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Dos Reis FI, de Magalhães PSC, Diegoli H, Longo AL, Moro CHC, Safanelli JA, Nagel V, Lange MC, Zétola VF. Stroke profile and care during the COVID-19 pandemic: What changed and what did not? A prospective cohort from Joinville, Brazil. Front Neurol 2023; 14:1122875. [PMID: 36873444 PMCID: PMC9977808 DOI: 10.3389/fneur.2023.1122875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction The COVID-19 pandemic has wrought negative consequences concerning quality of care for stroke patients since its onset. Prospective population-based data about stroke care in the pandemic are limited. This study aims to investigate the impact of COVID-19 pandemic on stroke profile and care in Joinville, Brazil. Methods A prospective population-based cohort enrolled the first-ever cerebrovascular events in Joinville, Brazil, and a comparative analyzes was conducted between the first 12 months following COVID-19 restrictions (starting March 2020) and the 12 months just before. Patients with transient ischemic attack (TIA) or stroke had their profiles, incidences, subtypes, severity, access to reperfusion therapy, in-hospital stay, complementary investigation, and mortality compared. Results The profiles of TIA/stroke patients in both periods were similar, with no differences in gender, age, severity, or comorbidities. There was a reduction in incidence of TIA (32.8%; p = 0.003). In both periods, intravenous thrombolysis (IV) and mechanical thrombectomy (MT) rates and intervals from door to IV/MT were similar. Patients with cardioembolic stroke and atrial fibrillation had their in-hospital stay abbreviated. The etiologic investigation was similar before and during the pandemic, but there were increases in cranial tomographies (p = 0.02), transthoracic echocardiograms (p = 0.001), chest X-rays (p < 0.001) and transcranial Doppler ultrasounds (p < 0.001). The number of cranial magnetic resonance imaging decreased in the pandemic. In-hospital mortality did not change. Discussion The COVID-19 pandemic is associated with a reduction in TIA, without any influence on stroke profile, the quality of stroke care, in-hospital investigation or mortality. Our findings show an effective response by the local stroke care system and offer convincing evidence that interdisciplinary efforts are the ideal approach to avoiding the COVID-19 pandemic's negative effects, even with scarce resources.
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Affiliation(s)
| | | | - Henrique Diegoli
- Division of Neurology, Hospital Municipal São José, Joinville, Santa Catarina, Brazil
| | - Alexandre Luiz Longo
- Division of Neurology, Hospital Municipal São José, Joinville, Santa Catarina, Brazil
| | | | | | - Vivian Nagel
- Hospital Municipal São José, Joinville Stroke Registry, Joinville, Santa Catarina, Brazil
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Zétola VF, Rundek T. Carotid artery stenosis: to infinity and beyond. Arq Neuro-Psiquiatr 2022; 80:337-338. [DOI: 10.1590/0004-282x-anp-2022-e004] [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] [Received: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Viviane Flumignan Zétola
- Universidade Federal do Paraná, Brazil; Academia Brasileira de Neurologia, Brazil; World Federation of Neurology, UK
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Marques PT, Beltrami LPB, Rosa CT, Massuda R, Barbosa FJL, Zétola VF, Lange MC. Post-traumatic stress disorder in non-disabled ischemic stroke patients. Gen Hosp Psychiatry 2020; 67:150-151. [PMID: 32340739 DOI: 10.1016/j.genhosppsych.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Paula Teixeira Marques
- Department of Neurology, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Camila Thieime Rosa
- Department of Neurology, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Raffael Massuda
- Department of Psychiatry, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Viviane Flumignan Zétola
- Department of Neurology, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Marcos Cristiano Lange
