RESUMO Objetivo Verificar correlações entre idade, gravidade do trauma, tempo de hospitalização (TH), cognição, capacidade funcional e qualidade de vida (QV) seis meses após alta hospitalar (AH) de vítimas de trauma crânio-encefálico (TCE). Método 50 pacientes tratados em um hospital de emergência brasileiro foram avaliados na admissão, AH e seis meses após AH. O protocolo de avaliação consistia em Escala Abreviada de Lesões, Índice de Gravidade de Lesão, Escala de Coma de Glasgow (ECG), Escore de Trauma Revisado (RTS), teste Mini-Mental, Índice de Barthel e Questionário Breve de QV da Organização Mundial de Saúde. Resultados Forte correlação negativa foi observada entre TH e ECG e TH e RTS. Correlação quase máxima foi observada entre RTS e ECG e capacidade funcional e ECG na AH. Idade e TH foram considerados preditores independentes de QV. Conclusão Idade e TH são preditores independentes de QV após TCE moderado e grave.

ABSTRACT Objective To verify correlations between age, injury severity, length of stay (LOS), cognition, functional capacity and quality of life (QOL) six months after hospital discharge (HD) of victims of traumatic brain injury (TBI). Method 50 patients consecutively treated in a Brazilian emergency hospital were assessed at admission, HD and six months after HD. The assessment protocol consisted in Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Mini Mental Test, Barthel Index and World Health Organization QOL - Brief. Results Strong negative correlation was observed between LOS and GCS and LOS and RTS. An almost maximal correlation was found between RTS and GCS and functional capacity and GCS at HD. Age and LOS were considered independent predictors of QOL. Conclusion Age and LOS are independent predictors of QOL after moderate to severe TBI.

RESUMO A lipoenxertia de face, apesar de consagrada, não é isenta de riscos e complicações. Neste relato de caso, descrevemos de forma inédita uma complicação isquêmica local, causada por enxerto de gordura. Simultaneamente, propomos a terapêutica com Oxigenioterapia Hiperbárica para o tratamento desta situação, não se limitando exclusivamente à gordura, mas principalmente ao PMMA, em que esta complicação é muito mais frequente. face consagrada complicações caso local gordura Simultaneamente situação PMMA frequente

ABSTRACT Facial fat grafting is not devoid of risks and complications, despite being a widely practiced procedure. In this case report, we describe a novel form of local ischemic complication that occurred secondary to fat grafting. Simultaneously, we propose Hyperbaric Oxygen therapy for the treatment of this situation. We propose that Hyperbaric Oxygen therapy should not be limited solely to fat graft-related ischemia, but should be effective in the management of the more frequently encountered complications associated with polymethylmethacrylate fillers. procedure report Simultaneously situation graftrelated graft related ischemia fillers

Para manter o equilíbrio postural, algumas estratégias posturais são normalmente usadas. OBJETIVO: Avaliar as estratégias posturais de jovens e idosos em diferentes condições sensoriais usando um sistema de sensores eletromagnéticos tridimensionais posicionados na primeira vértebra torácica e região sacral. Também reportamos valores de oscilação postural dos jovens e idosos. MÉTODO: Estudo transversal observacional. Participaram do estudo 25 jovens e 16 idosas. O equipamento PolhemusTM com dois sensores foi usado para avaliar os parâmetros de oscilação postural (deslocamento máximo, velocidade média e trajetória). A aquisição dos dados foi realizada com os sujeitos em pé, realizando um teste de 90 segundos para as quatro condições sensoriais: olhos abertos e fechados nas superfícies estável e instável. RESULTADOS: Os sensores 1 e 2 apresentaram alta correlação cruzada em todas as condições sensoriais para ambos os grupos (r > 0.99; p < 0.001). Comparando a correlação cruzada entre os grupos, não foram observadas diferenças significativas. CONCLUSÃO: Este estudo apresentou uma importante ferramenta na análise de oscilação postural e na avaliação das estratégias posturais de jovens e idosos em diferentes condições sensoriais. Os jovens e idosos apresentaram uma forte correlação entre os sensores (estratégia do tornozelo), porém, não foram observadas diferenças significativas entre os grupos.

