The myofascial component of the pain in the painful shoulder of the hemiplegic patient

OBJECTIVES: Poststroke shoulder pain occurs very frequently and compromises function and quality of life. Because treatment depends on a multidisciplinary approach, it is desirable to optimize effectiveness. Myofascial pain syndrome is defined by the presence of trigger points that can also be found in spastic stroke patients. The aim of this study was to evaluate the frequency of myofascial pain in the shoulder girdle muscles in patients with poststroke shoulder pain and to document the clinical and functional results obtained with specific treatment for this condition. METHODS: Spastic stroke hemiplegic patients undergoing rehabilitation at the Rehabilitation Center of the Hospital das Clínicas of the Ribeirão Preto Medical School of the University of São Paulo were evaluated regarding the intensity and characteristics of shoulder pain, previous therapeutic interventions, shoulder goniometry and the presence of trigger points. Patients underwent trigger point blockade by intramuscular infiltration of 1% lidocaine. The evaluation and treatment procedures were repeated in the subsequent 3 weeks as long as the pain intensity was greater than 5 on a visual analog scale (VAS). In the fourth week, the evaluation procedures were repeated. Patients who were in a multiprofessional rehabilitation program were instructed to continue the treatment, and the others received complementary therapeutic advice if necessary to initiate it. The evaluations were performed at 0, 1, and 3 weeks and after 4 months. RESULTS: Twenty-one patients (13 men; age=67.8±10.2 years; right hemiparesis: 11) participated in the study, and there was a reduction in pain assessed by VAS from baseline (7.6±2.7) to the first week (5.8±3.6; p<0.05) through the end of the third week (5.2±3.5; p<0.05), but not at the end of four months (6.6±2.9; p=0.11). Good responders had significantly lower pain levels after the third week and presented with a larger range of motion for passive abduction by the end of 4 months. These results demonstrate that the myofascial component of pain should be considered in poststroke shoulder pain and that its treatment may be a pathway for the rapid and long-lasting relief of symptoms. CONCLUSION: Trigger point blockade with lidocaine can reduce pain perception in spastic hemiplegic shoulder in as much as 50% of stroke survivors for four months.

Trombosis venosa cerebral asociada a consumo de sildenafil / Cerebral venous thrombosis associated with sildenafil intake

Se presentó un paciente masculino de 59 años de edad, con antecedentes de hipertensión arterial y consumo regular de sildenafil, que ingresó en el servicio de ictus por presentar convulsión aguda y cefalea. Al examen físico se detectó hemiplejia izquierda. Mediante resonancia magnética nuclear de cráneo, con gadolinio se observó lesión expansiva que captó contraste de forma heterogénea. Se planteó el diagnóstico de posible glioma cerebral de alto grado. Se realizó craneotomía frontoparietal derecha y no se visualizó lesión tumoral. Después de descartar la presencia de un glioma de alto grado se valoró el diagnóstico de infarto venoso hemorrágico. Se efectuó angioTAC y estudio de trombofilia para descartar estados protrombóticos que justificaran dicha entidad nosológica. Los estudios de hematología especial se encontraron dentro de valores normales. Se concluyó el caso como una trombosis de senos venosos asociada al consumo de sildenafil(AU)

A 59 year-old male patient with a history of hypertension and regular consumption of sildenafil entered the service because of acute stroke and headache seizure. Physical examination detected left hemiplegia. By skull nuclear gadolinium magnetic resonance, an expansive lesion is observed which caught heterogeneously contrast. Possible diagnosis of high-grade brain glioma was raised. Right frontoparietal craniotomy was performed and a tumor lesion was not visualized. After ruling out the presence of high-grade glioma, the diagnosis of hemorrhagic venous infarction was assessed. CT angiography and clotting was made to rule out prothrombotic states to justify this disease entity. Special hematology studies were within normal values. The case was concluded as a venous sinus thrombosis associated with the use of sildenafil(AU)

Effects of early spasticity treatment on children with hemiplegic cerebral palsy: a preliminary study / Efeitos do tratamento precoce da espasticidade em criancas com paralisia cerebral hemiplegica: um estudo preliminar

Objective To compare motor and functional performance of two groups of children with hemiplegic cerebral palsy (HCP). Only the study group (SG) received early treatment of spasticity with botulinum neurotoxin type A (BXT-A). Methods Gross Motor Function Measure (GMFM), functional performance (Pediatric Evaluation of Disability Inventory - PEDI), range of movement, gait pattern (Physician Rating Scale - PRS) and the speed of hand movements were considered. Results The SG, composed of 11 HCP (45.64±6.3 months), was assessed in relation to the comparison group, composed of 13 HCP (45.92±6.4 months). SG showed higher scores in four of the five GMFM dimensions, which included scores that were statistically significant for dimension B, and higher scores in five of the six areas evaluated in the PEDI. Active wrist extension, the speed of hand movements and PRS score were higher in the SG. Conclusion Children who received early BXT-A treatment for spasticity showed higher scores in motor and functional performance. .

