Conclusions. Psychomotor development delay, especially in the area of language, is more frequent in patients with severe congenital heart disease. The presence of cyanosis and the need for extracorporeal membrane oxygenation were the variables that are most associated with this type of pathology


Assuntos
Humanos , Masculino , Feminino , Lactente , Deficiências do Desenvolvimento/epidemiologia , Transtornos do Desenvolvimento da Linguagem/epidemiologia , Transtornos Psicomotores/epidemiologia , Testes Neuropsicológicos , Transtornos do Comportamento Infantil/epidemiologia , Deficiências do Desenvolvimento/diagnóstico , Dano Encefálico Crônico/etiologia , Transtornos do Comportamento Infantil/etiologia , Intervenção Precoce (Educação) , Deficiências do Desenvolvimento/etiologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Cardiopatias Congênitas/complicações , Hipóxia Encefálica/etiologia , Transtornos do Desenvolvimento da Linguagem/etiologia , Transtornos Psicomotores/diagnóstico , Estudos Retrospectivos
13.
Hum Brain Mapp ; 39(9): 3759-3768, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29749094

RESUMO

Traumatic brain injury can cause extensive damage to the white matter (WM) of the brain. These disruptions can be especially damaging in children, whose brains are still maturing. Diffusion magnetic resonance imaging (dMRI) is the most commonly used method to assess WM organization, but it has limited resolution to differentiate causes of WM disruption. Magnetic resonance spectroscopy (MRS) yields spectra showing the levels of neurometabolites that can indicate neuronal/axonal health, inflammation, membrane proliferation/turnover, and other cellular processes that are on-going post-injury. Previous analyses on this dataset revealed a significant division within the msTBI patient group, based on interhemispheric transfer time (IHTT); one subgroup of patients (TBI-normal) showed evidence of recovery over time, while the other showed continuing degeneration (TBI-slow). We combined dMRI with MRS to better understand WM disruptions in children with moderate-severe traumatic brain injury (msTBI). Tracts with poorer WM organization, as shown by lower FA and higher MD and RD, also showed lower N-acetylaspartate (NAA), a marker of neuronal and axonal health and myelination. We did not find lower NAA in tracts with normal WM organization. Choline, a marker of inflammation, membrane turnover, or gliosis, did not show such associations. We further show that multi-modal imaging can improve outcome prediction over a single modality, as well as over earlier cognitive function measures. Our results suggest that demyelination plays an important role in WM disruption post-injury in a subgroup of msTBI children and indicate the utility of multi-modal imaging.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Imagem Multimodal , Neuroimagem , Adolescente , Anisotropia , Ácido Aspártico/análogos & derivados , Ácido Aspártico/análise , Dano Encefálico Crônico/diagnóstico por imagem , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/patologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/patologia , Criança , Colina/análise , Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/patologia , Doenças Desmielinizantes/diagnóstico por imagem , Doenças Desmielinizantes/etiologia , Doenças Desmielinizantes/patologia , Feminino , Humanos , Masculino , Neuroimagem/métodos , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
14.
Rev Neurol ; 66(10): 325-330, 2018 05 16.
Artigo em Espanhol | MEDLINE | ID: mdl-29749592

RESUMO

INTRODUCTION: The concept of embolic stroke of undetermined source (ESUS) has recently appeared to better characterise patients with cryptogenic stroke. PATIENTS AND METHODS: A systematic review of studies published since 2014 was performed to evaluate the epidemiology, clinical features and prognosis of patients with ESUS and their proportion among patients with cryptogenic stroke. RESULTS: Ten studies were identified with a total of 14,810 patients. The frequency of ESUS varied between 6% and 42%. We observed a high percentage of patients with cryptogenic stroke who met ESUS criteria (37-82%). The mean age of these patients was 65-68 years. The mean severity of the stroke, as measured using the National Institutes of Health Stroke Scale, was found to be 3-7 points. A high degree of variability was seen in the proportion of atrial fibrillation (detected during follow-up) related to the electrocardiogram monitoring technique. In five studies, some minor source of cardioembolism was observed in one out of every two patients, the most frequent being the persistence of patent foramen ovale. The risk of recurrence was 5-14.5%. CONCLUSION: The application of the new ESUS criteria provides a better definition of patients with cryptogenic stroke. Applying the concept of ESUS requires not only adequate electrocardiogram monitoring, but also routine complementary examinations to rule out the presence of minor sources of cardioembolism and other sources of embolism other than atrial fibrillation.


