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1.
Säo Paulo med. j ; 139(2): 190-195, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1181008

ABSTRACT

ABSTRACT BACKGROUND: Although it is known that the new coronavirus disease (COVID-19), which was first seen in Wuhan, China, in December 2019 and has affected the whole world, mainly targets the respiratory tract, cases of this disease with a wide clinical spectrum are emerging as information is shared. CASE REPORT: We present the case of a pregnant woman who was diagnosed with venous sinus thrombosis after she developed headache and hemiparesis. Polymerase chain reaction (PCR) positivity lasted for two weeks after COVID-19 had been diagnosed. CONCLUSIONS: In patients with suspected COVID-19, especially in the presence of causes of hypercoagu- lability and presence of atypical features, venous sinus thrombosis needs to be kept in mind in making the differential diagnosis.


Subject(s)
Humans , Female , Pregnancy , Venous Thrombosis/diagnosis , SARS-CoV-2/isolation & purification , SARS-CoV-2/genetics , COVID-19/complications , Headache/etiology , Paresis/etiology , Sinus Thrombosis, Intracranial/diagnostic imaging , China , Polymerase Chain Reaction , Thrombophilia , COVID-19 Testing , COVID-19/diagnosis
2.
Article in Chinese | WPRIM | ID: wpr-878687

ABSTRACT

Segmental zoster paresis(SZP)is a rare complication in herpes zoster infection,with its symptoms often neglected due to the co-existence of pain.Here we reported a case of SZP.Also,we analyzed 42 Chinese SZP cases in literature,which revealed that the male to female ratio of SZP patients was 13∶8,and the median age of disease onset was 65 years.The most commonly affected region is upper limb.The diagnosis depends mainly on typical medical history and clinical symptoms.Although there is no definite therapy for SZP,the antiviral therapy is the most commonly used treatment,which achieved complete recovery in 78.6% of the patients and partial recovery in 14.3% of the patients.


Subject(s)
Aged , Female , Herpes Zoster/diagnosis , Humans , Male , Paresis/etiology , Upper Extremity/physiopathology
3.
Medicina (B.Aires) ; 79(supl.3): 6-9, set. 2019. tab
Article in Spanish | LILACS | ID: biblio-1040541

ABSTRACT

El objetivo fue describir la frecuencia, modo de presentación y características de la epilepsia en niños con hemiparesia congénita (HC). Estudio retrospectivo, descriptivo y multicéntrico, basado en la recolección de datos de las historias clínicas de pacientes de 0 a 19 años con HC secundaria a infarto perinatal en diferentes centros de la comunidad de Cataluña. Se incluyeron 310 niños (55% varones y 45% mujeres) de un total de 13 centros de Cataluña. Edad media del debut de las crisis fue de 2 ± 1 año. Presentaron epilepsia el 29.5% (n = 76), el subtipo vascular más frecuente fue el infarto presumiblemente perinatal (51.3%), seguido del accidente isquémico arterial neonatal (18.4%), infarto hemorrágico venoso periventricular (15.8%), infarto hemorrágico neonatal (10.5%) y trombosis venosa neonatal (3.9%). La semiología de las crisis más frecuente fue la focal motora en un 82%, seguida de las focales motoras con bilateralización secundaria en el 23%, focales discognitivas en 13.5%, generalizadas 2% y espasmos 6.5%. El 67.3% se controló con monoterapia y los fármacos empleados fueron el valproato, levetiracetam o carbamacepina. Se identificó el antecedente de estatus eléctrico durante el sueño en 3 pacientes, todos asociados a lesiones extensas que incluían al tálamo. Del total con epilepsia, el 35% debutaron con convulsiones neonatales en los primeros 3 días de vida. El 30% con accidente cerebrovascular perinatal y HC presentan riesgo de padecer epilepsia durante la infancia. Aquellos con infartos isquémicos tienen el riesgo más alto, por lo que requerirán un seguimiento dirigido a detectar precozmente la epilepsia e iniciar tratamiento.


The objective was to describe the frequency, mode of presentation and characteristics of epilepsy in children with congenital hemiparesis (CH). It is a etrospective, descriptive and multicenter study, based on the collection of data from the clinical records of patients from 0 to 19 years with CH secondary to perinatal infarction in different centers of the community of Catalonia. A total of 310 children were included (55% males and 45% females), from a total of 13 centers in Catalonia. Average age of onset of the crises was 2 ± 1 year. Epilepsy was present in 29.5% (n = 76), among which the most frequent vascular subtype was arterial presumed perinatal ischemic stroke (51.3%), followed by neonatal arterial ischemic stroke (18.4%), periventricular venous infarction (15.8%), neonatal hemorrhagic stroke (10.5%) and neonatal cerebral sinovenous thrombosis (3.9%). Semiology of the most frequent seizures was motor focal in 82%, followed by focal motor with secondary bilateralization in 23%, focal discognitive in 13.5%, generalized by 2% and spasms in 6.5%. The 67.3% were controlled with monotherapy and the drugs used were valproate, levetiracetam or carbamazepine. The antecedent of electrical status during sleep was identified in 3 patients, all associated with extensive lesions that included the thalamus. Of the total number of children with epilepsy, 35% began with neonatal seizu res in the first 3 days of life. The 30% of children with perinatal stroke and CH present a risk of epilepsy during childhood. Children with ischemic strock have the highest risk, so they will require a follow-up aimed at detecting prematurely the epilepsy and start a treatment.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Paresis/congenital , Paresis/etiology , Stroke/complications , Epilepsy/etiology , Seizures/etiology , Spain , Carbamazepine/therapeutic use , Retrospective Studies , Risk Factors , Valproic Acid/therapeutic use , Epilepsy/drug therapy , Levetiracetam/therapeutic use , Anticonvulsants/therapeutic use
4.
Rev. cuba. med. gen. integr ; 34(3)jul.-set. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1093456

