Edison Matos Nóvak

Acidente vascular cerebral em pacientes jovens: análise de 164 casos

We retrospectively analyzed the epidemiological features of 164 out-clinic patients with a first-onset stroke between 15 and 49 years old. Ischemic stroke occurred in 141 patients, hemorrhagic stroke in 16 patients, and venous thrombosis in 7 patients. Forty-eight percent of ischemic strokes were atherothrombotic, but no etiology was found in 32% of patients with ischemic stroke. Systemic arterial hypertension was the most frequent etiology in the hemorrhagic stroke group. The most frequent risk factors were systemic arterial hypertension, smoking, hypercholesterolemia, alcoholism and diabetes mellitus. Although stroke in young adults deserves some specific etiological investigation, we found that ordinary risk factors such as hypertension, tabacco use, hypercolesteremia and diabetes were prevalent in our population. It seems that prevention campaigns should be the target of our work.

Conhecimento leigo sobre doença vascular encefálica

The significance of the risk factors and the rapid diagnosis of encephalic vascular disease (EVD) is the reason for this research, where the authors decided to register and analyze the non-medical people knowledge about these risk factors and the symptoms of this group of disease. For this purpose a questionnaire with questions about these facts was applied to 500 voluntaries without pre-selection, 72.6% of them with ages between 16-35 years old, and the answers analyzed by statistical methods. The authors recognized that the risk factors has a good level of knowledge by this population (87.8 % for hypertension, 76.8 % for smoking, 70.8 % for obesity, 68.7 % for sedentary persons, 66.7 % to stress, 66.3 % to alcohol ingest, 60.7 % for fat diet, 59 % to illicit drugs) while the signs and symptoms of EVD has a minor level of knowing and correction: lost sensitivity 70.3 %, headache 64.2 %, twisted mouth 59.5 %, lost or altered speech 57.5 %, dizziness 56 %, syncope 51.7 %, amaurosis 50.3 %, disequilibrium 45 %, deafness 31.2 %, weakness 41.1 %, nervousness 20.7%, chest pain 20.2 %, fatigue 15.3 % and tinnitus 18.9 %. According this data, the authors suggest that the correction or prevention of risk factors as well the precocious medical attention by the recognition of symptoms of EVD must be the object of public health programs.

Meningite por linfoma primitivo do sistema nervoso central: relato de um caso

The case of a 17 years-old woman, with clinical findings of meningites, without identification of a pathogenic agent is reported. The pacient received treatment for tuberculous and fungi meningitis. In the clinical course were found neoplastic cells in the spinal fluid. Despite the radiologic investigation, the original site of the tumor was not found in life. In the post-mortem examination, a small tumor was discovered in the 4th ventricle. The hystologic examination revealed a primary central nervous system lymphoma, diffuse infiltration of the meninges by tumor cells and proliferation into the central nervous system through the Virchow-Robin space. The clinical course, laboratory investigation and anatomical findings of the tumor are presented. A short revision about the pathogenesis of neoplastic meningites and primary central nervous system lymphoma is made.The case of a 17 years-old woman, with clinical findings of meningites, without identification of a pathogenic agent is reported. The pacient received treatment for tuberculous and fungi meningites. In the clinical course were found neoplasic cells in the spinal fluid. Despite the radiologic investigation, the original site of the tumor was not found in life. In the post-mortem examination, a small tumor was discovered in the 4th ventricle. The hystologic examination revealed a primary central nervous system lymphoma, diffuse infiltration of the meninges by tumor cells and proliferation, into the central nervous system through the Virchow-Robin space. The clinical course, laboratory investigation and anatomical findings of the tumor are presented. A short revision about the pathogenesis of neoplasic meningites and primary central nervous system lymphoma is made.

Hemorrhagic stroke after naphazoline exposition: case report

Ten percent of all strokes are due to spontaneous cerebral hemorrhages. They are associated to drugs (licit and illicit) in 9.5% of all cases in young adults. This is a case report of a 44-year-old man, without previous morbidities, who presented a sudden onset headache and arterial hypertension 24 hours after use of naphazoline as nasal decongestant. Cranial tomography showed right thalamus hemorrhage. Cerebral angiography showed no aneurisms, vascular malformations or vasculitis. No other risk factors were found during investigation in this patient and the stroke was attributed to naphazoline exposition.

Clinical, neurovascular and neuropathological features in sneddon's syndrome

Sneddons syndrome (SS) is characterized by ischemic cerebrovascular episodes and livedo reticularis. It is more common in young women and can also be associated with valvulopathy, a history of spontaneous abortion, renal involvement and vascular dementia. We describe three cases of young women with this disease. The patients had repeated ischemic cerebral episodes, livedo reticularis and thrombocytopenia. CT and MRI showed strokes and cerebral atrophy. Autopsy in one of the patients revealed cerebral infarctions. Anticardiolipin antibodies were detected in two patients. Antiphospholipid antibodies may be found in some patients with ischemic cerebrovascular events and livedo reticularis. SS may thus be associated with antiphospholipid syndrome. We described three new cases of SS and discuss the pathophysiology of this disease.

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

UNLABELLED 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.

Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics (AP). The objective of this study was to investigate the profile of cases of NMS and to compare our findings with those published in similar settings. A series of 18 consecutive patients with an established diagnosis of NMS was analyzed, gathering data on demography, symptoms and signs. Two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of AP. The signs and symptoms of NMS episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. As expected, more than two thirds of our cases were using classic AP (68%), however the clinical profile of these in comparison with those taking newer agent was similar. Newer AP also carry the potential for NMS.

Incidência de cefaléia em uma comunidade hospitalar

O objetivo foi determinar em um grupo de pessoas de uma comunidade hospitalar a incidencia de cefaleia e para esta a frequencia, principais caracteristicas e investigacoes medicas mais solicitadas. Utilizamos a combinacao de questionario e entrevista. Do total de 1006 fichas aleatoriamente preenchidas, 987 pessoas responderam corretamente aos quesitos e destas 380 (38,5%) eram portadoras de cefaleia. Baseados na Classificacao Internacional de Cefaleia dividimos os portadores em dois principais grupos, a migrânea e a cefaleia do tipo tensional. As demais foram agrupadas num terceiro grupo. A idade media foi 31,18 anos, com predominio do sexo feminino em todos os tipos de cefaleia. A presenca de historia familiar foi positiva em 76,8% dos entrevistados. As caracteristicas mais frequentes foram: localizacao frontal, tipo pulsatil e intensidade moderada. O principal fator desencadeante foi o estresse. A procura de acompanhamento medico deu-se em 41,3% dos portadores. Destes, aproximadamente 56% consultaram um clinico geral, 23% consultaram um neurologista e 21% procuraram outras especialidades. O RX de crânio foi o exame mais solicitado pelos generalistas e o eletrencefalograma pelos neurologistas. A tomografia computadorizada do crânio nao foi solicitada com frequencia

Neurological diagnoses in the emergency room: differences between younger and older patients.

UNLABELLED 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 and >50 years old. RESULTS Cerebrovascular disease (59.6% vs. 21.8%, p<0.01) was most frequent in the >50 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.

Neuro-Behçet: report of three clinically distinct cases

We report three patients who collectively have very representative clinical forms of neuro-Behçet and different neurological findings. The first case, male, 49 years old, presents symptoms similar to multiple sclerosis. The second case, male 15 years old, presents with parenchymatous compromise and an association with antiphospholipid antibody. And the third case, female 25 years old, presents an acute meningitis. Neuro-Behçet must always be included as a differential diagnosis of neurological disorders that have any difficulties in establishing a definite diagnosis.