bluuebunny/crossref_metadata_2025 huggingface dataset:
Bizarre behavior during intracarotid sodium amytal testing (Wada test): are they predictable?
Authors: Paola Luciano de , Mäder Maria Joana , Germiniani Francisco M.B. , Coral Patrícia , Zavala Jorge A.A. , Watzo Djon J. , Kanegusuku Jorge , Silvado Carlos E.S. , Werneck Lineu C.
Published: April 2005

The intracarotid sodium amytal test (ISAT or Wada Test) is a commonly performed procedure in the evaluation of patients with clinically refractory epilepsy candidates to epilepsy surgery. Its goal is to promote selective and temporary interruption of hemispheric functioning, seeking to define language lateralization and risk for memory compromise following surgery. Behavioral modification is expected during the procedure. Even though it may last several minutes, in most cases it is subtle and easily manageable. We report a series of patients in whom those reactions were unusually bizarre, including agitation and aggression. Apart of the obvious technical difficulties (patients required physical restraining) those behaviors potentially promote testing delay or abortion and more importantly, inaccurate data. We reviewed those cases, seeking for features that might have predicted their occurrence. Overall, reactions are rare, seen in less than 5% of the ISAT procedures. The barbiturate effect, patients' psychiatric profiles, hemisphere dominance or selectiveness of the injection were not validated as predictors. Thorough explanation, repetition and simulation may be of help in lessening the risk of those reactions.
Potencial evocado somato-sensitivo em crianças com pontas evocadas por estímulo somato-sensitivo no eletrencefalograma
Authors: Tedrus Gloria M.A.S. , Fonseca Lineu Corrêa
Published: April 2005

Estudamos as características dos componentes corticais do potencial evocado somato-sensitivo (PES) de 31 crianças com pontas evocadas ao EEG (PE), das quais 20 com epilepsias benignas da infância (EBIPE) e 11 crianças sem epilepsia (PENE). Os dados foram comparados com um grupo de 20 "crianças normais". A amplitude do N60 e N75 foi maior nos grupos EBIPE e PENE em relação ao grupo normal. O P98 mostrou amplitude significantemente maior no grupo PENE do que no grupo normal. O achado de PES de amplitudes elevadas (N75 e P98) foi maior no grupo de crianças com PE do que no grupo normal. O exato mecanismo envolvido na gênese da PE e de componentes corticais com amplitudes elevadas não está esclarecido. Um provável mecanismo seria a hiperexcitabilidade cortical focal, de natureza funcional, não lesional. Não foi observada diferença nos componentes dos PES nas crianças com PE segundo a ocorrência ou não de epilepsia.
Eletrencefalograma quatitativo em crianças com epilepsia benigna da infância com pontas centrotemporais: análise de freqüências
Authors: Fonseca Lineu C. , Tedrus Glória M.A.S. , Chiodi Marcelo G. , Cerqueira Jaciara Näf , Duran Marcos Henrique Coelho
Published: April 2005

Abordaram-se parâmetros quantitativos do eletrencefalograma em crianças com epilepsia benigna da infância com pontas centrotemporais (EBICT). Foram estudadas 27 crianças com diagnósticos de EBICT. Foi realizado o eletrecenfalograma durante vigília, em repouso, e selecionadas cerca de 20 janelas com 2,56 s. Foram calculados os valores de potência absoluta e relativa nas faixas delta, teta, alfa e beta. Os resultados foram comparados aos de 27 crianças sadias pareadas quanto a idade e escolaridade materna. A potência absoluta foi significativamente maior no grupo EBICT nas nas bandas delta e teta para a quase totalidade dos eletrodos e para alguns eletrodos nas faixas alfa e beta. A potência relativa teta foi também maior no grupo EBICT na maioria dos eletrodos. Esses achados sugerem que na EBICT, embora a atividade epileptiforme seja focal. Ocorrem modificações funcionais difusas que incluem alterações do perfil da distribuição das faixas de frequência, com maior potência relativa teta.
Funções executivas em crianças fenilcetonúricas: variações em relação ao nível de fenilalanina
Authors: Malloy-Diniz Leandro Fernandes , Cardoso-Martins Cláudia , Carneiro Karina Cunha , Cerqueira Márcia Maria Magrille , Ferreira Ana Paula Almeida , Aguiar Marcos José B. de , Starling Ana Lúcia
Published: April 2005

Este estudo investiga a hipótese de um déficit específico das funções executivas em crianças com fenilcetonúria (PKU) cujo nível de fenilalanina encontra-se entre 360 e 600 mmol/l. Participaram do estudo 21 crianças fenilcetonúricas de nove meses de idade, tratadas precoce e continuamente, e 18 crianças normais de mesma idade. As crianças com PKU foram divididas em dois grupos em função do nível médio de fenilalanina antes do estudo: o grupo de crianças cujo nível encontrava-se entre 120 e 360 mmol/l e o grupo de crianças cujo nível encontrava-se entre 360 e 600 mmol/l. Embora os três grupos de crianças tenham apresentado desempenho semelhante em um teste que avalia o desenvolvimento mental global, as crianças com alto nível de fenilalanina apresentaram desempenho significativamente pior do que as demais crianças em um teste que avalia as funções executivas.
Evolução de 58 fetos com meningomielocele e o potencial de reparo intra-útero
Authors: Sbragia Lourenço , Machado Isabela Nelly , Rojas Carlos Eduardo Braidos , Zambelli Helder , Miranda Márcio Lopes , Bianchi Maria Otília , Barini Ricardo
Published: April 2005

