bluuebunny/crossref_metadata_2025 huggingface dataset:
Leptomeningeal dissemination of pilocytic astrocytoma at diagnosis in childhood: two cases report
Authors: Figueiredo Eberval Gadelha , Matushita Hamilton , Machado André Guelman G. , Plese José Píndaro P. , Rosemberg Sérgio , Marino Jr Raul
Published: April 2005

Pilocytic astrocytoma (PA) is a benign tumor that rarely spread along the neuraxis. At the moment there are no more than five cases of leptomeningeal dissemination (LD) from PA at diagnosis described in the literature. Different patterns of presentation or recurrence may be noted: local recurrence, malignant transformation, multicentric disease or metastatic disease. LD and multicentric disease can be distinct pathological entities. We report two cases and analyse literature, emphasizing leptomeningeal spread at presentation. Hydrocephalus, biopsy and parcial ressection are likely to be favorable factors to the occurrence of LD. Otherwise, LD may be part of natural history of PA, as evidenced by its ocurrence in non-treated cases.
Hoffman's syndrome: pseudohypertrophic myopathy as initial manifestation of hypothyroidism. Case report
Authors: Vasconcellos Luiz Felipe Rocha , Peixoto Maria Claudia , Oliveira Tatiana Nunes de , Penque Glória , Leite Ana Claudia Celestino
Published: April 2005

The frequency of myopathy in hypothyroidism ranges from 30 to 80%. The major symptoms related are weakness, muscular cramps and myalgia. The pseudohyperthrophic form is called Hoffman's syndrome. The electrophysiological study reveals myopathy, neuropathy or mixed pattern. Laboratorial investigation generally shows increased levels of muscle enzymes and low serum thyroid hormones, with thyrotrophic-stimulating hormone (TSH) elevated. The treatment consists in hormone replacement and the prognosis is good in most of the cases. We report an adult male who developed muscular cramps, myalgia, weakness, pseudohyperthrophy, associated with facial edema and alteration of his voice. The muscle enzymes were increased and T4 was undetectable with a raised level of TSH. The myopathy was the initial manifestation of hypothyroidism in this case.
Disseminated tuberculosis in a pregnant woman presenting with numerous brain tuberculomas: case report
Authors: Gasparetto Emerson L. , Tazoniero Priscilla , Carvalho Neto Arnolfo de
Published: April 2005

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, which has the pulmonary form as the most common presentation. Dissemination of the disease is common in immunocompromised patients, but immunodeficiency related to pregnancy severe enough to cause dissemination of the Mycobacteria is exceedingly rare. When dissemination occurs, any organ may be affected and in central nervous system, the infection presents as meningitis and single brain parenchyma tuberculomas. We report the case of a 17 year-old woman at the 34th week of pregnancy with respiratory and high intracranial pressure symptoms. On the day before admission she had a sudden onset of paraparesis and urinary retention and ten hours after the delivery she presented with paraplegia . The chest X-ray and CT scan were compatible with miliary tuberculosis. The cranial CT scan revealed numerous rounded hypodense lesions located at cerebral and cerebellar hemispheres, which presented ring-like enhancement after contrast injection. The patient underwent a craniotomy with biopsy of the lesions confirming the diagnosis of brain tuberculomas. The three-drug regimen was started and the cranial CT scan performed a year after diagnosis showed no brain lesions. We emphasize the aggressive dissemination of the disease in this case associated with pregnancy and the importance of early diagnosis and institution of therapy resulting in regression of the lesions.
Hemangioma cavernoso intramedular: relato de caso
Authors: Colonetti Juliano , Costa Fernando de Oliveira , Lima André Geraldo Dal Bó , Sanchez Giancarlo Bettin
Published: April 2005

O hemangioma cavernoso intramedular é anomalia vascular de baixo fluxo, curável através de ressecção cirúrgica. Entretanto, se não forem instituídos o diagnóstico precoce e a terapêutica adequada, pode levar à graves sequelas neurológicas. É extremamente raro a ocorrência de um angioma cavernoso intramedular. É relatado o caso de uma paciente de 33 anos, com um angioma cavernoso intramedular no nível de T6 - T7, que apresentava quadro clínico de compressão medular lenta e progressiva, com piora recente importante. A ressonância magnética da coluna torácica demonstrou, entre a sexta e a sétima vértebras dorsais, lesão expansiva intramedular que se apresentava hipointensa em T1 e discretamente hiperintensa em T2, com pequeno halo hipointenso à sua volta nas duas sequências. A paciente foi submetida a tratamento cirúrgico tardio e não apresentou recuperação neurológica. Os achados clínicos, de imagem e a importância de instituir precocemente o tratamento adequado são analisados e discutidos.
Tumor epidermóide intramedular: relato de caso
Authors: Rocha Júnior Marco Antônio , Carvalho Gervásio Teles C. de , Faria Marcelo Penholate , Faglioni Jr. Wilson , Souza Atos Alves de
Published: April 2005

É relatado um caso raro de tumor epidermóide intramedular, estendendo-se entre os níveis da segunda e quarta vértebras torácicas, em uma paciente de 15 anos do sexo feminino, tratado cirurgicamente com sucesso. São discutidos o quadro clínico e a etiopatogenia e é feita breve revisão da literatura.
Coma hiponatrêmico induzido pela oxcarbazepina: relato de caso
Authors: Holanda Maurus Marques de Almeida , Quinino Saul Cavalcanti de Medeiros , Silva José Alberto Gonçalves da
Published: April 2005

Relatamos um caso raro de hiponatremia grave, com evolução para o estado de coma desencadeado pelo uso de oxcarbazepina, após um mês de tratamento em pós-operatório de neurocirurgia. Chamamos a atenção para a importância deste quadro pouco freqüente, bem como enfatizamos o diagnóstico diferencial e a particularidade quanto ao uso desta droga.
Alterações neuropsiquiátricas na doença de Wilson e uso da eletroconvulsoterapia: relato de caso
Authors: Rodrigues Adriano C.T. , Dalgalarrondo Paulo
Published: April 2005

