Pattern and determinants of outcomes of neurological emergencies admitted into children emergency ward in a tertiary hospital in Port Harcourt, Nigeria

Neurological emergencies are life-threatening central nervous system disorders, significantly contributing to childhood morbidity and mortality. The sequelae may be irreversible and may impact negatively on the quality of life of affected children and their families. This study identified the morbidity pattern and determinants of the outcomes of children with neurological emergencies in the Children Emergency Room (CHER) of the Rivers State University Teaching Hospital (RSUTH). Method: A 4-year retrospective study was carried out in the CHER. Data on demography, diagnosis and outcomes of children with neurological disorders were extracted from the records. Data analysed with SPSS 24 were expressed in percentages and frequency tables. Results: Of the 3040 children admitted in the CHER, 364(12%) aged 0-15 years had neurological emergencies, commoner among males (59.3%) and children aged less than five years (70.9%). Meningitis (40.2%) and febrile convulsion (28.2%) were the topmost diagnoses made. Raised intracranial pressure (17.4%) and head injuries (25.5%) were significantly more prevalent among children aged five years and above. The mortality rate was 61(16.8%) and more among adolescents (30.6%). All the mortalities took place within the first 48hours of admission especially among those with head injuries (46.5%) and perinatal asphyxia (95%), (p < 0.05). Conclusion: Meningitis and febrile convulsion were the commonest neurologic emergencies seen in this study. Mortality rate was high, especially in the first 48 hours of admission and mainly from perinatal asphyxia and head injuries. Education on the prevention and management of neurologic emergencies should be strengthened

Impacto da aplicação de diretrizes na solicitação de tomografia computadorizada de crânio em traumatismo cranioencefálico leve: revisão sistemática / Impact of application of guidelines on the utilization of head computed tomography in minor head injury: systematic review

A tomografia computadorizada (TC) é exame de escolha para rastreamento de lesões no traumatismo cranioencefálico (TCE). Apesar disso, seu uso rotineiro no TCE leve é controverso O objetivo desta revisão foi avaliar o impacto da aplicação de diretrizes de manejo e conduta de TCE leve quanto à solicitação de TC de crânio. É busca realizada nas bases de dados LILACS, Medline, PubMed, SciELO, utilizando descritores do MeSH e DeCS. A busca inicial identificou 30.191 artigos. Após remoção de publicações duplicadas, seleção pelo título, seleção pelo resumo, restaram 25 publicações, que foram lidas na íntegra e cinco incluídas na presente revisão sistemática. Em conclusão, os artigos analisados apresentaram, em média, redução de 25,8% na solicitação de TC de crânio quando aplicadas as diretrizes, e orientam que protocolos para TCE leve são ferramentas eficientes para auxiliar a prática médica, impactando positivamente quando aplicados na população, devendo sempre ser levado em conta a avaliação clínica.

Computed tomography (CT) is the exam of choice for tracking injuries in traumatic brain injury (TBI). Despite this, its routine use in mild TBI is controversial. The objective of this review was to evaluate the impact of applying guidelines for the management and conduct of mild TBI on the request for CT of the head. A search was carried out in the LILACS, Medline, PubMed, SciELO databases, using MeSH and DeCS descriptors. The initial search identified 30,191 articles. After removal of duplicate publications, selection by title, selection by abstract, 25 publications remained, which were read in full and five were included in this systematic review. In conclusion, the articles analyzed showed, on average, a 25.8% reduction in the request for cranial CT when the guidelines were applied, and guide that protocols for mild TBI are efficient tools to assist medical practice, positively impacting when applied to the population. , and clinical evaluation should always be taken into account.

Desarrollo motor de una cohorte retrospectiva de niños colombianos de hasta un año de edad corregida, según la escala motora infantil de Alberta / Corrected motor development in a retrospective cohort of Colombian children of up to one year of age according to the Alberta Infant Motor Scale / Desenvolvimento motor de uma coorte retrospectiva de crianças colombianas até um ano de idade corrigida, de acordo com a Alberta Children's Motor Scale

RESUMEN Objetivos La escala motora infantil de Alberta (escala de Alberta en el texto) es utilizada a nivel mundial para evaluar el desarrollo motor en niños menores de 18 meses tanto pretermino como a término. En Colombia la herramienta es utilizada, pero hay poca información sobre los resultados que arroja. El objetivo del estudio fue caracterizar a una cohorte retrospectiva de niños menores de un año según la escala de Alberta para generar información sobre los resultados de la aplicación de esta en población colombiana atendida en un hospital de cuarto nivel. Métodos Estudio descriptivo, retrospectivo, transversal, donde se evaluaron las historias clínicas de 411 niños con edad corregida entre 0 y 12 meses de edad y antecedentes de edad gestacional de menos de 40 semanas, a todos los niños se les aplico la escala de Alberta entre 2010 y 2016 y los puntajes según esta se analizaron estadísticamente en forma descriptiva. Resultados La mayoría de los pacientes fueron clasificados por la escala como "desarrollo normal" como se esperaría por sus antecedentes, los niños de nuestra muestra presentan puntajes inferiores a los de la muestra original de Canadá en todas las edades. Conclusiones La escala se mostró útil en el tamizaje del niño normal, sin embargo, los pacientes presentaron menores puntajes al ser evaluados por la escala que en el estudio original, se genera evidencia sobre la necesidad de validar la escala en Colombia y generar curvas de referencia para esta.(AU)