INTRODUÇÃO: O diagnóstico pré natal da meningomielocele (MM) permite melhor planejamento de sua abordagem e, mais recentemente , um possível reparo intra-útero. OBJETIVO: Descrição da evolução perinatal de fetos com MM, acompanhados em um centro de referência em Medicina Fetal, identificando os possíveis fetos candidatos à cirurgia intra-uterina. MÉTODO: Análise retrospectiva descritiva de 58 casos de MM fetal, atendidos no CAISM-UNICAMP, de janeiro de 1997 a dezembro de 2001, identificando-se os casos cuja indicação de cirurgia fetal seria possível. RESULTADOS: Média da idade gestacional ao diagnóstico de 29 semanas (17-39); nível da lesão acima da região sacral em 85%; associação com hidrocefalia em 86%; taxa de complicações cirúrgicas de 39%. Na evolução, 98% apresentaram bexiga neurogênica e 60% deficiência neuro-mental. O potencial reparo intra-útero foi de 42%. CONCLUSÃO: MM está associada a graves e frequentes sequelas. Quase um terço dos nossos casos poderiam ter tido a cirurgia fetal como opção terapêutica.
Disfagia como complicação da cirurgia da coluna cervical via anterior
Authors: Falavigna Asdrubal , Righesso Neto Orlando , Ferraz Fernando Antonio Patriani , Martinato Geraldo , Riegel Rafael Ernesto
Published: April 2005

A disfagia é uma das complicações pós-operatórias da cirurgia cervical anterior. Apesar de freqüente, foram publicados poucos estudos sobre o assunto. Sua incidência e duração variam conforme o autor. Realizamos um estudo prospectivo, no qual são analisadas a incidência, a duração e a qualidade da disfagia nas cirurgias da coluna cervical pela via anterior.
Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência
Authors: Schelp Arthur Oscar , Cola Paula Cristina , Gatto Ana Rita , Silva Roberta Gonçalves da , Carvalho Lídia Raquel de
Published: April 2005

A doença vascular encefálica (AVE) é a principal causa de morte no Brasil. As seqüelas em indivíduos pós-acidente vascular encefálico incluem distúrbios motores, distúrbios de fala ou de linguagem e distúrbios de deglutição. A disfagia orofaríngea ocorre em cerca de 50% dos pacientes com AVE. Este estudo teve por objetivo determinar a incidência da disfagia após AVE. Foram avaliados todos os pacientes que deram entrada em hospital universitário de referência no período de um ano, tão logo apresentassem condições para avaliação clínica, fonoaudiológica e neurológica (102 pacientes), com análise objetiva da deglutição (61 pacientes). Foi observada incidência de disfagia em 76,5% dos pacientes avaliados clinicamente, este percentual elevando-se a 91% com avaliação videofluoroscópica. A alta incidência de disfagia observada neste estudo que avaliou pacientes com amplo espectro de gravidade, em diferentes fases de recuperação, ressalta a importância de equipe multidisciplinar, incluindo fonoaudiólogos capacitados, para avaliar os distúrbios da deglutição nos diversos momentos de recuperação dos AVEs.
Glioma supratentorial de baixo grau em adulto: experiência com 23 pacientes operados
Authors: Lynch José Carlos , Câmera Lygia , Escosteguy Claudia , Kislanov Sara , Pereira Celestino , Berteli Juliano
Published: April 2005

Os astrocitomas e oligodendrogliomas supratentoriais dos adultos são tumores infrequentes. Analisamos retrospectivamente 23 pacientes com este tipo de neoplasia que foram operados entre 1986 e 2002. Não ocorreu nenhum óbito no pós-operatório. A sobrevida de 5 e 10 anos de todo o grupo foi 67 e 30% respectivamente, semelhante a outras experiências. Em 14 pacientes obtivemos a remoção completa da lesão (60,8%) e em 9 (39,2%) ocorreu remoção parcial do tumor. No subgrupo da ressecção total do tumor, 89% sobreviveram 5 anos e 45% alcançaram 10 anos de sobrevida, em contraste com o subgrupo da remoção parcial em que somente 35% alcançaram os 5 anos de sobrevida e nenhum, 10 anos. Devido aos efeitos deletérios da radioterapia, nós preferimos prescrevê-la apenas nos casos de recorrência tumoral.
Tratamento agudo da crise de enxaqueca refratária na emergência: estudo comparativo entre dexametasona e haloperidol. Resultados preliminares
Authors: Monzillo Paulo H. , Nemoto Patricia H. , Costa Agnaldo R. , Sanvito Wilson L.
Published: April 2005

O objetivo principal deste estudo foi avaliar a resposta clínica em duas horas de dois medicamentos intravenosos (dexametasona e haloperidol) no tratamento da crise de enxaqueca refratária na emergência da Santa Casa de São Paulo. Foi também observada a presença de efeitos colaterais de ambas medicações. Avaliamos 29 pacientes, diagnosticados como portadores de enxaqueca (com e sem aura), segundo os critérios da International Headache Society. Todos referiam escore 10 de dor (escala analógica), antes do tratamento com um ou outro medicamento. Todos pacientes haviam recebido previamente dipirona (1g) intravenosa e aguardado 60 minutos, sem qualquer resposta clínica. O grupo 1 (14 pacientes) recebeu haloperidol 5 mg e o grupo 2 (15 pacientes) recebeu dexametasona 4 mg, ambas diluídas em 10 ml de água destilada. A avaliação de melhora clínica foi realizada a intervalos regulares (30, 60,90 e 120 minutos). Ambas as drogas mostraram-se igualmente eficazes no alívio da dor, após 2 horas. Entretanto o grupo 1 obteve alívio superior a 50% nos escores de dor já a partir de 30 minutos da infusão. Após 90 minutos, 100% dos pacientes estavam sem dor. Reações adversas foram observadas somente no grupo 1, não sendo importantes.
Cerebellar hemorrhage as a complication of temporal lobectomy for refractory medial temporal epilepsy: report of three cases
Authors: Paola Luciano de , Troiano André R. , Germiniani Francisco M.B. , Coral Patrícia , Della Coletta Marcus V. , Silvado Carlos E.S. , Moro Marlus , Araújo João Cândido de , Mäder Maria Joana , Werneck Lineu C.
Published: April 2005

