Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 31.424
Filtrar
1.
BMJ Case Rep ; 13(10)2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028572

RESUMO

A 13-year-old boy presented to hospital with 3-day self-limited fever, followed by dry cough, persistent asthenia and impaired general condition of 2 weeks' duration. Blood analyses showed a severe inflammatory status and chest X-ray images were consistent with bilateral COVID-19 pneumonia. He developed an acute respiratory failure that required paediatric intensive care admission and non-invasive ventilation. A targeted COVID-19 treatment was initiated with hydroxicloroquine, corticosteroids, enoxaparine and a single dose of tocilizumab. Repeated serological tests and real-time reverse transcription PCR for SARS-CoV-2 were negative. Other infectious pathogens were also ruled out. Thoracic high resolution CT showed an intense bilateral pulmonary dissemination with lytic vertebral bone lesions. After diagnostic investigations, Ewing's sarcoma with metastatic pulmonary dissemination was diagnosed. Nowadays, in the context of SARS-CoV-2 community pandemic, we cannot forget that COVID-19 clinical presentation is not specific and other entities can mimic its clinical features.


Assuntos
Infecções por Coronavirus/diagnóstico , Neoplasias Pulmonares , Nódulos Pulmonares Múltiplos , Pneumonia Viral/diagnóstico , Sarcoma de Ewing , Tomografia Computadorizada por Raios X/métodos , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica , Exame de Medula Óssea/métodos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/fisiopatologia , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/secundário , Masculino , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/patologia , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos
2.
Acta Neurol Scand ; 142(4): 385-391, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32914881

RESUMO

BACKGROUND: Idiopathic Parkinson's disease (PD) is characterized by clinical motor symptoms including hypokinesia, rigidity and tremor. In addition to the movement disorder, cognitive deficits are commonly described. In the present study, we applied FP-CIT SPECT to investigate the impact of nigrostriatal dopaminergic degeneration on cognitive function in PD patients. METHODS: Fifty-four PD patients underwent [123I]FP-CIT SPECT and CERAD (Consortium to Establish a Registry for Alzheimer's Disease) testing. FP-CIT SPECT visualized the density of presynaptic dopamine transporters in both striata, each subdivided into a limbic, executive and sensorimotor subregion according to the atlas of Tziortzi et al (Cereb Cortex 24, 2014, 1165). CERAD testing quantified cognitive function. RESULTS: In the CERAD testing, PD patients exhibited deficits in the domains of semantic memory, attention, visuospatial function, non-verbal memory and executive function. After correction for multiple testing, the performance of the subtests Figure Recall and Trail-Making Test A correlated significantly with FP-CIT uptake into the ipsilateral executive subregion. The performance of the subtest Figure Saving correlated significantly with FP-CIT uptake into the contralateral executive subregion. CONCLUSIONS: The significant correlation between cognitive function and density of nigrostriatal dopamine transporters, as assessed by FP-CIT SPECT, indicate that striatal dopaminergic pathways-primarily the executive striatal subregion-are relevant to cognitive processing in PD.


Assuntos
Cognição , Corpo Estriado/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Corpo Estriado/metabolismo , Feminino , Humanos , Masculino , Doença de Parkinson/fisiopatologia , Tremor
3.
Fortschr Neurol Psychiatr ; 88(9): 609-619, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32957144

RESUMO

The present work provides an overview of the various nuclear medicine methods in the diagnosis of neurodegenerative parkinsonian syndromes and their respective evidence and is intended to enable practical decision-making aids in the application and interpretation of the methods and findings. The value of the procedures differs considerably in relation to the two relevant diagnostic questions. On the one hand, it is the question of whether there is a neurodegenerative parkinsonian syndrome at all, and on the other hand the question of which one. While the DAT-SPECT is undisputedly the method of choice for answering the first question (taking certain parameters into account), this method is not suitable for answering the second question. To categorise parkinsonian syndromes into idiopathic (i. e. Parkinson´s disease) or atypical, various procedures are used in everyday clinical practice including MIBG scintigraphy, and FDG-PET. We explain why FDG-PET currently is not only the most suitable of these methods to differentiate an idiopathic parkinsonian syndrome, from an atypical Parkinson's syndrome, but also enables sufficiently valid to distinguish the various atypical neurodegenerative Parkinson's syndromes (i. e. MSA, PSP and CBD) from each other and therefore should be reimbursed by health insurances.


