Complicaciones en pacientes hemipléjicos por ictus / Complications in hemiplegic stroke patients

Introducción: el ictus representa la tercera causa de muerte y la primera de discapacidad en el mundo desarrollado. Las secuelas motoras constituyen la principal causa de discapacidad y la hemiplejía es la forma más frecuente. Las complicaciones pueden agravar las secuelas motoras. Objetivo: identificar las complicaciones en pacientes hemipléjicos por ictus y su comportamiento en relación con los factores clínicos asociados. Métodos: se estudiaron 110 pacientes con diagnóstico de ictus y hemiplejía como principal secuela. Se consideraron las variables independientes: datos demográficos, estados de comorbilidad asociados, tipo de ictus, tiempo de evolución, severidad del daño neurológico y discapacidad funcional, y las variables dependientes: presencia y tipos de complicaciones. La información se procesó mediante la media para variables cuantitativas y los porcentajes para las cualitativas. Se trabajó con IC del 95 por ciento. Para el análisis de significación estadística se utilizó el método de chi-cuadrado. Resultados: el 73,63 por ciento de los pacientes estudiados sufrieron algún tipo de complicación. Las más frecuentes fueron la depresión, el hombro doloroso, la epilepsia y las contracturas osteoarticulares. Los principales factores relacionados con la presencia de complicaciones fueron el tipo de ictus y el grado de discapacidad funcional. Conclusiones: las complicaciones del paciente hemipléjico por ictus son frecuentes e invalidantes. Es importante prevenir las que sean posible y reconocer otras no tan prevenibles, para aplicar las medidas terapéuticas pertinentes. Se destacan como factores clínicos asociados, el tipo de ictus y el grado de discapacidad funcional...

Introduction: stroke is the third leading cause of death and the first cause of disability in developed world. The motor sequelae are the leading cause of disability and hemiplegia is its most common form. Complications may exacerbate motor sequelae. Objective: to identifie complications in hemiplegic stroke patients and their behavior in relation to the associated clinical factors. Methods: 110 patients with a diagnosis of stroke and hemiplegia as main sequel were studied. Independent variables were considered (demographics, states associated comorbidity, type of stroke, duration, severity of neurological damage and disability) as well as dependent variables (presence and types of complications). The information was processed by the mean for quantitative variables and percentages for qualitative variables. 95 percent Ic was worked and the chi-square method was used for the analysis of statistical significance. Results: 73.63 percent of the patients suffered some kind of complications. The most frequent were depression, shoulder pain, epilepsy, and musculoskeletal contractures. The main factors associated with the presence of complications were stroke type and degree of disability. Conclusions: complications in hemiplegic patient due to stroke are frequent and invalidating. It is important to prevent possible complications and to recognize other less preventable, so as to implement the appropriate therapeutic measures. They stand as associated clinical factors, stroke type and degree of disability...

Restoring awareness: a review of rehabilitation in anosognosia for hemiplegia

Disturbances in body awareness offer important insights into neurocognitive processes involved in the construction of the bodily self. This review will focus ona specific disorder of awareness, namely, anosognosia for hemiplegia (AHP), or the denial of motor deficits contralateral to a brain lesion. Recently some progress has been made towards the management and rehabilitation of AHP, however to date no evidence-based treatment exists. Firstly, recent research on AHP will be reviewed, with the aim of providing an overview of the etiology, clinical presentation and assessment of the syndrome, as well as the majorneurological and neuropsychological explanations. This article will then focus on recent advances in the management and rehabilitation of AHP, using a casestudy example of intervention-based (i.e. video replay) motor awareness recovery (Fotopoulou, Rudd, Holmes & Kopelman, 2009). Finally, a dynamic theoreticalmodel of the multifaceted nature of anosognosia, using a predictive coding framework, will be proposed and future directions for research will also be discussed...

