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1.
Autops. Case Rep ; 11: e2021268, 2021. graf
Article in English | LILACS | ID: biblio-1249029

ABSTRACT

Background Neonatal acute liver failure (NALF) is a rare and life-threatening condition. It causes bilirubin to accumulate to a dangerous level in the body, causing permanent damage to vital organs such as the brain and lungs. In many cases, the etiology of NALF remains unknown. Case presentation We described a case of an 8-day-old baby girl who presented with poor oral intake, lethargy, and jaundice. Her clinical condition rapidly deteriorated with progression to multi-organ failure, and despite intensive resuscitation efforts, she expired. At autopsy, the most significant findings were liver necrosis, yellow hyaline membrane deposition in the lungs, and bilirubin deposition in the brain (kernicterus). Conclusions NALF is a rare and potentially fatal condition necessitating prompt recognition and disease-specific treatment approaches. Toxic accumulation of bilirubin in the lungs can lead to hypoxia and precipitate further ischemic injury to the liver.


Subject(s)
Humans , Female , Child , Hyaline Membrane Disease/pathology , Kernicterus/pathology , Autopsy , Rare Diseases , Cerebrum/pathology , Lung/pathology
2.
Rev. argent. radiol ; 82(2): 57-63, jun. 2018. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-958054

ABSTRACT

Objetivo La atrofia hipocampal es uno de los biomarcadores radiológicos más sensibles de la enfermedad de Alzheimer (EA) y existen diferentes métodos para evaluarla: análisis subjetivo visual (ASV), análisis objetivo manual (AOM) y análisis objetivo automático (AOA). Nos proponemos comparar esos métodos, y evaluar si el AOA presenta una confiabilidad cercana al AOM (método de referencia) y superior al ASV. Materiales y Métodos Se seleccionaron retrospectivamente imágenes de resonancia magnética (RM) fast spoiled gradient-echo (FSPGR) de 28 sujetos (14 con deterioro cognitivo leve, 7 con EAy 7 controles). El ASV fue realizado por 10 radiólogos, clasificando la atrofia hipocampal en: nula, leve, moderada o severa. El AOM se basó en la segmentación manual de los hipocampos por dos operadores. El AOA fue realizada por medio del software FreeSurfer 5.3. Se calcularon coeficientes de correlación rho de Spearman para las variables discretas y coeficientes de correlación intraclase para las variables continuas. Resultados Los coeficientes de correlación entre los dos operadores que realizaron el AOM fueron de 0,88 (p < 0,0001) para los hipocampos izquierdos y de 0,86 (p < 0,0001) para los hipocampos derechos. El coeficiente de correlación entre todos los ASV (promediados) y AOM fue de-0,81 (IC 95%-0,96- -0,66). Los coeficientes de correlación entre el AOA y el AOM fue de 0,54 (p < 0,0001) para los hipocampos izquierdos y de 0,61 (p < 0,0001) para los hipocampos derechos. Conclusión Si bien el AOA tiene moderada correlación con el método de referencia, no es superior al ASV promedio y se deberían tomar recaudos antes de ser implementado en la práctica asistencial.


Objective Hippocampal atrophy is one of the most sensible radiological biomarkers of Alzheimer's disease. There are different methods to evaluate atrophy: visual subjective analysis (VSA), manual objective analysis (MOA) and automatic objective analysis (AOA). We will compare these methods and evaluate if AOA has a confidence similar to MOA (gold standard), and better than VSA. Materials and Methods We retrospectively selected 3D FSPGR MRI from 28 subjects of whom 14 had mild cognitive impairment, 7 Alzheimer's disease and 7 controls. VSA was performed by 10 radiologists who classified hippocampal atrophy in none, mild, moderate and severe. ForMOA, two operatorsmanually segmented both hippocampus from all subjects. AOA was performed by FreeSurfer 5.3. Spearman's rho correlation coefficient was calculated for discrete variables and intraclass correlation coefficient was calculated for continuous variables. Results Correlation coefficients between the operators that performed MOA was 0.88 (p < 0.0001) for left hippocampi and 0.86 (p < 0,0001) for right hippocampi. Correlation coefficients between mean VSA and MOA was-0,81 (95% CI-0,96- -0,66). Correlation coefficients between AOA and AOM was 0.54 (p < 0.0001) for left hippocampi and 0.61 (p < 0.0001) for right hippocampi. Conclusion Even though AOA has moderate correlation with the gold standard it is not superior to average VSA and should be implemented with care in clinical practice.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Titrimetry/methods , Cerebrum/pathology , Alzheimer Disease/diagnostic imaging , Hippocampus/diagnostic imaging , Atrophy/diagnostic imaging , Magnetic Resonance Imaging/methods , Biomarkers , Retrospective Studies
3.
Int. j. morphol ; 34(1): 29-33, Mar. 2016. ilus
Article in English | LILACS | ID: lil-780471