Cerebellar hemorrhage is listed among the potential complications following neurosurgical pro ce dures. In this scenario it is usually reported as a rare condition. However, it seems that epilepsy surgery pa tients are somewhat more prone to this kind of complication, compared to other surgical groups. Head po si tioning, excessive cerebral spinal fluid draining and the excision of non-expanding encephalic tissue (or combinations among the three) are likely to be cause underlying remote cerebellar hemorrhage. Out of the 118 ATL/AH performed at our institution, between 1996 and 2002, we identified 3 (2.5%) patients pre sen ting with cerebellar hemorrhage. We report on such cases and review the literature on the topic.
Ventricular arteriovenous malformation bleeding: a rare cause of headache in children. Case report
Authors: Silva Hilton Mariano da , Silva Luciano Ricardo França da , Paschoal Eric Homero Albuquerque , Chaddad Neto Feres Eduardo Aparecido , Bordini Carlos Alberto , Speciali José Geraldo
Published: April 2005

Headache as a chief complaint is rare in the paediatric emergency room. Actually, very seldom cases secondary to life threatening conditions as non-traumatic subarachnoid haemorrhage have been reported. A child with severe headache and nuchal rigidity and no other abnormalities on the physical examination is reported. Magnetic resonance angiography and cerebral angiography disclosed a ventricular arteriovenous malformation in the choroid plexus, supplied by the anterior choroidal artery, classified according to Spetzler grading system as grade 3 (deep venous drainage: 1; eloquence area: 0 and size: 2). The differences in the clinical presentations of the central nervous system arteriovenous malformation between children and adults are discussed.
Isolated superficial peroneal nerve lesion in pure neural leprosy: case report
Authors: Freitas Marcos R.G. de , Nascimento Osvaldo J.M. , Freitas Marcela R. de , Hahn Myrian D.
Published: April 2005

Patients with leprosy may have only nerve involvement without skin changes. These cases are known as pure neural leprosy and can be seen in 10% of leprosy patients. Most patients have mononeuritic or multiple mononeuritic neuropathy patterns. The isolated lesion of the superficial peroneal nerve is uncommonly seen. We report a patient with involvement of this nerve in which there was no thickening of superficial nerves. The performed nerve biopsy showed inflammatory infiltration, loss of fibers and presence of Mycobacterium leprae. We believe that in prevalent leprosy countries we should take in mind the possibility of isolated pure neural leprosy in some patients without skin lesion. In these cases the diagnosis of leprosy is impossible on clinical grounds and nerve biopsy is mandatory.
Simvastatin-induced mononeuropathy multiplex: case report
Authors: Scola Rosana H. , Trentin Ana P. , Germiniani Francisco M.B. , Piovesan Élcio J. , Werneck Lineu C.
Published: April 2005

The association between the use of statins and neuromuscular disease is currently being intensely discussed. We relate a 63 years old man with possible case of statin-induced neuropathy in a patient with dislipidemia in use of simvastatina at high doses. The electrophysiologic studies disclosed findings compatible with mononeuropathy multiplex, suggested by clinical prescutation of asymmetrical numbness and weakness. More common causes of mononeuropathy multiplex were excluded and the patient improved after the discontinuation of the drug.
Progressive encephalomyelitis with rigidity: a paraneoplastic presentation of oat cell carcinoma of the lung. Case report
Authors: Spitz Mariana , Ferraz Henrique Ballalai , Barsottini Orlando G. P. , Gabbai Alberto Alain
Published: April 2005

Progressive encephalomyelitis with rigidity and myoclonus (PEWR) is a rare neurological disorder, characterised by muscular rigidity, painful spasms, myoclonus, and evidence of brain stem and spinal cord involvement. A 73-year-old white man was admitted with a 10-day history of painful muscle spasms and continuous muscle rigidity on his left lower limb. He had involuntary spasms on his legs and developed encephalopathy with cranial nerves signs and long tract spinal cord symptomatology. Brain CT scan and spinal MRI were normal. The CSF showed lymphocytic pleocytosis and no other abnormalities. EMG showed involuntary muscle activity with 2-6 seconds of duration, interval of 30-50 ms and a frequency of 2/second in the left lower limb. Anti-GAD antibodies were detected in the blood. We detected radiological signs of lung cancer during the follow-up, which proved to be an oat cell carcinoma. The patient died two weeks after the diagnosis of the cancer.
Leucoencefalopatia multifocal progressiva confirmada por PCR para vírus JC no líquor: relato de caso
Authors: Pasqualotto Alessandro Comarú , Mattos Alice J.Z. de , Rocha Marineide Melo
Published: April 2005

Relatamos um caso de leucoencefalopatia multifocal progressiva, doença infecciosa desmielinizante do sistema nervoso central, seguido de revisão da literatura. Comenta-se a importância diagnóstica dos métodos de imagem, bem como da análise do líquor e da técnica de reação em cadeia da polimerase (PCR). Até o presente momento, não há terapia efetiva para a condição, com sobrevida média de 1-6 meses nos pacientes não tratados; evolução favorável pode ocorrer no subgrupo de pacientes que obtém melhora da imunidade com o uso de terapia anti-retroviral.
Angeíte isolada do sistema nervoso central em paciente com síndrome mielodisplásica: relato de caso
Authors: Silva Gisele Sampaio , Siqueira Neto José Ibiapina , Frota Norberto Anísio Ferreira , Martins Gabriela Joca , Castro José Daniel Vieira de
Published: April 2005

