Prevalência das crises e síndromes epilépticas em uma clínica de epilepsia.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Clínica Médica, Curso de Medicina, Florianópolis, 199

Balo's concentric sclerosis – case report

Objetivos: O caso descrito a seguir busca incentivar a suspeição do médico frente a um provável diagnóstico de Esclerose Concêntrica de Baló (ECB). Métodos:Relato de caso associado à revisão da literatura científica a partir artigos publicados sobre o tema. Resultados: Há grande dificuldade na determinação da etiopatologia da ECB, já que há amplas áreas de desmielinização do sistema nervoso central (SNC) que  podem ser observadas em várias doenças neurológicas. A RNM faz grande suspeição diagnóstica, mas a confirmação só é realmente obtida através de biópsia cerebral. O tratamento consiste no uso de esteróides em doses altas com neuroimagem seriada de controle. Discussão: Uma vez determinada a natureza inflamatória da lesão, a dificuldade de determinar sua etiopatologia reside no fato de que amplas áreas de desmielinizaçãodo sistema nervoso central (SNC) podem ser observadas em várias doenças neurológicas.Clinicamente os pacientes com esclerose concêntrica de Balo se apresentam com sintomas agudos ou subagudos, sugerindo lesão expansiva encefálica. A doença tem um curso imprevisível, que varia de uma rápida evolução em semanas ou meses sem remissão até uma condição autolimitada que incluem vários sintomas cognitivos como cefaléia, afasia, distúrbios de comportamento, disfunção visual e ataxia.Goals: The case described forward search to motivate the medical suspicionin front of a probable diagnose of Balo’s Concentric Sclerosis (BCS) establishing a routine diagnostic. Methods: Case report with cientific review of articles published about the subject. Results: It is really difficult to determine the BCS’s etiology-fisiopathology because of the difuse demyelinating’s areas of the central nervous system (CNS) that are seen in a variety of CNS’s diseases. Magnetic resonance (MR) is very important to the diagnosis of BCS, but the diagnosis’s key is the brain biopsy. The therapy consists of high dose of steroidals being controled by magnetic resonance imaging. Discussion: Once the inflammatory demyelinating nature of the lesion has been established, the difficulty of determination ethiopathology as wide areas of demielynation of the central nervous system can be observed in several neurological diseases. On practice, the BCS’s patients show acute or sub-acute symptoms that suggest expansive brain injury. The disease has an unlikely course, that goes to a quickly evolution in weeks or months without remission until a self-limiting that includes several cognitive symptoms like headaches, aphasia, behavioral disturbance, visual dysfunction and ataxia

Definição e diagnóstico de neuropatia de fibras finas: consenso do Departamento Científico de Neuropatias Periféricas da Academia Brasileira de Neurologia

The aim of this study was to describe the results of a Brazilian Consensus on Small Fiber Neuropathy (SFN). Fifteen neurologists (members of the Brazilian Academy of Neurology) reviewed a preliminary draft. Eleven panelists got together in the city of Fortaleza to discuss and finish the text for the manuscript submission. Small fiber neuropathy can be defined as a subtype of neuropathy characterized by selective involvement of unmyelinated or thinly myelinated sensory fibers. Its clinical picture includes both negative and positive manifestations: sensory (pain/ dysesthesias/pruritus) or combined sensory and autonomic complaints, associated with an almost entirely normal neurological examination. Standard electromyography is normal. A growing list of medical conditions is associated with SFN. The classification of SFN may also serve as a useful terminology to uncover minor discrepancies in the normal values from different neurophysiology laboratories. Several techniques may disclose sensory and/or autonomic impairment. Further studies are necessary to refine these techniques and develop specific therapies.O objetivo deste estudo é descrever os resultados de um Consenso Brasileiro sobre Neuropatia de Fibras Finas (NFF). Quinze neurologistas (membros da Academia Brasileira de Neurologia) revisaram uma versão preliminar do artigo. Onze panelistas se reuniram na cidade de Fortaleza para discutir e terminar o texto para a submissão do manuscrito. NFF pode ser definida como um subtipo de neuropatia caracterizada pelo envolvimento seletivo de fibras sensitivas amielínicas ou pouco mielinizadas. Seu quadro clínico inclui manifestações negativas e positivas: sensitivas (dor/disestesias/prurido) ou queixas sensitivas e autonômicas combinadas, associadas a exame neurológico quase totalmente normal. A eletromiografia convencional é normal. Uma lista crescente de condições médicas causa NFF. NFF também pode servir como uma terminologia útil para referenciar pequenas discrepâncias nos valores normais de diferentes laboratórios de neurofisiologia. Diferentes técnicas podem evidenciar anormalidades sensitivas e/ou autonômicas. São necessários mais estudos para refiná-las e para o desenvolvimento de terapias específicas.Univ Fed Ceara, Fac Med, Hosp Univ Walter Cantidio, Fortaleza, CE, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Dept Neurociencias & Hosp Clin, Ribeirao Preto, SP, BrazilUniv Fed Santa Catarina, Florianopolis, SC, BrazilUniv Fed Rio de Janeiro, Dept Neurol, Rio De Janeiro, RJ, BrazilUniv Fed Cariri, Barbalha, CE, BrazilUniv Fed Fluminense, Fac Med, Dept Neurol, Niteroi, RJ, BrazilUniv Estadual Campinas, Dept Neurol, Campinas, SP, BrazilUniv Regiao Joinville, Joinville, SC, BrazilUniv Fed Sao Paulo, Dept Neurol, Sao Paulo, SP, BrazilUniv Fed Uberlandia, Fac Med, Uberlandia, MG, BrazilHosp Moinhos De Vento, Porto Alegre, RS, BrazilUniv Fed Sao Paulo, Dept Neurol, Sao Paulo, SP, BrazilWeb of Scienc