ABSTRACT

Bone damage and accidents, traumas can alter people's normal life, and damage the soft tissues. In this study, we aimed to investigate in calvarial defects in rats depending on the severity of cerebral contusion injury occurring in the temporal region. The rats were randomly divided into two groups: group 1 (control group), critical size cranial model with no treatment (n= 10); group 2 (14-day synthetic graft group given 7th day DEXA), critical size cranial model treated with Dexamethasone (0.05 mg/kg intramuscular injection) +Synthetic graft (n= 10) One calvarium defect of 7 mm was made in the parietal bone of each animal under general anesthesia. Calvarial defect results in dilatation of blood vessels, hemorrhage and deterioration was observed in glial fibrillary structures. Additionally, the increase in vascular endothelial growth factor expression showed a positive reaction with glial fibrillary acid protein astrocytes extensions. Apoptotic glial cells stained positive with Bcl-2. Calvarial defects caused by mild brain injury, to be induced by inflammatory cytokines, interrupting glial fibrillary degeneration by affecting the blood brain barrier is thought to promote apoptotic changes.


Daños óseos, accidentes y traumas pueden alterar la vida normal de las personas y dañar los tejidos blandos. Este estudio tuvo como objetivo investigar los defectos de calota en ratas en función de la gravedad de la lesión cerebral que ocurre en una contusión de la región temporal. Las ratas fueron divididas aleatoriamente en dos grupos: al grupo 1 (control), se le realizó un modelo de defecto craneal de tamaño crítico sin tratamiento (n= 10) y al grupo 2, se le realizó un modelo de defecto craneal de tamaño crítico que fue tratado con dexametasona (0,05 mg/kg vía i.m.) + injerto sintético (n= 10) (14 d con injerto sintético y el día 7 se le administró dexametasona). El modelo generó un defecto de 7 mm en el hueso parietal en cada animal, bajo anestesia general. Los defectos craneales produjeron dilatación de los vasos sanguíneos, hemorragias y deterioro en las estructuras gliales fibrilares. Además, el aumento de la expresión del factor de crecimiento vascular endotelial mostró una reacción con las positiva con la proteína ácida fibrilar de la glía el las extensiones de los astrocitos. Las células gliales apoptóticas se tiñeron positivas con Bcl-2. Los defectos de calota causan una lesión cerebral leve, inducidas por citoquinas inflamatorias, las que interrumpen la degeneración glial fibrilar al afectar la barrera hematoencefálica, induciendo cambios apoptóticos.


Subject(s)
Animals , Rats , Cerebrum/pathology , Skull/injuries , Immunohistochemistry , Rats, Sprague-Dawley
4.
Iranian Rehabilitation Journal. 2013; 11 (Special issue): 70-80
in English | IMEMR | ID: emr-162148

ABSTRACT

Cerebral hemispheres functioning have been found to be abnormal in children with ASD. The role of lateralization in implicit and explicit motor learning has received little attention in ASD researches. The main goal of this study is investigating the differences between two hands implicit and explicit motor learning in children with ASD and typical matched group. In the present random clinical trial study, 30 boys with ASD aged 7-11 were compared with 32 typical matched boys. Typical group and the ASDs, which were screened with ASSQ, were selected from elementary schools in Najafabad [Isfahan, Iran]. Participants performed a serial reaction time task [10 blocks] with each hand in implicit and explicit group with random allocation. Learning comparison between two groups showed significant difference which means explicit learning deficit in the ASDs with right [p=0.009] and left hand [p=0.004]. Results also indicated no significant difference in implicit learning between ASDs and typical matched group in right [p=0.385] and left hand [p=0.18]. Hands differences also showed speeded right hand in implicit learning in children with ASD [p=0.028] while no differences was seen in explicit learning and typical children. Explicit learning of right and left hand was impaired in children with ASD while implicit learning of both hands maintained intact and a right hand preference in implicit motor learning was observed in children with ASD due to left striatal system abnormality


Subject(s)
Humans , Male , Child , Asperger Syndrome/physiopathology , Learning , Child , Cerebrum/pathology , Hand/physiopathology
5.
São Paulo; s.n; 2013. 125 p. ilus, tab.
Thesis in Portuguese | LILACS, Inca | ID: lil-751059

ABSTRACT

A doença de Alzheimer (DA) é caracterizada por um declínio cognitivo progressivo associado ao acúmulo de peptídeo β-amilóide (placas neuríticas), proteína tau hiperfosforilada (emaranhados neurofibrilares), degeneração sináptica e morte neuronal no hipocampo e em outras regiões corticais. Vários estudos apontam uma reativação do ciclo celular em neurônios pós-mitóticos na DA, o que levaria à morte neuronal. Porém, ainda não existe um estudo que avalie marcadores do ciclo celular em indivíduos portadores da neuropatologia típica da DA, mas que não apresentem evidências de comprometimento cognitivo (DA assintomática). Diante disso, este trabalho pretende verificar se existe diferença entre indivíduos com DA sintomática, DA assintomática e indivíduos normais em relação a marcadores do ciclo celular e de morte celular. Nossos resultados mostram alterações significantes de marcadores do ciclo e morte celular nos indivíduos com DA sintomática comparados aos com DA assintomática e aos normais, enquanto que, entre os indivíduos com DA assintomática e sujeitos normais, não existem diferenças significativas. Este trabalho sugere associação entre o controle da maquinaria do ciclo celular nos neurônios pós-mitóticos, e a manutenção do status cognitivo normal...


