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1.
BMC Pregnancy Childbirth ; 20(1): 587, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023500

RESUMO

BACKGROUND: There are no published cases of tonic-clonic seizures and posterior bilateral blindness during pregnancy and Severe Acute Respiratory Syndrome (SARS) Coronavirus (COV) 2 (SARS-COV-2) infection. We do not just face new and unknown manifestations, but also how different patient groups are affected by SARS-COV-2 infection, such as pregnant women. Coronavirus Disease 2019 (COVID-19), preeclampsia, eclampsia and posterior reversible leukoencephalopathy share endothelium damage and similar pathophysiology. CASE PRESENTATION: A 35-year-old pregnant woman was admitted for tonic-clonic seizures and SARS-COV-2 infection. She had a normal pregnancy control and no other symptoms before tonic-clonic seizures development. After a Caesarean section (C-section) she developed high blood pressure, and we initiated antihypertensive treatment with labetalol, amlodipine and captopril. Few hours later she developed symptoms of cortical blindness that resolved in 72 h with normal brain computed tomography (CT) angiography. CONCLUSION: The authors conclude that SARS COV-2 infection could promote brain endothelial damage and facilitate neurological complications during pregnancy.


Assuntos
Anti-Hipertensivos/administração & dosagem , Betacoronavirus/isolamento & purificação , Cegueira Cortical , Cesárea/métodos , Infecções por Coronavirus , Eclampsia , Fibrinolíticos/administração & dosagem , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Convulsões , Adulto , Cegueira Cortical/diagnóstico , Cegueira Cortical/virologia , Encéfalo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diagnóstico Diferencial , Eclampsia/diagnóstico , Eclampsia/terapia , Eclampsia/virologia , Feminino , Humanos , Exame Neurológico/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/etiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Resultado da Gravidez , Convulsões/diagnóstico , Convulsões/etiologia , Convulsões/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
BMJ Case Rep ; 13(10)2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33060143

RESUMO

Early case series suggest that about one-third of patients with COVID-19 present with neurological manifestations, including cerebrovascular disease, reported in 2%-6% of hospitalised patients. These are generally older patients with severe infection and comorbidities. Here we discuss the case of a previously fit and well 39-year-old man who presented with fever and respiratory symptoms, evolving in pneumonia with hypoxia but only requiring continuous positive airway pressure. After resolution of the respiratory disease, the patient developed focal neurology and was found to have bilateral occipital, thalamic and cerebellar infarcts. A diagnosis of COVID-19 central nervous system vasculopathy was made. He developed a florid neuropsychiatric syndrome, including paranoia, irritability, aggression and disinhibition, requiring treatment with antipsychotics and transfer to neurorehabilitation. Neuropsychometry revealed a wide range of cognitive deficits. The rapid evolution of the illness was matched by fast resolution of the neuropsychiatric picture with mild residual cognitive impairment.


Assuntos
Sintomas Comportamentais , Infarto Encefálico , Tronco Encefálico , Doenças Cerebelares , Cerebelo , Disfunção Cognitiva , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adulto , Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/fisiopatologia , Sintomas Comportamentais/reabilitação , Betacoronavirus/isolamento & purificação , Infarto Encefálico/diagnóstico , Infarto Encefálico/fisiopatologia , Infarto Encefálico/psicologia , Infarto Encefálico/reabilitação , Tronco Encefálico/irrigação sanguínea , Tronco Encefálico/diagnóstico por imagem , Doenças Cerebelares/fisiopatologia , Doenças Cerebelares/psicologia , Doenças Cerebelares/reabilitação , Doenças Cerebelares/virologia , Cerebelo/irrigação sanguínea , Cerebelo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/reabilitação , Disfunção Cognitiva/virologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Humanos , Masculino , Exame Neurológico/métodos , Testes Neuropsicológicos , Pneumonia Viral/fisiopatologia , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Reabilitação Psiquiátrica/métodos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(43): e22900, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120840

