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2.
Medicina (B Aires) ; 79 Suppl 3: 6-9, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603835

RESUMO

The objective was to describe the frequency, mode of presentation and characteristics of epilepsy in children with congenital hemiparesis (CH). It is a etrospective, descriptive and multicenter study, based on the collection of data from the clinical records of patients from 0 to 19 years with CH secondary to perinatal infarction in different centers of the community of Catalonia. A total of 310 children were included (55% males and 45% females), from a total of 13 centers in Catalonia. Average age of onset of the crises was 2 ± 1 year. Epilepsy was present in 29.5% (n = 76), among which the most frequent vascular subtype was arterial presumed perinatal ischemic stroke (51.3%), followed by neonatal arterial ischemic stroke (18.4%), periventricular venous infarction (15.8%), neonatal hemorrhagic stroke (10.5%) and neonatal cerebral sinovenous thrombosis (3.9%). Semiology of the most frequent seizures was motor focal in 82%, followed by focal motor with secondary bilateralization in 23%, focal discognitive in 13.5%, generalized by 2% and spasms in 6.5%. The 67.3% were controlled with monotherapy and the drugs used were valproate, levetiracetam or carbamazepine. The antecedent of electrical status during sleep was identified in 3 patients, all associated with extensive lesions that included the thalamus. Of the total number of children with epilepsy, 35% began with neonatal seizu res in the first 3 days of life. The 30% of children with perinatal stroke and CH present a risk of epilepsy during childhood. Children with ischemic strock have the highest risk, so they will require a follow-up aimed at detecting prematurely the epilepsy and start a treatment.


Assuntos
Epilepsia/etiologia , Paresia/congênito , Paresia/etiologia , Acidente Vascular Cerebral/complicações , Adolescente , Anticonvulsivantes/uso terapêutico , Carbamazepina/uso terapêutico , Criança , Pré-Escolar , Epilepsia/tratamento farmacológico , Feminino , Humanos , Lactente , Recém-Nascido , Levetiracetam/uso terapêutico , Masculino , Estudos Retrospectivos , Fatores de Risco , Convulsões/etiologia , Espanha , Ácido Valproico/uso terapêutico , Adulto Jovem
4.
BMC Neurol ; 19(1): 196, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416436

RESUMO

BACKGROUND: Recovery of upper limb function in individuals after a stroke remains challenging. Modified constraint-induced movement therapy (m-CIMT) has strong evidence for increasing the use and recovery of sensorimotor function of the paretic upper limb. Recent studies have shown that priming with aerobic exercise prior to task-specific training potentiates upper limb recovery in individuals with stroke. This protocol describes a randomized clinical trial designed to determine whether priming with moderate-high intensity aerobic exercise prior to m-CIMT will improve the manual dexterity of the paretic upper limb in individuals with chronic hemiparesis. METHODS: Sixty-two individuals with chronic hemiparesis will be randomized into two groups: Aerobic exercise + m-CIMT or Stretching + m-CIMT. m-CIMT includes 1) restraint of the nonparetic upper limb for 90% of waking hours, 2) intensive task-oriented training of the paretic upper limb for 3 h/day for 10 days and 3) behavior interventions for improving treatment adherence. Aerobic exercise will be conducted on a stationary bicycle at intervals of moderate to high intensity. Participants will be evaluated at baseline, 3, 30, and 90 days postintervention by the following instruments: Motor Activity Log, Nottingham Sensory Assessment, Wolf Motor Function Test, Box and Block Test, Nine-Hole Peg Test, Stroke Specific Quality of Life Scale and three-dimensional kinematics. The data will be tested for normality and homogeneity. Parametric data will be analyzed by two-way ANOVA with repeated measures and Bonferroni's adjustment. For nonparametric data, the Friedman test followed by the Wilcoxon test with Bonferroni's adjustment will be used to compare the ratings for each group. To compare the groups in each assessment, the Mann-Whitney test will be used. DISCUSSION: This study will provide valuable information about the effect of motor priming for fine upper limb skill improvement in people with chronic poststroke hemiparesis, bringing new evidence about the association of two therapies commonly used in clinical practice. TRIAL REGISTRATION: This trial was retrospectively registered (registration number RBR-83pwm3 ) on 07 May 2018.