Assuntos
Transtornos Parkinsonianos/classificação , Transtornos Parkinsonianos/diagnóstico , Diagnóstico Diferencial , Humanos , Doença de Parkinson/diagnóstico , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada de Emissão de Fóton Único
4.
Nat Commun ; 11(1): 4659, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938936

RESUMO

The αvß6 integrin plays a key role in the activation of transforming growth factor-ß (TGFß), a pro-fibrotic mediator that is pivotal to the development of idiopathic pulmonary fibrosis (IPF). We identified a selective small molecule αvß6 RGD-mimetic, GSK3008348, and profiled it in a range of disease relevant pre-clinical systems. To understand the relationship between target engagement and inhibition of fibrosis, we measured pharmacodynamic and disease-related end points. Here, we report, GSK3008348 binds to αvß6 with high affinity in human IPF lung and reduces downstream pro-fibrotic TGFß signaling to normal levels. In human lung epithelial cells, GSK3008348 induces rapid internalization and lysosomal degradation of the αvß6 integrin. In the murine bleomycin-induced lung fibrosis model, GSK3008348 engages αvß6, induces prolonged inhibition of TGFß signaling and reduces lung collagen deposition and serum C3M, a marker of IPF disease progression. These studies highlight the potential of inhaled GSK3008348 as an anti-fibrotic therapy.


Assuntos
Butiratos/farmacologia , Fibrose Pulmonar Idiopática/tratamento farmacológico , Integrinas/antagonistas & inibidores , Naftiridinas/farmacologia , Pirazóis/farmacologia , Pirrolidinas/farmacologia , Administração por Inalação , Animais , Antígenos de Neoplasias/metabolismo , Bleomicina/toxicidade , Butiratos/administração & dosagem , Butiratos/metabolismo , Butiratos/farmacocinética , Colágeno/metabolismo , Modelos Animais de Doenças , Células Epiteliais/efeitos dos fármacos , Humanos , Fibrose Pulmonar Idiopática/induzido quimicamente , Fibrose Pulmonar Idiopática/patologia , Integrinas/metabolismo , Masculino , Camundongos Endogâmicos C57BL , Simulação de Acoplamento Molecular , Naftiridinas/administração & dosagem , Naftiridinas/metabolismo , Naftiridinas/farmacocinética , Pirazóis/administração & dosagem , Pirazóis/metabolismo , Pirazóis/farmacocinética , Pirrolidinas/administração & dosagem , Pirrolidinas/metabolismo , Pirrolidinas/farmacocinética , Bibliotecas de Moléculas Pequenas/química , Bibliotecas de Moléculas Pequenas/farmacologia , Tomografia Computadorizada de Emissão de Fóton Único , Fator de Crescimento Transformador beta/metabolismo , Pesquisa Médica Translacional
5.
Medicine (Baltimore) ; 99(36): e22038, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899061

RESUMO

The effectiveness of diethylenetriamine pentaacetic acid scan is regularly monitored for the assessment of any potential modifications in treatment responses or kidney functions in the pediatric population.This study attempts to compare the usefulness of diethylenetriamine pentaacetic acid and ultrasound imaging of renal disorders among paediatric patients.A retrospective observational study was conducted by enrolling 106 children. The demographic details such as: participant's age, gender, and the history of renal disease of each patient were recorded. Patients were administered radiopharmaceuticals in a fixed dose and were later subjected to computed tomography (CT) scan. The obtained data was analysed using descriptive statistics.Findings indicated increased sensitivity for CT (61.20%); whereas, a major decrease in specificity (23.68%) was observed. Comparison of Single-photon emission CT (SPECT) and CT findings revealed the increased sensitivity (90.90%) for ultrasound; whereas, there was a slight decrease in the specificity (40%) for SPECT. However, SPECT findings show 91% sensitivity among patients with 71.42% positive predictive value. Moreover, an increase in sensitivity for CT (61.20%), followed by a major decrease in specificity (23.68%) was observed.Ultrasonography has been proved to be the safest and the most effective method for the diagnosis and the treatment of most renal disorders, due to the higher predictive value of SPECT scans. It is thus suggested that patients with ureteral calculi should be diagnosed with renal scintigraphy and unenhanced helical computerized tomography.


