RESUMO
The purpose of this study was to correlate the morphology of giant intracranial aneurysms (GIA) with their clinical presentation. Eighty patients with GIA, 14 males and 66 females, were studied. Univariate and multivariate analyses were made to test the associations between morphological and clinical features. The main locations of the unruptured GIA included the carotid cavernous segment, and for the ruptured GIA, the most frequent were the carotid supraclinoid and middle cerebral arteries. There was a significant association among communicating arteries (CA) of "bad" quality and presence of thrombus and calcification (TC). The risk of rupture is 8 times higher in patients with CA of "bad" quality and 11 times higher in patients without TC. GIA are more frequent in the cavernous segment. There is a high rupture risk in the middle cerebral artery. CA of "bad" quality are associated with TC. The rupture risk is significantly higher in patients without TC.
Assuntos
Aneurisma Intracraniano/patologia , Adolescente , Adulto , Idoso , Aneurisma Roto/epidemiologia , Aneurisma Roto/prevenção & controle , Angiografia Digital , Calcinose/epidemiologia , Calcinose/etiologia , Criança , Feminino , Cefaleia/etiologia , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/cirurgia , Trombose Intracraniana/epidemiologia , Trombose Intracraniana/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/patologia , Modelos Estatísticos , Análise Multivariada , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: This study aimed to evaluate oral and maxillofacial trauma caused by falls during epileptic seizures. METHOD: A prospective case-control study was carried out among patients recruited from both the Epileptic Outpatient Clinic and the Emergency Room of Hospital de Base during 2006. The study group was composed of patients with epilepsy that had been diagnosed by a specialist. Oral and maxillofacial trauma was diagnosed using a questionnaire together with physical and radiographic examinations. A control group was formed from non-epileptic relatives or neighbors of the patients. The two groups were compared with regard to the number and type of oral and maxillofacial trauma events suffered. Odds ratios with a 95% confidence interval, dependency analysis and the Pearson χ(2) test were used for statistical analysis, and the significance level was set at p≤0.05. RESULTS: A total of 159 patients with epilepsy (91 males; 57.3%) and 68 control individuals (28 males; 41.1%) were enrolled in the study. The frequencies of oromaxillary trauma in the study and control groups were 23.9% and 4.4%, respectively. Generalized tonic-clonic, generalized and non-classified seizures were strongly associated with trauma. The commonest lesions were fractures of dental tooth crowns (32.9%), followed by tooth avulsion (7.6%), tooth luxation (5%) and fracturing of prostheses in edentulous patients (3.8%). CONCLUSION: This work shows that injuries to the face and teeth are statistically more common in patients with epilepsy than in the general population, and that individuals who suffer seizures without aura are the most affected.
Assuntos
Acidentes por Quedas , Epilepsia/complicações , Traumatismos Maxilofaciais/etiologia , Traumatismos Dentários/etiologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Traumatismos Maxilofaciais/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Avulsão Dentária/epidemiologia , Avulsão Dentária/etiologia , Fraturas dos Dentes/epidemiologia , Fraturas dos Dentes/etiologia , Traumatismos Dentários/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: This study aimed to evaluate oral and maxillofacial trauma caused by falls during epileptic seizures. METHOD: A prospective case-control study was carried out among patients recruited from both the Epileptic Outpatient Clinic and the Emergency Room of Hospital de Base during 2006. The study group was composed of patients with epilepsy that had been diagnosed by a specialist. Oral and maxillofacial trauma was diagnosed using a questionnaire together with physical and radiographic examinations. A control group was formed from non-epileptic relatives or neighbors of the patients. The two groups were compared with regard to the number and type of oral and maxillofacial trauma events suffered. Odds ratios with a 95 percent confidence interval, dependency analysis and the Pearson c² test were used for statistical analysis, and the significance level was set at p≤0.05. RESULTS: A total of 159 patients with epilepsy (91 males; 57.3 percent) and 68 control individuals (28 males; 41.1 percent) were enrolled in the study. The frequencies of oromaxillary trauma in the study and control groups were 23.9 percent and 4.4 percent, respectively. Generalized tonic-clonic, generalized and non-classified seizures were strongly associated with trauma. The commonest lesions were fractures of dental tooth crowns (32.9 percent), followed by tooth avulsion (7.6 percent), tooth luxation (5 percent) and fracturing of prostheses in edentulous patients (3.8 percent). CONCLUSION: This work shows that injuries to the face and teeth are statistically more common in patients with epilepsy than in the general population, and that individuals who suffer seizures without aura are the most affected.