ABSTRACT Objectives The Alberta Infant Motor Scale is used worldwide to assess motor development in children under 18 months of age, both preterm and full-term. In Colombia, the scale is used, but there is little information on the results it yields. The objective of this study was to characterize a retrospective cohort of children under one year of age according to the Alberta scale to generate information about the results of its application in a Colombian population treated at a highly specialized hospital. Methods Descriptive, retrospective, cross-sectional study, in which the medical records of 411 children with corrected age between 0 and 12 months and a history of gestational age less than 40 weeks were evaluated. The Alberta scale was applied to all children between 2010 and 2016, and scores were analyzed statistically in a descriptive form. Results Most patients were classified by the scale as "normal development" as would be expected based on their medical history. The children in our sample had lower scores than those of the original Canadian sample at all ages. Conclusions The scale was useful for screening normal children; however, the patients had lower scores when they were evaluated by the scale than in the original study, thus making evident the need to validate the scale in Colombia and generate reference curves.(AU)

RESUMO: Objetivos A Escala Motora Infantil de Alberta (escala Alberta no texto) é usada globalmente para avaliar o desenvolvimento motor em crianças menores de 18 meses, pré-termo e termo. Na Colômbia, a ferramenta é usada, mas há pouca informação sobre os resultados mostrados. O objetivo do estudo foi caracterizar uma coorte retrospectiva de crianças menores de um ano, de acordo com a escala de Alberta, para gerar informações sobre os resultados de sua aplicação na população colombiana atendida em um hospital de quarto nível. Métodos Estudo descritivo, retrospectivo, transversal, onde foram avaliados os prontuários de 411 crianças com idade corrigida entre 0 e 12 meses e histórico de idade gestacional inferior a 40 semanas, a escala de Alberta foi aplicada a todas as crianças entre 2010 e 2016 e as pontuações correspondentes foram analisadas estatisticamente de forma descritiva. Resultados A maioria dos pacientes foi classificada pela escala como "desenvolvimento normal", como seria de esperar em sua história; as crianças de nossa amostra tiveram escores mais baixos do que a amostra canadense original em todas as idades. Conclusões A escala foi útil na triagem da criança normal; no entanto, os pacientes tiveram escores mais baixos quando avaliados pela escala do que no estudo original; foram geradas evidências sobre a necessidade de validar a escala na Colômbia e gerar curvas de referência.(AU)

Lazarevic-Lasègue sign / Sinal de Lazarevic-Lasègue

ABSTRACT Charles Lasègue is reputed to have described the test/sign bearing his name, but he never wrote about it and misinterpreted its mechanism. The purpose of this note is to highlight the work of the Serbian, Laza Lazarević, who was first to present the original report of this seminal sign in sciatica and provide its appropriate pathophysiological interpretation.

RESUMO Charles Lasègue guarda a reputação de ter descrito o sinal que leva seu nome, mas nunca escreveu sobre isso e interpretava erradamente sua etiopatogenia. O propósito desta nota é chamar atenção para o trabalho do sérvio Laza Lazarević, que apresentou a descrição original do sinal mais importante na ciatalgia e forneceu a interpretação apropriada da sua fisiopatologia.

Erector spinae and scoliosis in a population with cerebral palsy: a preliminary study / Erector da espinha e escoliose em uma população com paralisia cerebral: estudo preliminar / Músculo erector de la columna y escoliosis en una población com parálisis cerebral: estudio preliminar

ABSTRACT Objective: To verify the relation of muscular response to the vestibular stimulation of the erector spinae, specifically longissimus thoracis and iliocostalis lumborum, with the origin of scoliosis in a population of individuals with level V cerebral palsy of the Gross Motor Function Classification System (GMFCS). Methods: Cross-sectional study of 12 individuals aged between four and 14 years. The muscular activity of the longissimus thoracis and iliocostalis lumborum was recorded by electromyography in the presence of anteroposterior and lateral imbalances, comparing it with that obtained in sitting position without imbalances. Scoliosis was assessed by radiological study following Cobb method. Results: Statistically significant differences were found between correct responses of both muscles to anteroposterior imbalances and absence of right thoracolumbar scoliosis (p=0.005; p=0.028), left thoracic scoliosis (p=0.005; p=0.046) and right lumbar scoliosis (p=0.005; p=0.046). Conclusions: The symmetry of muscular responses to anteroposterior imbalances, both of longissimus thoracis and iliocostalis lumborum, seems to be one of the factors that prevent the development of spine deviations in this population. Level of evidence: IV. Type of Study: Case series

RESUMO Objetivo: Avaliar a relação da resposta muscular à estimulação vestibular do eretor da espinha, específicamente longuíssimo do tórax e iliocostal lombar, com a origen da escoliose em uma população de individuos com paralisia cerebral pertencente ao grupo V da sistema classificação da função motora grossa (GMFCS). Métodos: Estudo transversal de 12 indivíduos com idade entre quatro e 14 anos. A atividade muscular contra desequilibrios anteroposterior e laterais do longuíssimo do tórax e iliocostal lombar foi gravado em comparação com a obtida sem desestabilição na posição sentada. Escoliose radiografias foram avalaidas utilizando o método de Cobb. Resultados: Foram observados diferençãs estatisticamente significativas entre as respostas corretas de ambos músculos contra desequilíbrios anteroposteriores e falta de escoliose toraco-lombar direita (p=0.005; p= 0.028), torácica esquerda (p=0.005; p= 0.046) e lombar direita (p=0.005; p= 0.046). Conclusões: A simetría das respostas do músculo contra desequilíbrios ântero-posterior, tanto longuissimo do tórax como iliocostal lombar, parece ser um dos factores que impedem a ocorrência de desvíos da coluna vertebral em nesta população. Nivel de Evidência: IV. Tipo de Estudos: Série de Casos

