Dissecting central post-stroke pain:a controlled symptom-psychophysical characterization

Central post-stroke pain affects up to 12% of stroke survivors and is notoriously refractory to treatment. However, stroke patients often suffer from other types of pain of non-neuropathic nature (musculoskeletal, inflammatory, complex regional) and no head-to-head comparison of their respective clinical and somatosensory profiles has been performed so far. We compared 39 patients with definite central neuropathic post-stroke pain with two matched control groups: 32 patients with exclusively non-neuropathic pain developed after stroke and 31 stroke patients not complaining of pain. Patients underwent deep phenotyping via a comprehensive assessment including clinical exam, questionnaires and quantitative sensory testing to dissect central post-stroke pain from chronic pain in general and stroke. While central post-stroke pain was mostly located in the face and limbs, non-neuropathic pain was predominantly axial and located in neck, shoulders and knees (P < 0.05). Neuropathic Pain Symptom Inventory clusters burning (82.1%, n = 32, P < 0.001), tingling (66.7%, n = 26, P < 0.001) and evoked by cold (64.1%, n = 25, P < 0.001) occurred more frequently in central post-stroke pain. Hyperpathia, thermal and mechanical allodynia also occurred more commonly in this group (P < 0.001), which also presented higher levels of deafferentation (P < 0.012) with more asymmetric cold and warm detection thresholds compared with controls. In particular, cold hypoesthesia (considered when the threshold of the affected side was <41% of the contralateral threshold) odds ratio (OR) was 12 (95% CI: 3.8–41.6) for neuropathic pain. Additionally, cold detection threshold/warm detection threshold ratio correlated with the presence of neuropathic pain (ρ = −0.4, P < 0.001). Correlations were found between specific neuropathic pain symptom clusters and quantitative sensory testing: paroxysmal pain with cold (ρ = −0.4; P = 0.008) and heat pain thresholds (ρ = 0.5; P = 0.003), burning pain with mechanical detection (ρ = −0.4; P = 0.015) and mechanical pain thresholds (ρ = −0.4, P < 0.013), evoked pain with mechanical pain threshold (ρ = −0.3; P = 0.047). Logistic regression showed that the combination of cold hypoesthesia on quantitative sensory testing, the Neuropathic Pain Symptom Inventory, and the allodynia intensity on bedside examination explained 77% of the occurrence of neuropathic pain. These findings provide insights into the clinical-psychophysics relationships in central post-stroke pain and may assist more precise distinction of neuropathic from non-neuropathic post-stroke pain in clinical practice and in future trials

Neuromielite óptica: além das lesões medulares longitudinalmente extensas

Objective: To describe the radiological features and their prevalence in neuromyelitis optica (NMO) patients, and to compare our results with the current literature. Methods: Two neuroradiologists retrospectively reviewed 40 brain and 41 spinal cord conventional MRI studies of NMO patients. Exams were analyzed for presence or absence of lesion, topography, aspect, enhancement, brain lesions suggestive of multiple sclerosis (MS), and distinctive NMO brain lesions. Results: Most spinal cord lesions involved over three or more vertebral segments (70%). 78% of brain scans were abnormal. The most prevalent brain finding was nonspecific foci of T2 hyperintensities in the white matter. One patient had lesions compatible with MS. Brain lesions suggestive of NMO occurred at least once in 19 (48%) patients. Conclusion: Spinal cord lesions were often longitudinally extensive and showed a tendency to change its appearance with time. Brazilian NMO patients have a high prevalence of brain lesions and nearly half of them had at least one distinctive NMO brain lesion. *artigo será submetido ao periódico Multiple Sclerosis Journal.Objetivo: Descrever os aspectos radiológicos e sua prevalência em pacientes com neuromielite óptica (NMO), e comparar nossos resultados com a literatura. Métodos: Dois neurorradiologistas retrospectivamente revisaram 40 ressonâncias magnéticas de cérebro e 41 de medula de pacientes com NMO. Os exames foram analisados com relação a presença ou ausência de lesão, topografia, aspecto, realce, lesões cerebrais sugestivas de esclerose múltipla (EM), e lesões cerebrais distintas para NMO. Resultados: A maioria das lesões medulares acometeu três ou mais corpos vertebrais (70%). 78% dos exames de cérebro apresentaram anormalidades. O achado cerebral mais prevalente foram focos inespecíficos de hiperssinal em T2 na substância branca. Um paciente apresentou lesões compatíveis com EM. Lesões cerebrais sugestivas de NMO ocorreram pelo menos uma vez em 19 (48%) dos pacientes. Conclusão: Lesões medulares são frequentemente longitudinalmente extensas e tiveram uma tendência de mudar seu aspecto com o tempo. Pacientes brasileiros com NMO tem uma elevada prevalência de lesões cerebrais e quase a metade dos mesmos apresenta pelo menos uma lesão cerebral distinta para NMO.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Arterite de Takayasu na infância e na adolescência: relato de três casos

A arterite de Takayasu (AT) é uma vasculite sistêmica que acomete principalmente a aorta e seus ramos. Apesar de ser a terceira vasculite mais frequente na infância, sua ocorrência na faixa etária pediátrica é pouco descrita. Relatamos três casos de AT na faixa etária pediátrica com ênfase nas manifestações clínicas, alterações angiográficas e abordagem terapêutica