Predictive value of transcranial doppler ultrasound for cerebral small vessel disease in elderly patients / Valor preditivo do ultrassom doppler transcraniano para doença de pequenos vasos em pacientes idosos

ABSTRACT Objective: To investigate the predictive value of transcranial Doppler (TCD) ultrasound for cerebral small vessel disease in elderly patients. Methods: Transcranial Doppler ultrasound and magnetic resonance imaging (MRI) were performed on 184 elderly patients with cerebral small vessel disease. The relationship of clinical characteristics and TCD ultrasound parameters with severe white matter lesions (WMLs) in MRI were investigated by univariate analysis and multivariate analysis. Results: The univariate analysis showed that age, left middle cerebral artery (MCA) mean flow velocity, right MCA mean flow velocity and mean MCA pulsatility index were significantly correlated with severe WMLs (p < 0.05). The multivariate logistic regression analysis showed that only age (odds ratio: 1.21; 95%CI: 1.10-1.36; p < 0.01) and MCA pulsatility index (dominance ratio: 1.13; 95%CI: 1.06-1.80; p = 0.02) were significantly correlated with severe WMLs. The analysis of TCD ultrasound parameters showed that when the cut-off for MCA pulsatility index was 1.04, it could identify severe WMLs. The area under the curve was 0.70 (95%CI: 0.60-0.80). The sensitivity and specificity were 63.0% and 72.0%, respectively. The positive and negative predictive values were 35.4% and 86.6%, respectively. Conclusion: The MCA pulsatility index in TCD ultrasound is significantly correlated with severe WMLs; and TCD ultrasound can guide selective MRI for the detection of WMLs.

RESUMO Objetivo: Investigar o valor preditivo do ultrassom de Doppler transcraniano (TCD) para doença de pequenos vasos (SVD) em pacientes idosos. Métodos: ultrassonografia de TCD e ressonância magnética (RM) foram realizadas em 184 idosos portadores de SVD cerebral. As relações das características clínicas e os parâmetros ultrassonográficos do TCD com lesão grave de substância branca (WML) no desempenho da RM foram investigados por análise univariada e análise multivariada. Resultados: A análise univariada mostrou que, a idade, a velocidade média de fluxo (MFV) da artéria média cerebral (MCA) esquerda, a MFV da MCA direita e o índice de pulsatilidade (PI) médio estiveram significativamente relacionados à WML grave (P <0,05). A análise de regressão logística multivariada mostrou que apenas a idade (razão de chances: 1,21; IC95%: 1,10-1,36; P <0,01) e o PI da MCA (razão de dominância: 1,13; IC 95%: 1,06-1,80; P = 0,02) estiveram significativamente relacionados a WML grave. A análise dos parâmetros ultrassonográficos do TCD mostrou que, quando o ponto de corte do IP do MCA foi 1,04, ele pôde identificar à WML grave. A área sob a curva foi de 0,70 (IC 95%: 0,60-0,80). A sensibilidade e especificidade foram de 63,0% e 72,0%, respectivamente. Os valores preditivos positivos e negativos foram de 35,4% e 86,6%, respectivamente. Conclusão: O PI da MCA na ultrassonografia do TCD está significativamente relacionado à WML grave. A ultrassonografia TCD pode orientar a ressonância magnética seletiva para detecção da WML.

Investigación clínica de la ptosis cerebral: presentación de seis nuevos casos / Cerebral ptosis: analysis of six cases

Background: Cerebral ptosis is understood as the bilateral paralysis of eyelid elevation linked to a stroke or hemorrhage of the middle cerebral artery (MCA). It is a transient condition, independent of the evolution of the lesion. Aim: To analyze six patients with the condition. Patients and Methods: Report of five women and one male aged 42 to 72 years. Results: All suffered an infarction or hemorrhage in the territory of the middle cerebral artery of the non-dominant hemisphere and developed a bilateral palpebral ptosis. The recovery started after the fourth day. At the tenth day, eye opening was effortless and did not require frontal help, despite the persistence of hemiplegia. Conclusions: Cerebral ptosis is a mimetic dysfunction of a specific non-injured area of the cerebral cortex, originated from a nearby parenchymal damage such as the middle cerebral artery of the same hemisphere. Cerebral ptosis expresses the inhibition of the voluntary eyelid elevation center, of prefrontal location in the non-dominant hemisphere.

