Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Stroke"

Navegando por Palavras-chave "Stroke"

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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation
(Elsevier Science Inc, 2017) Calkins, Hugh; Hindricks, Gerhard; Cappato, Riccardo; Kim, Young-Hoon; Saad, Eduardo B.; Aguinaga, Luis; Akar, Joseph G.; Badhwar, Vinay; Brugada, Josep; Camm, John; Chen, Peng-Sheng; Chen, Shih-Ann; Chung, Mina K.; Nielsen, Jens Cosedis; Curtis, Anne B.; Davies, Wyn; Day, John D.; d'Avila, Andre; De Groot, N. M. S. (Natasja); Di Biase, Luigi; Duytschaever, Mattias; Edgerton, James R.; Ellenbogen, Kenneth A.; Ellinor, Patrick T.; Ernst, Sabine; Fenelon, Guilherme [UNIFESP]; Gerstenfeld, Edward P.; Haines, David E.; Haissaguerre, Michel; Helm, Robert H.; Hylek, Elaine; Jackman, Warren M.; Jalife, Jose; Kalman, Jonathan M.; Kautzner, Josef; Kottkamp, Hans; Kuck, Karl Heinz; Kumagai, Koichiro; Lee, Richard; Lewalter, Thorsten; Lindsay, Bruce D.; Macle, Laurent; Mansour, Moussa; Marchlinski, Francis E.; Michaud, Gregory F.; Nakagawa, Hiroshi; Natale, Andrea; Nattel, Stanley; Okumura, Ken; Packer, Douglas; Pokushalov, Evgeny; Reynolds, Matthew R.; Sanders, Prashanthan; Scanavacca, Mauricio; Schilling, Richard; Tondo, Claudio; Tsao, Hsuan-Ming; Verma, Atul; Wilber, David J.; Yamane, Teiichi
Acesso aberto (Open Access)
2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary
(Elsevier Science Inc, 2017) Calkins, Hugh; Hindricks, Gerhard; Cappato, Riccardo; Kim, Young-Hoon; Saad, Eduardo B.; Aguinaga, Luis; Akar, Joseph G.; Badhwar, Vinay; Brugada, Josep; Camm, John; Chen, Peng-Sheng; Chen, Shih-Ann; Chung, Mina K.; Nielsen, Jens Cosedis; Curtis, Anne B.; Davies, D. Wyn; Day, John D.; d'Avila, Andre; de Groot, N. M. S. (Natasja); Di Biase, Luigi; Duytschaever, Mattias; Edgerton, James R.; Ellenbogen, Kenneth A.; Ellinor, Patrick T.; Ernst, Sabine; Fenelon, Guilherme [UNIFESP]; Gerstenfeld, Edward P.; Haines, David E.; Haissaguerre, Michel; Helm, Robert H.; Hylek, Elaine; Jackman, Warren M.; Jalife, Jose; Kalman, Jonathan M.; Kautzner, Josef; Kottkamp, Hans; Kuck, Karl Heinz; Kumagai, Koichiro; Lee, Richard; Lewalter, Thorsten; Lindsay, Bruce D.; Macle, Laurent; Mansour, Moussa; Marchlinski, Francis E.; Michaud, Gregory F.; Nakagawa, Hiroshi; Natale, Andrea; Nattel, Stanley; Okumura, Ken; Packer, Douglas; Pokushalov, Evgeny; Reynolds, Matthew R.; Sanders, Prashanthan; Scanavacca, Mauricio; Schilling, Richard; Tondo, Claudio; Tsao, Hsuan-Ming; Verma, Atul; Wilber, David J.; Yamane, Teiichi
Acesso aberto (Open Access)
2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary
(Springer, 2017) Calkins, Hugh; Hindricks, Gerhard; Cappato, Riccardo; Kim, Young-Hoon; Saad, Eduardo B.; Aguinaga, Luis; Akar, Joseph G.; Badhwar, Vinay; Brugada, Josep; Camm, John; Chen, Peng-Sheng; Chen, Shih-Ann; Chung, Mina K.; Nielsen, Jens Cosedis; Curtis, Anne B.; Davies, D. Wyn; Day, John D.; d'Avila, Andre; de Groot, N. M. S. (Natasja); Di Biase, Luigi; Duytschaever, Mattias; Edgerton, James R.; Ellenbogen, Kenneth A.; Ellinor, Patrick T.; Ernst, Sabine; Fenelon, Guilherme [UNIFESP]; Gerstenfeld, Edward P.; Haines, David E.; Haissaguerre, Michel; Helm, Robert H.; Hylek, Elaine; Jackman, Warren M.; Jalife, Jose; Kalman, Jonathan M.; Kautzner, Josef; Kottkamp, Hans; Kuck, Karl Heinz; Kumagai, Koichiro; Lee, Richard; Lewalter, Thorsten; Lindsay, Bruce D.; Macle, Laurent; Mansour, Moussa; Marchlinski, Francis E.; Michaud, Gregory F.; Nakagawa, Hiroshi; Natale, Andrea; Nattel, Stanley; Okumura, Ken; Packer, Douglas; Pokushalov, Evgeny; Reynolds, Matthew R.; Sanders, Prashanthan; Scanavacca, Mauricio; Schilling, Richard; Tondo, Claudio; Tsao, Hsuan-Ming; Verma, Atul; Wilber, David J.; Yamane, Teiichi
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Absence of Association between TNF-alpha Polymorphism and Cerebral Large-Vessel Abnormalities in Adults with Sickle Cell Anemia
