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1.
J Neuroimaging ; 33(2): 218-226, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36585957

RESUMO

BACKGROUND AND PURPOSE: Intracranial hemorrhage (ICH) is a common life-threatening condition that must be rapidly diagnosed and treated. However, there is still a lack of consensus regarding treatment, driven to some extent by prognostic uncertainty. While several prediction models for ICH detection have already been published, here we present a deep learning predictive model for ICH prognosis. METHODS: We included patients with ICH (n = 262), and we trained a custom model for the classification of patients into poor prognosis and good prognosis, using a hybrid input consisting of brain CT images and other clinical variables. We compared it with two other models, one trained with images only (I-model) and the other with tabular data only (D-model). RESULTS: Our hybrid model achieved an area under the receiver operating characteristic curve (AUC) of .924 (95% confidence interval [CI]: .831-.986), and an accuracy of .861 (95% CI: .760-.960). The I- and D-models achieved an AUC of .763 (95% CI: .622-.902) and .746 (95% CI: .598-.876), respectively. CONCLUSIONS: The proposed hybrid model was able to accurately classify patients into good and poor prognosis. To the best of our knowledge, this is the first ICH prognosis prediction deep learning model. We concluded that deep learning can be applied for prognosis prediction in ICH that could have a great impact on clinical decision-making. Further, hybrid inputs could be a promising technique for deep learning in medical imaging.


Assuntos
Hemorragia Cerebral , Aprendizado Profundo , Humanos , Hemorragias Intracranianas , Prognóstico , Curva ROC
2.
J Headache Pain ; 23(1): 85, 2022 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-35864440

RESUMO

BACKGROUND AND AIM: Headache attributed to intracranial endovascular procedures is described in the ICHD-3. Our aim was to study the frequency and characteristics of headache specifically related to thrombectomy in patients with ischemic stroke. METHODS: Prospective evaluation of clinical features of headache after thrombectomy using an ad hoc questionnaire. RESULTS: One hundred seventeen patients were included (52.1% females). Most had an anterior circulation artery occlusion (91.5%). 93 (79.5%) received general anaesthesia. 111 (94.9%) required stent retriever, 21 (24.4%) angioplasty and 19 (16.2%) aspiration thrombectomy. 31 (26.5%; 95% CI 18.8-35.5%) had headache related to thrombectomy, and it was associated with a history of primary headache (p = 0.004). No differences about sex, initial NIHSS score, or the type or complexity of the procedure were observed. Headache was usually moderate and oppressive, ipsilateral to the artery occlusion and usually lasted less than 48 hours. CONCLUSIONS: Almost one-third of patients with ischemic stroke who undergo endovascular thrombectomy experience headache in the first 24 hours, occurring more frequently in patients who had a previous history of headaches regardless of the procedure complexity.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/métodos , Feminino , Cefaleia/etiologia , Cefaleia/cirurgia , Humanos , AVC Isquêmico/complicações , AVC Isquêmico/cirurgia , Masculino , Estudos Prospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Trombectomia/efeitos adversos , Resultado do Tratamento
4.
JACC Cardiovasc Interv ; 12(9): 873-882, 2019 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-31072509

RESUMO

OBJECTIVES: The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS). BACKGROUND: CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain. METHODS: The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs). RESULTS: A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001). CONCLUSIONS: The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.


Assuntos
Estenose das Carótidas/terapia , Circulação Cerebrovascular , Transtornos Cerebrovasculares/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Hemodinâmica , Stents , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Estenose das Carótidas/fisiopatologia , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/mortalidade , Transtornos Cerebrovasculares/fisiopatologia , Transtornos da Consciência/epidemiologia , Transtornos da Consciência/fisiopatologia , Procedimentos Endovasculares/mortalidade , Feminino , Cefaleia/epidemiologia , Cefaleia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/epidemiologia , Medição de Risco , Fatores de Risco , Convulsões/epidemiologia , Convulsões/fisiopatologia , Índice de Gravidade de Doença , Fatores Sexuais , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento
5.
Rev. colomb. anestesiol ; 46(3): 253-256, July-Sept. 2018. graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-959814

RESUMO

Abstract Head and neck arteriovenous fistulas are uncommon. Central venous catheterization is a very frequent medical procedure, and complications are not unusual. We report a case of a 56-year-old woman who developed an arteriovenous vertebro-vertebral fistula after internal jugular vein cannulation. The only clinical manifestation was tinnitus, and physical examination revealed systolic cervical murmur and cervical thrill. The diagnosis was made with computed tomography and angiography, and the treatment was performed by means of non-invasive fistula closure with platinum coil embolization.