Doppler velocimetry in fetal rats exposed to enoxaparin and unfractionated heparin (UFH) during pregnancy

Abstract Purpose: To evaluate the effects of enoxaparin and unfractionated heparin (UFH) administered in prophylactic and therapeutic doses on fetal vessels in healthy pregnant Wistar rats, according to Doppler velocimetry measurements. Methods: Fifty animals were assigned to one of five groups: controls (saline), prophylactic and therapeutic enoxaparin (1 and 2 mg/kg/day, respectively), and prophylactic and therapeutic UFH (72 and 400 UI/kg/day, respectively). Uterine horns were examined by ultrasound for identification of live fetuses. A sample of these fetuses underwent Doppler velocimetry. Spectral curves, peak systolic velocity (PSV), pulsatility index (PI), and resistance index (RI) of the middle cerebral artery, ductus venosus, and umbilical artery were investigated. Differences were considered statistically significant when p<0.05. Results: No significant differences in PSV, PI, or RI values were observed among the groups. Conclusion: Doppler velocimetry measurements revealed no significant effects of enoxaparin or unfractionated heparin on fetal vessels in pregnant Wistar rats.

O papel do DOPPLER da artéria cerebral média nos fetos com Crescimento Restrito Tardio / The role of middle cerebral artery Doppler in late onset fetal growth restriction

Ocrescimento intrauterino restrito (CIUR) é uma inibição patológica do crescimento fetal, acometendo 5-10% das gestações e está associado ao aumento da morbimortalidade perinatal. Este estudo tem como objetivo realizar uma revisão não sistemática sobre os eventos adversos perinatais dos fetos com CIUR tardio e alteração seletiva do Doppler da artéria cerebral média (ACM). A pesquisa bibliográfica foi realizada através da base de dados do PubMed, obtendo um total de 25 referências, que serviram de base para o presente artigo. Conclui-se que a artéria cerebral média possui valor particular na identificação e predição de resultados adversos nestes fetos, os quais possuem risco aumentado de desenvolvimento neurológico anormal ao nascimento e aos dois anos de idade.(AU)

Intrauterine growth restriction (IUGR) is a pathological inhibition of the fetal growth that affects 5-10% of pregnancies and it is associated with an increase of perinatal morbidity and mortality. This study aims to conduct a non-systematic review of perinatal adverse events of fetuses with late-onset IUGR and selective changes in middle cerebral artery (MCA) Doppler. A literature search was performed using the PubMed database. A total of 25 references, which were the basis for this article was obtained. It concludes the middle cerebral artery has a particular value in the identification and prediction of adverse outcomes in these fetuses, which has an increased risk of abnormal neurological performance at birth and at two years of age.(AU)

Severe fat embolism in perioperative abdominal liposuction and fat grafting / Embolia gordurosa grave no peroperatório de lipoaspiração abdominal e lipoenxertia

ABSTRACT BACKGROUND AND OBJECTIVES: Fat embolism syndrome may occur in patients suffering from multiple trauma (long bone fractures) or plastic surgery (liposuction), compromising the circulatory, respiratory and/or central nervous systems. This report shows the evolution of severe fat embolism syndrome after liposuction and fat grafting. CASE REPORT: SSS, 42 years old, ASA 1, no risk factors for thrombosis, candidate for abdominal liposuction and breast implant prosthesis. Subjected to balanced general anesthesia with basic monitoring and controlled ventilation. After 45 min of procedure, there was a sudden and gradual decrease of capnometry, severe hypoxemia and hypotension. The patient was immediately monitored for MAP and central catheter, treated with vasopressors, inotropes, and crystalloid infusion, stabilizing her condition. Arterial blood sample showed pH = 7.21; PCO2 = 51 mmHg; PO2 = 52 mmHg; BE = -8; HCO3 = 18 mEq L-1, and lactate = 6.0 mmol L-1. Transthoracic echocardiogram showed PASP = 55 mmHg, hypocontractile VD and LVEF = 60%. Diagnosis of pulmonary embolism. After 24 h of intensive treatment, the patient developed anisocoria and coma (Glasgow coma scale = 3). A brain CT was performed which showed severe cerebral hemispheric ischemia with signs of fat emboli in right middle cerebral artery; transesophageal echocardiography showed a patent foramen ovale. Finally, after 72 h of evolution, the patient progressed to brain death. CONCLUSION: Fat embolism syndrome usually occurs in young people. Treatment is based mainly on the infusion of fluids and vasoactive drugs, mechanical ventilation, and triggering factor correction (early fixation of fractures or suspension of liposuction). The multiorgânico involvement indicates a worse prognosis.