A doença de Wilson (DW) é condição sistêmica decorrente de erro inato do metabolismo, com importantes manifestações neuropsiquiátricas. Estas requerem identificação diagnóstica adequada e intervenções terapêuticas eficazes. Existem, estabelecidos, quatro clusters de sintomas neuropsiquiátricos na DW: distúrbios de comportamento e/ou personalidade, distúrbios do humor, déficit cognitivo e quadros psicóticos. Embora tais pacientes sejam vistos, mais comumente, em clínicas neurológicas e de hepatologia, os profissionais de saúde mental devem manter alto nível de suspeição para DW, já que os quadros iniciais podem se manifestar como síndromes psiquiátricas. Neste artigo é apresentada uma revisão da literatura sobre os aspectos neuropsiquiátricos da doença de Wilson, enfatizando-se as dificuldades diagnósticas. Um homem de 26 de idade DW com apresentação psiquiátrica inicial polimórfica é apresentado. O tratamento deste paciente com a eletroconvulsoterapia é relatado, somando-se esta forma de intervenção terapêutica, neste caso, aos dois únicos existentes na literatura
Proposta de uma versão brasileira para a escala ADCS-CGIC
Authors: Bertolucci Paulo H.F. , Nitrini Ricardo
Published: April 2005

Com o crescente volume de pesquisas sobre novas terapias para as demências, em particular a doença de Alzheimer, tornou-se evidente que a avaliação mais tradicional, centrada nas alterações da cognição, não seria suficiente para detectar algumas das alterações significativas que novos tratamentos podem trazer. Deste modo, foram acrescentadas escalas para avaliar alterações do comportamento e da dependência funcional. Ainda assim, restavam mudanças, percebidas pelos familiares, que poderiam não ser captadas por essas escalas. As escalas de impressão clínica de mudança (CIGIC) baseiam-se nas informações fornecidas pelo informante, no que é observado durante a consulta, e, se necessário, em breves testes de cognição. Apresentamos a versão de uma escala deste tipo, largamente utilizada, desenvolvida para a doença de Alzheimer (ADCS-CIGIC), que foi obtida pelo método recomendado de tradução, retro-tradução e versão final por consenso.
Value of extent of hippocampal resection in the surgical treatment of temporal lobe epilepsy
Authors: Bonilha Leonardo , Kobayashi Eliane , Mattos João Paulo V. , Honorato Donizete C. , Li Li M. , Cendes Fernando
Published: April 2005

OBJECTIVE: Unilateral hippocampal atrophy is indicator of good surgical prognosis in patients with temporal lobe epilepsy (TLE). Some patients however do not become seizure free after surgery. We assessed if the extent of hippocampal and amygdala resection is associated with outcome. METHODS: Thirty patients with TLE with unilateral or clearly asymmetric hippocampal atrophy who underwent surgical treatment were evaluated concerning preoperative clinical variables and interictal EEG abnormalities. Amygdala and hippocampal resection was evaluated by post-operative MRI. We compared seizure free versus non-seizure free patients, and patients with good outcome (Engel's classes I and II) versus patients with poor outcome. RESULTS: There was significant association between the extent of hippocampal resection and the outcome. Pre-operative variables and interictal EEG abnormalities did not show relationship with outcome as documented in previous studies. CONCLUSION: The extent of hippocampal resection is associated with outcome. Incomplete resection of atrophic hippocampus may explain most surgical failures in patients with TLE due to unilateral hippocampal sclerosis.
Experimental therapy of epilepsy with transcranial magnetic stimulation: lack of additional benefit with prolonged treatment
Authors: Brasil-Neto Joaquim P. , Araújo Doralúcia P. de , Teixeira Wagner A. , Araújo Valéria P. , Boechat-Barros Raphael
Published: April 2005

OBJECTIVE: To investigate the effect of three months of low-frequency repetitive transcranial magnetic stimulation (rTMS) treatment in intractable epilepsy. METHODS: Five patients (four males, one female; ages 6 to 50 years), were enrolled in the study; their epilepsy could not be controlled by medical treatment and surgery was not indicated. rTMS was performed twice a week for three months; patients kept records of seizure frequency for an equal period of time before, during, and after rTMS sessions. rTMS was delivered to the vertex with a round coil, at an intensity 5 % below motor threshold. During rTMS sessions, 100 stimuli (five series of 20 stimuli, with one-minute intervals between series) were delivered at a frequency of 0.3 Hz. RESULTS: Mean daily number of seizures (MDNS) decreased in three patients and increased in two during rTMS- one of these was treated for only one month; the best result was achieved in a patient with focal cortical dysplasia (reduction of 43.09 % in MDNS). In the whole patient group, there was a significant (p<0.01) decrease in MDNS of 22.8 %. CONCLUSION: Although prolonged rTMS treatment is safe and moderately decreases MDNS in a group of patients with intractable epilepsy, individual patient responses were mostly subtle and clinical relevance of this method is probably low. Our data suggest, however, that patients with focal cortical lesions may indeed benefit from this novel treatment. Further studies should concentrate on that patient subgroup.
Quantitative electroencephalography (qEEG) to discriminate primary degenerative dementia from major depressive disorder (depression)
Authors: Deslandes Andréa , Veiga Heloisa , Cagy Mauricio , Fiszman Adriana , Piedade Roberto , Ribeiro Pedro
Published: April 2005

