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1.
Neurol Sci ; 42(2): 437-444, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33389228

RESUMO

Coronavirus disease 2019 (COVID-19) pandemic has struck many countries and caused a great number of infected cases and death. Healthcare system across all countries is dealing with the increasing medical, social, and legal issues caused by the COVID-19 pandemic, and the standards of care are being altered. Admittedly, neurology units have been influenced greatly since the first days, as aggressive policies adopted by many hospitals caused eventual shut down of numerous neurologic wards. Considering these drastic alterations, traditional ethical principles have to be integrated with state-of-the-art ethical considerations. This review will consider different ethical aspects of care in neurologic patients during COVID-19 and how this challenging situation has affected standards of care in these patients.


Assuntos
Procedimentos Endovasculares/ética , Doenças do Sistema Nervoso/terapia , Neurologia/ética , Cuidados Paliativos/ética , Sistemas de Apoio Psicossocial , Respiração Artificial/ética , Triagem/ética , Humanos
5.
J Neurosurg Anesthesiol ; 33(1): 77-81, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32815827

RESUMO

BACKGROUND: The World Health Organisation declared a coronavirus disease 2019 (COVID-19) pandemic on March 11, 2020. Following activation of the UK pandemic response, our institution began planning for admission of COVID-19 patients to the neurointensive care unit (neuro-ICU) to support the local critical care network which risked being rapidly overwhelmed by the high number of cases. This report will detail our experience of repurposing a neuro-ICU for the management of severely ill patients with COVID-19 while retaining capacity for urgent neurosurgical and neurology admissions. METHODS: We conducted a retrospective process analysis of the repurposing of a quaternary level neuro-ICU during the early stages of the COVID-19 pandemic in the United Kingdom. We retrieved demographic data, diagnosis, and outcomes from the electronic health care records of all patients admitted to the ICU between March 1, 2020 and April 30, 2020. Processes for increase in surge capacity, reduction in ICU demand, and staff redeployment and rapid training are reported. RESULTS: Over a 10-day period, total ICU capacity was increased by 21.7% (from 23 to 28 beds) while the capacity to provide mechanical ventilation was increased by 77% (from 13 to 23 beds). There were 30 ICU admissions of 29 COVID-19 patients between March 1 and April 30, 2020; median (range) length of ICU stay was 9.9 (1.3 to 32) days, duration of mechanical ventilation 11 (1 to 27) days, and ICU mortality rate 41.4%. There was a 44% reduction in urgent neurosurgical and neurology admissions compared with the same period in 2019. CONCLUSIONS: It is possible to repurpose a dedicated neuro-ICU for the management of critically ill non-neurological patients during a pandemic response, while maintaining access for urgent neuroscience referrals.


Assuntos
/terapia , Unidades de Terapia Intensiva/organização & administração , Doenças do Sistema Nervoso/terapia , Adulto , Idoso , Cuidados Críticos , Feminino , Número de Leitos em Hospital , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/ética , Masculino , Conduta do Tratamento Medicamentoso , Pessoa de Meia-Idade , Pandemias , Admissão do Paciente , Encaminhamento e Consulta , Respiração Artificial , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido
6.
Emerg Med Clin North Am ; 39(1): 47-65, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218662

RESUMO

The diagnosis and management of neurologic conditions are more complex at the extremes of age than in the average adult. In the pediatric population, neurologic emergencies are somewhat rare and some may require emergent consultation. In older adults, geriatric physiologic changes with increased comorbidities leads to atypical presentations and worsened outcomes. The unique considerations regarding emergency department presentation and management of stroke and altered mental status in both age groups is discussed, in addition to seizures and intracranial hemorrhage in pediatrics, and Parkinson's disease and meningitis in the geriatric population.


