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1.
J Neurovirol ; 27(1): 86-93, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33417193

RESUMO

The COVID-19 pandemic has infected more than 22 million people worldwide. Although much has been learned about COVID-19, we do not know much about its neurological features and their outcome. This observational study was conducted on the patients of Imam Hossein Hospital, and 361 adult patients (214 males) with confirmed diagnosis of COVID-19 from March 5, 2020 to April 3, 2020, were enrolled. Data was gathered on age, sex, comorbidities, initial symptoms, symptoms during the disease course, neurological symptoms, and outcome. The mean age of the patients was 61.90 ± 16.76 years. The most common initial symptoms were cough, fever, and dyspnea. In 21 patients (5.8%), the initial symptom was neurological. History of dementia was associated with severe COVID-19 disease (odds ratio = 1.28). During the course of the disease, 186 patients (51.52%) had at least one neurological symptom, the most common being headache (109 [30.2%]), followed by anosmia/ageusia (69, [19.1%]), and dizziness (54, [15%]). Also, 31 patients had neurological complications (8.58%). Anosmia, ageusia, dizziness, and headache were associated with favorable outcome (P < 0.001), while altered mental status and hemiparesis were associated with poor outcome. The mortality rate of patients who had neurological complications was more than twice than that of patients without neurological complication (P = 0.008). Almost half of the patients experienced at least one neurological symptom, which may be the initial presentation of COVID-19. Dementia appears to be associated with severe COVID-19. Mortality was higher in patients with neurological complications, and these patients needed more intensive care.


Assuntos
/complicações , Demência/complicações , Dispneia/complicações , Cefaleia/complicações , Paresia/complicações , /patogenicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Ageusia/complicações , Ageusia/diagnóstico , Ageusia/mortalidade , Ageusia/virologia , /diagnóstico , /virologia , /mortalidade , Tosse/complicações , Tosse/diagnóstico , Tosse/mortalidade , Tosse/virologia , Demência/diagnóstico , Demência/mortalidade , Demência/virologia , Dispneia/diagnóstico , Dispneia/mortalidade , Dispneia/virologia , Feminino , Febre/complicações , Febre/diagnóstico , Febre/mortalidade , Febre/virologia , Cefaleia/diagnóstico , Cefaleia/mortalidade , Cefaleia/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/mortalidade , Paresia/virologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida
2.
J Stroke Cerebrovasc Dis ; 30(3): 105518, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33388631

RESUMO

OBJECTIVES: The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST) proved to be highly efficient in the treatment of emergent large vessel occluding (ELVO) strokes in the anterior circulation. To achieve a timely diagnosis, a robust combination of few and simple signs to identify ELVOs in AIS patients applicable by paramedics in the prehospital triage is worthwhile. MATERIALS AND METHODS: This retrospective single-center study included 904 AIS patients (324 ELVO, 580 non-ELVO) admitted between 2010 and 2015 in a tertiary stroke center. We re-evaluated two symptoms based on NIHSS items, gaze deviation and hemiparesis of the limbs ("Gaze deviation and Paresis Score, GPS") for the pre-hospital prediction of ELVO. RESULTS: A positive GPS AIS in patients predicted ELVO with a sensitivity of 0.89, specificity = 0.97, positive predictive value (PPV) = 0.95, negative predictive value (NPV) = 0.94 and diagnostic odds ratio (DOR) = 34.25 (CI: 20.75-56.53). The positive Likelihood-ratio (LR+) was 29.67, the negative Likelihood ratio (LR-) 0.11. NIHSS of patients with positive GPS (gaze palsy NIHSS ≥ 0, Motor arm NIHSS ≥2 and Motor leg NIHSS ≥2) was markedly higher compared to negative GPS patients (p < 0.001). CONCLUSIONS: The GPS proved to be similarly accurate in detecting ELVO in the anterior circulation of AIS patients and even more specific than other published clinical scores. Its simplicity and clarity might enable non-neurological medical staff to identify ELVO AIS patients with high certainty in a preclinical setting.


