Neurofibromatosis Type 1 (NF1) is a rare cause of ischemic stroke (IS) in the general population. We report a case of a young patient with NF1 in whom IS was caused by fibromuscular dysplasia. An angiographic study demonstrated occlusion in the right internal carotid artery (ICA), just after its origin, and the left ICA, just before the intracranial portion, and brain magnetic resonance imaging showed the limits of an area of brain infarction in the right frontoparietal region. Despite these concomitant neuroimaging findings, this association is rare, and it is difficult to establish the contribution to the outcome made by each of these diseases, which treatment is the best to implement, or what prognosis is.
Background: Multiple System Atrophy is a neurodegenerative disease with parkinsonism, cerebelar ataxia and autonomic failure. Neurodegeneration with Brain Iron Accumulation diseases are neurodegenerative diseases, as the Pantothenate Kinase-Associated Neurodegeneration, with a very distinct pattern on neuroimaging, known as the “Eye of the Tiger Sign”, which is rare in MSA but many studies confirm the role of striatal regions iron accumulation in parkinsonisms. Objective: We describe MSA patients with iron accumulation in striatal regions in neuroimaging. Methods: We report clinical cases from São Paulo State University-Brazil. Results: 62-year-old with 5 years of bradykinesia and stiffness progressing to wheelchair, REM sleep behavioral disorder, no improvement with levodopa, disarthrophonia and choking with gastrostomy after 3 years, associated to syncope episodes. Neurological examination showed blood pressure of 105x80mmHg lying down and 80x60mmHg standing up, severe disarthrophonia, anterocapitis, severe parkinsonism, postural instability and ataxia. Neuroimaging showed the “Eye of the Tiger”, “putaminal rim” and the “hot cross bun” signs. 78-year-old with 1.5 years syncope episodes, slow walking, falls, difficulty moving hands and feet and constipation. No improvement with levodopa. Neurological examination showed blood pressure of 130x80 mmHg lying down and 90x60 mmHg standing up, severe bradykinesia and stiffness, drooling, ataxia and “square-wave jerks”. Neuroimaging showed “Eye of Tiger” and bilateral “putaminal rim” signs and cerebellar atrophy. In both cases were excluded all differential diagnosis. Conclusions: Both cases fulfilled criteria for MSA, with the radiological sign of the “Eye of the Tiger”. We emphasize the importance of knowing this variation of MSA to avoid diagnostic confusion.
Um modelo de processo de software é uma representação abstrata de um processo que o descreve em alguma perspectiva particular. A literatura apresenta uma variedade de propostas para a modelagem de processos, cada qual oferecendo uma diferente visão sobre o processo a ser modelado. Este estudo apresenta uma revisão sistemática da literatura com o objetivo de comparar três especificações para modelagem de processos de software: BPMN, SPEM e Essence. O estudo busca mapear suas características, entender as vantagens e desvantagens, identificar as tendências de pesquisa, bem como listar o ferramental de suporte na sua implementação. Resultados parciais são apresentados a partir de 40 artigos selecionados no processo de revisão.
Background: The “Coca-Cola Bottle Sign” is a classic sign of thyroid diseases, especially Graves’ disease, with the appearance of eye orbit muscles edema seen by Magnetic Resonance Imaging. The belly of the muscle increases in thickness, giving the characteristic appearance. Despite being classically associated with this etiology, the finding may be present in other diseases, especially infiltrative ones. Objectives: To demonstrate how this radiological signal can suggest other etiologies, when atypical. Methods: Case report of a patient with an image finding suggestive of “CocaCola Bottle Sign”. Results: Patient, 71 years old, with Breast Cancer and Hepatic Metastasis, using Anastrazole. Osmophobia started and after 3 months, reduced visual acuity in the right eye, evolving in 20 days to amaurosis in the right eye, dizzying, and loss of visual acuity in the left eye. Upon examination, he had a missing direct pupillary reflex in the right eye and only light perception, and counting fingers in the left eye; paresis of the Superior Rectus, Medial, and Lower Oblique muscles of the Left Eye, with paresis maintained in the forced duction test. On ophthalmoscopy, he had atrophy of the retinal pigment epithelium in the bilateral periphery, without Papilledema. Metabolic screening did not show any relevant changes. In the Magnetic Resonance of Orbits, an intraconal nodular image was seen in the right orbital cavity, with perineuritis and extension to the belly of the lateral rectus muscle on this side, as the “Coca-Cola Bottle Sign”. Due to unilateral muscle involvement and signs of meningeal involvement, lumbar puncture with cytopathological examination was requested, being positive for Carcinoma Metastasis. Conclusions: The “Coca-Cola Bottle sign” is a classic sign of Graves’ disease, however, some signs, such as, unilateral and single orbital musculature involvement, may be suggestive of involvement by other etiologies, suggesting the benefit of an early expanded investigation.
Context: Stroke is one of the main leaders of death and disability in the world. Currently, mechanical thrombectomy with stent retrievers is the technique of choice for large vessel occlusion, however, the primary aspiration technique has been proposed as a fast and safe alternative. Case report: J.E.M, male, 57 years old, hypertensive, atrial fibrillation. Started claudication of neurological deficits, with intermittent paresthesia in left upper limb for 2 days. Admitted with NIHSS 2 (nasolabial sulcus erasure and hypoesthesia in LUL), in thrombolysis window, has seen in cerebral and neck angiotomography critical stenosis of the internal carotid artery and in CT scan with perfusion Mismatch volume 72 ml and infinite ratio. Since the patient did not have sufficient criteria for thrombolysis and since the clinical prognosis was unfavorable, a diagnostic arteriography was indicated, which showed ICAR stenosis 90%. The patient proceeded with angioplasty and stenting using the ADPAT technique and mechanical thrombectomy due to occlusion in segment M1 with total recanalization (TICI 3) and NIHSS after and at discharge of 0. Conclusion: The advent of thrombectomy impacts the improvement of functional dependence and the reduction of mortality, especially in stroke with large vessel occlusion, whose treatment with thrombolytic therapy only has a low chance of recanalization.
A análise estática de código é uma técnica aplicada na etapa de verificação de um software, com o objetivo de identificar defeitos sem a necessidade da execução da aplicação. Atualmente existem diversas ferramentas de análise estática disponíveis no mercado, onde cada uma possui suas particularidades e diferentes escopos de análise. Portanto, escolher a ferramenta correta a ser usada não é uma atividade trivial. Este estudo tem como objetivo comparar duas ferramentas de análise estática de código sendo elas o SonarQube e o PMD, analisando a sua eficácia na identificação de defeitos em um código de software. Com esta finalidade foram criados mutantes a partir de projetos Open Source, que auxiliaram a verificar a eficácia das ferramentas.
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