Alzheimer's disease (AD) is characterized by progressive cognitive decline associated with accumulation of amyloid-β peptide (neuritic plaques), hyperphosphorylated tau protein (neurofibrillary tangles), synaptic degeneration and neuronal death in the hippocampus and in other cortical regions. Several studies indicate a reactivation of the cell cycle in AD post-mitotic neurons, leading to neuronal death. However, studies evaluating cell cycle markers in patients with AD neuropathology, but with no evidence of cognitive impairment (asymptomatic AD) are lacking. Therefore, this study intends to investigate whether there are differences among subjects with symptomatic AD, asymptomatic AD and normal individuals in relation to cell cycle and cell death markers. Our results show significant changes in both cell cycle and cell death markers in subjects with symptomatic AD compared to asymptomatic AD and normal individuals, while between asymptomatic AD individuals and normal subjects, there were no significant differences. This study suggests an association between the control of cell cycle machinery in post-mitotic neurons, and maintenance of normal cognitive status...


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Tissue Array Analysis , Microarray Analysis/methods , Autopsy , Cerebrum/pathology , Alzheimer Disease/diagnosis , Alzheimer Disease/genetics , Cerebrum
6.
Arch. pediatr. Urug ; 84(2): 136-142, 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-754185

ABSTRACT

La tos convulsa es una infección bacteriana de las vías respiratorias, producida por Bordetella pertussis. En la era prevacunación fue una enfermedad endémica, con picos epidémicos cada 2 a 5 años. Luego de la vacunación generalizada, la tasa de infección disminuyó 150 veces. En Uruguay en el año 2011 hubo un aumento en los casos de tos convulsa, con mayor cantidad de ingresos a unidades de cuidados intensivos y de muerte por tos convulsa. Objetivo: describir los casos clínicos de 3 pacientes con tos convulsa grave que fallecieron en UCIN en el período de octubre-noviembre de 2011 y los hallazgos en la anatomía patológica. Se describen tres casos que se presentaron como tos coqueluchoide con fallo respiratorio que requirió asistencia ventilatoria mecánica. En los tres se confirmó el diagnóstico de infección por Bordetella pertussis. Los tres presentaron hiperleucositosis severa que requirió exanguinotransfusión y desarrollaron hipertensión pulmonar (HTP) severa con shock cardiogénico y fallo renal anúrico. En la anatomía patológica de los 3 pacientes se observó necrosis miocárdica extensa, necrosis tubular aguda y necrosis neuronal con edema cerebral. Conclusión: la tos convulsa ha resurgido en los últimos años, siendo de mayor gravedad en menores de 6 meses. Se destaca lo estereotipado de la presentación y evolución con hipoxemia refractaria e HTP que llevan al colapso cardiocirculatorio...


Subject(s)
Humans , Male , Infant , Bordetella pertussis/pathogenicity , Cerebrum/pathology , Myocardium/pathology , Necrosis , Kidney/pathology , Whooping Cough/diagnosis , Whooping Cough/mortality , Whooping Cough/therapy , Autopsy , Communicable Diseases, Emerging
7.
Rev. argent. radiol ; 76(2): 123-125, jun. 2012. ilus
Article in Spanish | LILACS | ID: lil-740571

ABSTRACT

La Leucoencefalopatía Hipóxica Tardía (LHT) es una enfermedad desmielinizante de infrecuente presentación. Se produce como consecuencia de un fenómeno de hipoxia-anoxia y aparece días o semanas más tarde. Los síntomas y cambios imagenológicos remiten casi totalmente y tienen un buen pronóstico En este reporte se ilustra el caso de una joven que desarrolló LHT luego de sufrir un paro cardiorrespiratorio...


Subject(s)
Humans , Female , Adult , Hypoxia/complications , Leukoencephalopathies/etiology , Cerebrum/pathology , Magnetic Resonance Imaging
8.
Bol. latinoam. Caribe plantas med. aromát ; 10(4): 338-350, jul. 2011. graf, ilus, tab
Article in Portuguese | LILACS | ID: lil-654646

ABSTRACT

The aim of this study was to investigate the potential neuroprotective and anticonvulsant effects of ethanolic extract from flowers (EEF) of B. perrenis in adult Swiss mice (2 months old) after seizures induced by pilocarpine. The animals were divided into 8 groups. The first group was treated with vehicle (0.05 percent Tween 80 dissolved in 0.9 percent saline) and the second with pilocarpine (400 mg/kg, P400 group). The third, fourth and fifth group were pretreated with EEF (50, 100 or 150 mg/kg) and 30 min later received P400 (EEF 50, EEF 100 or EEF 150 plus P400 groups), respectively. In turn, the remaining groups were treated with EEF alone (50, 100 or 150 mg/kg EEF 50, EEF 100 or EEF 150 groups), respectively. After treatment, the groups were observed for 24 h and then euthanized and their brains removed for histopathological analysis. All P400 group animals showed seizures that progressed to status epilepticus. Pre-treatment with EEF produced a significant reduction in those indices. P400 and EEF 50 plus P400 groups showed 87.5 percent and 37.5 percent of animals with brain damage in the hippocampus, respectively. In P400 group, the damage rate in striatum was 75 percent. In turn, this region has seen a reduction of 46.99 percent neuronal damage of those of EEF 50 plus P400 group. According to our results we suggest that the EEF may modulate epileptogenesis and promote anticonvulsant and neuroprotective mechanisms in model of seizures induced by pilocarpine.