Assuntos
Avaliação da Deficiência , Serviços Médicos de Emergência , Fixação Ocular , Transtornos da Motilidade Ocular/diagnóstico , Paresia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Procedimentos Endovasculares , Feminino , Humanos , /fisiopatologia , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia , Paresia/etiologia , Paresia/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Triagem
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 588-591, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018057

RESUMO

Stroke survivors are often characterized by hemiparesis, i.e., paralysis in one half of the body, that severely affects upper limb movements. Continuous monitoring of the progression of hemiparesis requires manual observation of the limb movements at regular intervals and hence is a labour intensive process. In this work, we use wrist-worn accelerometers for automated assessment of hemiparetic severity in acute stroke patients through bivariate Poincaré analysis between accelerometer data from the two hands during spontaneous and instructed movements. Experiments show that while the bivariate Poincaré descriptors CSD1 and CSD2 can identify hemiparetic patients from control subjects, a novel descriptor called Complex Cross-Correlation Measure (C3M) can distinguish between moderate and severe hemiparesis. Further, we justify the use of C3M by showing that it is described by multiple-lag cross-correlations, representing the co-ordination of activity between two hands. The descriptors are compared against the National Institutes of Health Stroke Scale (NIHSS), the clinical gold standard for evaluation of hemiparetic severity, and studied using statistical tests for developing supervised models for hemiparesis classification.Clinical relevance-This study establishes the suitability of wrist-worn accelerometers in identifying hemiparetic severity in stroke patients through novel descriptors of hand co-ordination.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Dispositivos Eletrônicos Vestíveis , Acelerometria , Humanos , Paresia/diagnóstico , Acidente Vascular Cerebral/complicações , Estados Unidos
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3735-3738, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018813

RESUMO

Stroke survivors are often characterized by upper limb hemiparesis due to which activities in one of the hands is significantly restricted. Manual evaluation of the progression of hemiparesis in acute stroke patients involves 24x7 medical supervision, which is prone to inter-rater variability, is labor-intensive and consequently expensive in public hospitals. In this paper, we investigate the use of wrist-worn accelerometers for automated identification of upper limb hemiparesis in acute stroke. We propose a set of spontaneous and instructed movements in order to estimate two-hand activity correlation using accelerometry data. We use this information to determine the weak hand and further investigate an Activity Based Distance (ABD) measure to quantify this correlation. We compare ABD with standard time-series distance measures such as Lp norms and Dynamic Time Warping (DTW) for hemiparetic severity estimation. We study these distance measures with respect to the National Institutes of Health Stroke Scale (NIHSS), the clinical gold standard to determine hemiparetic severity, and demonstrate their suitability for developing a wearable based automated hemiparesis detection and monitoring system.Clinical relevance-This study presents a novel experimental paradigm for identifying upper limb hemiparesis in acute stroke patients using measures of two-hand activity correlation.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Mãos , Humanos , Paresia/diagnóstico , Acidente Vascular Cerebral/complicações , Estados Unidos , Extremidade Superior
6.
J Stroke Cerebrovasc Dis ; 29(11): 105202, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066924

RESUMO

INTRODUCTION AND OBJECTIVES: Motor evoked potentials (MEPs) have been postulated to be useful in predicting recovery in patients with motor impairment. We aimed to investigate whether MEPs elicited by transcranial magnetic stimulation (TMS), serum brain derived neurotrophic factor (BDNF) and its genotype have prognostic value on stroke recovery in patients with hand paresis due to stroke. METHODS: This was an observational cohort study. Patients underwent TMS with MEPs from abductor digiti minimi evaluation between 2-14 (D0) and 30 days (D30) after stroke and their impact on motor function of the upper limb and general outcome was assessed after 3 months (D90). The presence of a BDNF gene polymorphism was determined and serum BDNF concentrations were measured at D0, D30 and D90. RESULTS: The presence of MEPs and their amplitude at rest and in effort significantly correlated with improvement of upper-limb paresis and general outcome after 3 months. Resting motor threshold did not have prognostic value. Central motor conduction time and MEP latency less consistently predicted stroke outcome or motor deficit improvement. Neither BDNF polymorphisms nor BDNF concentration at D0, D30 and D90 corresponded with the degree of paresis or the independence of patients 3 months after stroke. CONCLUSIONS: The presence of MEPs and their amplitude are useful predictors of upper-limb motor function recovery and general outcome after stroke. BDNF concentration and its genotype had no prognostic value. Further studies conducted on large cohorts are necessary to determine the usefulness of these methods in motor recovery and stroke outcome prediction.


