Lesión cerebral post paro cardiaco: aspectos médicos, éticos y legales / Brain injury after cardiac arrest: Medical, ethical and legal issues disorder

RESUMEN Los sobrevivientes de la reanimación cardiopulmonar posterior a un paro cardiaco pueden tener un amplio rango de desenlaces y van desde recuperación neurológica completa, estado de vigilia sin respuesta, compromiso cognoscitivo diverso o la muerte. La lesión del tejido cerebral se presenta inmediatamente después del paro cardíaco, durante la reanimación y al retornar la circulación espontánea. La severidad y duración de la noxa isquémica determinarán el devenir neurológico. El examen clínico es el punto de partida en el abordaje multimodal del neuropronóstico. Se debe complementar con electroencefalograma, potenciales evocados somatosensoriales, neuroimágenes y biomar-cadores séricos. Entre un 10 a 15% de los pacientes con lesión cerebral posterior al paro cardiaco evolucionan hacia muerte por criterios neurológicos y son potenciales candidatos a la donación de órganos. Un retiro temprano de las terapias de sostenimiento de vida puede malograr la posibilidad de un potencial donante de órganos. Se puede estimar de manera temprana qué pacientes tienen mayor riesgo de evolucionar a muerte por criterios neurológicos. El neurólogo tiene un papel protagónico en el manejo de pacientes con lesión cerebral post paro cardiaco y sus decisiones tienen implicaciones éticas y legales.

ABSTRACT People who survive cardiopulmonary resuscitation (CPR) after cardiac arrest, have a wide range of outcomes including complete neurological recovery, coma, compromised cognitive function and death. Injury of the brain parenchyma starts immediately after a cardiac arrest, during CPR and return of spontaneous circulation. The severity of the ischemic injury will define the neurological outcome. The first step needed to determine a neurological prognosis is the clinical exam, with the help of electroencephalography, somatosensory evoked potentials, neuroimaging, and serum biomarkers. Between 10 and 15% of patients with brain injury after a cardiac arrest, develop brain death and become potential candidates for organ donation. A premature withdrawal of vital support can hamper the possibility of organ donation. The patients with higher risk of developing brain death can be identified early based on neurological criteria. The neurologist has a major role in the approach of patients with brain injury after cardiac arrest and the decision making with legal and ethical consequences.

Association between autism spectrum disorder and changes in the central auditory processing in children

SUMMARY OBJECTIVE: To verify the scientific evidence on the association between Autistic Spectrum Disorder and Central Auditory Processing Disorder in children, aiming to answer the following research question: What is the association between Autistic Spectrum and Alteration of Auditory Processing in Children? METHODS: Studies were chosen through the combination based on the Medical Subject Heading Terms (MeSH): [(auditory processing) and (children) and (autism) and (neurological disorders)]. The MEDLINE (PubMed), LILACS, and SciELO databases were used. The analyzed papers covered a ten-year period, from 2010 to 2020. We selected descriptive, cross-sectional, cohort, and case studies. We evaluated the quality of the papers, which had a minimum score of six in the modified scale of the literature. RESULTS: 126 papers were retrieved after the exclusion phase, and 17 of them followed the inclusion criteria. Only two papers answered the guiding question with audiological results. CONCLUSIONS: Patients diagnosed with autistic spectrum disorder may have disturbance central auditory processing, considering that changes were found both in absolute and interpeak latencies in the brainstem evoked response audiometry, as well as in latency and laterality of the N1c wave amplitude. In addition, there were changes in the assessment behavioral auditory processing. Thus, disturbance central auditory processing is common in children with autistic spectrum disorder.

Vestibular evoked myogenic potentials in the prognosis of sudden hearing loss - a systematic review / O potencial evocado miogênico vestibular no prognóstico da surdez súbita - uma revisão sistemática

Abstract Introduction: Sudden hearing loss is an otorhinolaryngological emergency that often leads to severe damage to the auditory and vestibular function. The vestibular evoked myogenic potential is a test that allows a noninvasive evaluation of the otolithic system function and vestibulospinal and vestibulo-ocular pathways. Objective: To evaluate the importance of vestibular evoked myogenic potential in determining the prognosis of patients with sudden hearing loss. Methods: A search for articles published up to December 2018 was performed in the PubMed, Cochrane, VHL and LILACS databases using MeSH descriptors. Retrospective and prospective articles were included containing cervical or ocular vestibular evoked myogenic potential in sudden hearing loss patients and information on associated vertigo and/or dizziness. Results: Sixteen of 62 initially selected articles met the inclusion criteria and were analyzed. Regarding the methodology of the evaluated studies, 8 studies were prospective, six were retrospective, one contained part of the data from a retrospective analysis and another part from a prospective analysis, and one study was cross-sectional. A total of 872 patients were evaluated (50.22% males and 49.77% females) with a mean age of 51.26 years. Four hundred and twenty-six patients (50.35%) had vertigo and/or dizziness associated with sudden hearing loss. The cervical vestibular evoked myogenic potential was performed in all studies, but only seven assessed the ocular vestibular evoked myogenic potential. The cervical vestibular evoked myogenic potential showed alterations in 38.65% of 846 evaluated ears, whereas ocular vestibular evoked myogenic potential showed alterations in 47.88% of 368 evaluated ears. The hearing recovery rate was analyzed by 8 articles, with 63.4% of 410 evaluated ears showing hearing recovery. Conclusions: The studies suggest that the assessment of the vestibular system using vestibular evoked myogenic potential seems to be important in the prognosis of sudden hearing loss. For better follow-up of patients with sudden hearing loss, the emphasis should not be limited to the cochlea, but also include the diagnosis and treatment of vestibular abnormalities, regardless of the presence of vertigo.