O objetivo desse estudo foi investigar o potencial efeito neuroprotetor e anticonvulsivante do extrato etanólico das flores de B. perrenis (EEF) em camundongos Swiss adultos (2 meses) após convulsão induzida por pilocarpina. Os animais foram divididos em 8 grupos. O primeiro grupo foi tratado com veículo (Tween 80 0,05 por cento dissolvido em salina 0,9 por cento) e o segundo com pilocarpina (400 mg/kg, grupo P400). Já o terceiro, quarto e quinto grupo foram tratados com EEF (50, 100 ou 150 mg/kg), e 30 min depois receberam P400 (grupos EEF 50, EEF 100 ou EEF 150 plus P400), respectivamente. Por sua vez, os demais grupos foram tratados somente com EEF (50, 100 ou 150 mg/kg; grupos EEF 50, EEF 100 ou EEF 150), respectivamente. Após os tratamentos, os grupos foram observados durante 24 h e em seguida eutanasiados e seus cérebros removidos para as análises histopatológicas. Todos os animais do grupo P400 apresentaram convulsões que progrediram para o estado de mal epiléptico. O pré-tratamento com EEF produziu uma redução significativa nesses índices. Os grupos P400 e EEF 50 plus P400 apresentaram 87,5 por cento e 37,5 por cento de animais com lesão cerebral no hipocampo, respectivamente. No corpo estriado dos animais do grupo P400 houve um comprometimento de 75 por cento. Por sua vez, nessa região foi vista uma redução de 46,99 por cento nesse comprometimento nos animais do grupo EEF 50 plus P400. De acordo com nossos resultados podemos sugerir que o EEF pode modular a epileptogênese e promover ação neuroprotetora e anticonvulsivante no modelo das convulsões induzidas por pilocarpina.


Subject(s)
Male , Animals , Mice , Bellis perennis/pharmacology , Cerebrum/pathology , Seizures/chemically induced , Plant Extracts/pharmacology , Pilocarpine/pharmacology
10.
Int. j. morphol ; 28(4): 1255-1261, dic. 2010. ilus
Article in Spanish | LILACS | ID: lil-582920

ABSTRACT

El interés en el estudio del proceso de envejecimiento cerebral y los cambios comportamentales relacionados con la edad en caninos y felinos geriátricos ha aumentado en la última década (Mentzel, 2005a; Ingram & Williams, 2010). Las alteraciones del comportamiento canino que responden a cambios fisiopatológicos relacionados con la edad y que involucran distintas esferas conductuales y cognitivas, se engloban bajo la denominación de Síndrome de Disfunción Cognoscitiva (SDC) (Mentzel, 2005b). El cual fue descrito en 1997 y se observó en perros de más de 9 años (Ingram & Williams). El Síndrome de Disfunción Cognoscitivo (SDC) es también llamado Alzheimer canino por las similitudes histopatológicas cerebrales y conductuales relacionadas. En el presente estudio, los caninos geriátricos presentaron los mismos depósitos proteicos anormales presentes en la enfermedad de Alzheimer, como las placas seniles, los cuerpos ubiquitinados y la angiopatía amiloide, pero no presentaron los ovillos neurofibrilares, los cuales son los responsables de la demencia que se padece en la enfermedad. Las únicas herramientas de evaluación prácticas en clínica para esta patología son las encuestas y formularios relacionados con aspectos comportamentales. Además existen exámenes diagnósticos postmortem que permiten identificar de una manera eficaz la presencia de elementos anormales involucrados en la neuropatología, uno de ellos es la inmunohistoquímica. En este estudio se utilizaron los anticuerpos monoclonales de uso humano anti-b-amiloide, anti-proteína tau y anti-ubiquitina en muestras de cerebros de perros mayores de 10 años. El modelo canino hoy en día está constituyendo un significado indispensable para el estudio de los procesos de neurodegeneración porque ha permitido un acercamiento a la teoría del problema desde nuevas perspectivas (Dimakopoulos & Mayer, 2002).


The interest in the study of the process of cerebral aging and the changes in the behaviour related to age in geriatric canine and feline has increased in the last decade (Mentzel, 2005a; Ingram & Williams, 2010). The alterations of the canine behaviour that respond to physiopathological changes related to the age and which involve different conducts and cognitive spheres are included under the denomination of Canine Cognitive Dysfunction Syndrome (CDS) called canine Alzheimer, considering the cerebral and histopathologic behavioural similarities. In the present study the geriatric patients displayed the same abnormal protein deposits present in Alzheimer disease, such as senile plaques ubiquitinate bodies and the amyloid angiopathy. However they did not display the balls of neurofibrillary tangles which are characteristic of the disease. The only practical tools of evaluation in clinic for this pathology are the surveys and forms related to behavioural aspects. In addition there are post mortem exams such as those in inmunohistochemistry, that allow an effective identification of abnormal elements present in the neuropathology. In this study the monoclonal antibodies were used anti-b-amyloid, anti-protein tau and anti-ubiquitin in samples of brains in dogs over 10 years of age. The canine model constitutes an indispensable meaning for the study of the neurodegeneration processes because it has allowed an approach to the theory of the problem from a new perspective (Dimakopoulos & Mayer, 2002).