(Karger, 2011-01-01) Vicari, Perla [UNIFESP]; Silva, Gisele Sampaio [UNIFESP]; Elko Nogutti, Maria Aparecida [UNIFESP]; Moreira Neto, Faustino [UNIFESP]; Santos, Normelia Jesus dos [UNIFESP]; Massaro, Ayrton Roberto [UNIFESP]; Figueiredo, Maria Stella [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Stroke is a serious complication of sickle cell anemia (SCA) affecting children and adults. Recent reports suggested that tumor necrosis factor-alpha (TNF-alpha) (-308) polymorphism is an important risk factor for stroke in children with SCA. the role of TNF-alpha polymorphism in the frequency of brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) abnormalities in adults with SCA is still uncertain. Our objective was to evaluate the frequency of INF-alpha polymorphism in adults with SCA and to correlate it to brain MRI and MRA findings. TNF-alpha (-308) polymorphism was determined in 49 adults with SCA. All subjects were evaluated with brain MRI/MRA to establish the presence of intracranial abnormalities. Thirty-three (67.3%) had abnormal brain MRA scans, 8 (16.3%) had intracranial stenosis and 29 (59.2%) showed arterial tortuosity. Forty-one (83.7%) had the GG genotype and 8 had the GA genotype. There was no correlation between homozygosity for G allele and MRA or MRI abnormalities. Although INF-alpha (-308) polymorphism is a potential predictor of the genetic risk for stroke in children, we found no association between the polymorphism and large vessel abnormalities in adults with SCA. Copyright (C)2010 S. Karger AG, Basel
Acesso aberto (Open Access)
Acidentes vasculares encefálicos em pediatria
(Sociedade Brasileira de Pediatria, 2009-12-01) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Santa Catarina Unidade de Terapia Intensiva Pediátrica; Hospital Pronto-Socorro Infantil Sabará Unidade de Terapia Intensiva Pediátrica; Universidade de São Paulo (USP)
OBJECTIVES: To summarize 1) the definitions and epidemiological features of stroke in children; 2) the main risk factors that can lead to stroke in pediatrics and neonatology; 3) the main pathophysiological features involved in the genesis of brain injury in stroke; 4) the clinical manifestations and imaging diagnosis; and 5) the latest recommendations concerning the support measures, treatment, and prophylaxis of stroke in children. SOURCES: A review of the literature published in PubMed, EMBASE, and SciELO databases using the search terms stroke, pediatrics, and neonatology was performed, including relevant references from the chosen texts. SUMMARY OF THE FINDINGS: Stroke in children are rare conditions, with incidence rates among two and eight per 100,000 children up to 14 years, and most cases show an underlying disease such as heart diseases, prothrombotic conditions, sickle-cell disease, and vascular malformations. There are no specific guidelines currently in place for the treatment of stroke in children, although central elements include support treatment, monitoring, and anticoagulation as secondary prevention in certain cases. Prognosis depends on the extent of brain damage and the underlying disease but recurrence rates are high in most cases. CONCLUSIONS: Early diagnosis of stroke in children is very important and pediatricians should be aware of the lack of specificity of the symptoms to avoid late sequelae and improve life quality.
Acesso aberto (Open Access)
Angiotensin II antagonists: clinical experience in the treatment of hypertension, prevention of cardiovascular outcomes and renal protection in diabetic nephropathy and proteinuria
(Sociedade Brasileira de Endocrinologia e Metabologia, 2006-04-01) Ribeiro, Artur Beltrame [UNIFESP]; Gavras, Haralambos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); University School of Medicine Hypertension and Atherosclerosis Section
Angiotensin II antagonists (AIIAs) were introduced to treat hypertension about 10 years ago. During this period they were evaluated not only in terms of efficacy and safety but also in several large studies with clinical outcomes. They are efficacious in all clinical forms of hypertension and are effective also in all ethnic groups. Cardiovascular and renal protection in proteinuric diabetic nephropathy beyond blood pressure reduction was proved in major clinical studies: Losartan Intervention For Endpoint reduction in hypertension study (LIFE), Reduction of Endpoint in Non-Insulin dependent Diabetes Mellitus with the AII Antagonist Losartan (RENAAL) and Irbesartan Type 2 Diabetic Nephropathy Trial (IDNT). Their blood pressure independent protective effect is also mentioned by the blockade of AT1 receptor. As a class AIIs have a tolerability profile similar to placebo.