One resorts to various postural strategies while attempting to maintain balance. OBJECTIVE: To assess the postural strategies adopted by young and elderly subjects in varying sensory conditions by using a system of tridimensional electromagnetic sensors positioned on the projection of the first thoracic vertebra and on the sacral region. Postural oscillation values for young and elderly subjects were also reported. METHOD: This observational cross-sectional study enrolled 25 young and 16 elderly individuals. A PolhemusTM device equipped with two sensors was used to assess postural oscillation parameters (maximum displacement, mean velocity, and trajectory). Data acquisition was carried out with subjects standing while undergoing a 90-second test in four sensory conditions: eyes opened, eyes closed, on a stable surface, and on an unstable surface. RESULTS: Sensors 1 and 2 presented significant cross-correlations in all sensory conditions for both groups (r > 0.99; p < 0.001). No statistically significant differences were seen when the cross-correlations for both groups were compared. CONCLUSION: This study presented an important tool to analyze postural oscillation and assess the postural strategies of young and elderly subjects in different sensory conditions. Young and elderly individuals presented strong correlations between sensors (ankle strategy), but no statistically significant differences were seen between groups.

OBJECTIVE: Obstructive sleep apnea is frequent during the acute phase of stroke, and it is associated with poorer outcomes. A well-established relationship between supine sleep and obstructive sleep apnea severity exists in non-stroke patients. This study investigated the frequency of supine sleep and positional obstructive sleep apnea in patients with ischemic or hemorrhagic stroke. METHODS: Patients who suffered their first acute stroke, either ischemic or hemorrhagic, were subjected to a full polysomnography, including the continuous monitoring of sleep positions, during the first night after symptom onset. Obstructive sleep apnea severity was measured using the apnea-hypopnea index, and the NIHSS measured stroke severity. RESULTS: We prospectively studied 66 stroke patients. The mean age was 57.6±11.5 years, and the mean body mass index was 26.5±4.9. Obstructive sleep apnea (apnea-hypopnea index >5) was present in 78.8% of patients, and the mean apnea-hypopnea index was 29.7±26.6. The majority of subjects (66.7%) spent the entire sleep time in a supine position, and positional obstructive sleep apnea was clearly present in the other 23.1% of cases. A positive correlation was observed between the NIHSS and sleep time in the supine position (r s = 0.5; p<0.001). CONCLUSIONS: Prolonged supine positioning during sleep was highly frequent after stroke, and it was related to stroke severity. Positional sleep apnea was observed in one quarter of stroke patients, which was likely underestimated during the acute phase of stroke. The adequate positioning of patients during sleep during the acute phase of stroke may decrease obstructive respiratory events, regardless of the stroke subtype.

OBJECTIVE: The aim of this study was to assess the subjective visual vertical in patients with bilateral vestibular dysfunction and to propose a new method to analyze subjective visual vertical data in these patients. METHODS: Static subjective visual vertical tests were performed in 40 subjects split into two groups. Group A consisted of 20 healthy volunteers, and Group B consisted of 20 patients with bilateral vestibular dysfunction. Each patient performed six measurements of the subjective visual vertical test, and the mean values were calculated and analyzed. RESULTS: Analyses of the numerical values of subjective visual vertical deviations (the conventional method of analysis) showed that the mean deviation was 0.326±1.13º in Group A and 0.301±1.87º in Group B. However, by analyzing the absolute values of the subjective visual vertical (the new method of analysis proposed), the mean deviation became 1.35±0.48º in Group A and 2.152±0.93º in Group B. The difference in subjective visual vertical deviations between groups was statistically significant (p,<0.05) only when the absolute values and the range of deviations were considered. CONCLUSION: An analysis of the absolute values of the subjective visual vertical more accurately reflected the visual vertical misperception in patients with bilateral vestibular dysfunction.

O objetivo deste estudo foi investigar a influência da obesidade e da força de preensão palmar (FPP) no equilíbrio postural estático de idosas ativas nas condições de olhos abertos e fechados. Participaram 31 idosas (16 eutróficas e 15 obesas). A idade média e o Índice de Massa Corpórea (IMC) das eutróficas foram, respectivamente, 68,3±2,7 anos e 23,4±1,6kg/m², e das obesas 69,1±2,7 anos e 33,5±3kg/m². A FPP foi avaliada usando um dinamômetro (JAMAR). O equilíbrio postural estático foi avaliado usando um sistema tridimensional nas condições de olhos abertos (OA) e fechados (OF), durante 90 segundos cada condição. A FPP das idosas eutróficas foi 25,1±4,6kgf e das obesas foi 24,8±5,2kgf, não havendo diferenças significativas. No equilíbrio postural, foram observadas diferenças significativas entre os grupos apenas no deslocamento máximo a-p com AO (p=0,04) e OF (p<0,01), com as idosas obesas apresentando menor deslocamento a-p em relação às eutróficas. Não houve correlação entre o deslocamento máximo a-p com IMC e a FPP. No presente estudo FPP não influenciou o equilíbrio postural estático, enquanto a obesidade foi fator determinante de menor deslocamento ântero-posterior de idosas ativas.