Resumen Las fistulas arteriovenosas de cabeza y cuello son muy poco frecuentes. La cateterización de vías venosas centrales es un procedimiento médico muy frecuente y no exento de complicaciones. Presentamos el caso de una mujer de 56 años con fistula arteriovenosa vertebro-vertebral tras canalización de vía venosa central vía yugular interna. La única manifestación clínica fue la presencia de acufenos, y la exploración física demostró soplo cervical y thrill a la palpación. El diagnóstico se realizó mediante angiografía y tomografía computerizada, y el tratamiento por técnica no invasiva con cierre mediante embolización con espirales de platino.


Assuntos
Humanos
6.
Psychiatry Res ; 202(1): 80-3, 2012 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-22595509

RESUMO

The aim of this study was to use a region-of-interest approach with magnetic resonance imaging to examine the volume of the straight gyrus volume change in first-episode schizophrenia-spectrum patients compared with healthy subjects over a 1-year follow-up period. We did not find a differential pattern of volumetric change between the two groups.


Assuntos
Fibras Nervosas Amielínicas/patologia , Córtex Pré-Frontal/patologia , Transtornos Psicóticos/patologia , Esquizofrenia/patologia , Adulto , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Estudos Longitudinais , Masculino , Tamanho do Órgão
7.
Age Ageing ; 40(2): 175-80, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21239411

RESUMO

BACKGROUND: ischaemic cerebrovascular small vessel disease (SVD) is a prevalent and under-diagnosed condition that triggers vascular cognitive impairment (VCI). OBJECTIVE: to describe the neuropsychological and clinical profiles in SVD (Binswanger's disease, BD; lacunar state, LS) from the clinician's perspective at the VCI stage. METHODS: a total of 1257 patients admitted to a tertiary center with a diagnosis of stroke, neuroradiological vascular disease, cognitive impairment/dementia, during a 13-year period were investigated. We prospectively assessed cognition in a subset of 141 patients with VCI (LS n = 28, BD n = 69, large vessel disease-LVD-n = 44) with MMSE, CAMDEX-H, WAIS-R, EXIT-25 and Trail making test. RESULTS: executive dysfunction (ECD) (n = 89, 91.7% versus n = 10, 22.7%; P < 0.001) and gait disturbances (n = 74, 76.3% versus n = 15, 34.1%; P < 0.001) characterized SVD. Prior strokes (n = 9, 9.3% versus n = 23, 52.3%; P < 0.001) and embologenous cardiopathy (n = 39, 40.2% versus n = 28, 63.6%; P < 0.04) featured LVD cases. BD was defined by hypertension (n = 52, 75.4% versus n = 30, 44.1%; P < 0.001), ECD (n = 65, 94.2% versus n = 34, 47.2%; P < 0.001) and VCI onset with cognitive impairment but not strokes (n = 44, 63.8% versus n = 34, 50%; P < 0.01). CONCLUSIONS: ECD and a frontal gait are SVD's clinical landmarks in our sample. LS and BD cases share a similar cognitive profile.


Assuntos
Transtornos Cerebrovasculares/complicações , Transtornos Cognitivos/etiologia , Cognição , Demência por Múltiplos Infartos/etiologia , Demência Vascular/etiologia , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/psicologia , Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Demência por Múltiplos Infartos/diagnóstico por imagem , Demência por Múltiplos Infartos/fisiopatologia , Demência por Múltiplos Infartos/psicologia , Demência Vascular/diagnóstico por imagem , Demência Vascular/fisiopatologia , Demência Vascular/psicologia , Diagnóstico Precoce , Função Executiva , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Hipertensão/etiologia , Hipertensão/fisiopatologia , Modelos Logísticos , Masculino , Testes Neuropsicológicos , Razão de Chances , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Espanha , Tomografia Computadorizada por Raios X
8.
Handb Clin Neurol ; 97: 459-68, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20816446

