Posterior circulation cerebrovascular syndromes: diagnosis and management.

One in five strokes affects the posterior circulation. Diagnosing posterior circulation stroke can be challenging, as the vascular anatomy can be variable, and because presenting symptoms are often non-specific and fluctuating. Nevertheless, making the correct diagnosis is important, as these strokes have a high chance of recurrence, can be life threatening, and can lead to equally life-threatening complications. Investigation and management largely follow those for stroke in general, although some specific differences exist. These include the preferred use of MRI for diagnosing posterior fossa lesions, the management of basilar artery thrombosis, which may have a longer time window for recanalisation therapy, and the use of endovascular therapies for secondary prevention, which, so far, have not shown any benefit in the treatment of vertebral or basilar artery stenosis. In this review, we summarise the anatomy, aetiology and presentation of posterior circulation stroke, and discuss current approaches to management.

Le château de Vincennes,

"Bibliographie": p. [107]-108.

Perceptual evaluation of motor speech following treatment for childhood cerebellar tumour

The speech characteristics, oromotor function and speech intelligibility of a group of children treated for cerebellar tumour (CT) was investigated perceptually. Assessment of these areas was performed on 11 children treated for CT with dysarthric speech as well as 21 non-neurologically impaired controls matched for age and sex to obtain a comprehensive perceptual profile of their speech and oromotor mechanism. Contributing to the perception of dysarthria were a number of deviant speech dimensions including imprecision of consonants, hoarseness and decreased pitch variation, as well as a reduction in overall speech intelligibility for both sentences and connected speech. Oromotor assessment revealed deficits in lip, tongue and laryngeal function, particularly relating to deficits in timing and coordination of movements. The most salient features of the dysarthria seen in children treated for CT were the mild nature of the speech disorder and clustering of speech deficits in the prosodic, phonatory and articulatory aspects of speech production.

Cerebellar language and cognitive functions in childhood: A comparative review of the clinical research

Background: Recent research addressing evidence from functional neuroimaging studies, neurophysiological research, and new advances in neuropsychology together with traditional cerebellar lesion studies have recently implicated the cerebellum in adult language and cognitive functions. However, more limited information is currently available in describing the functional connectivity present in the paediatric population. Aims: It is the purpose of this paper to review recent clinical research pertaining to paediatric populations, outlining the impact of site of lesion and specific associated clinical changes in children with cerebellar disturbances. Main contribution: The specific contribution of the right cerebellar hemisphere to language function is identified to also exist in the paediatric population, highlighting the existence of functional connections between this region of the brain and left frontal cortical areas early in development. Conclusions: Implications for future research in paediatric populations are extensive, as a greater awareness and an understanding of the recently acknowledged involvement of the cerebellum in cognition and nonmotor linguistic function is anticipated to also add new dimension and direction to the analysis of childhood language outcomes associated with the cerebellum.

Articulatory imprecision in dysarthria following childhood cerebellar tumor: A perceptual and acoustic investigation of three male participants

Articulatory imprecision has been documented as a key perceptual feature of the dysarthria associated with childhood cerebellar tumor (CCT). As yet the underlying acoustic and physiological characteristics of motor speech production that contribute to this perceptual feature have not been identified. The aim of the current study was to describe perceptual and acoustic characteristics of consonant production in three children with dysarthria associated with CCT The results indicated that in all three cases the timing of articulatory movements during stop consonant production differed from that measured in a control group of same-age peers. The impact of cerebellar lesions in adulthood on articulatory gestures is used as a reference for discussing the findings of the current study with similarities evident. Also discussed are future research directions for examining the underlying acoustic or physiological basis for articulatory imprecision in children with dysarthria associated with CCT.

Language outcomes subsequent to treatment of brainstem tumour in childhood

While the occurrence and management of brainstem tumours in children would not traditionally indicate potential direct structural impact on classical language centres, recent theories have implicated some involvement of the brainstem in a functional language and cognitive neural loop between the cerebellum and the cerebral hemispheres. Thus, the present paper explored the impact of treatment for brainstem tumour on the general and high-level language abilities of six children treated for brainstem tumour, in addition to phonological awareness skills. Group analysis revealed that children treated for brainstem tumour demonstrated intact language and phonological awareness abilities in comparison to an age- and gender-matched control group. Individual analysis revealed only one of six children treated for brainstem tumour revealed evidence of language disturbances, with an additional child demonstrating an isolated mildly reduced score on one phonological awareness task. Language deficits identified in a child treated with a combination of both radiotherapy and chemotherapy were noted in the high-level language area of lexical generation. Findings highlighted that no overt language disturbances were evident in children treated for brainstem tumour. However, further analysis into higher-level language skills in the present study indicated that both general and high-level language abilities require long-term monitoring in this population.

