RESUMO
OBJECTIVES: To determine the rate of magnetic resonance imaging (MRI)-detected noncystic white matter injury (WMI) in a prospective cohort of premature newborns, and to evaluate its associations with changes in clinical predictors of WMI over the study period. STUDY DESIGN: A prospective cohort of premature newborns (<33 weeks gestational age) was studied with MRI within 4 weeks of birth and near term-equivalent age. A pediatric neuroradiologist scored the severity of WMI on T1-weighted MRI according to published criteria. WMI was classified as none/mild or moderate/severe. Subjects with severe cystic WMI, periventricular hemorrhagic infarction, or motion artifact on MRI were excluded. Changes in clinical characteristics and predictors of WMI over the study period (1998-2011) were evaluated. Predictors of moderate/severe WMI, including birth year, were evaluated using multivariate logistic regression. RESULTS: Among 267 newborns, 45 (17%) had moderate/severe WMI. The rate of moderate/severe WMI decreased over the study period (P = .002, χ(2) test for trends). On multivariate logistic regression, the odds of moderate/severe WMI decreased by 11% for each birth year of the cohort (OR, 0.89; 95% CI, 0.81-0.98; P = .02). Prolonged exposure to indomethacin also was independently associated with reduced odds of moderate/severe WMI. CONCLUSION: The decreasing burden of MRI-detected moderate/severe noncystic WMI in our cohort of premature newborns is independent over time of changes in the known clinical predictors of WMI. Prolonged exposure to indomethacin is associated with reduced WMI.
Assuntos
Dano Encefálico Crônico/fisiopatologia , Recém-Nascido Prematuro , Imageamento por Ressonância Magnética/métodos , Substância Branca/lesões , Anti-Inflamatórios não Esteroides/administração & dosagem , Dano Encefálico Crônico/diagnóstico , Dano Encefálico Crônico/prevenção & controle , California , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Indometacina/administração & dosagem , Recém-Nascido , Modelos Logísticos , Masculino , Estudos Prospectivos , Fatores de Risco , Substância Branca/patologiaRESUMO
Introducción. La afectación de los procesos cognitivos es muy frecuente en pacientes con daño cerebral adquirido (DCA). Una adecuada evaluación neuropsicológica permite arribar a un diagnóstico certero de la magnitud del déficit y su repercusión funcional. Este estudio examina la correlación entre un test de cribado tradicional, el Examen Mínimo del Estado Mental (MMSE) y un test específico para la evaluación de la memoria, la Escala de Memoria de David Wechsler-I (WMS-I), en una muestra de 124 pacientes con DCA. Para ello se empleó el Método de Pearson. La correlación global obtenida entre ambos test fue significativa (p≤0.05) Conclusiones. Los test de cribado constituyen una manera breve y práctica para aproximarnos al diagnóstico neuropsicológico y este estudio de correlación constata la sensibilidad y el valor predictivo del MMSE como uno de los test de rastreo más empleados en la práctica clínica para orientar la exploración de las funciones comprometidas tras la lesión cerebral. No obstante, consideramos que en modo alguno deberían sustituirse las pruebas neuropsicológicas por los test de cribado para evaluar cognición en pacientes con daño cerebral adquirido.
Introduction. The cognitive impairments are frequently in patients with acquired brain injury (ABI). The neuropsychological assessment must provide a good diagnosis of the severity and functional repercussion of the cognitive impairments. This study examines the correlation between a traditional screening test, MiniMental State Examination (MMSE) and a specific test for the memory evaluation, the Wechsler Memory Scale I (WMS)I, in a sample of 124 patients with sequel of ABI. The global correlation (using coefficient of Pearson) between MMSE and WMS I was statistical significant (p≤0.05). Conclusions. The screening test constitutes an easy and brief way to obtain an adequate neuropsychological diagnosis. This correlation verifies the sensibility and the predictor value of the MMSE like one of the most employees test in the clinical practice to guide the exploration by damaged functions after the brain injury. Nevertheless, we consider that neuropsychological assessment in acquired brain injury patients should not be substituted by a scrutiny instrument.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Dano Encefálico Crônico/diagnóstico , Dano Encefálico Crônico/fisiopatologia , Testes Neuropsicológicos , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/fisiopatologia , Escalas de WechslerRESUMO
BACKGROUND: The neurorehabilitation of the patient with cerebral damage implies the reestablishment of the visual functions. Botulinum toxin can be considerate as a less invasive alternative for treatment. OBJECTIVE: to demonstrate the answer to the treatment using botulinum toxin of the visual motor alterations in patients with cerebral damage. METHODS: Descriptive study of patients with visual alterations associated to cerebral damage. The visual treatment included three areas: sensorial, refracting and motor under quimiodenervation with botulinum toxin, of May 2009 to May 2010. RESULTS: 48 patients were studied, age 22,4 years ± 23. The strabismus were: esotropia 52%, exotropia 39,5%, vertical 8%, nystagmus 4%. 50% of the patients had psychomotor delay. Some of the most important causes of cerebral damage were: Down syndrome, epilepsy, tumor, hydrocephalus, neuroinfection, infantile cerebral paralysis, multiple sclerosis, metabolic syndrome, cranial trauma, congenital cardiopathy, ventricular hemorrhage, cerebrovascular stroke. The dose of botulinum toxin was 8,1 UI ± 3. We registered good results in 56.5%, regular 23,9% and bad 19,5%. The global percentage of rehabilitation was 69% of correction with a r of Pearson of 0,5. DISCUSSION: Patients with cerebral damage have diverse types of visuomotor alterations, strabismus and nystagmus.Use of botulinum toxin as a paralytic muscle agent is a good alternative in these cases. CONCLUSION: The botulinum toxin is an effective option for the visual rehabilitation in patients with cerebral damage and prevents the progression of more cerebral changes secondary to strabismus.