Assuntos
Nefropatias/diagnóstico por imagem , Ácido Pentético/administração & dosagem , Cintilografia/métodos , Ultrassonografia/métodos , Cálculos Ureterais/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Nefropatias/fisiopatologia , Masculino , Medicina Nuclear/métodos , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos/administração & dosagem , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos
6.
Psiquiatr. biol. (Internet) ; 27(2): 78-81, mayo-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193252

RESUMO

Las anomalías físicas menores (minor physical anomalies [MPA]) son desviaciones anatómicas sutiles en la apariencia de una persona que pueden sugerir una embriogénesis alterada. Se ha observado que pacientes con esquizofrenia de inicio temprano (early onset schizophrenia [EOS]) presentan un mayor número de MPA, las cuales podrían servir como biomarcadores para predecir el inicio o pronóstico de esta enfermedad. Estas pueden ser numerosas, sin embargo, las más relevantes incluyen las ubicadas en cabeza y boca. Existe poca información respecto a la relación entre estudios de neuroimagen funcional y las MPA en pacientes con esquizofrenia, por lo que presentamos el siguiente caso de un adolescente varón de 16años. Encontramos que la Escala de Waldrop para anomalías físicas menores se puntuó en 6. En la tomografía por emisión de fotón único cerebral (SPECTc) se evidenció una hiperperfusión en las siguientes áreas: lóbulo frontal, corteza orbitofrontal bilateral y núcleos caudados


Minor physical anomalies (MPA) are subtle anatomical deviations in a person's appearance, which may suggest an altered embryogenesis. It has been observed that patients with early onset schizophrenia (EOS) have a higher number of MPA, which could serve as biomarkers to predict the onset or prognosis of this disease. Although these can be numerous, the most relevant include those located in the head and mouth. There is little information regarding the relationship between functional neuroimaging studies and MPA in patients with schizophrenia, and for this reason the following case of a 16-year-old male adolescent is presented. The Waldrop Scale for minor physical anomalies gave a score of 6. The single photon emission tomography (SPECT) scan showed hyper-perfusion in the following areas: frontal lobe, bilateral orbital-frontal cortex, and caudate nuclei


Assuntos
Humanos , Masculino , Adolescente , Esquizofrenia/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único
8.
PLoS One ; 15(8): e0237443, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813713

RESUMO

BACKGROUND: It is controversial to evaluate the function of hydronephrotic kidneys by renal dynamic imaging (RDI). Our aim was to study the features of renal dynamic imaging (RDI) at different stages after unilateral ureteral obstruction (UUO) and to investigate a method that could be reasonably used to evaluate renal function and predict renal functional recoverability. METHODS: We made UUO models using fifteen adult New Zealand white rabbits and systematically observed the changes in kidney morphology, blood flow, radiotracer distribution and function by RDI. We then compared the differences in terms of imaging features between different periods and analyzed the relationship between blood flow and function in obstructed kidneys. RESULTS: 1) Obstructed kidneys gradually became larger than preoperative kidneys and contralateral kidneys (P<0.05) and reached their peak size between days 42 and 56, after which they gradually got smaller in size. 2)The correlation between the blood perfusion of the obstructed kidney and the obstruction duration (r = 0.125, P = 0.045) was very weak. In the initial period of obstruction, the perfusion of the obstructed kidney significantly decreased, followed by a sharp rebound in later days, and then the perfusion declined again. The peak in blood perfusion was on day 7. 3) The uptake rate of the obstructed kidney drastically decreased in the early stage and became lower than that of the contralateral kidney and the kidney before the operation (P<0.05), after which uptake increased gradually; the peak was on day 28. After that, uptake gradually decreased. 4) The grading of the radiotracer distribution in obstructed kidneys was positively correlated with the obstruction duration (r = 0.975, P = 0.000), and a uniform renal distribution was an early feature of obstruction. 5) The blood perfusion of the obstructed kidney and its functioning frequently increased or decreased simultaneously, but sometimes there was also a mismatch. The peak of renal blood perfusion recovery occurred prior to the peak of renal function recovery. CONCLUSION: In different periods of severe UUO, the imaged features of obstructed kidneys were different. These features are beneficial for determining the degree of hydronephrosis and renal function and predicting renal functional recoverability.