Electroencephalography (EEG) can be a valuable technique to assess electrophysiological changes related to dementia. In patients suspected of having dementia, the EEG is often quite informative. The sensitivity of the EEG to detect correlates of psychiatric disorders has been enhanced by means of quantitative methods of analysis (quantitative EEG). Quantitative features are extracted from, at least, 2 minutes of artifact-free, eyes closed, resting EEG, log-transformed to obtain Gaussianity, age-regressed, and Z-transformed relative to population norms (Neurometrics database). Using a subset of quantitative EEG (qEEG) features, forward stepwise discriminant analyses are used to construct classifier functions. Along this vein, the main objective of this experiment is to distinguish profiles of qEEG, which differentiate depressive from demented patients (n = 125). The results showed that demented patients present deviations above the control group in variables associated to slow rhythms: Normed Monopolar Relative Power Theta for Cz and Normed Bipolar Relative Power Theta for Head. On the other hand, the deviation below the control group occurs with the variable associated to alpha rhythm: Normed Monopolar Relative Power Alpha for P3, in dementia. Using this method, the present investigation demonstrated high discriminant accuracy in separating Primary Degenerative Dementia from Major Depressive Disorder (Depression).
Análise da eficácia do metilfenidato usando a versão abreviada do questionário de conners em transtorno de déficit de atenção/hiperatividade
Authors: Andrade Ênio Roberto de , Scheuer Claudia
Published: April 2005

O transtorno de déficit de atenção/hiperatividade (TDAH) é quadro diagnóstico bastante complexo, de início precoce, com evolução crônica que repercute em diversos contextos. Três a 5% das crianças em idade escolar apresentam esse transtorno. O questionário de Conners vem sendo utilizado como instrumento de levantamento epidemiológico para o TDAH. OBJETIVO: Este estudo visa a utilização deste instrumento para a análise da eficácia do tratamento com metilfenidato em crianças com TDAH. MÉTODO: Foram selecionadas 21 crianças do gênero masculino, com TDAH do tipo combinado, idade cronológica entre sete anos completos a 10 anos e 11 meses e todos foram tratados com metilfenidato. A versão abreviada do questionário de Conners para pais e professores foi aplicada em dois momentos: um antes da medicação e outro entre seis a oito meses após o seu início. RESULTADOS: Obteve-se redução na pontuação no questionário de Conners em todas as crianças com TDAH concomitante à melhora clínica. CONCLUSÃO: Observou-se que o questionário de Conners mostrou-se útil não só como auxílio diagnóstico, mas também como um instrumento de avaliação da eficácia do tratamento do TDAH.
Craniotomia sem tricotomia: avaliação de 640 casos
Authors: Dvilevicius Amylcar E. , Machado Silvio , Rêgo José Iram M. do , Santos Daniel Souza , Pietrowski Fábio , Reis Arnaldo Dias
Published: April 2005

A remoção do cabelo para realização de craniotomia utilizada rotineiramente na maioria dos serviços de neurocirurgia para procedimentos cranianos diversos questionada em sua necessidade a partir da avaliação retrospectiva de 640 pacientes submetidos a cirurgias cranianas, em que foi observada uma porcentagem de infecção de ferida cirúrgica de 1,09 %, não superior àquelas com tricotomia revisadas na literatura. Nos 7 casos com infecção, 3 pacientes foram submetidos a derivações liquóricas, 3 pacientes eram vítimas de traumatismo crânio-encefálico e uma paciente substituida a craniotomia para tratamento de tumor cerebral. A técnica para preservação e manuseio do cabelo, suas vantagens e desvantagens são descritas e discutidas.
Atrofia muscular progressiva: estudo clínico e laboratorial em onze pacientes
Authors: Ferraz Maria Elisabeth Matta de Rezende , Zanoteli Edmar , Oliveira Acary Souza Bulle , Gabbai Alberto Alain
Published: April 2005

A atrofia muscular progressiva (AMP) é um tipo raro de doença do neurônio motor (DNM) com acometimento exclusivo do neurônio motor inferior (NMI) e com características clínicas bem definidas. A eletroneuromiografia é o principal exame subsidiário para a realização do diagnóstico, com demonstração de alterações neurogênicas generalizadas, agudas e crônicas. Outras doenças que mimetizam comprometimento do NMI devem ser excluídas através de investigação laboratorial ampla. Neste estudo são apresentados 11 casos de AMP (5,9% de todos os nossos casos de DNM), sendo 9 homens e 2 mulheres. O início dos sintomas ocorreu preferencialmente abaixo dos 50 anos, com média de idade de 45,5 anos. A cãibra foi o sintoma que mais comumente precedeu a fraqueza muscular. Outras queixas preliminares foram dor, fadiga muscular e fasciculações. O padrão mais freqüente de inauguração dos sintomas foi fraqueza muscular assimétrica, preferencialmente nos membros superiores. Com a evolução da doença, todos os pacientes apresentaram comprometimento bulbar. Não foi identificado nenhum fator predisponente para a doença, nem tampouco as evoluções foram distintas entre os casos. Oftalmoparesia e acometimento dos esfíncteres, sinais pouco comuns nas DNMs, foram observados em dois pacientes que se mantiveram por longo tempo em respiração artificial. As terapêuticas imunossupressoras / imunomodulatórias utilizadas (ciclofosfamida, gamaglobulina hiperimune, plasmaferese) não tiveram resultado favorável. A doença teve caráter progressivo em todos os casos. Todos os pacientes faleceram, com tempo médio de sobrevida de 44 meses.
Guillain-Barré syndrome in the course of dengue: case report
Authors: Santos Nilse Querino , Azoubel Ana Cláudia B. , Lopes Antonio Alberto , Costa Gersonita , Bacellar Aroldo
Published: April 2005