Assuntos
Toxinas Botulínicas Tipo A , Dano Encefálico Crônico/complicações , Bloqueio Nervoso , Nistagmo Patológico/reabilitação , Oftalmoplegia/reabilitação , Estrabismo/reabilitação , Adulto , Idoso , Dano Encefálico Crônico/fisiopatologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/tratamento farmacológico , Nistagmo Patológico/etiologia , Nistagmo Patológico/fisiopatologia , Músculos Oculomotores/inervação , Músculos Oculomotores/fisiopatologia , Oftalmoplegia/tratamento farmacológico , Oftalmoplegia/etiologia , Oftalmoplegia/fisiopatologia , Estudos Prospectivos , Transtornos Psicomotores/complicações , Transtornos Psicomotores/fisiopatologia , Estrabismo/tratamento farmacológico , Estrabismo/etiologia , Estrabismo/fisiopatologia , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Aphasia tests validated according to the brain injury side are necessary, especially for Spanish instruments. OBJECTIVES: To study the concurrent validity of this Brief Aphasia Evaluation (BAE) to differentiate patients with left cerebral lesions (LC) from patients with right cerebral lesions (RC) as well as LC from healthy participants (HP). To study, through an unrestricted-sub-test-factor analysis, the BAE conceptual and content validity to generate a verbal homogeneous construct. MATERIALS AND METHODS: Data were obtained from a sample of 109 right-handed volunteers: 37 LC, 34 RC and 38 HP. The three groups were matched according to gender, age and education. RESULTS: Both groups of patients were similar in type and site of lesion, time since onset of condition, risk factors, presence of hemianopsia and hemiparesis and number of hospital visits. The Cronbach's alpha coefficient indicated an internal consistency of 0.99 for the total score and 0.88 or above for any of the sub-tests. All sub-tests (with loadings of 0.65 or above) grouped in one factor which explained 78% of the variance. The BAE showed a sensitivity and specificity of 0.84 or above to identify the LC (median as cut-off point). CONCLUSIONS: This test of free distribution demonstrated a satisfactory validity.
Assuntos
Dano Encefálico Crônico/diagnóstico , Dominância Cerebral/fisiologia , Lateralidade Funcional/fisiologia , Aprendizagem Verbal/fisiologia , Adulto , Análise de Variância , Dano Encefálico Crônico/patologia , Dano Encefálico Crônico/fisiopatologia , Dano Encefálico Crônico/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , EspanhaRESUMO
Pristanic acid (Prist) is accumulated in various peroxisomal disorders characterized by severe neurological dysfunction whose pathogenesis is poorly understood. Since oxidative damage has been demonstrated in brain of patients affected by neurodegenerative disorders, in the present work we investigated the in vitro effects of Prist on important parameters of oxidative stress in cerebral cortex from young rats. Prist significantly increased malondialdehyde levels, reflecting an increase of lipid peroxidation. This effect was totally prevented by the free radical scavenger melatonin, suggesting the involvement of reactive species. Prist also provoked protein oxidative damage, as determined by increased carbonyl formation and sulfhydryl oxidation. Otherwise, it did not alter nitric oxide production, indicating that nitrogen reactive species were not implicated in the lipid and oxidative damage provoked by Prist. Furthermore, the concentration of glutathione (GSH), the major brain non-enzymatic antioxidant defense, was significantly decreased by Prist and this decrease was fully prevented by melatonin and attenuated by α-tocopherol. It is therefore presumed that Prist elicits oxidative stress in the brain probably via reactive oxygen species formation and that this pathomechanism may possibly be involved in the brain damage found in patients affected by peroxisomal disorders where Prist accumulates.