RESUMO

RATIONALE: Spinal cord infarction (SCI) accounts for only 1% to 2% of all ischemic strokes and 5% to 8% of acute myelopathies. Magnetic resonance imaging (MRI) holds a role in ruling out non-ischemic etiologies, but the diagnostic accuracy of this procedure may be low in confirming the diagnosis, even when extensive cord lesions are present. Indeed, T2 changes on MRI can develop over hours to days, thus accounting for the low sensitivity in the hyperacute setting (ie, within 6 hours from symptom onset). For these reasons, SCI remains a clinical diagnosis. Despite extensive diagnostic work-up, up to 20% to 40% of SCI cases are classified as cryptogenic. Here, we describe a case of cryptogenic longitudinally extensive transverse myelopathy due to SCI, with negative MRI and diffusion-weighted imaging at 9 hours after symptom onset. PATIENT CONCERNS: A 51-year-old woman presented to our Emergency Department with acute severe abdominal pain, nausea, vomiting, sudden-onset of bilateral leg weakness with diffuse sensory loss, and paresthesias on the trunk and legs. DIAGNOSES: On neurological examination, she showed severe paraparesis and a D6 sensory level. A 3T spinal cord MRI with gadolinium performed at 9 hours after symptom onset did not detect spinal cord alterations. Due to the persistence of a clinical picture suggestive of an acute myelopathy, a 3T MRI of the spine was repeated after 72 hours showing a hyperintense "pencil-like" signal mainly involving the grey matter from T1 to T6 on T2 sequence, mildly hypointense on T1 and with restricted diffusion. INTERVENTIONS: The patient was given salicylic acid (100 mg/d), prophylactic low-molecular-weight heparin, and began neuromotor rehabilitation. OUTCOMES: Two months later, a follow-up neurological examination revealed a severe spastic paraparesis, no evident sensory level, and poor sphincteric control with distended bladder. LESSONS: Regardless of its relatively low frequency in the general population, SCI should be suspected in every patient presenting with acute and progressive myelopathic symptoms, even in the absence of vascular risk factors. Thus, a clinical presentation consistent with a potential vascular syndrome involving the spinal cord overrides an initially negative MRI and should not delay timely and appropriate management.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Doenças da Medula Espinal/diagnóstico , Isquemia do Cordão Espinal/diagnóstico por imagem , Assistência ao Convalescente , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Serviço Hospitalar de Emergência , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Exame Neurológico/métodos , Paraparesia/etiologia , Parestesia/diagnóstico , Parestesia/etiologia , Ácido Salicílico/administração & dosagem , Ácido Salicílico/uso terapêutico , Doenças da Medula Espinal/etiologia , Isquemia do Cordão Espinal/tratamento farmacológico , Isquemia do Cordão Espinal/patologia , Isquemia do Cordão Espinal/reabilitação
4.
Pain Physician ; 23(4S): S205-S238, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942812

