RESUMO
INTRODUCTION: The increase in the number of people with upper limb spasticity as a sequela of cerebrovascular disease, which negatively impacts their autonomy, functional independence and participation, and affects their quality of life, calls for the application of precise and objective instruments for its measurement and evaluation. OBJECTIVE: To assess the validity and reliability of the Tardieu scale in the evaluation of upper extremity spasticity in adults with cerebrovascular disease. MATERIALS AND METHODS: The search strategy was implemented in eight databases; the systematic review protocol was registered beforehand in INPLASY (with registration no. 2023110076). The evidence was synthesised in three phases: a tabular presentation of results, an evaluation of the quality of the articles, and a narrative synthesis of the findings. RESULTS: Only three of the 33 articles identified fulfilled the variables that enable the validity and reliability of the Tardieu scale to be established. The measurements of angles and velocities R1, R2 and R2-R1 were analysed. Student's t-test to assess the reliability between the measurements of R1 and R2; and angles R2 and R2-R1 showed statistical significance, which confirmed the reliability of the scale. CONCLUSIONS: The Tardieu scale proved robust. It is important to note that the sample size, the time of evolution of the disease and the age of the patients may influence the results of the scale.
TITLE: Validez y fiabilidad de la escala de Tardieu para evaluar la espasticidad en miembro superior en adultos con enfermedad cerebrovascular. Revisión sistemática.Introducción. El incremento en el número de personas con espasticidad en los miembros superiores como secuela de una enfermedad cerebrovascular, que impacta negativamente en la autonomía, la independencia funcional y la participación, y afecta a la calidad de vida de las personas, demanda la aplicación de herramientas clínicas precisas y objetivas para su medición y evaluación. Objetivo. Evaluar la validez y la fiabilidad de la escala de Tardieu en la evaluación de la espasticidad en las extremidades superiores de adultos con enfermedad cerebrovascular. Materiales y métodos. La estrategia de búsqueda se implementó en ocho bases de datos; el protocolo de revisión sistemática se registró previamente en INPLASY (registro n.o 2023110076). La síntesis de la evidencia se llevó a cabo en tres fases: presentación tabular de resultados, evaluación de la calidad de los artículos y síntesis narrativa de los hallazgos. Resultados. De los 33 artículos identificados, sólo tres cumplieron con las variables que permiten establecer la validez y la fiabilidad de la escala de Tardieu. Se analizaron las medidas de los ángulos y velocidades R1, R2 y R2-R1. La prueba de la t de Student para evaluar la fiabilidad entre las medidas de R1 y R2; los ángulos R2 y R2-R1 mostraron significancia estadística, lo que confirmó la confiabilidad de la escala. Conclusiones. La escala de Tardieu demostró robustez. Es importante considerar que el tamaño de la muestra, el tiempo de evolución de la enfermedad y la edad de los pacientes pueden influir en los resultados de la escala.
Assuntos
Transtornos Cerebrovasculares , Espasticidade Muscular , Extremidade Superior , Humanos , Espasticidade Muscular/etiologia , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/fisiopatologia , Reprodutibilidade dos Testes , Transtornos Cerebrovasculares/complicações , Extremidade Superior/fisiopatologia , AdultoRESUMO
Fibromuscular dysplasia (FMD) is a rare non-atherosclerotic arterial disease that primarily affects middle-aged Caucasian women. Carotid web (CW) is a variant of FMD characterized by a nonatheromatous, membrane-like tissue protrusion into the carotid bulb. Reversible cerebral vasoconstriction syndrome (RCVS) is defined by severe headaches and reversible narrowing of cerebral arteries, which typically resolves within three months. While most RCVS cases have identifiable triggers, a significant portion occurs without known causes. Recent studies have reported a high prevalence of neurovascular abnormalities in RCVS patients. We present a case of a thirty-year-old woman with a sudden-onset severe headache, diagnosed with RCVS associated with carotid web. The patient had no ischemic involvement and responded well to flunarizine treatment. Follow-up imaging showed no stenosis. This case highlights a potential association between carotid web and RCVS, suggesting that FMD may contribute to vascular hyperreactivity and presents as a risk factor for RCVS. Further investigations are needed to understand the underlying mechanisms connecting these two vascular disorders. Keywords: reversible vasoconstriction syndrome; fibromuscular dysplasia; carotid web; structural abnormalities; vascular hyperreactivity.
