Video Head Impulse Test e doenças do sistema nervoso central: uma revisão integrativa / Video Head Impulse Test and central nervous system diseases: a integrative review

RESUMO Objetivos verificar a aplicabilidade do Video Head Impulse Test (vHIT) em doenças do sistema nervoso central (SNC), bem como os resultados encontrados e as doenças descritas. Estratégia de pesquisa revisão integrativa da literatura, em que foi realizada a busca em nove bases eletrônicas de dados, a partir da palavra-chave "video head impulse test". Critérios de seleção foram incluídos estudos que utilizaram o vHIT no diagnóstico de doenças do SNC e excluídos os estudos publicados antes de 2009 e estudos que realizaram outros procedimentos de investigação clínica, ou que aplicaram o teste no diagnóstico de doenças vestibulares periféricas. Resultados a amostra final foi composta por 18 estudos. Os resultados verificados mostraram que o reflexo vestíbulo-ocular (RVO) tem apresentado alterações na população investigada. Foram observados achados sugestivos de acometimento central, tais como ganho ou média de ganho do RVO nos canais semicirculares verticais, inferior aos laterais, ganho aumentado, correlação negativa do ganho com a gravidade da doença na ataxia espinocerebelar tipo 3, ponto de corte de 0,70 e assimetria de ganho menor de 20% para diferenciar neurite vestibular de derrame no ramo medial da artéria cerebelar posteroinferior, ganho normal com provas oculomotoras alteradas, presença de nistagmo espontâneo vertical, além de alterações no RVO com e sem otimização visual, na perseguição sacádica e no teste de desvio de inclinação. Conclusão verificou-se que o vHIT é aplicável quanto a avaliação do RVO de alta frequência em indivíduos com doenças do SNC, uma vez que trouxe evidências clínicas sobre alterações da função vestibular periférica e central nos diferentes quadros neurológicos.

ABSTRACT Purpose To verify the applicability of the Video Head Impulse Test (vHIT) in central nervous system (CNS) diseases, as well as the results found and the diseases described. Research strategy Integrative literature review, in which nine electronic databases were searched using the keyword "video head impulse test". Selection criteria Studies that used the vHIT in the diagnosis of CNS diseases were included, and studies published before 2009, studies that performed other clinical investigation procedures or that concerned the diagnosis of peripheral vestibular diseases were excluded. Results The final sample consisted of 18 studies. The verified results show that the vestibulo-ocular reflex (VOR) has shown alteration in this population. Suggestive findings of central involvement were observed, such as lower gain or average VOR in the vertical semicircular canals than in the lateral ones, increased gain, the negative correlation of gain with disease severity in Spinocerebellar Ataxia Type 3, cutoff point of 0.70, and gain asymmetry of less than 20% to differentiate vestibular neuritis from a stroke in the medial branch of the posteroinferior cerebellar artery, normal gain with altered oculomotor tests, presence of spontaneous vertical nystagmus, as well as alterations in the VOR with and without visual enhancement, in saccadic pursuit, and the tilt deviation test. Conclusion We found that the vHIT applies to the assessment of high-frequency VOR in individuals with CNS diseases since it provided clinical evidence of changes in peripheral and central vestibular function in different neurological conditions

Urgencias hematooncológicas: desde la perspectiva del intensivista / Hematology/oncology urgencies: from the perspective of the intensivist

Entre los años 2000 y 2016 en Argentina, se reportaron al Registro Oncopediátrico Hospitalario Argentino (ROHA) 22.450 casos de cáncer en niños menores de 15 años de edad. Las Leucemias constituyen la enfermedad oncológica más frecuente, seguida de los Tumores de Sistema Nervioso Central y los Linfomas. Esta distribución es similar a la descripta en los países desarrollados de Europa y Norteamérica. Su tasa de curación a nivel mundial, llega al 80% debido al uso de quimioterapia intensiva, situación que mejora la supervivencia pero que también aumenta la frecuencia de complicaciones. Estas complicaciones pueden ser debidas tanto al propio cáncer como al tratamiento y en ocasiones ser la primera manifestación de la enfermedad oncológica. Los eventos que amenazan la vida en pacientes inmunocomprometidos son mayores que en la población general, y cuando ocurren tienen una mortalidad elevada. El reconocimiento temprano es clave para el resultado en términos de sobrevida y disminución de la mortalidad. Las acciones deberán centrarse al reconocimiento temprano de eventos críticos en pacientes oncológicos. Los pacientes Hemato-Oncológicos constituyen un gran número de ingresos no planificados a las unidades de cuidados intensivos. Uno de cada 4 pacientes requerirá durante su evolución ingreso a Unidades de Cuidados Intensivos. El propósito de este artículo es describir tres de las urgencias oncológicas que requieren con mayor frecuencia admisión en UCI: la presentación y manejo del shock séptico, Shock Cardiogénico y las complicaciones neurológicas en los pacientes con leucemias agudas (AU)