RESUMO

BACKGROUND: The COVID pandemic has impacted almost every aspect of human interaction, causing global changes in financial, health care, and social environments for the foreseeable future. More than 1.3 million of the 4 million cases of COVID-19 confirmed globally as of May 2020 have been identified in the United States, testing the capacity and resilience of our hospitals and health care workers. The impacts of the ongoing pandemic, caused by a novel strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have far-reaching implications for the future of our health care system and how we deliver routine care to patients. The adoption of social distancing during this pandemic has demonstrated efficacy in controlling the spread of this virus and has been the only proven means of infection control thus far. Social distancing has prompted hospital closures and the reduction of all non-COVID clinical visits, causing widespread financial despair to many outpatient centers. However, the need to treat patients for non-COVID problems remains important despite this pandemic, as care must continue to be delivered to patients despite their ability or desire to report to outpatient centers for their general care. Our national health care system has realized this need and has incentivized providers to adopt distance-based care in the form of telemedicine and video medicine visits. Many institutions have since incorporated these into their practices without financial penalty because of Medicare's 1135 waiver, which currently reimburses telemedicine at the same rate as evaluation and management codes (E/M Codes). Although the financial burden has been alleviated by this policy, the practitioner remains accountable for providing proper assessment with this new modality of health care delivery. This is a challenge for most physicians, so our team of national experts has created a reference guide for musculoskeletal and neurologic examination selection to retrofit into the telemedicine experience. OBJECTIVES: To describe and illustrate musculoskeletal and neurologic examination techniques that can be used effectively in telemedicine. STUDY DESIGN: Consensus-based multispecialty guidelines. SETTING: Tertiary care center. METHODS: Literature review of the neck, shoulder, elbow, wrist, hand, lumbar, hip, and knee physical examinations were performed. A multidisciplinary team comprised of physical medicine and rehabilitation, orthopedics, rheumatology, neurology, and anesthesia experts evaluated each examination and provided consensus opinion to select the examinations most appropriate for telemedicine evaluation. The team also provided consensus opinion on how to modify some examinations to incorporate into a nonhealth care office setting. RESULTS: Sixty-nine examinations were selected by the consensus team. Household objects were identified that modified standard and validated examinations, which could facilitate the examinations.The consensus review team did not believe that the modified tests altered the validity of the standardized tests. LIMITATIONS: Examinations selected are not validated for telemedicine. Qualitative and quantitative analyses were not performed. CONCLUSIONS: The physical examination is an essential component for sound clinical judgment and patient care planning. The physical examinations described in this manuscript provide a comprehensive framework for the musculoskeletal and neurologic examination, which has been vetted by a committee of national experts for incorporation into the telemedicine evaluation.


Assuntos
Infecções por Coronavirus , Exame Neurológico/métodos , Ortopedia/métodos , Dor/diagnóstico , Pandemias , Pneumonia Viral , Telemedicina/métodos , Betacoronavirus , Humanos , Exame Neurológico/tendências , Ortopedia/tendências , Telemedicina/tendências , Estados Unidos
6.
Neurology ; 95(15): 693-694, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-32732294

RESUMO

Coronavirus disease 2019 (COVID-19) may pose unique challenges to clinicians attempting to diagnose brain death in patients infected with the SARS-CoV-2. Among these challenges is the risk of aerosol generation during the traditional apnea testing using the insufflation technique in addition to the risk of complications due to SARS-CoV-2-related lung disease. In this article, we discuss these challenges and provide further guidance to minimize such risks to ensure safety of healthcare professionals and other patients. We also emphasize the importance of maintaining the standards of brain death determination in this critical time.


Assuntos
Morte Encefálica/diagnóstico , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Exame Neurológico/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/transmissão , Humanos , Insuflação/métodos , Pneumonia Viral/transmissão
7.
Pract Neurol ; 20(5): 396-403, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32862137

RESUMO

Tele-neurology is a neurological consultation at a distance, or not in person, using various technologies to achieve connectivity, including the telephone and the internet. The telephone is ubiquitous and is a standard part of how we manage patients. Video consulting has been used for a long time in some centres, particularly in those where the geography means that patients have to travel long distances. Various technologies can be used, and with the development of various internet-based video-calling platforms, real-time video consulting has become much more accessible. We have provided a tele-neurology service in the North East of Scotland since 2006 using video conferencing with far-end camera control. More recently, we have complemented this using an internet-based platform (NHS Near Me). Here we outline the practicalities of video consulting in 'ordinary' times and comment on its use in the 'extraordinary' times of the coronavirus pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Exame Neurológico/tendências , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Encaminhamento e Consulta/tendências , Telemedicina/tendências , Comunicação por Videoconferência/tendências , Infecções por Coronavirus/epidemiologia , Humanos , Exame Neurológico/métodos , Exame Neurológico/normas , Neurologia/métodos , Neurologia/normas , Neurologia/tendências , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta/normas , Escócia/epidemiologia , Telemedicina/métodos , Telemedicina/normas , Comunicação por Videoconferência/normas
8.
Medicine (Baltimore) ; 99(28): e20918, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664087