RESUMO

Activity-related headaches can be brought on by Valsalva maneuvers ("cough headache"), prolonged exercise ("exertional headache"), and sexual excitation ("orgasmic headache"). These headaches account for 1-2% of the consultations due to headache in a general neurological department. These entities are a challenging diagnostic problem as they can be primary or secondary and as their etiologies differ depending on the headache type. About 50% of patients with cough headache will show no demonstrable etiology, while the other half will be secondary to structural lesions, mostly a Chiari type I malformation at the foramen magnum level. As compared to the primary variety, secondary cough headache begins earlier (average 40 versus 60 years), is located posteriorly, lasts longer (years versus months), is associated with posterior fossa symptoms/signs, and does not respond to indomethacin. Patients with secondary cough headache show difficulties in cerebrospinal fluid circulation in the foramen magnum region in dynamic magnetic resonance imaging studies and preoperative plateau waves, which disappear after posterior fossa reconstruction. Headaches provoked by physical exercise and sexual headache have many points in common. In contrast to cough headache, secondary cases are rare, and sentinel subarachnoid bleeding is the most frequent etiology. The mean age at onset for primary headaches provoked by physical exercise and sexual activity is similar (40 years); they share clinical characteristics (bilateral, pulsating) and respond to beta-blockers. In conclusion, provoked headaches account for a low proportion of headache consultations. Cough headache is a different condition when compared to headache due to physical exercise and sexual activity, which are clinical variants of the same entity.


Assuntos
Tosse , Transtornos da Cefaleia Primários , Exercício Físico , Cefaleia , Humanos , Comportamento Sexual
10.
Neuroimage ; 53(3): 1016-22, 2010 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-19913623

RESUMO

Neuregulin 1 (NRG1) and Disrupted-in-schizophrenia (DISC1) genes, which are candidate genes for schizophrenia, are implicated in brain development. We have previously reported an association between the T allele of the rs6994992 SNP within NRG1 gene and lateral ventricle (LV) enlargement in first-episode schizophrenia patients. Moreover, transgenic mice with mutant DISC1 have also been reported as showing LV enlargement. In this study, we examined the possible interactive effects of NRG1 and DISC1 on brain volumes in a sample of first-episode schizophrenia patients. Ninety-one patients experiencing their first episode of schizophrenia underwent genotyping of three SNPs within DISC1 and structural brain MRI. These results were combined with our previously reported genotypes on three SNPs within NRG1. The T/T genotype of rs2793092 SNP in DISC1 was significantly associated with increased LV volume. However, taking into account the rs6994992 SNP in the NRG1 gene, which was also associated with LV volume in a previous study, the DISC1 SNP only predicted LV enlargement among those patients carrying the T allele in the NRG1 SNP. Those patients with the "at risk" allelic combinations in both genes had LV volumes which were 48% greater than those with none of the allelic combinations. Our findings suggest that NRG1 and DISC1 genes may be associated with brain abnormalities in schizophrenia through their influence on related pathways of brain development.


Assuntos
Predisposição Genética para Doença , Ventrículos Laterais/patologia , Proteínas do Tecido Nervoso/genética , Neuregulina-1/genética , Esquizofrenia/genética , Esquizofrenia/patologia , Adulto , Feminino , Genótipo , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Polimorfismo de Nucleotídeo Único
11.
Biol Psychiatry ; 65(6): 535-40, 2009 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-19058791

RESUMO

BACKGROUND: Structural brain abnormalities are already present at early phases of psychosis and might be the consequence of neurodevelopmental deviance. Neuregulin 1 gene (NRG1) is a candidate gene for schizophrenia, and its protein has different roles in nervous system development and plasticity. A single nucleotide polymorphism (SNP) within NRG1, SNP8NRG243177, has been associated with brain function among healthy and high-risk subjects and with reduced cell migration among patients with schizophrenia. We examined whether variations in this polymorphism influence brain volumes in first-episode schizophrenia subjects. METHODS: Ninety-five minimally medicated patients experiencing their first episode of schizophrenia underwent genotyping of three SNPs within the NRG1 gene and structural brain magnetic resonance imaging (MRI). A comparison of volumes of lobar gray matter (GM), lateral ventricles, and cortical cerebrospinal fluid (CSF) was made between the groups according to their genotype after controlling for total intracranial volume. RESULTS: The SNP8NRG243177 risk T allele was significantly associated, in an allele copy number-dependent fashion, with increased lateral ventricle volume. Genotype explained 7% of the variance of lateral ventricle volume. No significant differences in GM lobar or cortical CSF volumes were found among subgroups. CONCLUSIONS: Our findings suggest that genetic variations of the NRG1 gene can contribute to the enlargement of the lateral ventricles described in early phases of schizophrenia. These results suggest novel lines of research into potential mechanisms by which schizophrenia susceptibility genes might exert their effect on brain structure.