OBJETIVO: O objetivo desse estudo foi avaliar a relação da epilepsia sobre as ocorrências de trauma dento-alveolar e maxilofacial causados por quedas. MÉTODO: Estudo caso-controle prospectivo foi conduzido no ambulatório de epilepsia e do Pronto Atendimento do Hospital de Base de São José do Rio Preto-SP no ano de 2006. Pacientes do grupo caso foram diagnosticados pelo neurologista chefe (sênior) especialista em epilepsia e avaliados quanto ao trauma oral e maxilo-facial pelo pesquisador, por meio de questionário, exame clínico e radiográfico, por ordem de chegada. O grupo controle (GC) foi constituído incluindo indivíduos sem crises, que fossem familiares ou vizinhos próximos dos pacientes com diagnóstico de epilepsia. Intervalo de confiança 95 por cento, ODD, análise de dependência (ANADEP) e c² de Pearson foram utilizados para análise estatística e se adotou nível de significância de p≤0,05. RESULTADOS: Analisaram-se 159 pacientes com epilepsia, dos quais 91(57,3 por cento) masculinos e 68 do GC, dos quais 28 (41,1 por cento) masculinos. A frequência do trauma oro-maxilar em paciente com epilepsia foi 23,9 por cento e no GC foi de 4,4. As crises tônico-clônicas generalizadas, crises generalizadas e as não classificadas estão fortemente co-relacionadas ao trauma. Fraturas das coroas dentais (32,9 por cento), seguidas de avulsão dentária (7,6 por cento), luxação dentária (5 por cento) e fratura da prótese em pacientes edêntulos (3,8 por cento) foram as lesões mais encontradas. CONCLUSÃO: O trabalho mostra que os ferimentos na face e dentes são frequentes em pacientes com crises epilépticas quando comparados ao GC, sendo as pessoas com crises sem a aura as mais afetadas.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Acidentes por Quedas , Epilepsia/complicações , Traumatismos Maxilofaciais/etiologia , Traumatismos Dentários/etiologia , Estudos de Casos e Controles , Traumatismos Maxilofaciais/epidemiologia , Estudos Prospectivos , Avulsão Dentária/epidemiologia , Avulsão Dentária/etiologia , Fraturas dos Dentes/epidemiologia , Fraturas dos Dentes/etiologia , Traumatismos Dentários/epidemiologiaRESUMO
OBJECTIVE: To determine the survival rate according to the main findings of emergency electroencephalography (EEGs) of patients treated in a tertiary hospital. METHOD: In this prospective study, the findings of consecutive emergency EEGs performed on inpatients in Hospital de Base in São José do Rio Preto, Brazil were correlated with survival utilizing Kaplan-Meyer survival curves. RESULTS: A total of 681 patients with an average age of 42 years old (1 day to 96 years) were evaluated, of which 406 were male. The main reasons for EEGs were epileptic seizures (221 cases), hepatic encephalopathy [116 cases of which 85 (73.3%) were men, p-value=0.001], status epilepticus (104 cases) and impaired consciousness (78 cases). The underlying disease was confirmed in 578 (84.3%) cases with 119 (17.5%) having liver disease [91 (76.0%) were men, p-value=0.001], 105 (15.4%) suffering strokes, 67 (9.9%) having metabolic disorders, 51 (7.5%) central nervous system infections and 49 (7.2%) epilepsy. In the three months following EEG, a survival rate of 75% was found in patients with normal, discreet slow activity or intermittent rhythmic delta activity EEGs, of 50% for those with continuous delta activity and generalized epileptiform discharges, and of 25% for those with burst-suppression, diffuse depression, and in alpha/theta-pattern coma. Death was pronounced immediately in patients with isoelectric EEGs. CONCLUSION: The main findings of EEGs, differentiated different survival rates and are thus a good prognostic tool for patients examined in emergencies.
Assuntos
Eletroencefalografia/mortalidade , Emergências/epidemiologia , Adolescente , Adulto , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Adulto JovemRESUMO
OBJECTIVE: To determine the survival rate according to the main findings of emergency electroencephalography (EEGs) of patients treated in a tertiary hospital. METHOD: In this prospective study, the findings of consecutive emergency EEGs performed on inpatients in Hospital de Base in São José do Rio Preto, Brazil were correlated with survival utilizing Kaplan-Meyer survival curves. RESULTS: A total of 681 patients with an average age of 42 years old (1 day to 96 years) were evaluated, of which 406 were male. The main reasons for EEGs were epileptic seizures (221 cases), hepatic encephalopathy [116 cases of which 85 (73.3 percent) were men, p-value=0.001], status epilepticus (104 cases) and impaired consciousness (78 cases). The underlying disease was confirmed in 578 (84.3 percent) cases with 119 (17.5 percent) having liver disease [91 (76.0 percent) were men, p-value=0.001], 105 (15.4 percent) suffering strokes, 67 (9.9 percent) having metabolic disorders, 51 (7.5 percent) central nervous system infections and 49 (7.2 percent) epilepsy. In the three months following EEG, a survival rate of 75 percent was found in patients with normal, discreet slow activity or intermittent rhythmic delta activity EEGs, of 50 percent for those with continuous delta activity and generalized epileptiform discharges, and of 25 percent for those with burst-suppression, diffuse depression, and in alpha/theta-pattern coma. Death was pronounced immediately in patients with isoelectric EEGs. CONCLUSION: The main findings of EEGs, differentiated different survival rates and are thus a good prognostic tool for patients examined in emergencies.
