bluuebunny/crossref_metadata_2025 huggingface dataset:
Dissecção espontânea da artéria carótida em jovem: Um artigo de revisão
Authors: Laden Hammoud Shema El- , Good Gabrielle Gruppelli , Bizetto André Luiz Cristani , Matsubara Anderson
Published: December 2021

Background: Spontaneous dissection of the carotid artery is a significant cause of stroke in young people, and may be the etiology of up to 25% of ischemic strokes in this age group. Understanding the causes and clinical parameters about the disease is essential, since the perception of signs and symptoms that anticipate a cerebrovascular accident is an important prognostic factor. Objectives: Expand knowledge about the clinical and etiological mechanisms of spontaneous carotid dissection, in addition to the possibilities of diagnostic tools, providing an early approach to the disease. Methods: The study was carried out through the selection of scientific articles of systematic review on pathology, published in journals stored in the database of the Scientific Electronic Library Online (SCIELO), PUBMED and Google Scholar website. Results: The pathology is associated with several factors, including systemic arterial hypertension, type II diabetes mellitus, antiphospholipid antibody syndromes, mild cervical trauma and genetic alterations. Acute ipsilateral pain to the neck, associated with unilateral throbbing headache, was the most reported symptom. Conclusions: The perception of symptoms anticipating a cerebrovascular accident is essential to prevent secondary injuries. Although digital angiography is the gold standard test, MRI angiography and color Doppler ultrasound have been increasingly used during the acute phase of spontaneous carotid dissections.
An Eye of a Tiger cannot see all the true: a case series
Authors: Teixeira Igor de Lima e , Trivellato Stella de Angelis , Fonseca Igor Oliveira da , Margato Danielle Patrícia Borges , Bazan Rodrigo , Schelp Arthur Oscar
Published: December 2021

Background: Multiple System Atrophy is a neurodegenerative disease with parkinsonism, cerebelar ataxia and autonomic failure. Neurodegeneration with Brain Iron Accumulation diseases are neurodegenerative diseases, as the Pantothenate Kinase-Associated Neurodegeneration, with a very distinct pattern on neuroimaging, known as the “Eye of the Tiger Sign”, which is rare in MSA but many studies confirm the role of striatal regions iron accumulation in parkinsonisms. Objective: We describe MSA patients with iron accumulation in striatal regions in neuroimaging. Methods: We report clinical cases from São Paulo State University-Brazil. Results: 62-year-old with 5 years of bradykinesia and stiffness progressing to wheelchair, REM sleep behavioral disorder, no improvement with levodopa, disarthrophonia and choking with gastrostomy after 3 years, associated to syncope episodes. Neurological examination showed blood pressure of 105x80mmHg lying down and 80x60mmHg standing up, severe disarthrophonia, anterocapitis, severe parkinsonism, postural instability and ataxia. Neuroimaging showed the “Eye of the Tiger”, “putaminal rim” and the “hot cross bun” signs. 78-year-old with 1.5 years syncope episodes, slow walking, falls, difficulty moving hands and feet and constipation. No improvement with levodopa. Neurological examination showed blood pressure of 130x80 mmHg lying down and 90x60 mmHg standing up, severe bradykinesia and stiffness, drooling, ataxia and “square-wave jerks”. Neuroimaging showed “Eye of Tiger” and bilateral “putaminal rim” signs and cerebellar atrophy. In both cases were excluded all differential diagnosis. Conclusions: Both cases fulfilled criteria for MSA, with the radiological sign of the “Eye of the Tiger”. We emphasize the importance of knowing this variation of MSA to avoid diagnostic confusion.
Effect of DBS on decreasing pain intensity in individuals with PD: a systematic review
Authors: Vieira Gabriela Albertino , Souza Raquel Medeiros de , Assunção Érica Rocha , Figueiredo Laís Soares , Perdigão Natália Rafael , Scalzo Paula Luciana
Published: December 2021

Background: Pain is a common non-motor symptom in Parkinson’s disease (PD), causing impairment in the functionality and quality of life. Objectives: To summarize the effects of deep brain stimulation (DBS) on pain intensity in PD. Design: Systematic review. Methods: A search was conducted using the Pubmed, Scielo, Embase, Lilacs, and Cochrane databases. Keywords were: “Parkinson* AND (“DBS” OR “deep brain stimulation”) AND “pain”. Complete available articles that measured pain intensity before and after DBS were selected. Results: Of the 251 studies, 17 met the criteria. The sample included from 14 to 79 patients (n = 532). The time of surgery was 3 to 96 months. The subthalamic nucleus was the main surgical target. Seventeen and 389 individuals were submitted to unilateral and bilateral implantation, respectively. Globus pallidus was used as a surgical target in three studies. The unilateral implant was performed in 12 patients and the bilateral in 37. Different instruments were used to measure the pain intensity. It declined after surgery in all studies. Conclusion: The results show that pain intensity decreased after DBS, and most studies performed bilateral stimulation in the subthalamic nucleus. This information is important in guiding the therapeutic approach in PD patients with pain. However, the different surgical parameters and instruments used to assess pain limit the summarization of results.
The Impact of Meditation on the Cognitive Functions of Patients with Alzheimer’s Disease
Authors: Rezende Maria Clara Lopes , Moreira Mariana Vanon , Muffato Bárbara Gomes , Dias Yves Henrique Faria , Tubenchlak Ana Luíza Badini , Dutra Milla Giancristofaro , Zanetti Bernardo Valle , Dutra Leonardo Moreira
Published: December 2021