Assuntos
Ventrículos Laterais/patologia , Proteínas do Tecido Nervoso/genética , Esquizofrenia/genética , Esquizofrenia/patologia , Adulto , Alelos , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Neuregulina-1 , Tamanho do Órgão , Polimorfismo de Nucleotídeo Único , Esquizofrenia/diagnóstico
13.
Clin Rheumatol ; 28(3): 315-20, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19043772

RESUMO

Computed tomography (CT)-guided biopsy of the spine is considered a safe, accurate, and relatively inexpensive examination technique. Our purpose was to determine the diagnostic accuracy of CT-guided biopsies exclusively for vertebral osteomyelitis. A retrospective study was performed from a consecutive series of 72 patients with confirmed vertebral osteomyelitis with 46 CT-guided biopsies performed in 40 patients. Biopsy specimens were sent for bacteriologic and cytologic analysis. An adequate specimen for microbiologic examination was not obtained in one case and not enough sample for additional pathologic examination in 17 cases. The mean age of patients was 58 years, with a range of 1-88 years, including 24 men and 16 women. The level of spinal biopsy was thoracic in 18 (40%) and lumbar in 28 (60%). The analysis revealed the infection agent in 20 cases (43% sensitivity). Diagnostic rates obtained in patients with previous antibiotic treatment were significantly lower (23% vs. 60%, p = 0.013). Computed tomography-guided fine-needle aspiration biopsy is an important tool in the diagnostic evaluation of vertebral osteomyelitis. However, this technique yields a lower diagnostic rate than previously reported biopsy of neoplastic vertebral lesions, especially if performed in patients with previous antibiotic treatment.


Assuntos
Osteomielite/patologia , Doenças da Coluna Vertebral/patologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/microbiologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/microbiologia , Vértebras Torácicas/patologia , Adulto Jovem
14.
Rev Esp Geriatr Gerontol ; 43(1): 32-43, 2008.
Artigo em Espanhol | MEDLINE | ID: mdl-18684385

RESUMO

INTRODUCTION: stereology is a body of methods that allow unbiased and efficient estimation of geometric quantities defined in arbitrary physical structures. In particular, stereology is a valuable tool to assist neuroimaging in the estimation of morphometric parameters in the brain. Therefore, stereology may confer objectivity in the complementary and diagnostic evaluation of dementia by adding disease by adding quantitative data to clinical evaluation. OBJECTIVES AND METHODS: our purpose was to illustrate estimation of brain volume and pial surface area by means of quantitative, computer-assisted stereological methods. Both parameters were estimated by means of a vertical design with a single series of parallel Cavalieri sections at a random orientation and perpendicular to a fixed horizontal plane. The sections were obtained by magnetic resonance imaging. Suitable test systems (of test points for volume, and of cycloids for surface area) were superimposed on these sections with the aid of special software. RESULTS: to explore the statistical error of the volume estimator due to stereological sampling, 5 or 10 systematic sections were used in combination with two test point densities in a ratio of 1:4, so that the workload varied in the proportions 1:2:4:8. The four resulting estimators varied between 986 and 1120 cm(3). The surface area estimators varied between 1947 and 2096 cm(2), with workloads varying in the proportions of 1:2:2.3:4.6. CONCLUSIONS: stereology is a simple and efficient tool to obtain objective brain volume and surface area estimators that are unbiased by design and accurate at a modest cost. Thus the corresponding methods can effectively assist in diagnostic and follow-up evaluation of elders with dementia.