RESUMO

RATIONALE: Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare neuropathic syndrome with typical clinical and radiological features. There are large amounts of risk factors resulting in RPLS, those including hypertension, eclampsia, neoplasia treatment, renal failure, systemic infections, chemotherapy, and immunosuppressive therapy after organ transplantation. PATIENT CONCERNS: A 27-year-old male patient was admitted for a 2-week history of paroxysmal tic of limbs along with consciousness disorder. Blood pressure elevation was discovered for the first time on admission, and the highest record was 210/150 mmHg during hospitalization. Neurological examinations were positive among mental state, speech, reaction and pathological reflex. The computed tomography scan of the abdomen demonstrated a mass derived from right adrenal gland. The magnetic resonance imaging of the brain showed reversible lesions in the centrum ovale, paraventricular, area and corpus callosum. DIAGNOSES: After control of blood pressure and rationally preoperative preparation, the mass was radically resected and verified to be pheochromocytoma by postoperative pathologic findings. He was diagnosed as having RPLS due to adrenal pheochromocytoma. INTERVENTIONS: The right adrenal gland mass was completely removed after 2 weeks of α-blockers and ß-blockers to treat hypertension. OUTCOMES: One week after surgery, the cerebral lesions of RPLS gradually faded and the blood pressure was easy to control well. LESSONS: A few case reports of RPLS related to pheochromocytomas had been documented in the literature. Therefore, we believe that pheochromocytomas may be a potential risk factor of RPLS. If patients receive timely diagnosis and treatment, it can often lead to a favorable prognosis.


Assuntos
Encéfalo/diagnóstico por imagem , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Síndrome da Leucoencefalopatia Posterior/etiologia , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Assistência ao Convalescente , Encéfalo/patologia , Criança , Transtornos da Consciência/etiologia , Feminino , Hospitalização , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Exame Neurológico/métodos , Feocromocitoma/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Fatores de Risco , Transtornos de Tique/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
9.
BMJ Case Rep ; 13(7)2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641309
11.
BMJ Case Rep ; 13(6)2020 Jun 14.
Artigo em Inglês | MEDLINE | ID: covidwho-599773

RESUMO

A 57-year-old man presented with a progressive flaccid symmetrical motor and sensory neuropathy following a 1-week history of cough and malaise. He was diagnosed with Guillain-Barré syndrome secondary to COVID-19 and started on intravenous immunoglobulin. He proceeded to have worsening respiratory function and needed intubation and mechanical ventilation. This is the first reported case of this rare neurological complication of COVID-19 in the UK, but it adds to a small but growing body of international evidence to suggest a significant association between these two conditions. Increasing appreciation of this by clinicians will ensure earlier diagnosis, monitoring and treatment of patients presenting with this.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Síndrome de Guillain-Barré , Imunoglobulinas Intravenosas/administração & dosagem , Pandemias , Pneumonia Viral , Respiração Artificial/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Diagnóstico Precoce , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/fisiopatologia , Síndrome de Guillain-Barré/terapia , Humanos , Fatores Imunológicos/administração & dosagem , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Exame Neurológico/métodos , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
12.
BMJ Case Rep ; 13(6)2020 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-32540883

RESUMO

A 57-year-old man presented with a progressive flaccid symmetrical motor and sensory neuropathy following a 1-week history of cough and malaise. He was diagnosed with Guillain-Barré syndrome secondary to COVID-19 and started on intravenous immunoglobulin. He proceeded to have worsening respiratory function and needed intubation and mechanical ventilation. This is the first reported case of this rare neurological complication of COVID-19 in the UK, but it adds to a small but growing body of international evidence to suggest a significant association between these two conditions. Increasing appreciation of this by clinicians will ensure earlier diagnosis, monitoring and treatment of patients presenting with this.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Síndrome de Guillain-Barré , Imunoglobulinas Intravenosas/administração & dosagem , Pandemias , Pneumonia Viral , Respiração Artificial/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Diagnóstico Precoce , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/fisiopatologia , Síndrome de Guillain-Barré/terapia , Humanos , Fatores Imunológicos/administração & dosagem , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Exame Neurológico/métodos , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
Neurology ; 95(3): e299-e309, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32576632