ABSTRACT

Introducción: Una paresia tiene que ser objeto de un detallado análisis para conocer su correcta etiología. La exploración física debe incluir una minuciosa valoración neurológica que oriente la localización de la lesión. Caso Clínico: Paciente con paresia de extremidad inferior derecha, hiperreflexia, clonus y disminución de sensibilidad térmica y algésica por debajo de la apófisis xifoides. Estos hallazgos señalan a nivel vertebral dorsal, D8, posible localización de una lesión que afecta a la vía piramidal motora y la vía sensitiva. La sospecha clínica se confirma mediante RMN que mostró la presencia de masa intramedular, posible ependimoma. Conclusiones: El conocimiento de la anatomía de los haces nerviosos que discurren por la médula espinal y la información nerviosa que proporcionan, contienen signos clínicos motores y sensitivos que permiten discernir qué haces nerviosos están lesionados. Este juicio clínico puede dirigir, de manera mucho más concreta, hacia el tipo de exploraciones y pruebas complementarias que pueden ser necesarias para concretar un diagnóstico y reducir el gasto sanitario, así como el tiempo de espera para un posible tratamiento quirúrgico(AU)


Introduction: A paresis must be the object of a detailed analysis to know its correct etiology. Physical examination should include a thorough neurological assessment to guide the location of the lesion. Clinical case: Patient with paresis of the lower right extremity, hyperreflexia, clonus, and decreased thermal and algic sensitivity below the xiphoid process is preseneted. These findings point to the dorsal vertebral level, D8, possible location of a lesion that affects the pyramidal motor pathway and the sensory pathway. Clinical suspicion is confirmed by MRI that showed the presence of intramedullary mass, possible ependymoma. Conclusions: The knowledge of the anatomy of the nerve bundles that run through the spinal cord, and the nerve information they provide contain clinical and sensory clinical signs, allowing to discern which nerve bundles are injured. This clinical judgment can lead, in a much more concrete way, to the type of explorations and complementary tests that may be necessary to diagnose and reduce health costs, as well as the waiting time for a possible surgical treatment(AU)


Subject(s)
Humans , Male , Paresis/etiology , Ependymoma/diagnosis
5.
Acta fisiátrica ; 23(1): 12-15, mar. 2016.
Article in English, Portuguese | LILACS | ID: biblio-1136

ABSTRACT

Objetivo: Investigar os critérios para estabelecer a velocidade inicial da esteira e viabilizar um treinamento motor funcional ou cardiorrespiratório em hemiparéticos crônicos. Métodos: Foram recrutados 15 hemiparéticos crônicos determinados pelo Lower Extremity Motor Coordination Test (LEMOCOT) e submetidos à avaliação da marcha pelo Time up and go (TUG), Teste de Esforço Máximo (TES) e Teste de velocidade de marcha de 10 metros (TV10M). Resultados: A análise dos valores do LEMOCOT demonstrou uma média de 26,87 ± 9,76 acertos nos alvos no lado não parético e 15,40 ± 8,46 no lado parético. No TUG verificou-se a velocidade média de 0,37 ± 0,14 m/s e no TV10M 0,63 ± 0,23 m/s. No TES a velocidade média foi 0,60 ± 0,25 m/s. Houve correlação forte e significante entre os valores de TUG, TV10M e TEX. Conclusão: O TES e TV10M são testes adequados para serem utilizados como critério de elegibilidade da velocidade inicial para treinos aeróbios, todavia o TES é capaz de revelar o tempo em que o paciente consegue manter a marcha. O TUG não revelou ser um bom instrumento para estabelecer a velocidade inicial do treinamento


Objective: To investigate the criteria for establishing the initial treadmill speed and create a functional or cardiorespiratory motor training for hemiparetic individuals. Methods: Fifteen chronic hemiparetic individuals were recruited and qualified by the Lower Extremity Motor Coordination Test (LEMOCOT) and submitted to gait evaluation through the Timed Up and Go (TUG), Stress Test (ST), and the 10-Meter Walk Test (10MWT). Results: The analysis of the LEMOCOT results showed a mean of 26.87 ± 9.76 target hits for the non-paretic side and 15.40 ± 8.46 for the paretic side. In the TUG, the average speed of 0.37 ± 0.14 m/s was found and in the 10MWT, 0.63 ± 0.23 m/s. In the ST the average speed was 0.60 ± 0.25 m/s. There was strong and significant correlation between the TUG, 10MWT, and ST values. Conclusion: The ST and 10MWT are suitable tests to be used as eligibility criteria for the initial speed of aerobic trainings, however the ST is able to reveal the time for which the patient is able to maintain the gait. The TUG did not prove to be a good instrument to establish the initial training speed


Subject(s)
Humans , Paresis/etiology , Exercise , Stroke/physiopathology , Exercise Test/instrumentation , /instrumentation
6.
Acta fisiátrica ; 22(1)mar. 2015.
Article in Portuguese | LILACS | ID: lil-771291

