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1.
Arq. neuropsiquiatr ; 78(8): 494-500, Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131736

ABSTRACT

ABSTRACT Background: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Results: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.


RESUMO Introdução: Mais de um terço dos pacientes com COVID-19 apresentam sintomas neurológicos que variam de anosmia a AVC e encefalopatia. Além disso, doenças neurológicas prévias podem exigir tratamento especial e estar associadas a piores desfechos. Não obstante, o papel dos neurologistas na COVID-19 é provavelmente pouco reconhecido. Objetivo: O objetivo deste estudo foi relatar os motivos para solicitar consultas neurológicas por clínicos e intensivistas em um hospital dedicado à COVID-19. Métodos: Estudo retrospectivo realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brasil, um centro dedicado à COVID-19 com 900 leitos (incluindo 300 leitos para unidades de terapia intensiva). O diagnóstico de COVID-19 foi confirmado por SARS-CoV-2-RT-PCR em swabs nasais. Todas as interconsultas de neurologia hospitalar entre 23 de março e 23 de maio de 2020 foram analisadas. Os neurologistas realizaram o exame neurológico, avaliaram todos os dados disponíveis para diagnosticar a patologia neurológica e solicitaram exames adicionais conforme necessidade. Diagnósticos difíceis foram estabelecidos em reuniões de consenso. Após o diagnóstico, os neurologistas participaram da condução dos casos. Resultados: Foram solicitadas consultas neurológicas para 89 de 1.208 (7,4%) em pacientes internados por COVID-19 durante o período. Os principais diagnósticos neurológicos incluíram: encefalopatia (44,4%), acidente vascular cerebral (16,7%), doenças neurológicas prévias (9,0%), crises epilépticas (9,0%), transtornos neuromusculares (5,6%), outras lesões encefálicas agudas (3,4%) e outros sintomas leves inespecíficos (11,2%). Conclusões: A maioria das consultas neurológicas em um hospital dedicado à COVID-19 foi solicitada para condições graves que poderiam afetar o desfecho clínico. Os médicos na linha de frente devem ser capazes de reconhecer sintomas neurológicos. Os neurologistas são membros importantes da equipe médica no atendimento hospitalar à COVID-19.


Subject(s)
Humans , Pneumonia, Viral/diagnosis , Referral and Consultation/statistics & numerical data , Coronavirus Infections/diagnosis , Pandemics , Nervous System Diseases/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Brazil/epidemiology , Retrospective Studies , Coronavirus Infections , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Betacoronavirus , Hospital Bed Capacity , Hospitals, University , Nervous System Diseases/diagnosis , Nervous System Diseases/therapy , Neurology
3.
Arq. bras. neurocir ; 37(4): 285-290, 15/12/2018.
Article in English | LILACS | ID: biblio-1362679

ABSTRACT

Objective To present the functional outcomes of distal nerve transfer techniques for restoration of elbow flexion after upper brachial plexus injury. Method The files of 78 adult patients with C5, C6, C7 lesions were reviewed. The attempt to restore elbow flexion was made by intraplexus distal nerve transfers using a fascicle of the ulnar nerve (group A, n » 43), or a fascicle of themedian nerve (group B, n » 16) or a combination of both (group C, n » 19). The result of the treatment was defined based on the British Medical Research Council grading system: muscle strength < M3 was considered a poor result. Results The global incidence of good/excellent results with these nerve transfers was 80.7%, and for different surgical techniques (groups A, B, C), it was 86%, 56.2% and 100% respectively. Patients submitted to ulnar nerve transfer or double transfer (ulnar þ median fascicles transfer) had a better outcome than those submitted to median nerve transfer alone (p < 0.05). There was no significant difference between the outcome of ulnar transfer and double transfer. Conclusion In cases of traumatic injury of the upper brachial plexus, good and excelent results in the restoration of elbow flexion can be obtained using distal nerve transfers.