Assuntos
Transtornos Cerebrovasculares , Displasia Fibromuscular , Transtornos da Cefaleia Primários , Vasoespasmo Intracraniano , Pessoa de Meia-Idade , Humanos , Feminino , Adulto , Vasoconstrição , Displasia Fibromuscular/complicações , Transtornos Cerebrovasculares/complicações , Fatores de Risco , Artérias Cerebrais , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/complicações , Transtornos da Cefaleia Primários/complicaçõesAssuntos
Transtornos Cerebrovasculares , Febre de Chikungunya , Acidente Vascular Cerebral , Vasoespasmo Intracraniano , Humanos , Vasoconstrição , Febre de Chikungunya/complicações , Febre de Chikungunya/diagnóstico , Transtornos Cerebrovasculares/complicações , Acidente Vascular Cerebral/complicações , Vasoespasmo Intracraniano/complicações , Vasoespasmo Intracraniano/diagnóstico por imagemRESUMO
BACKGROUND: The coronavirus disease 2019 (COVID-19) is a systemic illness that implies neurological features and complications. Persistent (>48 hours) hiccups (ie, singultus or hiccoughs) have been recently described as a rare presentation of COVID-19. Even when considered benign, the frequency and duration of hiccup spells can be burdensome and sometimes difficult to treat. CASE PRESENTATION: We report the case of a 62-year-old man known by the treating physicians for vascular cognitive impairment, who consulted for progressive persistent hiccups that commenced 5 days earlier, about 24 hours after testing positive for the severe acute respiratory syndrome coronavirus 2 by real-time reverse transcription polymerase chain reaction. The patient could barely sleep because the hiccups reached the highest rate of 47 per minute in a spell lasting almost 72 hours. The patient initially received levomepromazine 25 mg by mouth, but sedation and delirium impeded the continuation of treatment, which only reduced the frequency of the hiccup spells by about 25%. Afterward, the patient was offered levosulpiride 25 mg thrice a day by mouth, resulting in a steady reduction in the hiccups rate, as well as the duration and daily frequency of spells, which disappeared after 3 days of levosulpiride treatment. COVID-19 pneumonia was moderate by chest computed tomography scan imaging and biomarkers, meriting continuous oxygen therapy, dexamethasone 6 mg once a day by mouth for 10 days, and enoxaparin 40 mg once a day, subcutaneously, for 7 days (due to elevated D-dimer serum concentration). Oxygen therapy was gradually withdrawn after 12 days. CONCLUSIONS: Oral levosulpiride is a suitable option in persistent hiccups that occur in patients with COVID-19 pneumonia. To our knowledge, this is the fourth published case of persistent hiccups as a clinical feature of COVID-19.
Assuntos
COVID-19/complicações , Disfunção Cognitiva/complicações , Soluço/etiologia , Sulpirida/análogos & derivados , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Soluço/diagnóstico por imagem , Soluço/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Sulpirida/uso terapêuticoRESUMO
BACKGROUND: As the COVID-19 pandemic unfolds worldwide, different forms of reports have described its neurologic manifestations. OBJECTIVE: To review the literature on neurological complications of SARS-CoV-2 infection. METHODS: Literature search performed following systematic reviews guidelines, using specific keywords based on the COVID-19 neurological complications described up to May 10th, 2020. RESULTS: A total of 43 articles were selected, including data ranging from common, non-specific symptoms, such as hyposmia and myalgia, to more complex and life-threatening conditions, such as cerebrovascular diseases, encephalopathies, and Guillain-Barré syndrome. CONCLUSION: Recognition of neurological manifestations of SARS-CoV-2 should be emphasized despite the obvious challenges faced by clinicians caring for critical patients who are often sedated and presenting other concurrent systemic complications.
Assuntos
Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/complicações , Pneumonia Viral/complicações , Ageusia/complicações , Encefalopatias/complicações , COVID-19 , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/fisiopatologia , Síndrome de Guillain-Barré/complicações , Humanos , Mialgia/complicações , Doenças do Sistema Nervoso/fisiopatologia , Transtornos do Olfato/complicações , PandemiasRESUMO
ABSTRACT Background: As the COVID-19 pandemic unfolds worldwide, different forms of reports have described its neurologic manifestations. Objective: To review the literature on neurological complications of SARS-CoV-2 infection. Methods: Literature search performed following systematic reviews guidelines, using specific keywords based on the COVID-19 neurological complications described up to May 10th, 2020. Results: A total of 43 articles were selected, including data ranging from common, non-specific symptoms, such as hyposmia and myalgia, to more complex and life-threatening conditions, such as cerebrovascular diseases, encephalopathies, and Guillain-Barré syndrome. Conclusion: Recognition of neurological manifestations of SARS-CoV-2 should be emphasized despite the obvious challenges faced by clinicians caring for critical patients who are often sedated and presenting other concurrent systemic complications.
