Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil

There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.

Microcirurgia de tumor orbital guiada por imagem (navegação): Relato de Caso / Orbital tumor microsurgery guided by computerized image: a case report

Descrição de caso de tumor orbital extraconal subperiostal superior, produzindo proptose e desvio caudal do globo ocular, sem interferência nos movimentos oculares, com dezoito meses de evolução, em paciente feminina, com 39 anos de idade. Ausência de alterações ósseas, ao R, TC e RM, demonstrava presença de massa tumoral medindo 3 x 1,5 cm, extraconal, sobre o músculo elevador da pálpebra e sob o periósteo, no segmento orbital superior direito. Cirurgia programada, com sistema de navegação (cirurgia guiada por imagem) com superposição de imagens, de TC e RM. Ressecção completa da lesão, sem comprometimento neurológico ou funcional do globo, e excelente resultado estético.

Dissinergia cerebelar mioclônica de Ramsay-Hunt. Estudo clínico, eletroencefalográfico e por tomografia axial computadorizada - Diagnóstico diferencial / Ramsay-Hunt cerebellar myoclonic dyssynergia

Os autores descrevem um caso de dissinergia cerebelar mioclônica de Ramsay-Hunt, associada a epilepsia em uma menina de 14 anos. O diagnóstico foi baseado em um quadro cerebelar associado a mioclonias, epilepsia grande mal e história familiar. O ECG mostrou uma atividade de fundo normal, associado a ondas agudas, polipontas e polipontas ondas, que näo sofrem alteraçäo pela alcalose cerebral, mas que é ativado pela fotoestimulaçäo intermitente. Os autores concluem que o diagnóstico pode ser dado pelo quadro clínico, traçado eletroencefalográfico característico, e a inclui entre as epilepsias mioclônicas progressivas e degenertivas