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Recife, Brazil

Magalhaes J.E.,University of Pernambuco | Azevedo-Filho H.R.C.,Hospital da Restauracao | Rocha-Filho P.A.S.,Federal University of Pernambuco

Objectives The aim of this study was to assess the risk of headache in patients undergoing surgical treatment of intracranial aneurysms. Background The risk of the post-craniotomy headache has never been studied. Methods Patients with intracranial aneurysm, who were consecutively admitted to the Hospital da Restauração, Brazil, from May 2009 to October 2010, were interviewed before they underwent surgical or non-surgical treatment of the aneurysms. The patients were followed for 4 months after intervention. The International Headache Society criteria for post-craniotomy headache were used after surgery and adapted for headache after embolization (maximum intensity of pain on the same side of the aneurysm). We also used the Headache Impact Test, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale. Results Of 101 patients enrolled, 53 patients underwent craniotomy and 48 patients embolization. The surgery group was younger and had fewer women. The incidence of headache was 28/51 cases (54.9%) after surgery and 12/47 cases (25.5%) after embolization (relative risk = 2.15; 95% confidence interval [CI] 1.24-3.72). The incidence of persistent headache was not different between the 2 groups. The only risk factor for headache after the intervention was craniotomy (odds ratio = 2.6; 95% CI 1.1-6.7) and for persistent headache was anxiety prior to treatment (odds ratio = 8.5; 95% CI 1.7-42.3). The headache after treatment was not associated with the risk of anxiety or depression after the intervention. Conclusions Patients who underwent craniotomy had an increased risk of headache after treatment of intracranial aneurysms. The incidence of persistent headache after 3 months was higher among patients who had anxiety before the intervention. © 2013 American Headache Society. Source

Andrade G.,Interventional Neuroradiology | Ponte De Souza M.L.,Interventional Neuroradiology | Marques R.,Interventional Neuroradiology | Silva J.L.,Interventional Neuroradiology | And 2 more authors.
Interventional Neuroradiology

This study aimed to propose an alternative treatment for carotid cavernous fistula (CCF) using the balloon-assisted sinus coiling (BASC) technique and to describe this procedure in detail. Under general anesthesia, we performed the BASC procedure to treat five patients with traumatic CCF. Percutaneous access was obtained via the right femoral artery, and a 7F sheath was inserted, or alternatively, a bifemoral 6F approach was accomplished. A microcatheter was inserted into the cavernous sinus over a 0.014-inch microwire through the fistulous point; the microcatheter was placed distal from the fistula point, and a "U-turn" maneuver was performed. Through the same carotid access, a compliant balloon was advanced to cross the point of the fistula and cover the whole carotid tear. Large coils were inserted using the microcatheter in the cavernous sinus. Coils filled the adjacent cavernous sinus, respecting the balloon. Immediate complete angiographic resolution was achieved, and an early angiographic control (mean = 2.6 months) indicated complete stability without recanalization. The clinical follow-up has been uneventful without any recurrence (mean = 15.2 months). An endovascular approach is optimal for direct CCF. Because the detachable balloon has been withdrawn from the market, covered stenting requires antiplatelet therapy and its patency is unconfirmed, but cavernous sinus coiling remains an excellent treatment option. Currently, there is no detailed description of the BASC procedure. We provide detailed angiograms with suitable descriptions of the exact fistula point, and venous drainage pathways. Familiarity with these devices makes this technique effective, easy and safe. Source

Dos Santos L.F.,Hospital da Restauracao | Amorim Jr. M.A.P.,Residente de Cirugia Plastica | Batista O.B.,Residente de Cirugia Plastica | Leite L.A.S.,Hospital Agamenon Magalhaes
Cirugia Plastica Ibero-Latinoamericana

Sixteen male patients aging from 20 to 35 years had been submitted to Reconstructive Surgery with pediculate remnant of nape, from 2000 to 2003, at the Plastic Surgery Department of Agamenon Magalhães Hospital, Recife, Pernambuco (Brazil), for treatment of chronic inflammatory injuries of mycotic origin and 1 case of secondary injury due to electric burning with scalp necrosis and bone exposition, all located in occipital region. The internment time varied between 3 and 4 days. Three cases of necrosis of remnant tip had been identified, in retro-auricular region, measuring between 0.5 cm and 1 cm that had healed by second intention. Any case of pedicular necrosis or infection has been registered. The proposal technique presented advantages as the correction in only one surgical procedure and the direct closing of the injury with a good cosmetic aspect. As disadvantages, there were increase of glabrous area and, sometimes, the presence of hypertrophic scar, which, in patients' opinion, did not compromise their quality of life. Source

Araujo L.M.,Federal University of Fluminense | Ferreira M.L.B.,Hospital da Restauracao | Nascimento O.J.,Federal University of Fluminense
Arquivos de Neuro-Psiquiatria

Zika virus (ZIKV) is now considered an emerging flavivirosis, with a first large outbreak registered in the Yap Islands in 2007. In 2013, a new outbreak was reported in the French Polynesia, with associated cases of neurological complications including Guillain-Barré syndrome (GBS). The incidence of GBS has increased in Brazil since 2015, what is speculated to be secondary to the ZIKV infection outbreak. The gold-standard test for detection of acute ZIKV infection is the polymerase-chain reaction technique, an essay largely unavailable in Brazil. The diagnosis of GBS is feasible even in resource-limited areas using the criteria proposed by the GBS Classification Group, which is based solely on clinical grounds. Further understanding on the relationship of ZIKV with neurological complications is a research urgency. © 2016, Associacao Arquivos de Neuro-Psiquiatria. All rights reserved. Source

Objective: To present the results of prospective and retrospective studies on multiple sclerosis patients cognitive dysfunctions, as well as to discuss the batteries of neuropsy-chological tests used in these investigations. Method: A systematic review was performed involving 40 studies published from 1997 to 2009, in PubMed, Scopus, Ovid, ISI Web of Knowledge, Scientific Electronic Library on line (Scielo) and Latin-American and Caribbean Center of Health Sciences Informations database. Clear description of multiple sclerosis patients cognitive deficits evaluation, study design, sample size; inclusion-exclusion and discontinuation criteria; instruments for neuropsychological evaluation, diagnostic methods, evaluated functions and detailed statistical analysis had been the inclusion criteria. Results: There is consensus on cognitive impairment of multiple sclerosis patients, especially on memory, speed processing, executive function, attention and concentration domains. One has identified use of 23 batteries and 74 neuropsychological tests, despite the recommendation of Consortium of Multiple Sclerosis Centers to the application of MACFIMS battery. Considerations: The absence of the uniformization for multiple sclerosis patients cognitive evaluation battery has precluded to achieve evidences to recommend its incorporation on diagnostic routine. Nevertheless this tendency is already outlined. Source

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