-Cognitive symptoms are common in patients with congestive heart failure (CHF) and are usually attributed to low cerebral blood flow. In the present study, we aimed to evaluate global cognitive function (Mini Mental State Exam -MMSE) in relation to both cardiac function (evaluated by echocardiogram) and cere b rovascular hemodynamics (evaluated by transcranial Doppler -TCD) in CHF patients. In 83 patients studied, no correlation was found between echocardiographic parameters and MMSE scores. In contrast, a significant correlation was found between right middle cerebral art e ry (RMCA) mean flow velocity and MMSE score (r=0.231 p=0.039), as well as between RMCA pulsatility index and MMSE score (r s = -0.292 p=0.015). After excluding patients with a previous history of stroke, only RMCA pulsatility index c o rrelated with MMSE score (r s =-0,314 p=0,007). The relationship between high cere b rovascular re s i s t a n c e and worse cognitive scores suggest that microembolism may be responsible for a significant pro p o rtion of cognitive symptoms in CHF patients.KEY WORDS: transcranial Doppler, congestive heart failure, cognitive dysfunction cere b rovascular disord e r s .Disfunção cognitiva na insuficiência cardíaca congestiva: evidência de etiologia micro e m b ó l ica ao Doppler transcraniano RESUMO -Sintomas cognitivos são comuns em pacientes com insuficiência cardíaca congestiva (ICC) e são geralmente atribuídos a um regime de baixo fluxo sanguíneo cerebral. Neste estudo, objetivamos avaliar a função cognitiva global (Mini Exame do Estado Mental -MEEM) em pacientes com ICC e sua relação com o grau de disfunção cardíaca (avaliada pelo ecocardiograma) e a hemodinâmica cerebral (avaliada pelo Doppler transcraniano -DTC). Em 83 pacientes estudados, nenhuma correlação foi encontrada entre a pontuação no MEEM e parâmetros ecocardiográficos. Em contraste, uma correlação significativa foi encontrada entre a velocidade média na artéria cerebral média direita (ACMD) e a pontuação no MEEM (r=0,231 p=0,039), assim como entre o índice de pulsatilidade na ACMD e a pontuação no MEEM (r s =-0,292 p=0,015). Após excluir pacientes com histórico prévio de acidente vascular encefálico, somente o índice de pulsatilidade na ACMD manteve uma correlação com a pontuação no MEEM (r s =-0,314 p=0,007). A relação entre maior resistência vascular cerebral e pior desempenho cognitivo sugere que microembolia pode ser re s p o nsável por uma proporção significativa de sintomas cognitivos em pacientes com ICC. PALAVRAS-CHAVE: Doppler transcraniano, insuficiência cardíaca congestiva, acidente vascular cerebral.
Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.
Chagas disease (CD) remains a major cause of stroke in developing countries, but cognitive repercussion of CD has not been well studied.ObjectiveTo compare the frequency and pattern of cognitive dysfunction in patients with CD cardiomyopathy (CDC) and other cardiomyopathies (OC).MethodsWe studied 37 patients with CDC and 42 patients with OC with similar age, educational level and cardiac systolic function. Cognitive tests were applied to both groups by a single examiner blinded to CD status. Logistic regression multivariable models were constructed to ascertain predictors of cognitive dysfunction for each test.ResultsCognitive dysfunction was detected in 9 (24%) CDC patients and 6 (14%) OC patients by Mini Mental State Exam (MMSE) corrected for educational level. Independent predictors of abnormal MMSE (p<0.05) included stroke history (OR=5.51; 95% CI=1.27–24.01) and digoxin use (OR=0.23, 95% CI=0.06–0.89), while CD showed a trend toward statistical significance (OR=4.63; 95% CI=0.87–24.73, p=0.07). Delayed recall of Rey’s Complex Figure Test was significantly worse in CD patients, where this remained a significant predictor in the multivariable analysis (OR=4.67; 95% CI=1.23–17.68).ConclusionsCognitive dysfunction is frequent in Chagas disease and should be considered as an outcome measure in Chagas disease studies.
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