Assuntos
Encéfalo/patologia , Córtex Cerebral/patologia , Demência/patologia , Imageamento por Ressonância Magnética , Idoso , Atrofia , Fenômenos Biofísicos , Biofísica , Diagnóstico por Computador , Humanos , Masculino , Tamanho do Órgão
15.
J Headache Pain ; 9(5): 259-66, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18751938

RESUMO

Headaches provoked by cough, prolonged physical exercise and sexual activity have not been studied prospectively, clinically and neuroradiologically. Our aim was to delimitate characteristics, etiology, response to treatment and neuroradiological diagnostic protocol of those patients who consult to a general Neurological Department because of provoked headache. Those patients who consulted due to provoked headaches between 1996 and 2006 were interviewed in depth and followed-up for at least 1 year. Neuroradiological protocol included cranio-cervical MRI for all patients with cough headache and dynamic cerebrospinal functional MRI in secondary cough headache cases. In patients with headache provoked by prolonged physical exercise or/and sexual activity cranial neuroimaging (CT and/or MRI) was performed and, in case of suspicion of subarachnoid bleeding, angioMRI and/or lumbar tap were carried out. A total of 6,412 patients consulted due to headache during the 10 years of the study. The number of patients who had consulted due to any of these headaches is 97 (1.5% of all headaches). Diagnostic distribution was as follows: 68 patients (70.1%) consulted due to cough headache, 11 (11.3%) due to exertional headache and 18 (18.6%) due to sexual headache. A total of 28 patients (41.2%) out of 68 were diagnosed of primary cough headache, while the remaining 40 (58.8%) had secondary cough headache, always due to structural lesions in the posterior fossa, which in most cases was a Chiari type I malformation. In seven patients, cough headache was precipitated by treatment with angiotensin-converting enzyme inhibitors. As compared to the primary variety, secondary cough headache began earlier (average 40 vs. 60 years old), was located posteriorly, lasted longer (5 years vs. 11 months), was associated with posterior fossa symptoms/signs and did not respond to indomethacin. All those patients showed difficulties in the cerebrospinal fluid circulation in the foramen magnum region in the dynamic MRI study and preoperative plateau waves, which disappeared after posterior fossa reconstruction. The mean age at onset for primary headaches provoked by physical exercise and sexual activity began at the same age (40 years old), shared clinical characteristics (bilateral, pulsating) and responded to beta-blockers. Contrary to cough headache, secondary cases are rare and the most frequent etiology was subarachnoid bleeding. In conclusion, these conditions account for a low proportion of headache consultations. These data show the total separation between cough headache versus headache due to physical exercise and sexual activity, confirm that these two latter headaches are clinical variants of the same entity and illustrate the clinical differences between the primary and secondary provoked headaches.


Assuntos
Tosse/complicações , Exercício Físico , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/etiologia , Indometacina/uso terapêutico , Comportamento Sexual , Adulto , Angiografia Cerebral , Inibidores de Ciclo-Oxigenase/uso terapêutico , Feminino , Seguimentos , Transtornos da Cefaleia/classificação , Transtornos da Cefaleia/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Neurocirurgia/métodos , Estudos Prospectivos , Estudos Retrospectivos , Tomógrafos Computadorizados , Adulto Jovem
16.
Dement Geriatr Cogn Disord ; 25(5): 451-60, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18401174

RESUMO

BACKGROUND/AIMS: To describe the natural history of the prodromal stages of ischemic vascular dementia (pVaD). METHODS: A sample of 314 inpatients with pVaD or a clini- cal diagnosis of vascular dementia (VaD; lacunar state, Binswanger's disease, pure cortical VaD, corticosubcortical and strategic infarctions) admitted to a teaching tertiary center during a 13-year period was assessed (retrospectively n = 88, prospectively n = 226). Prospective neuropsychological assessment consisted of Mini Mental State Examination, Revised Wechsler Adult Intelligence Scale, Exit-25, Trail Making tests, Blessed Dementia Scale and Camdex H, Global Depression Scale and Hamilton Depression Rating Scale tests. Univariate analysis and logistic regressions are displayed. RESULTS: An unrecognized pVaD was related with a clinical onset with cognitive impairment no dementia (CIND) versus symptomatic cerebrovascular events (p < 0.0001), and with being under therapy with anticoagulant or antiplatelet agents (p < 0.01). Age <85 years at diagnosis of VaD (p < 0.01) correlated with a delayed pVaD diagnosis. CIND onset was associated with a longer prodromal stage (p < 0.01), no clinical strokes during pVaD (p < 0.001), silent ischemia (p < 0.01) and Binswanger's disease (p < 0.01). CONCLUSIONS: Vascular cognitive impairment remains an underdiagnosed, yet treatable entity. A brief neuropsychological examination and informant interviews should become standard practice in elderly populations with vascular risk factors. Small-vessel disease is a prevalent condition with a distinct natural history.


