No abstract

Recent epidemiological studies have revealed a correlation between atypical features and worse functional outcomes in Parkinson’s disease (PD) patients with cerebrovascular disease (CVD). We aimed to evaluate the brain hemodynamics of PD patients with risk factors for CVD using Doppler ultrasonography. In this prospective pilot study, we randomly included 27 outpatients diagnosed with PD. Transcranial color-coded sonography (TCCS) examinations were performed, obtaining measurements of middle cerebral artery mean flow velocities (Vm), the resistance index (RI), and the pulsatility index (PI). The breath-holding index (BHI) was used to assess cerebrovascular reactivity (cVR). Standardized functional scales (UPDRS III, Hoehn & Yahr scale, and MoCA) were administered. The patients were divided into two groups: those with two or more vascular risk factors (PDvasc) and those with fewer than two vascular risk factors (PDnvasc). Patients in the PDvasc group showed higher PI (1.00 vs. 0.85; p = 0.020 ), RI (0.59 vs. 0.5; p = 0.05 ), H&Y mean (2.4 vs. 1.4; p = 0.036 ), higher frequency of altered cVR (90.9% vs. 25.0%; p = 0.001 ), and lower BHI (0.46 vs. 1.01; p = 0.027 ). We also divided the patients in other two groups: one with patients with classical and another with akinetic-rigid PD clinical type. Patients with the akinetic-rigid type of PD had significantly higher RI (0.60 vs. 0.51; p = 0.03 ), PI (0.99 vs. 0.77; p = 0.03 ), higher frequency of altered cVR (80% vs. 35%; p = 0.02 ), and lower BHI (0.48 vs. 0.96; p = 0.05 ) than patients with classic-type PD. We concluded that TCCS displays impaired cerebrovascular reactivity and a more severe disease pattern in Parkinsonian patients with two or more risk factors for CVD and in the akinetic-rigid type. Doppler ultrasonography may be a useful tool in a clinical setting to investigate PD patients.

Objetiva-se, com este trabalho, realizar uma revisão de literatura de estudos primários que abordaram a aplicação da espectroscopia de prótons por ressonância magnética (1H-MRS) como método diagnóstico e de estadiamento nos gliomas cerebrais. Todos os artigos analisados, através do PubMed mostraram significância estatística na correlação entre 1H-MRS com a histopatologia da lesão. Dos 26 estudos analisados, 9 mostraram diferenças entre gliomas de outras lesões do Sistema Nervoso Central (SNC) e 23 avaliaram a diferença entre gliomas de baixo grau e gliomas de alto grau. Procurou-se mostrar que as linhas de pesquisa que usaram 1H-RMS apresentaram resultados mais refinados quanto ao diagnóstico destes tumores. Destes estudos, conclui-se que a 1H-MRS associada à MRI é um método diagnóstico com boa acurácia quando comparado com a análise histopatológica. Os metabólitos detectados pela espectroscopia se correlacionam bem com a gradação dos gliomas e fornecem fortes evidências de que este método possa ser mais utilizado para avaliação e seguimento de pacientes no pré e no pós-operatório.