RESUMO JUSTIFICATIVA E OBJETIVOS: A Síndrome da Embolia Gordurosa (SEG) pode acontecer em pacientes vítimas de politrauma (fratura de ossos longos) ou operações plásticas (lipoaspiração), comprometendo circulação, respiração e/ou sistema nervoso central. O presente relato mostra evolução de SEG grave após lipoaspiração e lipoenxertia. RELATO DO CASO: SSS, 42 anos, ASA 1, sem fatores de risco para trombose, candidata a lipoaspiração abdominal e implante de prótese mamária. Submetida à anestesia geral balanceada com monitorização básica e ventilação controlada. Após 45 minutos de procedimento, houve queda súbita e progressiva da capnometria, hipoxemia e hipotensão grave. Imediatamente foi monitorizada com PAM e cateter central, tratada com vasopressores, inotrópicos e infusão de cristaloides, obtendo estabilização do quadro. Amostra sanguínea arterial mostrou pH = 7,21; PCO2 = 51 mmHg; PO2 = 52 mmHg; BE = -8; HCO3 = 18 mEQ/l e lactato = 6,0 mmol/l. Ecocardiograma transtorácico mostrou PSAP = 55 mmHg, VD hipocontrátil e FEVE = 60%. Diagnóstico de embolia pulmonar. Após24 h de tratamento intensivo, a paciente evoluiu com anisocoria e coma com escala de glasgow 3. Realizada TC de encéfalo que evidenciou isquemia cerebral grave, hemisférica, com sinais de êmbolos de gordura em A. cerebral média D; o ecocardiograma transesofágico mostrou forame oval patente. Finalmente, após 72 h de evolução, a paciente evoluiu para morte encefálica. CONCLUSÃO: A SEG ocorre geralmente em jovens. O tratamento baseia-se principalmente na infusão de líquidos e drogas vasoativas, ventilação mecânica e correção do fator desencadeante (fixação precoce de fraturas ou suspensão da lipoaspiração). O comprometimento multiorgânico indica pior prognóstico.

The correlation between lateralization of intracerebral hemorrhage in basal ganglia and handedness

PURPOSE: To investigate the correlation between lateralization of cerebral basal ganglia hemorrhage and handedness. METHODS: Medical records and computed tomography (CT) scans for 84 patients with primary hypertensive intracerebral hemorrhage (ICH) in basal ganglia were reviewed. Data of gender, age, handedness, and location of basal ganglia hematoma were statistically analyzed. Data of age, gender, handedness, health condition, and mean blood flow velocity (BFV) in middle cerebral arteries (MCAs) and anterior cerebral arteries (ACAs) on both sides of 114 healthy individuals were statistically analyzed. RESULTS: We found out that the patients with right basal ganglia hemorrhage were mostly left-handed, while patients with left basal ganglia hemorrhage were mostly right handed (p=0.021, r=0.251). And the mean BFV in the right MCAs of left-handed ones are relatively higher, the mean BFV in the left MCAs of right-handers are relatively higher (p=0.008, r=0.248). CONCLUSION: There 's a correlation between lateralization of cerebral basal ganglia hemorrhage and handedness.

