Speech disorder and behavioral involvement in a thalamic stroke: a case report

Data from literature on clinical manifestation of thalamic strokes have been published for ages. First in 1906 Dejerine e Roussy have spoken about sensorymotor disturbances and have opened the door to new pathologic disorders that may occur after thalamic lesions. From 1925 behavior and speech disorders related with thalamic injury were described. Since then a classification of thalamic syndromes into four groups based on the four main arterial territories was accepted. As we know thalamic stroke account for 11% of vertebra basilar infarct. Inferolateral territory infarctions are the most common injury (45%), followed by the paramedian territory infarctions (35%) and the anterior territory lesions (12%), the posterior territory infarctions are less frequent (8%). Anyway lots of symptoms cannot still be classified easily and strictly into only one of this four groups and several variant topographic patterns of thalamic strokes with distinct manifestation and etiology have been proposed. Here we described the case of one young Caucasian man that was admitted to the emergency department for a sudden onset of dizziness with left lateropulsion, vertigo, visual impairment and speech disorder involving unpredictable topic shifts but grammatically correct. During recovery patient performed a typical behavior disorder consisting mainly in lack of emotion and memory long or short term loss. Magnetic resonance was performed and showed left thalamic infarction involving paramedian territory. The complex cognitive and behavioral disorders described can be explaned only supporting the already described different topographic patterns of thalamic infarctio

What does Doppler Ultrasonography Brings to the Diagnosis of Traumatic Vertebral Artery Dissection

Here we describe the case of a young woman with a late diagnosis of vertebral artery dissection and midbrain ischemic lesion after minor post traumatic injury. Doppler ultrasonography was used as the first diagnostic examination to evaluate the dissection. We present this unusual but not rare case related to the frequent events of cervical distraction after car accident in order to better understand the clinical approach the sensitivity Doppler ultrasonography in post-traumatic cervical distorsion

Case Report: Coexistence of SUNCT and Hypnic Headache in the Same Patient

Background: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and hypnic headache (HH) are two exceedingly rare and distinctly classified primary headaches. The hypothalamus seems to be a crucial region involved in the pathophysiology of both conditions, but no cases of SUNCT and HH co-occurrence have been described so far. Case results: A 49-year-old woman who has been suffering from SUNCT for years, with alternation of symptomatic periods and remissions, developed a new headache with different clinical features, presenting exclusively during sleep and with a dramatic responsiveness to caffeine, that met the diagnostic criteria for HH. Conclusions: The available literature suggests that SUNCT and HH are different conditions but the association in the same patient that we describe supports the concept that they are not mutually exclusive. Further studies are needed to establish if they share a common pathophysiological mechanism

Internacionalização de empresas SaaS: um estudo de caso da RD Station na Colômbia e no México

TCC (graduação) - Universidade Federal de Santa Catarina. Centro Sócio-Econômico. Relações Internacionais.O objetivo da presente pesquisa foi realizar o estudo da expansão internacional da RD Station na Colômbia e México, analisando como os avanços no setor de tecnologia de informação impactam na rápida internacionalização de uma empresa de Software as Service (SaaS). Para cumprir tal objetivo, a metodologia utilizada foi a revisão de bibliografia acadêmica e levantamento de dados primários. Para a revisão bibliográfica foram utilizadas as bases de dados Google Acadêmico, Scielo e Scopus, onde foram pesquisados os temas foco do trabalho, combinados por meio de pesquisa booleana, em artigos publicados nos últimos dez anos preferencialmente e nos idiomas português e inglês. Para o levantamento de dados primários, foram realizadas entrevistas com funcionários envolvidos diretamente com o processo de internacionalização da empresa, tendo como instrumento de coleta de dados o questionário semiestruturado e como procedimento de análise dos dados a análise de conteúdo. De forma complementar, foi realizada coleta de informações no website da RD Station e em documentos internos não sigilosos da empresa. Além disso, foram transcritas e analisadas entrevistas com o CEO-fundador da RD Station, Eric Santos, e retiradas as informações pertinentes para este estudo. Por meio da pesquisa realizada foi possível concluir que, por mais que empresas totalmente digitalizadas possuam vantagens para internacionalizar de maneira acelerada, há outras variáveis que afetam a estratégia de internacionalização da empresa, como modelo de negócio, complexidade do produto e avaliação de vantagens intangíveis.The aim of this research was to study the international expansion of RD Station in Colombia and Mexico, analyzing how advances in the information technology sector impact the rapid internationalization of a Software as Service (SaaS) company. To achieve this objective, the methodology used was the review of academic bibliography and survey of primary data. For the bibliographic review, the Google Scholar, Scielo and Scopus databases were used, where the focus themes of the work were researched, combined by means of Boolean research, in articles published in the last ten years, preferably in Portuguese and English. For the survey of primary data, interviews were conducted with employees directly involved in the company's internationalization process, using the semi-structured questionnaire as the data collection instrument and the content analysis as the data analysis procedure. In addition, information was collected on the RD Station website and on non-confidential internal documents of the company. Furthermore, interviews with RD Station's CEO and co-founder Eric Santos were transcribed and analyzed, and the relevant information for this study was collected. Through the research carried out it was possible to conclude that, even though fully digitalized companies have advantages to accelerate internationalization, there are other variables that affect the company's internationalization strategy, such as business model, product complexity and evaluation of intangible advantages

Contralesional Cathodal versus Dual Transcranial Direct Current Stimulation for Decreasing Upper Limb Spasticity in Chronic Stroke Individuals: A Clinical and Neurophysiological Study