Acesso aberto (Open Access)
Aplicação da terapia por contensão induzida em pacientes com acidente vascular cerebral em território da artéria cerebral média
(Universidade Federal de São Paulo (UNIFESP), 2005) Diniz, Leila [UNIFESP]; Massaro, Ayrton Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objetivo: Este estudo piloto procurou revisar a metodologia e discutir a aplicação da Terapia por Contensão Induzida (TCI) nos pacientes com acidente vascular cerebral isquêmico (AVCI) crônico, em um centro de reabilitação brasileiro. Método: Uma ampla revisão da literatura médica foi realizada para adaptar esta técnica em nosso meio. Foram selecionados 10 pacientes que se submeteram a 6 horas de tratamento por duas semanas consecutivas. Entre os critérios de seleção destacam-se AVCI em território da artéria cerebral média. Nestes 14 dias os pacientes foram submetidos a atividades motoras repetitivas utilizando o membro superior parético, enquanto o membro não parético era mantido com um dispositivo de contenção. Resultados: Houve melhora significativa no déficit motor do membro superior parético e concomitante melhora na resposta ao Teste de Função Motora de Wolf. Conclusão: Esta nova técnica de reabilitação específica para pacientes com déficit motor moderado em membro superior parético é viável em nosso país. Nosso estudo sugere que a dominância e tempo de lesão têm um efeito modificador sobre o tratamento em pacientes com lesão isquêmica crônica no território da artéria cerebral média.
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Atypical manifestations in Brazilian patients with neuro-Behcet's disease
(Springer, 2012-06-01) Dutra, Livia Almeida [UNIFESP]; Goncalves, Celio Roberto; Braga-Neto, Pedro [UNIFESP]; Pedroso, Jose Luiz [UNIFESP]; Gabbai, Alberto Alain [UNIFESP]; Barsottini, Orlando Graziani Povoas [UNIFESP]; Silva de Souza, Alexandre Wagner [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Israelita Albert Einstein; Universidade de São Paulo (USP)
Type and frequency of systemic and neurologic manifestations of Beh double dagger et's disease (BD) vary with ethnicity. in Brazil, BD occurs as sporadic cases. We describe clinical and radiological features of 36 Brazilian patients of mixed ethnicity with neuro-Beh double dagger et's disease (NBD). Medical records of 178 BD patients were reviewed and 36 (20%) NBD patients were identified. Twenty-one NBD patients (58.3%) were female and 27 (75%) presented with parenchymal manifestations. Brainstem involvement was the most common neurologic syndrome (41.7%). Seizures (27.8%), isolated aseptic meningitis (16.7%), optic neuropathy (ON) (16.7%), cerebral venous thrombosis (CVT) (8.3%), peripheral neuropathy (2.8%), and spinal cord involvement (5.6%) were other neurologic manifestations observed among Brazilian NBD patients. Eighteen (50%) had at least one relapse, and isolated aseptic meningitis was the most common relapsing manifestation. No significant differences concerning the number of relapses between parenchymal and non-parenchymal groups were found. A multivariate model including disease duration, cell count in spinal fluid, cyclosporine use, immunosuppressive use at disease onset, age at NBD onset, and ON did not reveal any significant associations with NBD relapse. There was a low frequency of CVT and an unexpected higher number of isolated aseptic meningitis. Brazilian NBD patients present more parenchymal and atypical manifestations, and relapse more often than NBD patients from other populations.
Acesso aberto (Open Access)
Avaliação clínica da relação entre postura, respiração e deglutição em paciente pós-acidente vascular cerebral na fase crônica: relato de caso
(CEFAC Saúde e Educação, 2013-10-01) Simão, Sináira Santos Seixas; Romero, Vivian Urbanejo; Baraldil, Karen; Oda, Adriana Leico; Viana, Celiana Figueiredo [UNIFESP]; Chiappetta, Ana Lúcia de Magalhães Leal [UNIFESP]; Pieri, Alexandre [UNIFESP]; Universidade de São Paulo (USP); Centro Universitário São Camilo; Universidade Nove de Julho; Universidade Federal de São Paulo (UNIFESP)
The Stroke is a neurological disorder that disables more adults. The breathing, posture and swallowing have a direct relationship in this disease, thus requiring a multidisciplinary approach. The goal of this study was to conduct a clinical evaluation integrated to analyze the relationship between these disorders. This case is a female patient aged 37 with six years of diagnosis of ischemic stroke with right hemiparesis complete predominantly crural, hypertension, dysphagia and dysarthrophonia. In history, reported symptoms related to dyspnea, pain in the lumbar spine, the presence of coughing and choking and drooling to food, especially during the speech. The patient has scoliosis, thoracic kyphosis and abdominal weakness. The evaluation showed a respiratory expiratory force below the expected range. The peak cough flow is lower than expected, demonstrating not have the strength to cough. The research revealed changes in speech increased time to eat, need to drink to help swallow solid food before any leaks, the need for multiple swallows due to the sense of stasis in laryngeal-pharyngeal cavity and decreased taste and thick and viscous saliva. Using physical and speech therapy evaluations, we concluded that a patient with stroke in chronic respiratory presents alterations that may prevent it from effectively protecting the lower airways, which, added to postural changes and swallowing show the importance of integrated assessment for future therapeutic interventions more effective.
