Correlación entre el examen mínimo del estado mental y la escala de memoria de Wechsler en una muestra de pacientes con daño cerebral / Correlation between mini mental state examination and the Wechsler memory scale in a sample of patients with sequel

Introducción. La afectación de los procesos cognitivos es muy frecuente en pacientes con daño cerebral adquirido (DCA). Una adecuada evaluación neuropsicológica permite arribar a un diagnóstico certero de la magnitud del déficit y su repercusión funcional. Este estudio examina la correlación entre un test de cribado tradicional, el Examen Mínimo del Estado Mental (MMSE) y un test específico para la evaluación de la memoria, la Escala de Memoria de David Wechsler-I (WMS-I), en una muestra de 124 pacientes con DCA. Para ello se empleó el Método de Pearson. La correlación global obtenida entre ambos test fue significativa (p≤0.05) Conclusiones. Los test de cribado constituyen una manera breve y práctica para aproximarnos al diagnóstico neuropsicológico y este estudio de correlación constata la sensibilidad y el valor predictivo del MMSE como uno de los test de rastreo más empleados en la práctica clínica para orientar la exploración de las funciones comprometidas tras la lesión cerebral. No obstante, consideramos que en modo alguno deberían sustituirse las pruebas neuropsicológicas por los test de cribado para evaluar cognición en pacientes con daño cerebral adquirido.

Introduction. The cognitive impairments are frequently in patients with acquired brain injury (ABI). The neuropsychological assessment must provide a good diagnosis of the severity and functional repercussion of the cognitive impairments. This study examines the correlation between a traditional screening test, Mini–Mental State Examination (MMSE) and a specific test for the memory evaluation, the Wechsler Memory Scale I (WMS)I, in a sample of 124 patients with sequel of ABI. The global correlation (using coefficient of Pearson) between MMSE and WMS I was statistical significant (p≤0.05). Conclusions. The screening test constitutes an easy and brief way to obtain an adequate neuropsychological diagnosis. This correlation verifies the sensibility and the predictor value of the MMSE like one of the most employees test in the clinical practice to guide the exploration by damaged functions after the brain injury. Nevertheless, we consider that neuropsychological assessment in acquired brain injury patients should not be substituted by a scrutiny instrument.

Categorization skills and recall in brain damaged children: a multiple case study / Habilidades de categorização e recordação em crianças com lesões cerebrais: um estudo de casos multiplos

During development, children become capable of categorically associating stimuli and of using these relationships for memory recall. Brain damage in childhood can interfere with this development. This study investigated categorical association of stimuli and recall in four children with brain damages. The etiology, topography and timing of the lesions were diverse. Tasks included naming and immediate recall of 30 perceptually and semantically related figures, free sorting, delayed recall, and cued recall of the same material. Traditional neuropsychological tests were also employed. Two children with brain damage sustained in middle childhood relied on perceptual rather than on categorical associations in making associations between figures and showed deficits in delayed or cued recall, in contrast to those with perinatal lesions. One child exhibited normal performance in recall despite categorical association deficits. The present results suggest that brain damaged children show deficits in categorization and recall that are not usually identified in traditional neuropsychological tests.

No desenvolvimento, as crianças tornam-se capazes de associar estímulos em categorias e de se beneficiar dessas associações para sua recordação posterior. Lesões cerebrais na infância podem interferir nesse desenvolvimento. Neste estudo, essas habilidades foram avaliadas em crianças com lesões cerebrais. A etiologia, topografia e época de instalação da lesão variaram. As tarefas incluíram: nomeação e recordação imediata de 30 figuras relacionadas perceptual e semanticamente; associação livre; recordação tardia e recordação com pistas. Testes neuropsicológicos tradicionais também foram usados. Duas crianças com lesões adquiridas na fase escolar associaram as figuras baseadas em relações perceptivas e não categóricas e apresentaram déficits de recordação tardia e com pistas, ao contrario das outras duas com lesões perinatais. Uma criança apresentou bom desempenho na recordação independentemente de associação categórica. Os resultados sugerem que crianças com lesões cerebrais podem apresentar déficits de categorização e recordação, que não são frequentemente evidenciados em testes tradicionais.