ABSTRACT

O acidente vascular encefálico (AVE) é considerado uma doença de grande impacto social porcausar grandes rupturas como a perda do emprego, a diminuição da renda, troca de papéisocupacionais, podendo se tornar um problema familiar grave. Objetivo: Analisar as alterações notrabalho e família, causadas pela hemiparesia em pacientes que sofreram AVE (Acidente VascularEncefálico). Métodos: Trata-se de um estudo quantitativo onde participaram trinta pacientes comhemiparesia decorrente de AVE no Hospital de Base de São José do Rio Preto. Os instrumentosutilizados foram a ficha de identificação contendo nome, idade, gênero, profissão atual e profissãoanterior entre outras, e questionário adaptado pelo serviço de Terapia Ocupacional com dezquestões fechadas, onde o participante tinha opção de resposta ??sim?? ou ??não??. Resultados: Apesquisa mostrou que antes da disfunção física 87% dos participantes trabalhavam e recebiamum salário e após a disfunção nenhum realiza atividade remunerada. As relações familiares dosparticipantes são mais comprometidas em pacientes que sofreram disfunção a mais tempo do queoutros pacientes que possuem a disfunção há menos tempo. Conclusão: Este estudo observouque pacientes com hemiparesia decorrente de AVE podem sofrer alterações nas relações laborais,socioeconômicas e familiares e esses dados são relevantes para que os profissionais de saúdepossam auxiliar o retorno desses sujeitos às atividades ocupacionais, após AVE.


A stroke is considered a disease of great social impact that causes major disruptions such asjob loss, decreased income, and changes in occupational roles; it can become a serious familyproblem. Objective: To analyze the changes in work and family caused by hemiparesis in patientswho have experienced a stroke. Methods: This is a quantitative study involving 30 patients withhemiparesis due to stroke in the Hospital de Base of São José do Rio Preto. The instrumentsused were the identification form containing their name, age, gender, and current and previousoccupation, among other things, along with a questionnaire adapted by the Occupational Therapyservice with ten closed questions where the participant could respond either ?yes? or ?no.?Results: The research showed that before having the stroke, 87% of the participants were workingand receiving a salary, and after the stroke none had any paid activity. The family relationships ofthose impaired for a longer time suffered more than of those who were impaired for a shortertime. Conclusion: This study found that patients with hemiparesis due to stroke may undergochanges in industrial, socioeconomic, and family relationships. This data is relevant so that healthprofessionals can assist the return of these subjects to occupational activities after a stroke.


Subject(s)
Paresis/etiology , Socioeconomic Factors , Occupational Therapy , Stroke/psychology , Cross-Sectional Studies
7.
Rev. bras. neurol ; 50(3): 60-65, jul.-set. 2014. tab
Article in Portuguese | LILACS | ID: lil-729073

ABSTRACT

A paresia distal crural, muito marcante nos pacientes com doença de Charcot-Marie-Tooth (CMT), provoca inúmeras alterações nos padrõesda marcha. Vários recursos de reabilitação têm sido propostos para gerenciar os problemas de deambulação, entre eles a utilização de órteses tornozelo-pé (OTP). O objetivo deste trabalho foi analisar efeitos imediatos do uso de OTP na cinemática da marcha e nos parâmetros estabilométricos em paciente com CMT. Buscou-se avaliar: o equilíbrio e a marcha, por meio da Escala de Avaliação da Mobilidade Orientada pelo Desempenho (POMA); a cinemática da marcha, com o sistema Qualisys Track Manager (QTM); e a estabilometria, utilizando a plataforma de força. As avaliações foram realizadas antes e durante o uso de OTP. Observou-se declínio na escala POMA durante o uso da OTP de 11%. Na cinemática da marcha, verificou-se decréscimo na velocidade e comprimento da passada, assim comoaumento na duração dela. Na estabilometria, observou-se aumento na velocidade médio-lateral e na velocidade média na condição sem restrição visual, e aumento em todos os parâmetros de velocidade e deslocamento na condição com restrição visual durante o uso da OTP. O paciente avaliado não apresentou melhoras imediatas com aplicação de OTP, fato justificado pela presença de contraturas e tempo de evolução da doença. A prescrição de órteses na CMT deve respeitar as particularidades do paciente e a forma de apresentação da patologia.


The distal crural weakness, very striking in patients with Charcot-Marie-Tooth disease (CMT), causes gait impairment. Several rehabilitationapproaches have been proposed to manage the ambulation problems, among them, the use of ankle-foot orthosis (AFO). The objective of this study is to analyze the immediate effects of using AFO in the gait kinematic and stabilometric parameters in a patient with CMT. We evaluated the balance and the gait using Performance Oriented Mobility Assessment (POMA) Scale, gait kinematics using the Qualisys Track Manager (QTM) system and stabilometry, using a force platform. The evaluations were performed before and during the use of AFO. A decreasing of POMA scores was observed when the patient used AFO (11%). In the gait kinematic a decrease was verified in the speed gait and step length, as an increase in the time. In the stabilometry was observed an increase in the mediolateral velocity and average velocity in the condition without visual restrictionand an increase in all parameters of velocity and displacement in thecondition with visual restriction during the use of the AFO. The assessedpatient didn?t present immediate improvement with the AFO due to contractures presented and the time of the disease course. Prescription of orthosis in the CMT should respect the patient?s particularities and the clinical manifestations, and the way the pathology is presented.