Subject(s)
Animals , Dogs , Aging , Cerebrum/pathology , Dog Diseases/pathology , Amyloid beta-Peptides/analysis , tau Proteins/analysis , Ubiquitin/analysis , Antibodies, Monoclonal , Brain Diseases/veterinary , Immunohistochemistry
11.
Rev. chil. endocrinol. diabetes ; 3(3): 181-184, jul. 2010. ilus, tab
Article in Spanish | LILACS | ID: lil-610315

ABSTRACT

Primary adrenal failure (PAF) can be congenital or acquired. X-linked adrenoleukodystrophy (ALD-X), produced by the mutation of the ABDC1 gene (Xq28), that leads to the plasma accumulation of very long chain fatty acids, is one of the congenital diseases associated to adrenal destruction. We report a 7 years old boy with fast progression of right strabismus and general symptoms as weariness, weakness and mucosal and skin pigmentation. A brain magnetic resonance image showed a leukoencephalopathy, characteristic of ALD-X. Low plasma cortisol, high ACTH levels and lack of response to ACTH test, confirmed the diagnosis of primary adrenal insufficiency. High plasma levels of C26:0 fatty acids, and C24/22, C26/22 ratios confirmed ALD-X.


Subject(s)
Humans , Male , Child , Adrenoleukodystrophy/diagnosis , Addison Disease/etiology , Addison Disease/drug therapy , Fatty Acids/blood , Adrenoleukodystrophy/complications , Adrenoleukodystrophy/blood , Anti-Inflammatory Agents/therapeutic use , Cerebrum/pathology , Strabismus/etiology , Adrenal Insufficiency/etiology , Adrenal Insufficiency/drug therapy , Magnetic Resonance Imaging
12.
Hist. ciênc. saúde-Manguinhos ; 16(4): 961-979, out.-dez. 2009.
Article in Spanish | LILACS | ID: lil-537236

ABSTRACT

Son analizados los argumentos defendidos por Cabanis en el Rapports du physique et du moral de l'homme, tomando como punto de partida las Memorias Octava y Novena. Estas Memorias, dedicadas a analizar las influencias del régimen y del clima, permiten leer de otro modo los argumentos utilizados por Cabanis para explicar la relación entre las características físicas y los hábitos morales de individuos y razas. Son analizadas las deudas con la historia natural, particularmente con la teoría de la degeneración de Buffon; con la tradición médica hipocrática, fundamentalmente con la teoría de los humores, y con los estudios de anatomía y patología cerebral. Finalmente, examinamos el papel que la medicina y la higiene, pensadas como ciencias humanas y morales, poseen en los proyetos de la regeneración de la especie humana.


Subject(s)
Behavior , Cerebrum/anatomy & histology , Cerebrum/pathology , Genetics/history , History of Medicine , France
13.
Rev. med. nucl. Alasbimn j ; 11(44)apr. 2009. ilus, tab, graf
Article in English | LILACS | ID: lil-522226

ABSTRACT

Several substances may produce brain perfusion abnormalities in drug-dependent patients. Their mechanism is unclear and several causes might be involved, especially vasospasm in cocaine consumption. Goal: To characterize residual brain perfusion abnormalities in substance-dependent population. We analyzed brain perfusion in 100 dependant patients (DSM-IV criteria) following a month of strict in-hospital abstinence (age:35 +/- 2y.o.; 86 percent men); 55 percent corresponded to poly-drug dependents, mainly to cocaine, alcohol and cannabis; 44 percent mono-drug users, mostly to alcohol. Results: Single Photon Emission Computed Tomography (SPECT) with 99mTc-ethylen-cysteinate-dimer (ECD) was abnormal in 54 percent of the cases, with bilateral cortical hypo-perfusion in 89 percent, focal in 54 percent and diffuse in 46 percent of them, with moderate or severe intensity in 61 percent. The abnormal perfusion group’s age was 38 +/- 12 versus 31 +/- 10 years in the normal SPECT group (P=0.005) with a consumption period of 16 +/- 11 versus 11 +/- 8 years, respectively (P=0.043). Only 29 percent of women had abnormal perfusion versus 58 percent of men (P=0.047). Abnormal brain perfusion in 64 percent of mono and 45 percent in poly-drug dependents (P=0.07). Psychometric tests performed in 25 patients demonstrated association between perfusion defects and cognitive abnormalities. Relative risk for abnormal psychometric test was 2.5 [95 percent;CI=1.1-5.6] for abnormal SPECT. Conclusion: Dependent population after a month of abstinence persists with cortical brain perfusion abnormalities, associated to age, sex and type of drug consumption.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Cerebrovascular Circulation , Cerebrum , Cerebrum/pathology , Organotechnetium Compounds , Tomography, Emission-Computed, Single-Photon , Substance-Related Disorders , Age and Sex Distribution , Cerebrum/blood supply , Prospective Studies , Psychometrics , Regional Blood Flow , Radiopharmaceuticals , Substance Withdrawal Syndrome , Substance-Related Disorders/physiopathology , Substance-Related Disorders/psychology
14.
Rev. chil. neuro-psiquiatr ; 47(1): 43-49, mar. 2009. ilus, tab
Article in Spanish | LILACS | ID: lil-554888