Introduction: Alzheimer’s disease (AD) is the most common form of dementia, which has no cure and, also, effective therapies to prevent or slow the progression of AD remain elusive. Thus, it is necessary to find another way to treat this disease Objective: Investigate the impact of meditation on the cognitive function of patients with AD. Methods: In April 2021, a systematic review was carried out on MEDLINE using the descriptors: “Meditation” and “Alzheimer Disease” and their variations. Studies published in the last 10 years and in English were included. Results: Of the 40 articles found, four are part of this review. It was showed that meditation generates improvements in memory as it increases cerebral blood flow, stabilizes synapses and elevates important neurotransmitters. Aligned, it can improve sleep quality and retrospective memory function. Furthermore, daily practices help in neuropsychological conditions and generate beneficial changes in brain structure and function. Finally, it provokes changes in the brain network, such as the increased power of the theta band, involved in memory processes. Conclusion: The results imply a positive effect of meditation on patients with AD. However, further research is needed to confirm the validity of the results.
Cavernous sinus thrombosis as a serious complication of sphenoid sinusitis in children
Authors: Marques Lícia Apoline Santos , Souza Iago Antunes Macedo de , Farias Luís Gustavo Miranda Cavalcante , Pestana Ellem Silva , Rocha Paula Sabrina Martins Gomes da , Oliveira Júnior Jailson de Sousa , Oliveira Rafaela Machado Dias de , Prado Frederico Maia
Published: December 2021

Introduction:The cavernous sinus is a venous plexus delimited by the dura mater and sited at the base of skull, laterally to the sella turcica and to the sphenoid sinus. The cavernous sinus thrombosis (CST) is a serious illness that may result from infection of any tissue drained by the cavernous sinus (septic thrombosis). Septic thrombosis (ST) may occur through the suppurative process by the level of the orbit, of the upper half of the face or paranasal sinuses , constituting a critical complication of sinusitis. Objectives: To verify the association between cavernous sinus thrombosis and sphenoid sinusitis in children, in the bibliographic productions of the last 10 years. Methods:This is an integrative literature review, with a search carried out in the database of the Medical Literature and Retrieval System onLine (MEDLINE), using a combination of the following Health Sciences Descriptors (DECS): “Sphenoid Sinusitis” and “Thrombosis” And “ Cavernous sinus” in “ Children ”. Incomplete studies were excluded from the research, carried out before 2012, totaling 7 bibliographic studies for detailed analysis. Results:CST can result from infection of any tissue drained from the cavernous sinus. This includes the face, tonsils, soft palate, teeth and ears.Only 15% of cases of CST in patients up to 12 years of age, originated from the paranasal sinuses. However, more recent studies advance that sinusitis is currently the most common etiology. When the sinuses are the cause of CST, the sphenoid sinus emerged as the most common primary source of infection predisposing to CST, since it has important anatomical relationships with the cavernous sinus. Streptococcus has been reported as the most common organism associated with sphenoid sinusitis. Conclusion:Although CTS is a rare clinical condition, acute and persistent sphenoid sinusitis can progress to such a condition, despite medical treatment. The main support of treatment includes early diagnosis, aggressive intravenous antibiotics and appropriate surgical treatment.
Relato de caso: Dissecção Carotídea associada a Síndrome de Eagle
Authors: Aguiar Vinícius de Queiroz , França Gustavo Sales , Abreu Bernardo Costa Berriel , Caixeta Talles Henrique , Dias Alexandre Henrique de Azevedo , Alves Daniela de Paula Paraiso , Marques Juliana de Lena Souza , Almeida Maria Victória Quintas de
Published: December 2021

Context: Eagle syndrome is characterized by the elongation or disfiguration of the styloid process, which leads to a range of clinical manifestations resulting from the structures that are affected by the prolongation of the bone, and the classic presentation is composed of pain and foreign body sensation in the throat, otalgia, and dysphagia. Case report: We describe the case of a 60-year-old man with an ischemic stroke due to dissection of the left internal carotid artery, associated with compression resulting from Eagle syndrome. At clinical presentation, the patient presented right hemiparesis and severe dysphagia, with NIH=18, characterizing the stroke. An angiotomography of the skull and brain was performed, which showed an image compatible with dissection of the left internal carotid artery from the prolongation of the styloid process, characterizing Eagle syndrome stylocarotid syndrome. The patient was submitted to thrombolysis with rt-PA, presenting a partial response, and surgical bone reduction. Patient evolved with partial recovery, with NIH=10, and, at the time of discharge, presented RANKIN 1, symptoms without disabilities. Conclusion: The Eagle syndrome, while it occurs more frequently in women, in general, with the classic presentation, can evolve with a more severe picture, associated with vessel dissection and brain involvement.
Anti -Iglon5 Syndrome: What we know so far? A non-systematic review
Authors: Silva Gustavo Figueiredo da , Silva Caroline Figueiredo da , Medeiros Junior Washigton Luiz Gomes de , Gonçalves Marcus Vinícius Magno
Published: December 2021

