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Abstract
Objective: Characterize victims of spinal cord injury (SCI) associated with traumatic brain injury (TBI) and risk factors. Methods: Study conducted with 52 victims of SCI associated with TBI. The variables studied were: sex; age; marital status; occupation; educational level; religion; etiology and the lesion area; neurological condition by the ASIA scale; associated injuries and potential risk factors. Results: The male (85%), aged between 21-30 years (25%), civil status stable union (56%), low level of education (69%) and the Roman Catholic religion (77%) presented the greater number of victims. Motor vehicle accidents (58%) were the main etiology. The cervical segment had higher injury risk (RR=3.48, p<0.0001). The neurological status ASIA-E (52%), the syndromic neck pain (35%) and the rate of mild TBI (65%) were the most frequent. Complications occurred in 13 patients with increased frequency of pneumonia (62%). The length of hospital stay was significantly higher (20±28 days) and 17% of patients died. Men (RR=2.14, p=0.028) and individuals exposed to motor vehicle accidents (RR=1.91, p=0.022) showed a higher risk of these lesions concurrently. Moreover, these patients had 2.48 (p<0.01) higher risk of death than victims of SCI alone. Conclusion: The SCI associated with TBI was more frequent in men, young adults, and individuals exposed to motor vehicle accidents. The cervical spine is more likely to be affected. Furthermore, the length of hospitalization is significantly higher and the subjects analyzed have higher risk of death.
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Affiliation(s)
| | - Waldir Antônio Tognola
- Faculdade de Medicina de São José do Rio Preto (FAMERP), Brazil; Hospital de Base, Brazil
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Abstract
Objective: To analyze individuals with spinal cord injury who developed secondary clinical complications, and the variables that can influence the prognosis. Methods: A prospective study of 321 patients with spinal cord injury. The variables were collected: age, sex, cause of the accident, anatomical distribution, neurological status, associated injuries, in-hospital complications, and mortality only in patients who developed complications. Results: A total of 72 patients were analyzed (85% male) with a mean age of 44.72±19.19 years. The individuals with spinal cord injury who developed clinical complications were mostly male, over 50 years of age, and the main cause was accidental falls. These patients had longer hospitalization times and a higher risk of progressing to death. Pneumonia was the main clinical complication. With regard to the variables that can influence the prognosis of these patients, it was observed that spinal cord injury to the cervical segment with syndromic quadriplegia, and neurological status ASIA-A, have a higher risk of developing pneumonia, the most common complication, as well as increased mortality. Conclusion: Clinical complications secondary to spinal cord injury are influenced by demographic factors, as well as characteristics of the injury contributing to an increase in mortality.
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Floriano VH, Torres US, Spotti AR, Ferraz-Filho JRL, Tognola WA. The role of dynamic susceptibility contrast-enhanced perfusion MR imaging in differentiating between infectious and neoplastic focal brain lesions: results from a cohort of 100 consecutive patients. PLoS One 2013; 8:e81509. [PMID: 24324699 PMCID: PMC3855761 DOI: 10.1371/journal.pone.0081509] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Differentiating between infectious and neoplastic focal brain lesions that are detected by conventional structural magnetic resonance imaging (MRI) may be a challenge in routine practice. Brain perfusion-weighted MRI (PWI) may be employed as a complementary non-invasive tool, providing relevant data on hemodynamic parameters, such as the degree of angiogenesis of lesions. We aimed to employ dynamic susceptibility contrast-enhanced perfusion MR imaging (DSC-MRI) to differentiate between infectious and neoplastic brain lesions by investigating brain microcirculation changes. Materials and Methods DSC-MRI perfusion studies of one hundred consecutive patients with non-cortical neoplastic (n = 54) and infectious (n = 46) lesions were retrospectively assessed. MRI examinations were performed using a 1.5-T scanner. A preload of paramagnetic contrast agent (gadolinium) was administered 30 seconds before acquisition of dynamic images, followed by a standard dose 10 seconds after starting imaging acquisitions. The relative cerebral blood volume (rCBV) values were determined by calculating the regional cerebral blood volume in the solid areas of lesions, normalized to that of the contralateral normal-appearing white matter. Discriminant analyses were performed to determine the cutoff point of rCBV values that would allow the differentiation of neoplastic from infectious lesions and to assess the corresponding diagnostic performance of rCBV when using this cutoff value. Results Neoplastic lesions had higher rCBV values (4.28±2.11) than infectious lesions (0.63±0.49) (p<0.001). When using an rCBV value <1.3 as the parameter to define infectious lesions, the sensitivity of the method was 97.8% and the specificity was 92.6%, with a positive predictive value of 91.8%, a negative predictive value of 98.0%, and an accuracy of 95.0%. Conclusion PWI is a useful complementary tool in distinguishing between infectious and neoplastic brain lesions; an elevated discriminatory value for diagnosis of infectious brain lesions was observed in this sample of patients when the rCBV cutoff value was set to 1.3.