Differential motor speech outcomes in children treated for mid-line cerebellar tumour

Primary objective: To investigate the nature of the motor speech impairments and dysarthria that can arise subsequent to treatment for childhood mid-line cerebellar tumours (CMCT). Research design: The motor speech ability of six cases of children with CMCT was analysed using perceptual and physiological measures and compared with that of a group of non-neurologically impaired children matched for age and sex. Main outcome and results: Three of the children with CMCT were perceived to exhibit dysarthric speech, while the remaining three were judged to have normal speech. The speech disorder in three of the children with CMCT was marked by deviances in prosody, articulation and phonation. The underlying pathophysiology was linked to cerebellar damage and expressed as difficulty in co-ordinating the motor speech musculature as required for speech production. These deficits were not identified in the three non-dysarthric children with CMCT. Conclusion: Differential motor speech outcomes occur for children treated for CMCT and these are discussed within the realm of possible mechanisms responsible for these differences. The need for further investigation of the risk factors for development of motor speech impairment in children treated for CMCT is also highlighted.

Combined arteriovenous fistula and venous aneurysm following knee arthrodesis

We study a case of a 65-year-old woman who developed popliteal arteriovenous fistula (AVF) and venous aneurysm following left knee arthrodesis. Presenting features included left popliteal and calf pain, a tender pulsatile mass posterior to her left knee, popliteal bruit and a thrill at the popliteal fossa and ankle. Left femoral angiography showed an AVF arising from the right tibioperoneal trunk and an aneurysm at the level of the AVF. Findings at open investigation included AVF between the tibioperoneal trunk and the popliteal vein, and a venous aneurysm arising from the popliteal vein opposite the neck of the arteriovenous communication. The aneurysm and fistula were repaired using prolene suture.

AVALIAÇÃO DO ESPAÇO DISPONÍVEL PARA ERUPÇÃO DOS SEGUNDOS E TERCEIROS MOLARES SUPERIORES PERMANENTES APÓS A DISTALIZAÇÃO DOS PRIMEIROS MOLARES SUPERIORES PERMANENTES

A presente pesquisa tem como objetivo avaliar cefalometricamente, o espaço e po-sicionamento das coroas dos segundos e terceiros molares superiores permanentes não erupcionados na região da tuberosidade maxilar durante a distalização dos pri-meiros molares superiores, além de verificar a correlação entre estas duas variáveis. A amostra foi constituída de 38 telerradiografias em norma lateral direita, obtidas de 19 pacientes, jovens brasileiros, leucodermas e melanodermas, sendo 6 do sexo masculino e 13 do sexo feminino, com idade média de 9 anos 5 meses 13 dias. A metodologia constou inicialmente da divisão dos tempos (T1) inicial, e após a distali-zação do primeiro molar superior permanente em (T2) por um período médio de 10 meses e 23 dias. Para avaliação do espaço e angulação das coroas existente utili-zou-se uma Linha referencial intracraniana (Linha M) sendo esta demarcada, a partir de dois pontos, o ponto SE localizado na sutura esfenoetmoidal, e o ponto Pt locali-zado na parte anterior da fossa pterigopalatina. Esta linha referencial foi transferida até o ponto F, (Linha M ) ponto este localizado na região mais posterio-inferior da tuberosidade maxilar. O espaço avaliado compreendeu entre a Linha M , até a face distal do primeiro molar superior permanente. Na análise estatística usou-se o teste t (Teste t Student) , e na correlação entre espaço e angulação foi utilizado o coefi-ciente de correlação de Pearson. Concluímos que o espaço correspondente entre a distal dos primeiros molares superiores permanentes e extremidade da tuberosidade maxilar, na fase inicial e após a movimentação distal, não é suficiente para a erup-ção dos segundos e terceiros molares superiores permanentes. A angulação das coroas na fase inicial e após a movimentação distal posicionam-se com angulações mais para distal. Quanto à correlação das angulações das coroas dos segundos e terceiros molares superiores permanentes e o espaço para erupção verificamos que quanto maior a angulação das coroas para distal, menor os espaços oferecidos para a erupção.(AU)

