Spinal Cord Infarction in a Patient with Immune Thrombocytopenic Purpura.

Immune thrombocytopenic purpura (ITP) can increase the risk of not only hemorrhagic incidents but also thrombotic events. Although several patients with ITP who developed cerebral infarction have been reported, concurrence of spinal cord infarction and ITP has not been reported. We report the case of a female patient who developed spinal cord infarction during the exacerbation of her ITP. This case suggests a possible association between spinal cord infarction and ITP, which can cause paradoxical thrombosis.

Paediatric spinal cord infarction-a review of the literature and two case reports.

Ischemic spinal cord infarction is rare in the paediatric population, and when it does occur, it is usually associated with traumatic injury. Other potential causes include congenital cardiovascular malformations, cerebellar herniation, thromboembolic disease and infection. Magnetic resonance imaging (MRI) findings can be subtle in the early evaluation of such patients. The outcome is variable and depends on the level and extent of the spinal cord infarct and subsequent rehabilitation. Here, we present two cases of ischemic spinal cord infarction in children.

Vertebral Artery Dissection Leading to Fornix Infarction: A Case Report.

BACKGROUND: The subcallosal artery is a proximal branch of the anterior communicating artery and has been recognized as the vessel responsible for fornix infarction. Fornix infarction caused by vascular damage to the posterior circulation has not been reported previously. RESULTS: A 26-year-old woman suffered from fornix infarction due to artery-to-artery embolism after vertebral artery dissection. Cerebral infarctions were also found in the left thalamus, body of the left caudate nucleus, and the left occipital lobe other than the fornix. CONCLUSIONS: Occlusion of the subcallosal artery results in cerebral infarction of fornix, anterior cingulate cortex, and genu of the corpus callosum. However, in our case, lesions were restricted to the territory of posterior circulation. In addition to subcallosal artery, lateral posterior choroidal artery, a perforating branch of the posterior cerebral artery, has been described to send branches to the fornix, so we speculated that the left lateral posterior choroidal artery was actually responsible for fornix infarction.

Combined statistical analysis method assessing fast versus slow movement training in a patient with cerebellar stroke: a single-case study.

BACKGROUND: Gold standards of data analysis for single-case research do not currently exist. OBJECTIVE: The purpose of this study was to determine whether a combined statistical analysis method is more effective in assessing movement training effects in a patient with cerebellar stroke. DESIGN: A crossover single-case research design was conducted. METHODS: The patient was a 69-year-old man with a chronic cerebellar infarct who received two 5-week phases of finger tracking training at different movement rates. Changes were measured with the Box and Block Test, the Jebsen-Taylor test, the finger extension force test, and the corticospinal excitability test. Both visual analysis and statistical tests (including split-middle line method, t test, confidence interval, and effect size) were used to assess potential intervention effects. RESULTS: The results of the t tests were highly consistent with the confidence interval tests, but less consistent with the split-middle line method. Most results produced medium to large effect sizes. LIMITATIONS: The possibility of an incomplete washout effect was a confounding factor in the current analyses. CONCLUSIONS: The combined statistical analysis method may assist researchers in assessing intervention effects in single-case stroke rehabilitation studies.

Intervenciones de enfermería en la atención del adulto con infarto agudo de miocardio (IAM) / Nursing interventions in the care of adults with acute myocardial infarction (AMI)

Intoducción: Las enfermedades cardiovasculares son un problema de salud pública, tanto por el incremento de su frecuencia, asociado a la mayor longevidad de la población, como por la cifra de años de vida saludable perdidos y la carga económica que representa la atención de los individuos que han sufrido episodios críticos y requieren intervenciones complejas para su recuperación. La GPC para las Intervenciones de Enfermería en la Atención del adulto con Infarto Agudo del Miocardio (IAM), orienta al personal de enfermería en la toma de decisiones clínicas basadas en la mejor evidencia disponible. Metodología: Se realizaron 9 preguntas acerca de las intervenciones de enfermería en la Identificación de datos objetivos y subjetivos de IAM, manejo del dolor agudo, atención de la disminución del gasto cardiaco, mejora de la perfusión tisular cardiopulmonar, disminución del riesgo de sangrado por terapia trombolítica, atención posterior a la Angioplastía, disminución de la ansiedad, fomento del bienestar psicosocial y diseño del plan de alta hospitalaria. Resultados: La estrategia de búsqueda de información se desarrolló en cuatro etapas; de 49 documentos que cumplieron con los criterios de selección, se utilizaron 15 (31%). La Guía presenta 8 Puntos de Buena Práctica, 68 evidencias (28% E.S. y 72% E.ESC.) y 72 recomendaciones (47% E.S. y 53% E.ESC.) cuya gradación corresponde a las escalas de la Sociedad Europea de Cardiología y la modificada de Shekelle. Ofrece información de efectos adversos y precauciones en el manejo de 17 medicamentos, además incorpora 8 planes de cuidados de enfermería. Conclusiones: La adopción de la Guía propuesta favorece la disminución de la variabilidad en la práctica clínica y mejora en la calidad de los procesos