This case report describes the findings of a 45-year-old white woman from Brazil, who developed myalgia, fever and macular rash. She was diagnosed as having dengue, based on clinical manifestations and specific IgM titers. One week after the first symptoms of dengue, the patient developed muscle weakness, followed by tetraplegia with areflexia, and respiratory insufficiency. The electromyography had evidence of demyelinating neuropathy and the cerebrospinal fluid showed albuminocytologic dissociation. These neurologic findings were consistent with the diagnosis of Guillain-Barré syndrome. The patient was treated with immunoglobulin and metylprednisolone. Mechanical ventilation was started one week after hospital admission and maintained for four weeks. After six weeks of hospitalization the patient was discharged from the hospital on wheel chair, presenting mild muscle weakness and loss of patellar and ankle reflexes. When the patient was seen at the outpatient service three weeks after hospital discharge she was able to walk with help. This case report suggests a possible association between dengue and Guillain-Barré syndrome.
Neuropatia periférica e miosite na síndrome hipereosinofílica idiopática: relato de caso
Authors: Scola Rosana Herminia , Trentin Ana Paula , Fabiani Giorgio , Mücke Denilson , Werneck Lineu Cesar
Published: April 2005

Descrevemos um caso de síndrome hipereosinofílica idiopática, com manifestações clínicas de neuropatia periférica e sinais de miosite inflamatória. Trata-se de mulher de 20 anos de idade, que apresentou dificuldade progressiva para caminhar com quedas freqüentes e edema de membros inferiores até o nível do joelho, associado a parestesias e cãibras. O exame neurológico revelou hipotonia, arreflexia e redução da força e sensibilidade nos membros inferiores. O exame parasitológico de fezes foi negativo e o hemograma mostrou 24 % de eosinófilos (1848/mm³). Estudo eletrodiagnóstico mostrou comprometimento axonal sensitivo-motor nos nervos dos membros inferiores. A biópsia muscular mostrou discreta reação inflamatória perivascular e intersticial. Tratada com prednisona a paciente apresentou remissão dos sintomas em dois meses.
Chronic subdural hematoma of the posterior fossa associated with cerebellar hemorrhage: report of rare disease with MRI findings
Authors: Costa Jr Leodante B. , Andrade Agustinho de , Valadão Gustavo Fonseca
Published: April 2005

Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case of a 64 year-old woman who suffered a spontaneous cerebellar hemorrhage, treated conservatively, and presented 1 month later with a chronic subdural posterior fossa hematoma.
Angular analysis of corpus callosum in 18 patients with frontonasal dysplasia
Authors: Giffoni Silvyo David Araújo , Gonçalves Vanda Maria Gimenes , Zanardi Verônica A. , Lopes Vera Lúcia Gil da Silva
Published: April 2005

Considering the rarity of the frontonasal dysplasia (FD) and the few reports about it in a large casuistry using magnetic resonance image (MRI), we describe the results of the angular analysis of the corpus callosum of 18 individuals with FD (7 male, 11 female), using an easily-reproductive method. Group I had 12 individuals with isolated form and Group II had 6 individuals with FD syndromic with unknown etiology. The results are presented in set. Comparing with the control group, patients with FD presented alpha angle increase and beta and gamma angles reduction (p<0.05). Alpha and gamma angles express the relationship between the anterior portion of corpus callosum and the floor of 4th ventricle. Considering the embryonary development, these findings would occur secondarily to failure during the development of nasal capsula. Thus, angular anomaly in corpus callosum would be a usual finding, and not fortuitous in patients with FD.
Cognitive dysfunction in children with sleep disorders
Authors: Carvalho Luciane Bizari Coin de , Prado Lucila Bizari Fernandes do , Silva Luciana , Almeida Marilaine Medeiros de , Silva Tatiana Almeida e , Vieira Célia Maria Alcântara Machado , Atallah Álvaro Nagib , Prado Gilmar Fernandes do
Published: April 2005

Sleep is basic for physical and cognitive development and some studies have suggested that there may be an association between sleep disorders (SD) and cognitive dysfunction (CD) in children. Little is known, however, about SD and cognition in 7-10-year-old children, a fact that motivated the present study. METHOD: We applied an SD questionnaire in 1180 children, 547 with SD and 633 without SD (CG), to assess cognition with a screening test (Bender Visual Motor Gestalt Test - BT). RESULTS: We observed a similar frequency of CD in the children with SD (39%) and that ot the CG (40%). The 8-year-old children with SD presented a lower prevalence of CD than the CG (SD=6%, n=6; CG=13%, n=16; p=0.04). CONCLUSION: The frequency of children with CD was equal in the study and control groups when considering the total sample (7- to 10-year-old children). In contrast to our expectations, the SD group of 8-year-old children presented a lower frequency of CD than the control group.
Quality of life of patients with obstructive sleep apnea syndrome treated with an intraoral mandibular repositioner
Authors: Machado Marco Antonio Cardoso , Prado Lucila Bizari Fernandes do , Carvalho Luciane Bizari Coin de , Francisco Silvio , Silva Ademir Baptista da , Atallah Álvaro Nagib , Prado Gilmar Fernandes do
Published: April 2005

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a very important and prevalent disease, which is associated with a poor quality of life in many patients. Treatments for OSAS include surgery, Continuos Positive Air way Pressure, and an intraoral mandibular repositioner (IOMR), but the tendency of sleep centers is to emphasize the apnea index, neglecting quality of life as treatment outcome. OBJECTIVE: To verify to what extent treatment with an IOMR improves the OSAS patient's quality of life. METHOD: Eleven male patients aged 34 to 63 years (mean=49) with mild to moderate OSAS were evaluated using the Calgary SAQLI questionnaire applied before and four weeks after treatment with an IOMR. The mandibular repositioners were manufactured individually for each patient with acrylic polymer and equipped with a retentive device to maintain the mandible in a forward position during sleep. RESULTS: Excellent improvement in the quality of life was observed in five patients (45.5%) and excellent improvement in symptoms in 10 (90.9%). CONCLUSION: The systematic use of the IOMR indicates a clear improvement in the global quality of life as well as in the symptoms of patients with OSAS.
Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients
Authors: Cintra Eliane de Araújo , Maciel Jr Jayme Antunes , Araújo Sebastião , Castro Margaret de , Martins Edna Freitas , Falcão Antônio Luiz Eiras , Sardinha Luiz A.C. , Terzi Renato G.G. , Dragosavac Desanka , Cardoso Ana Paula Devite , Oliveira Rosmari A.R.A.
Published: April 2005

