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 >>>

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 >>>

The diagnosis of dementia due to Alzheimer’s disease

The National Institute on Aging and the Alzheimer’s Association charged a workgroup with the task of revising the 1984 criteria for Alzheimer’s disease (AD) dementia. The workgroup sought to ensure that the revised criteria would be flexible enough to be used by both general healthcare providers without access to neuropsychological testing, advanced imaging, and cerebrospinal fluid measures, and specialized investigators involved in research or in clinical trial studies who would have these tools available. We present criteria for all-cause dementia and for AD dementia. We retained the general framework of probable AD dementia from the 1984 criteria. On the basis of the past 27 years of experience, we made several changes in the clinical criteria for the diagnosis. We also retained the term possible AD dementia, but redefined it in a manner more focused than before. Bio-marker evidence was also integrated into the diagnostic formulations for probable and possible AD dementia for use in research settings. The core clinical criteria for AD dementia will continue to be the cornerstone of the diagnosis in clinical practice, but biomarker evidence is expected to enhance the pathophysiological specificity of the diagnosis of AD dementia. Much work lies ahead for validating the biomarker diagnosis of AD dementia. >>> leia o artigo >>>

The rule of 4 of the brainstem: a simplified method for understanding brainstem anatomy and brainstem vascular syndromes for the non-neurologist

The rule of 4 is a simple method developed to help ‘students of neurology’ to remember the anatomy of the brainstem and thus the features of the various brainstem vascular syndromes. As medical students, we are taught detailed anatomy of the brainstem containing a bewildering number of structures with curious names such as superior colliculi, inferior olives, various cranial nerve nuclei and the median longitudinal fasciculus. In reality when we do a neurological examination we test for only a few of these structures. The rule of 4 recognizes this and only describes the parts of the brainstem that we actually examine when doing a neurological examination. The blood supply of the brainstem is such that there are paramedian branches and long circumferential branches (the anterior inferior cerebellar artery (AICA), the posterior inferior cerebellar artery (PICA) and the superior cerebellar artery (SCA). Occlusion of the paramedian branches results in medial (or paramedian) brainstem syndromes and occlusion of the circumferential branches results in lateral brainstem syndromes. Occasionally lateral brainstem syndromes are seen in unilateral vertebral occlusion. This paper describes a simple technique to aid in the understanding of brainstem vascular syndromes.  >>> Leia o artigo