RESUMEN Objetivo: Comprobar la relación de la respuesta muscular ante la estimulación vestibular del músculo erector de la columna, concretamente músculo longísimo torácico e iliocostal lumbar, con el origen de la escoliosis en una población de individuos con parálisis cerebral de nivel V de la Gross Motor Function Classification System (GMFCS). Métodos: Estudio transversal de 12 individuos de edades comprendidas entre los cuatro y los 14 años. Se registró mediante electromiógrafo la actividad muscular del longísimo torácico e iliocostal lumbar ante desequilibrios anteroposteriores y laterales, comparándola con la obtenida en sedestación sin desestabilizaciones. Las escoliosis se valoraron mediante estudio radiológico siguiendo el método de Cobb. Resultados: Se observan diferencias estadísticamente significativas entre respuestas correctas de ambos músculos ante los desequilibrios anteroposteriores y ausencia de escoliosis toracolumbar derecha (p = 0,005; p = 0,028), dorsal izquierda (p = 0,005; p = 0,046) y lumbar derecha (p = 0,005; p = 0,046). Conclusiones: La simetría de las respuestas musculares ante los desequilibrios anteroposteriores, tanto del músculo longísimo torácico como del iliocostal lumbar, parece ser uno de los factores que evitan la aparición de las desviaciones del raquis en esta población. Nivel de evidencia: IV.Tipo de Estudo: Serie de Casos.

ASQ-3: validación del Cuestionario de Edades y Etapas para la detección de trastornos del neurodesarrollo en niños argentinos / ASQ-3: Validation of the Ages and Stages Questionnaire for the detection of neurodevelopmental disorders in Argentine children

Introducción. La evaluación sistemática del desarrollo infantil durante los primeros años de vida es un componente esencial en el control de salud pediátrico. El Cuestionario de Edades y Etapas, tercera edición (Ages and Stages Questionnarie; ASQ-3, por sus siglas en inglés), es la escala con más estudios de validación y recomendada por el Fondo de las Naciones Unidas para la Infancia (UNICEF) para verificar que el neurodesarrollo de los niños sea normal. Es una herramienta de monitoreo que evalúa las principales áreas de desarrollo, como comunicación, motricidad gruesa, fina, socioindividual y de resolución de problemas, que permite la comparación de la población local con los estándares internacionales de desarrollo. Objetivo. Realizar la validación del ASQ-3 en un grupo de población infantil. Métodos. Se evaluaron niños en un hospital público de 1 a 66 meses de edad, por profesionales de la salud pediatras, psicólogos y psicopedagogas. Se utilizó el paquete SSPS para la determinación de los baremos de la población. Resultados. En la muestra de 630 niños, con una distribución homogénea por sexos, se establecieron una sensibilidad del 88%, especificidad del 94%, como valores predictivos positivos del 88% y negativos del 96%, comparados con la Prueba Nacional de Pesquisa (PRUNAPE) y los puntajes de corte para cada edad. Conclusión. El ASQ-3 pudo discriminar que el 19,5% de los niños estaban en riesgo de sufrir trastornos del neurodesarrollo. Cumplió con las propiedades psicométricas comparado con el estándar de oro PRUNAPE para la evaluación dirigida y sistemática de hitos madurativos en el control de salud, de manera rápida, sencilla y económica, por lo que resultó una herramienta útil en el monitoreo del neurodesarrollo infantil.

Introduction. The systematic assessment of child development in the first years of life is an essential component of pediatric health checkups. The Ages and Stages Questionnaire, third edition (ASQ-3) is the most validated scale, and has been recommended by the UNICEF to verify if children have a normal neurological development. It is a monitoring instrument to assess the main developmental areas, including communication, gross motor, fine motor, personal-social, and problem solving skills, and to compare the local population to the international development standards. Objective. To validate the ASQ-3 in a pediatric population group. Methods. Children aged 1-66 months were assessed at a public hospital by pediatricians, psychologists, and educational psychologists. The SSPS software package was used to determine population scales. Results. In 630 children, who had a homogeneous sex distribution, an 88% sensibility and a 94% specificity were determined, with a positive predictive value of 88% and a negative predictive value of 96%, compared to the National Screening Test (Prueba Nacional de Pesquisa, PRUNAPE) and the cut-off scores for each age group. Conclusion. The ASQ-3 established that 19.5% of children were at risk of experiencing neurodevelopmental disorders. The ASQ-3 met psychometric properties compared to the PRUNAPE, which is the gold standard for the targeted and systematic assessment of developmental milestones during health checkups in a rapid, simple and cost-effective manner, so it was considered useful to monitor child neurological development.

Doenças neurológicas em gatos: 155 casos / Neurological diseases in cats: 155 cases

Foi realizado um estudo epidemiológico retrospectivo de gatos com doenças neurológicas atendidos em um Hospital Veterinário Universitário entre 2001 e 2014. O objetivo foi identificar e caracterizar a idade, o sexo, a raça, as doenças neurológicas e classificá-las de acordo com a região anatômica e o acrônimo DINAMIT-V. Foram observados 155 gatos com doenças neurológicas em 13 anos, sendo o diagnóstico confirmado em 112 gatos (72,2%) e presuntivo em 43 (27,8%). Gatos sem raça definida (77,9%) foram os mais comuns, seguido de gatos da raça persa e siamesa. Os locais mais afetados foram medula espinhal entre T3-L3 (28,4%) e tálamo-córtex (24,5%). A maioria dos gatos (43,9%) foi diagnosticada com doença traumática, principalmente trauma de medula espinhal, seguida de doença inflamatória/infecciosa (33,5%). Pode se concluir que a maior prevalência das doenças neurológicas de gatos envolve a medula espinhal e o tálamo-córtex, sendo as traumáticas as mais frequentes. Os dados obtidos podem auxiliar em futuros estudos sobre a frequência e a distribuição das principais doenças neurológicas em gatos.(AU)

