7 research outputs found
Association between tomographic characteristics of the temporal bone and transtemporal window quality with transcranial color Doppler ultrasound in patients with stroke or transient ischemic attack: analytical and observational study
No full textIntrodução: O ultrassom transcraniano colorido (UTCC) é uma técnica ultrassonográfica que incorpora a imagem do parênquima cerebral à avaliação do fluxo sanguíneo dos vasos do polígono de Willis. Uma de suas maiores limitações é a necessidade de uma janela transtemporal adequada para insonação transcraniana, o que está ausente em cerca de 5-44% dos pacientes. A hiperostose da escama temporal tem sido fortemente associada a falência de janela transtemporal. Objetivamos neste estudo observacional analítico, avaliar a relação entre a a qualidade da janela transtemporal determinada com o UTCC e as características do osso temporal determinada com a tomografia computadorizada de crânio (TC). Materiais e métodos: Trata-se de estudo retrospectivo, analítico, observacional com avaliação de registros médicos onde foram incluídos para análise um total de 187 pacientes com acidente vascular cerebral ou AIT admitidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto entre Julho de 2014 e Janeiro de 2015 que realizaram UTCC e TC de acordo com o protocolo institucional. Classificamos a qualidade das janelas dos pacientes com um escore validado em nosso serviço. A análise da espessura e densidade do osso temporal nos exames de TC foi realizada de forma cega para os demais dados clínicos e ultrassonográficos. Resultados: Ausência de Janela temporal bilateral foi encontrada em 21,93% dos pacientes da amostra e destes pacientes (78,05%) foram do sexo feminino p value < 0,0001. A média de idade dos pacientes com presença de Janela temporal foi de 59,9±13,9 anos e as medias de idade dos pacientes sem janela temporal foi de 70,5±12,7 anos com p value <0,001. A área sob a curva ROC para acurácia diagnóstica na detecção de ausência de janela a partir da espessura da escama temporal foi de 0,8232 (0,7504; 0,896) e para o ponto de corte de espessura da escama temporal na ROI de 2,23mm encontramos uma sensibilidade de 0,878 e especificidade de 0,537; Em uma regressão logística univariada, obtivemos que para cada 1 mm de aumento na espessura do osso temporal, obtivemos Odds Ratio (OR) de 4,16 em não se obter janela transtemporal pelo UTCC. Em uma regressão logística multivariada, a espessura da escama temporal em mm (OR : 3,04; IC95%: 1,73-5,35; p: 0,001) idade (OR de 1,07; IC95%: 1,03-1,11; p: 0,003) sexo feminino (OR: 5,99 IC95%:2,09-17,15; p: 0,009) se associaram com ausência da janela transtemporal e a presença de pneumatização óssea na escama do osso temporal (OR: 7,90; IC95%: 1,94-32,04; p: 0,003) se associou com presença da janela transtemporal. Discussão e conclusão: Em concordância com estudos prévios de DTC, os resultados encontrados com a técnica de UTCC sugerem que mulheres idosas possuem maior espessura da escama temporal e por consequência maior taxa de falência de janela transtemporal. Maior espessura do osso temporal e presença de pneumatização do osso temporal são fatores independentes que aumentam a chance de falência de janela transtemporal. A partir da espessura do osso temporal é possível prever a falência de janela transtemporal e assim identificar pacientes elegíveis para a realização do UTCC ou DTCIntroduction: Transcranial color Doppler ultrasound (TCDU) is an ultrasonographic technique that incorporates the image of the cerebral parenchyma to evaluate blood flow in the vessels of the Willis polygon. One of its major limitations is the need for a transtemporal window suitable for transcranial insonation, which is absent in about 5-44% of patients. Hyperostosis of the temporal scale has been strongly associated with transtemporal window failure. In this analytical observational study, we aimed to evaluate the association between the quality of the transtemporal window determined with the TCDU and the characteristics of the temporal bone determined by cranial computed tomography (CT). Materials and methods: This was a retrospective, analytical, observational study with evaluation of medical records where a total of 187 patients with stroke or TIA admitted to the Emergency Unit of the Hospital das Clínicas of the Medical School of Ribeirão Preto between July 2014 and January 2015 who underwent TCDU and CT according to the institutional protocol. We rated the quality of patients\' windows with a score validated at our service. Analysis of temporal bone thickness and density on CT scans was performed blindly for other clinical and ultrasonographic data. Results: Absence of bilateral temporal window was found in 21.93% of the patients in the sample and of these patients 78.05% were female p value <0.0001. The mean age of the patients with presence of temporal window was 59.9 ± 13.9 years and the mean age of patients without temporal window was 70.5 ± 12.7 years with p value <0.001. The area under the ROC curve for diagnostic accuracy in the detection of window absence, from the thickness of