Subject(s)
Humans , Male , Adult , Orthotic Devices , Foot Deformities , Charcot-Marie-Tooth Disease/diagnosis , Charcot-Marie-Tooth Disease/rehabilitation , Charcot-Marie-Tooth Disease/therapy , Gait Disorders, Neurologic/rehabilitation , Foot Orthoses , Paresis/etiology , Treatment Outcome , Mobility Limitation , Neurologic Examination/methods
9.
Biomédica (Bogotá) ; 34(3): 330-339, July-Sept. 2014. ilus
Article in Spanish | LILACS | ID: lil-726796

ABSTRACT

Introducción. La resonancia magnética funcional es una técnica no invasiva que permite el mapeo cerebral y la visualización de redes de conectividad. La hemiparesia posterior a un accidente cerebrovascular constituye un buen modelo biológico para estudiar los cambios en la conectividad cerebral. El uso de este modelo se puede expandir si se obtiene información antes y después de la rehabilitación neurológica. Objetivo. Presentar los hallazgos por neuroimágenes funcionales de un paciente con accidente cerebrovascular antes y después del tratamiento de rehabilitación neurológica. Materiales y métodos. Como parte del protocolo de rehabilitación neurológica se tomaron imágenes de resonancia antes y después del tratamiento con un equipo que operaba a 1,5 T. Se obtuvieron imágenes volumétricas potenciadas en T1, imágenes de difusión para tractografía, imágenes de resonancia funcional con el paciente en reposo y haciendo movimientos de pinza con la mano derecha. Resultados. Se obtuvieron mapas funcionales antes y después de la terapia, los cuales se presentan conjuntamente con las imágenes de conectividad estructural obtenidas mediante tractografía. Se observó que los cambios clínicos estaban acompañados de cambios en los patrones de activación obtenidos por resonancia magnética funcional. Conclusión. La versatilidad que ofrece la resonancia magnética permite conocer el estado funcional y estructural del cerebro, generando así nuevas posibilidades de diagnóstico y pronóstico en pacientes que reciben rehabilitación neurológica, con lo que se pueden cuantificar y develar ciertos procesos dinámicos de plasticidad neuronal posteriores a una lesión, que son propios del sistema nervioso central.


Introduction: Functional magnetic resonance imaging is a noninvasive technique that allows mapping and visualizing of brain connectivity networks. The hemiparesis after a stroke is a good biological model to study changes in brain connectivity. This model can be expanded if information is obtained before and after neurorehabilitation therapy. Objective: To present the functional neuroimaging findings in a patient with stroke before and after performing neurorehabilitation therapy. Materials and methods: As part of the neurorehabilitation protocol, resonance imaging was performed before and after treatment with an equipment operating at 1.5 T. Volumetric T1-weighted images, diffusion images for tractography, functional resonance images with the patient at rest and with the patient performing pincer movement with the right hand were obtained. Results: Functional maps before and after therapy were obtained, which are presented together with structural connectivity images obtained by tractography. Clinical changes can be seen accompanied by changes in activation patterns obtained by functional magnetic resonance imaging. Conclusion: The versatility of magnetic resonance imaging allows further knowledge of the structural and functional state of the brain generating new possibilities for diagnosis and prognosis in patients undergoing neurorehabilitation therapy. Neurological rehabilitation processes can be quantified and they can reveal certain postlesional neuroplasticity dynamic processes that the central nervous system possesses.


Subject(s)
Child , Humans , Male , Brain Mapping/methods , Diffusion Tensor Imaging/methods , Infarction, Middle Cerebral Artery/complications , Magnetic Resonance Imaging/methods , Paresis/rehabilitation , Pyramidal Tracts/pathology , Dominance, Cerebral , Hand/physiopathology , Motor Activity/physiology , Physical Therapy Modalities , Paresis/etiology , Reflex, Abnormal , Sepsis/complications
10.
Braz. j. phys. ther. (Impr.) ; 18(4): 353-363, 08/2014. tab
Article in English | LILACS | ID: lil-718140

ABSTRACT

Background: Among the current instruments used to assess stair ambulation, none were observed that specifically evaluated the quality of movement or biomechanical strategies adopted by stroke patients. Objective: To evaluate the content validity of a clinical instrument designed to identify the qualitative and kinematic characteristics and strategies adopted by stroke patients during stair ascent and descent. Method: The first developed version, which comprised 80 items, had its content evaluated by an expert panel, which was composed of 9 well-known national and international professionals who are involved in stroke rehabilitation. The content validity index (CVI) and modified Kappa coefficients were employed for the statistical analyses. The items that demonstrated a CVI≥0.80 and Kappa≥0.75 were considered valid. Results: The content validation was performed in three stages. The final version of the instrument consisted of 38 items, which were divided into descriptive (8 items), a General Characteristics Domain (16 items) and adopted strategies (14 items) during stair ascent and descent. The total scores ranged from zero to 70 and zero to 74 for ascent and descent, respectively. Lower scores corresponded with better performance. Conclusion: Despite the satisfactory results obtained during the process of content validation, other psychometric properties of the instrument are necessary and must be evaluated. .


Contextualização: Dentre os instrumentos existentes que avaliam a subida e descida de escadas, não foi encontrado nenhum específico sobre a qualidade de movimento e as estratégias biomecânicas adotadas por indivíduos com hemiparesia devido ao Acidente Vascular Encefálico (AVE). Objetivo: Avaliar a validade de conteúdo do instrumento de avaliação das características cinemáticas qualitativas e das estratégias adotadas na subida e descida de escadas por indivíduos com hemiparesia devido ao AVE. Metódo: A primeira versão do instrumento foi desenvolvida com um total de 80 itens e foi submetida a um comitê constituído por oito especialistas nacionais e internacionais para validação de conteúdo. A análise estatística foi realizada por meio do Índice de Validade de Conteúdo (IVC) e do Coeficiente Kappa Modificado, sendo considerados válidos os itens que apresentaram IVC≥0,80 e Kappa≥0,75. Resultados: Foram realizadas três etapas de validação de conteúdo, e a versão final do instrumento apresenta 38 itens divididos em Itens Descritivos (oito itens), Domínio de Características Gerais da Subida e Descida de Escadas (16 itens) e Domínio de Estratégias Adotadas para Subida e Descida de Escadas (14 itens). O escore total para a subida de escada pode variar entre 0 e 70 pontos e, para a descida, entre 0 e 74 pontos. A pontuação mínima corresponde ao melhor desempenho, e a máxima, ao pior desempenho no teste. Conclusão: Apesar dos resultados satisfatórios obtidos no processo de validação de conteúdo, as demais propriedades psicométricas devem e serão mensuradas futuramente. .