Resumo Introdução: A surdez súbita é uma emergência otorrinolaringológica que frequentemente cursa com graves danos à função auditiva e vestibular. O potencial evocado miogênico vestibular é um exame que permite a avaliação não invasiva da função do sistema otolítico e das vias vestíbulo-espinhal e vestíbulo-ocular. Objetivo: Avaliar a importância do potencial evocado miogênico vestibular na determinação do prognóstico dos pacientes com surdez súbita. Método: Uma busca de trabalhos publicados até dezembro de 2018 foi realizada nos bancos de dados PubMed, Cochrane, BVS e Lilacs com descritores cadastrados no MeSH. Foram incluídos artigos retrospectivos e prospectivos que contivessem o potencial evocado miogênico vestibular cervical ou ocular em pacientes com surdez súbita e informações sobre vertigem e/ou tontura associados. Resultados: Dezesseis de 62 artigos selecionados inicialmente preencheram os critérios de inclusão e foram analisados. Quanto à metodologia dos trabalhos avaliados, 8 estudos foram prospectivos, seis retrospectivos, um continha parte dos dados oriunda de uma análise retrospectiva e outra parte de uma análise prospectiva e um estudo foi transversal. Foram avaliados 872 pacientes (50,22% do gênero masculino e 49,77% feminino) com média de 51,26 anos. Do total de pacientes, 426 (50,35%) apresentavam vertigem e/ou tontura associada à surdez súbita. O potencial evocado miogênico vestibular cervical foi realizado em todos os estudos, porém o potencial evocado miogênico vestibular ocular em apenas sete. O potencial evocado miogênico vestibular cervical apresentou alteração em 38,65% de 846 orelhas avaliadas, enquanto o potencial evocado miogênico vestibular ocular estava alterado em 47,88% das 368 orelhas avaliadas. A taxa de recuperação auditiva foi analisada por 8 artigos, 63,4% de 410 orelhas avaliadas apresentavam recuperação auditiva. Conclusões: Os estudos demonstram que a avaliação do sistema vestibular com o uso do potencial evocado miogênico vestibular parece ter importância no prognóstico da surdez súbita. Para melhor acompanhamento do paciente com surdez súbita a ênfase não deve se restringir à cóclea, mas também no diagnóstico e tratamento de alterações vestibulares, independentemente da presença de vertigem.

Morfología de los potenciales evocados auditivos de latencia tardía P300 y su rol en la evaluación de la conducta suicida / Morphology of auditory evoked potentials, and its role in the evaluation of suicidal behavior

El suicidio es un problema de salud a nivel mundial, siendo la conducta suicida uno de los predictores de mortalidad por suicidio; sin embargo, su valoración aún sigue siendo compleja. Aunque la cantidad de literatura que ha abordado distintas perspectivas de la conducta suicida es abundante, se requiere ahondar en nuevos métodos que permitan una valoración rápida y objetiva de ésta, proporcionando a los clínicos y pacientes, un sistema de evaluación que registre los cambios de estados emocionales de manera dinámica. El objetivo de este manuscrito fue proporcionar una visión general de la morfología de los potenciales evocados auditivos de latencia tardía p300 y su rol en la evaluación de la conducta suicida.

Suicide is a global health problem, with suicidal behavior being one of the predictors of suicide mortality; however, its assessment is still complex. Although the amount of literature that has addressed different perspectives of suicidal behavior is abundant, it is necessary to deepen new methods that allow a rapid and objective assessment of it, providing clinicians and patients with an evaluation system that allows changes in emotional state to be recorded dynamically. The aim of this manuscript was to provide an overview of morphological patterns of auditory evoked potential P300 latency late in the assessment of suicidal behavior.

Desempeño fonológico y actividad bioeléctrica auditiva en un niño con trastorno fonológico / Phonological performance and auditory bioelectric activity in a child with phonological disorder

Resumen Introducción. El trastorno fonológico es un déficit en la percepción, organización y producción fonológica del lenguaje. Los potenciales evocados auditivos de tronco cerebral identifican cambios electrofisiológicos generados en la vía auditiva, por tanto, el presente estudio pretende demostrar la utilidad de tales potenciales en la caracterización de los pacientes con trastornos fonológicos, permitiendo así evidenciar una alteración en la actividad bioeléctrica de la vía auditiva. Presentación del caso. Se presenta el caso de un menor con trastorno fonoaudiológico evaluado por medio de potenciales evocados auditivos de tronco cerebral, previa evaluación de la vía auditiva periférica excluyendo patologías adyacentes. El análisis de los resultados verifica que, en tiempo de transmisión del estímulo al recorrer la vía auditiva, se generó un aumento en las latencias absolutas de las ondas I, III y V, con aumento en las desviaciones estándar de la prueba. Conclusiones. Puede existir asociación entre el desarrollo fonológico y la actividad bioeléctrica de la vía auditiva, además, aumentando la muestra se podría generar una evaluación objetiva que valore algunas alteraciones del lenguaje en niños.