A retrospective epidemiological study on neurological disease of cats was performed using data from cats admitted to a Veterinary Teaching Hospital from 2001 to 2014. The aim the study was to determine the age, sex race, and type of neurological disease affecting cats and identify these diseases according to the anatomical region and disease classes, specified under the acronym DINAMIT-V. One hundred and fifty five cats with neurological disease were observed during 13 years; the diagnosis was confirmed in 112 (72.2%) and was presumptive in 43 (27.8%). Mixed breed cats (77.9%) were the most commonly affected, followed by Persian and Siamese cats. The most affected anatomic sites were segments T3-L3 of the spinal cord (28.4%) and thalamic-cortical area (24.5%). Most cats (43.9%), were diagnosed with trauma, mainly spinal cord trauma, followed by inflammatory/infectious disease (33.5%). It is concluded that the neurological disorders in cats have higher prevalence in the spinal cord and thalamic-cortical areas and that the most frequent class of disease is trauma. Data obtained may assist future studies regarding neurological diseases in cats.(AU)

Prevalência de traumatismos dentários em pacientes com distúrbio neuropsicomotor: estudo controlado / Prevalence of tooth injuries in patients with neuropsychomotor disorder

Introdução: Lesões dentárias por trauma constituem experiências angustiantes em crianças, que promovem alterações tanto físicas quanto emocionais e psicológicas. Objetivo: Avaliar a prevalência de traumatismos dentários em pacientes com distúrbio neuropsicomotor e comparar a indivíduos normorreativos. Material e método: Avaliaram-se 120 indivíduos, sendo 60 com alterações neuropsicomotoras (grupo de estudo) e 60 normorreativos (grupo controle), de ambos os sexos, de 2 a 15 anos de idade, assistidos na Fundação de Apoio ao Deficiente do Governo do Estado da Paraíba. Os dados foram coletados por meio de questionário estruturado e exame clínico. Foi realizada análise descritiva e inferencial (teste t-student; teste Exato de Fisher), adotando-se um nível de significância de 5%. Resultado: A prevalência de traumatismos dentários observada em pacientes com distúrbio neuropsicomotor foi de 20,0%, enquanto que no grupo controle foi de 16,6% (p>0,05); no grupo controle a ocorrência foi maior no sexo masculino. Os grupos diferiram quanto ao tipo de atividade no momento do trauma (p<0,05) em relação à etiologia (p<0,05) e em relação ao local de ocorrência (p<0,05). Para ambos os grupos, os dentes mais afetados foram os incisivos centrais superiores. As fraturas de esmalte, seguidas pelas de esmalte e dentina sem exposição pulpar foram as lesões mais comuns nos dois grupos. Conclusão: A prevalência de traumatismos dentários em indivíduos com alteração neuropsicomotora é similar à de indivíduos normorreativos, com maior ocorrência no sexo feminino, em fase anterior à adolescência, durante atividades de rotina.

Introduction: Traumatic dental injuries are distressing experiences in children, which promote both physical, emotional and psychological changes. Objective: To evaluate the prevalence of dental trauma in patients with neuropsychomotor disorder and to compare to normoreactive individuals. Material and method: 120 individuals, 60 neuropsychomotor changes (study group) and 60 normorreatives (control group), of both sexes, from 2 to 15 years old, assisted in the Foundation of Support to the Disabled of the Government of the State of Paraíba. Data were collected through a structured questionnaire and clinical examination. Descriptive and inferential analysis (t-student test; Fisher's exact test) was performed, adopting a significance level of 5%. Result: The prevalence of dental trauma observed in patients with neuropsychomotor disorder was 20.0%, whereas in the control group it was 16.6% (p>0.05); in the control group the occurrence was higher in males. The groups differed according to the type of activity at the moment of the trauma (p<0.05) in relation to the etiology (p<0.05), and in relation to the place of occurrence (p<0.05). For both groups, the most affected teeth were the maxillary central incisors. Enamel fractures, followed by enamel and dentin fractures without pulp exposure were the most common lesions in both groups. Conclusion: The prevalence of dental trauma in individuals with neuropsychomotor alterations is similar to that of normorreative individuals, with a higher occurrence in females, in preteen phase, during routine activities.

Screening tests for distal symmetrical polyneuropathy in Latin American patients with type 2 diabetes mellitus

ABSTRACT Objective This cross sectional study intended to evaluate two bedside tests (Neuropad and VibraTip) as screening tools for distal symmetrical polyneuropathy (DSPN) in Latin American patients with type 2 diabetes mellitus (T2D). Subjects and methods Ninety-three Colombian patients diagnosed with T2D were recruited. Anthropometric variables, glycemic control parameters, lipid profile and renal function were assessed for each patient. DSPN was defined by a Michigan Neuropathy Screening Instrument (MNSI) clinical score greater than 2. Both Neuropad and Vibratip tests were applied to each patient. Contingency analyses were performed to evaluate the diagnostic power of both tools. Results The prevalence of DSPN determined clinically by MNSI was 25.8%. DSPN in these patients was associated with age, worsening renal function, and insulin treatment. The sensitivity and specificity of the Neuropad test for DSPN was 66.6% and 63% respectively. Its negative predictive value (NPV) was 84.6%. The VibraTip test exhibited a sensitivity of 54.1% and specificity of 91.3%, with a NPV of 85.1%. Conclusion Neuropad and VibraTip are reliable screening tools for DSPN in Latin American population. VibraTip presents a considerable diagnostic power for DSPN in this population. Further studies regarding the cost-effectiveness of these tools in clinical practice are needed.