Objetivo Comparar a performance motora e funcional de dois grupos de crianças com paralisia cerebral hemiplégica (PCH). Apenas o grupo de estudo (GE) recebeu tratamento precoce da espasticidade com toxina botulínica do tipo A (BXT-A). Métodos Foram considerados a Função Motora Grossa (Gross Motor Function Measure - GMFM), performance funcional (Pediatric Evaluation of Disability Inventory - PEDI), amplitude de movimento, padrão da marcha (Physician Rating Scale - PRS) e a velocidade de movimento das mãos. Resultados O GE, composto de 11 PCH (45,64±6,3 meses), foi analisado em relação ao grupo de comparação, composto por 13 PCH (45,92±6,4 meses). O GE mostrou maiores escores em quatro das cinco dimensões da GMFM, sendo a diferença estatisticamente significativa na dimensão B, e melhores escores em cinco das seis áreas avaliadas na PEDI. A extensão ativa do punho, a velocidade de movimento das mãos e o escore na PRS foram maiores no GE. Conclusão As crianças que receberam tratamento precoce da espasticidade com BXT-A mostraram melhores escores motores e funcionais. .

Hemiplegia alternante da criança: Relato de caso / Alternating hemiplegia of childhood: Case report

É apresentado um caso de hemiplegia alternante da criança com 13 anos que se iniciou mais tardiamente que o habitual. A evolução clínica sugere, contudo, tratar-se da hemiplegia alternante benigna da infância. O tratamento com flunarizina foi benéfico ao paciente.

Effective newline of Unani treatment for hemiplegia

Falij-e-Nisfi or Hemiplegia refers to the paralysis of one side of the body, which is caused by an occlusion of vessels by Ghair-e-Tabayee Balgham [abnormal phlegm] as explained by Unani System of Medicine. According to modern medical system it is caused by an interruption of blood supply to a part of the brain, which controls body movements. This devastating illness afflicts the people and leaves them severely disabled for the rest of their lives, causing a major burden on the family and the community. Most of these patients are seeking herbal treatment because of their faith orientated cultural medical system which is still providing promising result. However, this promising result is considered either due to therapeutic effect or natural recovery. The recovery of the disease to the conventional therapy, which is practiced for many centuries, seems to be very slow. Therefore, it is a need to develop a new line of Unani treatment that could effectively treat this condition with speedy recovery. In this study, 120 hemiplegia patients of both sexes, ages ranging from 35 years to 75 years, with severe weakness of motor power were divided into two equal groups and one group was treated with the new line of Unani treatment and the other was with the standard conventional therapy. The CT Scans of the patients' brain were performed for the accurate diagnosis of the etiological factors and to establish a correlation between the aetiological factors and risk factors. The patients showed extremely good response to the new line of Unani treatment in just 60 days of treatment. The incidence of cerebral infarction and haemorrhage showed an increase with the severity of systolic pressure. The new line of Unani treatment was found very safe as well as effective

Hemiplegia alternante da infância: relato de caso / Alternating hemiplegia of childhood: case report

A hemiplegia alternante da infância é uma condiçao muito rara, de causa desconhecida, caracterizada por déficit dimidiado alternante ou mesmo tetraplegia, cujas crises iniciam antes dos 18 meses de idade. Estas manifestaçoes sao episódicas e, freqüentemente, associadas a nistagmo, paralisias oculares transitórias, disfunçao do sistema nervoso autônomo, dispnéia, envolvimento cognitivo, distonia e coreoatetose. A investigaçao laboratorial desta síndrome nao tem evidenciado uma etiologia definida, embora existam possibilidades de uma relaçao com enxaqueca. No presente trabalho, o autor relata um caso e sua resposta ao tratamento com flunarizina.