Subject(s)
Humans , Gait , Paresis/physiopathology , Stroke/physiopathology , Paresis/etiology , Physical Examination/methods , Stroke/complications
11.
Braz. j. phys. ther. (Impr.) ; 18(3): 276-281, May-Jun/2014. tab
Article in English | LILACS | ID: lil-713605

ABSTRACT

BACKGROUND: The Balance Evaluation Systems Test (BESTest) was recently created to allow the development of treatments according to the specific balance system affected in each patient. The Brazilian version of the BESTest has not been specifically tested after stroke. OBJECTIVE: To evaluate the intra- and inter-rater reliability and concurrent and convergent validity of the total score of the BESTest and BESTest sections for adults with hemiparesis after stroke. METHOD: The study included 16 subjects (61.1±7.5 years) with chronic hemiparesis (54.5±43.5 months after stroke). The BESTest was administered by two raters in the same week and one of the raters repeated the test after a one-week interval. Intraclass correlation coefficient (ICC) was calculated to assess intra- and interrater reliability. Concurrent validity with the Berg Balance Scale (BBS) and convergent validity with the Activities-specific Balance Confidence scale (ABC-Brazil) were assessed using Pearson's correlation coefficient. RESULTS: Both the BESTest total score (ICC=0.98) and the BESTest sections (ICC between 0.85 and 0.96) have excellent intrarater reliability. Interrater reliability for the total score was excellent (ICC=0.93) and, for the sections, it ranged between 0.71 and 0.94. The correlation coefficient between the BESTest and the BBS and ABC-Brazil were 0.78 and 0.59, respectively. CONCLUSIONS: The Brazilian version of the BESTest demonstrated adequate reliability when measured by sections and could identify what balance system was affected in patients after stroke. Concurrent validity was excellent with the BBS total score and good to excellent with the sections. The total scores but not the sections present adequate convergent validity with the ABC-Brazil. However, other psychometric properties should be further investigated. .


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Postural Balance , Paresis/diagnosis , Observer Variation , Physical Therapy Modalities , Paresis/etiology , Paresis/physiopathology , Physical Examination/statistics & numerical data , Reproducibility of Results , Stroke/complications
12.
Rev. bras. anestesiol ; 64(2): 124-127, Mar-Apr/2014. graf
Article in Portuguese | LILACS | ID: lil-711140

ABSTRACT

Lesões de nervos podem ocorrer na região faringolaríngea durante a anestesia geral. Os nervos mais comumente lesionados são o hipoglosso, lingual e laríngeo recorrente. As lesões podem surgir em decorrência de vários fatores, como, por exemplo, durante a laringoscopia, intubação endotraqueal e inserção de tubo e por pressão do balão, ventilação com máscara, manobra aérea tripla, via aérea orofaríngea, modo de inserção do tubo, posição da cabeça e do pescoço e aspiração. As lesões nervosas nessa região podem acometer um único nervo isolado ou causar a paralisia de dois nervos em conjunto, como a do nervo laríngeo recorrente e hipoglosso (síndrome de Tapia). No entanto, a lesão combinada dos nervos lingual e hipoglosso após intubação para anestesia é uma condição muito mais rara. O risco dessa lesão pode ser reduzido por meio de medidas preventivas. Descrevemos um caso de paresia unilateral combinada dos nervos hipoglosso e lingual após intubação para anestesia.


Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.


Durante la anestesia general pueden lesionarse los nervios en la región faringolaríngea. Los nervios más a menudo lesionados son el hipogloso, lingual y laríngeo recurrente. Las lesiones pueden surgir como resultado de varios factores que pueden ser, durante la laringoscopia, intubación endotraqueal e inserción del tubo y por presión del balón, ventilación con mascarilla, maniobra aérea triple, vía aérea orofaríngea, modo de inserción del tubo, posición de la cabeza y del cuello, y aspiración. Las lesiones nerviosas en esa región pueden comprometer un solo nervio aislado o causar la parálisis de 2 nervios en conjunto, como la del nervio laríngeo recurrente hipogloso (síndrome de Tapia). Sin embargo, la lesión combinada de los nervios lingual e hipogloso, después de la intubación para la anestesia, es una condición mucho más rara. El riesgo de una lesión se puede reducir con medidas preventivas. A continuación describimos un caso de paresia unilateral combinada de los nervios hipogloso y lingual después de la intubación para la anestesia.


Subject(s)
Adult , Female , Humans , Anesthesia, General/adverse effects , Hypoglossal Nerve Injuries/etiology , Intubation, Intratracheal/adverse effects , Lingual Nerve Injuries/etiology , Paresis/etiology
13.
Rev. bras. neurol ; 50(1): 1-3, jan.-mar. 2014. ilus
Article in English | LILACS | ID: lil-712076

ABSTRACT

Longitudinally extensive myelitis is a severe rare complication of varicella-zoster virus infection. We report a case in a 20-year-oldimmunocompetent patient who presented with a two-week history of lower-limb paresis and paresthesia below dermatome T12, andsphincter dysfunction. He presented with a zoster rash a week prior tothe onset of neurological symptoms. Spinal cord magnetic resonanceimaging revealed a C5-T12 intramedullary lesion and cerebrospinalfluid showed lymphocytic pleocytosis and elevated varicella-zostervirus immunoglobulin G. Patient had not gained much improvement after acyclovir and pulse therapy with methylprednisolone, which prompted a five-day course of plasmapheresis. He partially recovered, but remained with sphincter impairment.