Background Different transcranial direct current stimulation (tDCS) paradigms have been implemented to treat poststroke spasticity, but discordant results have been reported. Objective This study aimed to determine the efficacy and persistence of dual tDCS (anode over affected motor cortex [M1] and cathode over contralateral M1) compared with cathodal tDCS (cathode over contralateral M1) on upper limb (UL) functional, behavioral, and neurophysiological measures in chronic poststroke individuals. Subjects and Methods Ten subjects with UL spasticity (7 men; mean 62 years; 8 ischemic stroke; years from event: 2.3 years) were enrolled in a cross-over, double-blinded study. Cathodal and dual tDCS, both preceded by 1 week of sham stimulation 1 month before real stimulation, were applied with 3 months interval. Stimulating paradigm was 20 minutes for five consecutive days in each block. Evaluations were performed before (T1), after real or sham treatment (T2), and after 1 (T3), 4 (T4), and 8 weeks (T5). Functional, behavioral, and neurophysiological tests were performed at each time. Results Both tDCS paradigms decreased spasticity, increased strength, and ameliorated behavioral scales. Cathodal tDCS was superior to dual tDCS in reducing UL distal spasticity immediately after treatment (T2: cathodal > dual: P = .023) and provided a higher and longer lasting reduction at proximal districts (T3: cathodal > dual: P = .042; T4: cathodal > dual: P = .028; T5: cathodal > dual: P = .05). These findings are supported by an H-reflex modulation (overall time effect P > .002). Conclusions Cathodal tDCS is slightly more effective than dual tDCS in reducing distal UL spasticity in chronic poststroke subjects. A modulation of spinal inhibitory mechanisms, demonstrated by H-reflex modifications, supports this finding

Very High-Resolution Ultrasound of the Distal Median Nerve

Objective: A very high-resolution (70 MHz) ultrasound device (VHRUS) has recently been approved for use in humans. The aim of this study was to use VHRUS to collect data on healthy subjects to propose some reference values for the digital branches of the median nerves of the hand. Methods: A VHRUS with 70 MHz linear array transducer was used to measure the cross sectional area of the median nerve at the wrist (CSAw) and digital branches (CSAf), largest and smallest fascicles, the fascicles number (Nfasc), the fascicle density (FD), the flattening ratio (FR) and CSAw/CSAf. Results: Data from 20 healthy subjects were obtained for both hands. The median nerve at the wrist and digital branches were properly identified without anatomical alterations. No differences were found between the right and the left hand. In the dominant hand, CSAw was 9.35 mm2 (4.57-12.35) and Nfasc was 24 (18-38). FD and FR were respectively 2.94 (2.47-4.91) and 2.74 (1.70-4.90). Conclusion: VHRUS technology can visualize the median nerves at the wrist, their internal structure and their small branches at the fingers, providing both a qualitative and quantitative assessment. Results from this study provide preliminary reference values in a young healthy sample. Significance: Most conventional ultrasound devices are not able to properly visualize the distal branches of the median nerve. In contrast, VHRUS allows to detect and measure smaller structures of the nerve, assisting in clinical practice

evaluation of botulinum toxin therapy of spastic equinus in paediatric patients with cerebral palsy

Objective: To develop a clinical and instrumental protocol to assess the postural and dynamic effects following treatment with botulinum neurotoxin A in children with cerebral palsy affected by spastic equinus. Design: Open study, in which every patient served as his or her own control. Patients: Ten sequential children with cerebral palsy and spastic dynamic equinus foot. Methods: Botulinum neurotoxin A was injected in the gastrocnemius, soleus and tibialis posterior muscles. The main measures were: pedobarometry, dynamic surface electromyography, video gait analysis scale, and the modified As hworth Scale. Results: After treatment with botulinum neurotoxin A, pedobarometric evaluation revealed a significant change in all parameters, including a decrease in the modified Ashworth Scale and an increase in the range of motion. All children showed significant improvement in initial foot contact, as documented by the video gait analysis scale. The calf muscle electromyography pattern showed a decrease in co-contraction during gait in all children. These modifications were sta tistically significant for all parameters considered ( p < 0.05). Conclusion: This pilot study suggests that dynamic electr

Sleep brain networks and sleep depth during somatosensory stimulation

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Prion and prion-like protein strains: Deciphering the molecular basis of heterogeneity in neurodegeneration

Increasing evidence suggests that neurodegenerative disorders share a common pathogenic feature: The presence of deposits of misfolded proteins with altered physicochemical properties in the Central Nervous System. Despite a lack of infectivity, experimental data show that the replication and propagation of neurodegenerative disease-related proteins including amyloid-\u3b2 (A\u3b2), tau, \u3b1-synuclein and the transactive response DNA-binding protein of 43 kDa (TDP-43) share a similar pathological mechanism with prions. These observations have led to the terminology of "prion-like" to distinguish between conditions with noninfectious characteristics but similarities with the prion replication and propagation process. Prions are considered to adapt their conformation to changes in the context of the environment of replication. This process is known as either prion selection or adaptation, where a distinct conformer present in the initial prion population with higher propensity to propagate in the new environment is able to prevail over the others during the replication process. In the last years, many studies have shown that prion-like proteins share not only the prion replication paradigm but also the specific ability to aggregate in different conformations, i.e., strains, with relevant clinical, diagnostic and therapeutic implications. This review focuses on the molecular basis of the strain phenomenon in prion and prion-like proteins