Subject(s)
Ulnar Nerve/transplantation , Nerve Transfer/rehabilitation , Nerve Transfer/statistics & numerical data , Elbow Joint , Median Nerve/transplantation , Medical Records , Data Interpretation, Statistical , Nerve Transfer/methods , Statistics, Nonparametric , Brachial Plexus Neuropathies/surgery
4.
Arq. neuropsiquiatr ; 75(11): 796-800, Nov. 2017. tab, graf
Article in English | LILACS | ID: biblio-888274

ABSTRACT

ABSTRACT Objective: Restoration of the sensitivity to sensory stimuli in complete brachial plexus injury is very important. The objective of our study was to evaluate sensory recovery in brachial plexus surgery using the intercostobrachial nerve (ICBN) as the donor. Methods: Eleven patients underwent sensory reconstruction using the ICBN as a donor to the lateral cord contribution to the median nerve, with a mean follow-up period of 41 months. A protocol evaluation was performed. Results: Four patients perceived the 1-green filament. The 2-blue, 3-purple and 4-red filaments were perceptible in one, two and three patients, respectively. According to Highet's scale, sensation recovered to S3 in two patients, to S2+ in two patients, to S2 in six patients, and S0 in one patient. Conclusion: The procedure using the ICBN as a sensory donor restores good intensity of sensation and shows good results in location of perception in patients with complete brachial plexus avulsion.


RESUMO Objetivo: A restauração da sensibilidade em pacientes com lesão completa do plexo braquial é muito importante. O objetivo desse estudo foi avaliar a recuperação sensitiva em cirurgia do plexo braquial utilizando o nervo intercostobraquial (NICB) como doador. Métodos: Onze pacientes foram submetidos a reconstrução sensitiva usando o NICB como doador para a contribuição lateral do nervo mediano, com tempo de acompanhamento pós-operatório médio de 41 meses. Um protocolo de avaliação foi realizado. Resultados: Quatro pacientes perceberam o filamento 1-verde. Os filamentos 2-azul, 3-roxo e 4-vermelho foram percebidos por um, dois e três pacientes, respectivamente. Um paciente não apresentou recuperação sensitiva. Dois pacientes obtiveram recuperação S3, dois S2+, seis S2 e um S0, pela escala de Highet. Conclusão: O procedimento usando o NICB como doador promove boa intensidade de recuperação sensitiva e bons resultados são obtidos quanto ao local de percepção em pacientes com avulsão completa do plexo braquial.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Brachial Plexus/surgery , Brachial Plexus/injuries , Nerve Transfer/methods , Hand/surgery , Intercostal Nerves/transplantation , Prospective Studies , Follow-Up Studies , Treatment Outcome , Recovery of Function , Hand/physiology , Nerve Regeneration
5.
Arq. neuropsiquiatr ; 75(9): 667-670, Sept. 2017. graf
Article in English | LILACS | ID: biblio-888326

ABSTRACT

ABSTRACT The treatment of complete post-traumatic brachial plexus palsy resulting in a flail shoulder and upper extremity remains a challenge to peripheral nerve surgeons. The option of upper limb amputation is controversial and scarcely discussed in the literature. We believe that elective amputation still has a role in the treatment of select cases. The pros and cons of the procedure should be intensely discussed with the patient by a multidisciplinary team. Better outcomes are usually achieved in active patients who strongly advocate for the procedure.


RESUMO O tratamento das paralisias completas após lesões traumáticas do plexo braquial que resultam em um membro superior completamente paralisado permanecem como um desafio aos cirurgiões de nervos periféricos. A opção de amputar o membro superior é controversa e raramente discutida na literatura. Acreditamos que a amputação eletiva ainda tem utilidade no tratamento de casos selecionados. Os prós e contras do procedimento devem ser intensamente discutidos com o paciente por uma equipe multidisciplinar. Os melhores resultados são geralmente obtidos em pacientes atuantes que reivindicam vigorosamente o procedimento.


Subject(s)
Humans , Male , Arm/surgery , Brachial Plexus/surgery , Plastic Surgery Procedures/methods , Amputation, Surgical/methods , Pain Measurement , Brachial Plexus/injuries , Elective Surgical Procedures , Brachial Plexus Neuropathies , Upper Extremity
7.
Arq. neuropsiquiatr ; 73(9): 803-808, Sept. 2015. ilus
Article in English | LILACS | ID: lil-757397

ABSTRACT

Neonatal brachial plexus palsy (NBPP) has an incidence of 1.5 cases per 1000 live births and it has not declined despite recent advances in obstetrics. Most patients will recover spontaneously, but some will remain severely handicapped. Rehabilitation is important in most cases and brachial plexus surgery can improve the functional outcome of selected patients. This review highlights the current management of infants with NBPP, including conservative and operative approaches.


A paralisia neonatal do plexo braquial (PNPB) tem uma incidência de 1,5 casos por 1000 nascidos vivos e não tem diminuído a despeito dos recentes avanços em obstetrícia. A maioria dos pacientes recupera-se espontaneamente, mas alguns permanecerão com sequelas graves. A reabilitação é importante na maioria dos casos e a cirurgia do plexo braquial pode melhorar o resultado funcional em pacientes selecionados. Esta revisão destaca o manejo atual de lactentes com PNPB, incluindo as terapêuticas conservadora e cirúrgica.