Mielite longitudinalmente extensa é uma rara e grave complicação da infecção pelo vírus varicela-zóster. Relatamos o caso de um pacientede 20 anos de idade, imunocompetente, que há duas semanas apresentou paresia de membros inferiores e parestesias abaixo dodermátomo T12, associadas com disfunção esfincteriana. Ele apresentouum rash cutâneo sugestivo de herpes uma semana antes do início dos sintomas neurológicos. A ressonância magnética de medula espinhal demonstrou uma lesão intramedular de C5 a T12, e o líquido cerebroespinhal revelou uma pleocitose linfocítica com aumento de imunoglobulina IgG para o vírus varicela-zóster. O paciente não apresentou melhora após uso de aciclovir e pulsoterapia com metilprednisolona, o que motivou um curso de cinco dias de plasmaférese.Houve recuperação parcial, porém ele permaneceu com distúrbio esfincteriano.


Subject(s)
Humans , Male , Adult , Young Adult , Herpesvirus 3, Human , Myelitis/etiology , Myelitis/virology , Paresis/etiology , Spinal Cord/diagnostic imaging , Magnetic Resonance Imaging
14.
Rev. bras. neurol ; 49(4): 129-136, out.-dez. 2013. graf
Article in English | LILACS | ID: lil-712073

ABSTRACT

The aim of the present study was to evaluate changes in alpha, beta and gamma bands of distinct cortical regions in variable absolute power due to the execution of feeding motor gesture, through the actuation of mirror neurons system (MNS) and motor imagery (MI). A subject, male, 60 years old, right-handed, with left hemiparesis was subjected to five electroencephalographic measures in different experimental conditions: initial rest, motor practice, mirror neurons system, imagery and final rest. In alpha, there was less mental effort during the condition MI in C3 and Cz. In beta, there was high activity in derivations C4, T3, and T4 during the MNS condition, indicating that these neurons are recruited during the observation and execu-tion task. In gamma, during MI, there was high activation of C4. The MI and MNS promoted cortical activation of regions altered by ce-rebral damage and can be used in rehabilitation of individuals with stroke.


O objetivo do presente estudo foi avaliar alterações nas bandas alfa, beta e gama em regiões corticais distintas, na variável potên-cia absoluta decorrente da execução do gesto motor de alimentação, por meio do acionamento do sistema de neurônios espelhos (SNE) e imagética motora (IM). Um sujeito do sexo masculino, 60 anos, destro, hemiparético à esquerda, foi submetido a cinco medidas ele-troencefalográficas em condições experimentais distintas: repouso inicial, prática motora, sistema de neurônios espelho, imagética e repouso final. Em alfa, verificou-se menor esforço mental durante a condição IM nos eletrodos C3 e Cz. Em beta, houve elevada ati-vidade nas derivações C4, T3, e T4 na condição SNE, indicando que esses neurônios são recrutados durante a observação e execução da tarefa. Em gama, durante a IM, verificou-se alta ativação de C4. A IM e SNE promoveram ativação de regiões corticais alteradas pela lesão cerebral, podendo ser utilizados na reabilitação de indivíduos com AVE.


Subject(s)
Humans , Male , Middle Aged , Paresis/diagnosis , Brain Mapping , Stroke/complications , Electroencephalography/methods , Paresis/etiology
15.
Arq. neuropsiquiatr ; 71(4): 244-248, abr. 2013. tab, graf
Article in English | LILACS | ID: lil-670887

ABSTRACT

Objective: To compare the functional electrical stimulation associated with functional kinesiotherapy alone in patients after ischemic cerebrovascular accident. Methods: The study included 20 patients who were divided into two groups: Group I (GI): functional electrical stimulation plus functional kinesiotherapy and Group II (GII): functional kinesiotherapy. We evaluated active and passive range of motion, in knee flexion and extension muscle strength, activities of daily living and quality of life. The evaluations were conducted in the pretreatment period, after 10 sessions and after 20 physical therapy sessions. Results: There was a significant improvement in all variables studied for both groups. However, significant improvements for the sub-items functional capacity and social aspects were seen only in the patients treated with associated functional electrical stimulation and kinesiotherapy. Conclusion: Although both groups of patients improved with the treatment, the association of functional electrical stimulation and kinesiotherapy showed superiority in two quality of life items, in the sub-items functional capacity and social aspects. .


Objetivo: Comparar a estimulação elétrica funcional associada à cinesioterapia com a cinesioterapia funcional isolada no membro inferior de pacientes em fase subaguda após acidente vascular cerebral isquêmico. Método: Participaram do estudo 20 pacientes divididos em 2 grupos: Grupo I (GI): eletroestimulação funcional mais cinesioterapia funcional e Grupo II (GII): cinesioterapia funcional. Foram avaliadas as amplitudes de movimento ativo e de movimento passivo em flexão e extensão do joelho, a força muscular, as atividades da vida diária e a qualidade de vida. As avaliaçães foram realizadas nos períodos pré-tratamento, após 10 e após 20 sessões de fisioterapia. Resultados: Houve melhora significativa em todas as variáveis estudadas para ambos os grupos. Contudo, melhorias significativas para os subitens capacidade funcional e aspectos sociais foram vistos apenas nos pacientes tratados com a estimulação elétrica funcional associada à cinesioterapia. Conclusão: Os dois grupos de pacientes melhoraram com o tratamento, mas a associação da estimulação elétrica funcional à cinesioterapia mostrou superioridade nos subitens capacidade funcional e aspectos sociais da qualidade de vida. .