Assuntos
Fator Neurotrófico Derivado do Encéfalo/sangue , Potencial Evocado Motor , Mãos/inervação , Paresia/terapia , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Fator Neurotrófico Derivado do Encéfalo/genética , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Paresia/diagnóstico , Paresia/fisiopatologia , Polimorfismo Genético , Valor Preditivo dos Testes , Tempo de Reação , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
8.
J Stroke Cerebrovasc Dis ; 29(10): 105107, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912556

RESUMO

BACKGROUND: Peak neurologic recovery from acute stroke occurs within the first 3 months, and continues at a slower pace for 6 months. OBJECTIVE/HYPOTHESIS: The aim of this pilot study is to clarify the safety and feasibility of multiple diagonal-transcranial direct current stimulation (d-tDCS) sessions up to 3 months with electrodes placed diagonally over the lesional dorsolateral prefrontal cortex and contralesional primary motor cortex for upper limb hemiparesis in acute stroke. METHODS: Five patients with acute stroke (2 with intracerebral hemorrhage and 3 with cerebral infarction) with upper limb paresis participated. d-tDCS (1 mA, 20 min per day) combined with conventional rehabilitation was given starting 7-21 days after stroke onset. Each session consisted of 10 d-tDCS over 2 weeks and patients received 2 sessions in the acute phase and 2 sessions in the subacute phase for a total 40 treatments. Motor function was assessed using Fugl-Meyer Assessment for upper extremity (FMA-UE) before and after each session, and the period to achieve 70% of maximal potential recovery in FMA-UE was evaluated. RESULTS: All 5 patients completed the intervention and showed no adverse effects throughout the protocol. Of these, 3 (60%) achieved 70% predicted scores within 2 months. Regarding therapeutic gains of FMA-UE in each of the 10 sessions in the acute phase, 4 sessions showed great recovery, 3 sessions showed moderate recovery, and 3 sessions showed poor recovery. CONCLUSION: These findings suggest that d-tDCS over 3 months may be safe and feasible for acute stroke patients in the acute to subacute phases and have therapeutic potential to promote recovery of upper limb function, although further randomized, double-blind, sham-controlled trial is warranted with larger sample size.


Assuntos
Atividade Motora , Córtex Motor/fisiopatologia , Paresia/terapia , Córtex Pré-Frontal/fisiopatologia , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua , Extremidade Superior/inervação , Idoso , Avaliação da Deficiência , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/fisiopatologia , Projetos Piloto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Resultado do Tratamento
9.
J Stroke Cerebrovasc Dis ; 29(10): 105163, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912561

RESUMO

Acute pure motor hemiparesis can occur due to a vascular insult along the cortico spinal pathway. Rarely such a stroke can occur as a result of involvement of the pyramids located on the ventral aspect of the medulla. Neurological localization can be difficult in such strokes and moreover they can also pose imaging challenges since they are missed on the CT scans. So far only 4 such cases have been reported in literature. Here we present two cases of pure motor strokes caused by infarction of the medullary pyramids. We have described the anatomical correlates of the symptoms and signs and also highlight the importance of MRI in picking up these rare strokes.