the temporal bone, was 0.8232 IC 95% (0.7504; 0.896) and for the cutoff point of the temporal scale thickness at ROI of 2.23mm we found a sensitivity of 0.878 and Specificity of 0.537; In a univariate logistic regression, we found that for each 1 mm of increase in temporal bone thickness, there was an odds ratio (OR) of 4.16 of not being able to obtain a transtemporal window by the TCDU. In a univariate logistic regression, we found that for each 1 mm increase in thickness of the temporal bone, obtained odds ratio (OR) of 4.16 to not obtain transtemporal window by the TCDU. In a multivariate logistic regression, the thickness in mm of the temporal scale (OR: 3.04; 95% CI: 1.73 to 5.35; p: 0.001), age (OR 1.07; 95% CI: 1,03 to 1.11, p: 0.003), being female (OR 5.99 95% CI: 2.09 to 17.15, P: 0.009) were associated with the absence of the transtemporal window, and the presence of bone pneumatized scale in the temporal region (OR: 7.90; 95% CI: 1.94 to 32.04, P: 0.003) was associated with the absence of the transtemporal window. Discussion and conclusion: In agreement with previous TCD studies, we have found that older women have a greater thickness of temporal scales and, consequently, a higher rate of transtemporal window failure on TCDU. From temporal bone thickness it is possible to predict transtemporal window failure and therefore to predict those patients with acute stroke that are suitable for UTCC or TCD exams
A ressonância magnética no diagnóstico e estadiamento dos gliomas cerebrais: a aplicação da técnica da espectroscopia de prótons
No full textObjetiva-se, com este trabalho, realizar uma revisão de literatura de estudos primários que abordaram a aplicação da espectroscopia de prótons por ressonância magnética (1H-MRS) como método diagnóstico e de estadiamento nos gliomas cerebrais. Todos os artigos analisados, através do PubMed mostraram significância estatística na correlação entre 1H-MRS com a histopatologia da lesão. Dos 26 estudos analisados, 9 mostraram diferenças entre gliomas de outras lesões do Sistema Nervoso Central (SNC) e 23 avaliaram a diferença entre gliomas de baixo grau e gliomas de alto grau. Procurou-se mostrar que as linhas de pesquisa que usaram 1H-RMS apresentaram resultados mais refinados quanto ao diagnóstico destes tumores. Destes estudos, conclui-se que a 1H-MRS associada à MRI é um método diagnóstico com boa acurácia quando comparado com a análise histopatológica. Os metabólitos detectados pela espectroscopia se correlacionam bem com a gradação dos gliomas e fornecem fortes evidências de que este método possa ser mais utilizado para avaliação e seguimento de pacientes no pré e no pós-operatório.</jats:p
Ultrasonographic Changes in Brain Hemodynamics in Patients with Parkinson’s Disease and Risk Factors for Cerebrovascular Disease: A Pilot Study
No full textRecent epidemiological studies have revealed a correlation between atypical features and worse functional outcomes in Parkinson’s disease (PD) patients with cerebrovascular disease (CVD). We aimed to evaluate the brain hemodynamics of PD patients with risk factors for CVD using Doppler ultrasonography. In this prospective pilot study, we randomly included 27 outpatients diagnosed with PD. Transcranial color-coded sonography (TCCS) examinations were performed, obtaining measurements of middle cerebral artery mean flow velocities (Vm), the resistance index (RI), and the pulsatility index (PI). The breath-holding index (BHI) was used to assess cerebrovascular reactivity (cVR). Standardized functional scales (UPDRS III, Hoehn & Yahr scale, and MoCA) were administered. The patients were divided into two groups: those with two or more vascular risk factors (PDvasc) and those with fewer than two vascular risk factors (PDnvasc). Patients in the PDvasc group showed higher PI (1.00 vs. 0.85; p=0.020), RI (0.59 vs. 0.5; p=0.05), H&Y mean (2.4 vs. 1.4; p=0.036), higher frequency of altered cVR (90.9% vs. 25.0%; p=0.001), and lower BHI (0.46 vs. 1.01; p=0.027). We also divided the patients in other two groups: one with patients with classical and another with akinetic-rigid PD clinical type. Patients with the akinetic-rigid type of PD had significantly higher RI (0.60 vs. 0.51; p=0.03), PI (0.99 vs. 0.77; p=0.03), higher frequency of altered cVR (80% vs. 35%; p=0.02), and lower BHI (0.48 vs. 0.96; p=0.05) than patients with classic-type PD. We concluded that TCCS displays impaired cerebrovascular reactivity and a more severe disease pattern in Parkinsonian patients with two or more risk factors for CVD and in the akinetic-rigid type. Doppler ultrasonography may be a useful tool in a clinical setting to investigate PD patients
Influence of age, schooling and cognition on olfactory test performance in Parkinson\u27s Disease patients: a case-control study
No full textBackground: olfactory dysfunction is an early and prevalent non-motor symptom of Parkinson’s disease (PD). However, factors such as age, schooling, and cognition also influence olfactory test performance and are essential for the proper interpretation of results, especially in populations with low educational levels.