Assuntos
Embolia Intracraniana/epidemiologia , Idoso , Doenças da Aorta/complicações , Arteriosclerose/complicações , Fibrilação Atrial/complicações , Dano Encefálico Crônico/epidemiologia , Dano Encefálico Crônico/etiologia , Feminino , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico , Masculino , Placa Aterosclerótica/complicações , Prognóstico , Recuperação de Função Fisiológica
15.
Rev Neurol ; 66(10): 340-343, 2018 May 16.
Artigo em Espanhol | MEDLINE | ID: mdl-29749594

RESUMO

INTRODUCTION: Polyarteritis nodosa is a necrotizing vasculitis that mainly affects small and medium-sized arteries in skin and internal organs. Neurological involvement is reported in around 25% of cases: ischemic stroke is relatively common, but haemorrhagic lesions are extremely rare. Subarachnoid haemorrhage in polyarteritis nodosa is an uncommon expression of this disease, mostly associated with aneurism rupture. To the best of the authors' knowledge, there is just one published case in pediatric age with polyarteritis nodosa and subarachnoid haemorrhage with no underlying aneurismal disease. CASE REPORT: A 7-year-old girl, who presented a non-aneurismal subarachnoid haemorrhage with intraparenchymal extension in the left basal ganglia. She was previously diagnosed with polyarteritis nodosa and prothrombotic condition, being under immunosuppressive and anti-platelet treatment at that moment. CONCLUSIONS: The clinical features of polyarteritis nodosa together with continued anti-platelet therapy to prevent thromboembolic disease in this patient could have predisposed to the haemorrhagic event in the process of cerebral vasculitis. Standard subarachnoid haemorrhage management is initially required in such cases as cerebral aneurysms are the most common cause of haemorrhage in the context of polyarteritis nodosa disease.


Assuntos
Poliarterite Nodosa/complicações , Hemorragia Subaracnóidea/etiologia , Idade de Início , Dano Encefálico Crônico/etiologia , Isquemia Encefálica/etiologia , Angiografia Cerebral , Criança , Emergências , Feminino , Heterozigoto , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Mutação , Paresia/etiologia , Protrombina/genética , Hemorragia Subaracnóidea/diagnóstico por imagem , Trombofilia/complicações , Trombofilia/genética
16.
Rev Neurol ; 66(8): 261-267, 2018 Apr 16.
Artigo em Espanhol | MEDLINE | ID: mdl-29645069

RESUMO

AIM: To describe the clinical presentation, risk factors and complementary tests in patients of our paediatric emergency service with a final diagnosis of ischemic stroke. PATIENTS AND METHODS: Retrospective, analytical and observational study, performed in a Paediatric Emergency Service of a tertiary-level hospital. We included patients aged 1 month to 14 years during a 12-years period with a final diagnosis of ischemic cerebrovascular disease (CVD). We analyzed personal history, symptomatology and initial complementary tests. RESULTS: Twelve patients were included, 66% males, with a median age of 77 months. 42% had remarkable history. The most frequent clinical manifestation was motor disorder (75%). 42% were diagnosed in the first 24 hours, noticing an earlier diagnosis after the introduction of a multidisciplinary protocol about CVD. CT was performed in all patients, except in two cases in whom MRI was performed. 50% of the CTs were initially normal. In the etiological study developed lately, only 42% of the patients had risk factors. 91% had some kind of sequel. CONCLUSIONS: CVD is uncommon in pediatrics, but with a high morbimortality, so it is important to make an early diagnosis. Clinical and personal history are fundamental, nevertheless, we mainly deal with a previously healthy child without known risk factors at the time of the first evaluation. In case of clinical suspicion of stroke, a normal initial CT does not rule out a CVD, so other additional tests, such as MRI, are necessary.


Assuntos
Isquemia Encefálica/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Dano Encefálico Crônico/etiologia , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Cefaleia/etiologia , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Transtornos dos Movimentos/etiologia , Neuroimagem , Pediatria , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos , Tomografia Computadorizada por Raios X
17.
PLoS One ; 13(3): e0193884, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29513757

