Análise do procedimento de trombólise endovenosa em pacientes com acidente vascular encefálico isquêmico / Analysis of the procedure of endovenous thrombolysis in patients with acute ischemic stroke

Objetivo: O Acidente Vascular Encefálico isquêmico é uma das doenças mais prevalentes, de grande mortalidade, e requer trombólise endovenosa quando indicada. Esse trabalho objetivou avaliar a população submetida a terapia trombolítica, aplicada em pacientes com acidente vascular cerebral isquêmico, entre junho de 2018 a junho de 2020, em um hospital do Extremo Sul Catarinense. Métodos: Estudo observacional, transversal, com coleta censitária e análise de dados secundários. Estão incluídos os prontuários hospitalares de todos os pacientes com acidente vascular encefálico isquêmico, que receberam trombólise, entre junho de 2018 a junho de 2020. Análise estatística foi feita pelo Statistical Package for Social Sciences, com intervalo de confiança de 95%. Resultados: Foram incluídos 27 pacientes e desses, 15 eram homens; 24 eram brancos; 15 eram procedentes de Criciúma; média de idade foi 61,89 anos. Vinte e seis tinham fatores de risco prévios; 18 tinham mais de 60 anos; 18 tinham hipertensão; 13 tinham diabetes. Quatorze tiveram tempo porta-tomografia em até 10 minutos; 14 tiveram tempo porta-agulha entre 1 e 2 horas; 13 ficaram internados por 5 a 6 dias. Um teve complicações durante a trombólise. Não houveram óbitos, nem necessidade de trombectomia mecânica. Dezenove tiveram sequelas pós-trombólise. A mediana da National Institutes of Health Stroke Scale foi 12 pontos na entrada hospitalar, e 6 pontos na alta. Conclusão: A cerebrovasculopatia isquêmica é a principal causa de incapacidades, e quanto antes feita a trombólise, melhor o prognóstico. O controle dos fatores de risco e os menores tempos são ideais para a evolução sem sequelas.

Objective: Ischemic stroke is one of the most prevalent and high-mortality diseases in the world, and require intravenous thrombolysis when indicated. This research aimed to evaluate the population undergoing thrombolytic therapy, due to an acute ischemic stroke, from June 2018 to June 2020, in a hospital located in the extreme South of Santa Catarina, Brazil. Methods: A cross-sectional survey was conducted, with censos collection and secondary data analysis. Medical records of all patients who suffered from acute ischemic stroke and received intravenous thrombolysis treatment, from June 2018 to June 2020 were included. Statistical analysis was performed by the Statistical Package for Social Sciences, with 95% confidence intervals. Results: Twenty-seven patients were included and of these, 15 were men; 24 were white; 15 were from Criciúma; mean age was 61,89 years. Twenty-six had previous risk factors; 18 were over 60 years old; 18 had hypertension; 13 had diabetes. Fourteen had a CT scan time of up to 10 minutes; 14 had needle-holder time between 1 and 2 hours; 13 were hospitalized for 5 to 6 days. One had complications during thrombolysis. There were no deaths and not need mechanical thrombectomy. Nineteen had postthrombolysis sequelae. The National Institutes of Health Stroke Scale median was 12 points at hospital admission, and 6 points at discharge. Conclusion: Ischemic cerebrovasculopathy is the main cause of disabilities, and the sooner thrombolysis is done, the better is the prognosis. The control of risk factors and the shortest times are ideal for evolution without sequelae.

