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.

Impairment and disability in leprosy: in search of the missing link.

This paper describes the results of a survey aimed at studying the relationship between impairment and disability in leprosy. Persons affected by leprosy attending the Green Pastures Hospital, Pokhara, or one of the field clinics in the Western Region of Nepal visited during the study period were interviewed using a standardized questionnaire. Two hundred and sixty-nine subjects were included in the study. For the analysis, 'disability', was defined as activities being done with 'much difficulty', 'only with help' or being 'impossible'. The most commonly affected indoor activities were cutting nails (22%), washing clothes (16%), using scissors (17%) and tying a knot (18%). Among the outdoor activities, cutting grass, digging, harvesting, threshing and milking a cow or buffalo were the most commonly affected (22%-26%). Sensory impairment of the thumb and/or index finger at the 2 g level was a very significant risk factor for disability activities involving the hand(s). Muscle weakness of the thumb and mobile clawing of the fingers had a strong association with disability in several activities. Sensory impairment of the sole was the strongest determinant of disability in activities involving the lower limb. We recommend that efforts should be made to include disability as a standard activity for monitoring and evaluation of rehabilitation, both for individuals and on programme level.

Oxigenación tisular durante la crisis de disautonomía en el tétano severo / Tissular oxygenation during the crisis of dysautonomia in to severe tetanus

El síndrome de hiperactividad simpática en el marco del tétanos severo, es un cuadro de gravedad extrema por ya ser una de las principales causas de muerte. Fisiopatológicamente continúa siendo un "misterio", tratáse de explicar todo lo que ocurre debido a la elevada concentración de catecolaminas circulantes. Sin embargo, poco se sabe sobre el comportamiento de la oxigenación de los tejidos durante las crisis disautonómicas, dada las dificultades que existen para su diagnóstico, detección precoz y ausencia de literatura al respecto. Por tal motivo nos propusimos evaluar en forma prospectiva los pacientes con tétanos severo sometidos a monitoreo hemodinámico invasivo y de la perfusión del territorio esplácnico, particularmente durante los episodios de sobreactividad del sistema nervioso autónomo. Así, durante 20 crisis disautonómicas desarrolladas en 12 pacientes consecutivos se evidenció una profunda depresión miocárdica e hipoxia tisular, los que pueden constituir factores de riesgo clave que ayuden a explicar la elevada morbimortalidad cuando el síndrome hace su aparición en el marco del tétanos severo

Evaluación del sistema nervioso autónomo en personas asintomáticas

La evaluación del sistema nervioso autónomo (SNA) viene recobrando importancia en las diferentes áreas clínicas. Mediante un polígrafo de cuatro canales realizamos la valorización del SNA en 31 personas sanas, con un registro continuo y no invasivo de la presión arterial, frecuencia cardíaca y pulso. practicamos un valor en reposo antes de cada una de las siguientes pruebas: Inspiración profunda, hiperventilación, masaje carotídeo, prueba de frío en cara, prueba de ejercicio isométrico, cambios de posición y maniobra de Valsalva. Las cifras obtenidas para nuestra población son semejantes a las ya descritas. Llama la atención que 61 por ciento de las personas asintomáticas podrían tener un grado de disautonomía "leve".