Background: The first report of Anti-IgLON5 syndrome was in 2014. AntiIgLON5 antibodies have a prevalence of 12 in 150,000 patients per year. However, considering the unreported patients, the prevalence can be much higher. Objectives: Provide an overview of the current knowledge of Anti- IgLON5 syndrome. Design and setting: Narrative review. Methods: Non- systematic review on Pubmed database. Results: The IgLON proteins are a family of cell adhesion molecules and the presence of antibodies against IgLON5 is crucial for the AntiIgLON5 Syndrome diagnosis. This syndrome has an expanded clinical spectrum that involves prominent sleep disorder, progressive bulbar dysfunction, gait instability with abnormal eye movements reminiscent, and cognitive deterioration sometimes associated with chorea. The main neuropathological finding is the neuronal loss with hyperphosphorylated tau protein accumulation at the hypothalamus, brainstem tegmentum, hippocampus, periaqueductal gray matter, medulla oblongata, and upper cervical cord. The exact pathogenesis is still unclear and involves a neurodegenerative process and autoimmune response. Early diagnosis is important to avoid unnecessary tests and prevent complications. Important resources for diagnosis are the antibody testing of serum and cerebrospinal fluid for IgLON5-IgG. The Anti-IgLON5 syndrome mortality is high and new studies published described a good response to immune therapy, however, depends on some clinical and analytical characteristics. Conclusions: The Anti-Iglon5 syndrome is a pathology still poorly studied and described in the medical literature (only in case series, for example), being a syndrome probably underdiagnosed. Future studies are needed to thoroughly analyze the aspects of pathogenesis and treatment of this important pathological syndrome.
Benefits and Challenges of Cannabis Use in the Treatment of Refractory Epilepsy
Authors: Gabrielli Ângelo , Alves Camila Sousa Bragunce , Bicalho Bruna Oliveira , Alves Débora Pimenta
Published: December 2021

Introduction: Refractory epilepsy (RE) is a disease that causes continuous and debilitating seizures. Due to the ineffectiveness of antiepileptic therapies, there is a growing interest in drugs made with cannabidiol (CBD), a substance extracted from Cannabis. Objective: To point out benefits and challenges of the use of CBD in the treatment of RE. Methods: Literature review performed at PubMed, with the descriptors Epilepsy, Drug Therapy and Cannabis. Results: It is suggested that CBD is mediated by cannabinoid receptors coupled to protein G, by blockade of NMDA receptors, by GABAergic modulation, glutamatergic synapses and / or mechanisms involving noncannabinoid receptors. CBD can also oppose the actions of exogenous and endogenous cannabinoid agonists, due to the negative allosteric modulation. The benefits of CBD are: great therapeutic diversity, safety and tolerability, rare and mild side effects, low risk of drug interactions, and milder cognitive effects, when compared to other antiepileptic drugs. Despite the benefits, CBD has adverse effects such as drowsiness, appetite reduction, diarrhea, increased activity of liver enzymes and interaction with substances metabolized by cytochrome P450. Still, the inefficient regulation generates variation in the composition of the marketed drugs, which can lead to Δ9 - tetrahydrocannabinol (THC) intoxication. Conclusions: Thus, it is essential that the scientific community remains open to investigate the effects of CBD, given the advantages of its use for treating RE.
Epidemiological profile of neurological diseases in Brazil from 2011 to 2020
Authors: Lima Rebeca Menezes de Oliveira , Santos Caio Lopes Pereira , Coutinho Gabriela Malta , Neeser Natalia Guerreiro Costa , Bahia Tauá Vieira
Published: December 2021

Background: Studying the epidemiology of neurological diseases is important to improve the Public System. Objectives: To describe the epidemiological profile of neurological diseases in Brazil between 2011 and 2020. Design and setting: Ecological study in Brazil. Methods: Data was collected from the Ministry of Health, through DATASUS. The period analyzed was between 2011 and 2020. The data collected were region, age, deaths, mortality rate, and average stay due to neurological diseases. Results: 1,833,363 hospitalizations were recorded, with 89,046 deaths. The age group from 50 to 54 years old was the most hospitalized (147,832 cases) and the 80 years and over had the highest mortality rate (14.9). The average stay averages were 13.1 days and the average lethality rates were 4.9. Furthermore, the highest average prevalence of cases per 100,000 inhabitants occurred in the South (142), while the lowest was in the North (49). However, there was a higher mortality rate in the North (6.2) than in the South (4.2). Conclusions: The highest mortality rate in the age of 80 years and over may be associated whit the effects of old age. Moreover, the lowest prevalence of cases and the highest mortality rate in North is possibly related to a deficiency in the diagnosis and treatment of this diseases in that location.
Dyke-Davidoff-Masson Syndrome: A case Report in a patient presenting with drug-resistant epilepsy and pseudoseizures
Authors: Figueiredo Pedro Schmidt dos Reis Matos , Chaves Thiago Oliveira
Published: December 2021

Context: Dyke-Davidoff-Masson (DDM) syndrome is a rare neurological condition, first described in 1933. Characteristics include cerebral hemiatrophy, contralateral hemiparesis, seizures, and cognitive dysfunction, combined into different degrees and patterns. Brain magnetic resonance imaging (MRI) is used to perform diagnosis throughout its specific findings. Case Report: A eighteen-year-old female presented to our service with a history of cognitive dysfunction and seizures since early childhood, which persistence even with adequate use of antiepileptic drugs. During Investigation were found signs and symptoms compatible with DDM syndrome, and evidence of pseudoseizures captured in a video electroencephalography monitoring. Conclusion: DDM syndrome is a rare condition that must be part of differential diagnosis in patients with seizures and cerebral hemiatrophy. Management is based on adequate control of seizures and other comorbidities.
Evaluation of social cognition in post stroke patients: a hemispheric analysis
Authors: Pereira Nayara Karina Ferreira , Galvão Fábio Ricardo de Oliveira , Santos Vaneza Mirele Gomes dos , Cacho Enio Walker Azevedo , Chagas Marcos Hortes Nisihara , Cacho Roberta de Oliveira
Published: December 2021

