ABSTRACT
Resumen La exploración neurológica (EN) es la herramienta clínica más importante con que se cuenta en medicina para la detección y diagnóstico de las enfermedades del sistema nervioso. Como en muchas áreas de la medicina, la integración de los datos clínicos obtenidos mediante la EN con los conocimientos neuroanatómicos y neurofisiológicos resulta de vital importancia para la correcta interpretación de la EN. Para el estudiante de medicina, con frecuencia la EN, y en general las materias relacionadas con las neurociencias, son conceptualizadas como muy extensas, difíciles y áridas, por lo que resulta importante realizar de manera sencilla la enseñanza de las distintas disciplinas neurocientíficas al estudiante de medicina y al médico en general. En este sentido, el objetivo del presente artículo es proponer un esquema para la realización de una exploración neurológica básica (ENB) que le permita al médico de primer contacto identificar eficazmente posibles alteraciones neurológicas (sobre todo las más frecuentes o graves), para así poder brindar un tratamiento inicial adecuado o establecer criterios de referencia oportuna a otro nivel de atención.
Abstract The neurological examination (NE) is the most important clinical tool in medicine for the detection and diagnosis of nervous system diseases. In several medical areas, the integration of clinical data with neuroanatomical and neurophysiological knowledge is of vital importance for the correct utilization and interpretation of NE. Frequently for the medical students, the NE and other subjects related to neuroscience are conceptualized as lengthy, difficult and boring; so it is important to teach these subjects to the medical students and general practitioners in a simple and comprehensive manner. Hence, the main objective of this paper is to propose a scheme for performing a basic neurological examination (BNE) that will allow the primary care physician to readily identify possible neurological disorders (especially the most frequent or severe), in order to provide adequate initial treatment or establish opportune reference criteria to another level of medical assistance.
ABSTRACT
BACKGROUND AND OBJECTIVES: Verbal investigation is a critical step of nursing neurological evaluation of neuropathic pain patients, due to its multidimensionality. There are few studies in the literature specifically dealing with this subject. In light of the above, this study aimed at evaluating medical records on clinical topographic characteristics of neuropathic pain reported by patients from a multidisciplinary management center. METHODS: This is a documental, crossover and quantitative study evaluating 50 medical records of patients with established neuropathic pain diagnosis who came for routine consultations between January and June 2014. Data collection form was based on McGill Pain Questionnaire and data regarding age, gender, pain topography and presence of verbal descriptors were analyzed. Data were submitted to statistical analysis and Chi-square test was applied to compare association among variables. RESULTS: There has been prevalence of females (64%), with mean age of 57 years. Most common pain descriptors were from the sensory dimension and were associated to cases where neuropathy affected lower limbs (p=0.006). CONCLUSION: There has been association between topography and pain dimension. Due to the subjectivity and complexity involving neuropathic pain evaluation, it is necessary to understand its clinical manifestations and to prepare the whole multidisciplinary team, especially Nursing, which plays a critical role in verbal investigation of painful patients. .
JUSTIFICATIVA E OBJETIVOS: A investigação verbal é uma etapa fundamental do exame neurológico do enfermeiro na avaliação do paciente com dor neuropática, dada à sua multidimensionalidade. Na literatura, poucos são os trabalhos que lidam especificamente com esse tema. Diante disso, o objetivo deste estudo foi analisar registros em prontuários sobre as características clínico-topográficas da dor neuropática relatadas por pacientes de um centro de tratamento multidisciplinar. MÉTODOS: Estudo documental, transversal, de natureza quantitativa. Analisaram-se 50 prontuários de pacientes com diagnóstico estabelecido de dor neuropática que compareceram para consultas de rotina entre janeiro e junho de 2014. Utilizou- -se formulário para coleta de dados baseado no Questionário de Dor McGill e foram analisados dados referentes a idade, gênero, topografia da dor e presença de descritores verbais. Os dados foram submetidos a análise estatística e aplicou-se teste de Qui- -quadrado para comparar a associação entre as variáveis. RESULTADOS: Prevaleceram pacientes do gênero feminino (64%), com média de 57 anos. Os descritores de dor mais citados foram da dimensão sensorial e se associaram aos casos em que a neuropatia atingia os membros inferiores (p=0,006). CONCLUSÃO:: Foi observada uma associação entre topografia e dimensão da dor. Em virtude da subjetividade e complexidade que envolvem a avaliação da dor neuropática, faz-se necessário o conhecimento das suas manifestações clínicas e o preparo de toda a equipe multidisciplinar, sobretudo da Enfermagem, que desempenha papel fundamental na condução da investigação verbal do paciente com dor. .
ABSTRACT
[Objective] To evaluate the therapeutic effect of early composite treatment in patients with cervical spinal cord injury(SCI) caused by diving injury.[Method]27 patients of SCI caused by diving injury,including complete SCI in 15 patients and incomplete SCI in 12 patients,were analyzed.Early composite treatment scheme were as follows:(1) systemic treatment: respiratory support and effective circulation volume for maintenance of systolic pressure more than 90mmHg and oxygen saturation more than 90%.(2) Early pharmacological treatment such as methylprednisolone and dexamethasone.(3) Immobilization and reduction of the injured cervical spine by skull traction.(4) Early cervical decompression,reduction,graft and internal fixation.(5) Early hyperbaric oxygen therapy after operation.The stability and fusion of the injured segments and the complications of the hardware were observed on the X-ray film postoperatively.The spinal cord function was evaluated with ASIA grades and sensorymotor scores.[Result]All 27 patients were followed up for 12 to 36 months,with an average of 28 months.No intra-operative and post-operative complications,the incision healed well.The injured segments were stable and all bone grafts acquired fusion in 3 months,no plates or screws broken or loosen.The neurological recovery were detected in 13 patients.The neurological recovery rate was 20% in complete SCI,83.3% in incomplete SCI,48.1% in the total.The ASIA grades of the sensory and motor scores could hardly be improved postoperatively in complete spinal cord injury while in incomplete spinal cord injury the ASIA grades and sensorymotor scores increased significantly.[Conclusion]Early composite treatment of cervical spinal cord injury caused by diving injury can significantly improve neurological function of the cervical spinalcord injury patients.