Unidade de AVC – artigos para leitura


Artigos importantes que devem ser lidos durante o estágio na Unidade de AVC:

Classificação Internacional de Cefaleia (ICHD 3) em português.

Esta é a versão em português de Portugal da 3a. edição da Classificação Internacional de Cefaleia lançada no Congresso Mundial de Cefaleia em Boston. Como deve ser, a versão portuguêsa chama Enxaqueca de Enxaqueca (e não “migranea” um anglicismo inapropirado em nossa língua) e Cefaléia do Tipo Tensão (e não “cefaleia tensional” como erroneamente se fala e escreve no Brasil). Leia ou baixe aqui a classificação…

Classificação Internacional das Cefaléias (ICHD-3) em inglês

Esta é a terceira versão da Classificação Internacional das Cefaleias. Lançada em sua versão beta no último Congresso Mundial em Boston (junho de 2013) esta classificação deverá ser testada exaustivamente nos próximos anos. Concomitantemente a International Headache Society está fazendo um trabalho paralelo com a Organização Mundial da Saúde no sentido de inserir no CID-11 códigos para todos os diagnósticos da ICH-III. Acredita o Dr Jes Olesen, chairman do Comitê de Classificação da IHS, que em 2016 teremos as duas classificações (ICHD-III e CID-11) alinhadas o que vai facilitar muito o trabalho de todos. Clique aqui para acessar a ICH-III beta.


AVC – Manual de Rotinas do Ministério da Saúde

A Linha do Cuidado do AVC, instituída pela Portaria do Ministério da Saúde nº 665, de 12 de abril de 2012, e parte integrante da Rede de Atenção às Urgências e Emergências, propõe uma redefinição de estratégias para o enfrentamento das doenças cerebrovasculares. Este Manual de rotinas de atenção ao AVC traz os protocolos, escalas e orientações aos profissionais de saúde no manejo do paciente com AVC. Ele foi escrito por técnicos e assessores do Ministério da Saúde em conjunto com a Sociedade Brasileira de Doenças Cerebrovasculares e a Academia Brasileira de Neurologia. <<< acesse o manual >>>

Anatomy of the circulation of the brain and spinal cord

Para atender bem pacientes com AVC alguns conhecimentos são fundamentais. A compreensão da anatomia da circulação cerebral e medular e dos chamados territórios vasculares é fundamental para a elaboração diagnóstica e, muitas vezes, para a decisão terapêutica e prognóstica do caso. Este artigo, do Handbook of Clinical Neurology de 2009 descreve com detalhes as circulações arterial e venosa e seus respectivos territórios vasculares.  Leia mais …

Magnetic Resonance Spectroscopy in the Brain

Magnetic resonance spectroscopy (MRS) is a technique that detects metabolites, such as n-acetyl aspartate, choline-containing compounds, creatine/phosphocreatine, and lactate. Measurements of metabolite ratios provide diagnostic information that adds to that obtained by MRI alone MRS can be valuable in:
– The diagnosis of leukodystrophies and mitochondrial disorders
– Providing prognostic information in neonatal hypoxia/ischemia
– Differentiating among brain tumors, staging, and identifying a suitable biopsy site
– Differentiating between tumor progression and radiation necrosis
In most cases, single voxel MRS is used to obtain chemical information from a region of interest measuring 2x2x2 cm; in multivoxel MR spectroscopic imaging (MSRI), the voxel size is 1x1x1 cm (Radiology Rounds, July 2012 – Volume 10. Issue 7) <<< leia mais >>>


A neurologist has sent a patient for nerve conduction studies (NCS) and has received the report, but what does it mean? We hope to remove some of the mysteries that may surround NCS. The techniques and how they are affected by disease are described in general terms. These principles can be applied to specific conditions discussed elsewhere. We also discuss the numerous pitfalls that may be encountered with NCS. Understanding these basic concepts will allow you to get the most from your clinical neurophysiology department. NCS are only part of a complete peripheral neurophysiological examination (PNE) and are frequently accompanied by a needle electromyogram (EMG). The combination of both techniques and those detailed in other articles in this issue are often required for a complete diagnostic study. The process of choosing the appropriate tests is the responsibility of the clinical neurophysiologist (CN) and not the referring doctor and is planned as a dynamic series of steps designed to answer specific questions about nervous system function raised by the clinical picture. (J Neurol Neurosurg Psychiatry 2005;76(Suppl II):ii23–ii31) <<< leia mais >>>

