Jorge Armbrust-Figueiredo

Forma miopática da cisticercose

A case of pseudohypertrophic myopathy due to Cysticercus cellulosae infestation is reported. The clinical and paraclinical findings are discussed and confrontation is made with the four cases which were previously reported in the literature.

Meningites bacterianas no recém-nascido: estudo de 20 casos

The cases of 20 patients admited with purulent meningitis in the neonatal period are reported. The authors analyse the importance in recognizing the minimal signals and symptoms, as weel as the clinical patterns of the manifested disease. Some considerations are draw about the values of the early diagnostic before the high incidence of mortality and the gravity of sequaele that occur besides the high doses and long term antimicrobial therapy.The cases of 20 patients admitted with purulent meningitis in the neonatal period are reported. The authors analyse the importance in recognizing the minimal signals and symptoms, as weel as the clinical patterns of the manifested disease; Some considerations are draw about the values of the early diagnostic before the high incidence of mortality and the gravity of sequaele that occur besides the high doses and long term antimicrobial therapy.

A metisergide no tratamento da epilepsia temporal

Methysergide (1-methyl-lysergic acid butanolamide) was used experimentally in 78 patients with psychomotor epilepsy and with focal abnormal activity (sharp waves) in one of the temporal lobes, in the EEG. The usual dosage of methysergide was 2 to 6 mg daily (only 36 patients received more than 2 mg daily) and every patient received fenobarbital 0.1 g daily also. Out of the 78 patients, 59 responded well to the treatment; 47 were free of seizures and in 12 there was decrease in frequency and severity of seizures. Psychic symptoms also decreased with the use of methysergide. The EEG was improved in 27 per cent of patients and became normal in 37 per cent, after twelve months of treatment. Slight side effects were reported by 39 pacients but they disappeared in a few days.

Riso na epilepsia

Three cases of temporal lobe epilepsy in which the seizures were initiated by outbursts of laughter are reported. The laughter was forced and uncontrollable. This symptom disappeared with the use of anticonvulsivant drugs. The mechanism of laughter is discussed.

The electroencephalogram during spontaneous night sleep in epileptic patients

The sleep sistem results of the activity of two components: a descending component originated in the limbic structures, and an ascending system involving the bulbopontine structures which receives projections from the spinal cord components. Although the neocortex is not necessary for sleep mechanisms, it plays a very important role in sleep. Therefore, during the sleep state there is no significant quantitative difference in brain activity, but qualitative changes are recorded in EEG of epileptics patients during all night sleep.

Significado do eletrencefalograma no diagnóstico de crise convulsiva única em crianças

The authors studied the EEG of 20 children with history of a single epileptic seizure, in order to establish a presumptive pathological factor in the central nervous system. In this series, 13 patients (65%) had abnormal tracings, and 7 (35%) had normal EEG records. The most frequent abnormality found was a focal change, recorded in 12 patients, while the diffuse type was found in just one. Abnormal tracings, either at rest or during overventilation, were most frequently seen in 8 patients which had recurrent seizures, registered in a three years follow-up.