Between 2000 and 2016, 22,450 cases of cancer in children younger than 15 years of age were reported to the Argentine Hospital Registry of Childhood Cancer (ROHA). Leukemia was the most common cancer reported, followed by central nervous system tumors and lymphoma. This distribution is similar to that described in the developed countries of Europe and North America. The worldwide cure rate is up to 80% due to the use of intensive chemotherapy, which improves survival but also increases the complication rate. These complications may be due both to the cancer itself and to the treatment and are sometimes the first manifestation of the disease. Life-threatening events are more common in immunocompromised patients than in the general population, and when they occur, the mortality rate is high. Early recognition is essential for the outcome in terms of survival and decreased mortality. Interventions should focus on early recognition of critical events in cancer patients. Patients with hematology-oncology diseases account for a large number of unplanned admissions to intensive care units (ICU), while one in four of these patients will require admission to the ICU in the course of their disease. The aim of this study was to describe three oncology emergencies that most frequently require ICU admission: septic shock and its management, cardiogenic shock, and neurological complications in patients with acute leukemia (AU)

Stem cells in neurology - current perspectives / Células-tronco em neurologia - perspectivas atuais

Central nervous system (CNS) restoration is an important clinical challenge and stem cell transplantation has been considered a promising therapeutic option for many neurological diseases. Objective : The present review aims to briefly describe stem cell biology, as well as to outline the clinical application of stem cells in the treatment of diseases of the CNS. Method : Literature review of animal and human clinical experimental trials, using the following key words: “stem cell”, “neurogenesis”, “Parkinson”, “Huntington”, “amyotrophic lateral sclerosis”, “traumatic brain injury”, “spinal cord injury”, “ischemic stroke”, and “demyelinating diseases”. Conclusion : Major recent advances in stem cell research have brought us several steps closer to their effective clinical application, which aims to develop efficient ways of regenerating the damaged CNS. .

Restauração do sistema nervoso central (SNC) é um importante desafio clínico e o transplante de células-tronco tem sido considerado uma opção terapêutica promissora para muitas doenças neurológicas. Objetivo : O presente trabalho tem como objetivo descrever brevemente a biologia das células-tronco, assim como sua aplicação clínica no tratamento de doenças do SNC. Método : Revisão da literatura de experimentação animal e ensaios clínicos com humanos, usando as seguintes palavras chave: “células-tronco”, “neurogênese”, “Parkinson”, “Huntington”, “esclerose lateral amiotrófica”, “lesão cerebral traumática”, “lesão da medula espinal”, “acidente vascular cerebral isquêmico” e “doenças desmielinizantes”. Conclusão : Grandes avanços em pesquisas com células-tronco nos conduziram a novas perspectivas para uma aplicação clínica efetiva, visando desenvolver formas eficazes de regeneração do SNC. .

Procedimientos endovasculares como tratamiento de la esclerosis múltiple?: la hipótesis de la insuficiencia venosa crónica cerebro medular: [revisión] / Endovascular procedures as multiple sclerosis treatment?: the hipothesis of the chronic cerebrospinal venous insufficiency: [review]

In this "point of view" or special article, it has been reviewed the main bibliographic antecedents related to the entity denominated as chronic cerebrospinal venous insufficiency (CCSVI), which formulation has been stated by Zamboni et col, from the Vascular Diseases Center of the University of Ferrara-Italy, who have assigned it a pathogenic role or of aggravation one in Multiple Sclerosis (MS), what has led them to propose and carry out endovascular balloon angioplasty or venous stent in MS patients as a treatment. The bibliographic review at this stage of the knowledge of CCSVI does not let us to conclude whether this hypothetical entity has any role in the development or aggravation of MS. On the other hand, we agree with most of the clinicians and neuroimaging MS researchers because of the absence of arguments to indicate, support or propose envovascular "therapeutic" procedures for MS. To advance in the knowledge of CCSVI and the eventual relation with MS it is required some multicentric controlled studies carefully led and clinical and methodological rigorous procedures approved by committee of ethic in very well informed patients invited to participate in protocols of formal investigation who should be protected by complementary pertinent insurances and responsibilities connected to the investigation expenses.