RESUMO

OBJECTIVE: To identify similarities and differences in protocols on determination of brain death/death by neurologic criteria (BD/DNC) around the world. METHODS: We collected and reviewed official national BD/DNC protocols from contacts around the world between January 2018 and April 2019. RESULTS: We communicated with contacts in 136 countries and found that 83 (61% of countries with contacts identified, 42% of the world) had BD/DNC protocols, 78 of which were unique. Protocols addressed the following prerequisites and provided differing instructions: drug clearance (64, 82%), temperature (61, 78%), laboratory values (56, 72%), observation period (37, 47%), and blood pressure (34, 44%). Protocols did not consistently identify the same components for the clinical examination of brain death; 70 (90%) included coma, 70 (90%) included the pupillary reflex, 68 (87%) included the corneal reflex, 67 (86%) included the oculovestibular reflex, 64 (82%) included the gag reflex, 62 (79%) included the cough reflex, 58 (74%) included the oculocephalic reflex, 37 (47%) included noxious stimulation to the face, and 22 (28%) included noxious stimulation to the limbs. Apnea testing was mentioned in 71 (91%) protocols; there was variability in the technique and target across protocols. Ancillary testing was included as a requirement for all determinations of BD/DNC in 22 (28%) protocols. CONCLUSIONS: There is considerable variability in BD/DNC determination protocols around the world. Medical standards for death should be the same everywhere. We recommend that a worldwide consensus be reached on the minimum standards for BD/DNC.


Assuntos
Morte Encefálica/diagnóstico , Fidelidade a Diretrizes/normas , Internacionalidade , Exame Neurológico/normas , Morte , Humanos , Exame Neurológico/métodos
15.
J Electromyogr Kinesiol ; 53: 102437, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32554206

RESUMO

OBJECTIVE: We aimed to specify and quantify the characteristics of the decrement in low-frequency repetitive nerve stimulation response in Lambert-Eaton myasthenia syndrome (LEMS) and compare it to those of myasthenia gravis (MG). PATIENTS AND METHODS: We retrospectively reviewed 18 patients with LEMS and 24 patients with MG. Ten consecutive stimulations were applied at 3 Hz to the abductor pollicis brevis. We determined the position of the smallest wave in the stimulation sequence, and we calculated the decrement and recovery. RESULTS: The median sequential order of the minimum wave was 8 in the LEMS group and 5 in the MG group (p < 0.001). The median decrement in the LEMS group was 36.7%, while that in the MG group was 21.0% (p = 0.047). The recovery percentage was 1.4% in the LEMS group and 3.5% in the MG group (p = 0.001). The area under the curve for the sequential order of the minimum wave was 0.90, and the reciprocal optimum cut-off point was 6.5. CONCLUSIONS: We elucidated a pattern with a delayed nadir and subsequent poor recovery, featuring a low-frequency decrement; furthermore, we determined the most likely sequential order of the minimum wave in patients with LEMS, and the indicator was useful for differentiation.


Assuntos
Eletromiografia/métodos , Síndrome Miastênica de Lambert-Eaton/diagnóstico , Síndrome Miastênica de Lambert-Eaton/fisiopatologia , Músculo Esquelético/fisiopatologia , Exame Neurológico/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Idoso , Algoritmos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Neurology ; 94(24): 1077-1087, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: covidwho-155215