Enfermedades neurometabólicas: Orientación diagnóstica a partir de la clínica neurológica / Neurometabolic diseases: Diagnostic orientation based on neurological symptoms

Resumen Las Enfermedades Neurometabólicas (ENM) son trastornos bioquímicos en la estructura y/o función de proteínas, de origen genético, por mutaciones en el ADN, causando un déficit enzimático con acumulación del sustrato o producción de metabolitos anormales. Consideradas enfermedades raras por su escasa incidencia, en su conjunto constituyen un motivo de admisión, consulta y morbimortalidad infantil frecuente. Las formas clínicas de presentación incluyen la forma de "intoxicación", las que afectan el metabolismo energético y las que afectan las moléculas complejas con compromiso de las organelas celulares (lisosomas, peroxisomas). El diagnóstico preciso y oportuno de las ENM es crucial, especialmente para aquellos trastornos que son tratables o manejables, con menor impacto en los pacientes, evitando no solo la muerte sino secuelas irreversibles. El diagnóstico clínico es el primer paso para su abordaje partiendo de la elaboración de una adecuada historia clínica, recolección detallada de antecedentes familiares y personales, considerando la edad de la aparición de los síntomas, siendo el periodo neonatal donde la mayoría debutan. La exploración física completa por aparatos y sistemas con especial énfasis en el examen neurológico, permite solicitar con mayor precisión los exámenes complementarios correspondientes para realizar una aproximación diagnóstica más acertada. El uso de herramientas diagnósticas mediante programas electrónicos, algunos de ellos disponibles gratuitamente como el Programa NeurometPlus ( www.neurometplus.com ), permite alcanzar de forma rápida y efectiva el diagnóstico más probable, así como manejo médico y tratamiento disponible actual.

Abstract Neurometabolic Disorders are conditions caused by alterations in the biochemical structure and function of proteins resulting from changes in DNA, causing a lack or dysfunction of an enzyme leading to an accumulation of a substrate or production of abnormal metabolites. Though considered rare diseases, due to low incidence, together they constitute a frequent cause for pediatric admissions and consultations with significant morbidity and mortality in childhood. Neurometabolic disorders may be classified as disorders of intoxication, energy metabolism, or those disorders affecting complex molecules compromising the cellular organelles (lysosomes and peroxisomes). A timely and precise diagnosis is crucial especially in treatable conditions in order to avoid irreversible sequelae and even death. When encountering a child with a potential neurometabolic disorder, making a clinical diagnosis is the rst step which should include an adequate clinical history, taking into consideration the age of onset of symptoms, and a detailed family history. The neonatal period is when the majority of these conditions make their debut. A complete physical exam with special emphasis on the neurological exam allows for greater precision to help guide the complementary exams that correspond to each condition in order to reach the most probable diagnosis. The use of diagnostic tools including electronic programs and databases, some of which are free of charge such as NeurometPlus ( www.neurometplus.com ), allow a quick and effective diagnosis, along with a guide for medical management and current treatment regimens available.

Potencial evocado visual em cães e ovinos / Visual evoked potential in dogs and sheep

O potencial evocado visual (PEV) é técnica eletrodiagnóstica que permite avaliação das vias visuais. O PEV de 20 cães e 20 ovinos adultos, de ambos os sexos, foram obtidos para estudo normativo. Foram utilizados eletrodos de agulha monopolar posicionados em O1 e O2 (ativos), em Fpz (referência comum) e em Cz (terra). O estímulo foi na forma de flash a 1Hz. Dezessete cães e 17 ovinos foram incluídos no estudo, pois apresentaram potenciais auditivos com boa qualidade técnica. Os resultados da avaliação dos dois olhos foram agrupados, totalizando 34 exames em cada espécie. O achado mais consistente em todos os exames foi uma deflexão eletropositiva, com latência média de 55,4ms em cães (P55) e 63,75ms em ovinos (P63). Outras duas ondas eletronegativas também foram identificadas: N31 e N75 em cães; e N42 e N86 em ovinos. A metodologia utilizada neste estudo permitiu obtenção de potenciais visuais com pequena variabilidade, sendo útil para avaliação de animais com suspeita de alteração nas vias visuais centrais.(AU)

The visual evoked potential (VEP) is an electro-diagnostic technique that allows assessment of visual pathways. The VEP from 20 adult dogs and 20 adult sheep of both gender was obtained for normative study. Monopolar electrode needles were placed in O1 and O2 (active), Fpz (common reference) and Cz (ground). The stimuli were flash at 1Hz. Seventeen dogs and 17 sheep were included in the study because they had auditory potentials with good technical quality. The results from both eyes were grouped, totaling 34 results in each species. The most consistent result in all tests was an electropositive deflection, with a mean latency 55.4ms in dogs (P55) and 63.75ms in sheep (P63). Two negative deflections were also identified: N31 and N75 in dogs, and N42 and N86 in sheep. The methodology used in this study allowed to obtain potential similar to those described in other studies, with little variability, and is useful for evaluation of animals with suspected changes in the central visual pathways.(AU)

Postoperative surveillance in neurosurgical patients - usefulness of neurological assessment scores and bispectral index / Monitoramento de pacientes neurocirúrgicos no pós-operatório - utilidade dos escores de avaliação neurológica e do índice bispectral

Abstract Background and objectives: We examined the additive effect of the Ramsay scale, Canadian Neurological Scale (CNS), Nursing Delirium Screening Scale (Nu-DESC), and Bispectral Index (BIS) to see whether along with the assessment of pupils and Glasgow Coma Scale (GCS) it improved early detection of postoperative neurological complications. Methods: We designed a prospective observational study of two elective neurosurgery groups of patients: craniotomies (CG) and non-craniotomies (NCG). We analyze the concordance and the odds ratio (OR) of altered neurological scales and BIS in the Post-Anesthesia Care Unit (PACU) for postoperative neurological complications. We compared the isolated assessment of pupils and GCS (pupils-GCS) with all the neurologic assessment scales and BIS (scales-BIS). Results: In the CG (n = 70), 16 patients (22.9%) had neurological complications in PACU. The scales-BIS registered more alterations than the pupils-GCS (31.4% vs. 20%; p < 0.001), were more sensitive (94% vs. 50%) and allowed a more precise estimate for neurological complications in PACU (p = 0.002; OR = 7.15, 95% CI = 2.1-24.7 vs. p = 0.002; OR = 9.5, 95% CI = 2.3-39.4). In the NCG (n = 46), there were no neurological complications in PACU. The scales-BIS showed alterations in 18 cases (39.1%) versus 1 (2.2%) with the pupils-GCS (p < 0.001). Altered CNS on PACU admission increased the risk of neurological complications in the ward (p = 0.048; OR = 7.28, 95% CI = 1.021-52.006). Conclusions: Applied together, the assessment of pupils, GCS, Ramsay scale, CNS, Nu-DESC and BIS improved early detection of postoperative neurological complications in PACU after elective craniotomies.