En este artículo especial de la modalidad "puntos de vista", se revisan los antecedentes bibliográficos principales relacionados a la entidad denominada "Insuficiencia venosa crónica cerebro medular (IVCCM)" cuya formulación ha sido planteada por Zamboni y col, del Centro de Enfermedades Vasculares de la Universidad de Ferrara-Italia quienes le han adjudicado un rol patogénico o de agravación en la Esclerosis Múltiple (EM), que les ha llevado a proponer y realizar procedimientos de angioplastía mediante balón endovascular o stent venoso en pacientes con EM. La revisión de la bibliografía, en esta etapa del conocimiento de la IVCCM, no permite concluir si esta hipotética entidad tiene algún rol en el desarrollo o agravación de la EM. Por otro lado, concordamos con la mayoría de los clínicos e imagenólogos dedicados al estudio y tratamiento de la EM, en la ausencia de argumentos para indicar, alentar o propiciar procedimientos "terapéuticos" endovasculares para la EM. Para avanzar, en el conocimiento de la IVCCM y de eventual relación con la EM, se requieren estudios multicéntricos cuidadosamente conducidos, clínica y metodológicamente rigurosos, aprobados por comités de ética, en pacientes que sean invitados informadamente a participar en protocolos de investigación formales, que cuenten con las protecciones de seguros complementarios pertinentes y responsabilidades del gasto a costas de los investigadores.

Long-term potentiation and long-term depression: a clinical perspective

Long-term potentiation and long-term depression are enduring changes in synaptic strength, induced by specific patterns of synaptic activity, that have received much attention as cellular models of information storage in the central nervous system. Work in a number of brain regions, from the spinal cord to the cerebral cortex, and in many animal species, ranging from invertebrates to humans, has demonstrated a reliable capacity for chemical synapses to undergo lasting changes in efficacy in response to a variety of induction protocols. In addition to their physiological relevance, long-term potentiation and depression may have important clinical applications. A growing insight into the molecular mechanisms underlying these processes, and technological advances in non-invasive manipulation of brain activity, now puts us at the threshold of harnessing long-term potentiation and depression and other forms of synaptic, cellular and circuit plasticity to manipulate synaptic strength in the human nervous system. Drugs may be used to erase or treat pathological synaptic states and non-invasive stimulation devices may be used to artificially induce synaptic plasticity to ameliorate conditions arising from disrupted synaptic drive. These approaches hold promise for the treatment of a variety of neurological conditions, including neuropathic pain, epilepsy, depression, amblyopia, tinnitus and stroke.

Trasplante de células troncales: mecanismos de acción para sus usos potenciales en neurología / Stem cells transplant: potentially useful mechanism for neurology

Stem cells have a great potential for the treatment of presently incurable neurological diseases, including spinal trauma, cerebrovascular pathology, brain tumor and neurodegenerative processes, such as Parkinson and Alzheimer's disease, Huntington, multiple sclerosis and amyotrophic lateral sclerosis. Aims: To discuss the characteristics of the various stem cells types having been proposed for cell therapy, and the biological mechanisms responsible for their therapeutic effects. Report: Stem cells can be induced to differentiate into specialized cells such as neurons and glial cells, and they can influence the environment around them, both through the secretion of neurotrophic factors and immunomodulation of the host neuroimmune response. Furthermore, the understanding of the modulatory effect of stem cells could lead to the development of new therapeutic paradigms. Nevertheless, two important limitations of the field are that the ideal source for stem cells is not well defined yet and the mechanism of stem cell mediated functional improvement is not well understood. Conclusions: Research is currently focused on the biological mechanisms of stem cells therapy and the assessment of stem cell programming and delivery to the target regions. Furthermore, future research will increasingly target ways to enhance effectiveness of the stem cell therapy, including its combination with gene therapy. Regardless its enormous potentials, there are still many problems to be solved before clinical application of stem cell therapy can de used in neurological disease patients.