Introduction: Social cognition is an increasingly explored field of research in the study of post-acquired brain injury psychiatric disorders, encompasses a number of domains including theory of mind (ToM). The ToM refers to the ability to understand, infer emotions, and predict the behavior of others. ToM deficits can impair information processing, and the laterality of the brain injury can influence the level of impairment. Objectives: To investigate whether laterality of the post-stroke hemispheric lesion influences performance on ToM tasks. Methods: Cross-sectional observational study, with chronic post-stroke subjects, aged ≥18 years, without cognitive deficits suggestive by Mini Mental State Examination (MMSE). The volunteers were submitted to a single evaluation using the Theory of Mind Task Battery (ToM TB) in its version translated and adapted to Portuguese (Brazil). The participants were allocated into two groups: group with right hemisphere injury (RHI) and group with left hemisphere injury (LHI). Comparative statistics were performed based on the ToM TB scores between the two groups using Student’s t-test. Results: Thirty-eight participants (RHI=22 and LHI=16) were included. There was no difference between the RHI and LHI group regarding social cognition assessed by ToM TB (t=1.63; p=0.11). Conclusion: The laterality of brain injury appears to not influence the level of performance on ToM tasks in stroke survivors.
Assumed hemorrhagic stroke in a emergency of inland hospital: a case report
Authors: Bozzi Vitor Sossai , Gabriel Débora Cavalini , Vieira Francisco Mateus , Marasca Mateus Alan , Langbecker Priscila Martins , Fussiger Helena
Published: December 2021

Context: Hemorrhagic stroke (HS) is characterized by cerebral vessel´s rupture, causing potentially fatal hemorrhage. Approximately 20% of HS are due to spontaneous intracranial hemorrhage, being risk factors: age over 55, systemic arterial hypertension, smoking, obesity, physical inactivity and alcoholism. Case Report: Male, 84 years old, previously hypertensive, is brought by family members after being found unconscious. He was admitted to hypertensive emergency room, with irregular respiratory rate, anisochoric pupils (mydriasis on the right) non-photoreactive, Glasgow Coma Scale 3 and urinary loss. He was intubated without complications and later developed bradycardia (44 bpm), keeping hypertensive (160/90 mmHg), suggesting Cushing´s Triad (CT). Capillary bloody glucose of 98 mg/dl and laboratory tests showing: hemoglobin 9,3; platelets 184000; negative troponin; urea 52; creatinine 1.7; sodium 136; potassium 3.9. Due to the abrupt installation in a previously hypertensive patient, with unilateral mydriasis on physical examination and the development of CT, the diagnostic hypothesis were HS associated with intracranial hypertension. A skull´s scancomputed tomography or lumbar puncture were not requested because were unavailable at hospital. Patient was removed to a specialized servisse, 12 hours after arrival. Conclusion: Mortality after stroke is known to be substantially lower when patients are treated in high-volume regional centers and have access to qualified interventionists who specialize in neuro-intensive treatment. As it is a servisse without resources for definitive treatment, the patient was stabilized in the best way within the hospital condition, with priority being the removal of the patient as soon as possible, in order to reduce morbidity and mortality
Surgical correction of iatrogenic lesion of the median nerve after endoscopic decompression: Case report
Authors: Rufino Erlan Pércio Lopes , Gomes Eduarda Silvestre Ribeiro da Costa , Gomes Gabriela Silvestre Ribeiro da Costa , Neiva João Guilherme Araújo Magalhães , Albuquerque Maria Eduarda Queiroz de
Published: December 2021

Introduction: Carpal tunnel syndrome is neuropathy of compressive origin, surgical treatment can present complications that are difficult to solve, among them, painful neuromas of the peripheral nerves, affecting 2–60% of patients with nerve damage. There is no consensus on the ideal treatment for painful neuroma. Consequently, numerous modalities to treat neuroma pain are described. Case report: Female, 45 years old, presented with a left hand carpal tunnel syndrome clinic. There is a report of having undergone a surgical procedure for decompression of the carpal tunnel with endoscopy, progressing with worsening of symptoms. Another surgical procedure was performed (conventional open route) in the region of the left wrist with intra-op visualization of total nerve rupture. Neurorrhaphy of the median nerve was performed. Patient came to our service complaining of severe pain (VAS 9/10) in median nerve topography associated with paresis of the muscles innervated by the same. Neuroma resection and sural nerve grafting for the tenar motor branch, ulnar and radial median group and patient evolved with significant pain improvement (VAS of 2/10). Discussion: A wide variety of surgical techniques are described to treat painful neuroma. In this case, the success of the chosen tchnique is evidenced by the drop of 07 points in the VAS. Conclusion: It is evident that the endoscopic correction of carpal tunnel syndrome is not without complications and should be indicated with caution. It is necessary to carry out more studies that can evidence the best conduct for each case.
Neurological and adrenal insufficiency symptons in adult x-linked adrenoleukodystrophy: case report
Authors: Vasconcelos Matheus Felipe de Souza , Oliveira Francisco Tomaz Meneses de , Silva Rafael Zini Moreira da , Daoud Alex Michel
Published: December 2021