Papel de la medición de la velocidad sistólica máxima en arteria cerebral media en la isoinmunización rhesus / Fetal middle cerebral artery peak systolic velocity in rh isoimmunization

Objetivo: Evaluación del papel de la velocidad sistólica máxima en arteria cerebral media (VSM-ACM) en casos de isoinmunización Rh. Métodos: 67 casos de isoinmunización Rh, en el Hospital La Paz desde febrero del 2006 hasta agosto del 2009, con título de anticuerpos > 1:32, afectación en embarazo previo y/o casos de isoinmunización anti- Kell, en los que se ha realizado medición de la VSM-ACM. Resultados: La capacidad de detección de anemia moderada-severa en base a la medición de VSM-ACM presenta: sensibilidad 80 por ciento (IC95 por ciento: 59,8-100), especificidad y valor predictivo positivo 100 por ciento, y valor predictivo negativo 85,7 por ciento (IC95 por ciento: 70,7-100). El coeficiente de correlación de Pearson entre la hemoglobina estimada y la real es de 0,71. Conclusión: La medición de VSM-ACM predice casos de anemia moderada y severa que son los clínicamente cruciales por la necesidad de actuación obstétrica activa en forma de transfusión intrauterina o finalización del embarazo.

Objective: To evaluate the fetal middle cerebral artery peak systolic velocity (MCA-PSV) in the management of Rh isoimmunized pregnancies. Methods: 67 pregnancies complicated by Rh isoimmunization, in La Paz Hospital ( Madrid) since 2006 February until 2009 August 2009, with maternal antibody titers > 1:32, affected in previous pregnancies and/or anti-Kell isoimmunization, in which MCA-PSV has been measured. Results: For the detection of moderate-severe fetal anemia, Doppler ultrasonography of the middle cerebral artery had a sensitivity of 80 percent (CI95 percent: 59.8-100), a specificity and positive predictive value of 100 percent, and a negative predictive value of 85.7 percent (CI95 percent: 70.7-100). The Pearson correlation coefficient between estimated hemoglobin and real hemoglobin is 0.71. Conclusion: The measurement of MCA-PSV predicts moderate-severe fetal anemia cases, which are the most important in the clinical management because of the need of active treatment with intrauterine transfusion or induction labor.

Immunohistochemical identification of plasma protein deposits in the wall of lenticulostriate arteries in patients with long-standing hypertension, with and without lipohyalinosis / Identificação imuno-histoquímica de depósitos de proteínas plasmáticas na parede das artérias lentículo-estriadas em pacientes com hipertensão arterial de longa duração, com e sem lipo-hialinose

PURPOSE: To investigate, through an immunohistochemical method, whether there is deposition of plasma proteins in the wall of lenticulostriate, cortical and leptomeningeal arteries of hypertensive patients, with and without lipohyalinosis. METHOD: Forty patients with essential hypertension were selected at random, 20 with lipohyalinosis in the lenticulostriate arteries (HH group) and 20 without lipohyalinosis (H group), matched with 20 normotensive controls (C group). RESULTS: Plasma protein deposits were identified in eight patients (40 percent) in the C group, in 15 patients (75 percent) in the H group, and in all 20 patients (100 percent) in the HH group, the difference being significant for the H group and highly significant for the HH group, as compared with the C group. In all groups, the distribution of plasma protein deposits, subendothelial in normal arteries, and diffuse, irregular in the wall of arteries with lipohyalinosis, was more frequent in the lenticulostriate arteries of the putamen. CONCLUSION: Deposition of plasma proteins in the lenticulostriate arteries seems to be relatively frequent in normotensive individuals, starting in middle age. Such process appears to be intensified by hypertension, especially in individuals with lipohyalinosis.