Acesso aberto (Open Access)
Brazilian Guidelines for transcranial doppler in children and adolescents with sickle cell disease
(Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular, 2011-02-01) Lobo, Clarisse Lopes de Castro; Cançado, Rodolfo Delfini; Leite, Ana Claudia Celestino Bezerra; Anjos, Ana Claudia Mendonça dos; Pinto, Ana Cristina Silva; Matta, Andre Palma da Cunha; Silva, Célia Maria; Silva, Gisele Sampaio [UNIFESP]; Friedrisch, João Ricardo; Braga, Josefina Aparecida Pellegrini [UNIFESP]; Lange, Marcos Christiano; Figueiredo, Maria Stella [UNIFESP]; Rugani, Marília Álvares; Veloso, Orlando; Moura, Patrícia Gomes; Cortez, Paulo Ivo; Adams, Robert; Gualandro, Sandra Fátima Menosi; Castilho, Shirley Lopes de; Thomé, Ursula; Zetola, Viviane Flumignan; Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti; Faculdade de Ciências Médicas da Santa Casa de São Paulo; Fundação de Hematologia e Hemoterapia de Pernambuco; Universidade de São Paulo (USP); Fundação Hemocentro; Fundação Centro de Hematologia e Hemoterapia de Minas Gerais; UFRGS Hospital de Clínicas de Porto Alegre Serviço de Hematologia e Transplante de Medula Óssea; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Paraná Hospital de Clínicas Serviço de Neurologia; Ecodopler Laboratório; Universidade Federal do Rio de Janeiro Instituto de Puericultura e Pediatria Martagão Gesteira; Medical University of South Carolina
BACKGROUND: Sickle cell disease is the most common monogenic hereditary disease in Brazil. Although strokes are one of the main causes of morbidity and mortality in these patients, the use of transcranial Doppler to identify children at risk is not universally used. OBJECTIVE: To develop Brazilian guidelines for the use of transcranial Doppler in sickle cell disease children and adolescents, so that related health policies can be expanded, and thus contribute to reduce morbidity and mortality. METHODS: The guidelines were formulated in a consensus meeting of experts in transcranial Doppler and sickle cell disease. The issues discussed were previously formulated and scientific articles in databases (MEDLINE, SciELO and Cochrane) were carefully analyzed. The consensus for each question was obtained by a vote of experts on the specific theme. RESULTS: Recommendations were made, including indications for the use of transcranial Doppler according to the sickle cell disease genotype and patients age; the necessary conditions to perform the exam and its periodicity depending on exam results; the criteria for the indication of blood transfusions and iron chelation therapy; the indication of hydroxyurea; and the therapeutic approach in cases of conditional transcranial Doppler. CONCLUSION: The Brazilian guidelines on the use of transcranial doppler in sickle cell disease patients may reduce the risk of strokes, and thus reduce the morbidity and mortality and improve the quality of life of sickle cell disease patients.
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Descrição De Uma Série De Pacientes Com Acidente Vascular Cerebral Isquêmico E Doença De Chagas Com Foco Nos Subtipos Etiológicos Da Classificação De Toast (Trial Of Org 10172 In Acute Stroke Treatment) E Causative Classification System For Ischemic Stroke
(Universidade Federal de São Paulo (UNIFESP), 2017-02-23) Bezerra, Rodrigo De Paiva [UNIFESP]; Silva, Gisele Sampaio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
INTRODUCTION: The cardioembolic strokes accounts for about a fifth of ischemic strokes. In Brazil, Chagas disease (CD) is still an endemic disease among patients and nearly half are diagnosed only after the first stroke. Cardiac involvement in CD is close to 20% and these carriers of Chagas cardiomyopathy have 60% risk of heart embolism compared to those without cardiac involvement. In addition, the presence of traditional cardiovascular risk factors increases the chances of ischemic events. However, not all patients with Chagas disease present stroke of cardioembolic etiology. Thus, determination of the etiology of the key stroke is secondary prophylaxis for the better treatment to these patients and, thus, prevent further damage brain. OBJECTIVES: To evaluate the correlation between the systems of classifications of ischemic stroke TOAST and CCS in patients with Chagas disease. METHODS: Thirty-two patients followed in the clinic of Vascular Neurology at the Federal University of São Paulo from June 2012 to March 2015 were submitted to a structured questionnaire to the traditional etiological ratings TOAST and CCS, as well as clinical and epidemiological aspects; It used the kappa statistical analysis to evaluate the correlation between the etiologic subtypes. RESULTS: Among the 32 patients (mean age 62.7 +/- 10,1anos) patients with stroke and DC, at least one risk factor was found in 93.8%, and high blood pressure (87.5%) and cardiac failure (65.6%) were the most frequent. Regarding TOAST classified as cardioembolic 87.5%, 9.4% as large artery atherosclerosis and 3.1% as undetermined etiology. Using CCS 62.5% classified as apparent cardio-embolism and 15.6% as possible, 6.3% as occlusion of small arteries and 3.1% as probable. Atherosclerosis of large vessels clear 12.5%. No patients classified as undetermined with CCS. The complete agreement between TOAST and CCS was moderate (k 0.59). Among the subtypes espefícicos agreement for atherosclerosis of large arteries was excellent (k 0.84), good for cardio-embolism (k 0.67) and zero for occlusion of small arteries. CONCLUSION: The agreement between the CCS classification systems and TOAST in patients with CD was only moderate. The use of a classification system with a xvi structured assessment based on evidence established in the literature as the CCS in patients with AD and ischemic stroke is important to target therapeutic interventions and avoid unnecessary anticoagulation in the long run.