OBJETIVO: Determinar a taxa de sobrevivência (TS), segundo os principais achados de eletrencefalograma de urgência (E-EEG), dos pacientes atendidos nas emergências de hospital de alta complexidade. MÉTODO: Estudo prospectivo, por ordem de chegada, da correlação entre os achados de E-EEG, feitos nos pacientes à beira do leito, com TS, utilizando-se as curvas de sobrevidas de Kaplan Meyer no Hospital de Base de São José do Rio Preto, São Paulo/Brasil. RESULTADOS: Foram estudados 681 pacientes, dos quais 406 (59,6 por cento) masculinos, com idade média de 42 anos (1 dia a 96 anos). As principais motivações para o E-EEG foram crises epilépticas (221 casos), encefalopatia hepática [(116 casos, dos quais 85 masculinos (73,3 por cento), p= 0,001]; estado de mal epiléptico 104 e rebaixamento de consciência 78. O diagnóstico da doença de base foi confirmado em 578 (84,3 por cento), sendo 119 (17,5 por cento) hepatopatia, dos quais 91 (76, por cento) masculinos, p= 0,001; 105 (15,4 por cento) acidente vascular encefálico; 67 (9,9 por cento) distúrbio metabólico; 51 (7,5 por cento) infecção do sistema nervoso central e 49 (7,2 por cento) epilepsia. TS de 75 por cento nos três primeiros meses foi encontrada nos pacientes com E-EEG com alentecimento discreto ou com atividade delta rítmica intermitente. TS por volta de 50 por cento nos três meses foi encontrado nos pacientes com E-EEG com delta contínuo, crítico e com descargas periódicas. A TS foi menor que 25 por cento nos dois primeiros meses após E-EEG, nos pacientes com E-EEG com surto/supressão, com depressão difusa e com comas alfa/teta e 0 por cento nos E-EEG iselétricos. CONCLUSÃO: O E-EEG, com seus principais achados, foi capaz de diferenciar as diversas taxas de sobrevivências na amostra estudada, constituindo-se, portanto, bom instrumento de prognóstico para pacientes atendidos nas unidades de emergência hospitalar.
Assuntos
Adolescente , Adulto , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Eletroencefalografia/mortalidade , Emergências/epidemiologia , Brasil/epidemiologia , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Adulto JovemRESUMO
A epilepsia é uma desordem crônica que prejudica a qualidade de vida (QV) e interfere em aspectos emocionais, pessoais, sociais e de relacionamento familiar. Este estudo avaliou a QV de 165 pessoas com diagnóstico de epilepsia, com idade entre 18 e 75 anos (M=41,28; DP= 13,26), por meio do QQV-65. Os escores do questionário foram comparados com características clínicas da doença e entre aqueles pacientes que possuíam refratariedade das crises e com pacientes com crises controladas parcialmente. Não houve diferença em relação às duas populações no fator QV. O fator Emocional foi o mais afetado em ambos os grupos, uma vez que o z-escore médio estimado foi de 51,0±14,4 para o Grupo I e 49,9±14,7 para o Grupo II. Quanto ao tipo de crise, a análise de variância (ANOVA) revelou que Saúde foi o único fator do QQV-65 que apresentou diferença estatisticamente significante entre os z-escores (P=0,024). Entretanto, para a freqüência das crises epiléticas, exceto Saúde (P=0,185), os demais fatores do QQV-65 mostraram-se relacionados de forma estatisticamente significante (P>0,05). O estudo demonstrou que a percepção de controle de crises é muito importante na avaliação da QV em todos os seus aspectos (saúde, físico, social, emocional, lócus de controle, auto-conceito e cognitivo)(AU)
Epilepsy is a chronic disorder that impairs life quality (LQ) and interferes in emotional, personal, social and family relationship aspects. This study evaluated 165 people with epilepsy diagnosis, ranging from 18 to 75 years old (M=41,28; SD= 13,26), by means of the QQV-65 (Life Quality Questionnaire with 65 questions) and investigated the association between the questionnaire scores and the disease features, comparing patients who showed refrectory seizures with patients with partially controled seizures. There was no difference in relation to the two groups regarding the LQ factor. The QQV-65 emotional factor was the most affected in both groups, since the estimated mean z-escore was 51,0±14,4 for Group I and 49,9±14,7 for Group II. Regarding the type of crisis, the analysis of variance (ANOVA) revealed that Health was the only factor in QQV-65 that showed a statistically significant difference between the z-scores (P = 0.024). However, for the frequency of epileptic seizures, except Health (P = 0.185), other factors QQV-65 proved to be related in a statistically significant way (P> 0.05). The research demonstrated that seizure control perception is quite important in the evaluation of life quality in all its aspects (health, body, society, emotion, locus of control, self-concept and cognition)(AU)
RESUMO
Central venous cannulation is a routine procedure. We describe a rare complication of internal jugular vein catheterization leading to radiculopathy of the right upper arm. MRI of the neck showed compression of the spinal cord and C2-C7 roots by the engorged veins. Digital subtraction angiography demonstrated a fistula between subclavian artery and internal jugular vein. The fistula was successfully occluded by stent placement in the artery.