- Department of Neurology, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Machline-Carrion MJ, Santucci EV, Damiani LP, Bahit MC, Málaga G, Pontes-Neto OM, Martins SCO, Zétola VF, Normilio-Silva K, Rodrigues de Freitas G, Gorgulho A, De Salles A, Pacheco da Silva BG, Santos JY, de Andrade Jesuíno I, Bueno PRT, Cavalcanti AB, Guimarães HP, Xian Y, Bettger JP, Lopes RD, Peterson ED, Berwanger O. Effect of a Quality Improvement Intervention on Adherence to Therapies for Patients With Acute Ischemic Stroke and Transient Ischemic Attack: A Cluster Randomized Clinical Trial. JAMA Neurol 2019; 76:932-941. [PMID: 31058947 DOI: 10.1001/jamaneurol.2019.1012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging, especially in low- and middle-income countries. Objective To assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for care of patients with AIS and TIA. Design, Setting and Participants This 2-arm cluster-randomized clinical trial assessed 45 hospitals and 2336 patients with AIS and TIA for eligibility before randomization. Eligible hospitals were able to provide care for patients with AIS and TIA in Brazil, Argentina, and Peru. Recruitment started September 12, 2016, and ended February 26, 2018; follow-up ended June 29, 2018. Data were analyzed using the intention-to-treat principle. Interventions The multifaceted quality improvement intervention included case management, reminders, a roadmap and checklist for the therapeutic plan, educational materials, and periodic audit and feedback reports to each intervention cluster. Main Outcomes and Measures The primary outcome was a composite adherence score for AIS and TIA performance measures. Secondary outcomes included an all-or-none composite end point of performance measures, the individual process measure components of the composite end points, and clinical outcomes at 90 days after admission (stroke recurrence, death, and disability measured by the modified Rankin scale). Results A total of 36 hospitals and 1624 patients underwent randomization. Nineteen hospitals were randomized to the quality improvement intervention and 17 to routine care. The overall mean (SD) age of patients enrolled in the study was 69.4 (13.5) years, and 913 (56.2%) were men. Overall mean (SD) composite adherence score for the 10 performance measures in the intervention group hospitals compared with control group hospitals was 85.3% (20.1%) vs 77.8% (18.4%) (mean difference, 4.2%; 95% CI, -3.8% to 12.2%). As a secondary end point, 402 of 817 patients (49.2%) at intervention hospitals received all the therapies that they were eligible for vs 203 of 807 (25.2%) in the control hospitals (odds ratio, 2.59; 95% CI, 1.22-5.53; P = .01). Conclusions and Relevance A multifaceted quality improvement intervention did not result in a significant increase in composite adherence score for evidence-based therapies in patients with AIS or TIA. However, when using an all-or-none approach, the intervention resulted in improved adherence to evidence-based therapies. Trial Registration ClinicalTrials.gov identifier: NCT02223273.
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Affiliation(s)
| | | | | | - M Cecilia Bahit
- Fundacion Instituto de Neurología Cognitiva Rosario, Grupo Argentino Colaborativo en Investigación Clínica, Rosario, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ying Xian
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Janet Prvu Bettger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.,Brazilian Clinical Research Institute, São Paulo, Brazil
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Zétola VF, Pavanelli GM, Pereira GU, Germiniani FMB, Lange MC. Burnout syndrome: are stroke neurologists at a higher risk? Arq Neuro-Psiquiatr 2019; 77:84-90. [DOI: 10.1590/0004-282x20190002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 11/20/2018] [Indexed: 11/21/2022]
Abstract
ABSTRACT Background: Burnout syndrome is a work-related psychological response, characterized by emotional exhaustion, depersonalization and low professional accomplishment. Objective: The study aimed to evaluate the prevalence of burnout syndrome in neurologists in the State of Paraná, Brazil, dividing them into stroke neurologists and non-stroke neurologists. Methods: We performed a crosssectional observational study, with a quantitative approach, based on the online Maslach Burnout Inventory - Human Services Survey questionnaire. Results: A total of 74 neurologists were evaluated, 44.6% of whom had burnout syndrome, predominantly among females and stroke neurologists. Both the stroke neurologist and non-stroke neurologist groups had medium degrees of emotional exhaustion and depersonalization; however, while stroke neurologists had high professional accomplishment, non-stroke neurologists had mean-to-low scores of professional accomplishment. There was a proportional relationship between age and emotional exhaustion. Female neurologists also reported lower professional accomplishment levels. Conclusion: Burnout is prevalent among the neurologists of Paraná, corroborating the results previously reported in other studies. There seems to be no significant difference between those neurologists who work in the emergency stroke care setting compared with those who don't.
