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Introdução: O síndrome motor puro (SMP) é o síndrome lacunar mais frequente. Acomete fundamentalmente a cápsula interna mas também a coroa radiada, a protuberância e as pirâmides. A Tomografia Computorizada (TC) e a Ressonância Magnética (RM) são os métodos predilectos para a investigação topográfica das lesões. Este estudo pretende assim descrever os tipos e a prevalência de síndromes lacunares ocorridos na Unidade de AVC (UAVC) do Centro Hospitalar da Cova da Beira (CHCB) no ano 2009 e identificar um padrão clínico nos doentes com SMP que possa justificar a indicação da realização de uma TC/RM de controle.
Métodos: Estudo retrospectivo de todos os doentes internados na UAVC do CHCB, no ano 2009, com posterior selecção dos doentes com clínica compatível com o diagnóstico de SMP, para os quais foram recolhidas, através de análise documental, variáveis clínicas e imagiológicas.
Resultados: Isolaram-se 30 casos de SMP, 20 com uma lesão na TC e/ou RM compatível com a clínica manifestada. Observaram-se 27 SMP de etiologia isquémica – 14 lesões capsulares e três pontinas – e três de etiologia hemorrágica – três hematomas capsulares –. Dos 27 SMP isquémicos, 22 eram de causa lacunar, três atero-trombótica e um cardio-embólica.
Observou-se que existe maior prevalência de resultado positivo (p<0,05) na primeira TC-CE quando realizada a partir das 24 horas após o início dos sintomas (cinco em nove casos) e que a TC-CE de controle apresenta maior grau de positividade que a TC-CE de entrada (73,3 % para 25,9 % respectivamente) com uma proporção de resultados positivos maior quando realizada após as 48 horas. Quando a TC-CE de entrada apresenta uma lesão que explica a clínica do doente, esta está predominantemente localizada a nível da coroa radiada (p = 0,05). Observou-se também que quando a TC-CE de controle é positiva a lesão está principalmente localizada a nível do braço posterior da CI (p<0,05). Verificou-se por outro lado que as TC-CE de entrada e de controle eram mais positivas em doentes com graus de força menores (inferior a três em cinco) tanto a nível do membro superior (MS) como do membro inferior (MI).
Discussão/Conclusão: Elaborou-se assim um perfil de doentes podendo justificar a indicação para repetição da TC-CE. Doentes com uma hemiparésia proporcional e com um menor grau de força a nível do MS/MI, têm maior probabilidade de apresentar uma primeira TC-CE com resultado positivo, quando realizada a partir das 24 horas desde o início da sintomatologia, com lesão predominantemente localizada na coroa radiada. Se esta for negativa é necessária a repetição da TC-CE. Por fim, se o resultado desta última for positivo, a lesão identificada estará preferencialmente localizada no braço posterior da cápsula interna.
Introduction: Pure motor hemiparesis (PMH) is the most common of all lacunar syndromes. It is primarily caused by isquemic lesions involving the internal capsule, but also the corona radiata, the pons and the pyramids. Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) are the most accurate imaging exams to investigate the location of these lesions, although MRI has a greater sensibility then CT. The aim of this study is to describe the different types and numbers of lacunar syndromes occurred in the Stroke Unit of Centro Hospitalar Cova da Beira (CHCB), during year 2009, and identify a clinical pattern in patients with PMH justifying a control CT and/or MRI. Methods: A retrospective study of all patients hospitalized at the Stroke Unit of CHCB, during year 2009, with posterior selection of patients with clinical history compatible with PMH. For these latter patients, clinical and imaging variables were collected by documental analysis. Results: In 30 cases of PMH, 20 had a CT/MRI lesion compatible with their symptoms. Etiology was ischemic in 17 cases – 14 capsular lesions and three pontines – and hemorrhagic in three cases – three capsular hematomas. Ischemic strokes were due to lacunar (22 cases), aterotrombotic (three cases) and cardio-embolic causes (one case). There were more positive results (p<0,05) in the first CT, when realized 24 hours after the beginning of symptoms (five out of nine cases). Control CT had a higher positivity than the first (73,3 % and 25,9%), with a greater positive proportion when realized 48 hours onwards. When the first CT found a lesion that could explain the symptoms of the patient, it was predominantly located in the corona radiata (p=0,05). On the other side, when control CT presented a positive result, the lesion was preferentially in the posterior limb of the internal capsule (p<0,05). Finally, positive results in early CT occurred more in patients with lower muscle power (inferior at three out of five) of the upper or lower limbs. Discussion/Conclusion: A clinical pattern of patients, that seems to justify the indication to repeat CT, were identified. Patients with proportional hemiparesis and lower muscle power of the upper or lower limbs have more probability of having a positive early CT, when done 24 hours after clinical onset, with a lesion predominantly in the corona radiata. If the CT is negative, a control exam is necessary and the identified lesion will preferentially be located in the posterior limb of the internal capsule.
Introduction: Pure motor hemiparesis (PMH) is the most common of all lacunar syndromes. It is primarily caused by isquemic lesions involving the internal capsule, but also the corona radiata, the pons and the pyramids. Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) are the most accurate imaging exams to investigate the location of these lesions, although MRI has a greater sensibility then CT. The aim of this study is to describe the different types and numbers of lacunar syndromes occurred in the Stroke Unit of Centro Hospitalar Cova da Beira (CHCB), during year 2009, and identify a clinical pattern in patients with PMH justifying a control CT and/or MRI. Methods: A retrospective study of all patients hospitalized at the Stroke Unit of CHCB, during year 2009, with posterior selection of patients with clinical history compatible with PMH. For these latter patients, clinical and imaging variables were collected by documental analysis. Results: In 30 cases of PMH, 20 had a CT/MRI lesion compatible with their symptoms. Etiology was ischemic in 17 cases – 14 capsular lesions and three pontines – and hemorrhagic in three cases – three capsular hematomas. Ischemic strokes were due to lacunar (22 cases), aterotrombotic (three cases) and cardio-embolic causes (one case). There were more positive results (p<0,05) in the first CT, when realized 24 hours after the beginning of symptoms (five out of nine cases). Control CT had a higher positivity than the first (73,3 % and 25,9%), with a greater positive proportion when realized 48 hours onwards. When the first CT found a lesion that could explain the symptoms of the patient, it was predominantly located in the corona radiata (p=0,05). On the other side, when control CT presented a positive result, the lesion was preferentially in the posterior limb of the internal capsule (p<0,05). Finally, positive results in early CT occurred more in patients with lower muscle power (inferior at three out of five) of the upper or lower limbs. Discussion/Conclusion: A clinical pattern of patients, that seems to justify the indication to repeat CT, were identified. Patients with proportional hemiparesis and lower muscle power of the upper or lower limbs have more probability of having a positive early CT, when done 24 hours after clinical onset, with a lesion predominantly in the corona radiata. If the CT is negative, a control exam is necessary and the identified lesion will preferentially be located in the posterior limb of the internal capsule.
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Keywords
Síndrome motor puro Síndrome lacunar Síndrome motor puro - Tomografia computorizada - Meios de diagnóstico Síndrome motor puro - Ressonância magnética - Meios de diagnóstico
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Universidade da Beira Interior