Uso pedagógico do ábaco romano para ensino do algoritmo de multiplicação

This dissertation describes the construction of a alternative didactic incorporating a historical approach with the use of the Roman abacus for teaching multiplication to students of 2nd year of elementary school, through activities ranging from the representation of numbers to multiplying with the Roman abacus, for learning the multiplication algorithm. Qualitative research was used as a methodological approach since the research object fits the goals of this research mode. Concerning the procedures, the research can be seen as a teaching experiment developed within the school environment. The instruments used for data collection were: observation, logbook, questionnaires, interviews and document analysis. The processing and analysis of data collected through the activities were classified and quantified in tables for easy viewing, interpretation, understanding, analysis of data and then transposed to charts. The analysis confirmed the research objectives and contributed to indicate the pedagogical use of the Roman abacus for teaching multiplication algorithm through several activities. Thus, it can be considered that this educational product will have important contributions for the teaching of this mathematical content, in Basic Education, particularly regarding to the multiplication process

Ocorrência de compostos de interesse emergente no aquífero Dunas-Barreiras e nos esgotos de Natal/RN

The detection of emerging interest microcontaminants in environmental samples of surface water, groundwater, drinking water, wastewater and effluents from water and sewage treatment plants (WTP and STP), in many countries, suggests these pollutants are widespread in the environment, mainly in urban areas. This is a reason for great concern, since many of these compounds are potentially harmful for humans other living beings, and they are not efficiently removed in the majority of WTP and STP, which is exacerbated by precariousness of water supply and sanitation services. In Natal, like other Brazilian cities, the sewage system serves only part of the urban area (about 30%), so that the rest of the wastewater is infiltrated in the sandy soil of the region in cesspool-dry well systems. This has resulted in contamination of groundwater in the area (sand-dune barrier aquifer, which supplies more than 50% of the city population), which has been observed by the increase in nitrate concentration in supply wells. The vulnerability of the sanddune barrier aquifer, combined with reports of the presence of emerging interest microcontaminants in Brazil and worldwide, led to this research, which investigated the occurrence of fifteen microcontaminants in Natal groundwater and sewage. Samples were collected at five wells used for water supply, the raw sewage and the effluents from biological reactors from STP (UASB and activated sludge reactors). Two samples of each sample were taken, with one week apart between the samples. To determine the contaminants, extraction of aquifer water, and raw and treated sewage samples were performed, through the technique of using SPE Strata X cartridge (Phenomenex®) to the aquifer water, and Strata SAX and Strata X (Phenomenex® ) for samples of raw and treated sewage. Subsequently the extracts were analyzed using GC-MS technique. Much of the analyzed microcontaminants were detected in groundwater and sewage. The concentrations in groundwater are generally lower than those found in the sewers. Some of the compounds (estrone, estradiol, bisphenol A, caffeine, diclofenac, naproxen, paracetamol and ibuprofen) are partially removed at STP.

Studio stratigrafico e vulcanologico della successione piroclastica di Rocche Rosse

Lo scopo del lavoro di tesi è l’analisi stratigrafica e vulcanologica dei depositi della successione piroclastica di Rocche Rosse relativi all’ultima fase di attività esplosiva in età olocenica dell’isola di Lipari (Isole Eolie). L’attività di Rocche Rosse si caratterizza per l’emissione di una colata riolitica ossidianacea ben nota nella letteratura vulcanologica, che viene preceduta da un episodio di attività esplosiva a bassa magnitudo tale da costituire un basso cratere piroclastico sulla sommità dell’edificio di Monte Pilato, nel settore NE di Lipari (Forni et al., 2013). L’attività eruttiva di Rocche Rosse è datata in età Medievale (1220 AD). Recentemente è stata proposta la correlazione con l’unità di Rocche Rosse di un tefra affiorante all’interno della sequenza stratigrafica del cono di La Fossa di Vulcano, utilizzato come elemento cronostratigrafico per la ricostruzione della storia eruttiva di tale edificio (Fusillo et al, 2015). Anche alla luce di questa ipotesi, l’analisi stratigrafica e vulcanologica di dettaglio della successione piroclastica di Rocche Rosse può consentire di evidenziarne lo stile eruttivo, i meccanismi di trasporto e deposizione e la capacità di dispersione. Lo studio è stato effettuato in tre sezioni stratigrafiche puntuali descritte in aree prossimali e medio-prossimali, in corrispondenza del bordo del cratere di Rocche Rosse, sul bordo ed all’esterno del cratere di Monte Pilato. Sono state inoltre effettuate diverse osservazioni in altre sezioni lungo gran parte del settore centro-settentrionale dell’isola di Lipari, evidenziando l’assenza di depositi riconducibili alla successione di Rocche Rosse. Nell’insieme si propone uno studio stratigrafico della successione di Rocche Rosse suddivisa in diverse unità deposizionali ed una valutazione generica della dispersione di questi depositi.