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Machline-Carrion MJ, Santucci EV, Damiani LP, Bahit C, Málaga G, Pontes-Neto OM, Martins SCO, Zétola VF, Normilio-Silva K, de Freitas GR, Gorgulho A, De Salles A, da Silva BGP, Santos JY, de Andrade Jesuíno I, Bueno PRT, Cavalcanti AB, Guimarães HP, Xian Y, Bettger JP, Lopes RD, Peterson ED, Berwanger O. An international cluster-randomized quality improvement trial to increase the adherence to evidence-based therapies for acute ischemic stroke and transient ischemic attack patients: Rationale and design of the BRIDGE STROKE Trial. Am Heart J 2019; 207:49-57. [PMID: 30415083 DOI: 10.1016/j.ahj.2018.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/21/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging especially in low- and middle-income countries. OBJECTIVES The aim of this study is to assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for AIS and TIA patients care. DESIGN We designed a pragmatic, 2-arm cluster-randomized trial involving 36 clusters and 1624 patients from Brazil, Argentina, and Peru. Hospitals are randomized to receive a multifaceted quality improvement intervention (intervention group) or to routine care (control group). The BRIDGE Stroke multifaceted quality improvement intervention includes case management, reminders, health care providers' educational materials (including treatment algorithms), interactive workshops, and audit and feedback reports. Primary outcome is a composite adherence score to AIS and TIA performance measures. Secondary outcomes include an "all or none" composite end point to performance measures, the individual components of the composite end points, and clinical outcomes at 90 days following admission (stroke recurrence, death, and disability measured by the modified Rankin scale). SUMMARY The BRIDGE Stroke Trial is an international pragmatic evaluation of a multifaceted quality improvement intervention. If effective, this intervention could be potentially extended widely to improve the quality of care and outcomes of patients with AIS or TIA.
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Leitão JM, Moreira FMDS, Thiel IE, Spricido IY, Silva RHM, Zétola VF. Alarming lack of knowledge about antithrombotic therapy among patients with atrial fibrillation. Arq Neuro-Psiquiatr 2018; 76:807-811. [DOI: 10.1590/0004-282x20180126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/27/2018] [Indexed: 11/22/2022]
Abstract
ABSTRACT Large population campaigns have been conducted in Brazil to improve knowledge about the signs and symptoms of stroke and the importance of time to care. Objective: Parallel to these important actions, we aimed to evaluate the lay knowledge of patients with atrial fibrillation, a well-recognized etiology of stroke, adequate treatment and management of which can prevent up to 30% of cerebrovascular events. Methods: We questioned 143 patients with atrial fibrillation about the risks associated with the disease. Results: Ninety-one percent were on anticoagulation treatment. Of the total, 63.6% reported having been informed about the risks and benefits of anticoagulants but only 46.9% were able to correctly mention one of these risks. Ischemic stroke was identified as a risk by only 25.9% and hemorrhagic stroke was not mentioned. A CHADS2 ≥ 2 was scored by 84.0% of the patients. Conclusions: Our study showed an alarming knowledge gap in patients with atrial fibrillation. Difficulty in adherence to treatment resulting from the failure of this communication is possibly one of the factors responsible for the high incidence and recurrence of stroke, and should not go unnoticed.
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Tansini G, Ducci RDP, Nóvak EM, Germiniani FMB, Zétola VF, Lange MC. Exclusive bed for thrombolysis. A simple measure that allows 85% of ischemic stroke patients to be treated in the first hour. Arq Neuropsiquiatr 2016; 74:373-5. [PMID: 27191232 DOI: 10.1590/0004-282x20160048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/09/2015] [Indexed: 11/21/2022]
Abstract
The door-to-needle time is an important goal to reduce the time to treatment in intravenous thrombolysis. Objective Analyze if the inclusion of an exclusive thrombolytic bed reduces the door-to-needle time. Method One hundred and fifty patients admitted for neurological evaluation with ischemic stroke were separated in two groups: in the first, patients were admitted in the Emergency Room for intravenous thrombolysis (ER Group); in the second, patients were admitted in an exclusive thrombolytic bed in the general neurology ward (TB Group). Results Sixty-eight (86.0%) patients from TB Group were treated in the first 60 minutes of arrival as compared to 48 (67.6%) in the ER Group (p = 0.011). Conclusion The introduction of a thrombolytic bed in a general hospital setting can markedly reduce the door-to-needle time, allowing more than 85% of patients to be treated within the first hour of admission.