Assuntos
Terapia por Exercício/métodos , Exercício , Paresia/reabilitação , Projetos de Pesquisa , Reabilitação do Acidente Vascular Cerebral/métodos , Atividades Cotidianas , Adulto , Feminino , Humanos , Masculino , Paresia/etiologia , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Extremidade Superior/fisiopatologia
5.
Pan Afr Med J ; 32: 176, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303945

RESUMO

Central nervous system (CNS) tuberculosis is the second most common presentation after tuberculous meningitis. It is a major cause of morbidity and mortality in the developing countries, accounting for 10-30% of intracranial expansive lesions in these countries against 0.2% in some Western countries. This study aims to report an atypical clinical and radiological manifestation (brain MRI and spectroscopy) of cerebral tuberculoma in order to provide an update on this infectious disease. The study involved a 44-year old female patient with no particular previous history, with headaches persisting for 1 year and complicated by partial secondarily generalized seizures and heaviness at the left hemicorpus with episodes of vomiting without visual disorder or fever or deterioration of general condition after 8 months. Clinical examination showed conscious patient with Glasgow Coma Scale (GCS) 15, equal and reactive pupils, walking and/or standing without fault, with 4/5 left-sided hemiparesis without other neurological signs. Brain MRI objectified right parietal subtentorial plurilobulated isointense poorly differentiated lesion on T1 weighted sequence without contrast agents injection and heterogeneous lesion with hyperintense edge and hypointense fundus, suggesting fleshy process with areas of central necrosis and perilesionnal edema extending in finger-like fashion with intense annular enhancement after gadolinium injection on T2 weighted sequence. Spectroscopy showed glial tumor. The patient received anticonvulsant therapy and macroscopic complete resection. Anatomopathologic analysis showed cerebral tuberculoma. She received antituberculosis drugs with seizure stoppage and deficit recovery after 4 weeks. This study highlights the clinical and radiological polymorphism of cerebral tuberculoma. This is suspected based on laboratory tests as well as on a body of clinical and radiological evidences but definitive diagnosis is based on anatomopathologic analysis. Early management is essential because complications can be severe and result in a poor prognosis.


Assuntos
Antituberculosos/administração & dosagem , Cefaleia/etiologia , Convulsões/etiologia , Tuberculoma Intracraniano/diagnóstico , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Paresia/etiologia , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma Intracraniano/patologia , Vômito/etiologia
6.
Pan Afr Med J ; 33: 3, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303948

RESUMO

Spontaneous atlanto-axial (C1-C2) dislocation is an atlanto-axial instability, found in 10 to 30% of trisomy 21 patients, the majority of whom is asymptomatic. We report a case of a 21 years-old woman, with trisomy 21, admitted in our department presenting a spinal cord compression syndrome with right hemiparesis associated with a cervicalgia evolving for 3 months of admission without trauma. Standard cervical radiography showed a C1-C2 dislocation with posterior displacement of the odontoid process. A cervical computerized tomography revealed a C1-C2 dislocation with significant recoil of the odontoid process. A cervical magnetic resonance imaging (MRI) confirmed the bulbo-medullar junction compression on the dislocation. The surgical treatment consisted of a cervico-occipital fixation. The laxity of the transverse ligament is one of the main causes of C1-C2 dislocation; hypoplasia, malformation or complete absence of the odontoid process; are also predisposing factors. It must be early detected. The treatment of choice is surgical also by arthrodesis of C1 to C4 + graft and enlargement of the occipital foramen or occipito-cervical arthrodesis by synthetic graft and Cotrel-Dubousset system or occipito-C4 arthrodesis + laminectomy of C1 and enlargement of the occipital foramen.