Assuntos
Química Encefálica/efeitos dos fármacos , Dano Encefálico Crônico/induzido quimicamente , Córtex Cerebral/efeitos dos fármacos , Ácidos Graxos/toxicidade , Estresse Oxidativo/efeitos dos fármacos , Transtornos Peroxissômicos/induzido quimicamente , Animais , Química Encefálica/fisiologia , Dano Encefálico Crônico/metabolismo , Dano Encefálico Crônico/fisiopatologia , Córtex Cerebral/crescimento & desenvolvimento , Córtex Cerebral/fisiopatologia , Modelos Animais de Doenças , Ácidos Graxos/metabolismo , Peroxidação de Lipídeos/efeitos dos fármacos , Peroxidação de Lipídeos/fisiologia , Masculino , Estresse Oxidativo/fisiologia , Transtornos Peroxissômicos/metabolismo , Transtornos Peroxissômicos/fisiopatologia , Ratos , Ratos WistarRESUMO
Multiple disturbances following lesions of the insula are reviewed in the present article, including those related to autonomic function; gustatory, olfactory, auditory, somatosensory, and multimodal perception, as well as body awareness; the emotion of disgust; mood and willed action, addiction behavior, and language. Given the multiple and varied nature of the impairments revealed by lesion studies, we suggest that the insula, as a multimodal area, has a major role as a convergence zone implicated in the coordination between internal and external information through emotional subjective awareness. Methodological issues are discussed with attention paid to lesion etiology, and lesions involving adjacent areas to the insular cortex.
Assuntos
Conscientização/fisiologia , Córtex Cerebral/anatomia & histologia , Córtex Cerebral/fisiologia , Rede Nervosa/anatomia & histologia , Rede Nervosa/fisiologia , Percepção/fisiologia , Animais , Dano Encefálico Crônico/patologia , Dano Encefálico Crônico/fisiopatologia , Humanos , Dor/fisiopatologia , Dor/psicologiaRESUMO
AIM: to assess the auditory abilities of children with non-progressive chronic encephalopathy (NPCE), independently of the presence or not of hearing loss, and of the etiology of the encephalopathy; to characterize the benefit of hearing aids in children with NPCE and hearing loss. METHOD: neurologic, otorhinolaryngologic and auditory assessments. Application of the Parent's Evaluation of Aural/Oral Performance of Children (PEACH) protocol. RESULTS: out of the 46 assessed children, 22 (48%) presented no hearing loss and 24 (52%) presented some level of sensorineural hearing loss. Regarding the encephalopathy etiology, most of the participants presented ischemic hypoxic encephalopathy followed by infectious process and kernicterus. The results also indicate that 16 (35%) parents suspected that their child had hearing loss; out of this total, 56% had the hearing loss confirmed. Thirty parents (65%) did not have any hearing complaints about their children. For these children the auditory evaluation indicated that 50% presented some level of hearing loss. The PEACH protocol proved to be effective to assess the benefit of hearing aids. CONCLUSION: the results indicate that over half of participants presented hearing loss. No correlation was observed between etiology and complaints of hearing loss. This means that it is not possible to predict hearing loss based on complaints. All children who presented hearing loss benefited from the use of hearing aids.
Assuntos
Dano Encefálico Crônico , Auxiliares de Audição , Perda Auditiva Neurossensorial , Adolescente , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/fisiopatologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/reabilitação , Humanos , Lactente , MasculinoRESUMO
During development, children become capable of categorically associating stimuli and of using these relationships for memory recall. Brain damage in childhood can interfere with this development. This study investigated categorical association of stimuli and recall in four children with brain damages. The etiology, topography and timing of the lesions were diverse. Tasks included naming and immediate recall of 30 perceptually and semantically related figures, free sorting, delayed recall, and cued recall of the same material. Traditional neuropsychological tests were also employed. Two children with brain damage sustained in middle childhood relied on perceptual rather than on categorical associations in making associations between figures and showed deficits in delayed or cued recall, in contrast to those with perinatal lesions. One child exhibited normal performance in recall despite categorical association deficits. The present results suggest that brain damaged children show deficits in categorization and recall that are not usually identified in traditional neuropsychological tests.