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Affiliation(s)
- Gabriella Tansini
- Departamento de Medicina Interna, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Renata Dal-Prá Ducci
- Departamento de Medicina Interna, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Edison Matos Nóvak
- Departamento de Medicina Interna, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Oliveira-Filho J, Martins SCO, Pontes-Neto OM, Longo A, Evaristo EF, Carvalho JJFD, Fernandes JG, Zétola VF, Gagliardi RJ, Vedolin L, Freitas GRD. Guidelines for acute ischemic stroke treatment: part I. Arq Neuropsiquiatr 2013; 70:621-9. [PMID: 22899035 DOI: 10.1590/s0004-282x2012000800012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Jamary Oliveira-Filho
- Rua Reitor Miguel Calmon s/n; Instituto de Ciências da Saúde / sala 455; 40110-100 Salvador BA - Brasil
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Zamproni LN, Zétola VF, Lange MC. Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke? Arq Neuro-Psiquiatr 2012; 70:578-82. [DOI: 10.1590/s0004-282x2012000800004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 02/24/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: Patent foramen ovale is associated with paradoxical embolism (PE) and stroke. Hypercoagulable states, such as antiphospholipid syndrome (APS), can exacerbate PE by increasing clot formation. The aim of this study was to verify whether patients with APS and stroke present a right-to-left shunt (RLS) with greater frequency than patients with APS but without stroke. METHODS: Fifty-three patients with APS were tested for RLS using contrast-enhanced transcranial Doppler (cTCD): 23 patients had a history of stroke (Stroke Group) and 30 had no history of stroke (No-stroke Group). RESULTS: cTCD was positive in 15 patients (65%) from the Stroke Group and in 16 patients (53%) in the No-stroke Group (p=0.56). The proportion of patients with a small RLS (<10 high-intensity transient sign or HITS) and a large RLS (>10 HITS) was similar between the groups without significant difference. CONCLUSIONS: Our data do not support the theory that paradoxical embolism may play an important role in stroke in APS patients.
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Lange MC, Zétola VF, Parolin MF, Zamproni LN, Fernandes AF, Piovesan EJ, Nóvak EM, Werneck LC. Curitiba acute ischemic stroke protocol: a university hospital and EMS initiative in a large Brazilian city. Arq Neuropsiquiatr 2012; 69:441-5. [PMID: 21755118 DOI: 10.1590/s0004-282x2011000400006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 01/12/2011] [Indexed: 11/22/2022]
Abstract
UNLABELLED Few healthcare centers in Brazil perform thrombolytic therapy for acute ischemic stroke (AIS) patients. OBJECTIVE The aim of this study was to describe an interinstitutional protocol for the rapid identification and thrombolytic treatment of AIS patients at a public health hospital in a large Brazilian city. METHOD Emergency medical services (EMS) personnel evaluated 433 patients with possible stroke during a six-month period. After a standard checklist, patients with suspected AIS and symptoms onset of less than two hours were evaluated at our University Hospital (UH). RESULTS Sixty-five (15%) patients met the checklist criteria and had a symptom onset of less than two hours, but only 50 (11%) patients were evaluated at the UH. Among them, 35 (70%) patients had ischemic stroke, 10 (20%) had hemorrhagic stroke, and 5 (10%) had other diagnoses. Of the 35 ischemic stroke patients, 15 (43%) underwent IV thrombolysis. CONCLUSION The present study demonstrated that trained EMS workers could help to improve the rate of thrombolytic treatment in large Brazilian cities. Permanent training programs for EMS and hospital staff, with quality control and correct identification of AIS patients, should be implemented to increase appropriate thrombolytic therapy rates in Brazil.
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Affiliation(s)
- Marcos Christiano Lange
- Cerebrovascular Diseases Unit, Neurology Division, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba PR, Brazil.
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Lange MC, Zétola VF, Piovesan ÉJ, Werneck LC. Saline versus Saline with Blood as a Contrast Agent for Right-to-left Shunt Diagnosis by Transcranial Doppler: Is There a Significant Difference? J Neuroimaging 2010; 22:17-20. [DOI: 10.1111/j.1552-6569.2010.00521.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lange MC, Zétola VF, Piovesan EJ, Werneck LC. Valsalva maneuver procedures in the diagnosis of right-to-left shunt by contrast-enhanced transcranial doppler using agitated saline solution with blood as a contrast agent. Arq Neuropsiquiatr 2010; 68:410-3. [PMID: 20602046 DOI: 10.1590/s0004-282x2010000300016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 09/08/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare two different timings for the performance of the Valsalva maneuver (VM) using an infusion of agitated saline solution with blood as contrast agent (CA) to right-to-left shunt (RLS) screening. METHOD 42 patients were submitted to a standardized contrast-enhanced transcranial doppler (cTCD) to screen for right-to-left shunt (RLS). cTCD technique was done with two different moments of the VM: [1] the CA injection during the VM (CAduringVM test); [2] the CA injection before the VM (CApreVM test). RESULTS Positive MCA tests were observed in 47 (56%) CAduringVM tests and in 50 (59.5%) CApreVM tests, p=0.64. There was an almost perfect agreement for the positive tests between the CAduringVM and CApreVM test, r s=0.829 (95% CI 0.61-1.00, p<0.001). CONCLUSION The present study demonstrates that there is no significant difference in the results of RLS screening by cTCD when two different moments of VM were done.