Assuntos
Articulação Atlantoaxial/diagnóstico por imagem , Síndrome de Down/complicações , Luxações Articulares/etiologia , Instabilidade Articular/etiologia , Articulação Atlantoaxial/patologia , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Instabilidade Articular/diagnóstico por imagem , Imagem por Ressonância Magnética , Processo Odontoide/diagnóstico por imagem , Paresia/etiologia , Radiografia , Compressão da Medula Espinal/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
J Craniofac Surg ; 30(4): e306-e308, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31166274

RESUMO

Basal ganglionic germinoma (BGG) with syncytiotrophoblastic giant cells (STGC) is a rare type of ectopic germ cell tumors with mild elevation of human chorionic gonadotropin level. Intratumoral hemorrhage is not uncommon for BGG, but presenting with repeated hemorrhage is very rare. Herein, we described an extremely rare case of BGG with STGC mimicking a growing hematoma. Furthermore, the characteristics, treatment, and prognosis of BGG with STGC were investigated and reviewed.


Assuntos
Hemorragia dos Gânglios da Base/patologia , Gânglios da Base/patologia , Neoplasias Encefálicas/patologia , Germinoma/patologia , Hematoma/patologia , Diagnóstico Diferencial , Feminino , Células Gigantes/patologia , Humanos , Masculino , Paresia/etiologia , Prognóstico , Recidiva , Trofoblastos/patologia
8.
J Stroke Cerebrovasc Dis ; 28(8): 2140-2147, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31129103

RESUMO

OBJECTIVE: Spastic arm paralysis after central neurological injury has a long-term effect on the patient's quality of life. Effective neurosurgical treatment for this dysfunction has been described in our previous studies. It is of great significance to determine a set of unified and concise clinical standards for motor function grading in the neurosurgical treatment and management. METHODS: We first conducted a retrospective study that included 51 hemiplegic patients from the Neurosurgery and Microsurgery outpatient database of Huashan Hospital. The neurosurgeons cooperated with rehabilitation experts to design and administer the new rating system (Hua-Shan Grading of Upper Extremity, H-S grading) after analyzing the scale scores and video records of these patients. We then randomly enrolled 64 patients with unilateral spastic arm paralysis after stroke or brain trauma. The Fugl-Meyer Assessment, the Ashworth scale and the new grading system were applied and analyzed to evaluate the participants' motor function. RESULTS: Based on rehabilitation medicine scales and long-term follow-up, a feasible and concise grading system was applied that was based on the patients' characteristics and the examination experiences of neurosurgeons and rehabilitation experts in clinical practice. This method could effectively grade upper extremity motor function, usually in 3-5 minutes. A significant correlation was found between H-S grading and the Fugl-Meyer score by the Spearman test (r = .937, P < .01). The mean difference between any two levels of the new grading system was significant (P < .05). And good test-retest reliability, the Cronbach's alpha coefficient and the validity indices were presented. In addition, it was more sensitive to motor function compared with the Ashworth scale. CONCLUSION: As a supplement to the classic scales, H-S grading was developed in the area of spastic hemiplegia treatment. It is standardized and simplified for patients in the chronic stage after central neurological injury.


Assuntos
Avaliação da Deficiência , Atividade Motora , Exame Neurológico/métodos , Paresia/diagnóstico , Extremidade Superior/inervação , Adulto , Fenômenos Biomecânicos , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Valor Preditivo dos Testes , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
9.
Medicine (Baltimore) ; 98(8): e13918, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813122