Background: Cardiovascular diseases are a public health problem, both by increasing its frequency, associated with the increased longevity of the population, as the number of years of healthy life lost and economic burden of care of individuals who they have suffered critical episodes and require complex interventions for recovery. The GPC for nursing interventions in the care of adults with Acute Myocardial Infarction (AMI), guides the nurse in making decisions based on the best evidence available. Methodology: 9 questions about nursing interventions in: the identification of objective and subjective AMI data, acute pain management, decreased cardiac output, improved cardiopulmonary perfusion, risk of bleeding of thrombolytic therapy, aftercare angioplasty, decreased anxiety, promotion of psychosocial well-being and design discharge plan. Results: The information search strategy was developed in four stages; 49 documents that met the selection criteria were used 15 (31%). The Guide presents 8 Points of Good Practice, 68 evidence (28% and 72% E.ESC ES.) and 72 recommendations (47% and 53% E.ESC ES.) whose gradation corresponds to the scales of the European Society of Cardiology Shekelle and modified. Provides information on adverse effects and precautions in handling 17 drugs, also incorporates 8 nursing care plans. Conclusions: The adoption of the proposed guide helps to reduce variability in clinical practice and improvement quality processes.

Introdução: As doenças cardiovasculares são um problema de saúde pública, tanto através do aumento da sua frequência, associado ao aumento da longevidade da população, como o número de anos de vida saudável perdidos e encargos económicos dos cuidados de indivíduos que sofreram episódios críticos e exigem intervenções complexas para a recuperação. O GPC para intervenções de enfermagem no cuidado de adultos com Infarto Agudo do Miocárdio (IAM), orienta o enfermeiro na tomada com base nas melhores evidências clínicas disponíveis. Metodologia: 9 questões sobre intervenções de enfermagem na identificação de dados objetivos e subjetivos de IAM, gestão da dor aguda, importa redução do débito cardíaco, melhora da perfusão cardiopulmonar, diminuição do risco de terapia trombolítica, angioplastia pós-tratamento, diminuição da ansiedade, a promoção de psicossocial de bem-estar, e plano de alta. Resultados: A estratégia de busca de informações foi desenvolvido em quatro etapas; 49 documentos que preencheram os critérios de seleção foram utilizados 15 (31%). O Guia apresenta 8 Pontos de Boas Práticas, 68 evidência (28% e 72% E.ESC ES.) e 72 recomendações (47% e 53% E.ESC ES.), cuja gradação corresponde às escalas da Sociedade Europeia de Cardiologia e Shekelle. Fornece informações sobre os efeitos adversos e precauções no tratamento de 17 drogas também incorpora 8 planos de cuidados de enfermagem. Conclusões: A adoção do guia proposto ajuda a reduzir a variabilidade nos processos de prática clinica e de melhoria da qualidade.

Retrospective case series of outcomes following spinal cord infarction.

BACKGROUND AND PURPOSE: There are very few studies of functional and rehabilitation outcomes in patients with spinal cord injury (SCI) owing to infarction. METHODS: Retrospective chart review of consecutive admissions to a tertiary medical unit specializing in SCI rehabilitation, Melbourne, Australia. All admissions between 1 January 1995 and 31 December 2008 with a recent onset of SCI owing to ischaemia were included. Outcome measures included the following: demographic characteristics, American Spinal Injury Association (ASIA) Impairment Scale (AIS), length of stay (LOS), medical complications, accommodation, support services, continence, mobility and Functional Independence Measure (FIM) motor scores. Outcome measures recorded at admission, discharge and at 12 months post discharge. RESULTS: Forty-four patients were admitted for rehabilitation (men = 26, 59%), with a median age of 72 years (interquartile range [IQR], 62-79). On admission, 41 (93%) patients had paraplegia. The majority of patients (n = 33, 75%) had an incomplete SCI. Aetiology was vascular in 19 (43%) patients, idiopathic in 11 (25%) and other in 14 (33%). The median LOS in rehabilitation was 85 days (IQR, 24-129). The most common complications were pain (n = 34, 77%), urinary tract infection (n = 25, 57%), spasticity (n = 12, 27%), cardiac failure (n = 11, 25%) and pneumonia (n = 9, 20%). At rehabilitation discharge most patients (n = 35, 80%) had no change in their AIS grade. Despite this, the FIM motor subscale on admission (median = 28; IQR, 21-34) had significantly improved (P < 0.0000) by discharge (median = 66; IQR 42-78). CONCLUSION: Despite their comorbidities and limited change in AIS, these patients had significant improvement in functional abilities during impatient rehabilitation.