INTRODUCTION: Patients with severe brain lesions (SBL) and brain-dead patients (BD) frequently present with vasopressin (AVP) secretion disorders. OBJECTIVE: To evaluate AVP serum levels in SBL and BD patients. DESIGN: Prospective, open label, observational trial. SETTING: A general teaching hospital. METHOD: Three groups of adult subjects (age> 18y) of both sexes were included in this study: control group: 29 healthy volunteers; SBL group: 17 patients with Glasgow Coma Scale (GCS)< 8; and BD group: 11 brain-dead patients. Samples of venous blood were collected in the morning at rest from healthy volunteers and at 8 hourly intervals over a period of 24h from SBL and BD patients for AVP determinations. Concomitantly, some clinical and laboratorial variables were also recorded. RESULTS: AVP serum levels (pg/ml) were [mean (SD); median]: control [2.2(1.1); 2.0]; SBL [5.7(6.3); 2.9]; and BD [2.6(1.0); 2.8]. AVP serum levels varied greatly in SBL patients, but without statistically significant difference in relation to the other groups (p=0.06). Hypotension (p=0.02), hypernatremia (p=0.0001), serum hyperosmolarity (p=0.0001) and urinary hypoosmolarity (p=0.003) were outstanding in BD patients when compared with SBL. CONCLUSIONS: The AVP serum levels did not demonstrate significant statistical difference between the groups, only showing a greater variability in SBL patients (manifested as serum spike levels). Hypernatremia and hyperosmolarity were present in BD patients, indicating a failure of the hypothalamic-pituitary system in AVP production and release.
Plasma lipoprotein(a) levels: a comparison between diabetic and non-diabetic patients with acute ischemic stroke
Authors: Holanda Maurus Marques de Almeida , Filizola Rosália Gouveia , Costa Maria José de Carvalho , Andrade Rodrigo Vasconcelos C.L. de , Silva José Alberto Gonçalves da
Published: April 2005

OBJECTIVE: The aim of this study was to evaluate lipoprotein(a) (Lp(a)), total cholesterol, high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), very low density lipoprotein cholesterol (VLDL ), triglycerides , apolipoprotein A (apo A) and B100 (apo B100), uric acid, glycaemic and insulin plasmatic concentrations in patients affected by acute stroke. In this group of patients, we have compared the variables between type 2 diabetic patients and non-diabetic patients. METHOD: We evaluate a total of 34 non-diabetic patients (22 males and 12 females; mean age 66.71 ± 10.83 years) and a group of 26 type 2 diabetic patients (15 males and 11 females; mean age 66.35 ± 9.92 years) in a cross-sectional study. RESULTS: Mean Lp(a) concentration did not significantly differ between type 2 diabetic patients and non-diabetic subjects (29.49 ± 23.09 vs 44.81 ± 44.34 mg/dl). The distribution of Lp(a)levels was highly skewed towards the higher levels in both groups, being over 30 mg/dl in 50%. Lp(a) concentration was positively correlated with abdominal adiposity, using waist-hip ratio(WHR)(p< 0.05). No association was found between Lp(a) and others risk factors like sex, age, other lipidic parameters and the presence of stroke. CONCLUSIONS: Our results showed that there were no significant differences between diabetic and non-diabetic patients' serum Lp(a) levels, which indicates that elevated Lp(a) levels were associated with ischemic stroke, irrespective of the presence of type 2 diabetes mellitus (type 2 DM).
Results of the treatment of syringomyelia associated with Chiari malformation: analysis of 60 cases
Authors: Arruda José Arnaldo Motta de , Costa Carlos Maurício de Castro , Tella Jr Oswaldo Inácio de
Published: April 2005

We analyze the results of surgical treatment of 60 patients presenting syringomyelia (SM) associated with Chiari malformation (CM) who were operated in the period 1982-2000. For each case, analysis covered 15 signs and 16 symptoms included in a protocol that separated SM signs and symptoms from those of CM. A score system was established in parallel with the protocol to make the evaluation of treatment results easier. All cases were submitted to craniovertebral decompression by C1 and eventually C2 laminectomy and cerebellar tonsillectomy with duramater graft. To evaluate the results, statistical proportion difference tests and variance analyses were made to a reliability index of 95% (p=0.05). We conclude that the statistical improvement of CM signs and symptoms was very significant (p=0). Syringomyelia signs and symptoms also improved significantly, except for "upper limb hyporeflexia" , which did not improve. No statistical difference in the improvement of SM symptoms as compared to CM symptom was found. Syringomyelia signs improved statistically more than CM signs. In half of patients, the percent improvement of signs and symptoms ranged between 40% and 60%.
Padronização normal das fibras nervosas intraepidérmicas em 30 voluntários saudáveis com PGP 9,5
Authors: Moura Luciana , Oliveira Acary Souza Bulle , Zanoteli Edmar , Cardoso Ricardo , Schmidt Beny , Gabbai Alberto Alain
Published: April 2005

O recente método de avaliação das fibras nervosas intraepidérmicas com o PGP 9,5 vem se mostrando de grande utilidade no diagnóstico das neuropatias sensitivas de fibras finas, autonômicas e neuropatias periféricas subclínicas. Devido à variação da técnica relatada na literatura é de fundamental importância uma padronização normal. Estudamos 15 homens e 15 mulheres com média de idade de 34,5 anos. Em todos os voluntários foi realizada biopsia de pele na porção distal da perna. A média da densidade linear das fibras nervosas intraepidérmicas foi 5,3/mm com mediana de 6,0 e desvio padrão de 1,94. Essa técnica possui um grande número de vantagens em relação à biopsia de nervo convencional, é simples, pouco invasiva, reproduzível e pode ser repetida no mesmo paciente para avaliar progressão da neuropatia e possíveis respostas terapêuticas.
Análise comparativa de cortes de encéfalos humanos com coloração por três técnicas diferentes
Authors: Meneses Murilo Sousa de , Montano Pedroso Juan Carlos , Fuzza Rúbia Fátima , Milano Jerônimo Buzetti
Published: April 2005

