Successful intra-arterial thrombolysis in a patient with an intracranial meningioma.

Alteplase (recombinant tissue plasminogen activator [rt-PA]) label approval by the Food and Drug Administration remarks the contraindication of its use with known intracranial neoplasm because of potential bleeding complications. Despite this concern, the real risk of intracerebral bleeding in patients with intracranial neoplasms treated with rt-PA is unknown, and there are few reports of thrombolysis in patients with brain tumors. We report a case of a 78-year-old man who was seen in our emergency department within 2 hours from sudden onset of aphasia, right-sided hemiplegia, hypoesthesia, and homonymous hemianopsia. The National Institutes of Health Stroke Scale (NIHSS) score at admission was 20. Intra-arterial thrombolysis was performed with administration of .3 mg/kg of alteplase combined with mechanical thrombectomy. At discharge, his NIHSS score was 1, and after 90 days, his modified Rankin score was 1. To our knowledge, this is the first report of intra-arterial thrombolysis in a patient with acute ischemic stroke with an intracranial tumor.

Differential aspects of stroke and congestive heart failure in quality of life reduction: a case series with three comparison groups.

BACKGROUND: To assess QOL of patients with stroke in comparison to other groups (caregivers and CHF patients), to identify which items of QOL are more affected on each group and what is the functional profile of patients with stroke. METHODS: Consecutive stroke or congestive heart failure (CHF) patients were evaluated and compared to their caregivers (caregivers). The NIH Stroke Scale (NIHSS) and EuroQoL-5D (EQ-5D) scale were applied. RESULTS: We evaluated 67 patients with stroke, 62 with CHF and 67 caregivers. For stroke patients, median NIHSS score was four. EQ-5D score was significantly worse in stroke, as compared to CHF and caregivers (0.52, 0.69 and 0.65, respectively). Mobility and usual activity domains were significantly affected in stroke and CHF patients as compared to caregivers; and self-care was more affected in stroke as compared with the other two groups. CONCLUSIONS: Despite a mild neurological deficit, there was a significantly worse QOL perception in stroke as compared to CHF patients, mostly in their perception of self-care.

An unusual association between acute ischaemic stroke and cerebral venous thrombosis with thyrotoxic state.

Arterial cerebral ischaemia has been described in different diseases of the thyroid. Likewise, cerebral venous thrombosis (CVT) has been reported in association with hyperthyroidism. However, the association of arterial and venous cerebral ischaemic events in patients with hyperthyroidism has not been previously described. We report the case of a patient with thyrotoxicosis who presented initially with an arterial ischaemic stroke complicated by a concomitant CVT, ultimately treated with decompressive craniectomy. Laboratory results revealed elevated factor VIII coagulant activity and a positive lupus anticoagulant IgG. In conclusion, CVT and arterial ischaemic events can happen concomitantly in patients with hyperthyroidism. Although there is insufficient evidence to prove that a hypercoagulability state in hyperthyroidism predisposes to cerebral ischaemia, the presence of antiphospholipid antibodies and other hypercoagulability studies should be performed in patients with thyrotoxicosis and ischaemic events.

Avaliação do Programa de Triagem Neonatal na Bahia no ano de 2003 / Assessment of Bahia Neonatal Screening Program in 2003

OBJETIVOS: descrever e avaliar o perfil do Programa de Triagem Neonatal baiano em 2003. MÉTODOS: estudo descritivo baseado no banco de dados do Serviço de Referência de Triagem Neonatal baiano com todos os recém-nascidos que realizaram a triagem na rede de coleta do Estado em 2003. RESULTADOS: observou-se implantação do programa em 94,5 por cento dos municípios. A média mensal de testados foi de 13.991 (72,51 por cento dos recém-nascidos registrados). Na coleta, 63,9 por cento das crianças estavam com idade entre oito dias e um mês, 14,5 por cento com até sete dias e 21,6 por cento com mais de um mês. A incidência observada foi de 1:22.000 para fenilcetonúria, 1:4.000 para o hipotireoidismo congênito e 1:650 para as hemoglobinopatias. CONCLUSÕES: o Programa de Triagem Neonatal baiano mostrou, em 2003, dificuldades quanto a cobertura preconizada em 100 por cento; a faixa etária ideal para realização da coleta; ao tempo entre a coleta e a chegada das amostras ao Serviço de Referência em Triagem Neonatal; ao tempo de entrega dos resultados à família; e ao tempo de reconvocação dos casos positivos. Assim, são necessárias algumas melhorias para agilizar esses processos.