ABSTRACT

Delayed Hypoxic-isquemic Leucoencephalopathy described in 1976 by Ginsberg is a brain white matter demyelinization phenomenon that occurred days or weeks after a hypoxic-isquemic injury followed by a complete recovery of the episode. The pathogenesis process remains unknown. We describe a 48 year old woman with cervico-uterine cancer in palliative treatment with opoids. She enters the emergency room with a respiratory depression, a prolonged hypotension and confusion, that it was recovered. At admission exhibits a recurrent pneumonia. Two weeks later, in conditions of discharge, initiates with agitation in context with rapidly progressive decline cognition, with concordant lesions of Leucoencephalopathy defined in the Magnetic Resonance (MR) study The metabolic profile, the cerebrospinal fluid and the electroencephalogram allowed dismissing other etiologic hypothesis. In front to the suspicious of Ginsberg syndrome, she had normal levels of Arylsulfatase. This acute post-hypoxic demyelinization process has been pathogenic interpreted as an arylsulfatase deficiency. Although numerous cases develop with normal arylsulfatase and the experimental studies of hypoxia, has support the hypothesis of a central hypoxic axonopathy due to failing in axonal transport as the base of the demyelinization phenomenal.


La leucoencefalopatía hipóxico-isquémica retardada (EHIR), descrita por Ginsberg en el año 1976, es un fenómeno desmielinizante de la sustancia blanca cerebral, que se origina días o semanas después de un daño hipóxico-isquémico que había sido seguido de una recuperación completa del episodio. La patogenia del proceso no está completamente establecida. Se presenta una mujer de 48 años portadora de cáncer cérvicouterino, en tratamiento paliativo con opiáceos. Ingresa al Servicio de Urgencia por una depresión respiratoria, hipotensión prolongada y compromiso de conciencia, donde es recuperada. Se hospitaliza por una neumopatía intercúrrente. Dos semanas más tarde, estando en condiciones de alta, se inicia agitación psicomotora en el contexto de un deterioro cognitivo rápidamente progresivo, que el estudio de Resonancia Magnética (RM) definió como lesiones concordantes con una leucoencefalopatía. El perfil metabólico, el líquido cefalorraquídeo y el electroencefalograma, permitieron descartar otras hipótesis etiológicas. Frente a la sospecha de un síndrome de Ginsberg, los niveles de arilsulfatasa fueron normales. Este proceso desmielinizante agudo post-hipóxico, ha sido interpretado patogénicamente como un déficit de arilsulfatasa. Sin embargo, la existencia de numerosos casos que cursan con arilsulfatasa normal y los estudios experimentales de hipoxia, ha avalado la hipótesis de una axonopatía central hipóxica, atribuible a fallas del transporte axoplásmico, como base para el fenómeno desmielinizante.


Subject(s)
Humans , Female , Middle Aged , Cerebrum/pathology , Hypoxia-Ischemia, Brain/complications , Psychomotor Agitation/etiology , Axons/pathology , Confusion/etiology , Cognition Disorders/etiology
15.
Iranian Rehabilitation Journal. 2009; 7 (9): 50-56
in English | IMEMR | ID: emr-134560

ABSTRACT

Foreign Accent Syndrome is a rare speech disorder caused by the damage sustained to left hemisphere of the brain, in which a combination of segmental and suprasegmental deviations in speech production creates foreign accent. Despite of segmental pronunciation problems, prosodic errors are mainly considered as the main characteristics of Foreign Accent Syndrome. The present paper offers a report on a 53-year Persian-speaking woman who is pronouncing the words and sentences with foreign accent after a stroke and central semiovale focal infarctions of left hemisphere. According to researchers' information and follow-up done, this patient is considered as the first case of FAS in Iran. Prosodic characteristics of the patient's speech have been compared with speech features of ordinary speakers of Persian language. Being in direction of previously reported research findings, the obtained results show that there are main deviations in prosodic characteristics of the patient's speech which are related to the speech rate, stress, and juncture


Subject(s)
Humans , Female , Cerebrum/pathology , Stroke , Speech , Tomography, X-Ray Computed , Magnetic Resonance Imaging
16.
Rev. bras. neurol ; 44(4): 5-11, out.-dez. 2008. ilus, tab
Article in Portuguese | LILACS | ID: lil-505037

