ABSTRACT Objective To describe cerebrovascular manifestations in patients hospitalized for treatment of severe COVID-19, highlighting the comorbidities observed, and those that may play a relevant role as risk factors for severe outcomes. Methods This case series retrospective analyzed, from June to November, 2020, ten patients admitted to the emergency department, with positive nasopharyngeal swab polymerase chain reaction assay for SARS-CoV-2, presenting with neurological symptoms and positive findings at brain imaging studies. Results In this sample, the clinical severity of the symptoms varied from mild to critical. Ischemic stroke was observed in four patients, hemorrhagic events occurred in five cases. Three patients evolved with large parenchymal hemorrhage, and one presented petechial bleeding foci. In one case, we observed subarachnoid hemorrhage associated with bilateral hypodensity in both globus pallidus. Typical posterior reversible encephalopathy syndrome findings were observed in one patient on brain computed tomography. Conclusion Patients with neurovascular complications related to COVID-19 had positive findings in brain imaging and neurological symptoms. The pathological entities observed drew attention to the neurological risk of patients with SARS-CoV-2 infection, including worse outcomes in individuals whose medical history includes clinical comorbidities, especially hypertension and obesity.

Abstract Objective: To evaluate the importance of computed tomography and computed tomography angiography (CTA) in stroke protocols, as well as their impact on endovascular treatment and on the determination of the etiology. Materials and Methods Were evaluated 28 patients with acute/hyperacute stroke in the anterior circulation who underwent intracranial and cervical CTA between April 2018 and August 2019. The parameters evaluated were the degree of stenosis, plaque characteristics, type of infarct, treatment, etiology, and the Alberta Stroke Program Early CT Score (ASPECTS). Results: Of the 28 patients evaluated, 16 (57.1%) had an ASPECTS of 10 (the maximum score, indicative of normality). Four patients (14.3%) underwent thrombolytic treatment, and seven (25.0%) underwent mechanical thrombectomy. The etiology was atherosclerosis in 32.1% of the patients, cerebral small-vessel disease in 7.1%, cardioembolic in 7.1%, and undetermined in 53.6%. Regarding plaque, 17.9% of the patients presented stenosis ≥ 50%, 21.4% presented stable plaques, and 42.9% presented vulnerable plaques. Patients with a lower ASPECTS were more likely to have relevant stenosis and were more likely to have a total infarct. Conclusion: In the evaluation of patients with acute/hyperacute strokes, CTA provides important information, identifying occlusion, as well as helping define the etiology and inform decisions regarding treatment.

Resumo Objetivo: Avaliar a importância da tomografia computadorizada e angiotomografia computadorizada (ATC) no protocolo de acidente vascular encefálico (AVE) e o seu impacto no tratamento endovascular e na determinação da etiologia. Materiais e Métodos: Foram avaliados 28 pacientes com AVE agudo/hiperagudo da circulação anterior que realizaram ATC intracraniana e cervical, no período de abril de 2018 a agosto de 2019. Os parâmetros avaliados foram grau de estenose, placa, tipo do infarto, tratamento, etiologia e classificação Alberta Stroke Program Early CT Score (ASPECTS). Resultados: A maioria dos casos (16; 57,1%) apresentou ASPECTS de 10. Quatro pacientes (14,3%) realizaram tratamento trombolítico e sete (25%) foram submetidos a trombectomia mecânica. A etiologia foi aterosclerose em 32,1% dos pacientes, doença de pequenas artérias em 7,1%, cardioembólico em 7,1% e indeterminada em 53,6%. Em relação à placa, 17,9% apresentaram estenose maior que 50%, 21,4% apresentaram placas estáveis e 42,9%, placas instáveis. Pacientes com ASPECTS mais baixo apresentavam maior probabilidade de ter estenose relevante e apresentavam maior chance de ocorrência de infarto total. Conclusão: A ATC fornece informações importantes na avaliação do paciente com AVE agudo/hiperagudo, identificando a oclusão e auxiliando na definição da etiologia e no direcionamento do tratamento.

FUNDAMENTO: Alterações cardíacas são muito frequentes nos indivíduos portadores de doença renal crônica terminal e estão associadas com a morbimortalidade. OBJETIVOS: Avaliar as alterações evolutivas cardíacas após o transplante renal. MÉTODOS: Foram avaliados prospectivamente 40 pacientes com doença renal crônica terminal, imediatamente antes e com um mês, três meses e seis meses após o transplante renal, por meio de estudo ecocardiográfico com Doppler tecidual. Os parâmetros de massa ventricular, função sistólica e diastólica foram analisados. RESULTADOS: A média da idade foi 31,6 anos e 40% eram do sexo feminino. Observamos redução do diâmetro diastólico do VE (52,23 para 49,95 mm, p = 0,021) e do índice de massa do VE (131,48 para 113,039 g/m², p = 0,002) após o transplante renal. A razão E/e' média reduziu no terceiro e no sexto meses após o transplante renal em relação ao exame basal (8,13 e 7,85 vs 9,79, p < 0,05). A fração de ejeção aumentou a partir do primeiro mês do transplante renal em relação a exame basal (69,72% vs 65,68%, p < 0,05). A prevalência de disfunção diastólica reduziu 43% no período avaliado. A fração de ejeção e a razão E/e' média basais estiveram associadas com redução do índice de massa do VE após o transplante renal. O índice de massa do VE basal, o sexo feminino e a redução do fósforo sérico apresentaram associação com a redução da razão E/e' média após o transplante renal. CONCLUSÃO: O transplante renal promoveu alterações significativas nos parâmetros ecodopplercardiográficos de massa do VE, função sistólica e função diastólica nos pacientes com doença renal crônica terminal.