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Affiliation(s)
- Marcos Christiano Lange
- Neurology Division Cerebrovascular Diseases Unit, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Lange MC, Zétola VF, deSouza AM, Novak FM, Piovesan EJ, Werneck LC. Intracranial embolism characteristics in PFO patients: a comparison between positive and negative PFO by transesophageal echocardiography: the rule of nine. J Neurol Sci 2010; 293:106-9. [PMID: 20363000 DOI: 10.1016/j.jns.2010.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 01/16/2010] [Accepted: 02/02/2010] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Patent foramen ovale (PFO) can be diagnosed by contrast-enhanced transcranial Doppler (cTCD), but no definitive criteria exist to correlate the results obtained from cTCD with diagnoses of PFO obtained by contrast-enhanced transesophageal echocardiography (cTEE). The aim of the present study was to analyze markers in the positive RLS by cTCD that confirm the PFO by cTEE. METHODS Twenty-six stroke patients who had previously submitted to cTEE, 16 with PFO (PFO group) and 10 without PFO (no-PFO group), were evaluated for three markers based on a positive cTCD test. The number of microembolic signs (MES), the latency time (LT) to the first MES and the duration time (DT) of MES were evaluated to look for a difference between the PFO and no-PFO group. RESULTS The PFO group had higher MES (80.9+/-124.5 vs. 10.2+/-25.6, p<0.001), shorter LT (12.5+/-6.6 vs. 16.2+/-5.1, p=0.02) and longer DT (21.4+/-17.4 vs. 11.7+/-12.5, p=0.013) compared with the no-PFO group. Considering only MCA tests with more than 9 MES and LT shorter than 9s, 30% of patients from the PFO group had positive tests compared with no patients from the no-PFO group. This cutoff demonstrates a specificity and positive predictive value of 100%. CONCLUSIONS The rule of nine (>9 MES and LT <9s) for cTCD can be considered a marker for PFO diagnosis by cTEE.
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Affiliation(s)
- Marcos Christiano Lange
- Neurology Division, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil.
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Lange MC, Zétola VF, Souza AMD, Piovesan ÉJ, Muzzio JA, Germiniani FMB, Werneck LC. Transcranial Doppler for patent foramen ovale screening: is there a good correlation with transesophageal echocardiography? Arq Neuro-Psiquiatr 2008; 66:785-9. [DOI: 10.1590/s0004-282x2008000600001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 09/29/2008] [Indexed: 11/22/2022]
Abstract
Right-to-left shunt (RLS) can be identified by contrast-enhanced transcranial Doppler (cTCD) in patent foramen ovale (PFO) patients. AIM: To evaluate cTCD for PFO screening comparing it to cTEE. METHOD: 45 previous cTCD performed for PFO diagnosis and correlated its findings with cTEE. Patients were submitted to a cTCD standardized technique and were divided in two groups according to RLS: Group 1, patients with a positive RLS and Group 2 when RLS was negative. RESULTS: 29 (65%) patients were included in group 1 and 16 (35%) in group 2. PFO confirmation by cTEE was performed in 28 (62%) patients. cTCD had a 92.85% sensitivity, 82.35% specificity, 89.65% positive predictive value and 87.5% negative predictive value when compared to cTEE for PFO diagnosis. CONCLUSION: Standardized technique cTCD allows for RLS visualization in PFO patients with a good correlation with cTEE and can be used as a screening test before cTEE.
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Affiliation(s)
- Viviane Flumignan Zétola
- Internal Medicine Department, Neurology Service--Cerebrovascular Diseases, Paraná State Federal University (UFPR), Curitiba, PR, Brazil.