Progressive Multifocal Leukoencephalopathy and Systemic Lupus Erythematosus: Focus on Etiology

Progressive multifocal leukoencephalopathy (PML) caused by reactivation of the JC virus (JCV), a human polyomavirus, occurs in autoimmune disorders, most frequently in systemic lupus erythematosus (SLE). We describe a HIV-negative 34-year-old female with SLE who had been treated with immunosuppressant therapy (IST; steroids and azathioprine) since 2004. In 2011, she developed decreased sensation and weakness of the right hand, followed by vertigo and gait instability. The diagnosis of PML was made on the basis of brain MRI findings (posterior fossa lesions) and JCV isolation from the cerebrospinal fluid (700 copies/ml). IST was immediately discontinued. Cidofovir, mirtazapine, mefloquine and cycles of cytarabine were sequentially added, but there was progressive deterioration with a fatal outcome 1 year after disease onset. This report discusses current therapeutic choices for PML and the importance of early infection screening when SLE patients present with neurological symptoms. In the light of recent reports of PML in SLE patients treated with rituximab or belimumab, we highlight that other IST may just as well be implicated. We conclude that severe lymphopenia was most likely responsible for JCV reactivation in this patient and discuss how effective management of lymphopenia in SLE and PML therapy remains an unmet need.

Morfodinâmica do Banco das Três Marias – Barra do Rio Grande

Dados batimétricos detalhados obtidos na antepraia adjacente ao Molhe Oeste conhecida como banco das Três Marias, evidenciaram a presença de uma fossa junto a extremidade do molhe e um banco na forma de domo a SO da depressão. O banco tem sua base e crista respectivamente nas cotas de 8 e 6 m. A feição é aproximadamente oval, com o eixo maior semiparalelo à costa (sentido NNE – SSO) medindo aproximadamente 1600 m. O eixo menor, quase transversal à costa (sentido L-O), apresenta cerca de 1200 m de extensão. O banco representa o resquício do lobo terminal do delta de maré vazante (barra) da laguna formado durante a fixação de sua desembocadura. A fossa junto ao cabeço do molhe apresenta pendente íngreme, que inicia na isóbata de 8 m e alcança a isóbata dos 17 m, sendo provavelmente formada pela ação da corrente longitudinal de SO para NE. Foram coletadas também amostras de sedimento. Estes dados evidenciaram ao menos três subambientes refletindo diferentes níveis de energia. Do mais enérgico para o menos: o banco, onde o sedimento é mais grosso e melhor selecionado, a antepraia, com o sedimento pouco mais fino e a fossa, onde foi amostrada lama, mal selecionada.

Cirurgia endoscópica em tumores nasosinusais: experiência do IPOLFG

Introdução: Os tumores nasais são, classicamente, abordados pela via externa mas recentemente tem-se optado, também, pela via endoscópica. No entanto, em tumores localmente avançados, poderá não ser possível a remoção completa. Material e métodos: Foram analisados os processos clínicos dos 14 doentes com tumor das fossas nasais removido por via endoscópica no IPOLFG entre 2005 e 2012. Resultados: Dos 14 doentes, 8 apresentavam tumor maligno e 5 tumor benigno. Não houve preponderância de nenhum tipo histológico. 7 doentes realizaram RT adjuvante e 1 foi submetido a esvaziamento ganglionar cervical ipsilateral. Foram registadas 2 complicações cirúrgicas: 1 fístula de LCR e 1 complicação minor. Apenas 2 doentes recidivaram, recorrendo-se à via externa em 1. Conclusões: A abordagem de tumores nasais por via endoscópica é uma opção eficaz mas é necessária uma correta avaliação da extensão tumoral para decisão da via cirúrgica a utilizar, para remoção completa e obtenção de margens livres.