Objectives: to evaluate the influence of age, schooling, and cognition on olfactory test performance in Parkinson’s disease patients (PDG) and the control group (CG).
Materials and Methods: this cross-sectional case-control study included 106 participants (53 PDG and 53 CG), aged 60 to 85. All underwent olfactory testing with Sniffin´Sticks-12 (SS-12) and the modified Connecticut Chemosensory Clinical Research Center (mCCCRC) and cognitive screening with the Montreal Cognitive Assessment (MoCA). The PDG was scored by part III of the UPDRS-III and the H&Y scale. Statistical analyses were performed to assess associations between variables.
Results: PDG scored lower on both olfactory tests and on the MoCA. Cognitive performance positively influenced olfactory scores, especially for SS-12 in both groups. Education significantly affected SS-12 and MoCA scores but had no important effect on mCCCRC performance. Age negatively impacted mCCCRC scores in the CG.
Conclusion: although education significantly influenced SS-12 scores, our findings showed that mCCCRC performance was less affected by lower educational levels. This highlights the mCCCRC as a more education-independent olfactory test, suitable for use in populations with limited schooling. Integrating cognitive and olfactory testing may enhance clinical evaluation and monitoring in PD
Schistosomal myeloradiculopathy associated with hepatitis B virus infection: a case report
No full textA esquistossomose afeta mais de 200 milhões de pessoas em todo mundo. O envolvimento do Sistema Nervoso Central é raro, porém quando ocorre o acometimento medular é a forma mais frequente e grave. O caso relatado é de um paciente de 19 anos, com quadro de paraparesia assimétrica de evolução progressiva, arreflexia em membros inferiores, incontinência urinária e dor lombar. Havia história prévia de banhos em lagoas de região endêmica para S. mansoni. O líquor apresentava-se com pleocitose de 53 células por mm3 sendo 3% de eosinófilos, 87% de linfócitos, 10% de monócitos, glicose de 67mg/dL e proteínas 176mg/dL. A ressonância magnética de coluna mostrou lesão extensa de T1 a L2 nas aquisições ponderadas em T2 e impregnação heterogênea pelo contraste em medula lom-bossacra, sugerindo inflamação ativa nesta última região. Apresentou ainda exame parasitológico de fezes positivo para S. mansoni e sorologia positiva para o vírus da hepatite B (VHB) em sua forma crônica. Enfatiza-se neste trabalho que a mielorradiulopatia esquistos-somótica tem critérios diagnósticos clínicos consistentes e o diagnóstico e tratamento precoce é de suma importância para se evitar se-quelas neurológicas e incapacitantes.Schistosomiasis affects over 200 million people worldwide. The involvement of the central nervous system (CNS) is rare but when it occurs, the spinal cord damage is the most common and severe form. The reported case is a 19-years-old patient with asymmetric progressive paraparesis, areflexia in the lower limbs, urinary incontinence and back pain. He used to swim in ponds of endemic area for S. mansoni. Cerebrospinal fluid presented pleocytosis with 53 cells per mm3 where 3% eosinophils, 87% lympho-cytes, 10% monocytes, Glucose 67mg/dL protein and 176mg/dL. Spinal MRI showed extensive damage from T1 to L2 in T2-weighted acquisition and heterogeneous contrast uptake in lumbosacral cord, suggesting active inflammation in the latter region. It also presented positive stools for Schistosoma mansoni and positive serology for hepatitis B virus (HBV) in its chronic form. It´s emphasized in this paper that the myeloradiculopathy by schistosomiasis (MRE) has consistent clinical diagnostic criteria and early diagnosis and treatment is of paramount importance to avoid neurological and disabling sequelae
Altered Cerebral Vasoreactivity on Transcranial Color-Coded Sonography Related to Akinetic-Rigid Phenotype of Parkinson’s Disease: Interim Analysis of a Cross-Sectional Study