Context: X-linked adrenoleukodystrophy (X-ALD) is a rare genetic demyelinating disease caused by mutations in ABC1 gen associated with an impairment of beta- oxidation of very long chain fatty acids (VLCFA) in peroxisomes. It causes accumulation of VCLFA in tissues affecting majoritary the central nervous system, testicles and the adrenal córtex resulting in symptoms which provides restricted neurological prognosis and sequels. Methods: Specific data related of a clinical case through prontuary and complementary exams in a patient attended at Santa Casa de Misericórdia de São Paulo hospital. Case report: Male patient, 39 years old, complaning about vomiting, hyperpigmented skin associated with abolish, psicoses, urinary incontinence, temporal and spacial confusion as well as were found: hyperkalaemia, hyponatremia, hypoglycemia, elevated ACTH levels, basal cortisol decresead, antibody anti-21-hidroxilase non reagente, screening for infectious agents were carried out and infection subsequently ruled out. Were observed in MRI Brain: hypersignal in cerebral white matter on T2-FLAIR sequence bilaterally in which the occipitoparietal region, frontal lobe and basal ganglia were more affected. After metabolic and hydroelectric disorders estabilization using Prednisone, Fludrocortisone per day for 5 days, he evolved with worsening of cognitive and behavioral status until nowdays. Actually, he is totally dependent on his basic activities. Conclusions: It is a rare disease, but it must be recognized by every neurologist, since it is can affect other systems and can leave serious sequelae.
Non-aneurismatic subarachnoidal hemorrahge of hypertensive etiology: case report
Authors: Attuy Mayara Menezes , Yamanaka Lucas Hideo , Azevedo Wylson
Published: December 2021

Context: Subarachnoid hemorrhage (SAH) is a neurological emergency defined by the leakage of blood into the spaces that cover the central nervous system. Non-aneurysmatic SAH is defined according to the blood distribution on computed tomography (CT). Perimensencephalic SAH (PM-SAH) has blood distribution in perimesencephalic cisterns in front of the brain stem. Non- perimesencephalic SAH has a more diffuse distribution. Case report: A 54 years old man with systemic arterial hypertension. He reported that he had consumed alcoholic beverages the night before. On the morning of hospitalization he had a headache with loss of sensation on the left side of his body. In the EC, he presented sweating, left parestesia, mild dyslalia and deviation from the right rhyme. A cranial CT scan was performed revealing SAH involving the cisterns and furrows near the right cerebral hemisphere, next to the Sylvian fissure. The clinical and imaging results demonstrated SAH grade II Hunt & Hess and Fischer II, Glasgow 15, without motor loss. Cerebral angiography, the gold standard for the diagnosis and mapping of aneurysms, was performed, with a negative result. On the last day of hospitalization, CT and Doppler indicated resorption of edema and absence of vasospasm, respectively. There was also an adjustment of the hypertensive medications of the patient who did not have sequelae. Conclusion: PMs-SAH have excelente prognosis in short and long term with no risk of future rebleeds. The event occurred after an episode of excessive alcohol consumption in addition to decompensated arterial hypertension.
Guillain-Barre Syndrome in a patient with SARS-CoV-2 infection: Case Report
Authors: Almeida Louis Fernando Marques de , Albuquerque Déborah Inayara Mendes Tenório de , Borges Érico Induzzi , Schettini Marcele , Soares Neto Herval Ribeiro , Silva Sonia Maria Cesar de Azevedo
Published: December 2021

Introduction: Guillain-Barré syndrome is an acute/subacute set of clinical features of immune mediated polyradiculoneuropathy, typically after respiratory or gastrointestinal viral infection. In this scenario, we described a case of the syndrome mentioned after infection by sars-cov-2 virus. Objectives and Methods: Description of a clinical case after analysis of medical history and complementary exams, in addition to literature review. Design and Setting: Case report, type of descriptive study, developed in the Institute of Medical Assistance to the State Public Servant of São Paulo. Results: A 68-year-old female patient with clinical and laboratory diagnosis of coronavirus infection, hospitalized in need of oxygen supplementation, which evolved after twelve days of symptoms with hypoesthesia on legs and feet and progressively ascending and symmetrical flaccid paraparesis that led to tetraparesis. Neurological examination showed tetraparesis (muscle strength: grade III in MMSS and grade II in MMII), hyporeflexia in MMSS and reflexes abolished in the lower limbs, plantar skin reflex in flexion in both feet, preserved facial mimicry. About complementary tests, it presented cerebrospinal fluid with albuminocytologic dissociation (cell: 1, protein: 89, glucose: 86), RT-PCR for sars-cov-2 research in cerebrospinal fluid, inconclusive, in addition to four-limb electroneuromyography performed after 19 days of onset of neurological condition, indicated polyradiculoneuropathy with involvement of sensory and motor fibers, primarily demyering. Treatment with human immunoglobulin 400 mg/kg/day for 05 days was started. The reported patient was dismissed from the hospital with significant improvement, presenting muscle strength: grade V in MMSS and grade IV in MMII and already with the ability to walk. Conclusions: the case describes a classic neurological complication associated with a virus that was once non-circulating, but currently with a big clinical relevance.
Insular Glioma Surgery: Seven Rules - A case study
Authors: Monteiro Jander Moreira , Marques Victor Matheus Olaves , Mateus Danna Gomes , Andrade Guilherme Pamplona Bueno de , Carvalho Bruna Antunes Martins de , Buffon Viviane , Bark Samir Aler , Dobrowolsky Samuel , Braga Francisco Luiz Souza , Isolan Gustavo Rassier
Published: December 2021