Assuntos
Infartos do Tronco Encefálico/complicações , Infarto Cerebral/complicações , Bulbo/irrigação sanguínea , Músculo Esquelético/inervação , Paresia/etiologia , Tratos Piramidais/irrigação sanguínea , Idoso , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurônios Motores , Paresia/diagnóstico , Paresia/fisiopatologia , Tomografia Computadorizada por Raios X
10.
J Stroke Cerebrovasc Dis ; 29(10): 105174, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912567

RESUMO

Stroke survivors often face difficulty in community ambulation though they attain steady-state walking in clinical setups. Compliance and unpredictability of the environment may alter the muscle activity and challenge the individual's gait. Successful reintegration into the community requires gait assessment and training in a real-life challenging environment. Little is known about the assessment and training of gait in the community environment under challenging mobility dimensions. Hence, we aimed to study the changes that real-life environmental dimensions have on the activity of selected muscles in hemiparetic lower limb and gait velocity in stroke survivors. METHODS: An observational cross-sectional study was conducted on 16 ambulatory stroke survivors to assess the hemiparetic lower limb muscle activity during walking in real-life environmental dimensions. Participants were made to walk in the community on a walkway consisting of even surface, ramp, stairs, uneven terrain and obstacles. They were also made to manoeuvre through traffic and pick a load while walking for a distance in the walkway. Muscle activity of Rectus Femoris, Biceps Femoris, Gastrocnemius Medialis and Tibialis Anterior of the paretic lower limb were continuously recorded while walking using wireless surface electromyography. Gait velocity for the entire walkway and level of perceived difficulty while walking in different dimensions were also measured. Paired t-test was used to compare the percentage Maximum Voluntary Contraction (%MVC) of lower limb muscles between even surface and real-life environment dimensions while walking. One sample t-test was used to compare the gait velocity in real-life dimensions versus gait velocity in even surface measured in an earlier study. RESULTS: There was a significant reduction (p < 0.01) in the activity of all four hemiparetic lower limb muscles while walking under the influence of real-life environmental dimensions compared to even surface. Gait velocity (0.33 ± 0.17 m/s) was significantly lower than that is essential to be a community ambulator. The level of perceived difficulty across all dimensions was reported qualitatively with the highest difficulty reported during stair and obstacle clearance. CONCLUSION: Real-life environmental dimensions lead to the reduction of paretic lower limb muscle activities and gait velocity during walking in community-dwelling stroke survivors. Stroke survivors perceived more difficulty while walking in real-life environment dimensions particularly while negotiating stairs and obstacles. SIGNIFICANCE: Knowledge about the influence of real-life environmental dimensions will help the clinicians to target rehabilitation methods to improve walking adaptability.


Assuntos
Meio Ambiente , Contração Muscular , Músculo Esquelético/inervação , Paresia/fisiopatologia , Acidente Vascular Cerebral/complicações , Velocidade de Caminhada , Atividades Cotidianas , Adulto , Idoso , Estudos Transversais , Eletromiografia , Análise da Marcha , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Paresia/diagnóstico , Paresia/etiologia , Paresia/reabilitação , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral
11.
J Stroke Cerebrovasc Dis ; 29(9): 105035, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807447

RESUMO

BACKGROUND AND PURPOSE: Stiff-knee gait, which is a gait abnormality observed after stroke, is characterized by decreased knee flexion angles during the swing phase, and it contributes to a decline in gait ability. This study aimed to identify the immediate effects of pedaling exercises on stiff-knee gait from a kinesiophysiological perspective. METHODS: Twenty-one patients with chronic post-stroke hemiparesis and stiff-knee gait were randomly assigned to a pedaling group and a walking group. An ergometer was set at a load of 5 Nm and rotation speed of 40 rpm, and gait was performed at a comfortable speed; both the groups performed the intervention for 10 min. Kinematic and electromyographical data while walking on flat surfaces were immediately measured before and after the intervention. RESULTS: In the pedaling group, activity of the rectus femoris significantly decreased from the pre-swing phase to the early swing phase during gait after the intervention. Flexion angles and flexion angular velocities of the knee and hip joints significantly increased during the same period. The pedaling group showed increased step length on the paralyzed side and gait velocity. CONCLUSIONS: Pedaling increases knee flexion during the swing phase in hemiparetic patients with stiff-knee gait and improves gait ability.


