The electroencephalogram of idiopathic generalized epilepsy (critical review)

Idiopathic generalized epilepsy (IGE) is classified into several subsyndromes based on clinical and electroencephalography (EEG) features. The EEG signature of IGE is bisynchronous, symmetric, and generalized spike-wave complex; although focal, irregular, and so called “fragments” of discharges are not uncommon. Other characteristic EEG features include polyspikes, polyspike-wave discharges, occipital intermittent rhythmic delta activity, and photoparoxysmal response. Both human and animal data suggest involvement of the thalamus and the cortex in the generation of spike-wave discharges in IGE. Circadian variations of generalized epileptiform discharges are well described, and these can be useful in diagnostic confirmation. Those discharges tend to occur more often after awakening and during cyclic alternating pattern phase-A of non–rapid eye movement sleep. Activation procedures such as hyperventilation, intermittent photic stimulation, eye closure, and fixation-off are useful techniques to increase the yield of both interictal and ictal EEG abnormalities. Although not in routine use, specific triggers such as pattern stimulation and cognitive tasks may also be of value in eliciting rare reflex seizure-related EEG abnormalities. Variations of EEG abnormalities are evident between different electroclinical syndromes. EEG is also affected by certain external as well as internal factors, which should be borne in mind when interpreting EEG studies in IGE. (Epilepsia, 53(2):234–248, February 2012). <<< leia o artigo >>>

PRIMEIRO CONSENSO BRASILEIRO PARA TROMBÓLISE NO ACIDENTE VASCULAR CEREBRAL ISQUÊMICO AGUDO

Artigo com as conclusões do I Consenso Brasileiro para Trombólise no Acidente Vascular Cerebral (AVC). Em reunião promovida e coordenada pela Sociedade Brasileira de Doenças Cerebrovasculares, neurologistas especializados em doenças cerebrovasculares, analisaram e discutiram os requisitos assistenciais e profissionais e definiram as diretrizes e os protocolos para a trombólise em pacientes com AVC isquêmico agudo. <<< leia o artigo >>>

PRIMEIRO CONSENSO BRASILEIRO DO TRATAMENTO DA FASE AGUDA DO ACIDENTE VASCULAR CEREBRAL

Síntese do Iº Consenso Brasileiro do Tratamento da Fase Aguda do Acidente Vascular Cerebral (AVC), reunião patrocinada e coordenada pela Sociedade Brasileira de Doenças Cerebrovasculares, com especialistas em doenças cerebrovasculares, enfocando os principais itens na conduta frente a pacientes com AVC. <<< leia mais >>>

Emergências Neurológicas

A Neurologic Clinics de janeiro é dedicada a Neurologia na Emergência. São artigos de revisão sobre diversos temas muito interessantes.

Predicting outcome of IV thrombolysis–treated ischemic stroke patients: the DRAGON score

Objective: To develop a functional outcome prediction score, based on immediate pretreatment parameters, in ischemic stroke patients receiving IV alteplase.
Methods: The derivation cohort consists of 1,319 ischemic stroke patients treated with IV alteplase at the Helsinki University Central Hospital, Helsinki, Finland. We evaluated the predictive value of parameters associated with the 3-month outcome and developed the score according to the magnitude of logistic regression coefficients. We assessed accuracy of the model with bootstrapping. External validation was performed in a cohort of 330 patients treated at the University Hospital Basel, Basel, Switzerland. We assessed the score performance with area under the receiver operating characteristic curve (AUC-ROC).
Results: The DRAGON score (0–10 points) consists of (hyper)Dense cerebral artery sign/early infarct signs on admission CT scan (both = 2, either = 1, none = 0), prestroke modified Rankin Scale (mRS) score >1 (yes = 1), Age (≥80 years = 2, 65–79 years = 1, <65 years = 0), Glucose level at baseline (>8 mmol/L [>144 mg/dL] = 1), Onset-to-treatment time (>90 minutes = 1), and baseline National Institutes of Health Stroke Scale score (>15 = 3, 10–15 = 2, 5–9 = 1, 0–4 = 0). AUC-ROC was 0.84 (0.80–0.87) in the derivation cohort and 0.80 (0.74–0.86) in the validation cohort. Proportions of patients with good outcome (mRS score 0–2) were 96%, 88%, 74%, and 0% for 0–1, 2, 3, and 8–10 points, respectively. Proportions of patients with miserable outcome (mRS score 5–6) were 0%, 2%, 5%, 70%, and 100% for 0–1, 2, 3, 8, and 9–10 points, respectively. External validation showed similar results.
Conclusions: The DRAGON score is valid at our site and was reliable externally. It can support clinical decision-making, especially when invasive add-on strategies are considered. The score was not studied in patients with basilar artery occlusion. Further external validation is warranted.

 

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D. Strbian, MD, PhD, A. Meretoja, MD, PhD, MSc (Stroke Med), F.J. Ahlhelm, MD, PhD, J. Pitkäniemi, PhD (Stat), P. Lyrer, MD, M. Kaste, MD, PhD, S. Engelter, MD and T. Tatlisumak, MD, PhD

From the Department of Neurology (D.S., A.M., M.K., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Departments of Diagnostic and Interventional Neuroradiology (F.J.A.) and Neurology (P.L., S.E.), University Hospital Basel, Basel, Switzerland; and Department of Public Health (J.P.), University of Helsinki, Helsinki, Finland.

TCC na fase aguda do AVC – site para treinamento

Já está disponível o site – www.aspectsinstroke.com – desenvolvido pelo Calgary Stroke Team no Canadá para treinamento de interpretação de Tomografia Computadorizada do Crânio (TCC) no contexto da fase aguda do Acidente Vascular Cerebral Isquêmico (AVCi).

Trata-se de excelente ferramenta baseada no escore ASPECTS aplicável sobretudo nas doenças isquêmicas em território de artéria cerebral média.

O site roda em qualquer browser mas fica bem mais funcional no Internet Explorer. Além de discutir o papel da TCC na fase aguda do AVCi, explica e exemplifica o escore ASPECTS e traz casos para treinamento. Muito bom.