Brazilian Academy of Neurology practice guidelines for stroke rehabilitation: part I.

The Guidelines for Stroke Rehabilitation are the result of a joint effort by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology aiming to guide professionals involved in the rehabilitation process to reduce functional disability and increase individual autonomy. Members of the group participated in web discussion forums with predefined themes, followed by videoconference meetings in which issues were discussed, leading to a consensus. These guidelines, divided into two parts, focus on the implications of recent clinical trials, systematic reviews, and meta-analyses in stroke rehabilitation literature.

Latin American Consensus Statement for the Use of Contrast-Enhanced Transcranial Ultrasound as a Diagnostic Test for Detection of Right-to-Left Shunt.

Background: The role of patent foramen ovale is a field of debate and current publications have increasing controversies about the patients' management in young undetermined stroke. Work up with echocardiography and transcranial Doppler (TCD) can aid the decision with better anatomical and functional characterization of right-to-left shunt (RLS). Medical and interventional strategy may benefit from this information.

Experience on Mechanical Thrombectomy for Acute Stroke Treatment in a Brazilian University Hospital.

Background: Brazil is a developing country struggling to reduce its extreme social inequality, which is reflected on shortage of health-care infrastructure, mainly to the low-income class, which depends exclusively on the public health system. In Brazil, less than 1% of stroke patients have access to intravenous thrombolysis in a stroke unit, and constraints to the development of mechanical thrombectomy in the public health system increase the social burden of stroke.

Objective: Report the feasibility of mechanical thrombectomy as part of routine stroke care in a Brazilian public university hospital.

Carotid artery stenting in the context of endovascular treatment of acute ischemic stroke.

Unlabelled: Mechanical thrombectomy as an adjunctive to intravenous thrombolysis is now the standard treatment for acute ischemic stroke (AIS) due to large vessel occlusions. However, the best management of acute carotid tandem occlusions (CTO) remains controversial.

Method: Twenty patients underwent endovascular treatment of acute CTO.

Functional versus Nonfunctional Rehabilitation in Chronic Ischemic Stroke: Evidences from a Randomized Functional MRI Study.

Motor rehabilitation of stroke survivors may include functional and/or nonfunctional strategy. The present study aimed to compare the effect of these two rehabilitation strategies by means of clinical scales and functional Magnetic Resonance Imaging (fMRI). Twelve hemiparetic chronic stroke patients were selected.

Outcomes of carotid artery stenting at a high-volume Brazilian interventional neuroradiology center.

Objectives: Carotid artery stenting is an emerging revascularization alternative to carotid endarterectomy. However, guidelines have recommended carotid artery stenting only if the rate of periprocedural stroke or death is < 6% among symptomatic patients and < 3% among asymptomatic patients. The aim of this study is to evaluate and compare clinical outcomes of symptomatic and asymptomatic patients who had undergone carotid artery stenting as a first-intention treatment.

Early versus late carotid artery stenting for symptomatic carotid stenosis.

Introduction: Early carotid revascularization (≤ 14 days) is recommended for symptomatic carotid stenosis. Carotid artery stenting (CAS) has become an alternative to carotid endarterectomy (CEA); however, safety data on early CAS is controversial. The study aims to compare early versus late CAS, when CAS is performed as a first intention revascularization strategy.

Carotid artery stenting performed with a flow-reversal technique: improved technical performance.

Objective: To report our experience in carotid artery stenting (CAS) with GORE flow reversal system, focusing the assessment of its efficacy, security and practice procedure evolution.

Methods: Twelve patients treated for atherosclerotic carotid stenosis were prospectively evaluated. All patients were symptomatic.

Frequency and predictors of symptomatic intracranial hemorrhage after intravenous thrombolysis for acute ischemic stroke in a Brazilian public hospital.

Objective: Scarce data are available on the occurrence of symptomatic intracranial hemorrhage related to intravenous thrombolysis for acute stroke in South America. We aimed to address the frequency and clinical predictors of symptomatic intracranial hemorrhage after stroke thrombolysis at our tertiary emergency unit in Brazil.

Method: We reviewed the clinical and radiological data of 117 consecutive acute ischemic stroke patients treated with intravenous thrombolysis in our hospital between May 2001 and April 2010.

Risk factors for swallowing dysfunction in stroke patients.

Context: Stroke is a frequent cause of dysphagia.

Objective: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke.

Methods: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke.

Brazilian guidelines for the application of transcranial ultrasound as a diagnostic test for the confirmation of brain death.

Neurosonological studies, specifically transcranial Doppler (TCD) and transcranial color-coded duplex (TCCD), have high level of specificity and sensitivity and they are used as complementary tests for the diagnosis of brain death (BD). A group of experts, from the Neurosonology Department of the Brazilian Academy of Neurology, created a task force to determine the criteria for the following aspects of diagnosing BD in Brazil: the reliability of TCD methodology; the reliability of TCCD methodology; neurosonology training and skills; the diagnosis of encephalic circulatory arrest; and exam documentation for BD. The results of this meeting are presented in the current paper.

Clinical and scintigraphic swallowing evaluation of post-stroke patients.

Background: deglutition of post-stroke patients.

Aim: to study the swallowing of post-stroke patients through clinical and scintigraphic evaluations.

Method: participants were 26 patients, who had suffered their first stroke within the last two months.

A scintigraphic study of oral, pharyngeal, and esophageal transit in patients with stroke.

Although stroke affects mainly the oral and pharyngeal phases of swallowing, it may also impair esophageal contractions. Our hypothesis is that stroke may affect esophageal transit. The oral, pharyngeal, and esophageal transit was studied by the scintigraphic method in 26 patients (age range=26-83 years), eight of whom had mild dysphagia but all were able to feed orally and who had suffered an acute first-ever ischemic stroke 10-56 days (median = 43 days) before transit evaluation.

[Relation between clinical evaluation of deglutition and the computed tomography in acute ischemic stroke patients].

Stroke is one of the main causes of permanent lesions in adults and can provoke global motor sequels, speech and language alterations, and swallowing. During the acute phase, the detection of aspiration risks is essential to prevent lung complications and to allow appropriate therapeutic interventions, making possible precocious oral feeding. In the literature, the correlations between the disturbance of the deglutition and the location of the lesion in patients with stroke are not specific.

Cerebral infarct in children aged zero to fifteen years.

Cerebral infarcts in children present peculiar characteristics either due to their diversity of causes or due to the unknown nature of the causes. The etiologies of cerebral infarct were reviewed in children from zero to 15 years old, attended at a tertiary hospital, in Ribeirão Preto (Brazil), from 1990 to 1997, adopting the modified Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria of classification; 1-Atherosclerosis in large arteries; 2-Cardioembolic; 3-Occlusion of small vessels; 4-Other etiologies; 5-Undetermined cause. Thirty-nine children were included, 18 males and 21 females, aged 2 months to 15 years, mean age 5.