Assuntos
Acidentes por Quedas/prevenção & controle , Ciclismo , Terapia por Exercício , Transtornos Neurológicos da Marcha/reabilitação , Marcha , Articulação do Joelho/fisiopatologia , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Análise da Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/etiologia , Paresia/fisiopatologia , Projetos Piloto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Método Simples-Cego , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
12.
J Clin Neurosci ; 78: 301-306, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32389546

RESUMO

Patients with stroke (PwS) demonstrate impaired gait and balance, and asymmetric gait, placing them at high risk of falls. We aimed to investigate the effects of a single training session that included mechanical external perturbation which resists forward movement of the paretic leg during its swing phase of walking on gait and balance in PwS. In a pre-post pilot study, gait asymmetry and balance function were assessed in 22 first-event chronic PwS (i.e., unilateral hemiparesis). PwS underwent tests during baseline and one week later, after participating in a single training session that resisted forward stepping during the swing phase of walking with a device secured around the patient's waist and connected diagonally to the patient's foot by a tension cord. Ground reaction forces and center of pressure were sampled during treadmill gait to assess step length asymmetry. Performance-oriented mobility assessment (POMA), a two-minute walk test (2MWT), and the voluntary step execution test were also measured. We found no significant improvement in step length asymmetry. However, POMA scores, as well as voluntary step execution tests improved with a moderate effect size. It seems that applying diagonal resistance force to the swinging leg resulted in insufficient horizontal force. However, the improvement in the preparation phase, i.e., better weight-bearing abilities during the voluntary stepping, may be due to the compression force applied to the lower limb joints thus providing proprioceptive training. This suggests that proprioceptive training may improve gait performance in stroke patients in a very short training period.


Assuntos
Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/reabilitação , Marcha/fisiologia , Paresia/reabilitação , Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Teste de Esforço/métodos , Terapia por Exercício/métodos , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/fisiopatologia , Projetos Piloto , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
13.
Int J Infect Dis ; 95: 265-267, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32272261

RESUMO

Histoplasmosis is the most common endemic mycosis in the United States and is caused by the organism Histoplasma capsulatum. Infection is often asymptomatic or self-limited, but when symptomatic it usually presents in the form of pulmonary histoplasmosis. In its most severe form, H. capsulatum can spread to extrapulmonary sites causing disseminated infection. Here we present a peculiar case of central nervous system (CNS) histoplasmosis wherein multiple focal spinal cord lesions were the only manifestation of CNS infection, causing bilateral lower extremity paresis and loss of sensation. Although uncommon, CNS histoplasmosis should be included in the differential diagnosis when a patient presents with meningitis, encephalitis, or isolated brain or spinal cord lesions in endemic areas.


Assuntos
Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Histoplasma , Histoplasmose/diagnóstico , Paresia/diagnóstico , Idoso de 80 Anos ou mais , Encéfalo/patologia , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Diagnóstico Diferencial , Histoplasma/isolamento & purificação , Histoplasmose/fisiopatologia , Humanos , Extremidade Inferior , Masculino , Paresia/etiologia
14.
J Stroke Cerebrovasc Dis ; 29(6): 104788, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32234269

RESUMO

Creutzfeldt-Jakob disease (CJD) is a prion disease characterized by rapidly progressive dementia that is often followed by behavioral disturbances, ataxia, myoclonus, and akinetic mutism. The initial symptoms of CJD reportedly vary, but the onset is usually gradual. Here, we report a case of CJD with a sudden, stroke-like onset of right hemiparesis to alert readers that CJD can mimic a stroke during its early stage.