RESUMO

We have previously demonstrated that arginine-rich and poly-arginine peptides possess potent neuroprotective properties, with poly-arginine peptide R18 identified as being highly effective at reducing infarct volume following middle cerebral artery occlusion (MCAO) in the Sprague Dawley rat. Since peptides synthesised using D-isoform amino acids have greater stability than L-isoform peptides due to increased resistance to proteolytic degradation, they represent potentially more effective peptide therapeutics. Therefore we compared the neuroprotective efficacy of R18 and its D-enantiomer R18D following permanent MCAO in the Wistar rat. Furthermore, as increased peptide stability may also increase peptide toxicity, we examined the effects of R18 and R18D on cultured cortical neurons, astrocytes, brain endothelial cells (bEND.3), and embryonic kidney cells (HEK293) following a 10-minute or 24-hour peptide exposure duration. The in vivo studies demonstrated that R18D resulted in a greater reduction in mean infarct volume compared to R18 (33%, p = 0.004 vs 12%, p = 0.27) after intravenous administration at 300 nmol/kg 30 minutes after MCAO. Both R18D and R18 reduced cerebral hemisphere swelling to a comparable degree (27%, p = 0.03 and 30%, p = 0.02), and improved neurological assessment scores (1.5, p = 0.02 and 2, p = 0.058 vs 3 for vehicle). No abnormal histological findings specific to peptide treatments were observed in hematoxylin and eosin stained sections of kidney, liver, spleen, lung and heart. In vitro studies demonstrated that R18 and R18D were most toxic to neurons, followed by astrocytes, HEK293 and bEND.3 cells, but only at high concentrations and/or following 24-hour exposure. These findings further highlight the neuroprotective properties of poly-arginine peptides, and indicate that R18D at the dose examined is more potent than R18 in Wistar rats, and justify continued investigation of the R18 peptide as a novel neuroprotective agent for stroke.


Assuntos
Infarto da Artéria Cerebral Média/tratamento farmacológico , Fármacos Neuroprotetores/uso terapêutico , Peptídeos/uso terapêutico , Animais , Astrócitos/efeitos dos fármacos , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/prevenção & controle , Edema Encefálico/etiologia , Edema Encefálico/prevenção & controle , Células Cultivadas , Córtex Cerebral/citologia , Avaliação Pré-Clínica de Medicamentos , Células HEK293 , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/patologia , Peptídeos e Proteínas de Sinalização Intracelular , Masculino , Neurônios/efeitos dos fármacos , Fármacos Neuroprotetores/química , Fármacos Neuroprotetores/toxicidade , Peptídeos/química , Peptídeos/toxicidade , Ratos , Ratos Sprague-Dawley , Ratos Wistar , Estereoisomerismo
18.
World Neurosurg ; 113: e161-e165, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29421452

RESUMO

OBJECTIVE: Common sequelae of subarachnoid hemorrhage (SAH) include somatic and/or cognitive impairment. This can cause emotional stress, social tensions, and difficulties in relationships. To test our hypothesis that more severe somatic and cognitive impairments increased the likelihood of disruption of a relationship after SAH, we assessed the integrity of marriage or partnership status in a well-evaluated subset of SAH patients. METHODS: Our sample comprised 50 SAH patients who were discharged to a neurologic, in-house rehabilitation center between 2005 and 2010. Deficits on admission to the rehabilitation center were divided into 18 categories and grouped into minor and major somatic deficits, as well as cognitive deficits. Clinical outcome scores, marital/partnership status, and duration of partnership before ictus were recorded. A follow-up questionnaire after 4.3 (2012) and 8.8 (2017) years was used to assess changes in marital/partnership status. Possible predictor parameters were estimated and included in a stepdown regression analysis. RESULTS: In 2012, after a mean follow-up of 4.3 years, 8 of the 50 SAH patients were divorced or separated, whereas after 8.8 years only 1 additional relationship had ended. In our regression model analysis, a "short duration of relationship" before SAH and the presence of a "few minor somatic deficits" were associated with a higher likelihood of divorce or separation in the near future and remained unchanged at long-term follow-up. CONCLUSION: Contrary to our hypothesis, neither the presence of severe somatic or cognitive deficits nor clinical evaluation scores reliably predicted divorce or separation after SAH.


Assuntos
Aneurisma Roto/psicologia , Divórcio , Aneurisma Intracraniano/psicologia , Casamento , Cônjuges/psicologia , Hemorragia Subaracnóidea/psicologia , Adulto , Idoso , Aneurisma Roto/complicações , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/psicologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Emoções , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/reabilitação , Inquéritos e Questionários , Fatores de Tempo
19.
World Neurosurg ; 113: e29-e37, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29410100