RESUMO

The COVID-19 pandemic is causing world-wide social dislocation, operational and economic dysfunction, and high rates of morbidity and mortality. Medical practices are responding by developing, disseminating, and implementing unprecedented changes in health care delivery. Telemedicine has rapidly moved to the frontline of clinical practice due to the need for prevention and mitigation strategies; these have been encouraged, facilitated, and enabled by changes in government rules and regulations and payer-driven reimbursement policies. We describe our neurology department's situational transformation from in-person outpatient visits to a largely virtual neurology practice in response to the COVID-19 pandemic. Two key factors enabled our rapid deployment of virtual encounters in neurology and its subspecialties. The first was a well-established robust information technology infrastructure supporting virtual urgent care services at our institution; this connected physicians directly to patients using both the physician's and the patient's own mobile devices. The second is the concept of one patient, one chart, facilitated by a suite of interconnected electronic medical record (EMR) applications on several different device types. We present our experience with conducting general teleneurology encounters using secure synchronous audio and video connections integrated with an EMR. This report also details how we perform virtual neurologic examinations that are clinically meaningful and how we document, code, and bill for these virtual services. Many of these processes can be used by other neurology providers, regardless of their specific practice model. We then discuss potential roles for teleneurology after the COVID-19 global pandemic has been contained.


Assuntos
Infecções por Coronavirus , Exame Neurológico/métodos , Neurologia/métodos , Pandemias , Pneumonia Viral , Telemedicina/métodos , Comunicação por Videoconferência , Centros Médicos Acadêmicos , Betacoronavirus , Centers for Medicare and Medicaid Services, U.S. , Codificação Clínica , Documentação , Registros Eletrônicos de Saúde , Humanos , Cidade de Nova Iorque , Mecanismo de Reembolso , Estados Unidos
18.
Medicine (Baltimore) ; 99(19): e20032, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384463

RESUMO

RATIONALE: Spontaneous spinal subdural hematoma (SSDH) is a rare disease that can cause severe permanent neurological dysfunction. Here we present a case of spontaneous SSDH, in which a series of magnetic resonance images (MRIs) taken through the course of the disease facilitated understanding of the resolution process of the hematoma and the diagnosis of SSDH. PATIENT CONCERNS: A 59-year-old male presented with sudden severe back pain and rapid onset of paraplegia. This symptom had continued developing while he was transferred to the emergency department. Initial physical examination showed flaccid paralysis of both lower limbs with areflexia and loss of all sensation below T6 bilaterally. MRI images showed an anterior subdural hematoma from C7 to T7 with spinal cord compression. DIAGNOSIS: Based on MRI findings, the diagnosis was SSDH. INTERVENTIONS: We chose conservative treatment of 1-week bed rest and intensive rehabilitation for the patient due to the presence of sacral sparing and the slight motor recovery at 24 hours after the onset. OUTCOMES: Frequent MRI images demonstrated that the spinal cord compression was surprisingly mitigated only 2 days and mostly absorbed 4 days after the onset. The patient's motor function was recovered completely and he was discharged after 8 weeks of hospitalization. LESSONS: Our chronological MRI findings provide crucial information for diagnosing SSDH and also suggest that spinal surgeons should consider the potential option of a conservative approach for treating SSDH. Although prompt selection of a therapeutic strategy for SSDH could be challenging, the surgeons could observe the course of the patient's neurological status for a few days to detect signs of spontaneous recovery.


Assuntos
Tratamento Conservador/métodos , Hematoma Subdural Espinal , Imagem por Ressonância Magnética/métodos , Paraplegia , Canal Vertebral/diagnóstico por imagem , Hematoma Subdural Espinal/complicações , Hematoma Subdural Espinal/diagnóstico , Hematoma Subdural Espinal/fisiopatologia , Hematoma Subdural Espinal/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Exame Neurológico/métodos , Paraplegia/etiologia , Paraplegia/fisiopatologia , Paraplegia/reabilitação , Recuperação de Função Fisiológica , Remissão Espontânea , Resultado do Tratamento
19.
Neurology ; 94(24): 1077-1087, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32358217