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Dissecção espontânea das artérias carótidas e vertebrais: aspectos clínicos e de neuroimagem
(Universidade Federal de São Paulo (UNIFESP), 2006) Pieri, Alexandre [UNIFESP]; Massaro, Ayrton Roberto [UNIFESP]
Introdução: A dissecção espontânea das artérias cervicais é considerada uma causa rara e pouco conhecida de acidente vascular cerebral, particularmente nos países com população multiétnica. Objetivo: O presente estudo teve como objetivo avaliar as características clínicas e de neuroimagem dos pacientes com dissecção espontânea das artérias cervicais em uma população multiétnica. Métodos: Foram estudados 66 pacientes com diagnóstico de dissecção espontânea das artérias cervicais em dois hospitais terciários de São Paulo-Brasil. Foi aplicado um questionário inicial e os pacientes foram seguidos prospectivamente. Resultados: Dos pacientes estudados, 82 por cento eram brancos, 53 por cento eram homens e a média de idade foi de 41,7 (20-62) anos. Os fatores de risco cardiovasculares mais freqüentes foram hipertensão arterial e tabagismo, presentes em 38 e 51 por cento respectivamente. História prévia de enxaqueca foi identificada em 34 (51 por cento) pacientes. Cefaléia foi o sintoma de apresentação mais comum, descrito por 91 por cento dos pacientes. A angiografia por ressonância magnética foi diagnóstica em 94 por cento dos pacientes com dissecção de artéria carótida. O tratamento inicial mais comumente utilizado foi a anticoagulação, em 58 por cento dos pacientes. Um prognóstico favorável foi observado em 74 por cento dos pacientes e houve apenas um óbito nos 6 meses de seguimento. Recanalização arterial em 6 meses foi detectada em 53 por cento dos pacientes e recidiva foi observada em apenas 3 pacientes. Conclusão: Apesar de a população estudada ser multiétnica, houve um marcante predomínio de pacientes brancos. A análise das características clínicas e de neuroimagem dos pacientes com dissecção espontânea das artérias cervicais possibilita um melhor conhecimento da doença, levando a um diagnóstico precoce e tratamento mais adequado.
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Distância base de língua - parede posterior da faringe, aspiração laringotraqueal e resíduos faríngeos pós acidente vascular cerebral
(Universidade Federal de São Paulo (UNIFESP), 2021) Zica, Guilherme Maia [UNIFESP]; Goncalves, Maria Ines Rebelo [UNIFESP]; Universidade Federal de São Paulo
Objective: To investigate the association between base tongue-posterior pharyngeal wall distance (BT-PPW) at rest with supraglottic penetration, laryngotracheal aspiration and pharyngeal residues in individuals after stroke. Method: Descriptive, cross-sectional and retrospective study of swallowing videofluoroscopy exams in 56 patients with medical diagnosis of stroke and a control group with 84 individuals. The distance between the base of the tongue and the posterior wall of the pharynx at rest was measured using the Image J program. The measure found was correlated with the sociodemographic characteristics and the clinical findings of swallowing. Results: Regarding the BT-PPW measures, statistical significance was observed in relation to gender; male patients had greater distance means than female patients (M>F). Regarding the BT-PPW measures, statistical significance was observed in relation to age; being that elderly patients had greater distance means than adult patients (elderly>adults). Conclusions: Male patients had significantly greater distance means than female patients (M>F). Elderly patients had significantly higher mean distances than adult patients (elderly>adults). There were no statistically significant correlations in relation to the BT-PPW distance with the swallowing findings (penetration, aspiration and residues).
