Unilateral spatial neglect in the acute phase of ischemic stroke can predict long-term disability and functional capacity

OBJECTIVE: The aim of this study was to assess the relationship between the degree of unilateral spatial neglect during the acute phase of stroke and long-term functional independence. METHODS: This was a prospective study of right ischemic stroke patients in which the independent variable was the degree of spatial neglect and the outcome that was measured was functional independence. The potential confounding factors included sex, age, stroke severity, topography of the lesion, risk factors, glycemia and the treatment received. Unilateral spatial neglect was measured using the line cancellation test, the star cancellation test and the line bisection test within 48 hours of the onset of symptoms. Functional independence was measured using the modified Rankin and Barthel scales at 90 days after discharge. The relationship between unilateral spatial neglect and functional independence was analyzed using multiple logistic regression that was corrected for confounding factors. RESULTS: We studied 60 patients with a median age of 68 (34-89) years, 52% of whom were male and 74% of whom were Caucasian. The risk for moderate to severe disability increased with increasing star cancellation test scores (OR=1.14 [1.03-1.26], p=0.01) corrected for the stroke severity, which was a confounding factor that had a statistically positive association with disability (OR=1.63 [1.13-2.65], p=0.01). The best chance of functional independence decreased with increasing star cancellation test scores (OR=0.86 [0.78-0.96], p=0.006) corrected for the stroke severity, which was a confounding factor that had a statistically negative association with independence (OR=0.66 [0.48-0.92], p=0.017). CONCLUSION: The severity of unilateral spatial neglect in acute stroke worsens the degree of long-term disability and functional independence.

Low haemoglobin levels increase unilateral spatial neglect in acute phase of stroke / Níveis baixos de hemoglobina aumentam a negligência espacial unilateral na fase aguda do acidente vascular cerebral

Objective The objective of this study was to evaluate the relationship between unilateral spatial neglect (USN) and haemoglobin (Hb) level in acute phase of stroke. Method Cross-sectional study was performed after right hemisphere ischemic stroke. Independent variable: Hb level (mg/dL); Outcome: USN; Potential confounding factors: Age, National Institutes of Health Stroke Scale (NIHSS), and glycaemia (mg/dL); Characterization variables were obtained from electronic medical records, Hb, mean corpuscular volume (MCV) and glycaemia by laboratory exams, and USN by cancellation and bisection tasks. The relationship between Hb and USN was assessed by Spearman correlation and linear regression model. Results 40 individuals were evaluated; it was observed that the higher the Hb level, the better the USN test performance, with the two being negatively correlated. There was no significant correlation between VCM level and USN performance. Conclusion Low hemoglobin levels may indicate a worse performance in USN cancellation and bissection tests in acute phase of stroke. .

Objetivo O objetivo do estudo foi avaliar a relação entre a negligência espacial unilateral (NEU) e hemoglobina (Hb) na fase aguda do acidente vascular cerebral (AVC). Método Foi realizado estudo transversal em pacientes com AVC de hemisfério direito dentro das primeiras 48 horas do ictus. Variáveis independentes: nível de Hb (mg/dL); Desfecho: NEU; Fatores potenciais de confundimento: Idade, National Institutes of Health Stroke Scale (NIHSS) e glicemia (mg/dL); A caracterização das variáveis foram obtidas por meio de prontuários eletrônicos, Hb e glicemia por exames laboratoriais, e NEU por meio do Line Cancellation (LCT), Star Cancelation (SCT), e Line Bisection Tasks (LBT). Resultados 40 indivíduos foram avaliados e foi observado que quanto maior os níveis de Hb, melhor o desempenho nos testes de NEU, demonstrando correlação negativa entre eles. Conclusão Níveis baixos de hemoglobina podem indicar pior desempenho nos testes de NEU na fase aguda do AVC. .