Assuntos
Rim/fisiopatologia , Pentetato de Tecnécio Tc 99m/química , Obstrução Ureteral/patologia , Animais , Estudos de Casos e Controles , Modelos Animais de Doenças , Rim/diagnóstico por imagem , Masculino , Coelhos , Índice de Gravidade de Doença , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único
9.
Clin Imaging ; 67: 136-142, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32622334

RESUMO

We report a marked abnormality in myocardial attenuation on non-gated contrast-enhanced CT in a patient with multiorgan sarcoidosis and correlate our findings with CMR, PET and SPECT. The noteworthy observation of myocardial hypoattenuation, in correspondence with the multimodality cardiovascular imaging findings, suggests that standard contrast-enhanced CT may provide information regarding tissue characterization. This report also demonstrates the independent clinical utility of CMR and PET in the evaluation and management of cardiac sarcoidosis.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Miocárdio , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos
11.
Med Oral Patol Oral Cir Bucal ; 25(5): e683-e690, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32683387

RESUMO

BACKGROUND: This study aims to evaluate whether the uptake difference by the condyles evaluated using single photon emission computed tomography (SPECT) examination is useful for predicting the activity of the feature and the advance of this pathology. MATERIAL AND METHODS: An observational and prospective study has been carried out on nine patients affected by unilateral condylar hyperplasia (UCH) with complete bone maturation, with a follow-up over 18 months. At the beginning of the study, a test-battery was conducted including dental casts, articular examination, teleradiography and cephalometry, computed tomography and SPECT, creating two groups of patients from a difference in uptake between both condyles greater than 10% over the follow-up period. Evolution of data obtained with the rest of the diagnostic tests were compared to confirm UCH activity predicted by SPECT. RESULTS: The comparison of both groups did not show hardly any significant differences, with little clinical significance. Deviation of the mandibular line, the size of the branches or condyles behaved similarly in both study groups. CONCLUSIONS: From the data obtained in our study, we can conclude that the use of the difference in uptake between both condyles by applying the SPECT technique is not a valid approach for predicting clinical activity in cases of UCH.


Assuntos
Côndilo Mandibular , Tomografia Computadorizada de Emissão de Fóton Único , Humanos , Hiperplasia , Mandíbula , Estudos Prospectivos
12.
Eur J Nucl Med Mol Imaging ; 47(11): 2487-2492, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32700058
13.
World Neurosurg ; 139: 762-774, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32689697

RESUMO

Though frequently effective in the management of medically refractory seizures, epilepsy surgery presents numerous challenges. Selection of the appropriate candidate patients who are likely to benefit from surgery is critical to achieving seizure freedom and avoiding neurocognitive morbidity. Identifying the seizure focus and mapping epileptogenic networks involves an interdisciplinary team dedicated to formulating a safe and effective surgical plan. Various strategies can be employed either to eliminate the epileptic focus or to modulate network activity, including resection of the focus with open surgery or laser interstitial thermal therapy; modulation of epileptogenic firing patterns with responsive neurostimulation, deep brain stimulation, or vagus nerve stimulation; or non-invasive disconnection of epileptic circuits with focused ultrasound, which is also discussed in greater detail in the subsequent chapter in our series. We review several challenges of epilepsy surgery that must be thoughtfully addressed in order to ensure its success.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Seleção de Pacientes , Fatores Etários , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/terapia , Eletroencefalografia , Encefalite/cirurgia , Técnicas de Ablação Endometrial , Lateralidade Funcional , Neuroimagem Funcional , Humanos , Neuroestimuladores Implantáveis , Imagem por Ressonância Magnética , Magnetoencefalografia , Testes Neuropsicológicos , Tomografia por Emissão de Pósitrons , Implantação de Prótese , Encaminhamento e Consulta , Tomografia Computadorizada de Emissão de Fóton Único , Falha de Tratamento , Esclerose Tuberosa/cirurgia
14.
World Neurosurg ; 139: 750-761, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32689696

