Preferred curricular activities and reduced problem behaviors in students with intellectual disabilities

This research examined the relation between students' preferences for curricular activities and the occurrence of problem and desirable behaviors in 3 students with moderate intellectual disabilities. Activity preference was determined with a systematic assessment procedure. Subsequently, the influence of activity preference on student behavior was evaluated using a reversal design. Results showed that preferred activities were associated with reduced levels of problem behavior and increased levels of desirable behaviors. The findings of this investigation contribute to the applied literature on activity preference and suggest directions for future research in the areas of curriculum design, preference, and curricular modifications as a viable behavior-management strategy.

[Reactive arthritis caused by Giardia lamblia in a patient with secretory IgA deficiency]

The authors report a case of seronegative polyarthritis resistant to the anti-inflammatory therapy in a 16-year-old male with intermittent diarrhea. A stool examination showed the presence of cysts of Giardia lamblia and an immunological study detected a partial serum IgA deficiency, including its secretory fraction. Based on clinical, analytical and radiological findings and the clinical improvement after treatment with metronidazole, a diagnosis of reactive arthritis associated to chronic giardiasis was made. Authors make a brief review of the literature the regarding this case.

[Neuroradiology in the physiopathologic diagnosis of subarachnoid hemorrhage--cerebral aneurysm]

The clinical importance of the cerebral aneurismatic lesion in well known. In Portugal we still do not have reliable statistics regarding the occurrence of the subarachnoid hemorrhage, however we can make a comparison through Kassel's and Drake's studies where they refer that annually 28,000 North-Americans suffer from subarachnoid hemorrhage attributed to the rupture of the cerebral aneurysm. This is a clinical situation that needs to be analyzed, more so because if it is not diagnosed and treated in time, it can cause a high level of morbidity and mortality. From 1984 to 1990, the authors studied 208 clinical cases of in-patients at the Santa Maria Hospital who had been diagnosed as having subarachnoid hemorrhage-cerebral aneurysm. They analyzed 172 cranium-encephalic Tomographies and 190 cerebral Angiographies. They found levels that overlapped the series already published with respect to the location of the lesion, dimensions and age groups involved. They tried to relate the presence aneurysm in the willis arterial circle with the occurrence of locoregional anatomic variants that were detected in 51% of the patients with aneurysm of the anterior communicating artery and in 33% of the cases in the posterior communicating artery. The high occurrence of serious forms of tomodensitrometric presentation should also be emphasized. As a matter of fact, 42.6% of the patients studied were grouped in degree IV of the Fisher Scale. This result translates the effort that is still required towards an early clinical and imaging diagnosis of warning hemorrhage to avoid or prevent a catastrophic hemorrhage recurrence.

Herpes zoster and controlateral hemiplegia in an African patient infected with HIV-1

One of the neurologic complications of human immunodeficiency virus infection are cerebrovascular accidents. In HIV infected patients, ischemic strokes have been reported secondary to nonbacterial thrombotic endocarditis and cerebral arteritis. We describe an unusual cause of stroke in HIV-1 infection: Herpes Zoster ophtalmicus with contralateral hemiplegia.

[The patient with acute cerebrovascular disorders: assessment of associated diseases]

We performed a prospective study in 106 patients with acute stroke. The main purpose was to evaluate the associated diseases and to determine their prevalence and incidence in two different types of cerebrovascular disease: the intracerebral hemorrhage (HI) and ischaemic events (AI). The studied population included 54 men and 52 women with a mean age of 66.8 +/- 10.3 years. A clinical examination was performed in all patients by different specialists and all were submitted to diverse complementary tests, including a computed tomography scan of the brain (TAC) and an echocardiogram (ECO). We found 24 (23%) HI and 82 (77%) AI. In the past history, previous stroke were more prevalent in AI (p less than 0.01). Heart disease was present in 87 (82%) patients but, among them, only atrial fibrillation which was found in 19 (18%) patients, was significantly more frequent in AI (p less than 0.02). Hypertension (HTA) existed in 79 (75%) patients, respiratory complications and periferic vascular disease in 9 (8%), diabetes in 44 (42%) and dyslipidemia in 31 (29%) patients. No significant difference was found between the two groups of stroke regarding these diseases; however, there was a tendency for HTA and diabetes to be more prevalent in HI and for periferic vascular disease in AI. In the blood tests, high haematocrit was found in 35 (33%) patients, anemia in 21 (20%), hypercholesterolemia in 17 (16%), hypertrigliceridemia in 18 (17%) and uremia or creatinemia or ionic alteration in 32 (30%) patients, without any difference in their prevalence and incidence in the two groups of stroke. In conclusion, in this prospective study of patients with an acute stroke, there was 23% of HI and 77% of AI, a high prevalence of previous stroke, heart disease and HTA, but only the previous stroke and, within heart disease, the atrial fibrillation were significantly more frequent in the AI group. Also, periferic vascular disease had a tendency to be more frequent in AI, as well as diabetes and HTA had in HI.