BACKGROUND: Cardiac disorders are very common in individuals with chronic kidney disease and are associated with morbimortality. OBJECTIVE: To evaluate cardiac alterations after kidney transplantation. METHODS: We prospectively evaluated 40 patients with chronic kidney disease, immediately before and one month, three months and six months after kidney transplantation, using tissue Doppler echocardiographic study. The left ventricular mass, systolic and diastolic function parameters were analyzed. RESULTS: The mean age was 31.6 years and 40% of patients were female. We observed a reduction in left ventricular diastolic diameter (52.23 to 49.95 mm, p = 0.021) and LV mass index (131.48 to 113.039 g/m2, p = 0.002) after kidney transplantation. The mean E/e' decreased in the third and sixth months after kidney transplantation, when compared to basal values (8.13 and 7.85 vs. 9.79, p <0.05). The ejection fraction increased from the first month after kidney transplantation compared to basal assessment (69.72% vs. 65.68%, p <0.05). The prevalence of diastolic dysfunction decreased 43% during the evaluated period. The basal ejection fraction and mean E/e' were associated with reduced LV mass index after kidney transplantation. The LV mass index at baseline, female sex and decrease in serum phosphorus were associated with a reduction in the mean E/e ' ratio after kidney transplantation. CONCLUSION: Kidney transplantation resulted in significant alterations in Doppler echocardiographic parameters of LV mass, systolic and diastolic function in patients with chronic kidney disease.

Sangramento digestivo é causa comum de internação nos serviços de emergência. Hemorragias originadas de malformações arteriovenosas no estômago foram raramente descritas na literatura. O tratamento por embolização oferece boa chance de controle do sangramento. Descrevemos caso de paciente com hematêmese e melena recorrentes, cuja angiografia identificou malformação arteriovenosa na grande curvatura do estômago. Foi realizado tratamento da hemorragia por meio de embolização arterial.

Gastrointestinal bleeding is a common cause of admission to emergency services. Hemorrhages originated from arteriovenous malformations in the stomach have been rarely described in the literature. Embolization offers a good chance for the control of bleeding. We describe the case of a patient with recurrent hematemesis and melena whose angiography identified arteriovenous malformations in the greater curvature of the stomach. The bleeding was treated by arterial embolization.

INTRODUÇÃO: O tumor sólido-cístico do pâncreas é raro, e teve várias denominações, entre elas "tumor cístico papilar", "tumor cístico sólido", "neoplasia epitelial sólida e papilar". Cerca de 90% dos casos são encontrados em mulheres jovens, medindo entre sete a 20 centímetros de diâmetro, estando 40% deles na cabeça, 32% na cauda e 28% no corpo. RELATO DO CASO: Mulher de 29 anos foi admitida para investigação de fortes e persistentes dores em hipocôndrio direito. Foram realizados ultrassonografia e tomografia computadorizada de abdome, mostrando massa lobulada, com consistência de partes moles na cauda do pâncreas, realce capsular periférico e centro hipovascular medindo 5,5x5,5x5,0 cm. A ressonância magnética definiu melhor, com sinal intermediário em T1 e T2, pequenos focos esparsos de hipossinal em T2 e realce periférico pelo gadolíneo, sugerindo tumor de Frantz. Foi submetida à pancreatectomia caudal e esplenectomia total. Achados anatomopatógicos macroscópicos e microscópicos sugeriram, e o estudo imunoistoquímico confirmou o diagnóstico CONCLUSÃO: Deve-se considerar esta neoplasia no diagnóstico diferencial de massas abdominais em mulheres jovens.

BACKGROUND: The solid-cystic tumor of the pancreas is rare, and had several names, including "papillary cystic tumor," "solid cystic tumor," "solid and papillary epithelial neoplasm." About 90% of cases are found in young women, measuring between seven and 20 cm in diameter, with 40% of them in the head, tail 32% and 28% in the body. CASE REPORT: Woman of 29 years was admitted for investigation of strong and persistent pain in right hypochondrium. It was performed ultrasonography and abdominal computed tomography, showing lobulated mass with the consistency of soft parts in the tail of the pancreas, peripheral capsular enhancement and hypovascular center measuring 5.5x5,5x5,0 cm. MRI better defined, with intermediate signal on T1 and T2, small scattered foci of low signal on T2 and peripheral enhancement by gadolinium, suggesting tumor Frantz. She underwent parcial pancreatectomy and total splenectomy. Macroscopic and microscopic findings suggested, and immunohistochemistry confirmed the diagnosis. CONCLUSION: Should be considered this tumor in the differential diagnosis of abdominal masses in young women.