PROPÓSITO: Investigar, por meio de método imuno-histoquímico, a deposição de proteínas plasmáticas na parede das artérias lentículo-estriadas, corticais e leptomeníngeas em pacientes com hipertensão arterial, com e sem lipo-hialinose. MÉTODO: Quarenta pacientes com hipertensão arterial foram selecionados aleatoriamente, sendo 20 com lipo-hialinose nas artérias lentículo-estriadas (grupo HH) e 20 sem lipo-hialinose (grupo H), pareados com 20 controles normotensos (grupo C). RESULTADOS: Depósitos de proteínas plasmáticas foram identificados em oito pacientes (40 por cento) do grupo C, em 15 pacientes (75 por cento) do grupo H e em todos os 20 pacientes (100 por cento) do grupo HH, a diferença sendo significativa para o grupo H e altamente significativa para o grupo HH, quando comparada com o grupo C. Em todos os grupos, a distribuição dos depósitos de proteínas plasmáticas, subendotelial em artérias normais e difusa, irregular, na parede das artérias com lipo-hialinose, foi mais freqüente nas artérias lentículo-estriadas do putâmen. CONCLUSÃO: A deposição de proteínas plasmáticas nas artérias lentículo-estriadas parece ser um fenômeno relativamente freqüente em indivíduos normotensos, a partir da meia-idade. Tal processo parece ser intensificado pela hipertensão arterial, particularmente naqueles pacientes com lipo-hialinose.

Efeito do sulfato de magnésio sobre o índice de pulsatilidade das artérias uterinas, umbilical e cerebral média fetal de acordo com a persistência da incisura protodiastólica da artéria uterina na pré-eclâmpsia grave / Effect of magnesium sulfate on pulsatility index of uterine, umbilical and fetal middle cerebral arteries according to the persistence of bilateral diastolic notch of uterine arteries in patients with severe preeclampsia

OBJETIVO: avaliar o efeito do sulfato de magnésio sobre o índice de pulsatilidade (IP) das artérias uterinas, umbilicais e cerebral média fetal, de acordo com a persistência ou não da incisura protodiastólica bilateral das artérias uterinas na pré-eclâmpsia grave. MÉTODOS: foi desenvolvido um estudo do tipo coorte, incluindo 40 gestantes com pré-eclâmpsia grave, das quais 23 apresentavam incisura protodiastólica bilateral e 17, incisura ausente/unilateral. As pacientes foram submetidas a doplervelocimetria antes e depois de 20 minutos da administração intravenosa de 6 g do sulfato de magnésio. O exame foi realizado com a paciente em posição semi-Fowler, obtendo-se os sonogramas durante a inatividade fetal, em períodos de apneia e ausência de contrações uterinas. Todos os exames foram realizados por dois pesquisadores, considerando a média como resultado final. A comparação dos IP antes e depois do sulfato de magnésio em cada grupo foi realizada pelo teste de Wilcoxon. A diferença das duas medidas (antes e depois do sulfato de magnésio) foi comparada entre os grupos (incisura bilateral e incisura ausente/unilateral) utilizando-se o teste de Mann-Whitney. RESULTADOS: houve um aumento significativo da frequência cardíaca materna e uma diminuição da pressão arterial materna e da mediana dos IP das duas artérias uterinas e da artéria cerebral média fetal depois da utilização do sulfato de magnésio em ambos os grupos. Houve redução significativa do IP da artéria uterina esquerda e da artéria umbilical apenas no grupo com incisura protodiastólica unilateral/ausente. No entanto, não foram encontradas diferenças significativas em relação ao IP da artéria uterina direita e relação umbilical/cerebral antes e depois do sulfato de magnésio em cada grupo. Não se encontrou diferença entre os grupos, antes e depois do sulfato de magnésio, para nenhum dos desfechos estudados. CONCLUSÕES: após a administração intravenosa de 6 g do sulfato de magnésio nas...