Resumo Justificativa e objetivos: Avaliamos o efeito aditivo da escala de Ramsay, Escala Neurológica Canadense (CNS), Escala da Enfermagem de Triagem de Delírio (Nu-DESC) e Índice Bispectral (BIS) para observar se, juntamente com a avaliação das pupilas e da Escala de Coma de Glasgow (GCS), melhorava a detecção precoce de complicações neurológicas no pós-operatório. Métodos: Projetamos um estudo observacional, prospectivo, de dois grupos de pacientes submetidos à neurocirurgia eletiva: craniotomia (Grupo C) e não craniotomia (Grupo NC). Analisamos a concordância e a razão de chance (OR) de alterações nas escalas neurológicas e no BIS na sala de recuperação pós-anestesia (SRPA) para complicações neurológicas no pós-operatório. Comparamos a avaliação isolada das pupilas e da GCS (pupilas-GCS) com todas as escalas de avaliação neurológica e o BIS (escalas-BIS). Resultados: No Grupo C (n = 70), 16 pacientes (22,9%) apresentaram complicações neurológicas na SRPA. As escalas-BIS registraram mais alterações do que as pupilas-GCS (31,4% vs. 20%; p < 0,001), foram mais sensíveis (94% vs. 50%) e permitiram uma estimativa mais precisa das complicações neurológicas na SRPA (p = 0,002; OR = 7,15, IC 95% = 2,1-24.7 vs. p = 0,002; OR = 9,5, IC 95% = 2,3-39,4). No grupo NC (n = 46) não houve complicações neurológicas na SRPA. As escalas-BIS mostraram alterações em 18 casos (39,1%) versus um caso (2,2%) com as pupilas-GCS (p < 0,001). Alteração na CNS na admissão à SRPA aumentou o risco de complicações neurológicas na enfermaria (p = 0,048; OR = 7,28, IC 95% = 1,021-52,006). Conclusões: Aplicados em conjunto, avaliação das pupilas, GCS, escala de Ramsay, CNS, Nu-DESC e BIS melhoraram a detecção precoce de complicações neurológicas no pós-operatório na SRPA após craniotomias eletivas.

Diagnóstico y evaluación de la esclerosis múltiple: lo que el radiólogo debe conocer e informar. Conceptos actuales / Diagnosis and Evaluation of Multiple Sclerosis: What the Radiologist Should Know and Report. Current Concepts

La esclerosis múltiple (EM) es una enfermedad inflamatoria y neurodegenerativa, de curso crónico, caracterizada por áreas focales de desmielinización/daño axonal, llamadas "placas". Los criterios actualmente utilizados en su diagnóstico incluyen la demostración clínica o paraclínica de diseminación de estas lesiones en el espacio y en el tiempo, y la exclusión de diagnósticos alternativos. La resonancia magnética (RM) es la herramienta paraclínica más importante para establecer el diagnóstico de EM y permite demostrar la diseminación en el espacio, con base en la presencia de, al menos, un criterio en dos de las cinco localizaciones características: una lesión en cortical-yuxtacortical, tres en la sustancia blanca periventricular, una en el tejido nervioso infratentorial, una en la médula espinal y una en el nervio óptico. La diseminación en tiempo se puede establecer a partir de la detección simultánea de lesiones con y sin realce con el medio de contraste en un mismo examen de RM, o mediante la demostración de nuevas lesiones en estudios de RM de seguimiento. El curso de la enfermedad y el tratamiento farmacológico producen cambios característicos en las imágenes de RM que incluyen el desarrollo de atrofia, la leucoencefalopatía multifocal progresiva y el síndrome inflamatorio de reconstitución inmunológica.

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease characterized by focal areas of demyelination/axonal damage known as "plaques". The diagnostic criteria currently used include clinical or para-clinical demonstration of the dissemination of these lesions in space and time, and the exclusion of alternative diagnoses. Magnetic resonance imaging (MRI) is the most important para-clinical tool for the diagnosis of MS and allows to demonstrate the dissemination in space based on the presence of at least one criteria in two of the five characteristic locations: one lesion in cortical-yuxtacortical, three in the periventricular white matter, one in the infratentorial nervous tissue, one in the spinal cord and one in the optic nerve. Dissemination in time can be established from the simultaneous detection of lesions with and without contrast enhancement in a single MRI study, or through the demostration of new lesions in follow-up MRI studies. The course of the disease and its pharmacological treatment lead to characteristic changes in imaging including the development of atrophy, multifocal progressive leukoencephalopathy and immune reconstitution inflammatory syndrome.