As angeítes isoladas do sistema nervoso central (SNC) são vasculites de pequenos e grandes vasos de etiologia indeterminada que acometem exclusivamente a vasculatura do sistema nervoso. Geralmente não estão associadas a doenças pré-existentes. Relatamos caso de angeíte isolada de SNC em um paciente com diagnóstico hematológico de síndrome mielodisplásica.
Príncipe Liev Nikoláievitch Míchkin ("O Idiota", Fiódor Dostoevsky) e a síndrome de personalidade interictal na epilepsia do lobo temporal
Authors: Souza Leonardo Cruz de , Mendes Mirian Fabíola Studart Gurgel
Published: April 2005

A obra do romancista russo Fiódor Dostoevsky (1821-1881), além de seu extraordinário valor literário, reveste-se de importância especial para neurologistas e epileptologistas. O escritor, que era portador da enfermidade, transmitiu através de seus textos o universo do epiléptico e a maneira como esse é percebido pela sociedade. Seus livros tiveram grande influência na maneira como a cultura ocidental percebe a doença. O romance "O Idiota" tem como protagonista o Príncipe Liev Nikoláievitch Míchkin, um epiléptico com personalidade marcante. Considerando a proposta feita por Geschwind-Waxman (1975) de síndrome de personalidade interictal na epilepsia do lobo temporal, este artigo pretende discutir as alterações comportamentais no paciente epiléptico a partir de Míchkin, personagem principal de "O Idiota", de Fiódor Dostoevsky.
Hyperphosphorylated tau protein in the cerebrospinal fluid of patients with Alzheimer's disease and other dementias: preliminary findings
Authors: Hartmann Ana Paula Barbosa Jeronimo , Almeida Sérgio Monteiro de , Livramento José Antonio , Nitrini Ricardo , Takahashi Daniel , Caramelli Paulo
Published: April 2005

Alzheimer's disease (AD) is pathologically characterized by the accumulation of amyloid plaques and tau-associated neurofibrillary tangles in the cerebral tissue. The search for antemortem biomarkers is intense including analysis of cerebrospinal fluid (CSF) beta-amyloid and tau proteins concentrations seeking for an accurate and early diagnosis. Levels of hyperphosphorylated tau at threonine 181 were measured in the CSF of 34 patients with AD (19 with senile AD - SAD and eight with presenile AD - PSAD) and seven with other dementias (OD). The levels of CSF phosphotau were significantly higher in the AD patients compared to OD (AUC 0.812), with no association with severity of dementia, age of onset, duration of the disease or scores in the Mini-Mental State Examination. There were no differences of phosphotau levels between SAD and PSAD patients. These findings corroborate some previous studies and indicate that CSF phosphotau may help to differentiate AD from other dementias.
Taenia antigens detection in the cerebrospinal fluid of patients with neurocysticercosis and its relationship with clinical activity of the disease
Authors: Abraham Ronaldo , Pardini Alessandra Xavier , Vaz Adelaide José , Livramento José Antonio , Machado Luís dos Ramos
Published: April 2005

OBJECTIVE: (1) To determine the concentration of Taenia antigens in the cerebrospinal fluid (CSF) of patients with neurocysticercosis (NC); (2) to establish its relationship with clinical activity of the disease and with classical variables of CSF. METHOD: A CSF examination was performed in one sample from 36 patients with definitive diagnosis of NC, including: quantitative and cytomorphological study, biochemical tests, immunological reactions for cysticercosis and Taenia antigens. The antibodies for antigens detection were obtained from the larval form of Taenia crassiceps, ORF strain. After intraperitoneal passage through female mice, a group of rabbits was immunized with vesicular fluid antigens. RESULTS: The Taenia antigen was detected in CSF from 17 patients (47.2%), especially in those patients with epileptic symptoms in the last 12 months. CONCLUSION: Taenia antigens presence in CSF have significant relationship with clinically active forms of NC, being a more sensitive marker than the classic eosinophil presence.
Assessment of the epilepsy treatment gap in two cities of south-east of Brazil
Authors: Noronha Ana Lúcia Andrade , Marques Lúcia Helena , Borges Moacir Alves , Cendes Fernando , Guerreiro Carlos Alberto Mantovani , Li Li Min
Published: April 2005

OBJECTIVE: To assess the epilepsy treatment gap in Campinas and São José do Rio Preto, two cities in the State of São Paulo, Brazil. METHOD: The treatment gap was estimated using the formula n1-n2/n1x100, where n1 was calculated using 1.86% prevalence and represented the number of individuals with epilepsy, while n2 represented the number of people who could be treated with an adult standard dose for a year utilizing the antiepileptic drugs supplied by the public health system. RESULTS: Our estimates revealed that in 2001, approximately 50% of the population with epilepsy was treated with the recommended antiepileptic medication. CONCLUSION: These results suggest that a relevant percentage of patients with epilepsy are not untreated. Further epidemiological studies are needed to investigate the reasons for this treatment gap so that interventions can reduce this gap and improve the quality of life of patients with epilepsy.
Analysis of the prevalence of insomnia in the adult population of São José do Rio Preto, Brazil
Authors: Marchi Nely Silvia Aragão de , Reimão Rubens , Tognola Waldir Antonio , Cordeiro José Antonio
Published: April 2005

OBJECTIVE: To establish the prevalence of insomnia in the adult urban population of São José do Rio Preto, Brazil and correlate it with the demographic data. METHOD: We evaluated 1105 individuals in to guarantee an error margin of 3% and a confidence level of 95% using a structured questionnaire and following the DSM-IV and DSM-III-R criteria, in the period from January 10 to February 28 2001. RESULTS: We encountered a prevalence of 32% of insomnia, which was most commonly seen in women, single people, from the lower economical brackets, with a low level of schooling and it was less associated with younger adults (18-31 year-olds). CONCLUSION: Our findings indicate that the prevalence of insomnia in the adult population of São José do Rio Preto is comparable with other countries such as the USA and those of Europe and also with other cities in Brazil.
Effect of episodic tension-type headache on the health-related quality of life in employees of a Brazilian public hospital
Authors: Silva Jr Hilton Mariano , Garbelini Roberta P. , Teixeira Simone O. , Bordini Carlos A. , Speciali José G.
Published: April 2005