Background: The best treatment for insular gliomas is surgical resection. The surgical treatment complexity of these lesions is due to the anatomy of the insula, and its proximity to functional cortical and subcortical structures, and to vascular structures. Efforts to preserve the integrity of these structures based exclusively on microsurgical anatomy do not guarantee that the patient will not present motor or language deficit in the postoperative period. Objectives: To present seven rules to achieve greater therapeutic success, aiming at increasing disease-free survival and the patient’s quality of life. Methods: Review article based on the senior author experience in insular microsurgical anatomy dissections, and 45 microsurgeries for insular gliomas, performed between 2006 and 2018. Results: There are 4 anatomical rules (fronto-orbital branch of the facial nerve, insular cortex, sylvian fissure and lenticulostriate arteries) and 3 functional rules (cortical mapping, subcortical mapping and internal capsule). Conclusions: Primarily, one must have a great anatomical domain and expertise in neurophysiological monitoring to obtain satisfactory results in the surgery of insular gliomas.
Relation between spirituality/ religiosity and quality of life in the members of the university pastoral project in Tubarão- SC
Authors: Vieira Marcella Beghini Mendes , Leonel Vilson
Published: December 2021

Introduction: It is a growing theme, full of meaning and subjectivism, which increasingly demonstrates an important relationship with the quality of life and with various adaptive functions of the human being, including spirituality as a source of strength and resistance and greater resilience in the face of problems. health or difficult situations. For a broader understanding, it is essential to differentiate between spirituality and religiosity. Spirituality is a personal search for answers to existential questions, whereas religiosity encompasses a relationship, also personal, with God based on the rituals of a religion. Methods: The present work had a total of fifty members of the extension group Pastoral Universitaria linked to Unisul – Tubarão, which includes academics, university employees and members of the local community, religious or not. Results: the results showed a statistically significant difference between the total value of the spirituality questionnaire and the quality of life questionnaire (p= 0,0076), but there was no relationship between these values and the sociodemographic data. It can be seen, therefore, that higher levels of spirituality are closely related to better quality of life rates, when assessed through subjective scales. Conclusion: Therefore, it is possible to observe a strong correlation between spirituality and quality of life in the existing literature, which is no different in this research, therefore, the same alert about the importance of discussing the topic. Bringing it to the fore is a way of bringing faith and science together, fostering studies and increasing one’s interest in life.
Effectiveness of Expressive Therapies in Sleep Disorders in Elderly Hyperfrequent of Primary Health Care
Authors: Grangeiro Adriano Filipe Barreto , Gomes Lucy de Oliveira , Cunha Cristina da Silva , Nóbrega Otávio de Toledo
Published: December 2021

Background: Sleep disorders have multifactorial causes affecting 25 to 30%of the adult population, which can consist of primary or secondary conditions, representing a serious risk to public health. They are risk factors for the elderly population, estimating that 50% of this age group have symptoms related to sleep. Objectives: to verify the efficacy of expressive therapies (ET) in sleep disorders in hyperfrequent elderly (HE) of Primary Health Care (PHC). Methods: Quasi-experimental study, with 69 elderly people assisted at PHC in a metropolitan region of the Midwest, divided into two groups: intervention (hyperfrequent elderly) and control (non-hyperfrequent). The sleep questionnaires were used: Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESE), Insomnia severity index (ISI) and STOP-Bang (SB), in addition to the investigation of sociodemographic and anthropometric variables. and related to health services. For data analysis, chi-square tests, multivariate analysis of variance and Wilks’ Lambda test were used, considering p ≤ 0.05. Results: The intervention group (IG) showed a decrease in the scores of PSQI (p = 0.003), ESE (p = 0.006), ISI (p <0.001), SB (p = 0.002) with significant differences between groups. Conclusions: Expressive therapies were effective in hyperfrequent elderly, mitigating sleep disorders. Thus, by reducing sleep disorders in the group of hyperfrequent elderly people using non-pharmacological intervention in PHC, it is possible to improve sleep quality and, consequently, decrease the use of health services, reducing financial costs for the public health system.
Benefits of Botulinum Toxin type A in post-stroke neurorehabilitation
Authors: Garrido João Guilherme Santos , Oliveira João Gustavo dos Anjos Morais , Reis Luana Brandão de Sales , Moreno Beatriz do Nascimento Garcia , Carmo Junior Ricardo Moreno do
Published: December 2021

Background: Stroke can injure the upper motor neuron, and may develop spasticity, a speed-dependent excessive contraction that makes muscle extension difficult. The botulinum toxin type A make contraction difficult, by inhibiting acetylcholine liberation by the lower motor neuron. Thus, it is hypothesized that the botulinum toxin has benefits in post-stroke spasticity. Objective: To evaluate the benefits of botulinum toxin in post-stroke spasticity. Methods: This is a literature review, which articles were searched via PubMed, with MeSH descriptors, using the formula: (“Botulinum toxin type A”) AND (“stroke”) AND (“spasticity”). Clinical trials, systematics reviews and metanalysis, that used botulinum toxin type A as intervention were included. Results: The search resulted in 16 articles, and 5 were selected. A metanalysis, that included 10 clinical trials, evaluated 950 patients and the botulinum toxin type A in superior limbs spasticity has not shown benefits. Yet, another metanalysis which evaluated 27 clinical trials with 2793 patien ts, with both superior and inferior limbs spasticity, demonstrated improvement in levels of tonicity and deficiency evaluation scales. A prospective cohort whose outcome was based in doctor-patient goals has shown great improvement in mobility (87%), positioning (100%), pain relief and spasms (>80%). A clinical trial has also shown improvement on inferior limb function after 3 months of botulinum toxin use. Conclusions: The botulinum toxin use for improvement in inferior limbs spasticity is well described on the literature. However, its use for superior limbs is still controversial, requiring more studies.
Hospitalizations for meningococcal infection in the southern region of Brazil: epidemiologic characterizations and prevalent serotypes
Authors: Silva Taís Lorrane Mendes , Zava Júlia Maria Orsini , Santos Bruna Chociai dos , Barrena Helenton Cristhian
Published: December 2021