Crianças com encefalopatia crônica não evolutiva: avaliação audiológica e próteses auditivas / Children with chronic non-progressive encephalopathy: hearing evaluation and hearing aids

OBJETIVO: avaliar a capacidade auditiva de crianças com encefalopatias crônicas não evolutivas (ECNE) independentemente de suspeita de perda auditiva e da etiologia e caracterizar o benefício do uso de prótese auditiva em crianças com ECNE que apresentaram perda auditiva. MÉTODO: avaliação neurológica, otorrinolaringológica e audiológica e aplicação do protocolo Parent's Evaluation of Aural / Oral Performance of Children (Peach). RESULTADOS: Das 46 crianças avaliadas, encontraram-se 22 (48 por cento) sem perdas e 24 (52 por cento) com algum grau de perda auditiva sensorioneural. Quanto às etiologias encontradas nas 46 crianças, a maior porcentagem é de encefalopatia hipóxica isquêmica seguida de processos infecciosos e kernicterus. Quanto à suspeita de perda auditiva, nas 16 (35 por cento) crianças cujos pais tiveram suspeita, o percentual de algum grau de perda auditiva foi de 56 por cento, e nas 30 (65 por cento) cujos pais não a tiveram, a avaliação audiológica revelou que 50 por cento apresentaram algum grau de perda auditiva. O protocolo Peach se mostrou um instrumento eficaz para avaliar o benefício da prótese auditiva. CONCLUSÃO: das crianças avaliadas, mais da metade apresentou perda auditiva, no entanto, não houve relação estatisticamente significante entre a etiologia e a suspeita de perda auditiva. Assim, consideramos que não é possível prever qualquer perda auditiva a partir da suspeita e recomendamos a avaliação auditiva em todas as crianças com ECNE, pois todas as crianças com perda auditiva examinadas neste estudo revelaram benefícios importantes com o uso da prótese auditiva.

AIM: to assess the auditory abilities of children with non-progressive chronic encephalopathy (NPCE), independently of the presence or not of hearing loss, and of the etiology of the encephalopathy; to characterize the benefit of hearing aids in children with NPCE and hearing loss. METHOD: neurologic, otorhinolaryngologic and auditory assessments. Application of the Parent's Evaluation of Aural/Oral Performance of Children (PEACH) protocol. RESULTS: out of the 46 assessed children, 22 (48 percent) presented no hearing loss and 24 (52 percent) presented some level of sensorineural hearing loss. Regarding the encephalopathy etiology, most of the participants presented ischemic hypoxic encephalopathy followed by infectious process and kernicterus. The results also indicate that 16 (35 percent) parents suspected that their child had hearing loss; out of this total, 56 percent had the hearing loss confirmed. Thirty parents (65 percent) did not have any hearing complaints about their children. For these children the auditory evaluation indicated that 50 percent presented some level of hearing loss. The PEACH protocol proved to be effective to assess the benefit of hearing aids. CONCLUSION: the results indicate that over half of participants presented hearing loss. No correlation was observed between etiology and complaints of hearing loss. This means that it is not possible to predict hearing loss based on complaints. All children who presented hearing loss benefited from the use of hearing aids.

Encefalopatía crónica no progresiva secundaria a enfermedad vascular cerebral hemorrágica por deshidratación hipernatrémica: a propósito de un caso / Non progressive chronic encephalopathy secondary to cerebral vascular hemorrhage due to hipernatremic dehydration: a purpose of a case

El estudio en los últimos años de las enfermedades vasculares cerebrales en la infancia ha permitido el reconocimiento de los factores de riesgo para este grupo etario. La hiperosmolaridad (policitemia, trombocitosis, hiperglicemia, hipernatremia), que a nivel del sistema nervioso central provoca trombosis de vasos arteriales y venosos con ruptura de los mismos y sangramientos intracerebrales, subdurales, subaracnoides, puede ser causa de fenómenos isquémicos y/o hemorrágicos cerebrales, conllevando a largo plazo a lesiones estructurales. El presente trabajo se basa en la descripción clínica y procedimientos diagnósticos de un niño con encefalopatía crónica no progresiva, secundaria a enfermedad vascular cerebral hemorrágica por deshidratación hipernatrémica, tomando los datos de la historia clínica y la evaluación directa del mismo. El paciente se evaluó en Barquisimeto, estado Lara en el año 2007.