Abstract Introduction: Phonological disorder is a deficit in the perception, organization and phonological articulation of speech. Brainstem auditory evoked potentials identify electrophysiological changes generated in the auditory pathway. This study aims to demonstrate the usefulness of such potentials to characterize patients with phonological disorders and expose alterations in the bioelectric activity of the auditory pathway. Case presentation: This paper presents the case of a child with a phonological disorder evaluated using brainstem auditory evoked potentials, after evaluating the peripheral auditory pathway to rule out adjacent pathologies. The analysis of the results confirms that, during the transmission of the stimulus when crossing the auditory path, an increase was generated in the absolute latencies of waves I, III and V, with an increase an in the standard deviations of the test. Conclusions: An association between phonological development and bioelectric activity of the auditory pathway may exist. A larger sample could lead to an objective evaluation that assesses some language disorders in children.

Potencial evocado auditivo de tronco encefálico por condução óssea: uma revisão integrativa / Bone-conducted brainstem auditory evoked response: an integrative review

O objetivo deste estudo foi de realizar uma revisão de forma integrativa sobre os procedimentos utilizados nos critérios de aquisição do exame de Potenciais Evocados Auditivos de Tronco Encefálico por condução óssea com fins ao auxílio no diagnóstico de problemas auditivos. Foi realizada uma busca nas seguintes bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline) e Scientific Eletronic Library Online (SciELO). Utilizaram-se as seguintes palavras-chave: Potencial Evocado Auditivo, Eletrofisiologia e Condução Óssea, encontrados por meio de Descritores em Ciências da Saúde (DeCS). Os resultados apresentados são referentes aos 35 estudos selecionados. A maioria dos estudos optou pelo uso do estímulo clique, com transdutores por condução aérea os fones supra-aurais, como o TDH-39, para o estímulo por condução óssea, o vibrador Radioear B-71, com pressão de 425+/-25g. Observou-se que a mastoide foi à região onde mais se posicionou mais o vibrador ósseo. A maioria dos estudos refere usar polaridade alternada, com taxa de apresentação diversificada, sendo 57,7/s a mais utilizada e filtro de 30-3000 Hz, com uma janela de 15 ms de duração. Para taxa do estímulo a maioria dos estudos utilizou de 2048, e um total de estímulos de 2 registros. O Potencial Evocado Auditivo de Tronco Encefálico é um exame que vem sendo pesquisado há muitos anos e muito se tem descrito na literatura sobre seus aspectos de aquisição e analise, além de destacar a importância da sua utilização na população neonatal.

The aim of this study was to conduct an integrative review of the procedures used in the acquisition criteria of the Bone-Conducted Brainstem Auditory Evoked Potentials examination in order to help in the diagnosis of hearing problems. A search was conducted on the following databases: Latin American and Caribbean Literature on Health Sciences (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Scientific Electronic Library Online (SciELO). The following keywords were used: AEPs, Electrophysiology and Bone Conduction, found via Descriptors in Health Sciences Headings (MeSH). The results shown are for the 35 selected studies. Most studies opted to use click stimuli and supra-aural headphones, such as the TDH-39, as conduction transducers, and the Radioear B-71 vibrator, with a pressure of 425+/- 25g, for bone conducted stimulation. It was observed that the the bone vibrator was most frequently placed in the mastoid region. The majority of studies report using alternating polarity, with different presentation rates, the most widely used being 57.7/s, with a 30-3000 Hz filter and a window of 15 ms. Most studies used a stimulus rate of 2048, and a total of 2 stimulus recordings. The Brainstem Auditory Evoked Response exam has been studied for many years and much has been written in the literature regarding acquisition and analysis, in addition to underscoring its importance for newborns.

Design and field calculation of coil array for transcranial magnetic stimulation (TMS) based on genetic algorithm / 生物医学工程学杂志

It is the intent of this paper to locate the activation point in Transcranial Magnetic Stimulation (TMS) efficiently. The schemes of coil array in torus shape is presented to get the electromagnetic field distribution with ideal focusing capability. Then an improved adaptive genetic algorithm (AGA) is applied to the optimization of both value and phase of the current infused in each coil. Based on the calculated results of the optimized current configurations, ideal focusing capability is drawn as contour lines and 3-D mesh charts of magnitude of both magnetic and electric field within the calculation area. It is shown that the coil array has good capability to establish focused shape of electromagnetic distribution. In addition, it is also demonstrated that the coil array has the capability to focus on two or more targets simultaneously.