O estudo anatômico do encéfalo em cortes é facilitado empregando-se métodos de coloração para substância cinzenta. Os métodos mais freqüentemente empregados são os de Barnard, Robert e Brown, Mulligan e Green. O objetivo deste estudo foi determinar qual dessas técnicas apresenta melhores resultados com relação à diferenciação entre substâncias branca e cinzenta. Trinta cortes coronais de hemisfério cerebral humano foram submetidos às três técnicas, comparados entre si e analisados de acordo com três parâmetros estabelecidos: grau de diferenciação entre as substâncias branca e cinzenta; presença de linha única e contínua separando a substância branca do córtex cerebral; grau de impregnação da coloração em outros locais de substância branca. Atribuíram-se pontuações de 0 a 3 conforme a presença destes parâmetros, cada corte recebendo pontuação total que variava de 0 a 9. Após análise estatística, a técnica de Barnard, Robert e Brown apresentou média 8,33; a de Green 7,93 e a de Mulligan, 7,5, com diferença estatisticamente significativa.
Avaliação do funcionamento psicossocial na esclerose múltipla: características psicométricas de quatro medidas de auto-relato
Authors: Haase Vitor Geraldi , Lacerda Shirley Silva , Lima Eduardo de Paula , Corrêa Tatiana de Deus , Brito Daniela Cristina Sampaio de , Lana-Peixoto Marco Aurélio
Published: April 2005

A depressão maior e a subsindrômica são altamente prevalentes na esclerose múltipla (EM). A avaliação do funcionamento psicossocial requer instrumentos psicométricos validados. As medidas de auto-relato oferecem várias vantagens, mas não existe um questionário preciso e válido para diagnosticar os sintomas depressivos na EM. O Inventário de Depressão de Beck (IDB) e o Questionário de Saúde Geral (QSG) foram validados e são amplamente usados no contexto neuropsicológico brasileiro. No IDB sintomas de EM podem ser interpretados como sintomas de depressão. Nós examinamos as propriedades psicométricas do IDB, QSG e dois questionários de auto-relato para fadiga (CPF-MS) e auto-eficácia (MSSE) na EM. Todas as escalas apresentaram exceletentes coeficientes de consistência interna.O IDB e o QSG discriminaram a amostra de EM de um grupo controle. Intercorrelações significativas foram observadas entre os escores nas diversas escalas de auto-relato, mas não entre estas e indicadores tradicionais de déficit neurológico (IA e EDSS). Os sintomas depressivos e a fadiga podem representar uma dimensão de comprometimento neurológica distinta dos déficits físicos e sensoriais. Questionários de auto-relato podem ser úteis no diagnóstico de depressão e sofrimento psíquico, mesmo quando estes não atingem níveis sindrômicos compatíveis com um diagnóstico categorial.
Método para avaliação da conduta visual de lactentes
Authors: Gagliardo Heloisa G.R. Gardon , Gonçalves Vanda M. Gimenes , Lima Maria Cecília Marconi Pinheiro
Published: April 2005

O objetivo deste estudo é apresentar um método para avaliação de funções visuais em lactentes no primeiro trimestre de vida. Utilizou-se o Roteiro de Avaliação da Conduta Visual em Lactentes, modificado de Gagliardo (1997). O material foi aro suspenso por cordão. Realizou-se estudo piloto com 33 lactentes, segundo os critérios de inclusão: neonatos assintomáticos, sem necessidade de cuidados especiais nas primeiras 48 horas; idade cronológica variando entre 1 e 3 meses; avaliação mensal sem nenhuma falta; procedência da região de Campinas/SP. No 1º mês destacaram-se as provas: fixação visual-93,9%; contato de olho-90,9%; seguimento visual horizontal-72,7% e exploração visual do ambiente-97,0%. No 3º mês: exploração visual da mão-42,4% e aumento da movimentação de braços-36,4%. Este Roteiro permitiu observar a função visual segundo a idade cronológica; desvio dessa função possibilitará pronto encaminhamento a serviços médicos para diagnóstico.
Tratamento cirúrgico dos aneurismas não rotos da artéria cerebral média
Authors: Faleiro Luiz Carlos Mendes , Pimenta Newton José Godoy , Faleiro Rodrigo Moreira , Costa Rodrigo Antônio , Esmeraldo Augusto César
Published: April 2005

Descrevemos nossa experiência no tratamento microcirúrgico de 34 pacientes portadores de aneurismas não rotos da artéria cerebral média. Houve prevalência no sexo masculino. Oitenta e três por cento dos aneurismas apresentava tamanho menor que 10 mm. Não houve óbito na presente série, com morbidade de 3% após 1 ano. Indicamos, portanto, microcirurgia como tratamento de escolha para os aneurismas não rotos da artéria cerebral média.
Anastomose arterial extra-intracraniana para tratamento de paciente com isquemia cerebral refratária ao manejo clínico
Authors: Falavigna Asdrubal , Ferraz Fernando Antonio Patriani , Breunig Juliano de Avelar , Michelin Marja Mandelli
Published: April 2005