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Affiliation(s)
- Valdeci Hélio Floriano
- Department of Radiology, Hospital de Base, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
- * E-mail:
| | - Ulysses S. Torres
- Department of Radiology, Hospital de Base, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Antonio Ronaldo Spotti
- Department of Neurological Sciences, Hospital de Base, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - José Roberto Lopes Ferraz-Filho
- Department of Radiology, Hospital de Base, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Waldir Antônio Tognola
- Department of Neurological Sciences, Hospital de Base, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
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Morais DF, Spotti AR, Cohen MI, Mussi SE, Melo Neto JSD, Tognola WA. Perfil epidemiológico de pacientes com traumatismo raquimedular atendidos em hospital terciário. Coluna/Columna 2013. [DOI: 10.1590/s1808-18512013000200012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar o perfil epidemiológico de pacientes com traumatismo raquimedular atendidos em hospital terciário. MÉTODOS: Estudo descritivo, transversal, prospectivo, com 321 pacientes vítimas de traumatismo raquimedular, realizado de janeiro de 2008 a junho de 2012. Foram estudadas as variáveis: sexo; idade; estado civil; profissão; escolaridade; religião; procedência; etiologia, morfologia e região da lesão; condição neurológica pela escala da ASIA e lesões associadas. RESULTADOS: Amostra constituída por 72% pacientes do sexo masculino e 28% do feminino, prevalência da faixa etária de 21 a 30 anos. Os estados civis mais frequentes foram união estável (46,8%) e solteiros (41,7%). O nível de escolaridade foi ensino fundamental incompleto (57%) e completo (17,8%). As causas mais frequentes foram acidentes automobilísticos (38,9%) e queda (27,4%). A lesão mais presente foi fratura explosão (23,7%), as regiões mais afetadas foram cervical subaxial (41,7%) e transição toracolombar (30,5%). A lesão associada mais frequente foi traumatismo cranioencefálico (TCE) (28,2%). O estado neurológico mais observado na internação/alta foi ASIA-E. Ocorreram 25 óbitos (7,8%), sendo que 76% com lesão na região cervical foram estratificados com ASIA-A, e 68% tiveram complicações respiratórias. CONCLUSÃO: O trauma raquimedular acometeu mais adultos jovens do sexo masculino com união estável e baixo nível de escolaridade. A causa mais frequente foi acidente automobilístico, o tipo de lesão foi fratura explosão e a região cervical a mais acometida. A condição neurológica mais presente foi ASIA-E, o TCE foi a lesão associada mais frequente e a maior gravidade pela classificação da ASIA nos casos de envolvimento cervical aumentou o risco de complicações respiratórias e morbidade e mortalidade.
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dos Santos MLT, Spotti AR, dos Santos RMT, Borges MA, Ferrari AF, Colli BO, Tognola WA. Giant intracranial aneurysms: morphology and clinical presentation. Neurosurg Rev 2012; 36:117-22; discussion 122. [PMID: 22791075 DOI: 10.1007/s10143-012-0407-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 04/03/2012] [Accepted: 05/20/2012] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to correlate the morphology of giant intracranial aneurysms (GIA) with their clinical presentation. Eighty patients with GIA, 14 males and 66 females, were studied. Univariate and multivariate analyses were made to test the associations between morphological and clinical features. The main locations of the unruptured GIA included the carotid cavernous segment, and for the ruptured GIA, the most frequent were the carotid supraclinoid and middle cerebral arteries. There was a significant association among communicating arteries (CA) of "bad" quality and presence of thrombus and calcification (TC). The risk of rupture is 8 times higher in patients with CA of "bad" quality and 11 times higher in patients without TC. GIA are more frequent in the cavernous segment. There is a high rupture risk in the middle cerebral artery. CA of "bad" quality are associated with TC. The rupture risk is significantly higher in patients without TC.
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Affiliation(s)
- Marcio L Tostes dos Santos
- Department of Neurological Sciences, Medical School of São José do Rio Preto, São José do Rio Preto, SP, Brazil.
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Santos MLTD, Demartini Júnior Z, Matos LAD, Spotti AR, Tognola WA, Sousa AAD, Santos RMTD. Angioarchitecture and clinical presentation of brain arteriovenous malformations. Arq Neuropsiquiatr 2010; 67:316-21. [PMID: 19547834 DOI: 10.1590/s0004-282x2009000200031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 03/12/2009] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to correlate the angioarchitecture of brain arteriovenous malformations (AVM) with their clinical presentation. A total of 170 patients with AVM 78 males and 92 females, were studied. Univariate and multivariate analyses were conducted in order to test the associations between morphological features and clinical presentation. The most frequent clinical presentations at diagnosis were hemorrhage in 89 (52%) patients, headache in 79 (46%), focal neurological deficit in 54 (32%), and seizure in 52 (31%). According to the Spetzler-Martin classification, grade I was found in 15 patients, II in 49, III in 55, IV in 41, and grade V in 10 patients. AVM with small nidus size, single feeding artery and single draining vein were associated with hemorrhage. Hemorrhage was positively associated with Spetzler-Martin grade I and negatively with grade V. The association between seizure and large nidus size was positive, however negative with small nidus size.
