Arquivos de neuro-psiquiatria
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Noninvasive sensory evoked potentials (SEP) performed at bedside in the Intensive Care Unit for patients in coma can be helpful in establishing both a diagnosis and a prognosis. Based on a more than 6-year experience on this subject, the authors discuss general aspects concerning these EP, their probable known generators, and propose a classification depicting different aspects observed for flash visual EP (F-VEP), brainstem auditory EP (BAEP), and median nerve somato-sensory EP (SSEP). Isolated, SSEP shows the best diagnostic and prognostic performance. ⋯ Abnormal BAEP implies bad prognosis, as would be expected considering the severity of a brainstem lesion; on the other hand, a normal BAEP per se does not allow a precise definition, resting on other EP the role prognosis characterization. SSEP if bilaterally normal or only mildly abnormal imply good prognosis; bilateral absence of SSEP thalamo-cortical components has always carried a bad prognosis, since younger patients may at best evolve into a persistent vegetative state; SSEP intermediary results are more often accompanied by variable evolution. FVEP results parallel those of SSEP.
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Spinal adhesive arachnoiditis is not an uncommon disease, usually having a monophasic course. We studied an atypical patient with recurrent spinal adhesive arachnoiditis nine years after intrathecal anesthesia and the first attack of the disease. Also noteworthy was the favorable evolution after surgery.
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The electroencephalographic (EEG) findings observed in nine patients with post-anoxic myoclonic encephalopathy are reported. The tracings showed typical myoclonus potential in some, and characteristic diffuse brain injury in others. In two of our cases the spike and wave complex was faster than in the others. Our EEG tracings are similar to those studied by Gastaut and Rémond in 1952.
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Four male obese patients with obstructive sleep apnea were evaluated by polysomnography, both prior and 3-4 months following gastroplasty. The surgery was performed as an alternative weight loss treatment. These patients were selected for gastroplasty because they had severe obesity, obstructive sleep apnea with cardiopulmonary impairment and noncompliance on a weight loss diet. ⋯ The weight reduction varied from 16.3 to 41.4% of the initial weight. The recording documented normal sleep apnea indices in three cases and partial recovery in the remainder; increase in stages 3, 4 and REM; normal SaO2 in three out of 4 cases. These findings suggest that gastroplasty may be used as an alternative treatment for weight reduction in selected OSA patients.
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A case of a 10-year-old boy with a congenital arachnoid cyst in the right middle cranial fossa is reported. The symptoms were precipitated by head injury of moderate intensity, occurred some days before the beginning of the clinical picture. ⋯ The influence of the cyst in the hygroma formation has been suggested. The mechanisms of growth, the etiology, clinical aspects, the diagnostics and the surgical treatment of the arachnoid cysts are discussed.