Assuntos
Síndrome de Creutzfeldt-Jakob/complicações , Paresia/etiologia , Acidente Vascular Cerebral/complicações , Idoso de 80 Anos ou mais , Síndrome de Creutzfeldt-Jakob/diagnóstico , Síndrome de Creutzfeldt-Jakob/fisiopatologia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Paresia/diagnóstico , Paresia/fisiopatologia , Valor Preditivo dos Testes , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
15.
Top Companion Anim Med ; 38: 100381, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32115081

RESUMO

A 6.5-year-old male neutered Trailhound was admitted for hyperacute, nonprogressive, left-sided hemiparesis. Physical and neurologic examination revealed nonpainful, left-sided poorly ambulatory hemiparesis, decreased left-sided postural reactions and thoracic limbs hyporeflexia. Neuroanatomic localisation was consistent with a left-sided C6-T2 myelopathy. Haematology and biochemistry revealed nonspecific abnormalities. Magnetic resonance imaging of the neck revealed a focal intramedullary lesion at the level of C6-C7 vertebrae compatible with acute hydrated noncompressive nucleus pulposus extrusion or ischemic myelopathy. During the second day of hospitalization, the dog developed convergence-retraction nystagmus, up-gaze palsy and eyelid retraction (Collier's sign) compatible with dorsal midbrain syndrome. Magnetic resonance imaging of the brain revealed a focal lesion compatible with dorsal midbrain ischemic infarct. Further clinicopathologic testing, thoracic and abdominal imaging were unremarkable. Ischemic encephalopathy of unknown etiology was additionally diagnosed. Physiotherapy was performed therapeutically. At 1-year follow-up the dog was normal. This is an unusual report of a dog with myelopathy followed by ischemic encephalopathy with manifestation of convergence-retraction nystagmus in the absence of vestibular signs. This saccadic intrusion is a characteristic clinical manifestation of a dorsal midbrain syndrome localization. The importance of a complete differential diagnoses list formation in a dog with ischemic encephalopathy which leads to a thorough diagnostic investigation plan is highlighted. Moreover, this report contributes to the enrichment of the clinical reasoning veterinary literature on convergence-retraction nystagmus. To the authors' knowledge, this is the second case report (fourth dog) to describe convergence-retraction nystagmus in dogs as a manifestation of dorsal midbrain syndrome.


Assuntos
Isquemia Encefálica/veterinária , Doenças do Cão/patologia , Nistagmo Patológico/veterinária , Doenças da Medula Espinal/veterinária , Animais , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Doenças do Cão/diagnóstico por imagem , Cães , Imagem por Ressonância Magnética/veterinária , Masculino , Pescoço/diagnóstico por imagem , Paresia/diagnóstico , Paresia/veterinária , Modalidades de Fisioterapia/veterinária
16.
Medicine (Baltimore) ; 99(12): e19574, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195967

RESUMO

RATIONALE: Fat embolism syndrome (FES) is characterized by the classical triad of cerebral, respiratory, and cutaneous manifestations. In contrast, cerebral fat embolism (CFE), corresponding to incomplete pure type FES, is much rarer and usually follows trauma. CFE typically shows a "starfield" pattern on diffusion-weighted magnetic resonance imaging due to the involvement of multiple small arteries. We report 2 unusual cases of CFE that showed a nontraumatic etiology and the involvement of a single dominant cerebral artery. PATIENT CONCERNS: Case 1 was a 33-year-old woman without a history of trauma who visited the emergency room due to hemiparesis and hemisensory deficits. She was a heavy smoker and had used oral contraceptives for several years. Most importantly, she had 2 experiences of autologous fat grafting 2 months previously. Magnetic resonance angiography (MRA) revealed acute occlusion of the right middle cerebral artery. Case 2 was an 80-year-old man suddenly presented with dizziness, ataxia, and left-sided sensorimotor dysfunction. He had a history of hypertension, untreated atrial fibrillation, and chronic alcoholism. MRA demonstrated the occlusion of the distal basilar artery. DIAGNOSIS: Case 1: Microscopic findings demonstrated variable sized fat vacuoles intermixed with moderate amounts of thrombi. Case 2: Histologically, mature adipocytes were intermingled with fibrin, blood cells, and a fragment of entrapped soft tissue resembling the vessel wall. INTERVENTION: Case 1 and 2 underwent aspirational thrombectomy guided by transfemoral cerebral angiography. OUTCOME: Case 1 recovered well but Case 2 still suffers from gait ataxia. LESSONS: CFE can rarely occur in various nontraumatic conditions, with or without evident etiology. Furthermore, it may not show characteristic clinicopathological manifestations. Therefore, careful follow up of those who have undergone procedures that are likely to trigger FES or who have hemodynamic or hypercoagulable risk factors is needed.