RESUMO

RATIONALE: Spasticity is a common issue in chronic stroke. To date, no study has reported the long-term (up to 1 year) outcomes of Fu's subcutaneous needling in combination with constraint-induced movement therapy in chronic stroke. This report describes the successful addition of acupuncture on spasticity and arm function in a patient with chronic stroke and arm paresis. PATIENT CONCERNS: The patient suffered an infarction in the right posterior limb of the internal capsule 1 year ago, which resulted in hemiparesis in his left (nondominant) hand and arm. The only limitation for constraint-induced movement therapy was insufficient finger extension. The patient was unable to voluntarily extend his interphalangeal or metacarpophalangeal joints beyond the 10 degrees required for constraint-induced movement therapy. However, his muscle tension did not change after the BTX type A injection. DIAGNOSES: A 35-year-old male experienced arm paresis after an infarction in the right posterior limb of the internal capsule 1 year before the intervention. INTERVENTIONS: The BTX type A injection did not work, so the patient received Fu's subcutaneous needling as an alternative therapy before 5 h of constraint-induced movement therapy for 12 weekdays. OUTCOMES: All outcome measures (Modified Ashworth Scale, Fugl-Meyer Assessment, Action Research Arm Test, and Motor Activity Log) substantially improved over the 1-year period. Moreover, during the observation period, the patient's muscle tone and arm function did not worsen. LESSONS: As a result of a reduction in spasticity, a reduction of learned nonuse behaviors, or use-dependent plasticity after the combined therapy, the arm functions include volitional movements, and coordination or speed of movements in the paretic arm have been improved. However, we cannot rule out the possibility of an influence of the passage of time or the Hawthorne effect. The costs of the treatment of stroke may be reduced, if this combined therapy proved useful in future controlled studies.


Assuntos
Terapia por Acupuntura/métodos , Técnicas de Exercício e de Movimento/métodos , Espasticidade Muscular/reabilitação , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Terapia por Acupuntura/economia , Adulto , Braço/fisiopatologia , Doença Crônica , Terapia Combinada , Técnicas de Exercício e de Movimento/economia , Seguimentos , Humanos , Masculino , Espasticidade Muscular/etiologia , Agulhas , Paresia/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(8): e14447, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813143

RESUMO

RATIONALE: Friedrich ataxia (FA) is the most common inherited neurodegenerative cerebellar ataxic syndrome. In patients with FA, physiotherapy is highly recommended to improve motor function outcome. Cerebellar transcranial direct current stimulation (tDCS) has been demonstrated to be effective in improving symptoms by modulating cerebellar excitability. Recently, robotic rehabilitation with Lokomat-Pro has been used to treat motor impairment in ataxic syndromes by "modulating" cortical plasticity and cerebello-motor connectivity. PATIENT CONCERNS: A 29-year-old Italian male with FA, come to our Institute to undergo intensive rehabilitation training. He presented a moderate-to-severe spastic tetraparesis, brisk deep tendon reflexes, moderate dysarthria, occasional difficulty in speaking, and mild delay in swallowing. He was able to stand for at least 10 seconds in the natural position with constant support, and thus he used a wheelchair. DIAGNOSIS: Tetraparesis in a young patient with FA. INTERVENTIONS: The effects of a stand-alone robotic gait training with Lokomat-Pro preceded by cerebellar anodal tDCS (a-tDCS) versus Lokomat-Pro preceded by cathodal-tDCS (c-tDCS) are compared. OUTCOMES: The coupled approach (i.e., tDCS and Lokomat) demonstrated better improvement in functional motor outcomes on the Scale for the Assessment and Rating of Ataxia (SARA). LESSONS: Although only a single case is described, we found that the combined neuromodulation-neurorobotic approach could become a promising tool in the rehabilitation of cerebellar ataxias, possibly by shaping cerebello-cerebral plasticity and connectivity.