Introducción: Las células troncales tienen un gran potencial para el tratamiento de enfermedades neurológicas actualmente incurables, incluyendo el trauma espinal, patología cerebrovascular y procesos neurodegenerativos como el Parkinson, Alzheimer, Huntington, esclerosis múltiple o la esclerosis lateral amiotrófica. Objetivo: Discutir las características de diversas células troncales que han sido propuestas para terapia celular, y los mecanismos biológicos responsables de sus efectos terapéuticos. Desarrollo: Las células troncales pueden ser inducidas a diferenciarse en células especializadas como neuronas y células gliales, y pueden influenciar su entorno, tanto a través de la secreción de factores neurotróficos como por la inmunomodulación de la respuesta neuroinmune. La comprensión del efecto modulador de las células troncales podría orientar el desarrollo de nuevos paradigmas terapéuticos. Sin embargo, dos limitaciones importantes que persisten son, que la célula troncal ideal aún no está bien definida, y que los mecanismos que median la mejoría inducida por ellas no se comprende bien. Conclusiones: La investigación se enfoca actualmente en los mecanismos biológicos de la actividad terapéutica de las células troncales, en la evaluación de la programación celular y en su acceso a las regiones blanco. La investigación futura se dirigirá progresivamente a encontrar formas de aumentar la efectividad de las células troncales, incluyendo su combinación con terapia genética. Sin embargo, aún existen numerosos problemas que resolver antes que la terapia con células troncales pueda ser usada en pacientes con enfermedades neurológicas.

Dolor neuropático diagnóstico y tratamiento / Neuropathic pain diagnosis and treatment

El dolor neuropático tiene características semiológicas que facilitan su sospecha y diagnóstico, pero en ocasiones este no es fácil y tiende catalogarse como dolor neuropático, algunos dolores nociceptivos refractarios. Se requiere como pilar del diagnóstico la presencia de una enfermedad neurológica de base, ya sea periférica o central, que en general posee mecanismos fisiopatológicos múltiples, pero poco definidos. El manejo terapéutico si bien involucra múltiples alternativas de tratamiento, es difícil, con un número importante de pacientes con respuesta parcial o refractarios, lo cual plantea la necesidad de equipos multidisciplinarios para su manejo.

Autologous transplantation in the central nervous system.

Cell transplantation has been proposed to replace lost neurons in the diseased brain, and after injuries to the central nervous system (CNS). Strategies for cellular therapy in the CNS consist primarily in heterologous transplantations. Despite the CNS being an immunologically privileged site, immune rejection of intracerebral transplants remains a concern. In addition, the use of immunosuppressive drugs, like cyclosporine, is a major constraint associated with heterologous transplantations. Autologous transplantation is therefore viewed as the model of choice for cellular therapy. With the recent progress in somatic cell nuclear transfer (SCNT) research, and the confirmation that neurogenesis occurs in the adult brain and neural stem cells (NSCs) reside in the adult CNS, new opportunities for autologous transplantations are being considered for the CNS, and are promising.

Células troncales en neurología / Stem Cells in neurology

Las investigaciones sobre células troncales han concitado creciente actividad en el campo de la investigación y publicaciones científicas. Nuestra revisión de la literatura expone qué es una célula troncal, sus propiedades, algunas de las estrategias para aislar y hacer proliferar células troncales neurales y los mecanismos moleculares involucrados en la integración funcional de estas células al cerebro receptor. Finalmente se comentan los posibles pasos de las futuras investigaciones, las que deberán identificar mejor las señales del receptor a las células donantes, así como descifrar con mayor profundidad la capacidad neurogénica del ambiente celular del cerebro adulto.

Neuronal stem cells.

Stem cells are self regenerating multipotential cells, found in the human brain which have the potential to differentiate into neurons, astrocytes and oligodendrocytes, and to self renew sufficiently to provide adequate number of cells in the brain. Neural stem cell grafts have been studied in a variety of animal models for various diseases like metabolic disorders, muscular dystrophies, neurodegenerative disorders, spinal cord repair, brain tumors and demyelinating disease. Stem cells may be derived from autologus, allogeneic or xenogenic sources. Histocompatibility is prerequisite for transplantation of allogeneic stem cells. Fetal tissue is the best current tissue source for human neural stem cells, however ethical issues are a major concern. Thus the prospect that stem cells could potentially be used to promote neurogenesis following injury and disease may seem attractive, yet the inherent problems associated with isolation and rejection in case of stem cells from another source, the potential to form tumors and ethical issues are the major challenges.

Aplicaciones de la musicoterapia en la medicina / Medical uses of musical therapy

Music therapy is a science that has been applied since many centuries ago, but it has been organized as a profession during the past century. This science studies the therapeutic effects of music in human beings. Profesionals who practice this science are called "music therapists" and they must be trained not only in music theory and performance, but also in psychology, anatomy, research techniques, and other subjects. Today, we can find music therapy research in many areas such as the effects of music in children with autism, adults with psychiatric illnesses, elderly with Alzheimer and Parkinson disease, people with brain injuries, among others. Numerous studies demonstrate the functionality of music therapy in patients with neurological disorders. These studies show that music helps patients to gain control over their walking patterns after a brain injury, stimulates long and short term memory in patients with Alzheimer disease, and increase self esteem and social interaction in elders