Assuntos
Embolia Gordurosa/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Paresia/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/patologia , Angiografia Cerebral/métodos , Transtornos Cerebrovasculares/etiologia , Embolia Gordurosa/patologia , Embolia Gordurosa/cirurgia , Feminino , Humanos , Embolia Intracraniana/patologia , Embolia Intracraniana/cirurgia , Angiografia por Ressonância Magnética , Masculino , Artéria Cerebral Média/patologia , Paresia/etiologia , Trombectomia/instrumentação , Trombectomia/métodos , Resultado do Tratamento
19.
J Stroke Cerebrovasc Dis ; 29(1): 104463, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31740027

RESUMO

BACKGROUND: Stroke often results in motor impairment and limited functional capacity. This study aimed to verify the relationship between widely used clinical scales and instrumented measurements to evaluate poststroke individuals with mild, moderate, and severe motor impairment. METHODS: This cross-sectional study included 34 participants with chronic hemiparesis after stroke. Fugl-Meyer Assessment and Modified Ashworth Scale were used to quantify upper and lower limb motor impairment and the resistance to passive movement (i.e., spasticity), respectively. Upper limb Motor performance (movement time and velocities) and movement quality (range of motion, smoothness and trunk displacement) were analyzed during a reaching forward task using an optoelectronic system (instrumented measurement). Lower limb motor performance (gait and functional mobility parameters) was assessed by using an inertial measurement unit system. FINDINGS: Fugl-Meyer Assessment correlated with motor performance (upper and lower limbs) and with movement quality (upper limb). Modified Ashworth scale correlated with movement quality (upper limb). Cutoff values of 9.0 cm in trunk anterior displacement and .57 m/s in gait velocity were estimated to differentiate participants with mild/moderate and severe compromise according to the Fugl-Meyer Assessment. CONCLUSIONS: These results suggest that the Fugl-Meyer Assessment can be used to infer about motor performance and movement quality in chronic poststroke individuals with different levels of impairment.


Assuntos
Avaliação da Deficiência , Atividade Motora , Paresia/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Atividades Cotidianas , Idoso , Fenômenos Biomecânicos , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Paresia/reabilitação , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral , Resultado do Tratamento
20.
NeuroRehabilitation ; 45(3): 331-339, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31796703

RESUMO

PURPOSE: The aim of this study was to evaluate the internal consistency and validity of the Italian version of the Jebsen- Taylor Hand Function Test (JTHFT-IT) in Italian post-stroke adults with chronic hemiplegia or hemiparesis. METHODS: The test's internal consistency and validity were assessed by following international guidelines. Its internal consistency was examined using Cronbach's alpha (α) coefficient. Pearson's correlation coefficient was calculated for concurrent validity in comparison with a dynamometer instrument, whereas for construct validity, it was calculated in comparison with the mean execution time of the Wolf Motor Function Test time subscale (WMFT-IT-TIME). RESULTS: The test was administrated to 48 people with chronic stroke. Cronbach's alpha reported a value of 0.96 for the dominant hand and 0.92 for the non-dominant hand. To define the validity of the scale, Pearson's correlation as measured using the WMFT-IT-TIME, and the dynamometer showed statistically significant results. CONCLUSIONS: The present study supports the use of the JTHFT-IT as a measure of hand functionality in post-stroke adults with chronic hemiplegia or hemiparesis. It is an important tool for Italian professionals, and it can be useful both in clinical practice to evaluate improvement after rehabilitation treatments and for research in hand rehabilitation.


Assuntos
Avaliação da Deficiência , Mãos/fisiopatologia , Dinamômetro de Força Muscular/normas , Paresia/diagnóstico , Paresia/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Paresia/epidemiologia , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia
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