Curitiba acute ischemic stroke protocol: a university hospital and EMS initiative in a large Brazilian city

Few healthcare centers in Brazil perform thrombolytic therapy for acute ischemic stroke (AIS) patients. OBJECTIVE: The aim of this study was to describe an interinstitutional protocol for the rapid identification and thrombolytic treatment of AIS patients at a public health hospital in a large Brazilian city. METHOD: Emergency medical services (EMS) personnel evaluated 433 patients with possible stroke during a six-month period. After a standard checklist, patients with suspected AIS and symptoms onset of less than two hours were evaluated at our University Hospital (UH). RESULTS: Sixty-five (15%) patients met the checklist criteria and had a symptom onset of less than two hours, but only 50 (11%) patients were evaluated at the UH. Among them, 35 (70%) patients had ischemic stroke, 10 (20%) had hemorrhagic stroke, and 5 (10%) had other diagnoses. Of the 35 ischemic stroke patients, 15 (43%) underwent IV thrombolysis. CONCLUSION: The present study demonstrated that trained EMS workers could help to improve the rate of thrombolytic treatment in large Brazilian cities. Permanent training programs for EMS and hospital staff, with quality control and correct identification of AIS patients, should be implemented to increase appropriate thrombolytic therapy rates in Brazil

Hematoma intraparenquimatoso cerebral espontâneo: aspectos à tomografia computadorizada Spontaneous cerebral intraparenchymatous hematoma: computed tomography findings

OBJETIVO: Identificar os aspectos mais freqüentes do hematoma intraparenquimatoso cerebral espontâneo observados na tomografia computadorizada. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, os exames de tomografia computadorizada de 250 pacientes com hematoma intraparenquimatoso cerebral espontâneo, provenientes de três diferentes hospitais da cidade do Rio de Janeiro. RESULTADOS: O hematoma intraparenquimatoso cerebral profundo foi o de maior incidência, equivalendo a 54,4% (136 casos), seguido do lobar com 34,8% (87 casos). Mais raramente, observou-se sangramento cerebelar em 8,4% (21 casos) e do tronco cerebral em 2,4% (seis casos) dos pacientes. CONCLUSÃO: A cefaléia foi o sintoma mais comum e a hipertensão arterial foi o sinal mais freqüentemente apresentado. A drenagem do hematoma para o sistema ventricular ocorreu mais comumente nos hematoma profundos.<br>OBJECTIVE: To identify the most frequent aspects of spontaneous cerebral intraparenchymatous hematoma found at computed tomography examinations. MATERIALS AND METHODS: We reviewed, retrospectively, the computed tomography studies of 250 patients with spontaneous intracerebral hemorrhage carried out in three hospitals in Rio de Janeiro, Brazil. RESULTS: Deep intracerebral hematomas showed the highest incidence and were observed in 54.4% of the cases (136 patients) followed by lobar hemorrhage in 34.8% of the cases (87 patients). Cerebelar hemorrhage and brainstem bleeding were more rarely observed, occurring in 8.4% (21 patients) and 2.4% (six patients) of the cases, respectively. CONCLUSION: Chronic headache was the most frequent symptom whereas hypertension was observed in the majority of the cases. Blood draining into the ventricular system occurred more frequently in patients with deep hematomas

Diagnostic methods for extra-temporal neocortical focal epilepsies: present and future Métodos diagnósticos das epilepsias focais neocorticais extratemporais: presente e futuro

The progress of epilepsies diagnosis has been great, but, amongst the diagnostic detailing that demand research, one of the most important is the essential lateralization and localization of epileptogenic zone, considered as the cerebral cortex region, that removed, will result in a free state of seizures. The present study aims to analyze the possible uses of proton spectroscopy for clinical and pre-surgical evaluation of focal extratemporal epilepsies, since this group presents the highest difficulty degree for lateralizing and locating epileptogenic zones. In almost all cases, a non invasive diagnosis can be performed using routine electroencephalography, video-electroencephalography - considered as gold standard, and magnetic resonance imaging. However, when the results of these exams are contradictory, some patients need invasive techniques, as the intra-cranial video-EEG, using deep electrodes, sub-dural strip and grid, that are associated with increased diagnostic cost and risk of complications, as cerebral hemorrhages and intra-cranial infections. Proton spectroscopy appears as a possibility, given its capacity to evaluate cerebral metabolism, by N-acetyl-aspartate (NAA), creatine (Cre) and choline (Cho) concentrations, amongst other metabolites. This non invasive method may provide time reduction of this evaluation and reliable level improvement for this topographical diagnosis.<br>Tem sido grande o progresso no diagnóstico das epilepsias, mas dentre os detalhamentos diagnósticos a exigir pesquisas, estão a lateralização e a localização precisas da zona epileptogênica, considerada como a região do córtex cerebral que, removida, irá resultar num estado livre de crises. Por meio de revisão da literatura, o objetivo deste estudo é expor e analisar os métodos diagnósticos das epilepsias neocorticais extratemporais, dadas as características que as tornam mais complexas do que as epilepsias temporais visto que estas apresentam o maior grau de dificuldade para lateralização e localização das zonas epileptogênicas. Na maior parte dos casos, o diagnóstico pode ser firmado de forma não invasiva, empregando-se a eletrencefalografia de superfície, a vídeo-eletrencefalografia, considerada o padrão-ouro, e a imagem por ressonância magnética. No entanto, quando os resultados dessas investigações são contraditórios, alguns pacientes necessitam de técnicas invasivas, como o vídeo-EEG intracraniano, utilizando eletrodos profundos, placas ou estrias subdurais, que se associam ao aumento do custo diagnóstico e do risco de complicações, como as hemorragias cerebrais e as infecções intracranianas. A espectroscopia de prótons surge como uma possibilidade, dada sua capacidade de avaliar o metabolismo cerebral, por meio das alterações de N-acetil aspartato (NAA), creatina (Cr) e colina (Co), dentre outros metabólitos. Esse método não invasivo pode reduzir o tempo de avaliação e melhorar o nível de confiança desse diagnóstico topográfico