The objective of this study was to investigate the influence of the obesity and handgrip strength on the static balance of active older women in the opened and closed eyes conditions. Thirty one women aged from 65 to 75 years (16 eutrophic and 15 obese) were evaluated. Mean age and BMI of the eutrophic women were, respectively, 68.3±2.7 years and 23.4±1.6kg/m², and of the obese women were 69.1±2.7 years and 33.5±3kg/m². Handgrip strength was evaluated using a dynamometer (JAMAR). A tridimensional sensors system was used to evaluate the static postural balance. The tests were performed for 90 seconds, with eyes opened and closed. The mean handgrip strength of the eutrophic women was 25.1±4.6kgf and of the obese women was 24.8±5.2kgf, (p>0,05). Significant differences between groups were only observed in the maximum displacement with opened eyes (p=0,04) and closed eyes(p<0,01). There was no correlation between the maximum displacement neither with the BMI or the handgrip strength. The present study showed smaller a-p displacement in obese than in eutrophic women, with major statistic difference in the eyes closed condition. In the present study, the handgrip strength did not influence the static balance, however the obesity was a determinant factor for the smaller a-p displacement of the active older women.

INTRODUÇÃO: A abdominoplastia é uma das cirurgias estéticas mais realizadas e, como qualquer outro ato cirúrgico, está sujeita a inúmeras complicações, entre as quais os fenômenos tromboembólicos. O objetivo deste estudo foi analisar a incidência de complicações em uma série consecutiva de abdominoplastias, fatores de risco e a eficácia de dois protocolos de prevenção para tromboembolia. MÉTODO: Estudo retrospectivo de 563 abdominoplastias, isoladas ou não, realizadas entre março de 2008 e abril de 2011, que receberam dois protocolos de profilaxia de tromboembolismo diferentes: o farmacológico, com emprego de enoxaparina (357 pacientes), e o mecânico, com compressão pneumática intermitente (206 pacientes). RESULTADOS: Dentre os 563 pacientes, 4 (0,7%) eram do sexo masculino (0,7%) e 559 (99,3%), do sexo feminino. Foram submetidos a abdominoplastia isolada 201 (35,7%) pacientes, enquanto 362 (64,3%) foram submetidos a abdominoplastia associada a algum outro procedimento. Os grupos com profilaxia farmacológica e mecânica tinham fatores de risco e características demográficas e clínicas semelhantes. A incidência de complicações no grupo farmacológico em relação ao grupo mecânico foi de: hematoma, 5,6% e 10,7%; infecção, 2,2% e 2,4%; deiscência, 3,1% e 1,9%; seroma, 2,2% e 2,4%; e trombose venosa profunda/tromboembolia pulmonar, 0,6% e 0,5%. Nenhuma complicação apresentou diferença estatística significante entre os grupos. CONCLUSÕES: A taxa de complicações em 563 casos consecutivos de abdominoplastia foi semelhante à da literatura. A eficácia da profilaxia tromboembólica em abdominoplastia é a mesma observada com a utilização de métodos farmacológicos e mecânicos isoladamente.

BACKGROUND: Abdominoplasty is a common cosmetic surgery and is subject to the same complications as any surgical procedure, including thromboembolic phenomena. The aim of this study was to assess the incidence of complications in consecutive abdominoplasties performed over a 3-year period, to identify risk factors for the complications, and to compare the efficacy of two protocols for prevention of thromboembolism. METHODS: A retrospective study was conducted of 563 patients who underwent isolated abdominoplasty or abdominoplasty combined with additional cosmetic surgeries between March 2008 and April 2011. All patients received thromboembolism prophylaxis using either pharmacological (enoxaparin; 357 patients) or mechanical (intermittent pneumatic compression, IPC; 206 patients) protocols. RESULTS: Of the 563 patients studied, 4 (0.7%) were male (0.7%) and 559 (99.3%) were female. The patients underwent isolated abdominoplasty (201; 35.7%) or abdominoplasty combined with other procedures (362; 64.3%). The patient groups receiving pharmacological and mechanical prophylaxis presented similar demographic and clinical characteristics and had similar risk factors for thromboembolic events. The incidence of complications in the patient groups undergoing pharmacological versus mechanical prophylaxis were: hematoma (5.6% vs. 10.7%), infection (2.2% vs. 2.4%), dehiscence (3.1% vs. 1.9%), seroma (2.2% vs. 2.4%), and deep vein thrombosis/pulmonary embolism (0.6% vs. 0.5%). There were no statistically significant differences in the incidence of complications between the two groups. CONCLUSION: The incidence of complications in 563 consecutive cases of abdominoplasty was similar to that reported in the literature. The pharmacological and mechanical protocols for thromboembolic prophylaxis in abdominoplasty were equally effective.