A anastomose extra-intracraniana pode ser utilizada em casos selecionados de insuficiência vascular encefálica refratária ao tratamento clínico. Descrevemos um caso de isquemia encefálica em território de artéria cerebral média direita devida à oclusão da artéria carótida interna homolateral com conseqüente redução da perfusão e reserva vascular nos hemisférios frontal e parietal. Apesar do tratamento clínico, a melhora do déficit motor estava relacionada diretamente com a manutenção de níveis tensionais sistêmicos elevados pelo uso de vasopressor. Após anastomose extra-intracraniana término-lateral entre as artérias temporal superficial e cerebral média direita, houve melhora significativa da perfusão cerebral com remissão do déficit motor.
Teratoma sacrococcígeo: relato de três casos
Authors: Falavigna Asdrubal , Gandara Carlos , Ferraz Fernando Antonio Patriani , Saciloto Bruno
Published: April 2005

Os tumores de células germinativas são derivados da célula germinativa primordial de localização gonadal ou extragonadal. O teratoma é um dos seus constituintes, cuja localização extragonadal mais comum é a região sacrococcígea, independente da sua classificação histopatológica em benignos ou malignos. Descrevemos três casos de teratomas sacrococcígeos e enfatizamos aspectos do diagnóstico, técnica cirúrgica e manejo complementar.
Carotid transient ischemic attacks presenting as limb-shaking syndrome: report of two cases
Authors: Kowacs Pedro A. , Troiano André R. , Mendonça Célio Teixeira , Teive Hélio A.G. , Werneck Lineu C.
Published: April 2005

Limb shaking syndrome (LSS) is a rare presentation of transient ischemic attacks (TIAs), usually secondary to a critical carotid stenosis compromising intracranial circulation, first described 40 years ago. Two additional cases are described herein, aiming to add on to previous descriptions, and to warn physicians about this potentially harming and rather uncommon condition.
Whipple's disease with neurological manifestions: case report
Authors: França Jr Marcondes C. , Castro Rafael de , Balthazar Márcio Luiz F. , Malveira George Linard S. , Pirani Jr Clodoaldo , Deus-Silva Leonardo , Paz Alexandre R. da , Queiroz Luciano S. , Damasceno Benito P.
Published: April 2005

Whipple's disease (WD) is an uncommon multisystem condition caused by the bacillus Tropheryma whipplei. Central nervous system involvement is a classical feature of the disease observed in 20 to 40% of the patients. We report the case of a 62 yeards old man with WD that developed neurological manifestations during its course, and discuss the most usual signs and symptoms focusing on recent diagnostic criteria and novel treatment regimens.
Primary melanoma of Meckel's cave: case report
Authors: Falavigna Asdrubal , Borba Luis A. B. , Ferraz Fernando Antonio Patriani , Almeida Giovana Camargo de , Krindges Júnior José Valentim
Published: April 2005

We present a case of trigeminal neuralgia with cranial normal magnetic resonance image (MRI) and computed tomography. The pain was not relieved by carbamazepine and microvascular decompression surgery was done. After two months the pain was similar to the condition before surgery. At this time, MRI showed an expansive lesion in Meckel's cave that was treated with radical resection by extra-dural approach. The pathologic examination revealed a primary melanoma. The follow-up after six months did not show abnormalities.
Angioma cavernoso intramedular: relato de caso
Authors: Pedreira Adriana Vieira , Silva Cleonice Isabela Santos , Freitas Francine Judite , Barbosa Verônica Aline , Machado Jr Marcos Alberto da Costa
Published: April 2005

Relatamos um caso de angioma cavernoso em uma paciente de 56 anos, diagnosticado após investigação de lombociatalgia decorrente de protrusão discal, com RM que evidenciou além de sinais de protrusão discal, uma imagem com heterogeneidade de sinal, traduzindo componente hemático em diversas fases de degradação da hemoglobina, no interior da medula terminal. A RM é mais sensível que a TC, e a técnica mais apropriada é a seqüência gradiente-eco. O diagnóstico desta entidade é importante pela possibilidade de déficit neurológico súbito decorrente de sangramentos e também pela associação com angiomas cavernosos cranianos.
Desenvolvimento da versão brasileira da Multiple Sclerosis Funcional Composite Measure (MSFC-BCTRIMS): estudo piloto
Authors: Haase Vitor Geraldi , Lima Eduardo de Paula , Lacerda Shirley Silva , Lana-Peixoto Marco Aurélio
Published: April 2005

São relatados os esforços inicias para desenvolver e validar uma versão brasileira da Multiple Sclerosis Funcional Composite Measure (MFSC-BCTRIMS), uma medida de êxito em esclerose múltipla (EM) que avalia a função motora dos membros inferiores, dos membros superiores e cognitiva. A MSFC foi introduzida com o intuito de se constituir em uma medida sensível aos benefícios terapêuticos de novos fármacos modificadores do curso da doença e com características psicométricas aperfeiçoadas em relação a medidas tradicionais. Os resultados do estudo-piloto indicam que a MSFC-BCTRIMS discrimina entre portadores de EM e um grupo controle. Quanto à validade de construto, as intercorrelações com outras medidas sugerem que a velocidade de processamento é uma importante componente para a avaliação da função motora das mãos e da função cogntiva.
Effects of galantamine on attention and memory in Alzheimer's disease measured by computerized neuropsychological tests: results of the Brazilian Multi-Center Galantamine Study (GAL-BRA-01)
Authors: Caramelli Paulo , Chaves Márcia L.F. , Engelhardt Eliasz , Machado João Carlos B. , Schultz Rodrigo R. , Vale Francisco A.C. , Charchat-Fichman Helenice
Published: April 2005