Introduction: Meningococcal disease occurs due to infection by the bacterium Neisseria meningitidis, which is classified according to serogroups. Objective: To survey the profile of hospitalizations and prevalent serogroups of meningococcal infection in the southern region of Brazil. Design and Setting: Is an observational, cross-sectional study using public use data. Methods: The data were taken from the DATASUS, in the year 2020, in states of Paraná (PR), Santa Catarina (SC), and Rio Grande do Sul (RS). Results: In 2020 there were 139 hospitalizations, 76 in RS, 38 in PR and 25 in SC. In RS the most affected age group was 70- 79 years, in PR 60-69 and in SC 30-39. In all states, the male sex had the highest number of hospitalizations. The prevalence of serogroups in RS were B and Y, in PR B and C 1 and in SC, B. The category of ‘’Ignored/Blank’’ stands out in all regions. Conclusion: The highest number of hospitalizations was in RS and in male patients over 30 years old. The large number of serotypes filled in as ignored/blank denotes inadequate data updating, reinforcing the need for regular training for health professionals, so that the filled out data will allow a better configuration of the disease and implementation of public health measures.
Hemorrhagic stroke (ICH): A consequence of thromboembolic events resulting from COVID-19
Authors: Costa Guilherme Albuquerque de Araujo , Regadas Mariana Silva , Sampaio Myrela Murad
Published: December 2021

Introduction: The COVID-19 pandemic has been alarming the world since its first outbreak in December 2019. In this scenario, the presence of aggravating factors such as the elevation of the D-dimer and the reduction of the angiotensin-converting enzyme 2 (ACE2) during the clinical course of the disease, collaborated in the appearance of thromboembolic events derived from inflammatory processes and extensive intravascular coagulation, contributing to the emergence of diseases such as Hemorrhagic Stroke (ICH), leading the patient to have a worse clinical prognosis and a consecutive worsening of their health. Objective: To investigate occurrences of ICH derived from thromboembolic effects resulting from COVID-19. Methods: We selected 43 articles published between 2020 and 2021 on the PubMed platforms, SciELO portal, CAPES Journal and Google Scholar in order to conduct an integrative review within this database. Results: The elevated D-dimer was widely cited as a favorable factor for thromboembolic events due to the influence of excessive inflammatory processes, hypoxia and intravascular dissemination of coagulation, contributing to the development of ICH, given its greater association with disorders such as ischemic strokes, considering only these parameters. However, the reduction in ACE2 and the occurrence of cytokine storms end up causing increased inflammation and blood pressure, increasing the risk of stroke due to the rupture of capillaries sensitized by the action of thromboembolic effects and becoming a risk to the life and prognosis of patients infected with SARS-CoV2, especially in groups of individuals with a greater predisposition to the development of thromboembolic and hypertensive events related to COVID-19.
Is previous infection by EpsteinBarr Virus (EBV) or Cytomegalovirus (CMV) a considerable risk factor for the development of Multiple Sclerosis (MS) in adults?
Authors: Santos Leonardo Mattos , Oliveira João Gustavo dos Anjos Morais , Brandão Gabriela Sarno , Assis Ana Flávia Paiva Bandeira , Purificação Isaac Rêgo , Alves Isabella Trindade Lopes , Cruz Mariana Portella Lopes , Cunha Matheus Almeida Ribeiro da , Fernandes Raimundo Nonato Ribeiro
Published: December 2021

Background and objective: Multiple Sclerosis (MS) is a neurodegenerative, inflammatory and demyelinating disease of the central nervous system. The mechanisms that cause MS are still unknown. However, many variables appear as possible risk factors for the development of this disease. Therefore, this review aims to analyze the prevalence of MS cases in adult patients with a history of previous Epstein-Barr (EBV) or Cytomegalovirus (CMV) infection. Design and settings: This study is a literature review, produced in Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil. Methods: The studies evaluated were observational studies, published from 2016 to 2021, obtained in PubMed, with MeSH terms, published. The studies that did not correspond with the purpose of this review were excluded. Results: The search resulted in 254 articles, of which 60 were selected. In cohort studies, EBV was indicated as a relevant risk factor and CMV was identified as a protective factor. Besides, cross-sectional studies differ in relation to CMV being considered a risk or protection factor, while EBV was pointed out as a risk factor again. However, case-control studies show that there is no association between Epstein-Barr or Cytomegalovirus with the risk of developing Multiple Sclerosis. Conclusion: The evidence is still very uncertain, mainly due to the quality of the studies produced so far. Further studies of better methodological quality are needed to prove whether there is a causal association between these factors.
Quality indicators of a stroke unit in Curitiba (Paraná)
Authors: Tessaro Camila Lorenzini , Rodbard Gabriela Ávila , Brassaroto Marianna Yamila Gomes , Kishi Nathália Mitsue , Conde Ramon Eduardo Szymczak , Ducci Renata Dal-Prá , Lange Marcos Christiano
Published: December 2021