Neuroimaging criteria and cognitive performance in vascular mild cognitive impairment: a systematic review / Critérios de neuroimagem e desempenho cognitivo no comprometimento cognitivo leve vascular: uma revisão sistemática

ABSTRACT The recognition of Cerebrovascular Disease (CVD) at earlier clinical stages may favor the control of vascular risk factors and prevention of dementia. However, operational criteria for symptomatic phases at non-dementia stages are often difficult, as the current criteria normally require the evidence of extensive subcortical disease. OBJECTIVE To identify the neuroimaging profile of Vascular Mild Cognitive Impairment (VaMCI), the impact of those aspects over cognition and the neuropsychological tests that distinguished VaMCI from other groups. METHODS Searches were performed in Scopus, ISI and PsycINFO, using the following key terms: "vascular mild cognitive impairment" OR "vascular cognitive impairment no dementia" OR "vascular cognitive impairment not demented" OR "subcortical mild cognitive impairment". RESULTS Of 249 papers, 20 studies were selected. Ten of those included only patients with severe White Matter Hyperintensities (WMH), whereas 10 others admitted subjects with moderate-to-severe WMH. Both groups showed poor performances in Executive Function (EF) tasks in comparison to normal controls and other diagnostic groups. Among EF tests, those assessing "complex" EF abilities consistently distinguished VaMCI from other groups, regardless of the severity of WMH. VaMCI subjects with severe or moderate-to-severe WMH showed cognitive deficits in comparison with other groups. "Complex" EF tests were the most useful in differentiating those patients from the other groups. CONCLUSION The occurrence of VaMCI may be associated with the presence of CVD at moderate levels; the detection of vascular damage at earlier stages may allow the adoption of therapeutic actions with significant effect-sizes.

RESUMO O reconhecimento precoce da Doença Cerebrovascular (DCV) pode permitir o controle de fatores de risco e a prevenção de demência. Contudo, critérios operacionais em seus estágios sintomáticos não-demenciais apresentam problemas, já que critérios atuais requerem a presença de extensa doença isquêmica subcortical. OBJETIVO Identificar o perfil de neuroimagem do Comprometimento Cognitivo Leve Vascular (CCLV), o impacto destes aspectos sobre a cognição e os testes neuropsicológicos que distinguem CCLV de outros grupos. MÉTODOS Foram realizadas buscas no Scopus, ISI e PsycINFO, usando a estratégia: "vascular mild cognitive impairment" OR "vascular cognitive impairment no dementia" OR "vascular cognitive impairment not demented" OR "subcortical mild cognitive impairment". RESULTADOS De 249 artigos, 20 foram selecionados. 10 destes incluíram apenas pacientes com hiperintensidades de substância branca (HSB) graves, enquanto 10 outros admitiram pacientes com HSB moderadas-a-graves. Ambos os grupos apresentaram desempenho pobre em tarefas de Função Executiva (FE) em comparação com controles normais e outras categorias diagnósticas. Dentre os testes de FE, aqueles que avaliam FE "complexas" diferiram consistentemente CCLV de outros grupos, independentemente da gravidade de HSB. Sujeitos com CCLV e HSB graves ou moderadas-a-graves apresentaram dificuldades cognitivas quando comparados aos demais grupos. Testes que avaliam FE "complexa" foram os mais úteis na diferenciação destes pacientes dos outros grupos. CONCLUSÃO A ocorrência de VaMCI pode estar associada à presença de HSB moderadas; a detecção precoce do dano vascular permitiria a adoção de medidas terapêuticas com tamanhos de efeito significativos.

Ressonância magnética funcional e deglutição: revisão sistemática / Functional magnetic resonance imaging and swallowing: systematic review

Objetivo Avaliar a viabilidade e segurança da ressonância magnética funcional para a avaliação de áreas corticais envolvidas na deglutição. Estratégia de pesquisa Conduziu-se uma busca entre abril de 2003 e abril de 2013, usando as palavras chave “functional magnetic resonance imaging” or “fMRI” and “dysphagia” e “functional magnetic resonance imaging” or “fMRI” and “swallowing” na base de dados PubMed. Critérios de seleção Os estudos foram revisados por análise de seus títulos e abstracts e os critérios de inclusão utilizados foram: pesquisas envolvendo seres humanos, utilização de exames neurofuncionais, referência à função de deglutição, análise de população adulta e/ou idosa, relação com patologias neurológicas. Resultados A estratégia de busca resultou em 1167 citações, das quais apenas 35 preencheram os critérios de elegibilidade. Conclusão A ressonância magnética funcional foi considerada segura e viável para a avaliação de áreas corticais envolvidas na deglutição. Entretanto, os relatos de utilização de ressonâcia magnética funcional diferiram entre os estudos revisados e houve variabilidade na metodologia utilizada, dificultando as comparações. .

Purpose Evaluate the feasibility and safety of functional magnetic resonance imaging (fMRI) for the evaluation of cortical areas involved in swallowing. Research strategy The search was conducted from April 2003 to April 2013, using the keywords “functional magnetic resonance imaging” or “fMRI” and “dysphagia” and “functional magnetic resonance imaging” or “fMRI” and “swallowing” in “PubMed” database. Selection criteria Studies were reviewed by analyzing their titles and abstracts with the following inclusion criteria: research involving human subjects, use of neurofunctional tests, reference to swallowing function, adult and/or elderly population analysis and association with neurological disorders. Results the search strategy resulted in 1167 citations, from which only 35 met the eligibility criteria. Conclusion the functional magnetic resonance imaging was considered safe and feasible for evaluating cortical areas involved in swallowing. However, the reports of functional magnetic resonance usage differed between the reviewed studies and the variability in the methodology used, made meaningful comparisons difficult. .

Naturalez neuronal de los neuroblastomas de la clasificación de la Río Hortega del sistema nervioso central: estudio con técnicas argénticas e inmunohistoquímicas / Neuroblastomas neuronal nature of the classification of the Hortega River of the central nervous system. Argénticas study and immunohistochemical techniques

El objetivo fue demostrar que los llamados meduloblastomas del Sistema Nervioso Central son neuroblastomas, tumores de origen neural con identidad propia. Siguiendo a Del Río Hortega y Polak se estudiaron 33 meduloblastomas cerebelares clínica y anatomopatológicamente demostrados. Se utilizaron técnicas de anilinas, impregnación argéntica y de inmunohistoquímica. Se analizó extensamente la bibliografía haciendo énfasis en el origen e histogénesis de las neuronas. Se tuvo en cuenta un principio básico que para reconocerlas se debe teñir el núcleo, el citoplasma y sus prolongaciones. Con las técnicas habituales de hematoxilina- eosina se observa sólo el núcleo y citoplasma, con la inmunohistoquímica se caracteriza la estirpe y con las técnicas argénticas las prolongaciones, con las que Cajal, Del Río Hortega, Golgi y otros estudiaron y descubrieron las células del SNC normal y patológico, cuya teoría de la neurona de Cajal no fue superada hasta la actualidad.