Epidemiologic analysis of Leptospira spp. infection among sheep in Pernambuco state, Brazil

ABSTRACT: This study aimed to analyze epidemiological aspects and spatial characteristics of Lesptospira spp. infection among sheep in Pernambuco state, Brazil. A total of 426 samples were collected from unvaccinated animals aged 1 year or older, and submitted to Microscopic Agglutination Test (MAT). To study the risk factors, a standardized investigative survey of sheep farmers, with objective questions, was conducted to establish the general characteristics of the farm property production, reproductive management, and health plan. From 426 samples analyzed, 83 (19.5%; CI 15.9 - 23.6%) were positive; among them, the most prevalent serovar was Autumnalis (32.4%). Significant differences were observed between gender (OR = 0.38; CI 0.14 - 0.99), production system (OR = 2.03; CI 1.07 - 3.84), types of herd (OR = 2.28; CI 1.39 - 3.72), absence of rodents to the grain storage (OR = 0.55; CI 0.34 - 0.91), and restriction to surface waters (OR = 0.60; CI 0.37 - 0.99). Leptospira spp. infection is disseminated in sheep herds, and multiple factors can influence its occurrence. Health education programs and worker training in prevention and control of leptospirosis and other infectious diseases may be useful to reduce infection rates and economic losses caused by this disease

Clinical characteristics of patients with neuromyelitis optica spectrum disorders with early onset

Neuromyelitis optica spectrum disorder is a severe and disabling disease that manifests with severe relapses of optic neuritis, longitudinally extensive myelitis, and/or brainstem syndromes. The disease is complex and, although onset typically occurs in middle age, children and adolescents may be affected. The present study adds to the literature through detailed clinical data from 36 Brazilian patients with neuromyelitis optica spectrum disorder starting before age 21. This was a retrospective assessment of medical records from 14 specialized units in Brazil. The results showed that the course of neuromyelitis optica spectrum disorder was worse in patients with disease onset before the age of 12 years. Gender and ethnic background did not influence disability accumulation. Over a median period of 8 years, 14% of the patients who presented the initial symptoms of neuromyelitis optica spectrum disorder before the age of 21 years died. In conclusion, the present study adds to the reports from other authors examining the severity of early-onset neuromyelitis optica spectrum disorder34948749

Neuromyelitis Optica With Onset in Childhood and Adolescence

BACKGROUND: Neuromyelitis optica with onset before the age of 18 years is a relatively rare, yet potentially devastating condition. the objective of the present study was to contribute to the study of early-onset neuromyelitis optica with a case series. PATIENTS: Data were collected from medical records of Brazilian neurologists caring for patients with neuromyelitis optica occurring in childhood and adolescence. RESULTS: Twenty-nine patients with neuromyelitis optica occurring before the age of 18 years and fulfilling the diagnostic criteria were identified. the average age at disease onset was 13 years and the patients had had an average disease duration of 6 years. the expanded disability scale score at the latest consultation was, on average, 4.7, and one patient had died from the disease. the 29 patients had had an average 4.5 relapses during the disease, accounting for 0.75 relapses per year, irrespective of the medication used. All patients were using one or more of the following medications: azathioprine, prednisone, immunoglobulin, and glatiramer acetate. CONCLUSIONS: Neuromyelitis optica with onset in childhood and adolescence is a poorly understood condition that is often disabling and difficult to manage.Univ Metropolitana Santos, Santos, BrazilHosp Restauracao, Recife, PE, BrazilUniv Fed Estado São Paulo, São Paulo, BrazilSanta Casa Vitoria, Fac Ciencias Saude, Vitoria, BrazilUniv Fed Goias, Goiania, Go, BrazilUniv Fed Santa Catarina, Florianopolis, SC, BrazilUniv Fed Rio de Janeiro, Macae, BrazilHosp Beneficencia Portuguesa, São Paulo, BrazilHosp Paulistano, São Paulo, BrazilHosp Sirio Libanes, São Paulo, BrazilUniv Fed Estado São Paulo, São Paulo, BrazilWeb of Scienc