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Biomedical subjects

V Oliveira

Publications and source records attributed to V Oliveira.

31 records · Page 2Linked to original sources
PubMed1995

Headache associated with transient ischemic attacks.

Sixty (29%) of 205 consecutive patients with transient ischemic attacks registered in a hospital stroke data base had headache within 72 hours of onset. Headache was significantly more common in nonsmokers (odds ratio = 2.8; 95% confidence interval = 6.7 to 1.2). Headache was infrequent in patients with amaurosis fugax, and was not significantly associated with any other particular clinical presentation of transient ischemic attack. Headache was more common in vertebrobasilar (33%) than in carotid distribution (24%) episodes, and was not rare in transient ischemic attacks presenting as lacunar syndromes (29%). Headache was less frequent in patients whose computerized tomograms showed an infarct appropriate to the symptoms (odds ratio = 0.2; 95% confidence interval = 0.02 to 1.4). A diffuse headache was more common in patients with lacunar events than in patients with cortical attacks (odds ratio = 3.0; 95% confidence interval = 13 to 0.07). No other association was found between headache location and the presumed involved vascular territory. Headache in patients with transient ischemic attacks is poorly related/explained by the clinical characteristics of the ischemic event.

Aged↗
PubMed1994

Cerebrospinal fluid and therapy of isolated angiitis of the central nervous system.

BACKGROUND: Serial cerebral angiograms, computed tomography, and magnetic resonance imaging are among the proposed methods for monitoring disease activity and response to therapy in isolated angiitis of the central nervous system. Cerebrospinal fluid has not proved to be useful in monitoring clinical course. CASE DESCRIPTION: We describe a 45-year-old man with histological diagnosis of isolated angiitis of the central nervous system that was treated with prednisone plus azathioprine and monitored for 2 years. Samples of the cerebrospinal fluid were obtained for cytological and routine chemical examination, as well as albumin and immunoglobulin content. Before treatment, cerebrospinal fluid showed marked plasmatic transudation of albumin and intrathecal synthesis of immunoglobulins. During the first year of immunosuppression no events were noticed, and the previously abnormal aspects of the cerebrospinal fluid showed improvement. During the weaning of azathioprine, a new stroke occurred in conjunction with a marked deterioration of cerebrospinal fluid parameters. Immunosuppression was resumed at previous levels, and during the following year no further events occurred. Once again, abnormal cerebrospinal fluid values improved significantly. CONCLUSIONS: We report a case of isolated angiitis of the central nervous system in which the serial cerebrospinal fluid examinations (albumin and immunoglobulin content) showed a close correlation with clinical course. This method may be useful in monitoring response to therapy.

Albumins↗
PubMed1989

Kluver-Bucy syndrome in systemic lupus erythematosus.

The Kluver-Bucy syndrome has not been previously reported as a complication of systemic lupus erythematosus (SLE). A 48-year-old female is described who sustained several cerebral infarcts, some of which were bitemporal, due to SLE vasculopathy. She developed a complex behavioural picture consisting of global aphasia, left-side neglect, hyperorality, hypermetamorphosis and hypersexuality. She displayed appropriate emotional reaction to visually presented objects, indicating that her Kluver-Bucy syndrome could not be explained by lack of visual recognition.

Aphasia↗
PubMed1989

[Clinical pathology of the glomerulus--from phenomenon to entity. The mesangial lesion].