Estereopsis en niños operados de estrabismo en el Instituto Cubano de Oftalmología / Stereopsis in children operated on from strabismus at the Cuban Institute of Ophthalmology

Objetivo: determinar la presencia de estereopsis en los niños operados de estrabismo en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Métodos: se realizó un estudio observacional, descriptivo y transversal de marzo a octubre de 2011. Se seleccionaron aleatoriamente 50 niños a quienes se le realizó un examen oftalmológico completo. Resultados: predominó el sexo femenino 60 por ciento, el rango de edad fue de 3 a 4 años 32 por ciento. El 84 por ciento de los pacientes presentaban una agudeza visual de 1,0; de ellos, solamente 10 tenían estereopsis. El rango donde se obtuvo mayor cantidad de niños con estereopsis posoperatoria fue el de menores de 2 años. La mayoría de los niños tenían como diagnóstico una esotropía congénita, solamente tuvieron estereopsis con este tipo de estrabismo 5 niños, Otro tipo de estrabismo que presentaban fue la exotropia intermitente. Conclusiones: en la cirugía de estrabismo lograr el alineamiento ocular, su estabilidad y tener la unidad de visión en ambos ojos, no trae resultados sensoriales muy alentadores, si el niño no se opera a edades tempranas. Una intervención quirúrgica temprana resulta importante para mejorar los resultados funcionales visuales, principalmente antes de los 2 años de edad

Objective: to determine the existence of stereopsis in children operated on from strabismus in Ramón Pando Ferrer Cuban Institute of Ophthalmology. Methods: observational, descriptive and cross-sectional study from March to October, 2011. Fifty children were randomly selected to undergo a complete ophthalmologic exam. Results: females 60 percent and the 3 to 4 years-old age group 32 percent prevailed. In the study group, 84 percent of the patients had visual acuity of 1.0, and just 10 had stereopsis. The patients younger than 2 years old represented the highest number with postsurgical stereopsis. Most of the children were diagnosed as congenital esotropia, but just 5 children had stereopsis added to this type of strabismus. Another type of strabismus found was the intermittent exotropia. Conclusions: in the strabismus surgery, reaching the ocular alignment and its stability as well as the vision co-ordination in both eyes, does not attain very encouraging sensory outcomes when a child is operated on at later age. An early surgical intervention is important to improve the functional visual results, mainly before 2 years of age

Aspectos clínicos y modelos teóricos en el Síndrome de Neglect / Clinicalaspects and theoretical models in Neglect Syndrome

En este trabajo se revisa y discute el síndrome de neglect considerando diferentes modelos teóricos explicativos; de dirección atencional, de asimetrías hemisféricas cerebrales, del sesgo atencional o el modelo de atención selectiva. Se consideran los aspectos cognitivos, emocionales y neuroconductuales. El Síndrome de Neglect generalmente es consecuencia de un accidente cerebrovascular, afecta al hemisferio cerebral derecho y señala directamente al lóbulo parietal. Este es el resultado de una definición anatómica vasta más que una unidad fisiológica o funcional. El síndrome se manifiesta por déficits en la atención perceptiva y en la respuesta a estímulos presentados en el hemicampo contralesional. Es un síndrome heterogéneo. Pese a la preponderancia de las teorías de déficits atencionales, las explicaciones de déficits perceptivos y de representación del espacio están presentes. Son variaciones del síndrome la heminatención, la extinción, la hemicinesia y el neglect hemiespacial. Se resalta la importancia de incluir los aspectos emocionales y neuroconductuales junto con los cognitivos y la rehabilitación motora en el proceso de rehabilitación neuropsicológica del síndrome. Son característicos los síntomas de anosognosia, extinción, desinhibición de conducta, conducta de utilización o la falta de afecto. En cuanto a la recuperación y a cómo ocurre esta, se discuten varias explicaciones alternativas y se apunta el papel de la motivación como factor importante en el éxito de los tratamientos.

This paper reviews the syndrome Neglect considering different theoretical models: attentional direction; of cerebral hemispheric asymmetry, attentional bias, selective attention model. The cognitive, emotional and neurobehavioral characteristics are high lighted. Neglect syndrome usually results from a stroke that affects the right cerebral hemisphere and points directly to the parietal lobe. This is the result of an extensive anatomical definition more than that one functional unit or physiological. The syndrome is manifested by deficits in attention and perceptual responses to stimuli presented in the contralesional hemispace. Neglect is a heterogeneous syndrome. Despite the preponderance of theories of the attentional deficit, explanations of perceptual deficits and representation of space are present. The syndrome manifestations are the heminatención, the extinction, the hemispatial hemicinesia and the neglect. They are very important the emotional aspects as the cognitive, neurobehavioral and motor rehabilitation, in the neuropsychological rehabilitation process of syndrome. Symptoms of anosognosia, extinction, behavioral disinhibition, and the utilization behavior or lack of affection are the most prominent in the syndrome. In terms of recovery, how to happen this? We discuss several alternative explanations and the role of motivation as an important factor in the success of treatments.