O bloqueio do gânglio estrelado nas tromboses e embolias cerebrais agudas

The author presents the results obtained by using the stellate ganglion block in 43 cases of acute cerebral vascular accidents. Thirty one patients had cerebral thrombosis with no complications, 5 had thrombosis complicated by cardiac decompensation and 7 had cerebral embolism. In all cases the blocks were made by using a one per cent solution of procaine hydrochloride and the ganglion was always reached using the anterior approach. The stellate blocks were always made as early as possible and repeated every 12 hours, at least during the first four days. The results obtained were considered according to the type of vascular accident and to the time between the onset of symptoms and the stellate block. The best results were obtained in those patients who received treatment within the first 16 hours after the onset of their symptoms. From 32 patients 20 showed immediate improvement after the first block and 31 patients showed marked improvement after the eighth block. Eight patients had the first stellate block between 17 and 24 hours after the onset of their symptoms; 2 showed immediate improvement and 4 had improved after the onset of their symptoms; 2 showed immediate improvement and 4 had improved after the eighth block. Two patients had the stellate block 24 or more hours after the onset of the symptoms and did not show any improvement. According to the type of vascular accidents, the best results were obtained in that group of uncomplicated thrombosis. From 31 patients 28 showed marked improvement at the fourth day of treatment. Two patients out of 5 with complicated thrombosis and 5 out of 7 with cerebral embolism had good recovery. Electroencephalogram were recorded in 11 cases immediately prior and 1 hour and 4 hours after the first stellate block. The correlation betweei* the changes in the EEG and the clinical picture was always present. The cerebral blood flow was obtained in 5 cases immediately prior and 5 hours after the first block. Even though 4 patients had presented clinical improvement only in one case the blood flow showed increase in its value after the first block. The author concludes thai the stellate block is the best treatment at present time for acute cerebral thrombosis and embolism.

A radioterapia profunda em doses elevadas na epilepsia focal: contrôle clínico e eletrencefalográfico

Radiotherapy in high doses has been used in cases of symptomatic epilepsy with the purpose of to act against the focal epileptic activity, as coadjuvancy to the common medical treatment. Patients with clinical manifestations of epilepsy in whom convulsive foci were demonstrated in the EEG, have been selected; these foci have been recognized as well localized and well circunscribed, and in all them the etiology has been the same (atrophic lesions), according to the clinical and radiological (craniogram, pneumoencephalogram and arteriogram) examinations. The purpose of a so homogenous group was to study the results to be obtained in similar conditions. Twenty patients have been selected from a group of forty-eight, because it was possible to obtain a good follow-up for at least three months in each case. In all cases, a medical treatment (barbiturate plus hidantoi-nate) has been used in uniform manner, with the purpose of avoiding influence on the judgement of the value of radiotherapy, for it was impossible to interrupt the drug therapy. Radiotherapy has been used in high doses over the epileptic lesion, which had been localized by the EEG. Two different techniques were used; in both 200 kv, 0.5 mm. filter of Cu were employed. Fourteen patients were irradiated in four different areas, of 4 cm. in diameter each one; they received 150 r daily, 2 areas by day, performing an average total of 3,000 r. In the other 6 cases the technique of kinetic convergent radiotherapy was employed, using the Siemens apparatus; each patient received, through a cutaneous area, an average doses of 3,000 r into the focus and 2,000 r in the skin; they received from 100 r to 150 r in the focus daily. Studying the twenty cases individually, there was marked EEG improvement in 4, relative improvement in 8 and no change in 8; there was marked decrease in the number of seizures in 8, relative decrease in 10 and no change in 2; the mental status was markedly improved in 7, relatively improved in 6 and not changed in 7. The authors call attentiori to the following points: a) Radiotherapy seems to act directyl over the focal electric activity, for there was marked improvement in 4 cases, and relative improvement in 8 cases, immediately after its use; in 2 cases there was exacerbation of the focal activity later; b) In all cases there was decrease in the number of seizures just after radiotherapy; it was not possible, however, to associate this improvement only to radiotherapy, for there was increase of seizures in 2 patients when medical treatment was stopped; c) There was improvement of mental status in 13 cases, although it is important to remember that there was also improvement of the cerebral physiology due to the decrease in number of seizures and improvement of the emotional status of the patient related to their better clinical conditions; d) There was no relation between the number of seizures and focal activity evidenced by the EEG; e) There was no relation between the intensity of cerebral focal activity and the mental status of the patient. The authors conclude: 1) Radiotherapy in high doses decrease the epileptic cerebral focal activity; 2) It is impossible to affirm that the clinical improvement is due to radiotherapy only; 2 patients had increase of focal activity far away from radiotherapy, and 2 others presented increase in the number of seizures when medical treatment was discontinued.