Assuntos
Emergências , Doenças do Sistema Nervoso/diagnóstico , Doença Aguda , Fatores Etários , Idoso , Criança , Demência/diagnóstico , Demência/terapia , Serviço Hospitalar de Emergência , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/terapia , Meningite/diagnóstico , Meningite/terapia , Doenças do Sistema Nervoso/terapia , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Convulsões/diagnóstico , Convulsões/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
10.
Brain Nerve ; 72(10): 1057-1060, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33051392

RESUMO

Although non-urgent hospital visits should be avoided during the pandemic, patients with chronic neurological diseases still require a specialist even in such a situation. Telemedicine is a favorable solution to improve patients' access to specialists, and its use has rapidly accelerated worldwide. The need for telemedicine in neurological disorders, the brief history of telemedicine in Japan before and after the pandemic, and how to set up online visits and perform virtual neurological examinations will be discussed in this review.


Assuntos
Infecções por Coronavirus , Doenças do Sistema Nervoso , Pneumonia Viral , Telemedicina , Humanos , Japão , Doenças do Sistema Nervoso/terapia
13.
Med Sci (Paris) ; 36(8-9): 775-782, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32755537

RESUMO

The recent emergence of a new coronavirus, SARS-CoV-2, responsible for COVID-19, is a new warning of the risk to public health represented by viral zoonoses and in particular by coronaviruses. Mainly described as being able to infect the upper and lower respiratory tract, coronaviruses can also infect the central and peripheral nervous systems as many other respiratory viruses, such as influenza or respiratory syncytial virus. Viral infections of the nervous system are a major public health concern as they can cause devastating illnesses up to death, especially when they occur in the elderly, who are more susceptible to these infections. Knowledge concerning the pathophysiology of recently emerging coronaviruses (MERS-CoV, SARS-CoV and SARS-CoV-2) and how they reach the central nervous system are very sketchy and the work in progress aims in particular to better understand their biology and the mechanisms associated with neurological damage. In this review we will discuss the current state of knowledge on the neurotropism of human coronaviruses and the associated mechanisms by developing in particular the latest data concerning SARS-CoV-2.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/complicações , Animais , Transporte Biológico , Técnicas de Laboratório Clínico , Doenças Transmissíveis Emergentes , Coronaviridae/patogenicidade , Coronaviridae/fisiologia , Coronaviridae/ultraestrutura , Infecções por Coronaviridae/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Humanos , Sistema Nervoso/virologia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Doenças do Sistema Nervoso/virologia , Especificidade de Órgãos , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Tropismo Viral , Virulência , Replicação Viral , Zoonoses
14.
Brain Nerve ; 72(8): 893-899, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32741770

RESUMO

Due to progressive decline in activities of daily living, patients with intractable neurological diseases require long-term medical treatment with care and support. For continued medical- and nursing-care service provision desirable for patients, attempts have been made to establish a cooperation network system between specialized medical institutions and community healthcare institutions. This article describes the role of medical institutions responsible for home care in this system based on clinical practice.


Assuntos
Serviços de Assistência Domiciliar , Doenças do Sistema Nervoso , Atividades Cotidianas , Humanos , Assistência de Longa Duração , Doenças do Sistema Nervoso/terapia
15.
Medicine (Baltimore) ; 99(34): e21783, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846808

RESUMO

BACKGROUND: Scalp acupuncture is remarkable in improving neurological dysfunction of ischemic stroke patients. This study aims to systematically evaluate the efficacy and safety of scalp acupuncture in improving neurological dysfunction of ischemic stroke patients. METHODS: Randomized controlled trials of scalp acupuncture against ischemic stroke patients will be searched in PubMed, Web of Science, Embase, Cochrane Library, the Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biological and Medical database, China National Knowledge Infrastructure, and Wanfang database from inception to July, 2020. Two researchers will perform data extraction and risk of bias assessment independently. Statistical analysis will be conducted in RevMan 5.3. RESULTS: This study will summarize the present evidence by exploring the efficacy and safety of scalp acupuncture in improving neurological dysfunction in ischemic stroke patients. CONCLUSIONS: The findings of the study will help to determine potential benefits of scalp acupuncture against ischemic stroke at different stage. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/T26P8.