Acesso aberto (Open Access)
Doença cerebrovascular em pacientes com síndrome do anticorpo antifosfolípide: avaliação pelo Doppler transcraniano e ressonância magnética
(Universidade Federal de São Paulo (UNIFESP), 2019-06-27) Ricarte, Irapua Ferreira [UNIFESP]; Silva, Gisele Sampaio [UNIFESP]; Dutra, Lívia Almeida [UNIFESP]; http://lattes.cnpq.br/2916631594056232; http://lattes.cnpq.br/6812788681744190; http://lattes.cnpq.br/6623012368578821; Universidade Federal de São Paulo (UNIFESP)
Introduction: The potential mechanisms by which a patient with antiphospholipid antibody syndrome (APS) can present with cerebrovascular disease are numerous, including in situ thrombosis and embolism from distant sites. Transcranial Doppler (TCD) may be a useful tool in the evaluation of patients with APS, helping to stratify the risk of cerebrovascular ischemic events in this population. The characteristics of the TCD examination and its correlations with neuroimaging tests in patients with APS had not been previously systematically evaluated. Objectives: To describe the following characteristics of TCD examination: frequency of microembolic signal (MES), frequency of right-left shunt (RLS), presence of intracranial stenosis and cerebral vasomotor reactivity in a group of patients with primary APS (PAPS) and secondary APS (SAPS) in comparison with patients with systemic lupus erythematosus (SLE) and healthy volunteers; to determine the frequency of abnormalities on brain magnetic resonance imaging (MRI) of the studied patients and to correlate these abnormalities with TCD findings; to evaluate the association between history of cerebrovascular disease and TCD findings. Methods: This was a cross-sectional study that evaluated consecutive adult patients with the diagnosis of APS (primary and secondary) comparing with a group of patients with SLE and healthy controls matched by age and sex. All patients with adequate acoustic window were evaluated with a standardized TCD protocol performed by the same neurologist, including: basic exam with evaluation of mean velocities and pulsatility indexes of the intracranial arteries; assessment of cerebral vasoreactivity through the apnea test and microbubble test for RLS detection. After TCD examination, the patients underwent brain MRI. Results: A total of 94 subjects were included in the study (27 patients with SLE, 24 patients with PAPS, 22 patients with SAPS and 21 controls). MES were more frequently found in patients with SLE when compared to controls and patients with APS (PAPS: 4.3%, SAPS: 0%, SLE: 17.4%, controles: 0%, p=0.03). Patients with APS had a higher frequency of RLS when compared to volunteers (63.6% versus 38.1%, p=0.05). Breath holding index (BHI) values tended to be lower in patients with SAPS than in control subjects and patients with PAPS and SLE (p=0.06). Brain MRI findings were similar between the groups, except for the frequency of lacunar infarction, which was higher in patients with SAPS (p = 0.022). Patients with intracranial stenosis detected by TCD had a higher frequency of territorial infarction (40% versus 7.5%, p = 0.02), lacunar infarction (40% versus 11.3%, p=0.075) and borderzone infarction (20% versus 1.9%, p=0.034). Conclusions: Patients with SLE had a higher frequency of MES than patients with APS and healthy controls, which may suggest an effect of anticoagulant therapy used in patients with APS. Patients with APS had a higher frequency of RLS when compared to the control group, which alerts for the need of cardiological investigation in patients with APS and cerebrovascular disease. The frequency of abnormalities in brain MRI was similar between groups, except for the frequency of lacunar infarction. Patients with intracranial stenosis detected by TCD presented a higher frequency of territorial, lacunar and borderzone infarcts, suggesting that the evaluation of the intracranial vasculature should not be neglected in patients with APS and stroke. Key words: antiphospholipid syndrome, transcranial Doppler, microembolic signal, stroke, magnetic resonance, intracranial stenosis, right-left shunt. Methods: This was a cross – sectional study that evaluated consecutive adult patients with the diagnosis of APS (primary and secondary) comparing with a group of patients with SLE and healthy controls matched by age and sex. All patients with adequate acoustic window were evaluated with a standardized TCD protocol performed by the same neurologist, including: basic exam with evaluation of mean velocities and pulsatility indexes of the intracranial arteries; assessment of cerebral vasoreactivity through the apnea test and microbubble test for RLS detection. After TCD examination, the patients underwent brain MRI.