Assuntos
Transtornos Cognitivos/patologia , Transtornos Cognitivos/fisiopatologia , Demência Vascular/patologia , Demência Vascular/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Infarto Encefálico/patologia , Infarto Encefálico/fisiopatologia , Feminino , Humanos , Ataque Isquêmico Transitório/patologia , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Estudos Retrospectivos , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-18299232

RESUMO

Vascular complications after third molar extraction are very rare but may cause a life-threatening situation. The case presented is that of a 25-year-old male who appeared at our emergency department with severe dyspnea and increasing swelling of the left submandibular area 3 days after dental extraction. CT angiography and digital subtraction angiography demonstrated a pseudoaneurysm of the facial artery. Subsequent emergent endovascular embolization with n-Butyl-2-Cyanoacrylate was performed and the patient had a rapid satisfactory resolution.


Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Quimioembolização Terapêutica , Dente Serotino/cirurgia , Extração Dentária/efeitos adversos , Adulto , Falso Aneurisma/diagnóstico por imagem , Angiografia Digital , Artérias/lesões , Embucrilato/análogos & derivados , Embucrilato/uso terapêutico , Face/irrigação sanguínea , Humanos , Masculino , Mandíbula , Radiografia Intervencionista , Adesivos Teciduais/uso terapêutico
18.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 43(1): 32-41, ene. 2008. ilus, tab
Artigo em Es | IBECS | ID: ibc-63677

RESUMO

Introducción: la estereología es un conjunto de métodos que permiten la estimación insesgada y eficiente de cantidades geométricas definidas en estructuras arbitrarias. En particular, es una herramienta útil en la cuantificación de parámetros morfométricos cerebrales en estudios de neuroimagen. Por tanto, la estereología puede aportar una mayor objetividad en la evaluación complementaria y diagnóstica de ancianos con demencia, añadiendo datos cuantitativos a la evaluación clínica. Objetivos y métodos: nuestro objetivo es ilustrar la estimación del volumen cerebral y el área superficial de la corteza cerebral de un paciente anciano mediante procedimientos estereológicos cuantitativos asistidos por ordenador. Para estimar ambos parámetros se utilizó un diseño vertical con una serie de secciones paralelas de Cavalieri con orientación aleatoria y perpendiculares a un plano horizontal fijo. Las secciones se obtuvieron mediante resonancia magnética nuclear. Sobre ellas se superpusieron sondas sistemáticas (de puntos para el volumen y de cicloides para la superficie) mediante un software especial. Resultados: con objeto de explorar la variabilidad del error estadístico de las estimaciones, se utilizaron 5 o 10 secciones sistemáticas combinadas con dos densidades de puntos de sonda en la relación 1:4, de tal manera que el trabajo invertido varió en la relación 1:2:4:8. Los cuatro estimadores obtenidos variaron entre 986 y 1.120 cm3. Por otra parte, para el área de la superficie pial los estimadores variaron entre 1.947 y 2.096 cm2, con cargas de trabajo variables en la relación 1:2:2.3:4.6. Conclusiones: la estereología es una herramienta sencilla y eficiente, capaz de proporcionar estimaciones objetivas, no sesgadas por diseño, del volumen y la superficie cerebral pial con un coste modesto. Ello puede contribuir a facilitar la evaluación diagnóstica, evolutiva y pronóstica de pacientes ancianos con demencia