OBJECTIVE: To investigate the effects of galantamine on the performance of patients with mild to moderate Alzheimer's disease (AD) in a computerized neuropsychological test battery (CNTB). METHOD: Thirty-three patients with probable AD were treated with galantamine for three months and evaluated in a prospective, open-label, multi-center study. The CNTB and the ADAS-Cog were administered at baseline and after 12 weeks. The CNTB includes reaction time tests to evaluate attention, implicit and episodic memory for faces and words. Statistical comparisons were performed between the results in week 12 versus baseline. Patients who did not reach the therapeutic doses were excluded from the efficacy analysis. RESULTS: Four patients (12.1%) were excluded from the analysis either because of treatment discontinuation (n=3) or because a therapeutic dose was not reached (n=1). The remaining 29 patients were treated with doses of 24 mg/day (n=22) and 16 mg/day (n=7). After 12 weeks, significant reductions in reaction time were seen in the test of episodic memory for faces (p=0.023) and in the test of two-choice reaction time (p=0.039) of the CNTB. CONCLUSION: Treatment with galantamine produced improvement in computerized tests of attention and episodic memory after 12 weeks, leading to statistically significant reduction in the reaction times.
Clonidine in respiratory panic disorder subtype
Authors: Valença Alexandre M. , Nardi Antonio E. , Mezzasalma Marco A. , Nascimento Isabella , Lopes Fabiana L. , Zin Walter A. , Versiani Marcio
Published: April 2005

OBJECTIVE: Clonidine, which inhibits locus coeruleus discharge, would seem for theoretical reasons to be a good antipanic drug. Panic disorder (PD) presents a heterogeneous cluster of symptoms and a classification based on subtypes has been suggested and the respiratory symptoms group appears as a distinct subtype. METHOD: We report three cases of respiratory PD patients who were successfully treated with clonidine. RESULTS: Patients obtained panic free status, reduced anxiety levels and better functioning after clonidine administration (0.30-0.45 mg/day) for 6 weeks. CONCLUSION: Clonidine can be effective in the treatment of respiratory PD. This drug might play a role in relieving symptoms of anxiety due to noradrenergic hyperactivity in these patients.
Neurological morbidity in vaccine-associated paralytic poliomyelitis in Brazil from 1989 up to 1995
Authors: Dias-Tosta Elza , Kückelhaus Carlos Santos
Published: April 2005

We collected 30 cases of vaccine associated paralytic poliomyelitis (VAPP) from 4081 cases of acute flaccid palsies cases notified from 1989 to 1995 to the Brazilian Ministry of Health. There were 30 VAPP cases with 56% of children younger than 1 year old, 56.7% of female. 46% of cases were reported in the Northeast. Ten P2 vaccine virus, 8 P3 and 2 P1 and associations amongst them were isolated. The clinical pattern in 60 days was: monoplegia (16), paraplegia (6), tetraplegia (5), hemiplegia (2) and triplegia (1). There was no strong relationship between fever, before or after the prodrome period, or the use of intramuscular medication to morbidity. CONCLUSION: if the anti-poliomyelitis strategy adopted in Brazil has lead to the eradication of the poliomyelitis with wild virus infection, the existence of a minimum risk of vaccine-associated poliomyelitis is a matter of concern because there will be a permanent neurological deficit.
Sequelae from meningococcal meningitis in children: a critical analysis of dexamethasone therapy
Authors: Casella Erasmo Barbante , Cypel Saul , Osmo André Alexandre , Okay Yassuhiko , Lefèvre Beatriz Helena , Lichtig Ida , Marques-Dias Maria Joaquina
Published: April 2005

OBJECTIVE: To evaluate the effectiveness of dexamethasone as an adjunctive therapy to antibiotics in children with meningococcal meningitis. METHOD: A total of 81 children diagnosed with meningococcal meningitis hospitalized in sequence were studied at the University Hospital of São Paulo University, with the objective of evaluating the presence of sequelae in four different groups of patients, following the administration of dexamethasone: Group I - 25 patients who received the first dose at least 10 minutes before the introduction of the antibiotic therapy; Group II - 19 patients who received the corticosteroid concomitantly; Group III - 14 patients for which the dexamethasone was administered after beginning the antibiotic scheme; Group IV - 23 patients that did not receive dexamethasone. The groups were evaluated for homogeneity through the prognostic indexes and clinical and laboratory characteristics, based on the records obtained at hospitalization. RESULTS: Some degree of sequelae occurred in 16 (26.22%) of the survivors and 23 patients (28.39%) coursed with sequelae or died. The mean period of neurological attendance was 36.97 months and neurological alterations were detected in 16.17% of the patients. No significant difference was found between the four groups. There was also no statistical difference in the comparison of the neurological sequelae in the children from group IV with the children of groups I and II or even with groups I, II and III analyzed as a whole. The presence of hearing loss occurred in 11.11% of the patients, again there was no significant difference between the four groups. Psychological evaluation was performed using the WPSSI and WISC tests. A mild mental disability was detected in one patient from group I and another in group III. The overall analysis of the sequelae (neurological, auditory and intellectual level) also did not demonstrate any significant difference between the four groups. Comparing the children from groups I and II together and also groups I, II and III as a whole with the children in group IV also failed to detect a significant difference arising from the use or nonuse of the corticosteroid. CONCLUSION: Dexamethasone was not proven to be effective in decreasing the number of sequelae among patients with meningococcal meningitis.
The pattern of proton magnetic resonance spectroscopy in non-neoplastic encephalic lesions
Authors: Faria Andréia V. , Reis Fabiano , Zanardi Verônica A. , Menezes José R. , Cendes Fernando
Published: April 2005

The purpose of this article is show the role of proton magnetic resonance spectroscopy (MRS), associated with magnetic resonance images, in the study of non-neoplastic disorders, helping in diagnosis and better characterization of the nature of the lesion. Herein, we analyzed single voxel proton spectroscopy in eight different non-neoplastic lesions, displayed in six categories (infectious, ischaemic, demyelinating, inflammatory, malformation of development and phacomatosis). The presence or the ratios of signal intensities brain tissue metabolites observed with this technique (N-acetyl aspartate, choline, creatine, lactate and lipids) helped in their differentiation with neoplastic lesions and helped in correct diagnosis. In infectious diseases, signals of acetate, succinate and aminoacids were also important. In conclusion, proton MRS is a noninvasive method, very useful as an additional technique to define the nature of non-neoplastic encephalic lesions.