Acesso aberto (Open Access)
Efeito Do Padrão Circadiano Na Reabilitação De Pacientes Após Acidente Vascular Cerebral
(Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Pereira, Debora Dias [UNIFESP]; Coelho, Fernando Morgadinho Santos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objectives: The objectives of this study were: compare pre and post-treatment, according to the Constraint-Induced Movement Therapy (CIT) assessment scales, in stroke patients regarding circadian preference, sleep quality, and risk of Obstructive Sleep Apnea Syndrome (OSAS). Methods: In a retrospective study of patients after stroke who underwent CIT only in the morning, between 2009 and 2016 in the AACD, three different approaches were divided: A- three groups, according to the circadian reference; B- in two groups depending on the risk of OSAS and C- three groups according to sleep quality. Subsequently, the difference in the functional capacity scores before and after treatment with CIT were recorded. Results: Fortythree patients, 56.93 ± 14.97 years old, 58.14% males, the Body Mass Index (BMI) was 30.33 ± 2.37 kg / m2, with rehabilitation performed 6.15 ± 4.26 years after stroke. The stroke was ischemic in 29 patients (67.44%) and hemorrhagic in 12 patients (32.56%). All CIT assessment scales improved after therapy in general. When we analyzed the circadian preferences, the evening patients (with discordant circadian preference) had less improvement after the rehabilitation than the other groups, as well as the bad sleepers had worse performance. Conclusions: Patients after stroke with discordant circadian preference had lower gain after CIT. Patients after stroke with poor sleep quality had lower improvement too. Our stroke population was relatively young, the type of stroke and it’s location were consistent with the literature and most part of them were obese. There was a long time between the event and the beginning of rehabilitation. There was no excessive daytime sleepiness in stroke patients after stroke even with poor sleep quality and higher risk of OSAS.
Acesso aberto (Open Access)
Estimulação elétrica funcional na subluxação crônica do ombro após acidente vascular encefálico: relato de casos
(Universidade de São Paulo, 2009-03-01) Corrêa, Juliana Barbosa; Borges, Heloise Cazangi [UNIFESP]; Lucareli, Paulo Roberto Garcia; Liebano, Richard Eloin; Universidade Federal de São Paulo (UNIFESP); Centro Universitário São Camilo; Universidade Cidade de São Paulo
Shoulder subluxation is a common complication among stroke survivors; it may cause pain, brachial plexus injuries, adhesive capsulitis and rotator cuff muscle injuries, leading to rehabilitation delay and interference in patients' quality of life. The purpose of this study was to assess the effects of functional electrical stimulation (FES) in post-stroke hemiplegia shoulder subluxation. Three patients with over one year of stroke onset and shoulder subluxation confirmed by X ray were assessed prior to, and after FES treatment, as to: degree of shoulder subluxation and range of motion (ROM); sensory-motor function by the Fugl-Meyer scale; and pain at rest and at passive movement by means of a visual analog scale. All patients were treated with conventional physical therapy and FES in the hemiplegic member for ten sessions. Results showed improvement in final measures of ROM and sensory-motor assessments, pain relief and shoulder subluxation reduction after treatment. FES associated to conventional physical therapy has thus proved effective in decreasing subluxation, increasing upper limb function and in relieving pain in post-stroke shoulder subluxation patients.
Acesso aberto (Open Access)
Estudo da perda dental e do sono em pacientes após acidente vascular cerebral
(Universidade Federal de São Paulo (UNIFESP), 2019-08-29) Vago, Eliana Regina Lottenberg [UNIFESP]; Coelho, Fernando Morgadinho Santos [UNIFESP]; Machado, Marco Antônio Cardoso [UNIFESP]; Juliano, Maria Ligia [UNIFESP]; http://lattes.cnpq.br/3844314810128616; http://lattes.cnpq.br/0400402653122874; http://lattes.cnpq.br/4520146294812879; http://lattes.cnpq.br/4924389076731285; Universidade Federal de São Paulo (UNIFESP)
Objective: To evaluate sleep quality, excessive daytime sleepiness, risk for obstructive sleep apnea (OSA) and the frequency of edentulism, as well as the use or not of prostheses in patients following stroke. Methods: This is a transversal and observational investigation. 130 patients’ post- stroke participated in this study. The data collected were age, sex, BMI, TOAST, NIHSS, stroke type, modified Rankin Scale, comorbidity presence such as hypertension, diabetes mellitus and smoking. We measured through the application of questionnaires quality of life (SF-36), sleep quality (PSQI), risk for OSA (STOP- BANG) and excessive daytime somnolence (ESE). Results: Of the 130 patients included, 52.32% were male. Mean age of 59.7 ± 12.53 2 years. The average BMI was 26.36 ± 5.00 kg/m . The prevalence of ischemic stroke was 94.62%. According to Rankin's scale (1.66, ± 1.15) patients were considered with minimal sequelae and were classified as independent. For sleep quality, our sample demonstrated bad sleep quality at PSQI (7.13 ± 3.84). Our participants were at high risk for OSA according to the results from STOP BANG (4.11 ± 1.57) and did not present excessive daytime somnolence as seen by the Epworth Sleepiness Scale (8.16 ± 5.22). In relation to the teeth, the patients had 9 to 31 teeth (48,86%) or were edentate (26.15%), 60.77% used total and removable prostheses and half of them slept with them. At oral cavity evaluation, patients presented Mallampati classification III and IV (14,62% e 71,54%, respectively), elongated soft palate (72,32%), both predictors of OSA. Conclusion: Patients following stroke presented poor sleep quality, high risk for OSA, high frequency of missing teeth, anatomical variations predisposing to OSA, and it was not observed that the use of prostheses during sleep has benefited patients.
