Antonio Pedro Vargas

Persistent Sydenham's chorea.

Sydenhams chorea (SC) occurs in 26% of patients with rheumatic fever (RF). Despite usually being described as a self‐limited condition, few reports indicate that SC may persist in rare subjects.

Determinants of Quality of Life in Brazilian Patients with Parkinson's Disease

Our objective was to identify determinants of health‐related quality of life (HRQoL) in a cohort of Brazilian patients with Parkinsons disease (PD). Patients were evaluated by means of the Hoehn and Yahr staging (H&Y), Unified Parkinsons Disease Rating Scale (UPDRS), Schwab and England scale (S&E), Mini‐Mental State Exam, Geriatric Depression Scale, and Hospital Anxiety and Depression Scale (HADS). HRQol was assessed using the MOS‐Short‐Form 36 (SF‐36), the Parkinsons disease Questionnaire (PDQ‐39), and the Scales for Outcomes in Parkinsons Disease‐Psychosocial Questionnaire (SCOPA‐PS). 144 patients were evaluated (mean age 62 years; 53.5% men; mean duration of illness 6.6 years; median H&Y, 2 (range: 1–4). Mean SCOPA‐PS and PDQ‐39 Summary Index (SI) were 39.2 and 40.7, respectively. Both, PDQ‐39 and SCOPA‐PS SIs correlated at a moderate level (r = 0.30–0.50) with H&Y, S&E, total UPDRS, HADS subscales, and SF‐36 Physical and Mental Components. PDQ‐39 and SCOPA‐PS were closely associated (r = 0.73). HRQoL significantly deteriorated as H&Y progressed, as a whole. Mood disturbances, disability, motor complications, and education were independent predictors of HRQoL in the multivariate analysis model. In PD Brazilian patients, HRQoL correlated significantly with diverse measures of severity. Depression showed to be the most consistent determinant of HRQoL, followed by disability, motor complications, and education years. There was a close association between the PDQ‐39 and SCOPA‐PS summary scores.

Prevalence of patent foramen ovale in migraine patients with and without aura compared with stroke patients. A transcranial Doppler study

The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7± in migraine with aura (MA) patients, 33.7± in migraine without aura (MoA) patients, 33.8± in young stroke patients and 20.5± in elderly stroke patients (P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1± and 25± (P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.

Hemifacial spasm and arterial hypertension

Hemifacial spasm (HFS) is a form of segmental myoclonus often associated with vascular compression of the seventh nerve at its exit in the brain stem. Although a few uncontrolled studies describe the association of arterial hypertension (AH) with HFS, their relationship remains to be elucidated.

Independent validation of SCOPA-psychosocial and metric properties of the PDQ-39 Brazilian version

The objective of this study was to perform an independent validation of the Scales for Outcomes in Parkinsons Disease–Psychosocial questionnaire (SCOPA‐PS) and assessment of the Parkinsons Disease Questionnaire (PDQ‐39), Brazilian version. Patients were evaluated by means of the Unified Parkinsons Disease Rating Scale, Hoehn and Yahr staging (HY), Schwab and England scale, Mini‐Mental State Examination, and Hospital Anxiety and Depression Scale. Health‐related quality of life was evaluated using the MOS‐Short Form 36 (SF‐36), PDQ‐39, and SCOPA‐PS. One hundred forty‐four patients were included (mean age, 62 years; 53.5% males; mean duration of illness, 6.6 years; HY, 1–4). Mean SCOPA‐PS and PDQ‐39 Summary Index (SI) were 39.2 and 40.7, respectively. The internal consistency of SCOPA‐PS (Cronbachs alpha = 0.84; item–total correlation, 0.44–0.73) and PDQ‐39 dimensions (alpha = 0.61–0.85; item–total correlation, 0.46–0.82) were satisfactory. Concerning the stability of the questionnaires, intraclass correlation coefficient (ICC) values were 0.71 for the SCOPA‐PS and 0.86 for the PDQ‐39 SI. ICC for PDQ‐39 dimensions ranged from 0.52 (social support) to 0.80 (stigma). Standard error of measurement (SEM) values for each PDQ‐39 dimension ranged from 0.49 (emotional well‐being) to 17.52 (social support). SEM values for SCOPA‐PS and PDQ‐39 SI were 11.84 and 6.72, respectively. A significant correlation of SCOPA‐PS and PDQ‐39 SI with the SF‐36 physical (−0.42 and −0.52, respectively) and mental components (−0.41) was found. Correlation between SCOPA‐PS and PDQ‐39 SI was 0.73 (all coefficients, P < 0.0001). The SCOPA‐PS and PDQ‐39, Brazilian versions, have satisfactory metric attributes.

Stroke in asymptomatic Trypanosoma cruzi-infected patients.