ABSTRACT

Fundamento: A biópsia estereotáctica tem sido considerada técnica simples e sem complicações e com resultados satisfatórios para o diagnóstico. Neste estudo ficou evidente que nem sempre o procedimento é simples e pode apresentar riscos. Métodos: Foram analisados procedimentos (n=78) para biópsia estereotáctica de novembro de 2000 a setembro de 2007. As biópsias foram diagnósticas em 85,7% e não diagnósticas em 4%. Os procedimentos foram realizados em centro cirúrgico próximo à radiologia e à sala de patologia. Foi usado equipamento do tipo arco-alvo-centrado compatível com coordenadas cartesianas. Os fiduciais usados foram adequados somente para o equipamento de TC. A cânula de biópsia foi do tipo Nashold e as coordenadas foram calculadas no tomógrafo com programa computadorizado. Resultados: Pré-operatoriamente, observaram-se déficits motores e visuais em 35%, convulsões em 38% e alterações do nível de consciência em 27%. Foram incluídos nas biópsias pacientes com lesões expansivas intracranianas e as indefinidas. Foram excluídos os casos com discrasia sanguínea, tumores vasculares, intraventriculares e doença de Creutzfeldt-Jakob. As lesões expansivas predominaram no nível supratentorial e os homens foram mais afetados do que as mulheres: 64% e 36% respectivamente. O mais jovem tinha 16 anos e o mais velho 74. A lesão expansiva predominante foi o glioblastoma multiforme. Entre os diagnósticos da TC 1/3 não correspondeu à biópsia. Não houve morbidade e/ou mortalidade. Conclusão: O procedimento da biópsia estereotáctica não é isenta de risco, assim como de complicações. Em 1/3 dos casos o diagnóstico neuro-radiológico foi diferente do resultado da biópsia dificultando a conduta cirúrgica. O glioma predominante foi do tipo glioblastoma multiforme supratentorial em faixa etária mais alta e glioma de baixo grau nos mais jovens.


Background: Stereotactic biopsy has been considered simple and safe. In this paper it is shown that the stereotactic procedure is not always without risk. Methods: Procedures (n=78) for stereotactic biopsy were analysed from november 2000 to september 2007. Diagnosis was accurate in 85,7% and misdiagnosis was 4%. The isocentric stereotactic arc-centered system type was used with cartesian system of coordinates. Fiducials were adapted only for CT scanner. Biopsy probe Nashold was used. The coordinates were made within the tomographic machine. Results: The patients presented lesions causing motor déficits and visual disturbances in 35%, convulsions in 38%, and conscience level disturbances in 27%. Patients with tumours and undefined lesions were chosen. Patients with blood dyscrasia, vascular and intraventricular tumors, and Creutzfeldt-Jakob disease were excluded. The tumours were mainly supratentorial and men were more affected than women. The younger patient was 16 and the olderst 74 years old. Glioblastoma was the more frequent glioma. Among the cases, 1/3 diagnosed by neuroradiologists was different in relation to the pahological findings. No morbimortality was registered. Conclusions: Stereotactic biopsies are not always safe and with no risks. The neuroradiologic diagnosis were different in 1/3 of the cases in comparison to the pathological findings. The predominant glioma was the glioblastoma type for the older and low grade gliomas for the younger subjects.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Biopsy/methods , Cerebral Hemorrhage , Cerebrum/pathology , Glioma , Stereotaxic Techniques , Biopsy/instrumentation , Retrospective Studies , Tomography, X-Ray Computed
17.
Article in Spanish | LILACS | ID: lil-523043

ABSTRACT

El consumo prolongado y la adicción a diversas drogas se ha asociado consistentemente al deterioro de distintas funciones neuropsicológicas, entre las que destacan, por su crucial relevancia clínica, las funciones ejecutivas, siendo éste el objetivo de esta revisión.


The long consumption and the addiction to diverse drugs has associated to the deterioration of different neuropsychology functions, between its, the executive functions, for this, it is crucial clinical relevancy; by this reason this it is the aim of this review.


Subject(s)
Humans , Nervous System Diseases/physiopathology , Nervous System Diseases/psychology , Substance-Related Disorders/physiopathology , Substance-Related Disorders/psychology , Cerebrum/pathology , Behavior, Addictive/physiopathology , Psychomotor Performance/physiology , Neuropsychology
19.
Rev. chil. neuro-psiquiatr ; 46(1): 55-62, mar. 2008. tab
Article in Spanish | LILACS | ID: lil-513797

ABSTRACT

Background: Dementia is one of the main problems in public health, affecting 5 to 10 percent of the eider population. The cost-effectiveness analysis of the ancillary tests is controversial. The object of this research is to make a review of the recent studies related to neuroimaging and dementia. Method and Results: English and Spanish studies published in the last ten years were searched in Medline, using evidence-based techniques. 13 systematic reviews were found and analysed. Conclusion: While reversible cases of dementia are rare once detected, most of the experts recommend the routine use of computerized tomography scanning. If the access to this test were restricted, there are some rules to select patients. Magnetic resonance imaging is better for the diagnosis of some subtypes of dementia like Creutzfeldt-Jakob, Huntington or CADASIL. Volumetric spectrometry PET and SPECT would be reserved to investigation protocols or special cases of diagnostic doubt.