PURPOSE: to evaluate the effect of magnesium sulphate on the pulsatility index (PI) of the uterine, umbilical and fetal middle cerebral arteries, according to the persistency or not of the bilateral protodiastolic notch of the uterine arteries in severe pre-eclampsia. METHODS: a cohort study including 40 pregnant women with severe pre-eclampsia, 23 of them presenting bilateral protodiastolic notch, and 17, unilateral/absent notch. The patients were submitted to Doppler velocimetry before and 20 minutes after the intravenous administration of 6 g of magnesium sulphate. The examination was carried out with the patient in semi-Fowler position, the sonograms being obtained during fetal inactivity, in apnea and absent uterine contraction periods. All the exams were performed by two researchers, the average being considered as the final result. Wilcoxon's test was used to compare the PI, before and after magnesium sulphate in both groups. The difference between the two measurements (before and after magnesium sulphate) was compared between the groups (bilateral incision and unilateral/absent incision) using the Mann-Whitney test. RESULTS: there was a significant increase in the maternal heart rate (MHR) and decrease in the maternal blood pressure, and in the PI medians of the two uterine arteries and in the fetal middle cerebral artery, after magnesium sulphate in both groups. There was a significant decrease in the PI of the left uterine artery and in the umbilical artery, only in the protodiastolic unilateral/absent notch group. Nevertheless, it was not found any significant difference regarding the PI of the right uterine artery, or the cerebral/umbilical relationship, before and after magnesium sulphate in each group. No difference between the groups was found, before and after magnesium sulphate, for any of the studied outcomes. CONCLUSIONS: after the intravenous administration of 6 g of magnesium sulphate to patients with severe pre-eclampsia...

Doppler das artérias umbilicais e cerebral média fetal após sulfato de magnésio na pré-eclâmpsia / Doppler of the umbilical and fetal middle cerebral arteries after magnesium sulfate in preeclampsia

OBJETIVO: Comparar a relação da artéria umbilical e artéria cerebral média fetal através dos índices dopplervelocimétricos (índice de resistência, índice de pulsatilidade e relação S/D) antes e após a utilização do sulfato de magnésio nas gestantes com pré-eclâmpsia grave (pura ou superposta). MÉTODOS: Foi desenvolvido um estudo do tipo coorte prospectivo, no qual cada sujeito serviu como seu próprio controle. Foram selecionadas 40 gestantes com pré-eclâmpsia grave, submetidas ao exame dopplervelocimétrico antes e após 20 minutos da administração intravenosa de 6 g do sulfato de magnésio. As variáveis estudadas foram os índices dopplervelocimétricos da relação artéria umbilical e cerebral média fetal. A comparação das médias entre as duas medidas (antes e depois) de cada indivíduo foi realizada através do teste t student pareado. A comparação entre a distribuição de freqüência de diagnóstico fetal (normal, redução isolada na resistência da artéria cerebral média e centralizado) foi realizada através do teste Qui quadrado (c²) de Stuart-Maxwell. RESULTADOS: Não foi observada diferença estatisticamente significativa das médias da relação artéria umbilical/cerebral média nos índices dopplervelocimétricos antes e após o sulfato de magnésio. Verificou-se aumento da freqüência de redução isolada na resistência da artéria cerebral média após o sulfato de magnésio (25,0 por cento x 47,5 por cento; p = 0,01). CONCLUSÃO: A administração intravenosa do sulfato de magnésio nas gestantes com pré-eclâmpsia grave resultou em um aumento significativo na freqüência de fetos com diagnóstico de redução da resistência da artéria cerebral média na dopplervelocimetria.

BACKGROUND: To compare the ratio between the fetal middle cerebral artery and the umbilical artery using Doppler flow velocimetry indices (resistance index, pulsatility index and A/B relation) before and after administration of magnesium sulfate to pregnant women with severe preeclampsia (pure or superimposed). METHODS: A prospective cohort study was conducted with each pregnant woman representing her own control. Forty severe preeclamptic women were included and underwent Doppler sonography before and 20 minutes after administration of 6g of magnesium sulfate. Analysis variables were the Doppler flow velocimetry indices evaluating the ratio of the fetal middle cerebral artery to the umbilical artery. To compare the mean indices before and after magnesium sulfate for the same patient, the "t-paired" Student test was used. The Stuart-Maxwell c² was applied to determine the difference of fetal diagnosis (normal, brain-sparing or reduced middle cerebral artery resistance) before and after magnesium sulfate. RESULTS: No significant difference of the mean ratio between the middle cerebral artery and the umbilical artery, before and after administration of magnesium sulfate was observed. After magnesium sulfate (25.0 percent x 47.5 percent; p= 0.01), there was an increased frequency of isolated lower Doppler flow velocimetry indices in the middle cerebral artery. CONCLUSION: Intravenous administration of magnesium sulfate in patients with severe preeclampsia is associated with increased frequency of fetal Doppler diagnosis of reduced resistance in the middle cerebral artery.

