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Magalhaes J.E.,University of Pernambuco | Azevedo-Filho H.R.C.,Hospital da Restauracao | Rocha-Filho P.A.S.,Federal University of Pernambuco
Headache | Year: 2013

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.


PubMed | Neurological Clinic Belo Horizonte, Federal University of Goais, Rio de Janeiro State Federal University, Hospital Beneficencia Portuguesa Of Sao Paulo and 17 more.
Type: | Journal: Expert review of clinical pharmacology | Year: 2016

Natalizumab is a therapeutic option for treating multiple sclerosis (MS) and is particularly efficacious for patients with highly active disease. A long washout period has been recommended between withdrawal of natalizumab and start of fingolimod (another option for treating MS). This long washout period has been associated with a significant increase in MS activity. In the present study, a group of 96 patients who were switched from natalizumab to fingolimod had short washout periods between drugs, or monthly corticosteroid pulse therapy if longer washout periods were recommended. This therapeutic approach led to the lowest reported relapse rate so far, among patients with MS switching from natalizumab to fingolimod (8.3%). No complications from short withdrawal were observed in this group of patients.


PubMed | Hospital da Restauracao and Federal University of Pernambuco
Type: Journal Article | Journal: Arquivos de neuro-psiquiatria | Year: 2016

To assess the language and verbal fluency performance in aneurismal SAH pre- and post-surgery in patients caused by an aneurysm of the anterior communicating artery (AcomA), left middle cerebral artery (L-MCA) and left posterior comunicating artery (L-PcomA).Assessment in 79 patients with SAH, on two occasions: pre- and post surgical treatment. They were divided into three groups by the aneurysms location.Deterioration is detected in the performance of all patients during the post-surgical period; L-MCA aneurysm patients displayed a reduction in verbal naming and fluency; L-PcomA patients deteriorated in the written language and fluency tasks.After the surgical procedure the patients decreased in various language tasks and these differences in performance being directly related to the location of the aneurysm.


News Article | January 25, 2016
Site: www.biosciencetechnology.com

Two Latin American countries are investigating whether outbreaks of the mosquito-borne Zika virus are behind a rise in a rare and sometimes life-threatening nerve condition that can cause paralysis and leave victims on life-support. The Zika virus has already been tentatively linked to a rash of microcephaly, a birth defect in which babies are born with unusually small heads. And while the mechanics of how the virus may affect infants remain murky, authorities in Brazil, Colombia and El Salvador are urging women to avoid the risk by postponing pregnancies. The U.S. Centers for Disease Control and Prevention advised pregnant women to reconsider travel to countries with Zika outbreaks, and on Friday it expanded the warning to 22 destinations, most in Latin America and the Caribbean. The rise in cases of Guillain-Barre has also alarmed health officials region-wide. The nerve disorder causes muscle weakness that generally begins in the legs and spreads to the arms and face, and can cause numbness, trouble walking and even limb paralysis. While most people recover in weeks or months, in severe cases the muscles used for breathing weaken so much that patients require life-support. Anyone of any age can get Guillain-Barre, although it is very rare. It is thought to be triggered by an infection - something as simple as food poisoning - and happens when the immune system attacks the body's own nervous system. Researchers have been wary of Zika since French Polynesia noted a jump Guillain-Barre and microcephaly cases in tandem with an outbreak of the dengue-like virus, though the populations were far smaller than in the recent outbreaks. The World Health Organization said authorities in El Salvador reported 46 cases of Guillain-Barre in just five weeks, from Dec. 1 to Jan. 6. The full-year average for the country is 169 cases. Of 22 patients for whom there was information, at least 12 had experienced a rash-fever illness in the 15 days prior. Brazilian officials are also probing a near-simultaneous rise in Guillain-Barre and Zika, which was first identified in the country last May. It is believed that Zika may have arrived through a tourist at the 2014 World Cup or an international canoeing event the same year. Amid a Zika outbreak in the northeastern city of Salvador during last year's rainy season, the Couto Maia Hospital saw an unprecedented rise in Guillain-Barre. "Zika was really bad here from February to July and then all but disappeared in August. In May, June and July, we had 24 patients come in with Guillain-Barre, and none since August," said Antonio Bandeira, an infectious disease specialist at the hospital. In a normal year, he sees just two or three such cases. Most of the patients had also experienced Zika-like symptoms, which can include fever and red splotchy skin, Bandeira said. Meanwhile the Hospital da Restauracao in Recife treated about six times the normal number of Guillain-Barre cases, neurologist Maria Lucia Ferreira said. Of the 94 patients treated there during the rainy season, 50 of them died. However the scope of the problem remains unclear, as Guillain-Barre has been so rare that Brazil's Health Ministry does not track the exact number of cases. Albert Ko, a professor of epidemiology at the Yale School of Public Health, said a link between Zika and Guillain-Barre is "plausible and highly likely." But the difficulty of diagnosing Zika and the fact that Guillain-Barre can set in weeks later have made it tough to confirm the link. "While many of us are convinced and believe it's highly plausible that Zika virus caused this epidemic of Guillain-Barre, and can cause it anywhere the virus is being transmitted, we still lack really firm evidence to make that diagnosis," said Ko, who has conducted research in northeastern Brazil for two decades. Zika originated in Africa and expanded to parts of Asia. When it was first detected in Brazil, health officials were not initially alarmed since the virus appeared to be like a less potent form of dengue. But then came the spike in microcephaly: Since October the country has recorded 3,893 suspected cases, compared with fewer than 150 for all of 2014. Brazilian officials say they are convinced of a link. International health bodies say it is not yet scientifically established, but they are on alert. The CDC said Friday it issued its travel advisory "out of an abundance of caution." Earlier this week El Salvador recommended women avoid getting pregnant for the next two years, and some are taking that advice. "We were very lucky. My son was born before this," said Fatima Mejia, who took her 17-day-old infant to a clinic outside the Salvadoran capital for a checkup. "I'm not going to get pregnant until this passes. I'm not going to risk a child." In Colombia, Deputy Health Minister Fernando Ruiz said his country has recorded 13,531 suspected cases of Zika and that could hit a half-million this year. At least 560 involve pregnant women, though there have been no detected cases of microcephaly. Ruiz said there have been 12 cases of people with Guillain-Barre who also experienced Zika-like symptoms.