RESUMO Introdução: À medida que a pandemia da COVID-19 se desenvolve em todo o mundo, diferentes tipos de publicações descreveram suas manifestações neurológicas. Objetivo: Revisar a literatura sobre complicações neurológicas da infecção por SARS-CoV-2. Métodos: A pesquisa bibliográfica foi realizada seguindo diretrizes de revisões sistemáticas, usando palavras-chave específicas baseadas nas complicações neurológicas da COVID-19 descritas até 10 de maio de 2020. Resultados: Foram selecionados 43 artigos, incluindo descrições que variam de sintomas comuns e inespecíficos, como hiposmia e mialgia, a condições mais complexas e com risco de vida, como doenças cerebrovasculares, encefalopatias e síndrome de Guillain-Barré. Conclusão: O reconhecimento das manifestações neurológicas da SARS-CoV-2 deve ser enfatizado apesar dos óbvios desafios enfrentados pelos clínicos que cuidam de pacientes críticos, muitas vezes sedados e apresentando outras complicações sistêmicas concomitantes.
Assuntos
Humanos , Pneumonia Viral/complicações , Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/complicações , Encefalopatias/complicações , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/fisiopatologia , Infecções por Coronavirus , Síndrome de Guillain-Barré/complicações , Ageusia/complicações , Pandemias , Mialgia/complicações , Transtornos do Olfato/complicações , Doenças do Sistema Nervoso/fisiopatologiaAssuntos
Aneurisma/complicações , Transtornos Cerebrovasculares/complicações , Infecções por HIV/complicações , Infecções por HIV/fisiopatologia , Aneurisma/fisiopatologia , Aneurisma/virologia , Fármacos Anti-HIV/uso terapêutico , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/virologia , Criança , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Cerebrovascular disease (CVD) and cancer are among the most common causes of mortality worldwide, preceded only by ischemic heart disease (IHD). Thrombocytopenia was shown to be associated with poor outcomes in IHD and CVD in the general population. This study aimed to assess the relationship of thrombocytopenia with poor outcomes in cancer patients with CVD. MATERIALS AND METHODS: Data on patients with concomitant CVD and cancer who were initially treated at a cancer referral center between January 2010 and December 2017 were included. Thrombocytopenia was defined as a platelet count < 150,000/mm3 during the first 24 h of CVD symptom onset. The IRB (CI/837/17) approved the review of clinical records. RESULTS: Among 268 cancer patients with CVD included in the study, 210 met the inclusion criteria. Median overall survival of the entire cohort was 7.2 months, which was significantly shorter in males (p = 0.029) and patients with hematologic tumors (p = 0.009), hemorrhagic CVD (p < 0.001), altered mental status (p < 0.001), and thrombocytopenia (p < 0.001). Multiple regression logistic analysis revealed that thrombocytopenia (risk ratio [RR] 1.6, 95% confidence interval [CI] 1.1-2.4) and altered mental status (RR 2.7, 95% CI 1.9-4.0) remained statistically significant risk factors for mortality. CONCLUSION: In cancer patients with CVD, thrombocytopenia at the time of CVD diagnosis and altered mental status during initial clinical evaluation were associated with higher mortality, which should be confirmed in future studies.
Assuntos
Transtornos Cerebrovasculares/complicações , Neoplasias/sangue , Neoplasias/diagnóstico , Acidente Vascular Cerebral/complicações , Trombocitopenia/complicações , Transtornos Cerebrovasculares/sangue , Transtornos Cerebrovasculares/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Razão de Chances , Contagem de Plaquetas , Prognóstico , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/epidemiologia , Trombocitopenia/epidemiologiaRESUMO
Introducción: las neumonías asociadas a la ventilación causan grandes inquietudes a los médicos que plantean serias dificultades diagnósticas las que a su vez motivan a menudo la toma de decisiones terapéuticas desproporcionadas que favorecen la génesis de la resistencia antimicrobiana. Objetivo: valorar el comportamiento de la neumonía asociada a la ventilación mecánica como indicador de calidad asistencial en la Unidad de Terapia Intensiva de Adultos del Hospital General Docente Octavio de la Concepción y de la Pedraja de Baracoa entre enero-diciembre de 2015. Método: se realizó un estudio descriptivo transversal. De un universo de 67 pacientes se tomó una muestra de 27 pacientes por el método aleatorio simple, que desarrollaron esta enfermedad asociada a la ventilación según grupos de edades, sexo, afecciones que propiciaron usarla, tiempo de aparición de los síntomas y resultados microbiológicos. Resultados: las enfermedades de base que más incidieron fueron las enfermedades cerebrovasculares seguidas por distrés respiratorio y sepsis severa. En los primeros nueve días fue que aparecieron los síntomas. Se obtuvo mayor aislamiento de gérmenes Gram negativo. Conclusiones: el comportamiento de las neumonías asociadas a la ventilación estuvo dado en el sexo masculino, mayores de 60 años, se asociaron con mayor frecuencia a las enfermedades cerebrovasculares, en su mayoría los síntomas aparecieron entre 4 y 6 días; el Staphylococcus epidermidis y la Klebsiellap neumoniae fueron los gérmenes que con mayor frecuencia se aislaron en estos pacientes(AU)