The numerous findings discussed lead to the following conclusions: 1. The mesangial lesions, which may take a wide range of different forms, can be classified into two groups according to whether an underlying immunological pathomechanism is involved. Those that result from such a pathomechanism represent various types of glomerulonephritis. 2. Amongst these immunologically-mediated glomerulonephritides mesangioproliferative glomerulonephritis (and, of this group, IgA nephritis) is the most common. Membranoproliferative glomerulonephritis is the most severe of these diseases. Either may be idiopathic or secondary, or may occur in association with systemic disease. 3. The number of macrophages in the mesangial lesions in glomerulonephritis correlates with the severity of the glomerulonephritis, the localization of the immune complex deposits and the degree of proteinuria. If the immune complex deposits extend out of the mesangium into the subendothelial space, the number of macrophages is higher, the structural changes are more marked, and proteinuria is more severe. 4. Various pathomechanisms and nosologic entities can lead to mesangial lesions of the type seen in mesangioproliferative glomerulonephritis or membranoproliferative glomerulonephritis. On the other hand, the same entity may be associated with mesangial lesions of different severity, and consequently the prognosis varies. Differential diagnosis of the mesangial lesions, which represent heterogeneous nosologic entities, requires the use of light microscopic, immunohistochemical, and electron microscopic techniques. Exact diagnosis is necessary because of the differences in prognosis. 5. The course and prognosis of mesangial lesions are determined by immunological and nonimmunological factors. Long-term studies have demonstrated that prognostically relevant information can already be gained at the time of biopsy by the assessment of certain morphological features (e.g., immunohistological findings, severity of glomerulonephritis, the presence of focal/segmental lesions) and clinical parameters (e.g., proteinuria, hematuria, hypertension, and serum creatinine concentration). The decisive predictor of an unfavorable prognosis is the presence of interstitial fibrosis.

Glomerular Mesangium↗
PubMed1988

[Treatment of acute cerebrovascular disorders].

Recent advances in technology have improved stroke diagnosis, reduced the risks and increased the frequency of studies of stroke mechanism. Computer-assisted stroke data bank projects have provided new insights into the frequencies of stroke subtypes and the risks for progression and recurrence. A high frequency of strokes due to infarction remain unexplained despite thorough laboratory investigation. These infarcts of undetermined cause suffer recurrence rates almost as high as cardiogenic embolism, forcing a therapeutic decision even in the absence of a demonstrated cause. Stroke from atherosclerosis is far less common than formerly believed but carries the highest risk of worsening and early recurrence, prompting early treatment to attempt to avoid progression. Duplex and transcranial doppler methods of imaging blood vessels and insonating flow have now made it possible non-invasively to follow the course of atheromatous stenosis, embolism and recanalization, development of collateral flow, and vasospasm in ruptured aneurysms and arteriovenous malformations. Extracranial atheromatous disease may progress rapidly from mild to severe stenosis, stabilize at any point; intracranial collateral is not predicted by the degree of extracranial stenosis. Recanalization of cerebral embolism occurs early. Vasospasm after subarachnoid hemorrhage is common and often severe. Where available, magnetic resonance imaging is preferred to CT scanning for the diagnosis of every form of stroke including hemorrhage.

Acute Disease↗
PubMedDate not supplied

The detection of microembolic signals in patients at risk of recurrent cardioembolic stroke: possible therapeutic relevance.

The clinical predictors and potential therapeutic implications of microembolic signals (MES) were investigated in 104 patients with ischemic stroke or transient ischemic attack associated with high-risk (n = 60) or low-risk (n = 44) cardiac emboligenic conditions. Patients with artificial valves and carotid stenosis were excluded. MES counts were based on 30-min bilateral middle cerebral artery transcranial Doppler (TCD) monitoring recordings. MES were detected in 15 subjects (14%). The mean number of MES per hour was 1.9. MES prevalence and counts were influenced neither by age, gender or type of cerebral event, nor by cardiac disease. MES were more frequently detected and greater in number in patients with multiple cerebral ischemic events and in subjects monitored within 1 month of the last event. By multiple logistic regression, TCD recording within 1 month of the last event [Odds ratio (OD) = 13.5; 95% confidence intervals (CI) = 3.3-54.3] and multiple cerebral events (OD = 4.7; 95% CI = 1.3-17.3) were the best MES predictors. MES were detected in 40% (4/10) of patients on heparin, 5% (2/4) of untreated subjects and 13% (5/39) of those on antiplatelet drugs. For patients on warfarin, MES counts and prevalence were similar in subjects with international normalized ratios (INR) below and within/above the therapeutic range. MES were detected in only 2 out of 16 subjects with INR <2 and in 1 with INR >2. MES detection can be potentially relevant to the selection of antithrombotic treatment in acute stroke associated with cardioembolic disease, but further studies are necessary to assess its effectiveness as an additional guide to monitor oral anticoagulant intensity.

Administration, Oral↗
PubMedDate not supplied

[Diabetes mellitus and intracranial stenosis].