Transcranial doppler in sickle cell anaemia: evaluation of brain blood flow parameters in children of Aracaju, Northeast - Brazil / Doppler transcraniano em portadores de anemia falciforme: estudo dos parâmetros de fluxo sangüíneo cerebral em crianças de Aracaju, Sergipe

BACKGROUND: Environmental factors interfere on sickle cell anaemia (SCA). Transcanial Doppler (TCD) is important to evaluate cerebrovascular disease. OBJECTIVE: To evaluate brain haemodynamic profile of children with SCA in Sergipe. METHODS: Cross sectional study (group1: SCA patients aged 3-18; group2: age and sex matched healthy individuals). Baseline brain flow was evaluated. RESULTS: Group1=34 patients; group 2=81 controls. SCA patients had mean velocity (MV)=125.69 cm/s±23.40; pulsatility index (PI)=0.66±0.10; middle cerebral artery ratio (MCAr)=14.53±15.23; right anterior cerebral artery/right middle cerebral artery=0.77±0.20; left anterior cerebral artery/left middle cerebral artery=0.78±0.20. Controls had MV=79.44±15.54; PI=0.82±0.11; MCAr=13.19±13.77; right anterior cerebral artery/right middle cerebral artery=0.80±0.16; left anterior cerebral artery/left middle cerebral artery=0.84±0.18. MV and PI differences were statistically significant between groups. MV was related to age but not to gender. CONCLUSION: MV evaluation using TCD was similar to international standards and possible to be used in our setting.

INTRODUÇÃO: Aspectos ambientais interferem na apresentação da anemia falciforme (AF). Doppler transcraniano (DTC) é útil na avaliação do risco para doença cerebrovascular em pacientes com AF. OBJETIVO: Avaliar o perfil hemodinâmico cerebral de crianças com AF em Sergipe. MÉTODO: Estudo transversal (grupo1: portadores de AF 3-18 anos; grupo2: indivíduos saudáveis, pareados por idade e gênero). Foram avaliadas medidas de fluxo sangüíneo cerebral basal. RESULTADOS: Grupo1 (n=34): velocidade média (Vm)=125,69 cm/s ±23,40; índice de pulsatilidade (Ip)=0,66±0,10; relação entre artéria cerebral média (ACMs)=14,53±15,23; artéria cerebral anterior (ACA)/ACM direita=0,77±0,20; ACA/ACM esquerda=0,78±0,20. Grupo 2 (n=81): Vm=79,44 cm/s ±15,54; Ip=0,82±0,11, relação entre ACMs=13,19±13,77, ACA/ACM direita=0,80±0,16; ACA/ACM esquerda=0,84± 0,18. Vm foi maior e Ip menor no grupo1. Vm se correlacionou com idade mas não com gênero. CONCLUSÃO: O perfil hemodinâmico cerebral de crianças com AF em Sergipe assemelha-se às referências internacionais. Não se observou interferência de fatores ambientais sobre os resultados.

Estudo longitudinal dos valores normais do tempo de aceleração na artéria cerebral média fetal na segunda metade da gestação / Longitudinal study about the normal values of the acceleration time on the fetal middle cerebral artery in the second half of the pregnancy