Toxicokinetics of ketamine in rabbits / 法医学杂志

OBJECTIVE@#To investigate the toxicokinetics profiles of ketamine and its main metabolite norketamine in rabbits.@*METHODS@#The rabbits were administered orally the hydrochloride of ketamine with a dose of 0.15 g/kg. The serum and urine samples were collected before administration and at different time points after drug administration. The concentrations of ketamine and norketamine were determined by GC-NPD and GC-MS. Compartment model and toxicokinetics parameters were simulated and calculated by WinNorLin program. Changes of important vital signs of rabbits were recorded during the experiment.@*RESULTS@#The mean serum concentration-time profile of ketamine and norketamine were fitted to a two-compartment open model with first order kinetics. The kinetic equation of ketamine and norketamine were p(t) = 121.760 e(-0.0025t) +0.980 e(-0.002t) +4.579 e(-0.021 t) and p(t) = 640.919 e(-0.03 t) +1.023 e(-0.001 t) +9.784 e (-0.031 t), respectively. The peak time and the peak concentration of ketamine in serum were (40.950 +/- 12.098) min and (9.015 +/- 1.344) microg/mL, respectively. The elimination half-time of ketamine in rabbits was (430.370 +/- 28.436) min. The serum and urine showed a middle relation in concentrations of ketamine during 30-240 min after drug administration. After oral administration ketamine to rabbits, the toxic symptom on the rabbits occurred at 30 min and disappeared after 120 min.@*CONCLUSION@#The toxicokinetics parameters and kinetic equation of ketamine and norketamine in rabbits may provide the theoretical basis for forensic identification of reasonable specimen collection and inferring the time of oral administration ketamine from the ketamine concentration in serum.

Screening tests are not enough to detect hemineglect

OBJECTIVE: To verify the sensitivity of the conventional subtests of the Behavioral Inattention Test (BIT) in the diagnosis of hemineglect after stroke. METHOD: One hundred and two patients with cerebral infarct or hemorrhage were prospectively evaluated. In 22, hemineglect was diagnosed using standard BIT criteria. The frequency of hemineglect using 6 commonly used screening subtests of this battery was assessed. RESULTS: Hemineglect would not be recognized in 10 patients if they were only screened using the line crossing test; this would be the case in 2 patients with the letter cancellation test; and in 4 patient with the line bisection test. Three patients would not be diagnosed even if both line crossing and line bisection tests were used. CONCLUSION: Hemineglect may not be recognized with single screening tests commonly used. The use of a standard battery is recommended to improve diagnostic sensitivity in individuals with various subtypes of hemineglect.

OBJETIVO: Verificar a sensibilidade dos subtestes convencionais da Behavioral Inattention Test (BIT) no diagnóstico da heminegligência após o acidente vascular cerebral (AVC). MÉTODO: Foram avaliados prospectivamente 102 pacientes com AVC. Em 22 casos heminegligência foi diagnosticada através do BIT. A freqüência de diagnóstico correto utilizando os 6 subtestes específicos desta bateria foi analisada. RESULTADOS: 10 pacientes não seriam diagnosticados como heminegligentes se fossem avaliados apenas com o " line crossing" , 2 se o teste de triagem escolhido fosse o " letter cancellation" , e 4 se utilizássemos apenas o " line bisection" . Além disso, 3 pacientes não teriam recebido o diagnóstico correto mesmo utilizando dois testes usuais de triagem - " line crossing" e " line bisection" . CONCLUSÃO: O uso de testes isolados de triagem pode falhar em diagnosticar heminegligência após o AVC. O uso de uma bateria formal de avaliação é necessário para identificar indivíduos com diferentes tipos de heminegligência.