RESUMO

The diagnostic and surgical management of epilepsy has made enormous strides over the past 3 decades, concomitant with advances in technology and electrophysiologic understanding of neuronal connectivity. Distinct zones have been identified within this network that each communicate and play a role in the genesis of seizures. Invasive and noninvasive modalities for defining the epileptogenic lesion or region have been able to more accurately determine which patients are optimal candidates for treatment when their seizures are refractory to conventional conservative management. Ablative, palliative, and disconnecting procedures have been developed as alternatives for traditional open resection techniques, and in recent studies, they have shown excellent seizure control and mitigation of complications. In this review, we discuss the evolution of these advancements in the management of epilepsy and provide an overview of current and future neurosurgical therapeutic modalities.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Implantação de Prótese , Técnicas de Ablação , Lobectomia Temporal Anterior , Estimulação Encefálica Profunda , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/terapia , Eletrocorticografia , Eletroencefalografia , Neuroimagem Funcional , Ablação por Ultrassom Focalizado de Alta Intensidade , Humanos , Neuroestimuladores Implantáveis , Terapia a Laser , Imagem por Ressonância Magnética , Magnetoencefalografia , Tomografia por Emissão de Pósitrons , Radiocirurgia , Procedimento de Encéfalo Dividido , Tomografia Computadorizada de Emissão de Fóton Único , Estimulação do Nervo Vago
15.
Neurology ; 95(6): e662-e670, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32636325

RESUMO

OBJECTIVE: Early biomarkers for dementia with Lewy bodies (DLB) are lacking. To determine whether EEG differentiates the prodromal phase of DLB from other causes of mild cognitive impairment (MCI) and whether EEG is predictive for time to conversion from MCI to DLB, we compared EEGs and clinical follow-up of patients with MCI due to DLB with those of patients with MCI due to Alzheimer disease (MCI-AD). METHODS: We compared 37 patients with MCI who developed DLB during follow-up or had an abnormal 123I-PF-CIT SPECT scan (MCI-DLB) with 67 age-matched patients with MCI-AD. EEGs were assessed visually with a score of increasing abnormality (range 1-5). We performed fast Fourier transform to analyze the power spectrum. With survival analyses, EEG characteristics were related to time to progression to dementia. RESULTS: The visual EEG score was higher in MCI-DLB (score >2 in 60%) compared to MCI-AD (score >2 in 8%, p < 0.001). We found frontal intermittent delta activity in 22% of MCI-DLB, not in MCI-AD. Patients with MCI-DLB had a lower peak frequency (7.5 [6.0-9.9] Hz vs 8.8 [6.8-10.2] in MCI-AD, p < 0.001) and more slow-wave activity. Several individual EEG measures showed good performance to discriminate MCI-DLB from MCI-AD (areas under the curve up to 0.94). In MCI-DLB, high visual EEG score, diffuse abnormalities, and low α2 power were related to time to progression to dementia (hazard ratios 4.1, 9.9, 5.1, respectively). CONCLUSIONS: Profound EEG abnormalities are already present in the prodromal stage of DLB and have diagnostic and prognostic value. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that EEG abnormalities are more common in MCI-DLB than MCI-AD.