OBJECTIVE: To evaluate the impact of ETTH on HRQoL in a sample of employees of a Brazilian public hospital. METHOD: Three hundred and sixty Mário Gatti Hospital employees were asked about headache occurrence in the previous 6 months and completed a SF-36 and a pain questionnaires concerning impact of pain (0 to 10 scale) on daily activities, work efficiency, leisure and social activities in previous six months. Two groups were studied: 1. Episodic Tension-type headache group: 127 employees - 81 (63.8%) female and 46 (36.2%), male. 2. Control group: 124, 71 (57.3%) female and 53 (42.7%) male. RESULTS: ETTH had lowers scores than control in all domains of SF-36; in vitality and bodily pain the difference was statistically significant. CONCLUSION: Our results indicate that ETTH suffers have impact on HRQoL predominantly in vitality. Psychological factors associated to pain may explain this finding.
Depression and migraine
Authors: Galego José Carlos Busto , Cipullo José Paulo , Cordeiro José Antonio , Tognola Waldir Antonio
Published: April 2005

The objective of this study was to evaluate both the presence and intensity of depressive symptoms in patients with episodic migraine (EM) and transformed migraine (TM) or chronic migraine, comparing them with a control group. Beck Depression Inventory (BDI) was used for this purpose. The median of BDI score of the control group was significantly lower than the EM and TM groups (p<0.0005). Either the EM or the TM did not show any significant difference in relation to the median of BDI scores (p=0.12). The TM group showed a higher frequency of severe depression when analyzed qualitatively by dependence analysis. Symptoms of severe depression by means of qualitative analysis may strengthen a co-morbidity between depression and transformed migraine. This association might be considered rather a factor of TM perpetuation than a risk factor for the transformation of EM into TM.
A longitudial study of a neuropsychological rehabilitation program in Alzheimer's disease
Authors: Abrisqueta-Gomez Jacqueline , Canali Fabiola , Vieira Vera L.D. , Aguiar Ana Cristina P. , Ponce Carmen S.C. , Brucki Sonia M. , Bueno Orlando F.A.
Published: April 2005

Our aim was to study the duration of benefits derived from a neuropsychological rehabilitation program (NRP) for dementia patients. METHOD: The participants in this study were three patients diagnosed as probable Alzheimer's disease in the initial-to-moderate phase; the three were taking anticholinesterases. They were submitted to a neuropsychological evaluation (NE) before the NRP and then revaluated after 12 and 24 months of treatment. The aim of our intervention was to do practical work with implicit and explicit residual memory by training them in everyday life activities, and using compensatory strategies and their intact cognitive abilities. RESULTS: Analysis of quantitative NE data (descriptive measures) after the first year of NRP showed cognitive improvement, functional stabilization and fewer behavioral problems. However, this improvement did not continue in the second year, and the disease maintained its characteristic progression.
Cerebral tuberculomas in AIDS patients: a forgotten diagnosis?
Authors: Vidal José E. , Hernández Adrián V. , Oliveira Augusto C. Penalva de , Souza Alexandre de Leite , Madalosso Geraldine , Silva Paula R. Marques da , Dauar R.
Published: April 2005

The human immunodeficiency virus (HIV) infection epidemics increased the prevalence, multi-drug resistance and disseminated forms of tuberculosis. The central nervous system (CNS) tuberculosis has high mortality and morbidity, and it is usually divided into diffuse (meningitis) and localized (tuberculoma and abscess) forms. We report three cases of cerebral tuberculomas in AIDS patients: one with definitive diagnosis, confirmed with histopathology, and two with probable diagnosis, based on clinical information, radiological images, Mycobaterium tuberculosis isolation out of the CNS and adequate response to antituberculous treatment. Further, we discuss diagnostic, therapeutic and prognostic issues of tuberculomas, with emphasis in the distinction from cerebral tuberculous abscesses. Despite of their infrequent presentation, tuberculomas should be considered in the differential diagnosis of cerebral expansive lesions in patients with AIDS.
Auditory hypersensitivity in children and teenagers with autistic spectrum disorder
Authors: Gomes Erissandra , Rotta Newra T. , Pedroso Fleming S. , Sleifer Pricila , Danesi Marlene C.
Published: April 2005

OBJECTIVE: To verify if the clinical behavior of auditory hypersensitivity, reported in interviews with parents/caregivers and therapists/teachers of 46 children and teenagers suffering from autistic spectrum disorder, correspond to audiological findings. METHOD: The clinical diagnosis for auditory hypersensitivity was investigated by means of an interview. Subsequently, a test of the acoustic stapedial reflex was conducted, and responses to intense acoustic stimulus in open field were observed. RESULTS: Of the 46 subjects, 11 (23.9%) were clinically diagnosed as oversensitive to sound and only 2 showed discomfort when exposed to intense acoustic stimulus in open field. There was no statistically significant difference for the test of the ipsilateral acoustic stapedial reflex between the groups. CONCLUSION: Behavioral manifestations to sounds are not associated to hypersensitivity of the auditory pathways, but instead these are associated to difficulties in the upper processing, involving systems that usually are impaired in autistic spectrum patients, such as the limbic system.
Clinical presentation, treatment and outcome of patients with cerebral metastases: the University of São Paulo series
Authors: Andrade Fernanda , Aguiar Paulo Henrique , Fontes Ricardo Bragança de Vasconcellos , Nakagawa Edison , Teixeira Joel Augusto , Miura Flavio Key , Lepski Guilherme , Marie Suely Kazue Nagahashi , Marino Jr Raul
Published: April 2005