Effects of Passive Upper Arm Exercise on Range of Motion, Muscle Strength, and Muscle Spasticity in Hemiplegic Patients with Cerebral Vascular Disease

PURPOSE: The purpose of this study was to investigate the effects of passive upper arm exercise on range of motion, muscle strength, and muscle spasticity in hemiplegic patients with cerebral vascular disease. METHODS: A quasi-experimental design with nonequivalent control group was utilized. According to inclusion criteria, 25 patients were assigned to the control group with routine care, followed by 25 to the intervention group with passive exercise for 30 minutes per session, twice a day for 2 weeks. Eighteen patients in the intervention group and 17 in the control group completed the posttest measurement, including range of motion for upper arm joints, manual muscle test, and Modified Ashworth Scale for muscle spasticity. RESULTS: The intervention group had a significantly improved range of motion in the shoulder and wrist joints. No interaction effect was found for the elbow joint. No significant differences were found in muscle strength or muscle spasticity between the groups. CONCLUSION: Results of the study indicate that passive exercise safely applied for two weeks improves range of motion in joints of the upper arm in these patients. Further study with long-term follow-up is needed to verify the role of passive exercise in preventing muscle spasticity in this population.

Miasis en cavidad bucal / Oral cavity myiasis

Miasis deriva del griego myia: mosca. Son afecciones causadas por la presencia de larvas de moscas en los órganos y tejidos humanos o de otros animales, donde evolucionan como parásitos. Son atraídas por secreciones y olores, de positan sus huevos en el borde de las heridas, los orificios naturales y sobre la superficie cutánea con sangre coagulada y costras secas. Puede ser u na enfermedad benigna, leve o grave e incluso cursar en forma asintomática. La mortalidad es inferior al 10 por ciento y generalmente se asocia con lesiones cerebrales o de otras partes del sistema nervioso. El diagnóstico se basa en el examen clínico mediante la visualización de la larva. El objetivo de este artículo es describir un caso de miasis en la cavidad bucal y transmitir al odontólogo los conocimientos básicos de esta parasitosis.

Sympathetic skin responses in hemiplegic patients with and without complex regional pain syndrome.

BACKGROUND AND AIMS: To investigate whether there were changes in the sympathetic skin responses (SSR) in the limbs with complex regional pain syndrome (CRPS) type I in hemiplegic patients. SETTING: A physical medicine and rehabilitation center in Turkey. MATERIALS AND METHODS: Sympathetic skin responses were evaluated in 69 stroke patients (41 with CRPS and 28 without CRPS) and 20 healthy volunteers. SSR were recorded on the paretic and healthy hands after stimulation of the ipsilateral median nerve. Patients' ages ranged from 33 to 77 years, with a mean of 60.0+/-12.9 years. RESULTS: The SSR were obtained in all patients with CRPS, whereas SSR was absent in 9 of 28 patients with hemiplegia who did not have CRPS after stimulation of the plegic side and the difference was statistically significant (P=0.023). SSR amplitudes were increased at the hemiplegic limbs in patients affected by CRPS compared to individuals unaffected; this group difference was statistically significant (P=0.014). The mean amplitude of the SSR in the advanced stage of CRPS was greater than lower stage and the difference was statistically significant (P=0.035). CONCLUSION: Our results suggest that SSR can be obtained in stroke patients with CRPS even in the early stages of CRPS. SSR acquirability and amplitude increase as the stage of the disease advances. As an electrophysiologic technique, SSR may be used in the evaluation of the sympathetic function in hemiplegic patients and also in the diagnosis of CRPS and in monitoring of its treatment.

Hombro doloroso en el hemipléjico adulto / Painful shoulder in the adult hemiplegic

En esta revisión bibliográfica se reúnen antecedentes acerca del problema del hombro doloroso en el hemipléjico adulto, publicados preferentemente durante los últimos años. En un intento por aclarar la fisiopatología de este problema se presentan diversos factores predisponentes, que han sido estudiados con distintos énfasis, y se plantea la posible relación entre ellos, la que conduciría a la presentación del cuadro doloroso. Este cuadro parece ser altamente posible de prevenir, por lo que el terapista físico debería estar preparado para ello

Hemiplegia cruzada associada a impressäo basilar, malformaçäo de Arnold-Chiari e siringomielia: relato de caso / Cruciate hemiplegia associated with basilar impression, Arnold-Chiari malformation and syringomyelia: case report

Os autores apresentam um caso de hemiplegia cruzada associada a impressao basilar, malformaçao de Arnold-Chiari e siringomielia. Discutem as propostas anatômicas e a fiopatogenia desta síndrome de ocorrência bastante rara.