Background: Stroke represents the second leading cause of death and disability in Latin America. Thus, there is a constant need to understand the profile of patients admitted for stroke, as well as to analyze the quality indicators of treatment centers. Objectives: The aim of this study was to analyze the quality indicators of a stroke center in a tertiary service and to determine the epidemiological profile of inpatients. Design and setting: Observational cross- sectional study. Stroke unit from a tertiary center. Methods: The individuals included in the study were those admitted with stroke or TIA in the stroke unit of the Hospital de Clínicas - UFPR from November 2020 to April 2021. The variables and quality indicators were collected through the application of questionnaires in two moments, on admission and hospital discharge. Results: Of the 132 patients included, 53.8% were men, with a mean age of 62.7 years (SD +/- 17.5). Ischemic stroke was the most common type of stroke, accounting for 77.3% of cases. The majority of patients (68.9%) did not receive specific intervention, while 31% underwent intravenous thrombolysis, with a median door-to-needle time of 35 minutes. In 80.4% of the individuals, thrombolysis started in less than 60 minutes. All patients underwent neuroimaging, 87.4% underwent carotid imaging and 77.9% were monitored with Holter. Dysphagia screening was applied in 58.3% of cases. Regarding secondary prevention, 48.1% received antiplatelet drugs and 25.2% received anticoagulants. Conclusions: Intravenous thrombolysis is not performed in most hospitalized patients, however, when performed, it presents an adequate door-to-needle time. Hospitalization in a stroke unit allows a complete etiological investigation and optimization of secondary prevention and rehabilitation.
FDG-PET/CT patterns in patients with autoimmune encephalitis: a series of 9 cases
Authors: Barreto Maria Eduarda Slhessarenko Fraife , Campos Guilherme de Carvalho , Ferrari Bruna Letícia , Dutra Lívia Almeida
Published: December 2021

Background: Autoimmune encephalitis (AIE) is the main differential diagnosis of infectious encephalitis. Brain MRI is normal in up to 50% of cases and studies indicate that changes in FDG-PET/CT are more frequent and early. Objectives: To describe FDG-PET/CT findings in patients with AIE of Hospital Israelita Albert Einstein (HIAE) from 2015-2020. Design and setting: Retrospective cross-sectional study at HIAE. Methods: Medical records of patients with suspected AIE were reviewed. Laboratory results were compiled, and images were reassessed. Results: Amongst 250 records, we found 7.6% (n=19) of AIE, being 8 seropositive (5 anti-NMDA, 1 anti-CASPR2, 1 anti-MOG, 1 anti-VGKC and 1 anti-LGI1), 5 seronegative and 4 limbic encephalitis. The mean age was 48-22 years, 52% male. In encephalitic patients, the most common manifestations were epilepsy (78%), cognitive changes (63%), and behavioral changes (63%). Only 57% had abnormal MRI. We evaluated 23 PET/CTs at different stages of treatment; of the 9 FDG-PET/CTs performed at initial presentation, 88% were abnormal and 30% had normal MRI. Most frequent patterns found were hypometabolism in frontal (59.1%), temporal (39.1%) and left parietal (39.1%) regions. In follow-up, only 2 patients normalized FDG-PET/CT, with clinical improvement. Conclusions:FDG-PET/CT was altered in 88% of patients. In this series, no typical PET/CT pattern was demonstrated for AIE; the most frequent findings were hypometabolism in cortical areas, which also occur in degenerative diseases. We did not find hypermetabolism, or mixed areas of hypo- and hypermetabolism. The specificity of PET/CT for AIE diagnosis should be evaluated in future studies.
Optimalisasi Wawasan dan Keterampilan Berliterasi di Sekolah Guru SMP Negeri 2 Sukodono, Sidoarjo
Authors: Pujiastuti Rahayu , Retnosari Ira Eko , Astuti Sri Budi , Budiyono Sunu Catur
Published: December 2021

Guru harus memiliki pemahaman yang baik tentang literasi agar dapat mengimplementasikan secara nyata, baik dalam pembelajaran maupun di luar pembelajaran. Melalui pemahaman tersebut, guru dapat memfasilitasi para siswa untuk mengembangkan seluruh potensi dan keterampilan yang dimiliki. Berdasarkan observasi diperoleh informasi bahwa pemahaman para guru di SMP Negeri 2 Sukodono, Sidoarjo tentang literasi masih kurang. Padahal, literasi merupakan salah satu konten pembelajaran abad 21. Berdasarkan hal terebut, kegiatan yang dilakukan bertujuan mengoptimalkan wawasan dan keterampilan berliterasi guru di SMP Negeri 2 Sukodono, Sidoarjo. Metode pelaksanaan yang digunakan dalam kegiatan ini berupa pelatihan dan pendampingan. Ada tiga tahap yang dilakukan untuk melaksanakan kegiatan tersebut, yaitu persiapan, pelaksanaan, dan evaluasi. Untuk mengetahui hasil dari pelaksanaan digunakan angket. Hasil kegiatan ini memberi informasi bahwa setelah dilakukan pelatihan dan pendampingan, wawasan dan keterampilan berliterasi di sekolah para guru di SMP Negeri 2 Sukodono, Sidoarjo lebih optimal. Hal tersebut terbukti dari hasil angket tentang wawasan dan keterampilan berliterasi yang memunyai kriteria ‘sangat baik’ dan respon positif dari para guru.