Studies in the last years on cerebral vascular illnesses in childhood has allowed the recognition of risk factors for this age group. Increase in osmolarity (increase in the viscosity of the blood, polycitemia thrombocitocys, hyperglycemia, hypernatrenia) can cause ischemic phenomena and/or cerebral hemorrhage, causing long term structural lesions. The present work is based on the clinical description and aboy's diagnostic procedures with chronic non progressive encephalopaty secondary to cerebral vascular hemorrhagic illness due to hypernatrenic dehydration. The patient was evaluated in the city of Barquisimeto, Lara state in the year 2007.

Rett syndrome: clinical and epidemiological aspects in a Brazilian institution

Rett syndrome (RS) is a neurodevelopmental disorder, preferentially found in females and specifically involving the functions on which intelligence and its expression depend - learning, hand use and speech - leaving many others intact. Mutations have been identified at Xq28 on the MECP2 gene (methyl-CpG 2), which selectively silences the expression of other genes whose location is still unknown. This is a study on clinical, diagnostic and epidemiological aspects of RS in a Brazilian sample. It included 33 female patients with chronic encephalopathy without known etiology. RS was diagnosed in 24 patients (72.7 percent): 17 (70.8 percent) had classical RS; 5 (20.8 percent), atypical RS and 2 (8.4 percent), potential RS. In 9 girls clinical data and/or laboratory studies excluded diagnosis of RS. Among the atypical RS patients, 4 were form fruste and one, congenital form. Among the girls with other encephalopathies, cerebral malformation was the most frequent finding

Cortical, brainstem and autonomic nervous system dysfunction in infants with post-hemorrhagic hydrocephalus

OBJECTIVE: The aim of this study was to evaluate the degree of central and autonomic dysfunction by means of electroencephalographic (EEG) and cardio-pneumographic recording (CPGR) in infants with Post-Hemorrhagic Hydrocephalus (PHH). METHODS: Nineteen infants with PHH were studied, born from October 1998 to January 2000. Clinical diagnosis was confirmed by cephalic perimeter measurement and ultrasonographic study. Eight channel bipolar EEG and CPGR were performed after sleep deprivation, EEG features studied were: Temporal organization, symmetry, synchrony, frequency of normal and abnormal patterns. CPGR features studied were: Frequency of apnea and temporal organization by means of beat to beat variability. RESULTS: Averages of birth's age and weight, Apgar scores at one and five minutes, and cephalic perimeter showed lower values in PHH infants. PHH infants showed abnormalities in EEG and CPGR such as: Higher discontinuous activity (63), asymmetry (73), asynchrony (89), abnormal EEG patterns (89), apnea (26) and absence of heart rate variability (63). CONCLUSIONS: EEG and CPGR recordings are a useful tools in the examination of infants with PHH. These findings suggest cortical-subcortical, and brainstem dysfunction with severe encephalopathy and autonomic nervous dysfunction related to ventricular dilatation in infants with PHH.

Newer concepts and approaches to neonatal brain asphyxia.

The asphyxial injury to neonate brain seems to be mediated through a cascade of biochemical events during ischaemia--reperfusion which includes excitatory amino acids, free radicals and accelerated programmed cell death (Apoptosis). The diagnosis of asphyxia requires rigorous approach based on background clinical information, certain diagnostic tests and exclusion of alternative diagnosis which may have similar clinical presentation. The treatment currently employed for the management of birth asphyxia controversial and requires critical appraisal. The future strategies for management include a number of approaches based on putative mechanism for asphyxial brain injury but they are still being evaluated as research and should not be used for clinical purposes in human newborns as yet.