Assuntos
Terapia por Acupuntura/métodos , Doenças do Sistema Nervoso/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Terapia por Acupuntura/efeitos adversos , Isquemia Encefálica/complicações , Humanos , Metanálise como Assunto , Doenças do Sistema Nervoso/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Couro Cabeludo , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto
16.
Arq Neuropsiquiatr ; 78(8): 494-500, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32756734

RESUMO

BACKGROUND: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. OBJECTIVE: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. METHODS: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. RESULTS: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). CONCLUSIONS: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.


Assuntos
Infecções por Coronavirus/diagnóstico , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Betacoronavirus , Brasil/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Número de Leitos em Hospital , Hospitais Universitários , Humanos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Neurologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Estudos Retrospectivos
17.
Neurol Sci ; 41(9): 2353-2366, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32767055

RESUMO

COVID-19 is a pandemic caused by human coronavirus (HCoV) SARS-CoV-2, which originated in Wuhan, China, at the end of 2019 and spread globally during 2020. Due to the difficulty of clinical decision-making during this period, our study group reviewed current literature focusing on the neurological and psychiatric aspects of COVID-19. Despite the knowledge on this newly discovered virus which is constantly evolving, different pieces of evidence reported an association between COVID-19 and neurological symptoms like headache, dizziness, taste and smell disorders and complications involving the nervous system eventually triggered by the pathologic processes elicited by SARS-CoV-2. It seems that younger patients are less prone to develop severe forms of COVID-19. However, neurological signs have been reported in paediatric patients as well, and in some cases, the infection presented neurological sequelae. Furthermore, children with particular neurological diseases or treated with specific drugs (e.g. immune-suppressant therapies) must be carefully monitored during this pandemic. Neurologists should be aware of the main drug-drug interactions and the neurological side effects of COVID-19 treatments. Notably, adverse mental health impact has been reported in patients with SARS-CoV-2, which could be related either to the social strain or to the eventual neurotropic effects of the virus, which in other infections have been proven to promote the onset of psychiatric symptoms. Further, psychiatric population may be more vulnerable to the infection and at higher risk for adverse outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Transtornos Mentais/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Pneumonia Viral/epidemiologia , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia
19.
Clin Nucl Med ; 45(9): 700-702, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32657874

RESUMO

Bing-Neel syndrome is a rare neurological complication of Waldenström macroglobulinemia. We present the case of a 71-year-old man who underwent prechemotherapy and postchemotherapy FDG PET/MRI scan for the evaluation of cerebrospinal disease. In light of limited literature and lack of consensus guidelines on the role of metabolic imaging, we aim to highlight the utility of FDG PET/MRI in the diagnosis and response assessment in Bing-Neel syndrome.


Assuntos
Fluordesoxiglucose F18 , Imagem por Ressonância Magnética , Imagem Multimodal , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/terapia , Tomografia por Emissão de Pósitrons , Macroglobulinemia de Waldenstrom/complicações , Idoso , Humanos , Masculino , Doenças do Sistema Nervoso/complicações
20.
Stroke Vasc Neurol ; 5(3): 242-249, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32641446

RESUMO

During the COVID-19 epidemic, the treatment of critically ill patients has been increasingly difficult and challenging. During the epidemic, some patients with neurological diseases also have COVID-19, which could be misdiagnosed and cause silent transmission and nosocomial infection. Such risk is high in a neurological intensive care unit (NCU). Therefore, prevention and control of epidemic in critically ill patients is of utmost importance. The principle of NCU care should include comprehensive screening and risk assessment, weighing risk against benefits and reducing the risk of COVID-19 transmission while treating patients as promptly as possible.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva/normas , Doenças do Sistema Nervoso/terapia , Neurologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Consenso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Estado Terminal , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Interações Hospedeiro-Patógeno , Humanos , Doenças do Sistema Nervoso/diagnóstico , Saúde do Trabalhador , Segurança do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
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