Assuntos
Eletroencefalografia , Doença por Corpos de Lewy/diagnóstico , Idoso , Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/fisiopatologia , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Disfunção Cognitiva/líquido cefalorraquidiano , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/fisiopatologia , Diagnóstico Diferencial , Progressão da Doença , Diagnóstico Precoce , Feminino , Seguimentos , Análise de Fourier , Humanos , Radioisótopos do Iodo , Doença por Corpos de Lewy/líquido cefalorraquidiano , Doença por Corpos de Lewy/diagnóstico por imagem , Doença por Corpos de Lewy/fisiopatologia , Masculino , Pessoa de Meia-Idade , Países Baixos , Fragmentos de Peptídeos/líquido cefalorraquidiano , Estudos Prospectivos , Compostos Radiofarmacêuticos , Avaliação de Sintomas , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Proteínas tau/líquido cefalorraquidiano
16.
Neurology ; 95(6): e637-e642, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32636329

RESUMO

OBJECTIVE: To study neural networks involved in hyperkinetic seizures (HKS) using ictal SPECT. METHODS: We retrospectively identified 18 patients with HKS evaluated at the Cleveland Clinic between 2005 and 2015 with video-EEG monitoring and ictal SPECT. Semiology was confirmed by the consensus of 2 epileptologists' independent reviews and classified as type 1, 2, or 3 HKS. SPECT data were analyzed by 2 independent physicians using a z score of 1.5. Ictal hyperperfusion patterns for each group were analyzed visually and with SPM. Spatial normalization to Montreal Neurological Institute space for each patient's data was performed, followed by flipping of data from patients with left-sided ictal onset to the right side. Finally, an average z score map for each group was calculated. RESULTS: Visual analysis and SPM identified different patterns of ictal hyperperfusion in the 3 subtypes of HKS. Type 1 seizures showed hyperperfusion in a more anteriorly located network involving the anterior insula, orbitofrontal cortex, cingulate, and anterior perisylvian region and rostral midbrain. Type 2 seizures were associated with hyperperfusion in a more caudally located network involving the orbitofrontal cortex, cingulate (middle and posterior), basal ganglia, thalami, and cerebellum. Type 3 seizures showed a mixed pattern of SPECT hyperperfusion involving the temporal pole and anterior perisylvian region. CONCLUSIONS: Each of the 3 different semiologic subtypes of HKS is associated with distinct patterns of hyperperfusion, providing further insight into the neural networks involved. This knowledge may inform placement of invasive EEG electrodes in patients with HKS semiology undergoing presurgical evaluation.


Assuntos
Epilepsia Motora Parcial/diagnóstico por imagem , Hipercinese/diagnóstico por imagem , Rede Nervosa/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adolescente , Adulto , Mapeamento Encefálico , Circulação Cerebrovascular , Criança , Dominância Cerebral , Eletroencefalografia/métodos , Epilepsia Motora Parcial/classificação , Epilepsia Motora Parcial/fisiopatologia , Feminino , Humanos , Hipercinese/fisiopatologia , Masculino , Pessoa de Meia-Idade , Rede Nervosa/fisiopatologia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Gravação em Vídeo/métodos , Adulto Jovem
18.
Cerebrovasc Dis Extra ; 10(2): 66-75, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726777

