Elton Gomes da Silva

Pain in Parkinson’s disease: analysis of 50 cases in a clinic of movement disorders

INTRODUCTION Pain is a common symptom in Parkinsons disease (PD), and is often related to the illness itself. OBJECTIVE To prospectively establish the occurrence of pain in PD patients. METHOD This study was conducted within a population composed of 50 patients with PD to evaluate the presence of pain. RESULTS Twenty-eight patients reported pain; comparing the group with pain and the group without pain, there were no differences related to the beginning of the illness and the motor symptoms of PD. However, many patients related an improvement of pain when antiparkinsonian therapy was initiated or adjusted. CONCLUSION The use of techniques for analgesia and the adjustment of PD medication contribute to improve the manifestations of pain and the life quality of patients with PD.

Decompressive craniectomy in massive cerebral infarction

Twenty one patients were submitted to decompressive craniectomy for massive cerebral infarct. Ten patients (47.6%) presented a good outcome at the 6 months evaluation, eight had a poor outcome (38%) and three died (14.2%). There was no outcome statistical difference between surgery before and after 24 hours of ictus, dominant and non-dominant stroke groups. Patients older than 60 years and those who had a Glasgow Coma Scale (GCS)<8 in the pre-surgical exam presented worst outcome at six months (p<0.05). Decompressive craniectomy for space-occupying large hemispheric infarction increases the probability of survival. Age lower than 60 years, GCS >8 at pre-surgical exam and decompressive craniectomy before signs of brain herniation represent the main factors related to a better outcome. Dominant hemispheric infarction does not represent exclusion criteria.

Vascular parkinsonism: analysis of seven cases

INTRODUCTION Neuroimaging studies of elderly individuals reveal alterations in the white matter that are incompatible with the patients parkinsonism, mistakenly classified as vascular parkinsonism (VP). METHOD This study was conducted on a population composed of 20 patients with Parkinsons disease (PD) whose neuroimaging exams revealed vascular alterations in the white matter and seven patients with VP in order to compare diagnostic criteria. RESULTS Age at disease onset of patients with PD was 55+/-12 years and patients with VP it was 62+/-13 years. Twelve patients with PD and five patients with VP presented arterial hypertension; three patients with VP and two patients with PD presented gait impairment; all patients with VP presented rigidity and bradykinesia, six of them presented resting tremor; 19 patients with PD presented tremor and 19 of them presented rigidity, while 17 presented bradykinesia. When the symptoms and evolution of both diseases were compared, the vascular alterations in the white matter were considered unspecific. CONCLUSION Since clinical symptoms are unspecific, a differential diagnosis requires neuroimaging, good response to levodopa and clinical evolution.