Assuntos
Terapia por Exercício/métodos , Ataxia de Friedreich/reabilitação , Marcha/fisiologia , Robótica/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Terapia Combinada/métodos , Ataxia de Friedreich/complicações , Humanos , Masculino , Paresia/etiologia , Paresia/reabilitação , Recuperação de Função Fisiológica/fisiologia
11.
Gait Posture ; 70: 136-140, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30856525

RESUMO

BACKGROUND: Humans partially maintain gait stability by actively controlling step width based on the dynamic state of the pelvis - hereby defined as the "dynamics-dependent control of step width". Following a stroke, deficits in the accurate control of paretic leg motion may prevent use of this stabilization strategy. RESEARCH QUESTION: Do chronic stroke survivors exhibit paretic-side deficits in the dynamics-dependent control of step width? METHODS: Twenty chronic stroke survivors participated in this cross-sectional study, walking on a treadmill at their self-selected (0.57 ± 0.25 m/s; mean ± s.d.) and fastest-comfortable (0.81 ± 0.30 m/s) speeds. To quantify the dynamics-dependent control of step width, we calculated the proportion of the step-by-step variance in step width that could be predicted from mediolateral pelvis dynamics, and used partial correlations to differentiate the relative effects of pelvis displacement and velocity. Secondarily, we calculated the mean and standard deviation of more traditional gait metrics: step width; lateral foot placement; and mediolateral margin of stability (MoS). We used repeated measures ANOVA to test for significant effects of leg (paretic vs. non-paretic) and speed (self-selected vs. fastest-comfortable) on these measures. RESULTS: Relative to non-paretic steps, paretic steps exhibited a weaker (p ≤ 0.005) link between step width and pelvis dynamics, attributable to a decreased partial correlation between step width and pelvis displacement (p ≤ 0.001). Paretic steps were also placed more laterally (p < 0.0001), with a larger (p < 0.0001) and more variable (p = 0.003) MoS. The only effect of faster walking speeds was a narrower step width (p < 0.0001). SIGNIFICANCE: Pelvis displacement was less tightly linked to step width for paretic steps than for non-paretic steps, indicating a decrease in the step-by-step reactive control normally used to ensure mediolateral stability. Instead, stroke survivors placed their paretic leg farther laterally to ensure a larger MoS, behavior consistent with a greater reliance on a generalized feed-forward gait stabilization strategy.


Assuntos
Transtornos Neurológicos da Marcha/fisiopatologia , Marcha/fisiologia , Paresia/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Fenômenos Biomecânicos , Doença Crônica , Estudos Transversais , Teste de Esforço , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Velocidade de Caminhada
12.
BMC Neurol ; 19(1): 39, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30871480

RESUMO

BACKGROUND: After discharge from hospital following a stroke, prescriptions of community-based rehabilitation are often downgraded to "maintenance" rehabilitation or discontinued. This classic therapeutic behavior stems from persistent confusion between lesion-induced plasticity, which lasts for the first 6 months essentially, and behavior-induced plasticity, of indefinite duration, through which intense rehabilitation might remain effective. This prospective, randomized, multicenter, single-blind study in subjects with chronic stroke-induced hemiparesis evaluates changes in active function with a Guided Self-rehabilitation Contract vs conventional therapy alone, pursued for a year. METHODS: One hundred and twenty four adult subjects with chronic hemiparesis (> 1 year since first stroke) will be included in six tertiary rehabilitation centers. For each patient, two treatments will be compared over a 1-year period, preceded and followed by an observational 6-month phase of conventional rehabilitation. In the experimental group, the therapist will implement the diary-based and antagonist-targeting Guided Self-rehabilitation Contract method using two monthly home visits. The method involves: i) prescribing a daily antagonist-targeting self-rehabilitation program, ii) teaching the techniques involved in the program, iii) motivating and guiding the patient over time, by requesting a diary of the work achieved to be brought back by the patient at each visit. In the control group, participants will benefit from conventional therapy only, as per their physician's prescription. The two co-primary outcome measures are the maximal ambulation speed barefoot over 10 m for the lower limb, and the Modified Frenchay Scale for the upper limb. Secondary outcome measures include total cost of care from the medical insurance point of view, physiological cost index in the 2-min walking test, quality of life (SF 36) and measures of the psychological impact of the two treatment modalities. Participants will be evaluated every 6 months (D1/M6/M12/M18/M24) by a blinded investigator, the experimental period being between M6 and M18. Each patient will be allowed to receive any medications deemed necessary to their attending physician, including botulinum toxin injections. DISCUSSION: This study will increase the level of knowledge on the effects of Guided Self-rehabilitation Contracts in patients with chronic stroke-induced hemiparesis. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02202954 , July 29, 2014.


