Fernando Mendes Paschoal

Universidade Federal do Pará

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Edson Bor‐Seng‐Shu

Universidade de São Paulo

Eric Homero Albuquerque Paschoal

Amazon Research Foundation

Manoel Jacobsen Teixeira

Universidade de São Paulo

Marcelo de Lima Oliveira

Universidade de São Paulo

Ricardo de Carvalho Nogueira

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Elizabeth Sumi Yamada

Universidade Federal do Pará

ÂR

Ândrea Ribeiro‐dos‐Santos

Universidade Federal do Pará

Karla de Almeida Lins Ronconi

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Amanda Vidal

Vale Technological Institute

Ricardo A. Vialle

Icahn School of Medicine at Mount Sinai

Cooperative Institutions

Universidade de São Paulo

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Universidade Federal do Pará

Universidade Federal de São Paulo

Universidade do Estado do Pará

Hospital Universitário da Universidade de São Paulo

Hospital São Paulo

Hospital São Rafael

D’Or Institute for Research and Education

Centro Universitário do Pará

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Decompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluation

Frontiers in Neurology (2019)

Edson Bor‐Seng‐Shu Marcelo de Lima Oliveira Ricardo de Carvalho Nogueira Kelson James Almeida Eric Homero Albuquerque Paschoal

Background: There are no studies describing the cerebral hemodynamic patterns that can occur in traumatic brain injury (TBI) patients following decompressive craniectomy (DC). Such data have potentially clinical importance for guiding the treatment. The objective of this study was to investigate the postoperative cerebral hemodynamic patterns, using transcranial Doppler (TCD) ultrasonography, in patients who underwent DC. The relationship between the cerebral circulatory patterns and the patients' outcome was also analyzed. Methods: Nineteen TBI patients with uncontrolled brain swelling were prospectively studied. Cerebral blood circulation was evaluated by TCD ultrasonography. Patients and their cerebral hemispheres were categorized based on TCD-hemodynamic patterns. The data were correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. Results: Different cerebral hemodynamic patterns were observed. One patient (5.3%) presented with cerebral oligoemia, 4 patients (21%) with cerebral hyperemia, and 3 patients (15.8%) with cerebral vasospasm. One patient (5.3%) had hyperemia in one cerebral hemisphere and vasospasm in the other hemisphere. Ten patients (52.6%) had nonspecific circulatory pattern. Abnormal TCD-circulatory patterns were found in 9 patients (47.4%). There was no association between TCD-cerebral hemodynamic findings and outcome. Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient.

Glasgow Outcome Scale

Decompressive craniectomy

Cerebral Vasospasm

Cerebral circulation

Transcranial Doppler

10.3389/fneur.2019.00354

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Citations (14)

Ultrasonography of the optic nerve in fulminant hepatic failure

Fernando Mendes Paschoal K. A. L. Ronconi M. L. de Oliveira Rossana C. Nogueira Eric Homero Albuquerque Paschoal

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Realistic simulation is associated with healthcare professionals’ increased self-perception of confidence in providing acute stroke care: a before-after controlled study

Figshare (2021)

Suzete Nascimento Farias da Guarda João Pedro Souza SANTOS Mariana Sampaio Motta REIS Rogério da Hora Passos Luís Cláudio Lemos Correia

ABSTRACT Background: Simulations are becoming widely used in medical education, but there is little evidence of their effectiveness on neurocritical care. Because acute stroke is a neurological emergency demanding prompt attention, it is a promising candidate for simulation training. Objective: To assess the impact of a stroke realistic simulation course on clinicians’ self-perception of confidence in the management of acute stroke. Methods: We conducted a controlled, before-after study. For our intervention, 17 healthcare professionals participated in a stroke realistic simulation course. As controls, participants were chosen from a convenience sample of attendees to the courses Emergency Neurologic Life Support (ENLS) (18 participants) and Neurosonology (20 participants). All participants responded pre- and post-test questionnaires evaluating their self-perception of confidence in acute stroke care, ranging from 10 to 50 points. We evaluated the variation between pre- and post-test results to assess the change on trainees’ self-perception of confidence in the management of acute stroke. Multivariate analysis was performed to control for potential confounders. Results: Forty-six (83.63%) subjects completed both questionnaires. The post-test scores were higher than those from the pretests in the stroke realistic simulation course group [pretest median (interquartile range - IQR): 41.5 (36.7-46.5) and post-test median (IQR): 47 (44.7-48); p=0.033], but not in the neurosonology [pretest median (IQR): 46 (44-47) and post-test median (IQR): 46 (44-47); p=0.739] or the ENLS [pretest median (IQR): 46.5 (39-48.2), post-test median (IQR): 47 (40.2-49); p=0.317] groups. Results were maintained after adjustment for covariates. Conclusions: This stroke realistic simulation course was associated with an improvement on trainees’ self-perception of confidence in providing acute stroke care.

Health Professionals

Stroke

Acute stroke

Acute care

10.6084/m9.figshare.14275971

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Detection of Cerebral Vasculopathy by Transcranial Doppler in Children With Neurofibromatosis Type 1

Journal of Child Neurology (2015)

Joelma Karin Sagica Fernandes Paschoal Fernando Mendes Paschoal Fernanda Teresa de Lima Ricardo Silva Pinho Luiz Celso Pereira Vilanova

Neurofibromatosis type 1 is characterized by nerve sheath neurofibromas associated with a number of additional clinical features, including cerebrovascular disease. The aim of this study was to use transcranial Doppler as a screening method for identifying cerebral vasculopathy in children with neurofibromatosis type 1. Forty children with neurofibromatosis type 1, aged 5 to 18 years old, were examined by transcranial Doppler. Patients presenting with hemodynamic features of arterial stenosis/occlusion on transcranial Doppler underwent magnetic resonance angiography to confirm the findings. Magnetic resonance angiography was performed on 4 children who exhibited a transcranial Doppler hemodynamic pattern indicative of cerebral vasculopathy. Among these cases, 2 presented internal carotid artery stenosis/occlusion, 1 had bilateral middle cerebral artery stenosis, and 1 presented a normal magnetic resonance angiography result. Transcranial Doppler can be used routinely in the investigation of cerebrovascular disease in neurofibromatosis type 1 patients, where magnetic resonance angiography can be subsequently applied to confirm the diagnosis, further contributing to the prevention of cerebrovascular events.

