Meningoencefalite chagásica em AIDS simulando metástases cerebrais: relato de caso

A case of Chagas' meningoencephalitis in a 47 year-old patient with AIDS is presented. The diagnosis was established by examination of the cerebrospinal fluid which showed the presence of Trypanosoma cruzi. CT-scan revealed multiple cerebral lesions which only became evident by contrast administration. A second CT after 13 days showed a severe evolution with displacement of the midline structures leading to the patient's death. This case, as well as other case reports published, has shown the fulminant evolution of Chagas' meningoencephalitis in AIDS patients and the importance of cerebrospinal fluid examination for the diagnosis.Apresentamos um caso de meningoencefalite chagásica em paciente de 47 anos com AIDS. O diagnóstico foi feito pelo encontro do Trypanosoma cruzi no LCR. A tomografia de crânio mostrou múltiplas lesões cerebrais que se tornaram evidentes apenas na fase com contraste. Uma segunda tomografia após 13 dias mostrou evolução tipo tumoral com intenso efeito de massa e acentuado desvio de estruturas da linha média, levando o paciente ao óbito. Este caso e outros da literatura mostram a evolução fulminante da meningoencefalite chagásica em pacientes com AIDS e a importância do exame de LCR para o diagnóstico.Escola Paulista de Medicina Department of NeurologyHospital Albert Einstein Division of NeuroimagingUNIFESP, EPM, Department of NeurologySciEL

Torsion dystonia and Parkinson's syndrome

Four cases of torsion dystonia of the spasmodic torticollis type associated to Parkinson's syndrome are reported. All the patients were female and the ages at the begining of the parkinsonism and the dystonic syndrome varied respectively from 12 to 40 and from 18 to 40 years. In just one patient the dystonia preceded the parkinsonism. The Parkinson's syndrome was predominantly unilateral and hypertonic. The encephalitic etiology was suggested in all the cases.Os autores relatam 4 casos de distonia de torsão, do tipo torcicolo espasmódico, associada a síndrome parkinsoniana. Todos os pacientes eram do sexo feminino e as idades de início da síndrome parkinsoniana e da síndrome distônica variaram de 12 a 40 anos e de 18 a 40 anos, respectivamente. Em apenas uma paciente a distonia precedeu ao parkinsonismo. A síndrome parkinsoniana era predominantemente unilateral e hipertônica. A etiologia encefalítica foi a aventada em todos os casos.Escola Paulista de Medicina Departamento de Neurologia e NeurocirurgiaUNIFESP, EPM, Depto. de Neurologia e NeurocirurgiaSciEL

The electroencephalogram in the parkinsonian syndrome

The electroencephalograms of 50 parkinsonian patients with no convulsive antecedents were studied. EEG abnormalities were found in 20 patients (40% of the cases). The incidence of abnormal records was larger in the bilateral parkinsonian syndrome than in the unilateral one (52% and 25%, respectively). Paroxysmal abnormalities characterized mainly by bursts of theta waves were the most frequent ones (65% of the cases). Sharp activity found in the EEG patterns of three patients is emphasized. Alterations of the base rhythm were recorded in 30% of the abnormal EEG cases. The patient's age doesn't seem to have an important role in the genesis of the electroencephalographic abnormalities.Foram estudados os eletrencefalogramas de 50 pacientes parkinsonianos livres de qualquer antecedente convulsivo, sendo registrados traçados anormais em 40% dos casos. A incidência de traçados anormais foi maior na síndrome parkinsoniana bilateral do que na unilateral (52% e 25%, respectivamente). Entre as anormalidades assinaladas foram as paroxísticas as mais freqüentes (65% dos casos), caracterizando-se predominantemente por surtos de ondas teta. O registro de anormalidades paroxísticas do tipo irritativo encontrado em três casos é salientado. Alterações da atividade de base foram assinaladas em 35% dos pacientes. A idade dos pacientes não parece ter tido importante papel na gênese das anormalidades eletrencefalográficas.Escola Paulista de Medicina Departamento de Neurologia e NeurocirurgiaUNIFESP, EPM, Depto. de Neurologia e NeurocirurgiaSciEL

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Corioepitelioma com metástases cerebrais Chorionepithelioma with brain metastases

Os autores relatam um caso de metástases cerebrais de corioepitelioma em paciente de 30 anos de idade, internada por apresentar um tumor abdominal, amenorréia e cefaléia. O diagnóstico inicial fôra de gravidez normal e neoplasia do trato digestivo. Após breve revisão da literatura são comentadas as repercussões neurológicas deste tipo de neoplasia.A case of cerebral metastatic chorionepithelioma, with post-mortem examination in a 30 years old female patient having an abdominal tumor, amenorrhea and headache is reported. The initial diagnosis was that of normal pregnancy and neoplasm of the digestive tract. A review of the literature is made and the neurological repercussion of this tumor is discussed