Subject(s)
Humans , Infant, Newborn , Brachial Plexus Neuropathies/diagnosis , Brachial Plexus Neuropathies/therapy , Prognosis , Risk Factors , Severity of Illness Index
8.
Arq. neuropsiquiatr ; 71(10): 811-814, out. 2013. graf
Article in English | LILACS | ID: lil-689789

ABSTRACT

Traumatic peripheral nerve injury is a dramatic condition present in many of the injuries to the upper and lower extremities. An understanding of its physiopathology and selection of a suitable time for surgery are necessary for proper treatment of this challenging disorder. This article reviews the physiopathology of traumatic peripheral nerve injury, considers the most used classification, and discusses the main aspects of surgical timing and treatment of such a condition.


Traumatismos dos nervos periféricos resultam em lesões incapacitantes e estão presentes em muitas das lesões dos membros. A compreensão da fisiopatologia dessas lesões e a seleção do momento operatório mais adequado são imprescindíveis para que o tratamento seja adequado. Neste artigo revisamos a fisiopatologia das lesões traumáticas dos nervos periféricos, apresentamos a classificação mais utilizada dessas lesões e discutimos os principais aspectos relacionados ao momento da cirurgia e às formas de reparo cirúrgico.


Subject(s)
Humans , Peripheral Nerve Injuries/surgery , Medical Illustration , Peripheral Nerve Injuries/classification , Recovery of Function , Time Factors , Wounds, Nonpenetrating/surgery , Wounds, Penetrating/surgery
9.
Arq. neuropsiquiatr ; 71(6): 397-404, jun. 2013.
Article in English | LILACS, SES-SP, HANSEN, HANSENIASE, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: lil-677599

ABSTRACT

The authors proposed a systematic review on the current concepts of primary neural leprosy by consulting the following online databases: MEDLINE, Lilacs/SciELO, and Embase. Selected studies were classified based on the degree of recommendation and levels of scientific evidence according to the “Oxford Centre for Evidence-based Medicine”. The following aspects were reviewed: cutaneous clinical and laboratorial investigations, i.e. skin clinical exam, smears, and biopsy, and Mitsuda's reaction; neurological investigation (anamnesis, electromyography and nerve biopsy); serological investigation and molecular testing, i.e. serological testing for the detection of the phenolic glycolipid 1 (PGL-I) and the polymerase chain reaction (PCR); and treatment (classification criteria for the definition of specific treatment, steroid treatment, and cure criteria).

.

Os autores propuseram-se a realizar uma revisão sistemática em conceitos atuais sobre a hanseníase neural primária, consultando as seguintes bases bibliográficas on-line: MEDLINE, Lilacs/SciELO e Embase. Os estudos selecionados foram classificados conforme o grau de recomendação e o nível de evidência científica de acordo com o “Oxford Centre for Evidence-based Medicine”. Os seguintes temas foram revisados: investigações clínica e laboratorial cutâneas, ou seja, exame, esfregaço e biópsia de pele e reação de Mitsuda; investigação neurológica (anamnese, eletroneuromiografia e biópsia de nervo); investigação sorológica e testes moleculares, ou seja, testes sorológicos para detecção de um glicolipídio fenólico e reação de cadeia de polimerase (PCR) e tratamento (critérios de classificação para definição de tratamento específico, tratamento com esteroides e critérios de cura).

.


Subject(s)
Humans , Leprosy, Tuberculoid/diagnosis , Leprosy, Tuberculoid/therapy , Biopsy/methods , Diagnosis, Differential , Evidence-Based Medicine , Leprosy, Tuberculoid/physiopathology , Neural Conduction/physiology , Neurons/pathology , Sensitivity and Specificity , Skin/pathology
10.
Arq. neuropsiquiatr ; 70(5): 330-334, May 2012. graf, tab
Article in English | LILACS | ID: lil-622572

ABSTRACT

Diabetic polyneuropathy can be confirmed by nerve conduction studies. The data can be analyzed in the form of a combined index instead of individual parameters. METHODS: The combined index included five parameters of nerve conduction studies commonly used for evaluation of polyneuropathies. We evaluated sensitivity in 100 diabetic patients with suspected polyneuropathy, and specificity in 200 non-diabetic patients with suspected lumbosacral radiculopathy. All results were expressed in number of standard deviations (SD). RESULTS: The sensitivity of the combined index was 81 or 74%, and specificity was 97 or 98%, using respectively -2.0 or -2.5 SD as cutoff. The range of sensitivity of the other parameters was 57-65% or 48-56%, and specificity range was 96-98% or 98-100%, using the same criteria. DISCUSSION: The combined index had higher sensitivity and equivalent specificity compared to isolated parameters.