Introduction: pneumonias associated with ventilation cause great concern to physicians who pose serious diagnostic difficulties which in turn often motivate the making of disproportionate therapeutic decisions that favor the genesis of antimicrobial resistance. Objective: assess the behavior of pneumonia associated with mechanical ventilation as an indicator of quality of care in the Unit of Intensive Adult Therapy of the General Teaching Hospital "Octavio de la Concepción y de la Pedraja" of Baracoa between January-December 2015. Method: a cross-sectional descriptive study was carried out. From a universe of 67 patients, a sample of 27 patients was taken by the simple random method, which developed this disease associated with ventilation according to age groups, sex, conditions that led to its use, time of onset of symptoms and microbiological results. Results: the underlying diseases that most affected were cerebrovascular diseases followed by respiratory distress and severe sepsis. In the first nine days, the symptoms appeared. Greater isolation of Gram negative germs was obtained. Conclusions: the behavior of the pneumonias associated to ventilation was given in the male sex, older than 60 years, they were associated with a greater frequency to the cerebrovascular diseases, in the majority the symptoms appeared between 4 and 6 days; Staphylococcus epidermidis and Klebsiellap pneumoniae were the germs that were most frequently isolated in these patients(AU)
Introdução: as pneumonias associadas à ventilação são motivo de grande preocupação para os médicos que apresentam sérias dificuldades diagnósticas, que por sua vez, muitas vezes motivam a tomada de decisões terapêuticas desproporcionais que favorecem a gênese da resistência antimicrobiana. Objetivo: avaliar o comportamento da pneumonia associada à ventilação mecânica como um indicador de qualidade de atendimento na Unidade de Terapia Intensiva de Adultos do Hospital Geral de Ensino "Octavio de la Concepción y de la Pedraja" de Baracoa entre janeiro-dezembro de 2015. Método: foi realizado um estudo descritivo transversal. De um universo de 67 pacientes, uma amostra de 27 pacientes foi tomada pelo método aleatório simples, que desenvolveu essa doença associada à ventilação de acordo com as faixas etárias, sexo, condições que levaram ao seu uso, tempo de início dos sintomas e resultados microbiológicos. Resultados: as doenças de base que mais afetaram foram as doenças cerebrovasculares, seguidas de desconforto respiratório e sepse grave. Nos primeiros nove dias, os sintomas apareceram. Maior isolamento de germes Gram negativos foi obtido. Conclusões: o comportamento das pneumonias associadas à ventilação foi dado no sexo masculino, com idade superior a 60 anos, foram associadas com maior frequência às doenças cerebrovasculares, na maioria os sintomas apareceram entre 4 e 6 dias; Staphylococcus epidermidis e Klebsiellap pneumoniae foram os germes mais freqüentemente isolados nesses pacientes(AU)
Assuntos
Humanos , Idoso , Pneumonia Associada à Ventilação Mecânica/etiologia , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Transtornos Cerebrovasculares/complicações , Epidemiologia Descritiva , Unidades de Terapia IntensivaRESUMO
BACKGROUND: Frailty has been associated with increased risk of adverse-health related outcomes including cognitive impairment. However, little is know about the pathogenesis relating frailty to cognitive decline. Therefore, the main objective of this study was to investigate the association between vascular cerebral damage and frailty. METHODS: Cross-sectional study involving 176 community-dwelling participants aged 67-86 years, participating in the AMImage Study, an ancillary neuro-imaging project of the AMI cohort, a French prospective cohort including older farmers living in rural areas. Frailty was defined as proposed by Fried. 3T magnetic resonance imaging (MRI) examination was performed with anatomical, diffusion, and fluid-attenuated inversion recovery sequences. The evaluation included the assessment of white matter hyperintensities (WMH) volumes and of microstructural white matter integrity through exploration of diffusion tensor imaging (DTI) parameters. RESULTS: The analyses showed that WMH volumes were higher in frail persons compared with nonfrail subgroup. Frail participants presented DTI modifications in extensive areas of white matter. In comparison with nonfrail subgroup, frail participants showed a strong association between WMH volumes and DTI changes. CONCLUSION: These results show that subclinical cerebrovascular damage is present in the frail older person, which could support the hypothesis that frailty is a prodromal state of central nervous system vascular injury.