OBJECTIVE: The aim of this study was to evaluate the multisegmental static postural balance of active eutrophic and obese elderly women using a three-dimensional system under different sensory conditions. METHODS: A cross-sectional study was conducted on 31 elderly women (16 eutrophic and 15 obese) aged 65 to 75 years. The following anthropometric measurements were obtained: weight, height, waist and hip circumference, and handgrip strength. The physical activity level was evaluated using the International Physical Activity Questionnaire. Body composition was measured using the deuterium oxide dilution technique. The Polhemus® Patriot (three-dimensional) equipment was used to measure the parameters of postural balance along the anteroposterior and laterolateral axes. The data acquisition involved one trial of 60 s to test the limit of stability and four trials of 90 s each under the following conditions: (1) eyes open, stable surface; (2) eyes closed, stable surface; (3) eyes open, unstable surface; and (4) eyes closed, unstable surface. RESULTS: For the limit of stability, significant differences were observed in the maximum anteroposterior and laterolateral displacement (p<0.01) and in the parameter maximum anteroposterior displacement in the eyes closed stable surface condition (p<0.01) and maximum anteroposterior and laterolateral displacement in the eyes open unstable surface (p<0.01 and p = 0.03) and eyes closed unstable surface (p<0.01 and p<0.01) conditions. CONCLUSIONS: Obese elderly women exhibited a lower stability limit (lower sway area) compared with eutrophic women, leaving them more vulnerable to falls.

A síndrome do empurrador (SE) é um distúrbio de controle postural que acomete indivíduos com lesões encefálicas. Os objetivos deste estudo foram identificar as estruturas encefálicas envolvidas na SE, analisar a influência dos desvios de linha média (DLM) e volume do hematoma (VH) na gravidade e duração da SE. Dentre os pacientes internados na enfermaria de neurologia, foram identificados 31 pacientes com SE, idade média 67,4±11,89, 61,3% homens. Foram realizados exames neurológico e funcional. As análises das neuroimagens incluíram medidas de VH em pacientes com doença cerebrovascular (DC) hemorrágica, DLM, análise do território vascular, etiologia e lado da lesão. Lesão nas regiões parietal (p=0,041) e talâmica (p=0,001) foram significativamente mais frequentes nos pacientes com SE. Não foi observada correlação dos DLM e volume do hematoma com a gravidade e duração da SE.

Pusher behavior (PB) is a disorder of postural control affecting patients with encephalic lesions. This study has aimed to identify the brain substrates that are critical for the occurrence of PB, to analyze the influence of the midline shift (MS) and hemorrhagic stroke volume (HSV) on the severity and prognosis of the PB. We identified 31 pusher patients of a neurological unit, mean age 67.4±11.89, 61.3% male. Additional neurological and functional examinations were assessed. Neuroimaging workup included measurement of the MS, the HSV in patients with hemorrhagic stroke, the analysis of the vascular territory, etiology and side of the lesion. Lesions in the parietal region (p=0.041) and thalamus (p=0.001) were significantly more frequent in PB patients. Neither the MS nor the HSV were correlated with the PB severity or recovery time.

A subjetiva vertical visual (SVV) avalia a capacidade do indivíduo determinar a posição vertical. O uso do colar cervical (CC) fixa a cabeça do voluntário, reduzindo a inclicação cefálica durante o exame e prevenindo a torção ocular compensatória que influencia na SVV. OBJETIVO: Analisar a influência de informações sometossensoriais causadas pelo uso de um CC na SVV. MÉTODO: Trinta voluntários saudáveis realizaram a SVV estática e dinâmica: seis medidas com e seis medidas sem o CC. RESULTADOS: O valor médio da SVV estática foi -0,075º±1,15º sem CC e -0,372º±1,21º com. Na SVV dinâmica no sentido horário foi 1,73º±2,31º sem CC e 1,53º±1,80º com. Na SVV dinâmica no sentido anti-horário foi -1,50º±2,44º sem CC e -1,11º±2,46º com. As diferenças entre as medidas com e sem CC não foram estatisticamente significativas. CONCLUSÃO: Apesar de o pescoço possuir inumeros receptores sensoriais, o uso do CC não fornece aferências suficientes para alterar a percepção de visual de verticalidade de voluntários saudáveis.