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de Oliveira Filho LR, Matos LAD, Laurenti MR, Spotti AR, Tognola WA, dos Santos MLT. Bilateral amaurosis due to brain aneurysm rupture. Arq Neuropsiquiatr 2008; 66:908-9. [PMID: 19099141 DOI: 10.1590/s0004-282x2008000600031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Leonides Rocha de Oliveira Filho
- Unidade de Neurocirurgia Endovascular, Serviço de Neurocirurgia, Hospital de Base de São José do Rio Preto, Universidade de Marília, São José do Rio Preto SP, Brasil
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de Menezes FO, Demartini Z, Matos LAD, de Godoy JMP, Spotti AR, dos Santos MLT. Anomalous branch of the right common carotid artery. Arq Neuropsiquiatr 2008; 66:916-7. [PMID: 19099144 DOI: 10.1590/s0004-282x2008000600034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Demartini Jr Z, Martins RT, Rocha CED, Matos LAD, Spotti AR, Tognola WA, Santos MLTD. Surgical treatment of moyamoya disease in children. Arq Neuro-Psiquiatr 2008; 66:276-8. [DOI: 10.1590/s0004-282x2008000200032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | | | | | - Antonio Ronaldo Spotti
- Faculdade de Medicina de São José do Rio Preto, Brazil; Hospital de Base de São José do Rio Preto, Brazil
| | - Waldir Antônio Tognola
- Faculdade de Medicina de São José do Rio Preto, Brazil; Hospital de Base de São José do Rio Preto, Brazil
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dos Santos MLT, Demartini Z, Matos LAD, Borges MA, Spotti AR, Tognola WA. Radiculopathy due to iatrogenic fistula between subclavian artery and internal jugular vein. Clin Neurol Neurosurg 2008; 110:80-2. [DOI: 10.1016/j.clineuro.2007.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 08/16/2007] [Accepted: 08/24/2007] [Indexed: 10/22/2022]
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Abstract
CONTEXT Proton spectroscopy has been recognized as a safe and noninvasive diagnostic method that, coupled with magnetic resonance imaging techniques, allows for the correlation of anatomical and physiological changes in the metabolic and biochemical processes occurring within previously-determined volumes in the brain. There are two methods of proton magnetic resonance spectroscopy: single voxel and chemical shift imaging. OBJECTIVE The present work focused on the clinical applications of proton magnetic resonance spectroscopy in patients with brain lesions. CONCLUSIONS In vivo proton spectroscopy allows the detection of certain metabolites in brain tissue, such as N-acetyl aspartate, creatine, choline, myoinositol, amino acids and lipids, among others. N-acetyl aspartate is a neuronal marker and, as such, its concentration will decrease in the presence of aggression to the brain. Choline increase is the main indicator of neoplastic diseases. Myoinositol is raised in patients with Alzheimer's disease. Amino acids are encountered in brain abscesses. The presence of lipids is related to necrotic processes.
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Affiliation(s)
- Sérgio Luiz Ramin
- Department of Neurological Sciences, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
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Spotti AR, Santos ML. [Magnetic resonance angiography of intracranial aneurysms: comparative study with cerebral angiography]. Arq Neuropsiquiatr 2001; 59:384-9. [PMID: 11460184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We studied by magnetic resonance angiography and cerebral angiography 41 patients with 55 aneurysms confirmed by surgery. The MR angio detected 52 aneurysms with sensibility of 94.5% and the cerebral angiography detected 53 aneurysms with sensibility of 96.3%. For being non invasive, more quickly and less expensive MR angio may substitute vascular angiography in the diagnosis of intracranial aneurysms and prognosis of the subarachnoid hemorrhage
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Affiliation(s)
- A R Spotti
- Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
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Spotti AR, Lima ÉG, Santos MLT, Magalhães ÁCDA. Angiografia pela ressonância magnética nos aneurismas intracranianos: estudo comparativo com a angiografia cerebral. Arq Neuro-Psiquiatr 2001. [DOI: 10.1590/s0004-282x2001000300014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Avaliamos por angiografia pela ressonância magnética e por angiografia cerebral 41 pacientes com 55 aneurismas intracranianos confirmados pela cirurgia. A angiorressonância detectou 52 aneurismas com sensibilidade de 94,5% e a angiografia cerebral detectou 53 aneurismas com sensibilidade de 96,3%. Pela não invasibilidade, rapidez e baixo custo a angiorressonância poderá substituir a angiografia cerebral no diagnóstico de aneurismas intracranianos e no prognóstico da hemorragia subaracnóide.
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Abstract
Tumours of the pineal region are rare. Clinical and CT aspects, and results of the treatment of 12 cases observed in a 5 years period (1979-1984) are described. The authors consider the supracerebellar infratentorial approach, formerly described by Krause in 1926 and reintroduced by Stein in 1971, the best for the surgical management of these tumours.
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Affiliation(s)
- A R Spotti
- Departamento de Neurocirurgia da Faculdade Regional de Medicina de São José do Rio Preto, Brasil
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