A polineuropatia diabética pode ser confirmada por estudos de condução nervosa. Os dados podem ser analisados por um índice combinado ao invés de parâmetros isolados. MÉTODOS: O índice combinado incluiu cinco parâmetros usados rotineiramente na avaliação de polineuropatias. Avaliamos a sensibilidade em 100 pacientes diabéticos com suspeita de polineuropatia e a especificidade em 200 pacientes não diabéticos com suspeita de radiculopatia lombossacral. Todos os resultados foram expressos em número de desvios-padrão (DP). RESULTADOS: A sensibilidade do índice combinado foi 81 ou 74%, e a especificidade foi 97 ou 98%, usando respectivamente -2,0 ou -2,5 DP como ponto de corte. A sensibilidade dos parâmetros isolados oscilou entre 57-65% ou 48-56%, e a especificidade foi 96-98% ou 98-100%, usando os mesmos critérios. DISCUSSÃO: O índice combinado apresentou melhor sensibilidade e especificidade equivalente aos parâmetros isolados.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Diabetic Neuropathies/diagnosis , Neural Conduction/physiology , Peripheral Nerves/physiopathology , Case-Control Studies , Diabetic Neuropathies/physiopathology , Electrophysiology , Electrodiagnosis/instrumentation , Electrodiagnosis/methods , Retrospective Studies , Sensitivity and Specificity
11.
Arq. neuropsiquiatr ; 69(4): 666-669, Aug. 2011. ilus
Article in English | LILACS | ID: lil-596834

ABSTRACT

Lesions of lumbar plexus are uncommon and descriptions of surgical access are derived from vertebral spine approaches. METHOD: The extraperitoneal anterolateral approach to the lumbar plexus was performed in six adult fresh cadavers. The difficulties on dissection were related. RESULTS: An exposure of all distal elements of lumbar plexus was possible, but a cranial extension of the incision was needed to reach the iliohypogastric nerve in all cases. Ligation of vessels derived from common iliac artery was necessary for genitofemoral and obturator nerves exposure in two cases. The most proximal part of the lumbar roots could be identified only after dissection and clipping of most lumbar vessels. CONCLUSION: The extraperitoneal anterolateral approach allows appropriate exposure of terminal nerves of lumbar plexus laterallly to psoas major muscle. Cranial extension of the cutaneous incision may be necessary for exposure of iliohypogastric nerve. Roots exposure increases the risk of vascular damage.


As lesões do plexo lombar são incomuns e as descrições dos acessos cirúrgicos são derivadas de vias de acesso à coluna vertebral. MÉTODO: A via extraperitoneal anterolateral foi realizada em seis cadáveres para o acesso ao plexo lombar. Eventuais dificuldades na dissecção foram relatadas. RESULTADOS: Tal acesso permitiu a exposição dos elementos distais do plexo lombar, mas uma extensão cranial da incisão foi necessária para a exposição do nervo iliohipogástrico. Para a exposição dos nervos genitofemoral e obturador houve a necessidade da ligadura de vasos originados da artéria ilíaca comum em 2 casos. As raízes foram identificadas somente após dissecção e ligadura dos vasos lombares. CONCLUSÃO: O acesso anterolateral extraperitoneal permite uma exposição adequada dos nervos terminais do plexo lombar lateralmente ao músculo psoas maior. Uma extensão cranial da incisão pode ser necessária para exposição do nervo iliohipogástrico. A exposição das raízes implica em maior risco de lesão vascular.