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Abstract
O Doppler transcraniano (DTC) é um método relativamente novo, descrito em 1982 por Rune Aaslid e introduzido no Brasil em 1992 por Roberto Hirsch, na Universidade de São Paulo. O serviço de Neurologia do Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) disponibilizou esse exame em 2001, com divulgação das principais vantagens do método no diagnóstico, seguimento e manejo terapêutico de pacientes com suspeita ou portadores de doença cerebrovascular. O objetivo deste trabalho é demonstrar como o DTC vem sendo utilizado em nosso meio e quais são as especialidades médicas que vêm absorvendo o auxílio do método. Embora diretrizes como a publicada pela Academia Americana de Neurologia em 2004 validem as indicações do DTC, estabelecendo especificidade e sensibilidade do método, verificamos que a solicitação do exame em nosso meio depende da divulgação do serviço, da implementação de linhas de pesquisa e, finalmente, do reconhecimento de sua utilidade na prática diária.
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Affiliation(s)
- Viviane Flumignan Zétola
- Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Gagliardi RJ, André C, Fukujima MM, Melo-Souza SE, Zétola VF. Abordagem da doença carotídea na fase aguda do acidente vascular cerebral: opinião nacional. Arq Neuro-Psiquiatr 2005; 63:709-12. [PMID: 16172731 DOI: 10.1590/s0004-282x2005000400032] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Com finalidade de orientar e oferecer subsídios para a conduta diagnóstica e terapêutica em diferentes situações dentro das doenças cerebrovasculares, a Sociedade Brasileira de Doenças Cerebrovasculares constituiu um comitê composto por especialistas de diferentes áreas do Brasil, que emitiram um parecer, denominado "Opinião Nacional", redigido nos moldes dos consensos. O presente artigo analisa a "Doença Carotídea na Fase Aguda do AVC", abordando separadamente os seguintes tópicos: métodos de detecção de estenose carotídea na fase aguda; quando e como intervir sobre a carótida na fase aguda; tratamento clínico e marcadores de inflamação. São apresentados os comentários, baseados na literatura e na opinião pessoal dos participantes, e é descrito, como conclusão em cada item, a opinião do grupo.
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Lange MC, Zétola VF, Teive HAG, Scola RH, Trentin AP, Zavala JA, Pereira ER, Raskin S, Werneck LC, Sistermans EA. Cerebrotendinous xanthomatosis: report of two Brazilian brothers. ARQUIVOS DE NEURO-PSIQUIATRIA 2004. [PMID: 15608974 DOI: 10.1590/s0004‐282x2004000600028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cerebrotendinous xanthomatosis is a treatable rare autossomal recessive disease characterized by lipid storage secondary to a sterol 27-hydroxylase deficiency in the formation of cholic and chenodeoxycholic acids. We describe two Brazilian brothers with cognitive impairement and chronic diarrhea. One of them also presents bilateral cataracts. Neurological findings were progressive walking deficit, limb ataxia and pyramidal signs. Both patients had bilateral Achilles tendon xanthomata. Magnetic resonance image showed signal alterations in cerebellar hemispheres. We describe these cases with molecular genetic analysis confirming diagnosis and comparing with previous literature. The CYP27A1 gene study showed a C1187T mutation on exon 6.
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Affiliation(s)
- Marcos Christiano Lange
- Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Lange MC, Zétola VF, Teive HAG, Scola RH, Trentin AP, Zavala JA, Pereira ER, Raskin S, Werneck LC, Sistermans EA. Cerebrotendinous xanthomatosis: report of two Brazilian brothers. Arq Neuro-Psiquiatr 2004; 62:1085-9. [PMID: 15608974 DOI: 10.1590/s0004-282x2004000600028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cerebrotendinous xanthomatosis is a treatable rare autossomal recessive disease characterized by lipid storage secondary to a sterol 27-hydroxylase deficiency in the formation of cholic and chenodeoxycholic acids. We describe two Brazilian brothers with cognitive impairement and chronic diarrhea. One of them also presents bilateral cataracts. Neurological findings were progressive walking deficit, limb ataxia and pyramidal signs. Both patients had bilateral Achilles tendon xanthomata. Magnetic resonance image showed signal alterations in cerebellar hemispheres. We describe these cases with molecular genetic analysis confirming diagnosis and comparing with previous literature. The CYP27A1 gene study showed a C1187T mutation on exon 6.
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Affiliation(s)
- Marcos Christiano Lange
- Serviço de Neurologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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