A influência do conhecimento do paciente sobre o AVC no Brasil: um estudo transversal

Little is known about stroke patients’ awareness about the warning signs of stroke and its therapeutic time window in Brazil.Method We interviewed consecutive patients with acute stroke admitted to a terciary public hospital in Brazil. Data collected included demographics, mode of arrival, National Institutes of Health Stroke Scale (NIHSS) scores and knowledge of stroke warning signs and therapeutic time window. Early arrival was defined as within 4.5 hours of symptoms onset. Results Although 66.2% of patients knew the warning signs of stroke, only 7.8% reported to know that stroke had a limited therapeutic time window. Stroke severity measured by the NIHSS was independently associated with early arrival, but not knowledge of stroke signs and symptoms. Conclusion Knowledge about stroke symptoms was not a predictor of early arrival.Pouco se sabe sobre o conhecimento dos pacientes com acidente vascular cerebral (AVC) acerca dos sinais de alarme da doença e sua janela terapêutica no Brasil.Método Foram entrevistados consecutivamente os pacientes com AVC agudo internados em um hospital público terciário no Brasil. Os dados coletados incluíram dados demográficos, o modo de chegada, escala de AVC do National Institute of Health (NIH) e conhecimento sobre a janela de tempo terapêutica e os sinais de alerta do AVC através de um questionário padronizado. Chegada precoce foi definida como aquela dentro de 4,5 horas do início dos sintomas. Resultados Embora 66,2% dos pacientes sabiam os sinais de alerta do AVC , apenas 7,8% relataram saber que a doença tinha uma janela de tempo terapêutica limitada. A gravidade do AVC avaliada pela escala do NIH foi preditora de chegada precoce, mas conhecimento acerca dos sinais e sintomas do AVC não foram. Conclusão O conhecimento acerca dos sintomas do AVC não foi preditivo de chegada precoce ao hospital.Universidade Federal de São Paulo (UNIFESP) Departamento de Neurologia e NeurocirurgiaHospital Israelita Albert EinsteinUNIFESP, Depto. de Neurologia e NeurocirurgiaSciEL

Case report: Flow changes in routes of collateral circulation in patients with LVO and low NIHSS: a point favor to treat

The effectiveness of endovascular thrombectomy in patients presenting low National Institutes of Health Stroke Scale (NIHSS) scores remains controversial, and the acquisition of additional evidence is required to refine the selection of candidates who may benefit the most from this therapeutic modality. In this study, we present the case of a 62-year-old individual, with left internal carotid occlusion stroke and low NIHSS, who had compensatory collateral flow from Willis polygon via the anterior communicating artery. The patient subsequently exhibited neurological deterioration and collateral flow failure from Willis polygon, indicating the need for urgent intervention. The study of collaterals in patients with large vessel occlusion stroke has garnered considerable attention, with research suggesting that individuals with low NIHSS scores and poor collateral profiles may be at a heightened risk of early neurological deterioration. We postulate that such patients may derive significant benefits from endovascular thrombectomy, and may posit that an intensive transcranial Doppler monitoring protocol could facilitate the identification of suitable candidates for such intervention

Clinical spectrum of early onset cerebellar ataxia with retained tendon reflexes: an autosomal recessive ataxia not to be missed Espectro clínico da ataxia cerebelar de início precoce com reflexos mantidos: uma ataxia autossômica recessiva para não ser esquecida

Autosomal recessive cerebellar ataxias are a heterogeneous group of neurological disorders. In 1981, a neurological entity comprised by early onset progressive cerebellar ataxia, dysarthria, pyramidal weakness of the limbs and retained or increased upper limb reflexes and knee jerks was described. This disorder is known as early onset cerebellar ataxia with retained tendon reflexes. In this article, we aimed to call attention for the diagnosis of early onset cerebellar ataxia with retained tendon reflexes as the second most common cause of autosomal recessive cerebellar ataxias, after Friedreich ataxia, and also to perform a clinical spectrum study of this syndrome. In this data, 12 patients from different families met all clinical features for early onset cerebellar ataxia with retained tendon reflexes. Dysarthria and cerebellar atrophy were the most common features in our sample. It is uncertain, however, whether early onset cerebellar ataxia with retained tendon reflexes is a homogeneous disease or a group of phenotypically similar syndromes represented by different genetic entities. Further molecular studies are required to provide definitive answers to the questions that remain regarding early onset cerebellar ataxia with retained tendon reflexes.As ataxias cerebelares autoss&#244;micas recessivas s&#227;o um grupo heterog&#234;neo de doen&#231;as neurol&#243;gicas. Em 1981, foi descrita uma entidade neurol&#243;gica incluindo ataxia cerebelar progressiva de in&#237;cio precoce, disartria, libera&#231;&#227;o piramidal e manuten&#231;&#227;o ou aumento dos reflexos tend&#237;neos nos membros superiores e inferiores. Essa s&#237;ndrome &#233; conhecida como ataxia cerebelar de in&#237;cio precoce com reflexos mantidos. Neste artigo, o objetivo foi chamar a aten&#231;&#227;o para o diagn&#243;stico de ataxia cerebelar de in&#237;cio precoce com reflexos mantidos como a segunda causa mais comum de ataxia cerebelar autoss&#244;mica recessiva, ap&#243;s a ataxia de Friedreich, e tamb&#233;m realizar um estudo do espectro cl&#237;nico da s&#237;ndrome. Doze pacientes de diferentes fam&#237;lias preencheram os crit&#233;rios cl&#237;nicos para ataxia cerebelar de in&#237;cio precoce com reflexos mantidos. Disartria e atrofia cerebelar foram as caracter&#237;sticas mais frequentes. No entanto, n&#227;o h&#225; consenso se a ataxia cerebelar de in&#237;cio precoce com reflexos mantidos &#233; uma doen&#231;a homog&#234;nea ou um grupo de s&#237;ndromes com fen&#243;tipos semelhantes representadas por diferentes entidades gen&#233;ticas. Estudos moleculares futuros s&#227;o necess&#225;rios para fornecer respostas definitivas para as quest&#245;es pendentes em rela&#231;&#227;o &#224; ataxia cerebelar de in&#237;cio precoce com reflexos mantidos.</p