Comparing patients with spinal cord infarction and cerebral infarction: clinical characteristics, and short-term outcome.

BACKGROUND: To compare the clinical characteristics, and short-term outcome of spinal cord infarction and cerebral infarction. METHODS: Risk factors, concomitant diseases, neurological deficits on admission, and short-term outcome were registered among 28 patients with spinal cord infarction and 1075 patients with cerebral infarction admitted to the Department of Neurology, Haukeland University Hospital, Bergen, Norway. Multivariate analyses were performed with location of stroke (cord or brain), neurological deficits on admission, and short-term outcome (both Barthel Index [BI] 1 week after symptom onset and discharge home or to other institution) as dependent variables. RESULTS: Multivariate analysis showed that patients with spinal cord infarction were younger, more often female, and less afflicted by hypertension and cardiac disease than patients with cerebral infarction. Functional score (BI) was lower among patients with spinal cord infarctions 1 week after onset of symptoms (P < 0.001). Odds ratio for being discharged home was 5.5 for patients with spinal cord infarction compared to cerebral infarction after adjusting for BI scored 1 week after onset (P = 0.019). CONCLUSION: Patients with spinal cord infarction have a risk factor profile that differs significantly from that of patients with cerebral infarction, although there are some parallels to cerebral infarction caused by atherosclerosis. Patients with spinal cord infarction were more likely to be discharged home when adjusting for early functional level on multivariate analysis.

Epidural cortical stimulation enhances motor function after sensorimotor cortical infarcts in rats.

This study examined whether epidurally delivered cortical electrical stimulation (CS) improves the efficacy of motor rehabilitative training and alters neuronal density and/or cell proliferation in perilesion cortex following ischemic sensorimotor cortex (SMC) lesions. Adult rats were pre-trained on a skilled reaching task and then received partial unilateral SMC lesions and implantation of electrodes over the remaining SMC. Ten to fourteen days later, rats received daily reach training concurrent with anodal or cathodal 100 Hz CS or no stimulation (NoCS) for 18 days. To label newly generated cells, bromodeoxyuridine (BrdU; 50 mg/kg) was administered every third day of training. Both anodal and cathodal CS robustly enhanced reaching performance compared to NoCS controls. Neuronal density in the perilesion cortex was significantly increased in the cathodal CS group compared to the NoCS group. There were no significant group differences in BrdU-labeled cell density in ipsilesional cortex. Staining with Fluoro-Jade-B indicated that neurons continue to degenerate near the infarct at the time when cortical stimulation and rehabilitation were initiated. These data indicate that epidurally delivered CS greatly improves the efficacy of rehabilitative reach training following SMC damage and raise the possibility that cathodal CS may influence neuronal survival in perilesion cortex.

[The cognitive rehabilitation process in a case of bithalamic infarction]. / Proceso de rehabilitación cognitiva en un caso de infarto bitalámico.

INTRODUCTION: One of the fundamental lines followed by Neuropsychology today focuses on rehabilitation processes and their effectiveness. Cognitive rehabilitation is an eclectic process that is dependent on a number of variables. This variability makes it necessary to establish a work plan that guides the intervention carried out by professionals and also makes it clear what objectives are to be achieved, as well as the strategies and tools that must be used to reach them. The purpose of this study is to offer a practical examination of the different points that must be developed in a cognitive rehabilitation process--exemplified here in a case of bithalamic infarction. CASE REPORT: From a single case and from the specific needs of the individual, a thorough work plan is drawn up. This plan includes a description of everything from the choice of a practical framework for intervention and its underlying principles up to the different training processes, learning techniques and tools that were used and finally proved to be effective. The efficacy and safety of the different strategies and tools used are demonstrated by the short and long term results of the different neuropsychological examinations carried out, which at the same time proved the effectiveness of the work plan that was selected for application. CONCLUSIONS: A clear understanding of the value of the cognitive rehabilitation processes chosen for use helps to improve the way clinical work is carried out, with the common purpose of restoring neuropsychological deficits and increasing the individual's independence and quality of life.

Recovery following ischemic myelopathy.

Motor and sensory recovery were determined in five patients with ischemic myelopathy associated with traumatic laceration or surgical manipulation of the thoracic aorta. The neurologic level of injury was between T-2 and T-10. All patients had an anterior spinal artery pattern of incomplete spinal cord injury consisting of relatively greater loss of motor function than sensation and preservation of sacral sensation. None of the three patients with zero lower extremity motor function at 30 regained any motor function at 1 year. Two patients with partial motor function 1 month after infarction had further motor recovery at 1 year. One of these two individuals was able to ambulate independently with a reciprocal gait using orthoses.