ABSTRACT
OBJECTIVE: Obstructive sleep apnea is frequent during the acute phase of stroke, and it is associated with poorer outcomes. A well-established relationship between supine sleep and obstructive sleep apnea severity exists in non-stroke patients. This study investigated the frequency of supine sleep and positional obstructive sleep apnea in patients with ischemic or hemorrhagic stroke. METHODS: Patients who suffered their first acute stroke, either ischemic or hemorrhagic, were subjected to a full polysomnography, including the continuous monitoring of sleep positions, during the first night after symptom onset. Obstructive sleep apnea severity was measured using the apnea-hypopnea index, and the NIHSS measured stroke severity. RESULTS: We prospectively studied 66 stroke patients. The mean age was 57.6±11.5 years, and the mean body mass index was 26.5±4.9. Obstructive sleep apnea (apnea-hypopnea index >5) was present in 78.8% of patients, and the mean apnea-hypopnea index was 29.7±26.6. The majority of subjects (66.7%) spent the entire sleep time in a supine position, and positional obstructive sleep apnea was clearly present in the other 23.1% of cases. A positive correlation was observed between the NIHSS and sleep time in the supine position (r s = 0.5; p<0.001). CONCLUSIONS: Prolonged supine positioning during sleep was highly frequent after stroke, and it was related to stroke severity. Positional sleep apnea was observed in one quarter of stroke patients, which was likely underestimated during the acute phase of stroke. The adequate positioning of patients during sleep during the acute phase of stroke may decrease obstructive respiratory events, regardless of the stroke subtype.
Subject(s)
Female , Humans , Male , Middle Aged , Cerebral Hemorrhage/physiopathology , Sleep Apnea, Obstructive/diagnosis , Sleep/physiology , Stroke/physiopathology , Supine Position/physiology , Body Mass Index , Cerebral Hemorrhage/complications , Epidemiologic Methods , Polysomnography , Sleep Apnea, Obstructive/etiology , Stroke/complications , Time FactorsSubject(s)
Aged , Humans , Male , Postural Balance , Paresis/etiology , Sensation Disorders/etiology , Stroke/complicationsABSTRACT
We report a sequential neuroimaging study in a 48-years-old man with a history of chronic hypertension and lacunar strokes involving the ventral lateral posterior nucleus of the thalamus. The patient developed mild hemiparesis and severe contraversive pushing behavior after an acute hemorrhage affecting the right thalamus. Following standard motor physiotherapy, the pusher behavior completely resolved 3 months after the onset and, at that time, he had a Barthel Index of 85, although mild left hemiparesis was still present. This case report illustrates that pushing behavior itself may be severely incapacitating, may occur with only mild hemiparesis and affected patients may have dramatic functional improvement (Barthel Index 0 to 85) after resolution pushing behavior without recovery of hemiparesis.
Relatamos o estudo de neuroimagem seqüencial de um homem de 48 anos com história de hipertensão arterial crônica e acidentes vasculares cerebrais (AVCs) lacunares nos núcleos ventral lateral posterior do tálamo. O paciente desenvolveu hemiparesia leve e síndrome do empurrador (SE) grave após AVC hemorrágico no tálamo direito, sendo tratado com fisioterapia motora convencional. Três meses após o ictus, os sinais da síndrome haviam desaparecido e o paciente apresentava índice de Barthel 85, apesar da permanência da hemiparesia leve. Este caso demonstra que a síndrome do empurrador isolada pode ser gravemente incapacitante, pode ocorrer associada a hemiparesia leve e que os pacientes com esta síndrome podem apresentar recuperação funcional importante (índice de Barthel inicial 0 e final 85) após a resolução da SP sem alteração do grau de hemiparesia.
Subject(s)
Female , Humans , Male , Middle Aged , Movement Disorders/rehabilitation , Paresis/rehabilitation , Recovery of Function , Stroke/rehabilitation , Disability Evaluation , Functional Laterality , Magnetic Resonance Imaging , Movement Disorders/etiology , Paresis/etiology , Severity of Illness Index , Syndrome , Stroke/complicationsABSTRACT
The increase of relative cerebral blood flow (rCBF) may contribute for a change in blood oxygenation level dependent signal (BOLD). The main purpose of this study is to investigate some aspects of perfusional alterations in the human brain in response to a uniform stimulation: hypercapnia induced by breath holding. It was observed that the BOLD signal increased globally during hypercapnia and that it is correlated with the time of breath holding. This signal increase shows a clear distinction between gray and white matter, being greater in the grey matter.
O aumento relativo do fluxo cerebral sangüíneo (relative Cerebral Blood Flow - rCBF) pode contribuir para uma mudança no sinal dependente da oxigenação do sangue (Blood Oxygenation Level Dependent - BOLD). O objetivo principal deste trabalho foi estudar alguns aspectos da alteração perfusional no cérebro humano em resposta a um estímulo uniforme: hipercapnia, causada por um estado de apnéia induzida. Foi observado um aumento global no sinal BOLD durante a hipercapnia. Este aumento é correlacionado com a duração da apnéia e mostra uma clara distinção entre a substância branca e cinzenta, sendo maior na substância cinzenta.
Subject(s)
Female , Humans , Male , Brain/blood supply , Hypercapnia/physiopathology , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Oxygen/blood , Brain Mapping , Blood Flow Velocity/physiology , Brain/physiopathology , Respiration , Regional Blood Flow/physiologyABSTRACT
A localização precisa das áreas corticais eloquentes é de fundamental importância no planejamento neurocirúrgico, especialmente num contexto em que lesões expansivas, destrutivas ou anomalias do desenvolvimento cortical podem distorcer a anatomia cerebral normal. Recentemente tem sido demonstrado que a ressonãncia magnética funcional mesmo na presença destas distorções é útil na localização das principais ´´areas eloquentes, facilitando o planejamento cirúrgico. Este artigo analisa os principais aspectos relativos ao uso da ressonância funcional em cirurgia de epilepsia, incluindo suas limitações. Adicionalmente avalia o uso potencial de um paradigma específico para análise da memória espacial. Apresentamos os resultados da experiência recente do Centro de Cirurgia de Epilepsia (CIREP) da Faculdade de Medicina de Ribeirão Preto, envolvendo estudos funcionais em 40 pacientes candidatos à ressecções de zonas epileptogências localizadas em áreas eloquentes ou nas suas proximidades, e ainda 17 voluntários normais em um paradigma de navegação. Nossos resultados confirmam que a ressonância funcional em conjunção com outros métodos é inequivocamente útil na redução do tempo cirúrgico, na otimização da ressecção cirúrgica e na prevenção de potenciais déficits funcionais