Eli Faria Evaristo

Dissecção espontânea cervical carotídea e verbal: estudo de 48 pacientes

OBJECTIVE To report a Brazilian series of spontaneous cervical arterial dissections, risk factors, warning symptoms, clinical manifestations, diagnostic tests, treatment and prognosis. METHOD We performed the retrospective analysis of clinical and neuroradiological records (MRI, A-MRI and Angiography) of patients with this diagnosis who were evaluated in a tertiary hospital for the period of 1997-2003. RESULTS 48 patients (24 men) with median age 37.9 years: 26 patients with unilateral internal carotid dissection (ICAD), 15 with unilateral vertebral artery dissection (VAD) and 7 with multivessel dissections. All patients presented neurological deficits. Hypertension, smoking and dyslipidemia were the main risk factors. More than 80% of patients presented at least one initial symptom, most of them temporoparietal headache. 44% of patients with VAD and only 3.4% of patients with ICAD had neck pain. The median interval between the onset of symptom and the appearance of neurological deficit was 5.4 days for ICAD and 13.5 days for VAD. Five patients with ICAD presented preceding TIA. Angiography was performed in 93% of patients. In 42% of these patients, MRI and A-MRI were associated. In three patients the diagnosis was made just through cervical MRI. 75% of patients received anticoagulation. Two patients received intravenous thrombolytic therapy with no complications. Prognosis was good for all patients but two patients with bilateral ICAD died. CONCLUSION Our results are similar to the literature, except for the low frequency of neck pain in ICAD patients and predominance of temporoparietal headache in cervical artery dissection patients. Vascular risk factors were commonly found.

Sonothrombolysis for acute ischemic stroke: a systematic review of randomized controlled trials

OBJECT Sonothrombolysis has recently been considered an emerging modality for the treatment of stroke. The purpose of the present paper was to review randomized clinical studies concerning the effects of sonothrombolysis associated with tissue plasminogen activator (tPA) on acute ischemic stroke. METHODS Systematic searches for literature published between January 1996 and July 2011 were performed for studies regarding sonothrombolysis combined with tPA for acute ischemic stroke. Only randomized controlled trials were included. Data extraction was based on ultrasound variables, patient characteristics, and outcome variables (rate of intracranial hemorrhages and arterial recanalization). RESULTS Four trials were included in this study; 2 trials evaluated the effect of transcranial Doppler (TCD) ultrasonography on sonothrombolysis, and 2 addressed transcranial color-coded duplex (TCCD) ultrasonography. The frequency of ultrasound waves varied from 1.8 to 2 MHz. The duration of thrombus exposure to ultrasound energy ranged from 60 to 120 minutes. Sample sizes were small, recanalization was evaluated at different time points (60 and 120 minutes), and inclusion criteria were heterogeneous. Sonothrombolysis combined with tPA did not lead to an increase in symptomatic intracranial hemorrhagic complications. Two studies demonstrated that patients treated with ultrasound combined with tPA had statistically significant higher rates of recanalization than patients treated with tPA alone. CONCLUSIONS Despite the heterogeneity and the limitations of the reviewed studies, there is evidence that sonothrombolysis associated with tPA is a safe procedure and results in an increased rate of recanalization in the setting of acute ischemic stroke when wave frequencies and energy intensities of diagnostic ultrasound systems are used.

Guidelines for acute ischemic stroke treatment - Part I

Executive Committee: Charles André, Aroldo Luiz Bacellar, Daniel da Cruz Bezerra, Roberto Campos, João José Freitas de Carvalho, Gabriel Rodrigues de Freitas, Roberto de Magalhães Carneiro de Oliveira, Sebastião Eurico Melo de Souza, Soraia Ramos Cabette Fábio, Eli Faria Evaristo, Jefferson Gomes Fernandes, Maurício Friedrich, Marcia Maiumi Fukujima, Rubens José Gagliardi, Sérgio Roberto Haussen, Maria Clinete Sampaio Lacativa, Bernardo Liberato, Alexandre L. Longo, Sheila Cristina Ouriques Martins, Ayrton Roberto Massaro, Cesar Minelli, Carla Heloísa Cabral Moro, Jorge El-Kadum Noujaim, Edison Matos Nóvak, Jamary Oliveira-Filho, Octávio Marques Pontes-Neto, César Noronha Raffin, Bruno Castelo Branco Rodrigues, José Ibiapina Siqueira-Neto, Elza Dias Tosta, Raul Valiente, Leonardo Vedolim, Marcelo Gabriel Veja, Leonardo Vedolin, Fábio Iuji Yamamoto, Viviane Flumignan Zétola. Correspondence: Jamary Oliveira-Filho; Rua Reitor Miguel Calmon s/n; Instituto de Ciências da Saúde / sala 455; 40110-100 Salvador BA Brasil; E-mail: jamaryof@ufba.br Conflict of interest: There is no conflict of interest to declare. Received 18 February 2012; Received in final form 22 February 2012; Accepted 29 February 2012 Guidelines for acute ischemic stroke treatment – Part I

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br).

Stroke management in a university hospital in the largest South American city

OBJECTIVE To describe characteristics and provision of care for patients admitted with cerebrovascular disorders (CVD), focusing on ischemic stroke (IS), in a large, public, academic hospital in São Paulo, Brazil. METHOD We retrieved information about 357 patients with CVD admitted to the Neurology Emergency Department (NED) and Neurology Ward (NW) of our institution. We described patient characteristics and management of IS in NED and in NW. RESULTS IS was diagnosed in 79.6% of CVD patients admitted to NED; 2.7% were submitted to thrombolysis. Extent of IS investigation and management were significantly different in NED and NW. CONCLUSION IS patients in our center were younger than in developed countries. IS management was significantly influenced by patient characteristics. This information can aid in planning strategies to decrease stroke burden.

