Abstract:Os autores relatam um caso de paciente apresentando evolução favorável após confirmado diagnóstico de síndrome de desmielinização osmótica (mielinólise pontina central e extrapontina) através de exame de ressonância magnética.
“…The technology of medical imaging, such as digital cerebral angiography and three-dimensional (3D) mapping of brain vessels, has achieved relevant advances in interventional neuroradiology. A number of recent publications in Brazil highlight the importance of neuroradiology for diagnosis and treatment of several diseases (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) .…”
Objective: The present study was aimed at estimating the doses received by physicians and patients during cerebral angiography procedures in a public hospital of Recife, PE, Brazil. Materials and Methods: The study sample included 158 adult patients, and during the procedures the following parameters were evaluated: exposure parameters (kV, mAs), number of acquired images, reference air kerma value (K a,r) and air kerma-area product (P KA). Additionally, the physicians involved in the procedures were evaluated as for absorbed dose in the eyes, thyroid, chest, hands and feet. Results: The results demonstrated that the doses to the patients' eyes region were relatively close to the threshold for cataract occurrence. As regards the physicians, the average effective dose was 2.6 µSv, and the highest effective dose recorded was 16 µSv. Conclusion: Depending on the number of procedures, the doses received by the physicians may exceed the annual dose limit for the crystalline lenses (20 mSv) established by national and international standards. It is important to note that the high doses received by the physicians are due to the lack of radiation protection equipment and accessories, such as leaded curtains, screens and protective goggles.
“…The technology of medical imaging, such as digital cerebral angiography and three-dimensional (3D) mapping of brain vessels, has achieved relevant advances in interventional neuroradiology. A number of recent publications in Brazil highlight the importance of neuroradiology for diagnosis and treatment of several diseases (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) .…”
Objective: The present study was aimed at estimating the doses received by physicians and patients during cerebral angiography procedures in a public hospital of Recife, PE, Brazil. Materials and Methods: The study sample included 158 adult patients, and during the procedures the following parameters were evaluated: exposure parameters (kV, mAs), number of acquired images, reference air kerma value (K a,r) and air kerma-area product (P KA). Additionally, the physicians involved in the procedures were evaluated as for absorbed dose in the eyes, thyroid, chest, hands and feet. Results: The results demonstrated that the doses to the patients' eyes region were relatively close to the threshold for cataract occurrence. As regards the physicians, the average effective dose was 2.6 µSv, and the highest effective dose recorded was 16 µSv. Conclusion: Depending on the number of procedures, the doses received by the physicians may exceed the annual dose limit for the crystalline lenses (20 mSv) established by national and international standards. It is important to note that the high doses received by the physicians are due to the lack of radiation protection equipment and accessories, such as leaded curtains, screens and protective goggles.
“…A síndrome de desmielinização osmótica é uma doença desmielinizante do encéfalo que atinge principalmente a região da ponte, podendo vir a comprometer regiões extrapontinas 10,11 . Embora se associe a distúrbios metabólicos, especialmente a correção rápida de hiponatremia, pode ocorrer em pacientes sem evidência de desequilíbrio hidroeletrolítico.…”
Section: Discussionunclassified
“…Embora se associe a distúrbios metabólicos, especialmente a correção rápida de hiponatremia, pode ocorrer em pacientes sem evidência de desequilíbrio hidroeletrolítico. 10 Nesses casos, os pacientes geralmente apresentam outros fatores de risco, tais como antecedentes de abuso de álcool ou drogas, desnutrição, doença hepática, câncer e doença de Addison 10 . Podem ser confundidos os primeiros sintomas com transtornos psiquiátricos, sendo eles geralmente o mutismo e a disartria.…”
RESUMO
Introdução: A mielinólise pontina central (MPC) é uma doença desmielinizante aguda causada por oscilações abruptas na osmolalidade sérica, que resulta na desmielinização simétrica da parte central da base da ponte. Descrição: Paciente de 60 anos deu entrada no Pronto Socorro de um hospital do DF, com quadro de confusão mental iniciados há 07 dias, sem outras queixas. Ao exame físico estava em regular estado geral, glasgow 12, apresentando confusão mental, normotenso, normocardio e afebril. Pupilas isocóricas, fotorragenfes, sem rigidez de nuca, tetraplegia sequelar a um trauma raquimedular há 33 anos. Negava comorbidades e não fazia uso de medicação contínua. Sua TC de crânio realizada no 10º dia após rebaixamento do sensório evidenciou hipodensidade difusa e simétrica na ponte associada a edema, com apagamento das cisternas peripontinas. Devido à instabilidade do quadro, o paciente não conseguiu realizar o exame de ressonância magnética de crânio. Ao exame neurológico após retirada da sedação e desmame dos anticonvulsivantes, apresentava movimento ocular vertical com deslocamento rápido dos olhos para baixo, seguindo de retorno lento a posição inicial, denominado “BOBBING”. A etiologia da hiponatremia grave não foi esclarecida. O paciente evoluiu a óbito.
Conclusões: A mielinólise pontina central é uma patologia desmielinizante do encéfalo associada principalmente com a correção rápida da hiponatremia, manifestando-se especialmente por tetraparesia espástica e paralisia pseudo-bulbar. A evolução destes pacientes é variável desde a sua recuperação total sem sequelas até o óbito, tendo geralmente, recuperação lenta e gradativa.
“…There is a convention utilized to translate the detected voltage values into digital units, the absorption coefficient (attenuation). It is calculated in relation to the linear coefficient of water, for which the numeric value 0 is attributed, in a scale that may range from +1,000 to -1,000 Hounsfield units (HU) and is represented by a gray scale comprising a large spectrum of neuroradiology for the diagnosis and treatment of several diseases (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) .…”
Objective To identify and analyze the prevalence of cranial computed tomography findings in patients admitted to the emergency unit of Hospital Universitário Cajuru. Materials and Methods Cross-sectional study analyzing 200 consecutive non contrast-enhanced cranial computed tomography reports of patients admitted to the emergency unit of Hospital Universitário Cajuru. Results Alterations were observed in 76.5% of the patients. Among them, the following findings were most frequently observed: extracranial soft tissue swelling (22%), bone fracture (16.5%), subarachnoid hemorrhage (15%), nonspecific hypodensity (14.5%), paranasal sinuses opacification (11.5%), diffuse cerebral edema (10.5%), subdural hematoma (9.5%), cerebral contusion (8.5%), hydrocephalus (8%), retractable hypodensity /gliosis/ encephalomalacia (8%). Conclusion The authors recognize that the most common findings in emergency departments reported in the literature are similar to the ones described in the present study. This information is important for professionals to recognize the main changes to be identified at cranial computed tomography, and for future planning and hospital screening aiming at achieving efficiency and improvement in services.
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