Subject(s)
Aged , Humans , Middle Aged , Lumbosacral Plexus/anatomy & histology , Cadaver , Lumbosacral Region/anatomy & histology , Lumbosacral Region/innervation , Lumbosacral Region/surgery , Psoas Muscles/innervation , Psoas Muscles/surgery
12.
São Paulo; s.n; 2007. 235 p. ilus, tab, graf.
Thesis in Portuguese | LILACS | ID: lil-464476

ABSTRACT

Realizamos estudos de condução motora em 54 pacientes com plexopatia braquial obstétrica entre 10 e 60 dias de vida. Comparamos lado a lado as amplitudes dos potenciais de ação musculares compostos (PAMC) dos nervos axilar, musculocutâneo, radial (proximal e distal), mediano e ulnar. A relação entre a amplitude do PAMC do lado lesado sobre o lado são foi chamada de “Índice de Viabilidade Axonial” (IVA). Os pacientes foram classificados de acordo com a evolução clínica. O IVA correlacionou-se com o prognóstico, tendo apresentado especificidade superior e sensibilidade equivalente ao critério clínico de Gilbert (ausência de função bicipital aos 3 meses de vida) e, portanto, pode ser útil na indicação cirúrgica destes casos...


We performed motor nerve conduction studies in 54 patients with obstetric brachial plexopathy from 10 to 60 days of life. We compared side-to-side the compound muscle action potentials (CMAP) amplitudes from the axillary, musculocutaneous, radial (proximal and distal), median and ulnar nerves. The ratio between the CMAP amplitude of the affected limb and the healthy side was called “Viability Axonal Index” (VAI). We classified the patients according to the clinical evolution. The VAI correlated with the prognosis, with a better specificity and equivalent sensibility to the Gilbert’s clinical criterion (absence of biceps function at 3 months of age), therefore, it could be used for indication of surgery in these patients...


Subject(s)
Humans , Infant, Newborn , Infant , Brachial Plexus Neuropathies , Neural Conduction , Paralysis, Obstetric , Prognosis
13.
Arq. neuropsiquiatr ; 54(1): 42-6, mar. 1996. graf
Article in English | LILACS | ID: lil-164052

ABSTRACT

Forty-eight patients with partial seizures were analysed during treatment with 1200 mg/d or more of carabamazepine (CBZ). Thirty-three were on monotherapy and fifteen on polytherapy. The other drugs, were kept unchanged in the patients on polytherapy. The dose of CBZ was increased if no control was observed and the patient had no side effects. The doses used ranged between 1200 and 1900 mg/day 91200 mg/day, n=18; 1300 mg/day, n=l: 1400 mg/day, n=7: 1600 mg/day, n=9; 1700 mg/day, n=4; 1800 mg/day, n=8; 1900 mg/day, n=1). Anticonvulsant plasma levels were taken to confirm patient compliance. The average plasma level was 9.6 ug/mL. The period of follow up varied from 3 to 96 months (M=25,6). Seizure's control was observed in 7 (14.48 per cent) patients taking 1200 mg/day and in 2 (4.16 per cent patients taking 1400 mg/day of CBZ. Thirty-nine patients did not show any control (81.21 per cent). Ten patients (20.81 per cent) had signs of intoxication. When patients have no improvement with 1400 mg/day, it is difficult to obtain any control despite the use of higher doses of CBZ, which frequently expose the patient to signiflcant side effects.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Carbamazepine/administration & dosage , Epilepsies, Partial/drug therapy , Anticonvulsants/adverse effects , Anticonvulsants/blood , Anticonvulsants/therapeutic use , Carbamazepine/blood , Epilepsy, Complex Partial/drug therapy , Treatment Outcome
14.
Arq. neuropsiquiatr ; 53(4): 719-23, dez. 1995. graf
Article in English | LILACS | ID: lil-161574

ABSTRACT

Oitocentos e noventa e quatro epiléticos adultos tratados no período de 1983 a 1992 foram estudados retrospectivamente. Valores anormais de enzimas foram detectados em 49 por cento (n=438) dos casos. Em 200 pacientes (22.3 por cento), ao menos duas dosagens obtidas em momentos diferentes estavam alteradas. Estes últimos foram divididos em 3 grupos: GI, com alteraçoes de transaminases (3 por cento, n=6); GII com alteraçoes de gama-glutamil-tranferase (GGT) e fosfatase alcalina (AP) (72 por cento, n=144) e GIII com alteraçoes nos dois grupos de enzimas (25 por cento, n=50). Nenhum paciente desenvolveu sinais ou sintomas de doença hepática. O aumento de GGT e AP em pacientes em uso de drogras atiepiléticas é frequente e pode nao ter significado patológico. Pequenos aumentos de transaminases também podem ocorrer sem correçao clínica.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Anticonvulsants/therapeutic use , Epilepsy/enzymology , Liver/enzymology , Alanine Transaminase/blood , Alkaline Phosphatase/blood , Aspartate Aminotransferases/blood , Epilepsy/drug therapy , Follow-Up Studies , gamma-Glutamyltransferase/blood , Retrospective Studies
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