Transcranial Doppler

Magnetic resonance angiography

Carotid artery disease

Anterior cerebral artery

Moyamoya Disease

10.1177/0883073815595080

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Haste bloqueada "Faculdade de Medicina de Ribeirão Preto": experiência clínica no tratamento das fraturas femorais

Acta Ortopédica Brasileira (2000)

Fernando Mendes Paschoal Cleber Antônio Jansen Paccola

Uma série de 103 casos de fraturas diafisárias complexas do fêmur foram tratadas com a haste intramedular bloqueada FMRP, no período de maio de 1987 a dezembro 1995. Das 103 fraturas, 67 eram cominutivas, 12 bifocais (segmentar), 4 espirais, 13 proximais e 21 distais, instáveis, rotacionalmente, da diáfise femoral. Do total dos casos, constatou-se 97 bloqueios estáticos e 6 dinâmicos. Dessas 97 estáticas, 7 foram dinamizadas durante a evolução. Clínica e radiográficamente a consolidação ocorreu em 97,09% dos casos, com média de 16,72 semanas e em 3 casos não houve consolidação. Houve 4 casos de infecção suspeita e 3 estabelecidas que foram debeladas e evoluíram para consolidação. Houve 81 casos de encurtamentos que variaram entre 0,5 a 4 cm com média de 1 cm. O encurtamento menor ou igual a 2 cm ocorreu em 73 casos. Desvio de alinhamento em qualquer plano acima de 10 º e igual a 15º foi observado em 8 pacientes. Houve 10 casos de deformidades rotacionais, porém nenhum caso acima de 10º. A incidência de infecção foi baixa e a de consolidação alta. A estabilização dessas fraturas complexas permitiu imediata mobilização do paciente, reabilitação precoce do membro e diminuição da permanência hospitalar, excetuando os politraumatizados. A haste FMRP permitiu o tratamento dessas fraturas sem o uso de intensificador de imagens e de fresas flexíveis com baixo custo operacional. Os resultados foram semelhantes aos obtidos com as hastes intramedulares bloqueadas que necessitam de aparelhagem técnica mais sofisticada, porém com vantagens para o paciente e a equipe cirúrgica.

10.1590/s1413-78522000000400002

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Tratamento de 184 fraturas multifragmentárias do fêmur com haste intramedular bloqueada FMRP: estudo multicêntrico

Hélio Jorge Alvachian Fernandes Fernando Mendes Paschoal Cleber Antônio Jansen Paccola Fernando Baldy dos Reis

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Global miRNA expression profile reveals novel molecular players in aneurysmal subarachnoid haemorrhage

Scientific Reports (2018)

Kátia de Paiva Lopes Tatiana Vinasco-Sandoval Ricardo A. Vialle Fernando Mendes Paschoal Vanessa Bastos

The molecular mechanisms behind aneurysmal subarachnoid haemorrhage (aSAH) are still poorly understood. Expression patterns of miRNAs may help elucidate the post-transcriptional gene expression in aSAH. Here, we evaluate the global miRNAs expression profile (miRnome) of patients with aSAH to identify potential biomarkers. We collected 33 peripheral blood samples (27 patients with cerebral aneurysm, collected 7 to 10 days after the haemorrhage, when usually is the cerebral vasospasm risk peak, and six controls). Then, were performed small RNA sequencing using an Illumina Next Generation Sequencing (NGS) platform. Differential expression analysis identified eight differentially expressed miRNAs. Among them, three were identified being up-regulated, and five down-regulated. miR-486-5p was the most abundant expressed and is associated with poor neurological admission status. In silico miRNA gene target prediction showed 148 genes associated with at least two differentially expressed miRNAs. Among these, THBS1 and VEGFA, known to be related to thrombospondin and vascular endothelial growth factor. Moreover, MYC gene was found to be regulated by four miRNAs, suggesting an important role in aneurysmal subarachnoid haemorrhage. Additionally, 15 novel miRNAs were predicted being expressed only in aSAH, suggesting possible involvement in aneurysm pathogenesis. These findings may help the identification of novel biomarkers of clinical interest.

Subarachnoid haemorrhage

Pathogenesis

Thoracic aortic aneurysm

10.1038/s41598-018-27078-w

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Citations (26)

Multimodal brain monitoring in fulminant hepatic failure

World Journal of Hepatology (2016)

Fernando Mendes Paschoal Ricardo de Carvalho Nogueira Karla de Almeida Lins Ronconi Marcelo de Lima Oliveira Manoel Jacobsen Teixeira

Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy.Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF.The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis.Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation.In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring.Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages.The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support.New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed.These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates.The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting.

Fulminant hepatic failure

Intracranial pressure monitoring

Hepatic Encephalopathy

Neurointensive care

Cerebral edema

Fulminant

10.4254/wjh.v8.i22.915

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Citations (17)

Improvement in neurological outcome and brain hemodynamics after late cranioplasty

Acta Neurochirurgica (2021)

Arthur Maynart Pereira Oliveira Robson Luís Oliveira de Amorim Sérgio Brasil Gabriel Gattás Almir Ferreira de Andrade