Apoyo ventilatorio en pacientes con patología aguda del sistema nervioso central / Ventilatory support in patients with head injuries

Patients with severe head injury are prone to pulmonary complications that result in hypoxemia or hypercarbia, which could worsen their neurological condition. A rational ventilatory approach requires a good knowledge of respiratory and neurological pathophysiology. Airway management is of prime importance in neurological patients. Prophylactic chronic hyperventilation in head trauma is no longer recommended since it could impair cerebral perfusion, although transient hypocarbia could be of benefit to some patients. The use of low or moderate positive and expiratory pressure levels apparently improves oxygenation without worsening intracranial pressure. Ventilatory management should be closely monitored and adjusted to hemodynamic, respiratory and neurological status to achieve a good outcome

Infección oportunista del sistema nervioso central en pacientes con sida: factores pronósticos que afectan la sobrevida en el primer episodio / Opportunistic infection of the central nervous system in patients with sida: prognostic that affect the to survive in the episode first

Se evaluaron 40 pacientes con SIDA del sexo masculino, con signos y síntomas del SNC. Encontrándose que la infección más frecuente fue la toxoplasmosis cerebral, con 24 pacientes, (55 por ciento), en segundo lugar la criptococosis con 6 pacientes (15 por ciento), además se encontraron 2 pacientes con demencia VIH., 2 casos de leptomeningitis y un caso para cada una de las siguientes: neurosífilis, tuberculosis meningitis por cocos Gram+, histoplasmosis y 2 casos de infección polimicrobiana. Los sintomas más frecuentes fueron fiebre (55 por ciento), pérdida de peso (57,5 por ciento), alteración de la conciencia (50 por ciento) y focalización neurológica. Los de los linfocitos CD4 tenían una media de 87,36 células/cc. del citoquímico del LCR, los valores fueron: celularidad con una media de 106,76 células/cc, las proteínas con una media de 75 mg/cc y la glucosa con 43 mg/cc. sobreviviendo 25 pacientes y fallecieron 15. de las variables analizadas como pronóstico de sobrevida se encontró relación significante. La alteración de la conciencia (p=0,009), cefalea (p=0,046), convulsiones (p=0,041), al látex para Criptococcus neoformans (p=0,037) y la tinta china (p=0,03). No se encontró relación significante a los linfocitos CD4, celularidad del LCR proteínas LCR glucosa del LCR, a los hallazgos tomográficos ni a las infecciones concomitantes

Therapeutic implications of microglia activation by lipopolysaccharide and reactive oxygen species generation in septic shock and central nervous system pathologies: a review

The pathophysiology of organ system failure in sepsis, in particular the effects of septic shock on the central nervous system, are still incompletely understood. Lipopolysaccharide (LPS) from Gram-negative bacteria affects the permeability of the blood-brain barrier and causes the activation of brain microglia. A growing body of research supports involvement of activated brain microglia in brain pathologies caused by infectious diseases, trauma, tumors, ischemia, Alzheimer's disease, Parkinson's disease, Down's syndrome, multiple sclerosis and AIDS. Those seminal studies that have contributed to the characterization of the in vivo and in vitro effects of LPS on microglia function, mediator generation and receptor expression are presented within a historical perspective. In particular, all those in vitro studies on O2-, H2O2 and NO. generation by either unprimed or primed microglia have been extensively reviewed. The apparent controversial effect of LPS on microglia O2- is discussed. Because treatment modalities for septic shock have not significantly affected the current high mortality, alternative strategies with antioxidants are currently being investigated. Reduction of microglia O2- generation is proposed as a possible complementary strategy to antioxidative therapy for septic shock and CNS pathologies that involve activated microglia.

Tratamento neuro-intensivo: papel da enfermagem / Neuro intensive nursing care

Os pacientes neurológicos graves em Terapia Intensiva requerem cuidados, métodos diagnósticos e terapêuticos específicos. Apresenta-se a experiência do Centro de Tratamento Intensivo do Hospital Universitário Säo Vicente de Paulo, particularmente no que concerne aos aspectos do serviço de enfermagem, revisando-se a bibliografia

El impacto clínico de teorías recientes sobre control motor y aprendizaje motor / The clinical impact of modern theories about motor control and motor learning

Este artículo hace una revisión de conceptos y teorías sobre el control motor y aprendizaje motor, las cuales están cambiando las bases de las técnicas de evaluación y tratamiento aplicadas en pacientes con lateraciones neuromotoras