Octávio Marques Pontes Neto

Leigh-like syndrome with the T8993G mutation in the mitochondrial ATPase 6 gene: long-term follow-up discloses a slowly progressive course

We describe the long-term clinical outcome of a patient with Leigh-like syndrome presenting as an early onset encephalopathy and peripheral neuropathy caused by the T8993G mutation in the mitochondrial DNA (mtDNA). Clinical follow-up for 20 years revealed a peculiar pattern of slow disease progression, characterized by the addition of new minor deficits, while worsening of previous symptoms was mild. Brain MRI revealed cerebellar atrophy, diffuse demyelination of corona radiata and parietal white matter, and bilateral and symmetrical putaminal lesions. The proportion of mutant mtDNAs in blood was 72% (+/-0.02%) and in skeletal muscle was 81% (+/-0.4%). Leigh-like syndrome caused by the T8993G mtDNA mutation is a progressive disease, although not necessarily associated with an aggressive clinical course.

Carotid artery stenting in the context of endovascular treatment of acute ischemic stroke

UNLABELLED Mechanical thrombectomy as an adjunctive to intravenous thrombolysis is now the standard treatment for acute ischemic stroke (AIS) due to large vessel occlusions. However, the best management of acute carotid tandem occlusions (CTO) remains controversial. METHOD Twenty patients underwent endovascular treatment of acute CTO. The primary endpoint was the composite rate of complete or partial recanalization without a symptomatic intracranial hemorrhage (sICH). Secondary endpoints were recanalization times, procedure times, and clinical outcomes at three months. RESULTS The primary endpoint was reached in 17 (85%) patients. Recanalization rate was reached in 90% of patients (19/20) and sICH rate was 5% (1/20). At the 3-month follow-up we obtained a mRS ≤ 2 rate of 35% (7/20) and a mortality rate of 20% (4/20). CONCLUSION Carotid angioplasty stenting and endovascular treatment of AIS due to CTO appears effective with an acceptable rate of sICH.

Nonlinear mixing of two ultrasonic beams for transcranial sonothrombolysis

Evidences of ultrasound enhancement of fibrinolysis - called sonothrombolysis - using acoustic beams in the kHz range pointed out acceleration of enzymatic processes and improvement in the tissue penetration of sound waves in comparison with MHz range trials. However, trials using kHz range increased bleeding rates in strokes cases due to the formation of standing waves in the brain. This paper describes the use of two cofocused ultrasonic beams for transcranial sonothrombolysis. A confocal ultrasound transducer of 3.2 MHz of central frequency generated two independent ultrasonic beams with 20 kHz of difference frequency. The low-frequency acoustic field was mapped using a laser Doppler vibrometer based on the acousto-optic phenomenon. The nonlinear mixing of two cofocused ultrasonic beams generated a 20-kHz acoustic field with lower standing wave formation and higher focusing of the beam in comparison with the focal beam with AM modulation. The findings presented here will assist in the improvement of transcranial sonothrombolysis by focusing the site of excitation on the blood clot to avoid hemorrhage in the brain parenchyma.

Aspects correlates with Scandinavian Stroke Scale for predicting early neurological impairment

OBJECTIVE To investigate the correlation between the Alberta Program Early CT Score (ASPECTS) and the Scandinavian Stroke Scale (SSS) for the evaluation of neurological impairment in patients with acute stroke. METHOD 59 patients with a first acute ischemic stroke were evaluated. The ASPECTS were evaluated by 2 neurologists at admission and by another neurologist after 48 hours. The NIHSS and SSS was applied to determinate stroke severity. Correlations and agreements were analysed statistically by Spearman and Kappa tests. RESULTS ASPECTS was correlated with National Institute of Health Stroke Scale (NIHSS) at admission (r = -0.52; p < 0.001) and SSS (r = 0.50; p < 0.001). The ASPECTS and SSS items were most correlated with arm (r = 0.52; p < 0.001) and hand (r = 0.49; p < 0.001) motor power, and speech (r = 0.51; p < 0.001). The SSS of 25.5 shows sensitivity (68%) and specificity (72%) when associated with ASPECTS ≤ 7. CONCLUSION The SSS can predict worst neurological impairment when associated with lower values of ASPECTS.Objective To investigate the correlation between the Alberta Program Early CT Score (ASPECTS) and the Scandinavian Stroke Scale (SSS) for the evaluation of neurological impairment in patients with acute stroke. Method 59 patients with a first acute ischemic stroke were evaluated. The ASPECTS were evaluated by 2 neurologists at admission and by another neurologist after 48 hours. The NIHSS and SSS was applied to determinate stroke severity. Correlations and agreements were analysed statistically by Spearman and Kappa tests. Results ASPECTS was correlated with National Institute of Health Stroke Scale (NIHSS) at admission (r = -0.52; p < 0.001) and SSS (r = 0.50; p < 0.001). The ASPECTS and SSS items were most correlated with arm (r = 0.52; p < 0.001) and hand (r = 0.49; p < 0.001) motor power, and speech (r = 0.51; p < 0.001). The SSS of 25.5 shows sensitivity (68%) and specificity (72%) when associated with ASPECTS ≤ 7. Conclusion The SSS can predict worst neurological impairment when associated with lower values of ASPECTS.

Conhecimento leigo sobre AVC no Brasil: que informação sobre AVC é essencial?

Departamento de Neurociencias eCiencias do Comportamento,Faculdade de Medicina de RibeiraoPreto, Universidade de Sao Paulo,Ribeirao Preto SP, Brazil.Correspondence:Octavio Marques Pontes-Neto,Hospital das Clinicas, Faculdade deMedicina de Ribeirao Preto;Av. dos Bandeirantes, 3.900 / 4°andar / sala 438; 14049-900Riberao Preto SP, Brasil;E-mail: opontesneto@fmrp.usp.brConflict of interest:The author is currently the Presidentof the Brazilian Stroke Network, anon-governmental organization(NGO) devoted to promote andimprove global care of strokepatients throughout the country anddirectly involved on the organizationof stroke awareness campaigns inBrazil around the “World StrokeDay”. No financial incentives of anysort come from this position.Received 23 September 2014Accepted 30 September 2014

Stroke awareness in Brazil: what information about stroke is essential?

Departamento de Neurociencias eCiencias do Comportamento,Faculdade de Medicina de RibeiraoPreto, Universidade de Sao Paulo,Ribeirao Preto SP, Brazil.Correspondence:Octavio Marques Pontes-Neto,Hospital das Clinicas, Faculdade deMedicina de Ribeirao Preto;Av. dos Bandeirantes, 3.900 / 4°andar / sala 438; 14049-900Riberao Preto SP, Brasil;E-mail: opontesneto@fmrp.usp.brConflict of interest:The author is currently the Presidentof the Brazilian Stroke Network, anon-governmental organization(NGO) devoted to promote andimprove global care of strokepatients throughout the country anddirectly involved on the organizationof stroke awareness campaigns inBrazil around the “World StrokeDay”. No financial incentives of anysort come from this position.Received 23 September 2014Accepted 30 September 2014