SUMMARY: The purpose of this study was to demonstrate that the called meduloblastoma of the central nervous system, are neuroblastomas, tumors of neural origin with its own identity .Following the published studies from Del Rio Hortega and Pollak, we studied 33 cerebellar medulloblastoma, clinically and pathologically demonstrated We used silver, aniline stains and immunohistochemestry. A comprehensive literature review was conducted, with emphasis on the origin and histogenesis of neurons. A basic principle was considered to recognize a neuron, the nucleus, the cytoplasm and the neuronal extensions must be stained. With standard hematoxilin and eosin techniques we only observed the nucleus and the cytoplasm. The immunohistochemestry showed the cell line origin and the silver stain make evident the neuronal extensions. Del Rio Hortega, Cajal, Golgi and others discovered and studied the normal and pathological central nervous system cell. The Cajal’s neuron theory was unsurpassed even today.

Evaluation of RT-PCR and hemi-nested RT-PCR in brain samples from dogs with neurologic signs compatible with distemper / Avaliação das técnicas de RT-PCR e heminested RT-PCR em cérebros de cães com sinais neurológicos compatíveis com cinomose

The diagnostic value of RT-PCR and hemi-nested RT-PCR (hnRT-PCR) was compared in brain samples of dogs presenting neurological signs compatible with canine distemper. Samples of central nervous system (CNS) were collected from 68 dogs and tested by direct immunofluorescence test (RFID) and, independent of the results, they were stored at -20°C for at least three years. They were submitted to the RT-PCR and hnRT-PCR techniques aiming to determine the gene responsible for the viral nucleoprotein decoding. Fifty-nine samples were positive for RIFD, 40 for RT-PCR (Kappa = 0.358) and 54 for hnRT-PCR (Kappa = 0.740). All nine RIFD negative samples were also negative for RT-PCR and hnRT-PCR. In spite of the storage duration and proper sample conditions, the estimated accordance between hnRT-PCR and RIFD demonstrated that hnRT-PCR technique can be applied in retrospective studies...

Foi comparado o valor diagnóstico das técnicas de RT-PCR e heminested RT-PCR (hnRT-PCR) em amostras de cérebro de cães com sintomatologia nervosa compatível com cinomose. Fragmentos do sistema nervoso central (SNC) colhidos de 68 animais foram testados pela Imunofluorescência direta (IFD) e, independentemente do resultado, foram armazenados a -20°C por pelo menos três anos. Após esse período, foram submetidos a RT-PCR e a hnRT-PCR com oligonucleotídeos iniciadores direcionados ao gene codificador da nucleoproteína N. As proporções de resultados positivos/examinados foram: 59/68 para a IFD, 40/68 para a RT-PCR (Kappa = 0,358) e 54/68 quando associada à heminested PCR (Kappa = 0,740). Houve nove resultados negativos nas três técnicas empregadas. Os resultados do coeficiente Kappa entre a IFD e hnRT-PCR demonstram que apesar das condições de armazenamento, a hnRT-PCR pode ser utilizada em estudos retrospectivos...

Cross-cultural Adaptation and Linguistic Validation of the Korean Version of the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale

Distinction between neuropathic pain and nociceptive pain helps facilitate appropriate management of pain; however, diagnosis of neuropathic pain remains a challenge. The aim of this study was to develop a Korean version of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and assess its reliability and validity. The translation and cross-cultural adaptation of the original LANSS pain scale into Korean was established according to the published guidelines. The Korean version of the LANSS pain scale was applied to a total of 213 patients who were expertly diagnosed with neuropathic (n = 113) or nociceptive pain (n = 100). The Korean version of the scale had good reliability (Cronbach's alpha coefficient = 0.815, Guttman split-half coefficient = 0.800). The area under the receiver operating characteristic curve was 0.928 with a 95% confidence interval of 0.885-0.959 (P or = 12, sensitivity was 72.6%, specificity was 98.0%, and the positive and negative predictive values were 98% and 76%, respectively. The Korean version of the LANSS pain scale is a useful, reliable, and valid instrument for screening neuropathic pain from nociceptive pain.

Programa Antiestrés de Sincronización Cerebral mediante estimulación visual / Anti-stress software of synchronization of brain wave by visual stimulation

Se presenta un programa computarizado que permite la sincronización de las ondas cerebrales mediante una estimulación visual, a una frecuencia similar a la actividad eléctrica del cerebro en estado de sedación, lo cual favorece la disminución de los niveles de estrés en los pacientes que acuden al Centro de Histoterapia Placentaria para tratar las patologías de Vitiligo, Psoriasis y Alopecia Areata. La aplicación informática fue programada en lenguaje Delphi 7.0 y cuenta con dos módulos para su ejecución. El efecto antiestrés se determinó a través de criterios observacionales y mediante la cuantificación de los niveles de concentración de adrenalina y cortisol en suero sanguíneo(AU)

A computer program that allows synchronization of brain waves by visual stimulation, similar to the electrical activity of the brain in a state of sedation frequently, which helps to reduce stress levels in patients who come to Placental Histotherapy Center to treat Vitiligo, Psoriasis and Alopecia Areata is presented. The computer application was programmed in the language Borland Delphi 7.0 and has two modules for its execution. The anti-stress effect was determined by observational criteria and the cuantification of levels of epinephrine and cortisol concentration in the blood serum(AU)