Pressão arterial, excesso de peso e nível de atividade física em estudantes de universidade pública Blood pressure, excess weight and level of physical activity in students of a public university

FUNDAMENTO: A hipertensão arterial, o excesso de peso e o sedentarismo são importantes fatores de risco para doenças cardiovasculares e estão fortemente associados. OBJETIVO: Avaliar o estado nutricional, o nível de atividade física e os níveis de pressão arterial de estudantes da Universidade Federal do Piauí, em Teresina. MÉTODOS: Estudo transversal com amostra de 605 estudantes (46,1% do sexo masculino e 53,9% do feminino), com média de idade de 21,7 ± 3,7 anos. O estado nutricional global foi classificado pelo índice de massa corporal (IMC) e a adiposidade central pela circunferência da cintura (CC). O nível de atividade física foi avaliado utilizando-se o Questionário Internacional de Atividade Física (IPAQ) na versão curta. A pressão arterial aumentada foi definida como uma pressão sistólica > 140 mmHg e/ou diastólica > 90 mmHg. RESULTADOS: A prevalência de pressão arterial aumentada foi de 9,7%, sendo maior em homens. Excesso de peso (IMC > 25 kg/m²) foi encontrado em 18,2% dos estudantes, sendo as proporções de sobrepeso e obesidade de 15,2% e 3%, respectivamente. Obesidade abdominal foi encontrada em 2,4% dos estudantes, independentemente do gênero, e o sedentarismo em 52%. A pressão arterial média aumentou com o incremento do IMC e da CC. Não houve associação entre os níveis de atividade física e pressão arterial. CONCLUSÃO: Houve associação entre aumento do peso corporal e da circunferência da cintura com maiores níveis de pressão arterial entre os pesquisados. É necessário estabelecer instrumentos de avaliação precoce do risco cardiovascular e promover orientação preventiva para esses jovens.<br>BACKGROUND: High blood pressure, excess weight and sedentary lifestyle are important risk factors for cardiovascular diseases, and they are closely associated. OBJECTIVE: To evaluate the nutritional status, level of physical activity and blood pressure levels of students of Universidade Federal do Piauí, Teresina, Brazil. METHODS: Cross-sectional study with a sample of 605 students (46.1% males and 53.9% females), with a mean age of 21.7 ± 3.7 years. The nutritional status was classified according to body mass index (BMI), and central adiposity according to waist circumference (WC). The level of physical activity was evaluated using the short version of the International Physical Activity Questionnaire (IPAQ). Elevated blood pressure was defined as systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg. RESULTS: The prevalence of elevated blood pressure was 9.7%, and was higher among men. Excess weight (BMI > 25 kg/m²) was found in 18.2% of the students, with overweight and obesity rates of 15.2% and 3%, respectively. Abdominal obesity was found in 2.4% of the students regardless of gender, and sedentary lifestyle in 52%. The mean blood pressure increased with increasing BMI and WC. No association was found between the levels of physical activity and blood pressure. CONCLUSION: An association of increased body weight and waist circumference with higher blood pressure levels was observed among the participants. Instruments for an early assessment of the cardiovascular risk and preventive advice should be established for these young individuals

Progressive Cerebral Arteriopathy – Moyamoya Disease: A Report of Two Cases with Different Clinical Presentation

Moyamoya disease is a chronic and unusual cerebrovascular disorder characterized by progressive stenosis and occlusion of the distal portions of internal carotid arteries and its main branches within the circle of Willis. Posterior circulation (vertebral and basilar arteries) may also be affected; however, this presentation is uncommon. As well as stenosis of the terminal portion of intracranial arteries, it is seen the development of a network of collateral vessels abnormally dilated at the base of the brain with an aspect of a “puff of smoke,” whose term in Japanese is described as “moyamoya.” The present study aims to report two consecutive cases of patients who presented to our service with different clinical manifestations. Further investigation with digital subtraction angiography showed a moyamoya pattern