Assuntos
Registros Médicos , Educação de Pacientes como Assunto/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/reabilitação , Estudos Prospectivos , Qualidade de Vida , Projetos de Pesquisa , Método Simples-Cego , Acidente Vascular Cerebral/complicações
13.
NeuroRehabilitation ; 44(1): 131-140, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30814367

RESUMO

BACKGROUND: Pusher syndrome (PS) is a clinical disorder that causes decreased postural balance and active pushing away from the non-hemiparetic side in patients with right or left brain damage. Therapists are challenged by needing to manage both the hemiparetic and the pushing/non-hemiparetic sides. There is a minimal amount of evidence about effective treatment interventions for PS. OBJECTIVE: To describe treatment interventions that reduce pushing behavior and improve functional outcomes in patients with PS. METHODS: Five individuals (aged 42-76, admitted 5-16 days post-stroke) with PS participated in this case series. The participants received 90 minutes of physical therapy (5 days/week) with an average length of stay of 27 days. Treatment focused on regaining their sense of midline (balance and transfers), mobility retraining, and neuro re-education activities. Outcome measures examined pushing behavior, transfer ability, and sitting balance. RESULTS: All five participants demonstrated improvements in pushing behavior, balance and transfer status. CONCLUSIONS: These outcomes provide preliminary evidence of decreased pushing behavior, and improved balance and transfers following a program of interventions designed to improve the functional outcomes of patients with PS. Larger studies are needed to confirm these findings, and whether these interventions are effective for patients with less severe pushing behavior.


Assuntos
Modalidades de Fisioterapia , Equilíbrio Postural/fisiologia , Transtornos das Sensações/fisiopatologia , Transtornos das Sensações/terapia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Paresia/terapia , Transtornos das Sensações/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
14.
J Clin Neurosci ; 65: 100-105, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30910548

RESUMO

Isolated hand paresis may reflect an infarction of the "hand knob area", which represents less than 1% of all ischemic strokes. In this type of stroke, a potential source of embolism is often identified. There are no large case series regarding this topic in Latin America. Herein we present the largest cohort of this entity in the region and we compare our results with those previously published. We analyzed all stroke patients admitted to our hospital between May 2015 - June 2018. Only patients with motor +/- sensory deficits restricted to the hand and ischemic stroke confirmed by MRI were included. We assessed stroke mechanism, clinical characteristics and outcome. From 339 patients admitted with ischemic stroke, 12 (3.53%) were included (9 men, 75%). Mean age: 60.4 years-old (range:24-79). Localization of stroke: 8 patients (66%) precentral gyrus, 3 (25%) postcentral; in 1 both gyri were affected. Stroke mechanism according to TOAST classification was as follows: two patients (16%) large artery atherosclerosis, two cardioembolic, one other determined etiology (thrombophilia), seven (58%) undetermined etiology (SUE). Nine patients (75%) received antiplatelets and statins, and three (25%) anticoagulants. The mean follow-up period was 11 months (range 1-26). Stroke recurrence was observed in one patient. At follow up, eight patients (66%) had a modified Rankin Score (mRS) of 0 and one a mRS of 1. In conclusion, in this series the most prevalent stroke mechanism was SUE, mainly embolic stroke of undetermined source. The outcome was excellent regardless of stroke mechanism.