Complete motor recovery after acute paraparesis caused by spontaneous spinal epidural hematoma: case report

BackgroundSpontaneous spinal epidural hematoma is a relatively rare but potentially disabling disease. Prompt timely surgical management may promote recovery even in severe cases.Case presentationWe report a 34-year-old man with a 2-hour history of sudden severe back pain, followed by weakness and numbness over the bilateral lower limbs, progressing to intense paraparesis and anesthesia. A spinal magnetic resonance imaging scan was performed and revealed an anterior epidural hematoma of the thoracic spine. He underwent an emergency decompression laminectomy of the thoracic spine and hematoma evacuation. Just after surgery, his lower extremity movements improved. After 1 week, there was no residual weakness and ambulation without assistance was resumed, with residual paresthesia on the plantar face of both feet. After 5 months, no residual symptoms persisted.ConclusionsThe diagnosis of spontaneous spinal epidural hematoma must be kept in mind in cases of sudden back pain with symptoms of spinal cord compression. Early recognition, accurate diagnosis and prompt surgical treatment may result in significant improvement even in severe cases.

Intracranial vertebral artery dissection presenting as subarachnoid hemorrhage: successful endovascular treatment

Introduction– Intracranial vertebral artery dissection is a rare condition which may present as subarachnoid hemorrhage. In this situation, treatment is controversial. Case report– A case of intracranial right vertebral artery dissection in a 55‐year‐old woman presenting with subarachnoid hemorrhage is reported. The patient underwent therapeutic occlusion of the dissected artery through microcatheterization using pushing detachable platinum microcoils and had a good outcome. At this moment, the patient has a normal neurologic examination and a control digital subtraction angiography 1 year after the procedure showed an occluded right vertebral artery at V3; there was retrograde flow in the right intracranial vertebral artery up to the origin of a meningeal branch; the artery was thin and had mural irregularities, without any evidence of aneurismatic dilatation. Discussion– We review the literature and discuss the role of endovascular therapy and other therapeutic options in the treatment of this condition.

Revascularização clínica e intervencionista no acidente vascular cerebral isquêmico agudo: opinião nacional

Arq Neuropsiquiatr 2006;64(2-A):342-348* P a rticipantes: Ana Claudia Ferraz, Alexandre L. Longo, Aroldo Luiz Bacellar, Ay rton Roberto Massaro, Carla Heloisa Cabral Moro ,Cesar N. Raffin, Charles Andre, Edson Matos Novak, Eli Faria Evaristo, Elza Dias Tosta, Fabio Iuji Yamamoto, Gabriel Rodriguez deF reitas, Ibsen Thadeo Damiani, Jamary Oliveira Filho, Jayme Antunes Maciel Junior, Jefferson Gomes Fernandes, Jorge El KadumNoujaim, Jose Ibiapina Siqueira Neto, Marcia Maiumi Fukujima, Maria Lucia Pimentel, Mauricio Friedrich, Paulo Puglia, Roberto deMagalhaes Carn e i ro Oliveira, Rogerio Darwich, Rubens Jose Gagliardi, Sebastiao Eurico Mello-Souza, Sergio Roberto Haussen,Soraia Ramos Cabete Fabio, Viviane Flumignan Zetola, Waldir Antonio Tognola. O forum de “Opiniao Nacional” foi realizado emSao Paulo-SP, no dia 1o de julho de 2004. Os temas de trabalho foram divididos para analise inicial por grupos de 5 a 6 neuro l o g i s t a s .Os coordenadores do presente tema foram os Drs. Cesar N. Raffin e Jefferson Gomes Fernandes. Um esboco de texto foi propostopara analise em plenario em leitura publica. Comentarios, criticas e sugestoes de mudancas foram amplamente debatidos por esteplenario e incorporados ao texto final, redigido pelo grupo responsavel pelo tema. Recebido 8 Novembro 2005. Aceito 24 Janeiro 2006.

Cerebral microbleeds and intravenous thrombolysis: case report

Intravenous thrombolysis is an important procedure that has significant impact on ischemic stroke prognosis. However, intracranial hemorrhage (ICH) is a feared complication of this procedure. It has been suggested that cerebral microbleeds (CMBs) may increase the risk of ICH after thrombolysis. We report on a 69 years-old woman with multiple CMBs submitted to intravenous thrombolysis without complications.

Timectomia robótica para miastenia gravis

As the dissection proceeded, the innominate vein was identified, and the thymic veins were clipped and divided. The cardiophrenic angle was then dissected on the right side, and both upper thymic poles were isolated. The dissection finished at the lower right side, with identification of the right phrenic nerve and subsequent exploration of the pleura.The thymus gland and the anterior mediastinal/cervical fat tissue were resected radically and removed through the trocar port. After hemostasis had been achieved, a 28F drainage chest tube was inserted into the pleural cavity through the port of the fifth intercostal space, the lung was reinflated, and the other wounds were closed in a standard fashion. The total operative time was 120 min, including the robotic docking, thymus resection, and skin closure.The postoperative period was uneventful, the chest tube was removed 48 h after surgery, and the patient was discharged 72 h after surgery. The final histology revealed thymic hyperplasia, with no ectopic foci in the resected surrounding tissue.After a three-month follow-up period, the patient was clinically well, and a reduction in the prednisone dose was possible, although the cholinesterase inhibitors were kept at the same dosage. Although she had pain at the incision site for approximately one month, she returned to work 15 days after surgery and was able to resume light sports one month after hospital discharge.The first thymectomy by robot-assisted surgery for the treatment of a small thymoma was performed in 2001,