Subject(s)
Aged , Female , Humans , Male , Electric Stimulation Therapy , Physical Therapy Modalities , Paresis/rehabilitation , Stroke/rehabilitation , Paresis/etiology , Stroke/complications , Treatment Outcome
16.
Biomédica (Bogotá) ; 32(1): 8-12, ene.-mar. 2012. tab
Article in Spanish | LILACS | ID: lil-639806

ABSTRACT

Se presenta el caso clínico de un paciente de 54 años, negativo para VIH, con enfermedad cerebrovascular por trombosis de la arteria basilar, secundaria a neurosífilis meningovascular. La neurosífilis es el compromiso del sistema nervioso central por Treponema pallidum subespecie pallidum en cualquier estadio de la entidad e incluye las formas asintomáticas y sintomáticas de la infección; sus formas de presentación son diversas y dependen de la localización y la extensión de las lesiones. La recomendación actual es el tratamiento con 4 millones de unidades de penicilina cristalina cada 4 horas por 14 días.


Herein a case is described of a 54-years old patient, HIV negative, with cerebro-vascular disease by basilar artery thrombosis secondary to meningovascular neurosyphilis. Neurosyphilis is the impairment at any stage of the central nervous system by Treponema pallidum subspecies pallidum and includes asymptomatic and symptomatic forms of infection. The presentation can take many forms, depending on the location and extent of tissue damage. The currently recommended treatment is crystalline penicillin, 4 million units every 4 hours for 14 days.


Subject(s)
Humans , Male , Middle Aged , Meningitis/etiology , Neurosyphilis/complications , Thrombosis/etiology , Vasculitis/etiology , Vertebrobasilar Insufficiency/etiology , Alcoholism/complications , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Dysarthria/etiology , Emergencies , Endovascular Procedures , HIV Seronegativity , Hypertension/complications , Magnetic Resonance Imaging , Meningitis/drug therapy , Neurosyphilis/drug therapy , Paresis/etiology , Penicillin G/therapeutic use , Stents , Thrombectomy , Tomography, X-Ray Computed , Thrombosis/drug therapy , Thrombosis , Thrombosis/surgery , Vasculitis/drug therapy , Vertebrobasilar Insufficiency/diagnosis , Vertebrobasilar Insufficiency , Vertebrobasilar Insufficiency/surgery
17.
Rev. méd. Chile ; 140(1): 59-65, ene. 2012. tab
Article in Spanish | LILACS | ID: lil-627608

ABSTRACT

Background: Stroke is one of the main causes of disability and death in the world. Sixty three percent of stroke survivors require rehabilitation which is a complex functional recovery multidisciplinary task. Aim: To determine the psychometric properties of the Action Research Arm Test (ARAT), that is used to assess the functional recovery of a paretic upper limb. Patients and Methods: Eighty stroke survivors were assessed at their homes as a baseline and two months later applying ARAT and Motor Activity Log (MAL-30) assessments. In the latter evaluation quality of life was assessed with SIS 3.0 score and the General Health Questionnaire (GHQ-30) was applied. Participants received no intervention in the lapse between the two assessments. Results: Cronbach a values for ARAT were 0.88 and 0.89 at baseline and two months assessments, respectively. Temporary stability had an r value of 0. 93 (p < 0.01). The convergent validity with quality of movement of MAL-30 was r = 0.58 and r = 0.51. The figures with quantity of movement were r = 0.55 and r = 0.57. The convergent validity with SIS 3.0 was r = 0.53 for the hand, r = 0.57 for participation and r = 0.48 for recovery. ARATscores correlated inversely and significantly with age and pain. There was no discriminant validity between ARAT and emotion, memory, communication and mobility of SIS 3.0, GHQ-30 and the socio-economic level. Conclusions: ARAT is a reliable and valid instrument for assessing the functional recovery of paretic upper limbs after a stroke.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Paresis/rehabilitation , Recovery of Function/physiology , Surveys and Questionnaires , Stroke/rehabilitation , Cohort Studies , Cross-Sectional Studies , Psychometrics , Paresis/etiology , Reproducibility of Results , Stroke/complications
18.
Acta fisiátrica ; 19(1)jan. 2012.
Article in English, Portuguese | LILACS | ID: lil-668452

ABSTRACT

O objetivo do estudo foi verificar a influência da terapia por exercício com espelho (TEE) nos déficits sensoriais e motores dos pacientes hemiparéticos acometidos por Acidente Cerebrovascular (ACV), através de revisão sistemática. Método: Foi realizada a revisão nas bases de dados LILACS, MEDLINE, SciELO e PubMed, referente aos últimos 12 anos. A qualificação dos artigos foi feita através da plataforma PEDro. Resultados: Foram incluídos no trabalho cinco artigos em que todos eram ensaios clínicos, randomizado e controlado, que utilizaram a TEE no tratamento de pacientes hemiparéticos. A pontuação dos estudos variou de 4 a 7 pela escala PEDro, com uma nota média de 6,2. Discussão: Alguns estudos mostraram que a TEE é benéfica para aumentar a destreza, amplitude e velocidade do movimento, e outros evidenciaram que há uma maior função e recuperação motora nos pacientes tratados com a TEE. Um estudo analisou pacientes hemiparéticos na fase aguda do ACV e com a Síndrome da dor complexa regional tipo 1 (SDCRt1) e verificou que a TEE aumenta a função motora e sensorial. Conclusão: A TEE é benéfica para a recuperação motora,função sensório-motora e para a diminuição da dor. Indivíduos acometidos por ACV necessitam de fisioterapia e, claro, a quantidade de terapia pode influenciar no aprendizado motor, bem como a plasticidade neural. Sabemos a importância da estimulação de forma intensiva para aumentar a capacidade adaptativa do Sistema Nervoso Central em resposta a experiências, adaptações e condições diversas a estímulos repetidos. Dessa forma, se faz necessária a realização de novos protocolos de atendimento com diferentes frequências para evidenciar futuros resultados com a realidade em centros de reabilitação.