Assuntos
Dano Encefálico Crônico/fisiopatologia , Transtornos da Memória/fisiopatologia , Rememoração Mental/fisiologia , Adolescente , Fatores Etários , Lesões Encefálicas/fisiopatologia , Criança , Humanos , Masculino , Testes NeuropsicológicosRESUMO
OBJETIVO: avaliar a capacidade auditiva de crianças com encefalopatias crônicas não evolutivas (ECNE) independentemente de suspeita de perda auditiva e da etiologia e caracterizar o benefício do uso de prótese auditiva em crianças com ECNE que apresentaram perda auditiva. MÉTODO: avaliação neurológica, otorrinolaringológica e audiológica e aplicação do protocolo Parent's Evaluation of Aural / Oral Performance of Children (Peach). RESULTADOS: Das 46 crianças avaliadas, encontraram-se 22 (48 por cento) sem perdas e 24 (52 por cento) com algum grau de perda auditiva sensorioneural. Quanto às etiologias encontradas nas 46 crianças, a maior porcentagem é de encefalopatia hipóxica isquêmica seguida de processos infecciosos e kernicterus. Quanto à suspeita de perda auditiva, nas 16 (35 por cento) crianças cujos pais tiveram suspeita, o percentual de algum grau de perda auditiva foi de 56 por cento, e nas 30 (65 por cento) cujos pais não a tiveram, a avaliação audiológica revelou que 50 por cento apresentaram algum grau de perda auditiva. O protocolo Peach se mostrou um instrumento eficaz para avaliar o benefício da prótese auditiva. CONCLUSÃO: das crianças avaliadas, mais da metade apresentou perda auditiva, no entanto, não houve relação estatisticamente significante entre a etiologia e a suspeita de perda auditiva. Assim, consideramos que não é possível prever qualquer perda auditiva a partir da suspeita e recomendamos a avaliação auditiva em todas as crianças com ECNE, pois todas as crianças com perda auditiva examinadas neste estudo revelaram benefícios importantes com o uso da prótese auditiva.
AIM: to assess the auditory abilities of children with non-progressive chronic encephalopathy (NPCE), independently of the presence or not of hearing loss, and of the etiology of the encephalopathy; to characterize the benefit of hearing aids in children with NPCE and hearing loss. METHOD: neurologic, otorhinolaryngologic and auditory assessments. Application of the Parent's Evaluation of Aural/Oral Performance of Children (PEACH) protocol. RESULTS: out of the 46 assessed children, 22 (48 percent) presented no hearing loss and 24 (52 percent) presented some level of sensorineural hearing loss. Regarding the encephalopathy etiology, most of the participants presented ischemic hypoxic encephalopathy followed by infectious process and kernicterus. The results also indicate that 16 (35 percent) parents suspected that their child had hearing loss; out of this total, 56 percent had the hearing loss confirmed. Thirty parents (65 percent) did not have any hearing complaints about their children. For these children the auditory evaluation indicated that 50 percent presented some level of hearing loss. The PEACH protocol proved to be effective to assess the benefit of hearing aids. CONCLUSION: the results indicate that over half of participants presented hearing loss. No correlation was observed between etiology and complaints of hearing loss. This means that it is not possible to predict hearing loss based on complaints. All children who presented hearing loss benefited from the use of hearing aids.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Dano Encefálico Crônico , Auxiliares de Audição , Perda Auditiva Neurossensorial , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/fisiopatologia , Distribuição de Qui-Quadrado , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/reabilitaçãoRESUMO
During development, children become capable of categorically associating stimuli and of using these relationships for memory recall. Brain damage in childhood can interfere with this development. This study investigated categorical association of stimuli and recall in four children with brain damages. The etiology, topography and timing of the lesions were diverse. Tasks included naming and immediate recall of 30 perceptually and semantically related figures, free sorting, delayed recall, and cued recall of the same material. Traditional neuropsychological tests were also employed. Two children with brain damage sustained in middle childhood relied on perceptual rather than on categorical associations in making associations between figures and showed deficits in delayed or cued recall, in contrast to those with perinatal lesions. One child exhibited normal performance in recall despite categorical association deficits. The present results suggest that brain damaged children show deficits in categorization and recall that are not usually identified in traditional neuropsychological tests.
No desenvolvimento, as crianças tornam-se capazes de associar estímulos em categorias e de se beneficiar dessas associações para sua recordação posterior. Lesões cerebrais na infância podem interferir nesse desenvolvimento. Neste estudo, essas habilidades foram avaliadas em crianças com lesões cerebrais. A etiologia, topografia e época de instalação da lesão variaram. As tarefas incluíram: nomeação e recordação imediata de 30 figuras relacionadas perceptual e semanticamente; associação livre; recordação tardia e recordação com pistas. Testes neuropsicológicos tradicionais também foram usados. Duas crianças com lesões adquiridas na fase escolar associaram as figuras baseadas em relações perceptivas e não categóricas e apresentaram déficits de recordação tardia e com pistas, ao contrario das outras duas com lesões perinatais. Uma criança apresentou bom desempenho na recordação independentemente de associação categórica. Os resultados sugerem que crianças com lesões cerebrais podem apresentar déficits de categorização e recordação, que não são frequentemente evidenciados em testes tradicionais.