Acesso aberto (Open Access)
Fatores de risco cardiovasculares em pacientes com acidente vascular cerebral isquêmico e idade maior ou igual a 80 anos
(Universidade Federal de São Paulo (UNIFESP), 2011-04-27) Pieri, Alexandre [UNIFESP]; Gabbai, Alberto Alain [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Background and Purpose – Ischemic stroke is usually a catastrophic event, mostly in the elderly. Advanced age itself is a risk factor for stroke and cardiovascular involvement is the leading cause of ischemic stroke in this age population. Atrial fibrillation is also an important risk factor for ischemic stroke and therefore risk stratification schemes are important in these patients for indicating antithrombotic therapyand prevent stroke. Low socioeconomic status is also associated with a higher risk for ischemic stroke. Objectives - To evaluate the prevalence of cardiovascular risk factors in patients with age 80 or older in a hospital population with ischemic stroke and the relationship between socioeconomic status and ischemic stroke in different age groups, using a new socioeconomic stratification model. Methods – Retrospective analysis of consecutive patients diagnosed with ischemic stroke admitted to a tertiary health facility. For this population, we described the prevalence of cardiovascular risk factors and, for the patients who had the diagnosis of atrial fibrillation, we applied CHADS2 score and CHA2DS2-VASc score. For assessment of the relationship beteween socioeconomic status and ischemic stroke, we evaluated the incidence of ischemic stroke in two hospitals that serve different socioeconomic populations in Sao Paulo, with a new geographic socioeconomic segmentation tool. The patients were stratified by socioeconomic status and age (30 to 64 years, 65 to 79 years and 80 years or older). We also compared the number of ischemic stroke patients with patients from control groups from the same hospitals, to obtain the ischemic stroke rates in both hospitals. The odds ratio between ischemic stroke rates in the hospitals was calculated. Results .There was a female preponderance (p<0.01) in 215 patients admitted for ischemic stroke. Considering patients over eighty, 72% had hypertension and atrial fibrillation was more common among the oldest old (p<0.01). Among those patients who had ischemic stroke and atrial fibrillation, no patient had CHADS2 score of 0 and 25.5% had score of 1. All patients with CHADS2 score of 1 were not under anticoagulation, but in retrospect, had CHA2DS2-VASc score . 2, i.e., with indication for oral anticoagulation. Three hundred and seventy-seven patients with ischemic stroke and 2,297 patients of control group were analyzed in both hospitals. There was a greater proportion of older patients in the higher socioeconomic status population (χ2obs= 28.7, df= 2, p-value < 0.0001). In all ages, the odds of ischemic stroke was significantly higher in patients with lower socioeconomic status than in those with higher status, with χ2obs=21.3 (p-value< 0.0001) for age 30 to 64 years; χ2obs=39.8 (p-value< 0.0001) for age 65 to 79 years; and χ2obs=14.1 (p-value= 0.0002) for ≥ 80 years patients. The odds ratios between ischemic stroke odds in both hospitals were 2.4, 3.6 and 2.7 for groups of ages 30 to 64 years, 65 to 79 years and 80 years or older, respectively. Conclusions – Hypertension and atrial fibrillation are prevalent risk factors and should be treated aggressively in the elderly. Risk stratification using CHA2DS2-VASc score would have optimized indication for oral anticoagulation in our patients. Our study showed that, in São Paulo, lower socioeconomic status is associated with a higher odds of ischemic stroke, independent of age.
Somente Metadadados
The Field Assessment Stroke Triage for Emergency Destination (FAST-ED): a Simple and Accurate Pre-hospital Scale to Detect Large Vessel Occlusion Strokes
(Lippincott Williams & Wilkins, 2016) Lima, Fabricio O.; Furie, Karen L.; Frankel, Michael H.; Silva, Gisele S. [UNIFESP]; Lev, Michael H.; Faye, Erica C.; Haussen, Diogo; Singhal, Aneesh B.; Koroshetz, Walter J.; Smith, Wase S.; Nogueira, Raul G.
Somente Metadadados
The Field Assessment Stroke Triage for Emergency Destination (FAST-ED): a Simple and Accurate Pre-hospital Scale to Detect Large Vessel Occlusion Strokes
(Lippincott Williams & Wilkins, 2016) Lima, Fabricio O.; Furie, Karen L.; Frankel, Michael H.; Silva, Gisele S. [UNIFESP]; Lev, Michael H.; Faye, Erica C.; Haussen, Diogo; Singhal, Aneesh B.; Koroshetz, Walter J.; Smith, Wase S.; Nogueira, Raul G.

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