Assuntos
Isquemia Encefálica/complicações , Infarto Cerebral/complicações , Paresia/etiologia , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/complicações , Isquemia Encefálica/etiologia , Estudos de Coortes , Embolia/complicações , Feminino , Mãos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Adulto Jovem
16.
Top Stroke Rehabil ; 26(4): 247-254, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30907287

RESUMO

BACKGROUND: Knowledge of paretic upper limb (UL) use in the actual environment is crucial for defining treatment strategies that are likely to enhance performance. OBJECTIVE: To quantify the hand function and type of grasp performed in the actual environment following stroke and determine if any differences in hand use are dependent on the degree of motor impairment. METHOD: This cross-sectional study enrolled 41 participants with chronic hemiparesis classified as having either mild (11), moderate (20), or severe (10) UL impairment. A behavioral map was used while observing hand use over the 4-h experimental period, during which we checked: activity- unimanual, bimanual or non-task-related; hand function- stabilization, manipulation, reach-to-grasp, gesture, support or push; and type of grasp- digital or whole-hand. RESULTS: Participants with severe impairment did not use the paretic UL spontaneously; analyzing the moderate and mild subgroup together, the predominant UL hand functions were stabilization and manipulation, the paretic UL performs the stabilization function using the whole-hand more frequently (71.2%) than digital (28.8%) grasp. In the subgroup analysis, the paretic and non-paretic UL in the moderate and the paretic UL in the mild subgroup perform the whole-hand stabilization more frequently than digital. Digital grasp is more accomplished by the non-paretic UL in reach-to-grasp hand function, particularly in the mild subgroup. CONCLUSION: The paretic UL is predominantly employed for stabilization function using a whole-hand grasp. The type of grasp in the actual environment is affected by motor impairment, and greater motor impairment leads to the performance of less complex tasks.


Assuntos
Força da Mão/fisiologia , Mãos/fisiopatologia , Paresia/fisiopatologia , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Acidente Vascular Cerebral/complicações
17.
Medicine (Baltimore) ; 98(5): e14107, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702565

RESUMO

RATIONALE: Malignant melanoma with indiscoverable skin manifestations is unusual and refractory hypercalcemia with high metabolic signal of the rectum as initial manifestation is very rare. PATIENT CONCERNS: We present a case that presented with paresis, nausea, and vomiting. DIAGNOSES: Malignant melanoma with spinal metastasis. INTERVENTIONS AND OUTCOMES: The patient underwent posterior decompression, partial tumor resection, bone cement reconstruction, and internal fixation. The patient's hypercalcemia was controlled and muscle strength was partially recovered. The immunohistochemical stainings showed Melan-A (+), HMB45 (+), s-100 (+), Vimentin (+), and AE1/AE3 (-). LESSONS: We emphasize the necessity of screening potential existence of neoplasms for the patients with hypercalcemia. Surgical treatment is still necessary for patients with spinal metastasis.


Assuntos
Hipercalcemia/etiologia , Melanoma/complicações , Melanoma/patologia , Dermatopatias/etiologia , Neoplasias da Coluna Vertebral/secundário , Adulto , Descompressão Cirúrgica , Humanos , Masculino , Força Muscular , Paresia/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia
18.
BMJ Case Rep ; 12(2)2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30798276

RESUMO

This 37-year-old man presented with left sided facial warmth and numbness associated with new sudden-onset right hemiparesis. The patient first developed sudden numbness of his left lip and warmth in left ear which travelled to the rest of left face. His past medical history was significant for hypertension, Hodgkin lymphoma treated with radiation therapy at the age of 10, and sleeve gastrectomy for obesity 1 year ago complicated by bilateral ischaemic cerebral infarctions with residual left hemiparesis. No acute infarcts were found on MRI. Transesophageal echocardiography revealed a complex atheroma near the sinotubular junction in ascending aorta.