Chorionepithelioma with brain metastases

A case of cerebral metastatic chorionepithelioma, with post-mortem examination in a 30 years old female patient having an abdominal tumor, amenorrhea and headache is reported. The initial diagnosis was that of normal pregnancy and neoplasm of the digestive tract. A review of the literature is made and the neurological repercussion of this tumor is discussed.Os autores relatam um caso de metástases cerebrais de corioepitelioma em paciente de 30 anos de idade, internada por apresentar um tumor abdominal, amenorréia e cefaléia. O diagnóstico inicial fôra de gravidez normal e neoplasia do trato digestivo. Após breve revisão da literatura são comentadas as repercussões neurológicas deste tipo de neoplasia.Escola Paulista de Medicina Departamento de Neurologia e NeurocirurgiaEscola Paulista de Medicina Departamento de Neurologia e Neurocirurgia Departamento de Ginecologia e ObstetríciaUNIFESP, EPM, Depto. de Neurologia e NeurocirurgiaEscola Paulista de Medicina Depto. de Neurologia e Neurocirurgia Depto. de Ginecologia e ObstetríciaSciEL

Melkersson-Rosenthal's syndrome: review of the literature and report of four cases

Four cases of Melkersson-Rosenthal's syndrome in which the edema predominant in the lips and the facial palsy ocurred by bursts are reported. The four cases presented the lingua plicata and in two of them familiar antecedents were present. The fact that the facial palsy is generally the first sign and that this syndrome may start in early childhood is pointed out.São relatados 4 casos de síndrome de Melkersson-Rosenthal nos quais tanto o edema predominante nos lábios como a paralisia facial periférica ocorreram por surtos. Nos 4 casos havia língua plicata sendo que, em dois deles, este componente era familiar. É realçado o fato de ser a paralisia facial geralmente o primeiro sinal, bem como a possibilidade dessa síndrome ser iniciada nos primeiros anos de vida.Escola Paulista de Medicina Departamento de Neurologia e NeurocirurgiaUNIFESP, EPM, Depto. de Neurologia e NeurocirurgiaSciEL

Distonia de torsão e síndrome parkinsoniana Torsion dystonia and Parkinson's syndrome

Os autores relatam 4 casos de distonia de torsão, do tipo torcicolo espasmódico, associada a síndrome parkinsoniana. Todos os pacientes eram do sexo feminino e as idades de início da síndrome parkinsoniana e da síndrome distônica variaram de 12 a 40 anos e de 18 a 40 anos, respectivamente. Em apenas uma paciente a distonia precedeu ao parkinsonismo. A síndrome parkinsoniana era predominantemente unilateral e hipertônica. A etiologia encefalítica foi a aventada em todos os casos.<br>Four cases of torsion dystonia of the spasmodic torticollis type associated to Parkinson's syndrome are reported. All the patients were female and the ages at the begining of the parkinsonism and the dystonic syndrome varied respectively from 12 to 40 and from 18 to 40 years. In just one patient the dystonia preceded the parkinsonism. The Parkinson's syndrome was predominantly unilateral and hypertonic. The encephalitic etiology was suggested in all the cases

Oculogiric crisis and Parkinson's syndrome

From 111 patients with parkinsonism there were found twenty presenting oculogiric crisis corresponding to a 18% frequency. From these twenty patients 14 were male and 6 female, the starting age of the Parkinson's syndrome varying from 10 to 40 years. Only one patient presented the oculogiric crises as the initial sign. In 83% of the cases the vertical upward direction was observed, the convergence impairment and the diplopia being the other more frequent associated ocular signs. Statistically there was no difference of incidence of the oculogiric crisis in the unilateral or bilateral parkinsonism. Encephalitis was the most frequent etiology.Foram estudados 20 pacientes com síndrome parkinsoniana e crises oculógiras. Essa cifra, no cômputo geral de pacientes parkinsonianos estudados (111), mostra uma freqüência de 18%. Dos 20 pacientes citados, 14 eram do sexo masculino e 6 do feminino. As idades de início da síndrome parkinsoniana variaram entre 10 e 40 anos. Em apenas um paciente as crises oculógiras foram o sinal clínico inicial. Em 83% dos casos a direção foi vertical para cima. O déficit de convergência e a diplopia foram os sinais oculares associados mais freqüentes. Não houve diferença de incidência das crises oculógiras nas formas parkinsonianas uni ou bilaterais. A etiologia mais encontrada foi a encefalítica.Escola Paulista de Medicina Departamento de Neurologia e NeurocirurgiaEscola Paulista de Medicina Departamento de NeurologiaUNIFESP, EPM, Depto. de Neurologia e NeurocirurgiaEscola Paulista de Medicina Depto. de NeurologiaSciEL