[The importance of heart disease in the various types of cerebral vascular disease. A prospective study]

A prospective study was performed in 106 patients with acute stroke. The main purpose was the cardiac evaluation in the different types of cerebrovascular disease: Intracerebral hemorrhage (H), Cortical ischaemic events (C) and Subcortical ischaemic events (SC) and also to evaluate the interest of echocardiography in detecting occult cardiac sources of emboli. The study population included 54 men and 52 women with a mean age of 66.8 +/- 10.3 years. A thorough neurologic and cardiologic study with a computed tomography of the brain (TAC) and an echocardiogram (ECO) were performed in all patients. It was found 24 (23%) of H, 40 (38%) of C and 32 (30%) of SC. In the past history, heart diseases were more prevalent in C (p less than 0.04); previous stroke and systemic hypertension (HTA) were less prevalent in H (p less than 0.008) and in C (p less than 0.004), respectively. Atrial fibrillation (FA) was more frequent in ischaemic stroke (p less than 0.02) and within these in C (p less than 0.005). No more clinical and functional cardiac features or echocardiographic aspects had any difference in their prevalence in different types of stroke. Without clinical heart disease there were 19 (18%) cases but only in 10 were found in their echocardiograms a potentially embolic heart disease (PEHD) but 8 of them had questionable pathologic significance.

IN CONCLUSION

C had more heart disease in their past history; FA is more frequent in C; it is difficult to diagnose a cerebral embolism with only a coexistent C and CPE, but if there is FA or a past history of heart disease in a C, the diagnosis of cerebral embolism is more probable; finally, echocardiography is of limited value to diagnose a PEHD in the elderly, however it makes possible to better evaluate most cardiac situations.

[Cerebral vascular disorders and arterial hypertension: cardiologic and neurologic aspects]

OBJECTIVE

To report and discuss some cardiologic, neurologic and radiologic aspects in different types of stroke (AVC) present in hypertensive patients.

DESIGN

Retrospective study in patients with acute cerebrovascular accident (AVC) and high blood pressure (HTA). Separate this population in three groups according to the results of computerized tomography scanning of the brain (TAC): hemorrhage (H) cerebral infarction (IC) and lacune (L). In each group describe the findings.

SETTING

Department of Internal Medicine in a University Hospital of Lisbon.

PATIENTS

Thirty-four patients, after having discarded 8 because their TAC were normal. Twenty were men (M), 14 women (F) with a total age average of 58 years.

MEASUREMENTS AND MAIN RESULTS

All patients had AVC, HTA and underwent initial TAC. For each group were considered: Past history, cardiac repercussions of HTA, neurologic features and the localisations of cerebral lesions. For statistical study were used the Student T Test. There was 45% of IC, 24% of H and 26% of L. In past history was found 35% of cardiac diseases and 24% of diabetes. There wasn't any difference in blood pressure (systolic and diastolic) between the groups. Fifty-six percent had an important cardiac repercussion, with 72% of alterations of ventricular repolarization and 35% of coronary heart diseases. Both were more prevalent in IC than in the others. Twenty percent of H were in physical activity, 20% had a progressive start and in 10% there were meningeal signals. The site of cerebral lesions were characteristical, specially the H and L and 60% of H were thalamic. There wasn't any lacune neither in the cerebral stem nor in the cerebellum. It was reviewed some theoric aspects of neurologic feature.

CONCLUSIONS

IC is the more frequent AVC in hypertensive patients. The cardiac involvement, is the most frequent disease in past history. The cardiac repercussion of HTA is more important in IC. The findings were insufficient to well characterize the neurologic feature. Sometime TAC and seldom magnetic resonance are necessary. The localisations, specially of H and L are the same that have been described in medical literature.