RESUMO

The COVID-19 pandemic is causing world-wide social dislocation, operational and economic dysfunction, and high rates of morbidity and mortality. Medical practices are responding by developing, disseminating, and implementing unprecedented changes in health care delivery. Telemedicine has rapidly moved to the frontline of clinical practice due to the need for prevention and mitigation strategies; these have been encouraged, facilitated, and enabled by changes in government rules and regulations and payer-driven reimbursement policies. We describe our neurology department's situational transformation from in-person outpatient visits to a largely virtual neurology practice in response to the COVID-19 pandemic. Two key factors enabled our rapid deployment of virtual encounters in neurology and its subspecialties. The first was a well-established robust information technology infrastructure supporting virtual urgent care services at our institution; this connected physicians directly to patients using both the physician's and the patient's own mobile devices. The second is the concept of one patient, one chart, facilitated by a suite of interconnected electronic medical record (EMR) applications on several different device types. We present our experience with conducting general teleneurology encounters using secure synchronous audio and video connections integrated with an EMR. This report also details how we perform virtual neurologic examinations that are clinically meaningful and how we document, code, and bill for these virtual services. Many of these processes can be used by other neurology providers, regardless of their specific practice model. We then discuss potential roles for teleneurology after the COVID-19 global pandemic has been contained.


Assuntos
Infecções por Coronavirus , Exame Neurológico/métodos , Neurologia/métodos , Pandemias , Pneumonia Viral , Telemedicina/métodos , Comunicação por Videoconferência , Centros Médicos Acadêmicos , Betacoronavirus , Centers for Medicare and Medicaid Services, U.S. , Codificação Clínica , Documentação , Registros Eletrônicos de Saúde , Humanos , Cidade de Nova Iorque , Mecanismo de Reembolso , Estados Unidos
20.
J Clin Neurosci ; 77: 31-35, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32417126

RESUMO

This study aims to evaluate whether the upper extremity spasticity and hemiplegic posture have any effect on the morphology of the carpal tunnel and median nerve in stroke patients. Nerve conduction studies (NCS) were performed in 46 stroke patients and compared to those of 30 healthy controls. The cross-sectional area (CSA) of the carpal tunnel (CT) and median nerve (wrist/mid-forearm levels) was assessed by ultrasonography. The mean ages of the stroke and control group were 55.6 ± 13.5 and 56 ± 12.1 years, respectively. The median spasticity score of the forearm pronators and wrist flexor muscles was 2 (0-4) according to the Modified Ashworth Scale (MAS). The compound muscle action potential (CMAP) of the median nerve was reduced (10,093 ± 4,451 mV) when compared to non-paretic side (11,615 ± 4,397 mV) (p:0.02) and the CSA of the CT was thinner on the paretic side (1.9 ± 0.3 cm2 vs 2.08 ± 0.2 cm2) (p:0.03). Pronator spasticity had no significant effect on the CSA of the median nerve and NCS at the forearm level. The CSA of the median nerve at the wrist was significantly thicker in patients with the wrist flexor spasticity graded II (MAS) and above compared to those with spasticity graded I and below (9.5 ± 1.7 mm2 and 8.7 ± 1.7 mm2 respectively) (p:0.03). However, the thickening of the median nerve didn't cause significant abnormalities in NCS. This study shows that in stroke patients, wrist flexor spasticity and hemiplegic wrist posture can cause explicit morphological changes in the CT and median nerve albeit normal findings on NCS.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Hemiplegia/diagnóstico por imagem , Nervo Mediano/diagnóstico por imagem , Espasticidade Muscular/diagnóstico por imagem , Exame Neurológico/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Idoso , Síndrome do Túnel Carpal/fisiopatologia , Fenômenos Eletrofisiológicos/fisiologia , Feminino , Hemiplegia/fisiopatologia , Humanos , Masculino , Nervo Mediano/fisiologia , Pessoa de Meia-Idade , Espasticidade Muscular/fisiopatologia , Condução Nervosa/fisiologia , Postura/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Ultrassonografia de Intervenção/métodos , Punho/diagnóstico por imagem , Punho/inervação
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