Fragoso Y.D.,Metropolitan University of Santos | Adoni T.,Hospital Sirio Libanes | Bichuetti D.B.,University of Sao Paulo | Brooks J.B.B.,Metropolitan University of Santos | And 6 more authors.
Journal of Neurology | Year: 2013

Less than a hundred cases of pregnancies in women with neuromyelitis optica (NMO) have been published in the world. The aim of the present study was to add the Brazilian experience to this subject. Cases of women with NMO who became pregnant, or who developed NMO soon after pregnancy, were included. Retrospective analysis of medical data from these patients was carried out by the neurologist responsible for the case. Seventeen cases of pregnancies (16 full-term pregnancies, one miscarriage) were identified. The relapse rate of demyelinating events in the first trimester after pregnancy was significantly higher than at any other time. Disability progression was significantly worse 1 year after delivery. Pregnancy negatively influenced the disease course of NMO in these women. These results are similar to those of other authors, although the total number of cases so far described is still small. Obstetricians must be aware of the potential complications of a pregnancy in a woman who has NMO. © 2013 Springer-Verlag Berlin Heidelberg.


Amorim J.A.,CCS | Amorim J.A.,Hospital da Restauracao | Gomes De Barros M.V.,University of Pernambuco | Valenca M.M.,CCS
Cephalalgia | Year: 2012

Objective: This is an analytic, interventional, cross sectional study to evaluate the risk factors of post-dural (post-lumbar) puncture headache (PDPH) and the validity of the diagnostic criteria for PDPH from the ICHD II.Methods: Six-hundred-and-forty patients (332 non-pregnant women and 308 men) aged 8-65 years underwent spinal anesthesia with Quincke 25G or 27G needles in elective surgery.Results: Forty-eight (7.5%) of the patients developed PDPH. The binary logistic regression analysis identified as risk factors: gender [11.1% female vs. 3.6% male, OR 2.25 (1.07-4.73); p-=-0.03], age [11.0% 31-50 years of age vs. 4.2% others, OR 2.21 (1.12-4.36); p-=-0.02], previous history of PDPH [26.4% positive vs. 6.2% negative, OR 4.30 (1.99-9.31); p-<-0.01] and bevel orientation [16.1% perpendicular vs. 5.7% parallel, OR 2.16 (1.07-4.35); p-=-0.03]. The period of latency between lumbar puncture and headache onset range from 6 to 72 hours and the duration from 3 to 15 days. In 34/48 (71%) patients with PDPH, at least one of the following was present: neck stiffness, tinnitus, hypoacusia, photophobia, or nausea.Conclusion: In conclusion, 14/48 patients (29%) suffered none of the above-mentioned symptoms, indicating that a significant number of patients may suffer from PDPH in the absence of any symptoms apart from the headache itself. This suggests that a further analyses of existing studies should be made to determine if a criteria change may need consideration. © International Headache Society 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.


Da Silva J.C.,Hospital da Restauracao | De Melo Tavares De Lima F.,Hospital da Restauracao | Valenca M.M.,Hospital das Clinicas | Cirne De Azevedo Filho H.R.,Hospital da Restauracao
Neurological Research | Year: 2010

Background: Medical management of brain edema and elevated intracranial pressure (ICP) is a crucial challenge in neurosurgical practice. Depending on the cause, the treatments for brain edema fall into three categories: stabilization of the blood-brain barrier, depletion of brain water and surgical decompression. Although mannitol is the mainstay of hyperosmolar therapy, hypertonic saline (HS) is emerging as an effective alternative to traditional osmotic agents. Methods: Experimental elevated ICP (50 mmHg) was induced in rabbits using an intracranial balloon. The effects of mannitol and HS (10% NaCl) were compared in this specific physiopathological model. Twelve animals were divided into three groups (control, HS and mannitol) according to intravenous administration of 0.9% NaCl, 10% NaCl or 20% mannitol 5 minutes after the elevation of ICP. The doses of 10% NaCl and 20% mannitol were iso-osmolar. During 90 minutes, continuous recording of ICP, mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) was realized. Results: The control group had a median survival of only 53 minutes, significantly lower than the treated groups (p=0.0002). There was statistical difference between mannitol and HS; the 10% NaCl group had lower values of ICP (p=0.0116) and higher values of MAP (p<0.0001) and CPP (p<0.0001). Conclusion: The findings demonstrate higher efficacy of the 10% NaCl treatment in this comparison with 20% mannitol. Further efforts should be directed toward development of clinical studies using iso-osmotic doses of mannitol and HS in specific etiologies of intracranial hypertension. © 2010 W.S. Maney & Son Ltd.


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 | Year: 2016

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.


PubMed | Federal University of Fluminense and Hospital da Restauracao
Type: Journal Article | Journal: Arquivos de neuro-psiquiatria | Year: 2016

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-Barr 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.


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.

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