Pure motor hemiplegia with conjugate lateral gaze palsy in pontine lacunar infarction

The combination of pure motor hemiplegia and horizontal gaze palsy is a rare but identifiable lacunar syndrome. Among horizontal gaze palsies, one-and-a-half syndrome and abducens nerve palsy are reported to be associated with pure motor hemiplegia in pontine lacunar infarction. Although conjugate lateral gaze palsy is also hypothesized, pure motor hemiplegia with conjugate lateral gaze palsy has never been reported. We present a 75-year-old man who showed right hemiparesis and impaired left horizontal conjugate eyeball movement. Both the findings of the brain CT scan and those of the MRI study were consistent with a small infarction in the left midpontine tegmentum. Magnetic resonance angiography revealed no stenotic narrowing of the vertebrobasilar artery. Radiological findings suggested that pure motor hemiplegia with conjugate lateral gaze palsy, in our patient, might have been produced by the occlusion of a single penetrating branch of the basilar artery.

O ombro doloroso na hemiplegia: uma abordagem para o clínico / The dolorous shoulder in hemiplegia: an approach for the clinician

Os autores fazem uma revisäo bibliográfica, visando fornecer ao clínico geral, uma abordagem diagnóstica, terapêutica e preventiva das complicaçöes do ombro nos pacientes humiplégicos

Male sexual dysfunction after stroke.

Male sexual functions namely libido and potency were evaluated in fourteen right handed stroke patients. Half of the studied patients had reduced libido while reduced potency was found in 86% patients. Right hemispheric stroke patients had significantly higher reduction in libido as compared to left hemispheric stroke patients. Libido may have some specific cortical or limbic representation in right cerebral hemisphere.

Ombro do hemiplégico: prevençäo das complicaçöes dolorosas / Hemiplegia painful shoulder prevention and treatment

Num estado recente, de 219 hemiplégicos, nós mostramos que o ombro doloroso apresentava em 72% dos casos. A dor, em geral é devida à espasticidade e à subluxaçäo, numa proporçäo nitidamente menor do que por algodistrofia ou problema tendíneo. Parece portanto muito importante prevenir esta dor do ombro no hemiplégico colocando em açäo toda uma série de meios. Estes säo descritos, atraindo particularmente a atençäo sobre o posicionamento no leito e a manutençäo de uma boa mobilidade articular, que deve ser realizada sem provocar dor. O uso de órteses a estimulaçäo elétrica fazem igualmente parte desta prevençäo. Por outro lado, quando a prevençäo é insuficiente, ao lado do programa de reeducaçäo, o emprego de agentes físicos, de medicamentos espasmolíticos e eventualmente, de bloqueios por alcoolizaçäo ajudaräo a combater a espasticidade e a dor deste ombro

Esclerosis lateral amiotrófica una enfermedad frecuente en mujeres jóvenes: presentación de dos casos; uno con la variante de Mills y otro asociado a una esquizofrenia / Amyotropic lateral sclerosis a frequent disease in young females: presentation of 2 cases; one with hemiplegic variant and the other with schizophrenia

Se presentan dos casos clínicos de Esclerosis Lateral Amiotrófica en sendas mujeres jóvenes, uno con la variante hemipléjica y otro asociado a una Esquizofrenia. Se resalta esta excepcional coincidencia y se efectúa en ellos un despistaje de factibles lesiones vasculares del sistema nervioso, así como de probables factores congénitos o adquiridos que pudieran producir deformación u ocupación del canal medular o de la unión atlanto-axial. Se hace mención a algunas posibilidades etiológicas de la Esclerosis Lateral Amiotrófica y su eventual relación con la herencia, y se consignan y discuten en forma integral algunos aspectos clínicos y socio-psicogénicos de la Esquizofrenia