Objetivo: Determinar os valores normais do tempo de aceleração na artéria cerebral média entre a 22a e a 38a semanas de gestação e sua relação com a freqüência cardíaca fetal. Material e métodos: Foi feito um estudo prospectivo e longitudinal no qual 33 fetos de gestantes normais foram avaliados por meio da ultra-sonografia. Os exames dopplervelocimétricos foram realizados por um único observador em um mesmo equipamento. O traçado dopplervelocimétrico foi obtido com volume de amostra de 1 mm e posicionado na artéria cerebral média anterior o mais próximo da calota craniana. O ângulo de insonação foi de 50 a 190 e o filtro de parede utilizado de 50-100 Hz. Resultados: O tempo de aceleração foi de 40 milissegundos na 22a e 26a semanas; 50 milissegundos na 30a e 34a semanas e 60 milisegundos na 38a semana. Observamos aumento significante apenas na 30a semana de gesta- ção (p < 0,05). Conclusão: As medidas dopplervelocimétricas do TAACM de fetos normais podem ser comparadas com valores dopplervelocimétricos desse índice em gestações de alto risco, principalmente quando houver anormalidades cardíacas fetais (AU)

Objective: To determine the normal values of the acceleration time on the middle cerebral artery between 22 and 38 weeks of pregnancy and its relation with the fetal cardiac output. Material and methods: A prospective and longitudinal observational study was conducted on 33 fetuses of normal pregnant women evaluated by ultrasonography. Doppler ultrasound examination was performed by a single observer with the same equipment. The Doppler tracing was obtained with a sample volume of 1 mm and placed on the anterior middle cerebral artery as close as possible to the skullcap. The insonation angle was kept between 5o and 19o and the wall filter was adjusted to a frequency of 50-100 Hz. Results: The acceleration time was 40 milliseconds on the 22nd and 26th week, 50 milliseconds on 30th and 34th week and 60 milliseconds during the 38th week. The values were significantly higher only during the 30a gestational week (p<0,05). Conclusion: The Doppler velocimetry values of the TAACM of normal fetuses can be compared with Doppler velocimetry values of this index in high-risk pregnancy, specially when there is fetal cardiac anomalies (AU)

Tratamento cirúrgico dos aneurismas não rotos da artéria cerebral média / Surgical treatment of unruptured middle cerebral artery aneurysms

Descrevemos nossa experiência no tratamento microcirúrgico de 34 pacientes portadores de aneurismas não rotos da artéria cerebral média. Houve prevalência no sexo masculino. Oitenta e três por cento dos aneurismas apresentava tamanho menor que 10 mm. Não houve óbito na presente série, com morbidade de 3 por cento após 1 ano. Indicamos, portanto, microcirurgia como tratamento de escolha para os aneurismas não rotos da artéria cerebral média.

Multiphasic Perfusion CT in Acute Middle Cerebral Artery Ischemic Stroke: Prediction of Final Infarct Volume and Correlation with Clinical Outcome

OBJECTIVE: To assess the utility of multiphasic perfusion CT in the prediction of final infarct volume, and the relationship between lesion volume revealed by CT imaging and clinical outcome in acute ischemic stroke patients who have not undergone thrombolytic therapy. MATERIALS AND METHODS: Thirty-five patients underwent multiphasic perfusion CT within six hours of stroke onset. After baseline unenhanced helical CT scanning, contrast-enhanced CT scans were obtained 20, 34, 48, and 62 secs after the injection of 90 mL contrast medium at a rate of 3 mL/sec. CT peak and total perfusion maps were obtained from serial CT images, and the initial lesion volumes revealed by CT were compared with final infarct volumes and clinical scores. RESULTS: Overall, the lesion volumes seen on CT peak perfusion maps correlated most strongly with final infarct volumes (R2=0.819, p<0.001, slope of regression line=1.016), but individual data showed that they were less than final infarct volume in 31.4% of patients. In those who showed early clinical improvement (n=6), final infarct volume tended to be overestimated by CT peak perfusion mapping and only on total perfusion maps was there significant correlation between lesion volume and final infarct volume (R2=0.854, p=0.008). The lesion volumes depicted by CT maps showed moderate correlation with baseline clinical scores and clinical outcomes (R=0.445-0.706, p<=0.007). CONCLUSION: CT peak perfusion maps demonstrate strong correlation between lesion volume and final infarct volume, and accurately predict final infarct volume in about two-thirds of the 35 patients. The lesion volume seen on CT maps shows moderate correlation with clinical outcome.