7 research outputs found
Neurological diagnoses in the emergency room: differences between younger and older patients
MielinĂłlise pontina central e extra-pontina em paciente alcoolista sem distĂșrbios hidro-eletrolĂticos: relato de caso
Movement disorders secondary to long-term treatment with cyclosporine A Transtornos do movimento secundĂĄrios ao tratamento prolongado com ciclosporina A
OBJECTIVE: To analyze the prevalence, severity and functional interference of movement disorders (MD) secondary to chronic use of cyclosporine A (CsA). METHOD: We conducted a cross-sectional study of 60 patients (58.3% male) with mean age 23.1 (3-75) years, followed at the Bone Marrow Transplantation Service of the Hospital de ClĂnicas of the Federal University of ParanĂĄ, Brazil, taking CsA for at least six months. Our protocol included clinical data, assessment of functional interference of symptoms and neurological examination including observation and grading of MD. RESULTS: Eight (13.3%) subjects reported the presence of tremor at the moment of interview and 29 (48.3%) recalled this symptom at some point during treatment. Neurological examination identified 14 (23.3%) subjects with MD: upper limb symmetric action tremor in 13 (21.6%) and parkinsonism (rigidity and bradykinesia) in 1 (1.7%). No other MD was detected. The mean scores indicated mild clinical signs in all cases. Symptoms were considered subjectively mild with no functional interference. CONCLUSION: Almost one quarter of patients using CsA chronically presented MD, almost always mild and transitory action tremor, with minimal interference on daily living activities, not requiring any form of intervention in the majority of cases.OBJETIVO: Analisar a prevalĂȘncia, gravidade e interferĂȘncia funcional de transtornos do movimento (TM) secundĂĄrios ao uso crĂŽnico de ciclosporina A (CsA). MĂTODO: Realizamos um estudo transversal em 60 pacientes (58.3% do sexo masculino) com idade mĂ©dia de 23.1 (3-75) anos, acompanhados pelo Serviço de Transplante de Medula Ăssea do Hospital de ClĂnicas da Universidade Federal do ParanĂĄ, usando CsA por pelo menos seis meses. A avaliação incluiu dados clĂnicos, interferĂȘncia funcional de possĂveis sintomas e exame neurolĂłgico incluindo observação e graduação de TM. RESULTADOS: Oito (13.3%) entrevistados relataram tremor no momento da entrevista e 29 (48.3%) em alguma fase do tratamento. O exame neurolĂłgico identificou 14 (23.3%) pacientes com TM: 13 (21.6%) tremor de ação simĂ©trico de membros superiores e em 1 (1.7%) parkinsonismo (rigidez e bradicinesia). Nenhum outro TM foi detectado. Os escores mĂ©dios indicaram quadros leves em todos os casos. Os sintomas foram tambĂ©m considerados subjetivamente leves e sem interferĂȘncia funcional. CONCLUSĂO: Quase um quarto dos pacientes usando CsA cronicamente apresenta TM, quase sempre tremor de ação leve e transitĂłrio, interferindo pouco funcionalmente, nĂŁo requerendo intervenção na maioria dos casos
Neurological diagnoses in the emergency room: differences between younger and older patients
Neurological diseases are prevalent in the emergency room (ER). The aim of this study was to compare the neurological diagnoses between younger and older patients evaluated in the ER of a tertiary care hospital. METHOD: Patients admitted to the ER who required neurological evaluation in the first 24 hours were separated into two groups based on age, 50 years old. RESULTS: Cerebrovascular disease (59.6% vs. 21.8%, p50 years old group. Seizures (8.1% vs. 18.6%, p<0.01) and primary headache (3.7% vs. 11.4%, p<0.01) were most frequent in the <;50 years old group. CONCLUSION: The current study demonstrated that these three neurological diagnoses represented the majority of the neurological evaluations in the ER. National guidelines for ER teams that treat these prevalent disorders must be included in clinical practice and training
Cerebrotendinous xanthomatosis: report of two Brazilian brothers.
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58819.pdf (publisher's version ) (Open Access)Cerebrotendinous xanthomatosis is a treatable rare autossomal recessive disease characterized by lipid storage secondary to a sterol 27-hydroxylase deficiency in the formation of cholic and chenodeoxycholic acids. We describe two Brazilian brothers with cognitive impairement and chronic diarrhea. One of them also presents bilateral cataracts. Neurological findings were progressive walking deficit, limb ataxia and pyramidal signs. Both patients had bilateral Achilles tendon xanthomata. Magnetic resonance image showed signal alterations in cerebellar hemispheres. We describe these cases with molecular genetic analysis confirming diagnosis and comparing with previous literature. The CYP27A1 gene study showed a C1187T mutation on exon 6
Cognitive function assessment in idiopathic Parkinson's disease Avaliação da função cognitiva em doença de Parkinson idiopåtica
Idiopathic Parkinsonâs disease (PD) is characterized by reduced nigrostriatal and cortical dopaminergic influence, with changes in movement and, subsequently, behavioral and cognitive disturbances. We studied cognitive impairment in Parkinsonâs disease by assessing a group of 30 idiopathic Parkinsonâs disease patients with an average age of 64.23 years (PG group) and compared our findings with those for a control group of 30 patients (CG group). All the patients were submitted to the following assessments: motor function, using the UPDRS; staging, using the Hoehn-Yahr scales (PG group only); depression, using the Montgomery-Asberg scale; attention impairment; verbal fluency (FAR and animals); cognitive function, using the Mini Mental State Examination; visuospatial and executive functions; and clock drawing. In addition to altered motor function in PD patients, we found statistically significant differences between PD patients and controls in terms of cognitive function, verbal, executive and visuospatial functions, and attention deficits. Depression was more prevalent in the PG group.<br>A doença de Parkinson idiopĂĄtica (DP) caracteriza-se pela redução da influĂȘncia dopaminĂ©rgica nigroestriatal e cortical, com alteraçÔes em movimentos e posteriormente, comportamentais e cognitivas. Estudamos o comprometimento cognitivo de pacientes portadores de DP, avaliando 30 pacientes com doença de Parkinson idiopĂĄtica (GP) com mĂ©dia de idade de 64,23 anos e os comparamos com um grupo controle (GC) de 30 pacientes. Todos os pacientes foram submetidos as seguintes avaliaçÔes: motora pela escala de UPDRS; estadiamento pela escala de Hoehn-Yahr (somente GP); depressĂŁo pela escala de Montgomery-Asberg; comprometimento da atenção; fluĂȘncia verbal (FAR e animais); função cognitiva pelo Mini Exame do Estado Mental; funçÔes visuoespaciais e executivas e desenho do relĂłgio. ConcluĂmos que na DP os pacientes apresentam alĂ©m das alteraçÔes motoras diferenças estatisticamente significativas a nĂvel cognitivo, na função verbal, funçÔes executivas, visuoespaciais e distĂșrbios de atenção. DepressĂŁo foi mais prevalente no GP