Carlos Eduardo Ferrarez

Medical information regarding patient health is traditionally managed by healthcare professionals, often leaving patients and families in a passive role during the recovery process. To describe and evaluate a family-based functional graphic tool—the Family Observation of Limits and Learning on Well-being (FOLLOW)—designed for the monthly assessment of post-stroke sequelae by nonprofessionals. The tool is a color-coded visual graphic (red for no improvement, yellow for stability, and green for improvement) designed for intuitive understanding without specialized training. It evaluates seven domains: motor independence, sleep patterns, cognition and language, family quality of life, patient quality of life, fatigue, and emotional state. This study included 51 patients and assessed the usability and proficiency evaluation among three groups: family caregivers, healthcare professionals, and poststroke individuals. Significant differences were observed in the proficiency of completing the tool across the groups. Success rates were 94.1% for family caregivers and 100.0% for healthcare professionals, compared with 69.2% for poststroke individuals (p = 0.008). The graphic proved to be easily interpretable for both caregivers and professionals. The functional graphic is an effective tool when completed by family members or caregivers, though it is less reliable when completed by patients themselves. It provides a practical, longitudinal overview of the patient's home environment and clinical needs, while also serving as a complementary monitoring aid that enables early identification of complications and facilitating prompt intervention.

Microsurgical thrombectomy (MST) has been used for many years in few stroke cases without any prospective randomized study, nor detailed systemized technique description. As many centers worldwide are recruited for stroke thrombectomy availability, MST might increase in the near future either as a tertiary or salvage treatment option. A straight forward surgical plan is mandatory empowering a safe, efficient and rapid neurosurgical operation, so our aim is to describe the 2-1-2 microsurgical technique. Three patients presented at emergency department with large stroke not suitable to venous thrombolysis and/or mechanical thrombectomy due to late arrival time and endovascular suite technical problems. They were referred to 2-1-2 MST after imaging showed brain collaterals on head angio CT scan and ASPECTS greater than 6 points. The procedure comprised 2 insulin needle puncture in the target artery, 1mm micro-scissor transverse arteriotomy, milk thrombus removal and 2 simple sutures micro stitches. Sixty days clinical follow up and brain imaging control provided data results. All patients treated with 2-1-2 MST technique had complete thrombus removal by precise surgical maneuvers avoiding surgeons unplanned and insecure movements in order to reduced operation time. Head angio CT scan evidenced complete cerebrovascular circulation re-flow with clinical improvements in 60 days follow up without complications or hospital readmissions. 2-1-2 MST technique can be rapidly and efficaciously performed in a systemized manner offering a tertiary or salvage technique for acute stroke treatment. Specific microsurgical training is mandatory to accomplish this treatment and larger studies are necessary to confirm our hypothesis.

Although fluorescein is widely used for intraoperative angiography, some of its side effects remain obscure. In this report, we present the case of a 41-year-old patient with chronic ischemia caused by moyamoya syndrome who underwent bypass revascularization with intraoperative fluorescein angiography (FA). Immediately after the surgery, the patient presented homogeneous fluorescence of the entire skin. We discuss this curious phenomenon as well as other side effects that may arise due to FA.