Treatment for epilepsy in later life

Old age is now the commonest time to develop epilepsy, often as a consequence of underlying cerebrovascular or neurodegenerative disease. Age-related physiological changes can affect the pharmacokinetics and pharmacodynamics of antiepileptic drugs. Only three double-blind, head-to-head, randomised, controlled trials have been undertaken in this patient population and so pharmacological treatment tends to be empirical, often based on what antiepileptic drug not to chose for an individual patient. The available evidence has tended to favour lamotrigine, and perhaps gabapentin, over carbamazepine, based on better tolerability rather than superior efficacy for newly diagnosed epilepsy in this population. Preliminary data with levetiracetam suggest that this drug will also be useful in older people as a consequence of its favourable side effect profile and lack of idiosyncratic reactions and drug interactions. Despite the dearth of high quality trial evidence, published outcome data hint at a good prognosis with a single antiepileptic drug for the majority of elderly people with epilepsy. A few patients will require low dose combination therapy. Epilepsy surgery is also an occasional option in this population. As life expectancy rises, so will the likelihood of presenting with seizures in later life placing an increasing burden on healthcare resources. <<< leia mais >>>

Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria

New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use. Diagnostic criteria for multiple sclerosis (MS) include clinical and paraclinical laboratory assessments emphasizing the need to demonstrate dissemination of lesions in space (DIS) and time (DIT) and to exclude alternative diagnoses. Although the diagnosis can be made on clinical grounds alone, magnetic resonance imaging (MRI) of the central nervous system (CNS) can support, supplement, or even replace some clinical criteria, as most recently emphasized by the so-called McDonald Criteria of the International Panel on Diagnosis of MS. The McDonald Criteria have resulted in earlier diagnosis of MS with a high degree of both specificity and sensitivity, allowing for better counseling of patients and earlier treatment. Since the revision of the McDonald Criteria in 2005, new data and consensus have pointed to the need for their simplification to improve their comprehension and utility and for evaluating their appropriateness in populations that differ from the largely Western Caucasian adult populations from which the Criteria were derived. In May 2010 in Dublin, Ireland, the International Panel on Diagnosis of MS (the Panel) met for a third time to examine requirements for demonstrating DIS and DIT and to focus on application of the McDonald Criteria in pediatric, Asian, and Latin American populations. <<< leia mais>>>

NSAIDs and other complementary treatments for episodic migraine prevention in adults

Objective: To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: Are nonsteroidal anti-inflammatory drugs (NSAIDs) or other complementary treatments effective for migraine prevention?
Methods: The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications for migraine prevention.
Results: The author panel reviewed 284 abstracts, which ultimately yielded 49 Class I or Class II articles on migraine prevention; of these 49, 15 were classified as involving nontraditional therapies, NSAIDs, and other complementary therapies that are reviewed herein.
Recommendations: Petasites (butterbur) is effective for migraine prevention and should be offered to patients with migraine to reduce the frequency and severity of migraine attacks (Level A). Fenoprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium, MIG-99 (feverfew), magnesium, riboflavin, and subcutaneous histamine are probably effective for migraine prevention (Level B). Treatments considered possibly effective are cyproheptadine, Co-Q10, estrogen, mefenamic acid, and flurbiprofen (Level C). Data are conflicting or inadequate to support or refute use of aspirin, indomethacin, omega-3, or hyperbaric oxygen for migraine prevention. Montelukast is established as probably ineffective for migraine prevention (Level B). (Neurology 2012;78:1346–1353) <<< leia mais >>>

Pharmacologic treatment for episodic migraine prevention in adults – AAN Evidence-based guideline update

Objective: To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention?
Methods: The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications available in the United States for migraine prevention.
Results and Recommendations: The author panel reviewed 284 abstracts, which ultimately yielded 29 Class I or Class II articles that are reviewed herein. Divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity (Level A). Frovatriptan is effective for prevention of menstrual migraine (Level A). Lamotrigine is ineffective for migraine prevention (Level A). (Neurology 2012;78:1337–1345) <<< leia mais >>>