Subjective visual vertical (SVV) evaluates the individual's capacity to determine the vertical orientation. Using a neck brace (NB) allow volunteers' heads fixation to reduce cephalic tilt during the exam, preventing compensatory ocular torsion and erroneous influence on SVV result. OBJECTIVE: To analyze the influence of somatosensory inputs caused by a NB on the SVV. METHOD: Thirty healthy volunteers performed static and dynamic SVV: six measures with and six without the NB. RESULTS: The mean values for static SVV were -0.075º±1.15º without NB and -0.372º±1.21º with NB. For dynamic SVV in clockwise direction were 1.73º±2.31º without NB and 1.53º±1.80º with NB. For dynamic SVV in counterclockwise direction was -1.50º±2.44º without NB and -1.11º±2.46º with NB. Differences between measurements with and without the NB were not statistically significant. CONCLUSION: Although the neck has many sensory receptors, the use of a NB does not provide sufficient afferent input to change healthy subjects' perception of visual verticality.

A detecção precoce de distúrbios posturais é fundamental para a promoção de intervenções adequadas para pacientes com desequilíbrios. OBJETIVO: Este é um estudo piloto que descreve uma nova ferramenta para avaliação do equilíbrio postural estático. FORMA DE ESTUDO: Coorte contemporânea com corte transversal. MATERIAL E MÉTODO: Foram avaliados 25 voluntários (15 mulheres e 10 homens). Idade média de 25,8±4,2anos, peso 63,9±13,1Kg, estatura 1,68±0,08m e índice de massa corporal 22,3±3,3kg/m2. A posturografia foi realizada por meio da análise de oscilação postural utilizando um equipamento eletromagnético com um sensor fixado sobre o processo espinhoso da 1ª vértebra torácica. Os testes foram realizados com os sujeitos na posição ortostática durante 90 segundos, para as condições de olhos abertos (OA) e fechados (OF) em superfície estável e instável. RESULTADOS: Quando analisada a influência da superfície (estável x instável) para o equilíbrio postural na condição OA, foram observadas diferenças significativas nos parâmetros de trajetória médio-lateral (m-l) (p=0.004) e total (p=0.014) e de velocidade m-l (p=0.004) e total (p=0.014). Na condição OF, foram observadas diferenças significativas em todos os parâmetros estudados (p<0.001). Houve influência da visão em todos os parâmetros apenas na superfície instável (p<0.05). CONCLUSÃO: A ferramenta utilizada se mostrou eficaz para a análise da oscilação postural.

Early detection of postural disorders is essential for timely interventions in patients with imbalance. AIM: A pilot study describing a new tool for evaluating static postural balance. STUDY DESIGN: A cross-sectional study of a contemporary series. MATERIAL AND METHOD: Twenty-five volunteers (15 women and 10 men) were evaluated. The mean age was 25.8 ± 4.2 years, the mean weight was 63.9 ± 13.1Kg, the mean height was 1.68 ± 0.08 m and the body mass index was 22.3±3.3kg/m2. Posturography was done by analysing postural sway with an electromagnetic system; a sensor was attached to the skin over the spinous process of the first thoracic vertebra. Tests were carried out with the subjects in the orthostatic position for 90 seconds, with eyes opened(EO) and closed(EC) on stable and unstable surfaces. RESULTS: When the influence of the surface was analyzed (stable x unstable) in the EO condition, there were significant differences in the middle-lateral parameters (m-l) (p=0.004) and total path (p=0.01), and in the m-l (p=0.004) and total (p=0.014) speed. In the EC condition, there were significant differences in all parameters (p<0.001). The influence of the vision was observed in all parameters only on unstable surfaces (p<0.05). CONCLUSION: The new tool was efficient for analysing postural sway.