Assuntos
Fístula Arteriovenosa/etiologia , Cateterismo Venoso Central/efeitos adversos , Doença Iatrogênica , Veias Jugulares/patologia , Radiculopatia/etiologia , Artéria Subclávia/patologia , Adulto , Vértebras Cervicais , Feminino , HumanosRESUMO
OBJECTIVE: To assess the epilepsy treatment gap in Campinas and São Josédo Rio Preto, two cities in the State of São Paulo, Brazil. METHOD: The treatment gap was estimated using the formula n1-n2/n1x100, where n1 was calculated using 1.86% prevalence and represented the number of individuals with epilepsy, while n2 represented the number of people who could be treated with an adult standard dose for a year utilizing the antiepileptic drugs supplied by the public health system. RESULTS: Our estimates revealed that in 2001, approximately 50% of the population with epilepsy was treated with the recommended antiepileptic medication. CONCLUSION: These results suggest that a relevant percentage of patients with epilepsy are not untreated. Further epidemiological studies are needed to investigate the reasons for this treatment gap so that interventions can reduce this gap and improve the quality of life of patients with epilepsy.
Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Carbamazepina/uso terapêutico , Epilepsia/epidemiologia , Humanos , Fenobarbital/uso terapêutico , Fenitoína/uso terapêutico , Prevalência , Ácido Valproico/uso terapêuticoRESUMO
OBJETIVO: Estimar a lacuna de tratamento em epilepsia nas cidades de Campinas e São José do Rio Preto, interior do Estado de São Paulo. MÉTODO: Estimamos a lacuna de tratamento através da fórmula n1-n2/n1x100, onde se utiliza o número de pessoas com epilepsia, calculado pela prevalência (n1), e a quantidade de pessoas que podem ser tratadas com a dose padrão para adultos das DAEs, distribuídas no período de um ano na localidade (n2). Usamos a prevalência estimada de 1,86% e consumo de medicação antiepiléptica fornecida pela rede básica de saúde nestas duas cidades. RESULTADOS: Nossas estimativas mostram que somente em torno de metade da população com epilepsia foi tratada em 2001 usando doses preconizadas de medicação antiepiléptica. CONCLUSÃO: A nossa estimativa aponta que uma parcela importante dos pacientes com epilepsia não está sendo tratada no nosso meio. Estudos epidemiológicos futuros devem explorar os motivos desta lacuna de tratamento para que intervenções sejam realizadas para melhorar a qualidade de vida dos pacientes com epilepsia.
Assuntos
Adulto , Humanos , Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Brasil/epidemiologia , Carbamazepina/uso terapêutico , Epilepsia/epidemiologia , Prevalência , Fenobarbital/uso terapêutico , Fenitoína/uso terapêutico , Ácido Valproico/uso terapêuticoRESUMO
UNLABELLED: The aim of this study was to determine the prevalence of epilepsy in the urban population of São José do Rio Preto. This is a medium-sized city of 336000 inhabitants, located in the northwest of the state of São Paulo, Brazil. METHOD: A cross-sectional epidemiological investigation with a randomized sample was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The chi-square test was used in analysis of the results and p-value value < 0.05 was considered significant. Prevalence was calculated with 95% confidence interval. RESULTS: The study sample size was 17293 individuals, with distributions of gender, age, and race similar to the general population. The prevalence per 1000 inhabitants of epilepsy was 18.6, of these 8.2 were active, defined as at least one seizure within the last two years. The prevalence per 1000 inhabitants for the age groups (years) was 4.9 (04), 11.7 (514), 20.3 (1564) and 32.8 (65 or over). CONCLUSION: Prevalence of both accumulated and active epilepsy was elevated, comparable to other developing nations, in particular those of Latin America. However, the prevalence of epilepsy in childhood was low, whilst in aged individuals it was high similar to industrialized nations.