Introducción: Las demencias constituyen uno de los principales problemas de salud pública, afectando al 5-10 por ciento de la población mayor de 65 años. Existe controversia respecto al costo-beneficio de los exámenes complementarios destinados a esclarecer el subtipo de demencia y la presencia de factores potencialmente reversibles. El objetivo de este estudio es revisar la literatura actualmente disponible respecto a las neuroimágenes y el diagnóstico de demencia. Métodos y Resultados: Se realizó una búsqueda sistemática en Medline, en inglés y español, restringida a los últimos 10 años. Se encontró y analizó 13 revisiones atingentes al tema. Conclusiones: Aunque los casos de demencia reversible son muy escasos, la mayoría de los expertos recomienda el uso rutinario de la tomografía computarizada. Si el acceso a este examen fuera restringido, se sugiere pautas de selección de pacientes. La resonancia magnética es de mayor ayuda ante la sospecha de patologías específicas como Creutzfeldt-]akob, Huntington o CADASIL. La volumetría, espectrometría, PET y SPECT deberían reservarse por el momento a protocolos de investigación o casos puntuales de duda diagnóstica.


Subject(s)
Humans , Dementia/diagnosis , Diagnostic Imaging/methods , Magnetic Resonance Imaging , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed , Cerebrum/pathology
20.
Rev. chil. neuro-psiquiatr ; 46(1): 35-42, mar. 2008. ilus
Article in Spanish | LILACS | ID: lil-513799

ABSTRACT

MELAS is an acronym for the convergence of mitochondrial myopathy, encephalopathy lactic acidosis and stroke like episodes. It was described by Pavlakis et al. in 1984.This is a genetic disease caused by mutations in the maternal mitochondrial genome, affecting the adenosine triphosphate (ATP) synthesis. The mutations have heteroplasmic loads on different tissues, which could specially involve those highly energy-dependent such as muscles, brain and CNS tissues. We describe a 33 year old female presenting migraine headaches associated to stroke-like episodes, related to an infection. Neurological manifestations include language and visual disturbances. The magnetic resonance imaging (MRI) showed low-intensity areas, predominantly in the temporal, parietal and occipital left lobes. She further presented a status epilepticus. The complementary study shows elevated basal and post exercise lactic acidosis, ragged red fibers in the muscle biopsy, and the mutation of A3243G in the mitochondrial genome. Her asymptomatic mother and sister showed ragged red fibers in muscle biopsy. The patient showed clinical and radiological features improvement, maintaining non epileptic slow focal occipital discharges in the electroencephalogram. The assumption is that this mitochondrial disorder could be more frequent than detected in our medium, given that a significant number of women could be just asymptomatic bearers (Like the patient's mother and sister). This pathology should always be assessed in patients less than 40 years of age with strokes, regardless whether they have family history with the disease.


MELAS es un acrónimo inglés que define la convergencia de miopatía mitocondrial, encefalopatía, acidosis láctica y episodios de pseudo-infarto cerebral, descrita por Pavlakis et al, en 1984. Es una enfermedad mitocondrial originada por mutaciones en el genoma mitocondrial materno. Se afectan las funciones aeróbicas como consecuencia del déficit que se produce en la generación de adenosina trifosfato (ATP). El compromiso de los distintos tejidos es variable, debido a la heteroplasmia de la mutación, aunque preferentemente se suelen dañar el tejido muscular y el sistema nervioso central, tejidos con mayores requerimientos energéticos. Presentamos una paciente de 33 años que inicia su enfermedad con un síndrome jaquecoso, seguido de un episodio de pseudo infarto cerebral, en relación a un cuadro infeccioso. Clínicamente, evolucionó con alteraciones visuales y del lenguaje que eran concordantes con las áreas de hipointensidad en ambas cortezas temporales y en la corteza del lóbulo parietal y occipital izquierdo, vistas en la Resonancia Magnética. Varios días después de su ingreso cursó con un estatus epiléptico. Su estudio demostró aumento de la lactoacidemia de reposo (39,7) y de esfuerzo (89,4). En la biopsia muscular se observó la presencia de fibras rojas raídas, al igual que en su madre y hermana menor, ambas asintomáticas. El análisis genético demostró la presencia de la mutación A3243G del genoma mitocondrial, estimada en un 26 por ciento del total. La paciente mejoró espontánea y completamente en lo clínico y radiológico, sólo mantuvo una actividad lenta occipital izquierda, de carácter no epiléptico. Se presume que esta alteración mitocondrial podría ser más frecuente de lo detectado en nuestro medio, porque numerosas mujeres podrían ser sólo portadoras asintomáticas (como la madre y hermana de la paciente). Es una patología que debiera investigarse siempre en los accidentes vasculares de jóvenes menores de 40 años, aunque no tengan antecedentes familiar.


Subject(s)
Humans , Adult , Female , Stroke/pathology , MELAS Syndrome/genetics , MELAS Syndrome/pathology , DNA, Mitochondrial/genetics , Stroke/genetics , Acidosis, Lactic/genetics , Cerebrum/pathology , Magnetic Resonance Imaging , Mutation , Remission, Spontaneous
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