INTRODUCTION: Secondary neoplasias are the most common tumors affecting the central nervous system and several clinical aspects of this disease are still controversial. METHOD: Forty-seven consecutive patients with the diagnosis of cerebral metastases (CM) were retrospectively studied at the Clinical Hospital of São Paulo University Medical School. Mean age was 53.9 years and 25 patients were female. RESULTS: The most frequent primary sites were breast, lung and skin. Symptoms were related to increased intracranial pressure (ICP) in 48.9%, focal neurological events in 27.7% and both in 17.0%. Single brain metastases were found in 57.4% of those cases, the frontal lobe being most frequently affected. Surgical treatment was performed in 68.1%, radiotherapy in 40.4% and chemotherapy in 17.0%. CONCLUSION: After statistical analysis, there was a trend towards prolonged survival of female patients, patients with ICP symptoms and the surgical group. Data from different centers are essential to establish the best management of CM.
Surgical management of cerebrospinal fluid rhinorrhea under endoscopic control
Authors: Landeiro José Alberto , Flores Marlo S. , Lázaro Bruno C.R. , Melo Maria Helena
Published: April 2005

The surgical management of cerebrospinal fluid (CSF) rhinorrhea has changed after the introduction of functional endoscopic sinus surgery.The following three cases illustrate the repair of CSF leaks with the use of rigid endoscope. Two patients had the diagnosis and the site confirmed after intrathecal fluoresceine saline injection. The obliteration of the CSF was achieved with fat free, mucoperichondrial or mucoperiostal free grafts taken from middle or inferior turbinate and kept in place by fibrin glue. Primary closure was achieved in all patients. The repair of the CSF rhinorrhea by endonasal endoscopic surgery is safe, effective and is a valid alternative to the cranial approach.
Reflexo pudendo-anal em mulheres normais
Authors: Cavalcanti Geraldo de Aguiar , Manzano Gilberto Mastrocola , Bruschini Homero , Giuliano Lydia Maria , Srougi Miguel , Nóbrega João Antônio Maciel
Published: April 2005

São descritas observações do registro do reflexo pudendo-anal em mulheres sem queixas de incontinência urinária. Foram estudadas 31 voluntárias adultas, com estimulação elétrica bilateral e independente do clitóris e registros de superfície em ambos os lados do músculo esfíncter externo do ânus (EEA). As respostas foram obtidas com pulsos duplos de 0,2 ms de duração e intervalos de 5 ms, aplicados a uma freqüência menor que 0,5 Hz. Foram medidas as latências iniciais das respostas. Não foram evidenciadas diferenças entre as respostas obtidas de cada lado do EEA e nem entre os lados, com relação aos estímulos. Uma das voluntárias não apresentou respostas após estimulação de um dos lados. Não foram observadas diferenças relacionadas a paridade total e nem com a presença de partos vaginais. A idade e o índice de massa corpórea não se correlacionaram com as respostas. Em 12% das respostas, a medida das latências foi dificultada pela baixa relação sinal-ruído.
Alterações cognitivas em escolares de classe socio-econômica desfavorecida: resultados de intervenção psicopedagógica
Authors: Macedo Célia Sperandéo , Andreucci Lívia Christina , Montelli Terezinha de Cresci Braga
Published: April 2005

O objetivo deste estudo é analisar o resultado de intervenções psicopedagógicas no desempenho intelectual e em algumas funções cognitivas específicas em crianças provenientes de famílias de baixa renda, expostas a fatores pessoais e sociais adversos, como desnutrição, stress familiar, ambientes doméstico e de estimulação empobrecidos. Foram examinadas 63 crianças, alunas de escola, gratuita e em regime de semi-internato, que recebe crianças consideradas sob risco pessoal e social. Quarenta e três crianças receberam atividades que objetivam ativação cognitiva, durante período mínimo de 1 ano. Vinte crianças eram recém-admitidas. As técnicas da ativação escolhidas foram: método de aprendizagem ativa, com base em Piaget e método de ativação cognitiva para, através de exercícios psicomotores, desenvolver os pré-requisitos para aprendizagem e prevenção de dificuldades escolares, segundo Lambert. A avaliação das funções cognitivas mostrou: nível intelectual insatisfatório em 30% e médio ou superior em 70% e deficiências cognitivas específicas (noção do esquema corporal, percepção viso-motora, percepção de forma e perseveração) em 74%. Maior prevalência de crianças com inteligência superior (p < 0,05) associou-se a dois fatores: 1º: maior tempo de freqüência à escola (de 1 a 3 anos) e 2º: programas de ativação cognitiva. Não foram observadas diferenças entre os 2 grupos em relação à prevalência de alterações das funções cognitivas específicas examinadas. Os resultados demonstram que a recuperação de crianças com as dificuldades descritas é difícil. Exige investigação sistemática sobre os métodos psicopedagógicas selecionados e possivelmente, grande tempo de permanência da criança na escola, além de admissão mais precoce.
Blindness and total ophthalmoplegia after aesthetic polymethylmethacrylate injection: case report
Authors: Silva Marcus Tulius T. , Curi André Land
Published: April 2005

Microspheres of polymethyl-methacrylate (PMMA) are exciting new soft-tissue fillers that are becoming increasing popular for facial rejuvenation. Some reports of side effects of this procedure are basically in respect to dermal reaction, with late-onset granulomatous lesion with giant cells and vacuoles. We report blindness and total ophthalmoplegia after PMMA injection into glabellar area in a healthy woman and review the literature.
Paraplegia complicating percutaneous vertebroplasty for osteoporotic vertebral fracture: case report
Authors: Lopes Nilo M. , Lopes Vinicius K.
Published: April 2005