OBJETIVOS: Descrever uma nova metodologia de análise da oscilação postural estática sentada e comparar os resultados de jovens e idosos saudáveis. MÉTODOS: Participaram do estudo 38 indivíduos saudáveis, 17 jovens (idade média 23±2,38 anos) e 21 idosos (idade média 67±2,42 anos). A oscilação postural foi mensurada por meio do sistema eletromagnético Polhemus® 3Space Isotrack II. As avaliações foram feitas nas condições olhos abertos (OA) e fechados (OF), com os voluntários sentados sem apoio plantar e sem encosto em suportes de madeira (superfície estável-SE) e de espuma (superfície instável-SI). Cada condição sensorial foi avaliada durante 90 segundos. Os parâmetros analisados foram: deslocamento máximo (Dmáx), trajetória total (Traj) e velocidade média (Vel) nos planos sagital (X) e frontal (Y). RESULTADOS: Nas condições OA e OF em SE, foram encontradas oscilações nos planos X e Y dos parâmetros Traj e Vel maiores em jovens que em idosos. Em SI, foram observadas maiores Traj Y e Vel Y nos jovens, sem diferença significativa entre os grupos quanto a Traj X e Vel X com olhos fechados. Em relação ao Dmáx, tanto no plano X quanto no Y, em todas as condições sensoriais, só houve diferença significativa na condição OASE no plano sagital, sendo maior nos jovens. CONCLUSÕES: Jovens saudáveis oscilam mais que os idosos saudáveis na posição sentada. Além disso, a ferramenta utilizada mostrou ser útil para análise da oscilação postural estática na posição sentada, possibilitando o surgimento de estudos que a associem com o efeito de diversas tarefas motoras.

OBJECTIVES: To describe a new method to analyze the static sitting postural sway and to compare the results of healthy young and older adult subjects. METHODS: Thirty-eight healthy subjects took part in the study, including 17 young adults (mean age 23±2.38 years old) and 21 older adults (mean age 67±2.42 years old). The device used to quantify trunk sway was the magnetic field sensor Polhemus® 3Space Isotrack II. The measurements were taken in the eyes-opened (EO) and eyes-closed (EC) condition with the subjects seated first on a wooden stable surface (SS) then on a foam unstable surface (US) without back or foot support. Each sensory condition was assessed for 90 seconds. The analyzed parameters were: maximum amplitude (Amp), total trajectory (Traj) and mean velocity (Vel) in the sagittal (X) and frontal (Y) planes. RESULTS: In the EO and EC conditions on SS, young adults presented greater postural sway in the X and Y planes on the Traj and Vel parameters. In the US, young adults showed greater Y Traj and Y Vel in the EO and EC conditions, and there was no significant difference between the groups with regard to X Traj and X Vel in the EC condition. The young adults presented greater Amp only in the EOSS condition in the X plane. CONCLUSIONS: The young adult subjects presented greater sway in the sitting position than the older adult subjects. In addition, the Polhemus® device was a useful tool to analyze static sitting postural sway and can be used in future studies that associate static sitting postural sway with the effect of various motor tasks.

Relatamos o estudo de neuroimagem seqüencial de um homem de 48 anos com história de hipertensão arterial crônica e acidentes vasculares cerebrais (AVCs) lacunares nos núcleos ventral lateral posterior do tálamo. O paciente desenvolveu hemiparesia leve e síndrome do empurrador (SE) grave após AVC hemorrágico no tálamo direito, sendo tratado com fisioterapia motora convencional. Três meses após o ictus, os sinais da síndrome haviam desaparecido e o paciente apresentava Índice de Barthel 85, apesar da permanência da hemiparesia leve. Este caso demonstra que a síndrome do empurrador isolada pode ser gravemente incapacitante, pode ocorrer associada a hemiparesia leve e que os pacientes com esta síndrome podem apresentar recuperação funcional importante (Índice de Barthel inicial 0 e final 85) após a resolução da SP sem alteração do grau de hemiparesia.

We report a sequential neuroimaging study in a 48-years-old man with a history of chronic hypertension and lacunar strokes involving the ventral lateral posterior nucleus of the thalamus. The patient developed mild hemiparesis and severe contraversive pushing behavior after an acute hemorrhage affecting the right thalamus. Following standard motor physiotherapy, the pusher behavior completely resolved 3 months after the onset and, at that time, he had a Barthel Index of 85, although mild left hemiparesis was still present. This case report illustrates that pushing behavior itself may be severely incapacitating, may occur with only mild hemiparesis and affected patients may have dramatic functional improvement (Barthel Index 0 to 85) after resolution pushing behavior without recovery of hemiparesis.