RESUMO

OBJECTIVE: An onsite access to neurointerventional radiology (NIR) may be useful for managing patients with aneurysmal subarachnoid hemorrhage (aSAH) after the aneurysm-securing procedure. We aimed to assess the association between neurological outcomes related to aSAH and onsite access to NIR service. METHODS: This was a sequential period study of 47 patients with aSAH admitted consecutively during the pre-NIR period (January 2010 to June 2012) compared with 81 patients with aSAH admitted consecutively during the post-NIR period (January 2013 to June 2015) at an academic tertiary referral intensive care unit (ICU). The primary end point was the incidence of poor neurological outcome, defined as modified Rankin scale of ≥3 at 6 months from ictus. Secondary outcomes included incidence of symptomatic vasospasm (SV) and length of stay in ICU/hospital. RESULTS: The primary end point was observed in 18 of 47 (38%) patients during the pre-NIR period versus 25 of 81 (31%) patients during the post-NIR period (P = 0.39). The post-NIR period did not have an independent impact on neurological outcomes (adjusted odds ratio = 0.8, 95% confidence interval 0.3-2.1; P = 0.66). Of the patients who developed SV, 10 of 47 (21%) were during the pre-NIR period versus 33 of 81 (41%) during the post-NIR period (P = 0.02). The post-NIR period and higher Fisher grade were independent predictors of SV. Patients with SV had similar outcomes, but with longer stay in ICU during the post-NIR period compared with the pre-NIR period. CONCLUSIONS: Among patients with aSAH, the post-NIR period was associated with more frequent detection of SV, more endovascular procedures, longer hospital stay, but with no appreciable improvement in neurological outcomes either overall or in the subset of patients with SV. STUDY REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616000201471.


Assuntos
Aneurisma Roto/complicações , Dano Encefálico Crônico/etiologia , Aneurisma Intracraniano/complicações , Radiografia Intervencionista/estatística & dados numéricos , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Aneurisma Roto/cirurgia , Aneurisma Roto/terapia , Dano Encefálico Crônico/epidemiologia , Dano Encefálico Crônico/prevenção & controle , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/terapia , Tempo de Internação/estatística & dados numéricos , Ligadura , Masculino , Pessoa de Meia-Idade , Recidiva , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/etiologia , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento , Vasoespasmo Intracraniano/epidemiologia , Vasoespasmo Intracraniano/etiologia
20.
World Neurosurg ; 113: e153-e160, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29427813

RESUMO

BACKGROUND: In the past decade, neurosurgery in Uganda experienced increasing surgical volume and a new residency training program. Although research has examined surgical capacity, minimal data exist on the patient population treated by neurosurgery and their eventual outcomes in sub-Saharan Africa. METHODS: Patients admitted to Mulago National Referral Hospital neurosurgical ward over 2 years (2014 and 2015) were documented in a prospective database. In total, 1167 were discharged with documented phone numbers and thus eligible for follow-up. Phone surveys were developed and conducted in the participant's language to assess mortality, neurologic outcomes, and follow-up health care. RESULTS: During the study period, 2032 patients were admitted to the neurosurgical ward, 80% for traumatic brain injury. A total of 7.8% received surgical intervention. The in-hospital mortality rate was 18%. A total of 870 patients were reached for phone follow-up, a 75% response rate, and 30-day and 1-year mortality were 4% and 8%, respectively. Almost one-half of patients had not had subsequent health care after the initial encounter. Most patients had Glasgow Outcome Scale-Extended scores consistent with good recovery and mild disability, with patients experiencing trauma faring best and patients with tumor faring worst. A total of 85% felt they returned to baseline work performance, and 76% of guardians felt that children returned to baseline school performance. CONCLUSIONS: The neurosurgical service provided health care to a large proportion of nonoperative patients. Phone surveys captured data on patients in whom nearly one-half would be lost to subsequent health care. Although mortality during initial hospitalization was high, more than 90% of those discharged survived at 1-year follow up, and the vast majority returned to work and school.


Assuntos
Procedimentos Neurocirúrgicos , Pacientes Ambulatoriais , Sobreviventes , África ao Sul do Saara/epidemiologia , Assistência ao Convalescente , Dano Encefálico Crônico/epidemiologia , Dano Encefálico Crônico/etiologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Cuidadores , Telefone Celular , Comorbidade , Convalescença , Países em Desenvolvimento , Seguimentos , Humanos , Pacientes Internados , Malária/epidemiologia , Pacientes Ambulatoriais/psicologia , Satisfação do Paciente , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/psicologia , Qualidade de Vida , Fatores Socioeconômicos , Disrafismo Espinal/cirurgia , Análise de Sobrevida , Sobreviventes/psicologia , Resultado do Tratamento , Uganda/epidemiologia
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