No full textBackground: A correlation between worse functional outcomes in Parkinson’s disease (PD) patients with cerebrovascular disease (CVD) or the Akinetic-rigid phenotype has been argued in recent studies. We aimed to evaluate the association of cerebral hemodynamics impairments, assessed by Transcranial Color-coded Doppler sonography (TCCS), on PD patients with different phenotypes of the disease and with risk factors for CVD. Methodology: Idiopathic PD patients (n = 51) were divided into motor subtypes: Akinetic-rigid (AR) (n = 27) and Tremor-dominant (TD) (n = 24) and into two groups regarding vascular risk factors: when ≥2 were present (PDvasc) (n = 18) and <2 (PDnvasc) (n = 33). In a parallel analysis, the Fazekas scale on brain magnetic resonance imaging (MRI) was applied to a sample to assess the degree of leukoaraiosis. TCCS examinations were prospectively performed obtaining middle cerebral artery Mean Flow Velocities (Vm), Resistance Index (RI), and Pulsatility Index (PI). The Breath-Holding Index (BHI) was calculated to assess cerebrovascular reactivity (cVR). Standardized functional scales were administered (UPDRS III and Hoehn&Yahr). Results: The phenotype groups were similar in age, disease duration and demographic parameters, but there were significantly higher H&Y scores than TD group. cVR was impaired in 66.7% of AR vs. 37.5% of TD. AR group exhibited lower BHI (0.53 ± 0.31 vs. 0.91 ± 0.62; p = 0.000), lower Vm after apnea (44.3 ± 9.0 cm/s vs. 53.4 ± 11.4 cm/s; p = 0.003), higher PI (0.91 ± 0.26 vs. 0.76 ± 0.12; p = 0.000) and RI (0.58 ± 0.11 vs. 0.52 ± 0.06; p = 0.021). PDvasc group showed higher PI (0.98 vs. 0.76; p = 0.001) and higher frequency of altered cVR (72.2% vs. 42.2%; p = 0.004). There was a significant predominance of higher values on Fazekas scale in the PDvasc group. We found no difference between the Fazekas scale when comparing motor subtypes groups but there was a trend toward higher scores in the AR phenotype. Conclusions: TCCS, a cost-effective method, displayed impaired cVR in Parkinsonian patients with risk factors for CVD with higher degree of MRI leukoaraiosis. PD patients with the AR disease phenotype also presented impaired cVR on TCCS and greater functional impairment, although with just a trend to higher scores on MRI Fazekas
Minimal information for studies of extracellular vesicles 2018 (MISEV2018): a position statement of the International Society for Extracellular Vesicles and update of the MISEV2014 guidelines
No full textThe last decade has seen a sharp increase in the number of scientific publications describing physiological and pathological functions of extracellular vesicles (EVs), a collective term covering various subtypes of cell-released, membranous structures, called exosomes, microvesicles, microparticles, ectosomes, oncosomes, apoptotic bodies, and many other names. However, specific issues arise when working with these entities, whose size and amount often make them difficult to obtain as relatively pure preparations, and to characterize properly. The International Society for Extracellular Vesicles (ISEV) proposed Minimal Information for Studies of Extracellular Vesicles (“MISEV”) guidelines for the field in 2014. We now update these “MISEV2014” guidelines based on evolution of the collective knowledge in the last four years. An important point to consider is that ascribing a specific function to EVs in general, or to subtypes of EVs, requires reporting of specific information beyond mere description of function in a crude, potentially contaminated, and heterogeneous preparation. For example, claims that exosomes are endowed with exquisite and specific activities remain difficult to support experimentally, given our still limited knowledge of their specific molecular machineries of biogenesis and release, as compared with other biophysically similar EVs. The MISEV2018 guidelines include tables and outlines of suggested protocols and steps to follow to document specific EV-associated functional activities. Finally, a checklist is provided with summaries of key points. © 2018, © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of The International Society for Extracellular Vesicles