The purpose of this study was to assess the influence of mirror therapy (MT) on sensory and motor deficits of hemiparetic patients affected by stroke, through systematic review. Method: A review was performed in the LILACS, MEDLINE, PubMed and SciELO databases, covering the last 12 years. The classification of articles was made through the PEDro platform. Results: This study included all five articles, clinical trials, and randomized controlled trial, which used MT in the treatment of hemiparetic patients. The scores of studies ranged from 4 to 7 by the PEDro scale, with an average grade of 6.2. Discussion: Some studies have shown that MT is beneficial to increase the accuracy, range, and speed of movement and other studies have indicated that there is a greater recovery and motor function in patients treated with MT. One study analyzed hemiparetic patients with acute stroke and with complex regional pain syndrome type 1 (CRPSt1), concluding that MT improves motor and sensory function. Conclusion: MT is beneficial for motor recovery, sensory-motor function, and decreased pain. Individuals affected by stroke require physical therapy and the amount of therapy can influence the motor learning and neural plasticity. We know the importance of intensive stimulation to increase the adaptive capacity of the central nervous system in response to experiences, and adaptations to repeated stimuli under various conditions. Thus, it is necessary to carry out new clinical protocols with different frequencies to show future results with reality in rehabilitation centers.


Subject(s)
Humans , Paresis/etiology , Exercise Therapy/instrumentation , Stroke Rehabilitation , Motor Skills
19.
Acta fisiátrica ; 19(1)jan. 2012.
Article in English, Portuguese | LILACS | ID: lil-668454

ABSTRACT

A Estimulação Elétrica Funcional (FES) é uma das técnicas utilizadas em pacientes com sequelas motoras como a hemiparesia após acidente vascular cerebral (AVC). Estudos recentes mostram resultados positivos para o uso de FES no aumento da força muscular isométrica de extensores de punho e redução do tônus para pacientes com extensão ativa de punho superior a 20° antes da intervenção. Objetivo: Com relação à amplitude de movimento e redução do tônus para pacientes com 10° e 20° de extensão ativa de punho, não se observaram ganhos significativos. Método: Este estudo avaliou a eficácia da estimulação elétrica funcional otimizada (FES-O) por duas semanas sobre a destreza manual e a amplitude de movimento (ADM) em três indivíduos apresentando hemiparesia decorrente de AVC. Resultados: Todos os pacientes apresentaram melhora em um ou mais itens da avaliação (destreza manual e ADM).Conclusão: Podemos concluir que a aplicação de estimulação de acordo com este novo parâmetro mostrou-se benéfica,em pouco tempo de estimulação naquelespacientes com apenas esboço de movimento de dedos.


Functional Electrical Stimulation (FES) is one of the techniques used on patients with motor sequelae such as hemiparesis after a stroke (CVA). Recent studies show positive results for the use of FES in the increase of isometric muscular strength for wrist extensors and reduction of tonus for patients with active extension of upper wrist at 20° before the intervention. Objective: As for the amplitude of movement and reduction of tonus in patients with 10° and 20° of active extension of the wrist, no significant gains were observed. Method: This study evaluated the efficiency of optimized functional electrical stimulation (O-FES) for two weeks on the manual dexterity and range of movement (ROM) of three individuals showing hemiparesis due to a stroke. Results: All the patientsimproved in one or more items of the evaluation (manual dexterity and ROM). Conclusion: We can conclude that the application of stimulation according to this new parameter showed benefits with a short time of stimulation on those patients with only a hint of finger movement.


Subject(s)
Humans , Paresis/etiology , Electric Stimulation Therapy/instrumentation , Stroke Rehabilitation
20.
Gac. méd. Caracas ; 119(3): 249-254, jul.-sept. 2011. ilus
Article in Spanish | LILACS | ID: lil-701643

ABSTRACT

La migraña oftalmopléjica es una condición de la infancia caracterízada por crisis de severa cefalea hemicraneal seguida de parálisis ipsolateral de los nervios tercero, cuarto o sexto. Modernamente se explica mediante la teoría trigémino-vascular de la migraña. Aunque suele ser autolimitada puede dejar secuelas. Los autores comunican los casos de cuatro pacientes: tres niños con parálisis del tercer nervio craneal: una de ellas, desarrolló en el tiempo una regeneración aberrante secundaria, situación excepcional descrita en la literatura internacional en menos de diez pacientes. El último, un adulto con dos episodios de parálisis del sexto nervio craneal y una del tercer nervio. Se discuten sus manifestaciones clínicas y neurorradiológicas.


Ophthalmoplegic migraine in childhood is a painful migraine or headache complicated by an isolated III, IV or VI oculo-motor nerve palsy followed by total resolution without sequelae. The pathogenesis is unclear, however, more recently an hypothesis of trigeminovascular system activation have been proposed. The authors reported four patients with ophthalmoplegic migraine: three children with third cranial nerve palsy; one of them developed secondary aberrant regeneration of the third nerve. It is an exceptional case, because in the international literature less than ten patients had been reported. One case was an adult patient with recurrent nerve palsy (two episodes of sixth cranial nerve palsy and one event of third nerve palsy). Clinical and neuroradiological manifestations are discussed.


Subject(s)
Humans , Male , Adolescent , Female , Child , Young Adult , Blepharoptosis/etiology , /pathology , Magnetic Resonance Spectroscopy , Ophthalmoplegia, Chronic Progressive External/pathology , Facial Paralysis/physiopathology , Migraine Disorders/diagnosis , Paresis/etiology , Oculomotor Nerve Injuries/etiology
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