We report a case of spinal cord and root compression during percutaneous transpedicular polymethylmethacrylate vertebroplasty (PTPV) for a compression fracture due to osteoporosis. Sudden onset of excruciating pain in the distribution of the right sixth intercostal nerve with hyperemia along its path, prompted the interruption of the procedure. Under narcotic sedation the patient was taken to the ICU and 10mg of dexamethasone was administered intravenously. Few hours later she developed paraplegia with preservation of light touch and a CT scan and MRI showed epidural extravasation of polymethylmethacrylate with spinal cord and root compression. Surgical decompression was followed by neurological recovery. The cement could be removed after been thinned out by high speed drill, with microsurgical technique, through a wide three level laminectomy of D5 to D7. Extravasation of cement is commonly encountered in PTPV and most of the time it is asymptomatic. Root compression may require surgical intervention if nonresponsive to steroid treatment. Cord compression is less often seen and requires emergency surgery. The cement does not adhere to the duramater and it can be removed easily.
Laceration of the posterior inferior cerebellar artery by suboccipital puncture of the cisterna magna: case report
Authors: Portela Luiz Antonio Pezzi , Souza Valéria , Pahl Félix Hendrick , Cardoso Alberto Cappel , Vellutini Eduardo de Arnaldo Silva , Mutarelli Eduardo Genaro , Machado Luis dos Ramos , Livramento José Antonio
Published: April 2005

We report the case of a 27 year old man who presented to the emergency room of a hospital with headache, vomiting and an episode of loss of conciousness. A cranial CT scan was normal and the patient discharged. Ten hours later he came to the emergency room of our hospital with the same complaints. A technically difficult cisternal puncture in an anxious patient who moved during the needle introduction was done. The CSF sample showed 1600 intact red blood cells without other alterations. His headache worsened and after 6 hours he became drowsy, numb and exhibited decerebration signs. A new CT scan showed diffuse subarachnoid and intraventricular blood. An emergency angiogram demonstrated laceration of a left posterior-inferior cerebellar artery in its retrobulbar loop with a pseudoaneurysm. He was succesfully treated by surgical clipping without injury. Sixteen days later he was discharged with a normal neurological exam.
Interferon beta-1a in chronic inflammatory demyelinating polyneuropathy: case report
Authors: Maria Villa Andrés , Garcea Orlando , Di Egidio Marianna , Saizar Roberto , Pedro Sica Roberto Eduardo
Published: April 2005

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired immune-mediated neuropathy. It presents with a course of progression which may be slow and steady or step-wise or relapsing. Sensory ataxic polyneuropathy may be the only clinical manifestation of this disease. Treatment with interferon beta1a (INF beta1a) has been tried with different results in patients who were refractory to other, more conventional, immunomodulatory therapies. Here we report on a patient who had a relapsing form of pure sensory ataxic CIDP and who failed to respond to intravenous human immunoglobulin. He was put on INF beta1a for 3 years. During this period he suffered no relapses while his condition stabilized.
Sep diagnosing neurophaty of the lateral cutaneous branch of the iliohypogastric nerve: case report
Authors: Dias Rafael José Soares , Souza Lancaster de , Morais Wanderley Freitas de , Carneiro Armando Pereira
Published: April 2005

The article pertains to the uncommon clinical case of a patient with a proximal neuropathy of the lower extremity. It outlines the electrophysiological evaluation and reviews the medical literature. The electrophysiologic test that most accurately revealed the neuropathy was the segmental somatosensory evoked potential (SEP) of the lateral cutaneous branch of the iliohypogastric nerve. It showed well-defined and replicable cortical waveforms following the excitation of the lateral cutaneous branch of the iliohypogastric nerve in the asymptomatic lower extremity, but failed to present somatosensory evoked potentials arising from the excitation of the contralateral nerve in the symptomatic lower extremity. We did not find any previous reports diagnosing that particular pathology by the use of segmental SEP. In conclusion, it is important to remember that the accurate diagnosis of patients complaining of pain and dysesthesia in the proximal part of the lower extremities can possibly be achieved through the use of electrophysiologic tests such as the segmental SEP.
Progressive cervicocranial arteriopathy with dilatations and stenoses: case report
Authors: Conforto Adriana Bastos , Puglia Jr Paulo , Yamamoto Fábio Iuji , Scaff Milberto
Published: April 2005

We report the case of a 36 year-old woman who presented occlusion of a basilar artery fusiform aneurysm (FA) associated with pontine infarction, and two episodes of subarachnoid hemorrhage possibly due to arterial dissection. She also had asymptomatic FAs in the right middle cerebral and left internal carotid arteries. Over 5 years, lesions suggestive of fibromuscular dysplasia in the right vertebral artery and occlusion of the left vertebral artery were observed. This combination of lesions emphasizes the possibility of a common pathogenetic mechanism causing different degrees of media disruption in cervicocranial arteries.
Cefaléia numular: relato de caso
Authors: Monzillo Paulo Helio , Lima Neto Mario Moraes , Sanvito Wilson L. , Costa Agnaldo Rodrigues da , Saab Victor Marçal
Published: April 2005

A cefaléia numular (CN) ou cefaléia em forma de moeda (coin-shaped headache) foi descrita pela primeira vez por Pareja e colaboradores em 2002. É uma cefaléia de curso crônico, aparentemente primária, sendo a dor restrita a uma área circunscrita do crânio, cuja forma pode ser elíptica ou em moeda. Evolui ao longo do tempo com períodos de dor, intercalados por períodos assintomáticos. Na série de treze casos apresentada por esses autores ou não ocorreu concomitância com outras formas de cefaléias primárias ou relação temporal com trauma craniano. Apresentamos o primeiro caso em nosso país, com características clínicas superponíveis às da publicação de Pareja e col, com o intuito de chamar a atenção não só de especialistas em dor de cabeça, mas de neurologistas em geral, para esta forma não usual de cefaléia, bem como fazer considerações sobre o diagnóstico diferencial com esta entidade.
Avaliação da linguagem em crianças com doença cerebrovascular bilateral: estudo de dois casos
Authors: Oliveira Karina Tamarozzi de , Moura-Ribeiro Maria Valeriana Leme , Ciasca Sylvia Maria
Published: April 2005