Introduction: stereology is a body of methods that allow unbiased and efficient estimation of geometric quantities defined in arbitrary physical structures. In particular, stereology is a valuable tool to assist neuroimaging in the estimation of morphometric parameters in the brain. Therefore, stereology may confer objectivity in the complementary and diagnostic evaluation of dementia by adding disease by adding quantitative data to clinical evaluation. Objectives and methods: our purpose was to illustrate estimation of brain volume and pial surface area by means of quantitative, computer-assisted stereological methods. Both parameters were estimated by means of a vertical design with a single series of parallel Cavalieri sections at a random orientation and perpendicular to a fixed horizontal plane. The sections were obtained by magnetic resonance imaging. Suitable test systems (of test points for volume, and of cycloids for surface area) were superimposed on these sections with the aid of special software. Results: to explore the statistical error of the volume estimator due to stereological sampling, 5 or 10 systematic sections were used in combination with two test point densities in a ratio of 1:4, so that the workload varied in the proportions 1:2:4:8. The four resulting estimators varied between 986 and 1120 cm3. The surface area estimators varied between 1947 and 2096 cm2, with workloads varying in the proportions of 1:2:2.3:4.6. Conclusions: stereology is a simple and efficient tool to obtain objective brain volume and surface area estimators that are unbiased by design and accurate at a modest cost. Thus the corresponding methods can effectively assist in diagnostic and follow-up evaluation of elders with dementia (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Demência/diagnóstico , Cérebro/anatomia & histologia , Mapeamento Encefálico/instrumentação , Demência/fisiopatologia , Arteriosclerose Intracraniana/diagnóstico
19.
Prog Neuropsychopharmacol Biol Psychiatry ; 31(7): 1514-8, 2007 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-17706335

RESUMO

BACKGROUND: Structural brain anomalies are present at early phases of psychosis. The objective was to examine the impact of Catechol-O-Methyltransferase (COMT) gene variations on brain morphology in first-episode non-affective psychosis. We hypothesized that the low activity-COMT (COMT(L)) allele would be associated with the presence of structural brain changes as assessed by quantitative magnetic resonance imaging (MRI). METHODS: Fifty-two males and 23 females underwent COMT genotyping and MRI. Patients were categorized into three genetic subgroups: COMT(H/H), COMT(L/H) and COMT(L/L). MRI data were analyzed using BRAINS2. Global and lobar volumes of grey matter (GM) and cerebrospinal fluid (CSF) were compared among the three groups after controlling for total intracranial volume and age of illness onset. RESULTS: COMT(L) carriers showed a significant enlargement of the lateral ventricles (F = 7.13, p = 0.009), right lateral ventricle (F = 5.99, p = 0.017) and left lateral ventricle (F = 6.22, p = 0.015). No other significant differences in any of the brain structures were found among subgroups. CONCLUSIONS: Our findings suggest that genetic variations of COMT can contribute to the enlargement of the lateral ventricles described in early phases of non-affective psychosis.


Assuntos
Catecol O-Metiltransferase/genética , Ventrículos Laterais/patologia , Transtornos Psicóticos/genética , Transtornos Psicóticos/patologia , Adulto , Alelos , DNA/genética , Feminino , Genótipo , Heterozigoto , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Transtornos Psicóticos/líquido cefalorraquidiano
20.
Epileptic Disord ; 9(2): 134-9, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17525021

RESUMO

We report a patient diagnosed as having subacute encephalopathy with frequent seizures in alcoholics (SESA syndrome), in which recurrent, non-convulsive seizures of frontal origin contributed significantly to the alteration of the mental state. Our case suggests that the occurrence of episodes of complex partial status epilepticus (CPSE) may contribute greatly to the origin and pathophysiology of the confusional state in this rare, epileptic entity.


Assuntos
Alcoolismo/fisiopatologia , Eletroencefalografia/estatística & dados numéricos , Epilepsia Parcial Complexa/fisiopatologia , Estado Epiléptico/fisiopatologia , Encefalopatia de Wernicke/fisiopatologia , Transtornos Induzidos por Álcool/diagnóstico , Transtornos Induzidos por Álcool/fisiopatologia , Alcoolismo/diagnóstico , Confusão/diagnóstico , Epilepsia Parcial Complexa/diagnóstico , Lateralidade Funcional , Humanos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Portugal , Estado Epiléptico/diagnóstico , Síndrome , Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricos , Encefalopatia de Wernicke/diagnóstico
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