INTRODUCTION: The risk of having a cerebrovascular accident (CVA) is approximately 3 to 5 times greater in the diabetic population than in non-diabetics. The physiopathological mechanisms of CVAs in patients with diabetes mellitus are not well-known, since few studies of this have been done. OBJECTIVES: To verify the hypothesis that intracranial arteriosclerosis, interpreted from findings of stenosis on intracranial Doppler studies, is greater in diabetics than in non-diabetics, independently of other vascular risk factors. PATIENTS AND METHODS: Patients were selected from the Register of Cerebrovascular Diseases of the Neurology Department of the Hospital de Santa Maria as having had an ischemic cerebrovascular accident (CVA)/transient ischemic accident (TIA), assessed by a colour codified vertebral carotid eco-Doppler and transcranial Doppler. Intracranial changes in the diabetic and non-diabetic groups of patients were compared with relation to the presence of risks such as hypercolestrolaemia, arterial hypertension and smoking. RESULTS: 384 patients were included, 71 were diabetic and 313 non-diabetic. The two groups were comparable with regard to average age and sex. Intracranial stenosis was approximately 3.13 (95% CI = 1.69-5.79) times more frequent in the diabetic population than in non-diabetics. This difference persisted independently of the presence or absence of other vascular risk factors. CONCLUSIONS: Diabetes mellitus is an important independent risk factor of alterations in the intracranial blood vessels and therefore of CVA. The intracranial circulation should be studied in these patients in view of the great frequency of intracranial stenoses and possible future improvements with therapeutic intervention.

Brain↗
PubMedDate not supplied

[Headaches, otalgia and peripheral facial palsy as a form of presentation of neurosyphilis].

INTRODUCTION: Decrease in incidence of neurosyphilis over the last few decades implies that clinicians consider less frequently this diagnosis. On the other hand, some reports suggest an increase in atypical forms of this disease that represent an additional reason for missing this diagnosis. CLINICAL CASE: We report on a 16 year-old immunocompetent black female from Guinea-Bissau presented with headaches, ear pain, hearing loss and peripheral facial paralysis. A cranial CT scan showed a hypodense area in the left cortico-subcortical zone and a contrast enhancement on the left pontocerebellar angle and internal auditory meatus. On the third day of admission a diagnosis of meningitis was made, with high titles of VDRL and TPHA in CSF and serum, leading to a diagnosis of neurosyphilis. The epidemiological aspects of this case suggest either a late congenital syphilis or an infection as a result of a blood transfusion administered seven years earlier in Guinea-Bissau. CONCLUSION: This rare form of presentation of neurosyphilis emphasizes the importance of considering systematically this diagnosis, even in the context of atypical presentations.

Adolescent↗
PubMedDate not supplied

[Cerebral hematoma caused by mucormycosis].

INTRODUCTION: Invasion of the central nervous system by mucormycosis is rare. It is mainly seen in diabetic ketoacidosis, immunosensitive or severely debilitated patients and in cases of hematological neoplasias. We describe a case of cerebral hemorrhage with documented evidence of invasion of the cerebral vessels by mucormycosis, in a patient with a gastric adenocarcinoma. CLINICAL CASE: A 38 year old woman complained of the sudden onset of headache and disorder of vision which progressed rapidly to coma. Computerized tomography showed the presence of a parieto occipital hematoma. The patient died six hours later. She had had an operation for gastric carcinoma eight months previously. Anatomopathological study of the brain showed invasion of the arterial wall by mucormycosis. CONCLUSION: Solid tumors may lead to cerebral hemorrhage caused by mucormycosis.

Adenocarcinoma↗
PubMedDate not supplied

Lacunar stroke associated headache is not related to intracranial large vessel disease.

It was recently suggested that lacunar strokes presenting with headache may be due to large intracranial artery disease. From the stroke database of the Neurology department, Hospital Sta Maria, we retrieved all lacunar strokes who had investigations of the intracranial circulation. Forty seven of the 208 lacunar strokes registered had either angiography (5 cases) or transcranial doppler (42 cases). Twelve subjects noticed headache during stroke onset, but all had normal investigations of the intracranial circulation. In five patients transcranial Doppler showed ipsilesional increased peak systolic velocities and another subject had a middle cerebral artery branch occlusion. None of them reported headache. Headache associated with lacunar strokes is not related to intracranial artery disease.

Cerebrovascular Disorders↗