Background: The knowledge about the natural history of stroke in Chagas disease is incomplete. Methods: Vascular risk factors and stroke subtypes of asymptomatic Trypanosoma cruzi-infected patients with no clinical evidence of heart failure were assessed. They were compared with chronic chagasic cardiomyopathy patients who suffered a stroke and with a control group of 60 T. cruzi-noninfected stroke patients. Eighty-six consecutive chagasic stroke patients (mean age: 57.4 years; 64% females) were studied. Results: 38.4% of chagasic stroke patients had asymptomatic T. cruzi infection. Smoking was more frequent in asymptomatic chagasic stroke patients (21.2 vs. 5.7%; p = 0.04). Prevalence of hypertension, diabetes and prior stroke was similar in both groups. Small-vessel infarction (15.6 vs. 3.8%) and large-vessel atherosclerosis (9.4 vs. 3.8%) were significantly more frequent in asymptomatic than in symptomatic T. cruzi-infected stroke patients (p = 0.001). Nevertheless, their frequency was even higher in T. cruzi-noninfected stroke patients (36.7 and 13.3%, respectively). Apical aneurysm (27.3%), left atrial dilatation (12.1%), left ventricle hypokinesia (9.4%) and right bundle branch block (36.4%) were also detected in asymptomatic T. cruzi-infected stroke patients. Conclusions: Ischemic stroke may be the first manifestation of Chagas disease in asymptomatic patients with mild left ventricle dysfunction. Other noncardioembolic stroke subtypes can occur in asymptomatic T. cruzi-infected patients.

Longitudinal psychometric attributes, responsiveness, and importance of change: An approach using the SCOPA-Psychosocial questionnaire.

The objective of this study was to illustrate the analysis of longitudinal validity, responsiveness, and importance of change, using the SCOPA‐Psychosocial Questionnaire (SCOPA‐PS) as a source of empirical data. Sixty‐seven patients with PD in Hoehn and Yahr (HY) stage 2 were followed up for 1 year and assessed by means of the Schwab and England Scale, Unified PD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale (HADS), PDQ‐39, and SCOPA‐PS. A range of methods was applied to enable each of the target attributes to be analyzed from different conceptual stances. The SCOPA‐PS displayed satisfactory acceptability (no floor or ceiling effect), internal consistency (α = 0.80–0.84), convergent validity (rS = 0.70–0.82 with PDQ‐39), and precision (SEM = 8.80), both at baseline and at the end of follow‐up. The threshold value for significant change ranged from 17.25 (1.96 SEM) to 24.39 (Smallest real difference and Reliable change index). Threshold values for a clinically meaningful change were 0.73–1.26 (effect size, standardized response mean, responsiveness statistic). Change in SCOPA‐PS scores correlated strongly with change in total UPDRS, HADS, and PDQ‐39 scores, and reliably detected 70% of cases that worsened according to the PDQ‐39. The minimally important change (MIC) for “minimally impaired” patients as per the PDQ39 was 8.30–9.10 points. Indices such as 1.96 SEM, effect size, and correlation with the change in other measures provide useful information about different concepts of responsiveness. The MIC should be determined for each specific setting, using distribution‐ and anchor‐based methods. The SCOPA‐PS showed satisfactory longitudinal attributes and responsiveness in stage‐2 Brazilian patients with PD across 1 year of follow‐up.

Common recessive limb girdle muscular dystrophies differential diagnosis: why and how?

Limb girdle muscular dystrophies are heterogeneous autosomal hereditary neuromuscular disorders. They produce dystrophic changes on muscle biopsy and they are associated with mutations in several genes involved in muscular structure and function. Detailed clinical, laboratorial, imaging, diagnostic flowchart, photographs, tables, and illustrated diagrams are presented for the differential diagnosis of common autosomal recessive limb girdle muscular dystrophy subtypes diagnosed nowadays at one reference center in Brazil. Preoperative image studies guide muscle biopsy site selection. Muscle involvement image pattern differs depending on the limb girdle muscular dystrophy subtype. Muscle involvement is conspicuous at the posterior thigh in calpainopathy and fukutin-related proteinopathy; anterior thigh in sarcoglycanopathy; whole thigh in dysferlinopathy, and telethoninopathy. The precise differential diagnosis of limb girdle muscular dystrophies is important for genetic counseling, prognostic orientation, cardiac and respiratory management. Besides that, it may probably, in the future, provide specific genetic therapies for each subtype.

Disability and use of healthcare resources in Brazilian patients with Parkinson's disease

Purpose. To assess disability and healthcare resource use in Parkinsons disease (PD) patients. Methods. A cross-sectional survey of 144 Brazilian PD patients consecutively admitted at a Neurological outpatient clinic. Clinical evaluation was done using the Unified Parkinsons Disease Rating Scale (UPDRS) and Hoehn & Yahr staging (H&Y). The Schwab and England (SE) activity of daily living (ADL) scale was used to assess the level of dependence in the ADL. Information about the utilization of health resources was obtained interviewing the patient by means of a structured questionnaire. Results. A total of 66% of patients (mean age 62 years; males, 53%) had a Hoehn & Yahr stage ≤2. Mean UPDRS score was 46.2, and median SE scale score was 80. Disabled PD patients significantly received more visits by a general practitioner (p < 0.001). Patients with comorbid conditions significantly used more domiciliary nurse care and physiotherapist assistance (p < 0.01). The most frequent reason for hospitalization was the treatment of clinical complications and drug dose adjustment. Pharmacological treatment costs were associated with the severity of the disease (p < 0.05). Conclusion. Utilization of healthcare resources was influenced by functional status and comorbid conditions.

Vasculite cerebral e uso de cocaína e crack

Cocaine and crack abuse is strongly related to stroke, particularly in young patients. The present study reports the case of a cocaine and crack abuser who developed central nervous system vasculitis, resulting in extensive cerebral infarctions, leading to dementia, behavioural disturbances and seizures. The relevance of detecting drug abuse in young stroke patients is stressed. Assessing possible brain lesions in drug abusers with cognitive impairment is also important.