São descritas duas crianças, uma com idade cronológica de 5 anos e 6 meses e outra com 5 anos e 10 meses. Ambas apresentaram doença cerebrovascular (DCV) bilateral, confirmada na fase aguda através de exame neurológico clínico e de imagem. Os dois pacientes foram atendidos nesta fase por médico neurologista infantil da Disciplina de Neurologia Infantil da FCM/UNICAMP, ambulatório de DCV na infância. Nas avaliações utilizou-se Triagem Audiológica, Protocolo de Avaliação da Linguagem Infantil, Teste de Vocabulário por Imagens Peabody, com o objetivo de avaliar os diversos subsistemas lingüísticos e as noções perceptiva-cognitivas. Na análise qualitativa dos dois sujeitos, do ponto de vista fonoaudiológico e neurológico, houve recuperação completa do distúrbio adquirido de linguagem para o primeiro e alterações sutis no posterior processo de aprendizagem do segundo. O estudo dos casos revelou que os aspectos predominantes devem ser analisados de forma individual, quantitativa e qualitativamente para achados conclusivos.
Is MTHFR polymorphism a risk factor for Alzheimer's disease like APOE?
Authors: Fernandez Liana Lisboa , Scheibe Rosane Machado
Published: April 2005

BACKGROUND: The role of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms as risk factors for the occurence of Alzheimer's disease (AD) is still controversial: OBJECTIVE: To verify the association between MTHFR and apolipoprotein E (APOE) polymorphisms and Alzheimer's disease. METHOD: This work was conducted as a case-control study. Cases included thirty patients with probable AD. Controls were constituted by 29 individuals without dementia according to neuropsychological tests paired to age, sex, race and educational level. DNA was isolated from peripheral leukocytes of anticoagulated venous blood. Genotyping of APOE and MTHFR were performed by DNA amplification and digestion. The frequences of APOE and MTHFR genotypes were submitted by chi-square test corrected by Fisher test; the APOE genotypes, to chi-square linear tendency test and the frequences of MTHFR mutant and AD, by stratificated anlysis adjust by Mantel-Haenszel method. RESULTS: There was significant difference about APOE4 and APOE2 in the groups. (p=0.002) The odds ratio increased exponentially with the increased number of E4 allele (chi2 linear tendency test). No significant difference was detected on MTHFR genotypes in both case and control groups. CONCLUSION: The APOE4 is a risk factor and demonstrated a dose-depenent effect while APOE2 allele conferred a protection to AD. The MTHFR mutation had no correlation with AD.
Status dystonicus: study of five cases
Authors: Teive Hélio A.G. , Munhoz Renato P. , Souza Mônica M. , Antoniuk Sérgio A. , Santos Mara Lucia S.F. , Teixeira Manoel Jacobsen , Barbosa Egberto Reis , Carvalho Rodrigo C. , Scaff Milberto , Werneck Lineu César
Published: April 2005

Status Dystonicus (SD) is characterized by generalized muscle contractions in dystonic patients. We report 5 cases of SD, two of which in patients with dystonic cerebral palsy, one in a patient with primary segmental dystonia, one in a patient with Hallervorden-Spatz syndrome and one in a patient with Wilson's disease (WD). Three patients were admitted to an intensive care unit and treated with propofol and midazolam, and two were submitted to neurosurgical procedures (bilateral pallidotomy and bilateral pallidal deep brain stimulation). Triggering factors were identified in three patients as follows: infection, stress-induced and zinc therapy for WD. On follow-up, two patients presented with significant improvement of dystonia, whereas the other three cases the clinical picture ultimately returned to baseline pre-SD condition.
Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: a meta-analysis
Authors: Cardoso Eduardo , Rodrigues Bernardo , Lucena Rita , Oliveira Irismar Reis de , Pedreira Glícia , Melo Ailton
Published: April 2005

Muscle over-activity is one of the cardinal features of spasticity and it is a common disability of stroke patients. In this group, spasticity is responsible for several limitations that interfere in their daily activities and quality of life. To treat spasticity, neurologists usually prescribe drugs as baclofen, tizanidine or benzodiazepines or even use definitive treatment as phenol or surgery. Authors suggest the use of botulinum toxin type A (BTX-A) for spasticity in the upper limbs after stroke, but there are few papers with adequate methodology supporting this idea. In this article we summarize the data of previous double-blind, randomised clinical trials to asses, with a meta-analysis, if BTX-A is an adequate treatment for spasticity due to stroke. The results show a statistical superiority of BTX-A ov%r placebo on reducing muscle tone by the Modified Ashworth Scale (WMD= 0.95 [0.74 to 1.17]) in patients with post-stroke upper limb spasticity.
Does treatment with N-butyl cyanoacrylate embolization protect against hemorrhage in cerebral arteriovenous malformations?
Authors: Raupp Eduardo Floriani , Fernandes Jefferson
Published: April 2005

OBJECTIVE: To assess the role of this procedure to prevent hemorrhage in cerebral arteriovenous malformations (cAVM). METHOD: Between 1992 and 2000, we studied 104 patients submitted to embolization as the main treatment. Patients were followed until hemorrhage or death. RESULTS: Follow-up ranged from 1.6 months to 8 years. The most frequent presentations were hemorrhage (50%) and seizures (38%). In addition, 40% were small (<30 mm); 56% were medium (30-60 mm). Obliteration was <1/3 in 11% of the cases; from 1/3 to <2/3 in 49%; >2/3 in 36%; complete in 5%. The risk of death was 1%/year, and of bleeding, 5.4%/year. Presentation with hemorrhage and low obliteration rate were the main factors associated with hemorrhage. CONCLUSION: cAVM embolization provides limited protection against hemorrhage with obliteration rates below 2/3. Presentation with hemorrhage is the main factor for predicting hemorrhage.