Microsurgery of Cerebral Aneurysm: Epidemiological Profile

Objectives Intracranial aneurysm consists of localized dilatation of the vascular wall. Its importance includes the fearsome event of rupture and subarachnoid hemorrhage, which presents high morbimortality rates. The present study aimed to analyze the profile and clinical outcome of patients submitted to the microsurgical approach of cerebral aneurysm in the city of Criciúma, state of Santa Catarina, Brazil, from 2015 to 2018. Methods A retrospective observational study was performed, with secondary data collection and a quantitative approach of 47 charts. Results A predominance of females (74.5%) and amean age of 53 years old (53.53 9.64) was observed. The middle cerebral artery was the most affected vessel (36.2%), with the highest percentage of aneurysms being between 2.1mmand 7.0mm(65.9%). Therewas a correlation between consciousness level and classification on the Hunt-Hess (HH) scale. Patients with GlasgowComa Scale (GCS)> 7 points had a better prognostic score in the HH scale, and those with GCS 7 points had a worse prognostic score in the HH scale. Conclusions The present study observed the presence of important risk factors for cerebral aneurysm formation, such as gender, age, smoking, and systemic arterial hypertension. The present study can measure a correlation of the level of consciousness with the HH classification.

Alterações endocrinológicas após hemorragia subaracnóidea / Endocrinological Changes after Subarachnoid Hemorrhage

A avaliação da função hipofisária na fase aguda ou tardia dos pacientes que sofrem hemorragia subaracnóidea (HSA) é infrequente; entretanto, a HSA apresenta um risco significante de disfunção pituitária, principalmente devido à vulnerabilidade da sua suplência vascular. Há poucos estudos tratando do tema, mas os existentes sugerem que distúrbios hormonais pós-hemorragia subaracnóidea são mais prevalentes do que inicialmente se suspeitava. Não somente a hipófise anterior parece estar envolvida nessas alterações; a hiponatremia no estágio agudo pode ser uma manifestação de disfunção da hipófise posterior. As alterações hormonais após HSA ainda recebem pouca atenção das equipes assistenciais, podendo ser uma das complicações potencialmentegraves sendo tratável quando há suspeição pelo diagnóstico clínico e laboratorial.

The evaluation of pituitary function in the acute and at late time in the patients with subarachnoid hemorrhage (SAH) is unusual. Meanwhile the SAH present with a high risc of pituitary disfunction primarily by the vulnerability of the vascular feeding vessels. Few studies about this subject suggest that hormonal disturbance are more prevalent that were suspected before. Both the anterior and posterior pituitary areinvolved. The hormonal changes after SAH are not well recognized by the physicians and can be treated even been a critical medical situation with clinical and laboratorial findings.

Lymphoplasmacyte-rich meningioma: a case report of a rare neoplasm / Meningeoma rico em linfócitos e plasmócitos: relato de caso de uma rara neoplasia

Lymphoplasmacyte-rich meningioma (LPM) is a rare variant of meningioma, which is characterized by massive inflammatory cell infiltration and rare meningothelial elements. The authors report the clinicopathological features of a LPM located at the right parietal convexity in a patient with generalized tonic-clonic seizures and paresthesia in the left arm. The surgical specimen consisted of a gray nodule measuring 3.5 × 3 × 1.8 cm. At microscopy, a few epithelioid cells associated with numerous lymphocytes/plasma cells were identified. Positive immunoexpression for epithelial membrane antigen (EMA) and progesterone receptor was found in the epithelioid cells, and positive staining for CD3, CD5 and CD20 in the inflammatory cells. Thus, the diagnosis of LPM was established.

O meningeoma rico em linfócitos e plasmócitos (MLP) é uma variante rara de meningeoma, caracterizada por um infiltrado inflamatório massivo e raros elementos meningoteliais. Os autores descrevem as características clinicopatológicas de um MLP localizado na convexidade parietal direita de uma paciente com queixa de crises convulsivas tônico-clônicas generalizadas e parestesia no braço esquerdo. A peça cirúrgica consistia de um nódulo cinzento medindo 3,5 × 3 × 1,8 cm. À microscopia, foram identificadas poucas células epitelioides associadas a numerosos linfócitos e plasmócitos. Imunoexpressão positiva para antígeno da membrana epitelial (EMA) e receptor de progesterona foi encontrada nas células epitelioides, enquanto imunomarcação positiva para CD3, CD5 e CD20 foi identificada nas células inflamatórias. O diagnóstico de MLP foi então estabelecido.