Early impairment of cognitive functions in Parkinson's disease

BACKGROUND: Impairment in non-motor functions such as disturbances of some executive functions are also common events in Parkinson's disease patients. OBJECTIVE: To verify the performance of Parkinson's disease patients in activities requiring visuoconstructive and visuospatial skills. METHOD: Thirty elderly patients with mild or moderate stages of Parkinson's disease were studied. The assessment of the clinical condition was based on the unified Parkinson's disease rating scale (56.28; SD=33.48), Hoehn and Yahr (2.2; SD=0.83), Schwab and England (78.93 percent), clock drawing test (7.36; SD=2.51), and mini-mental state examination (26.48; SD=10.11). Pearson's correlation and stepwise multiple regression were used for statistical analyses. RESULTS: The patients presented deterioration in visuospatial and visuoconstructive skills. CONCLUSION: The clock drawing test proved to be a useful predictive tool for identifying early cognitive impairment in thesbe individuals.

CONTEXTO: Comprometimento em funções não-motoras como perturbações em algumas funções executivas são também eventos comuns em pacientes com doença de Parkinson. OBJETIVO: Verificar as performances de pacientes com doença de Parkinson em atividades que requerem habilidades visuo-construtivas e visuo-espaciais. MÉTODO: Pacientes idosos (n=30) nos estágios leve ou moderado da doença de Parkinson foram estudados. O diagnóstico da condição clínica foi realizado por meio de: unified Parkinson's disease rating scale (56,28; SD=33,48), Hoehn e Yahr (2,2; SD=0,83), Schwab e England (78,93 por cento), teste do desenho do relógio (7,36; SD=2,51), e mini-exame do estado mental (26,48; SD=10,11). A correlação de Pearson e a análise de regressão múltipla foram empregadas na análise estatística. RESULTADOS: Os pacientes apresentaram deterioração nas habilidades vísuo-espaciais e visuoconstrutivas. CONCLUSÃO: O teste do desenho do relógio provou ser uma ferramenta útil e preditiva para identificar o comprometimento cognitivo precoce nesses indivíduos.

Efecto de la desnutrición sobre el desarrollo neurointegrativo del niño: segunda parte / Effect of malnutrition on the neurointegrative development of the child: part II

En esta parte del estudio se compararon las proporciones de niños, con o sin antecedentes de desnutrición severa, que cometieron errores de equivalencia (juzgar como iguales formas diferentes). En todas las edades los supervivientes de desnutrición tuvieron niveles de competencia significativamente inferiores. Lo mismo ocurrió al comparar el desarrollo de la integración intersensorial auditivovisual. Considerando que la calificación es estimulación en el hogar también se asoció signifcativamente con la competencia cinestésico-visual, el retraso del desarrollo de esta función observado en los niños con antecedentes de desnutrición de tercer grado, viene a ser el resultado de los efectos de la desnutrición y de la acción negativa de ciertos factores microambientales relacionados con el cuidado del niño

Síndromes neuropsiquiátricos por lesión en el hemisferio cerebral derecho / Neuropsychiatric syndroms produced by lesions in the right brain hemisphere

El estudio de la dominancia cerebral desempeña un papel importante en el contexto de las desórdenes de las funciones cerebrales superiores. No sólo las neuropsicológicas se encuentran lateralizadas sino también las neuropsiquiátricas. El objetivo de nuestro trabajo es la presentación de tres pacientes con trastornos psiquiátricos secundarios a una lesión del hemisferio cerebral derecho. El caso 1 es una paciente con un síndrome de Capgras, los casos 2 y 3 un síndrome de hemidespersonalización. Es frecuente que lesiones en el hemisferio derecho sean responsables de síndromes neuropsiquiátricas. El hecho de que ni las alteraciones funcionales, ni las estructurales puedan explicar por sí solas todas las características de los síndromes en estos pacientes, hace suponer que es necesaria la conjunción de ambas em proporciones variables según los casos. Probablemente aparezca en un sujeto con terreno paranoide con ligeros desórdenes perceptivos; o a la inversa, en un paciente con importantes alteraciones perceptivas como nuestros pacientes (visual en el caso 1; y sensitivas en los casos 2 y 3), bastará un pequeño trastorno afectivo para que surja la idea delirante.