Assuntos
Valva Aórtica/fisiologia , Doenças das Valvas Cardíacas/diagnóstico , Paresia/etiologia , Acidente Vascular Cerebral/diagnóstico , Adulto , Anticolesterolemiantes/uso terapêutico , Valva Aórtica/diagnóstico por imagem , Aspirina/uso terapêutico , Ecocardiografia Transesofagiana , Inibidores do Fator Xa/uso terapêutico , Doenças das Valvas Cardíacas/tratamento farmacológico , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Paresia/fisiopatologia , Rivaroxabana/uso terapêutico , Rosuvastatina Cálcica/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
19.
J Stroke Cerebrovasc Dis ; 28(4): 954-962, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30630757

RESUMO

OBJECTIVE: Fast and scaled muscular activation is required to recover body balance following an external perturbation. An issue open to investigation is the extent to which the cerebral hemisphere lesioned by stroke leads to asymmetric deficits in postural reactive responses. In this experiment, we aimed to compare muscular responses to unanticipated stance perturbations between individuals who suffered unilateral stroke either to the right or to the left cerebral hemisphere. METHODS: Stance perturbations were produced by releasing a load attached to the participant's trunk, inducing fast forward body oscillation. Electromyography was recorded from the gastrocnemius medialis and biceps femoris muscles. Muscular activation from age-matched healthy individuals was taken as reference. RESULTS: Analysis indicated that damage to the right hemisphere induced delayed activation onset, and lower rate and magnitude of activation of the proximal and distal muscles of the paretic leg. Those deficits were associated with stronger activation of the nonparetic leg. Comparisons between left hemisphere damage and controls showed deficits limited to activation of the biceps femoris of the paretic leg. Manipulation of visual information led to no significant effects on muscular responses. CONCLUSIONS: These results suggest that right cerebral hemisphere damage by stroke leads to more severe deficits in the generation of reactive muscular responses to stance perturbation than damage to the left cerebral hemisphere regardless of visual information.


Assuntos
Cérebro/fisiopatologia , Lateralidade Funcional , Músculo Esquelético/inervação , Paresia/fisiopatologia , Equilíbrio Postural , Transtornos das Sensações/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Percepção Visual , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Avaliação da Deficiência , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/etiologia , Paresia/psicologia , Estimulação Luminosa , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/etiologia , Transtornos das Sensações/psicologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia
20.
J Stroke Cerebrovasc Dis ; 28(3): 850-852, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30595510

RESUMO

BACKGROUND: Polycythemia is a rare but important preventable cause of stroke with potential for recurrence when not identified and appropriately managed. CASE PRESENTATION: This is a case of a 55-year-old Ghanaian who presented to our tertiary facility after a 2-month delay with a history of sudden onset of right-sided hemiparesis and expressive aphasia. He had suffered a previous stroke with left hemiparesis 2 years previously where hypertension and polycythemia were identified and treatment initiated. However, patient defaulted treatment for 18 months prior to the onset of recurrent stroke. A cranial CT scan revealed chronic right and subacute left middle cerebral artery territorial infarcts. Presenting hematocrit was 71%. Treatments initiated included high dose hydroxyurea, venesections, and dual antiplatelet therapy of Aspirin and Clopidogrel. He has since been discharged and remains stable under follow-up with moderate functional deficits- Modified Rankin score of 3/6 and the hematocrit of 54% at 3 months postdischarge. CONCLUSIONS: Default of therapy for polycythemia is associated with a profound risk of recurrent strokes requiring patient education and support to prevent the devastating consequence of this modifiable but rare cause of stroke. This case report highlights the challenges of instituting secondary prevention for stroke in resource-limited settings.


Assuntos
Infarto da Artéria Cerebral Média/etiologia , Policitemia/complicações , Afasia de Broca/etiologia , Aspirina/administração & dosagem , Clopidogrel/administração & dosagem , Gana , Humanos , Hidroxiureia/administração & dosagem , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/terapia , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Paresia/etiologia , Flebotomia , Inibidores da Agregação de Plaquetas/administração & dosagem , Policitemia/diagnóstico , Policitemia/terapia , Recidiva , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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