RESUMO

INTRODUCTION: Moyamoya disease (MMD) is a rare cerebrovascular disease associated with cerebral infarction or hemorrhage. Hyperperfusion is the most significant complication of direct bypass surgery. Previous research has shown that an increase in cerebral blood flow (CBF) is strongly related to symptomatic hyperperfusion and highlighted the importance of postoperative assessment of CBF. OBJECTIVE: The principal aims of this study were to quantitatively analyze the relationship between intraoperative graft flow and increase in CBF and to evaluate the effectiveness of intraoperative graft flow measurement during bypass surgery for patients with MMD. METHODS: This study included 91 surgeries in 67 consecutive adult patients with MMD who underwent direct revascularization surgery at our institution between November 2013 and September 2018. Intraoperative graft flow of the branches and main trunk was measured in all patients, after anastomosis had been established. Postoperative CBF measurements were performed under sedation, immediately after surgery. Radiological hyperperfusion was defined as focal high uptake, as determined by CBF imaging immediately after surgery. Patients were divided into two groups (radiological hyperperfusion and nonradiological hyperperfusion groups), and the relationship between intraoperative graft flow and radiological hyperperfusion was analyzed. RESULTS: Significant differences were observed between the radiological hyperperfusion and nonradiological hyperperfusion groups in terms of intraoperative graft flow of both the branch (median 72 vs. 42 mL/min, respectively; p < 0.01) and main trunk (median 113 vs. 68 mL/min, respectively; p < 0.01). A receiver-operating characteristic analysis was performed to test the utility of intraoperative flow as a quantitative measure. We set the cutoff values for the intraoperative branch and main trunk flow at 57 mL/min (sensitivity: 0.707, specificity: 0.702; area under the curve [AUC]: 0.773; 95% confidence interval [CI]: 0.675-0.871) and 84 mL/min (sensitivity: 0.667, specificity: 0.771; AUC: 0.78; 95% CI: 0.685-0.875), respectively. CONCLUSIONS: Measuring intraoperative graft flow during bypass surgery may be an effective means of predicting hyperperfusion and could serve to facilitate early therapeutic intervention such as strict blood pressure control.


Assuntos
Angiografia Cerebral , Revascularização Cerebral/efeitos adversos , Circulação Cerebrovascular , Angiografia por Ressonância Magnética , Monitorização Intraoperatória , Doença de Moyamoya/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Adolescente , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Ter Arkh ; 92(4): 30-36, 2020 May 19.
Artigo em Russo | MEDLINE | ID: mdl-32598695

RESUMO

AIM: To study the relationship between pretest probability (PTP) of ischemic heart disease (IHD), calculated according to the recommendations of the European Society of Cardiology (ESC) of 2013 and 2019, with the perfusion of the left ventricle of the myocardium according to the single-photon emission tomography (SPECT) and the results of the invasive coronary angiography (CAG). MATERIAL AND METHODS: The study included 220 patients with a preliminary diagnosis of ischemic heart disease and planned invasive CAG. All patients underwent rest-stress perfusion myocardial SPECT within 1 month prior to or after CAG, standard quantitative parameters of left ventricular perfusion were assessed. Retrospectively clinical data was analyzed and PTP of IHD was assessed according to ESC recommendations for 2013 and 2019. RESULTS: Invasive CAG revealed obstructive lesion of one or more coromary arteries in 204 of the 220 patients (92.7%). In a retrospective analysis, taking into account gender, age and nature of the complaints, as recommended by ESC in 2013, PTP was rated as low (15%) in 13 patients (5.9%), as intermediate (1585%) in 207 patients (94.1%). Following the comprehensive survey (SPECT and CAG) 8 patients with low PTP (61.5%) underwent coronary revascularization. Among patients with intermediate PTP significant transient ischemia according to SPECT was detected in 31 (15.0%), initial at 107 (51.7%). According CAG among patients with intermediate PTP obstructive lesion was found in 192 (92.7%), 113 patients (58.8%) underwent revascularization. According to ESC recommendations of 2019, PTP was rated as low (15%) in 117 patients (53.2%), including 514% in 98 (44.5%). According to a survey (SPECT and CAG) 68 of them (58.1%) underwent revascularization. CONCLUSION: PTP measurements proposed by ESC can not be applied to patients of the Russian population with suspected ischemic heart disease without significant corrections. 2013 ESC recommendations with higher PTP values for all categories of patients reflect Russian population better, while 2019 recommendations mistakenly attribute patients to low PTP in at least 58% of cases. These results are preliminary and will be expanded in subsequent studies with more detailed analysis of PTP in included patients with suspected IHD.


Assuntos
Doença da Artéria Coronariana , Isquemia Miocárdica , Angiografia Coronária , Humanos , Probabilidade , Estudos Retrospectivos , Federação Russa , Tomografia Computadorizada de Emissão de Fóton Único
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA