José Geraldo Camargo Lima

Dengue: muscle biopsy findings in 15 patients

Dengue is known to produce a syndrome involving muscles, tendons and joints. The hallmark of this syndrome is severe myalgia but includes fever, cutaneous rash, and headache. The neuromuscular aspects of this infection are outlined only in isolated reports, and the muscle histopathological features during myalgia have not been described. In order to ascertain the actual neuromuscular involvement in dengue and better comprehend the histological nature of myalgia, we performed a clinical and neurological evaluation, a serum CPK level and a muscle biopsy (with histochemistry) in 15 patients (4 males), median age 23 years (range 14-47) with classic dengue fever, serologically confirmed, during the brazilian dengue epidemics from September 1986 to March 1987. All patients had a history of fever, headache and severe myalgia. Upon examination 4 had a cutaneous rash, 3 had fever, and 3 a small hepatomegaly. The neurological examination was unremarkable in all and included a manual muscle test. CPK was mildly elevated in only 3 patients. Muscle biopsy revealed a light to moderate perivascular mononuclear infiltrate in 12 patients and lipid accumulation in 11. Mild mitochondrial proliferation was seen in 3, few central nuclei in 3, rare foci of myonecrosis in 3, and 2 patients had type grouping. Dengue in our patients, produced myalgia but no detectable muscle weakness or other neuromuscular involvement. The main histopathological correlation with myalgia seems to be a perivascular mononuclear infiltrate and lipid accumulation.

Total sleep deprivation and Parkinson disease

Twelve Parkinson disease (PD) patients were submitted to a single night of total sleep deprivation (SD). Disease duration had a median of 5.1 years and all were using either anticholinergic or L-Dopa or the combination of both drugs. After SD there was an improvement of rigidity, bradykinesia, gait and posture disturbances and functional disability that remained significant for 2 weeks. No effect was observed on tremor. Concerning depressive symptoms, a significant difference was noted, that remained for one week. These results suggest that SD may be an useful procedure to improve PD symptomatology. It is discussed a possible change of dopaminergic receptors, induced by SD, to explain the improvement.

REM sleep deprivation in an experimental model of Parkinson's disease

Previous investigations have shown that REM sleep deprived (REM SD) rats display an enhanced response to dopamine agonists. This action seems to be mediated through a supersensitivity of dopamine post-synaptic receptors. Accordingly, REM SD was performed on rats with an experimental model of Parkinsons disease. The animals were bilaterally lesioned in the nigrostriatal pathway through a stereotaxically directed electrical current. Seven days after the surgery the animals were REM SD for 72 hours and immediately after the end of this period were observed in an open field for ambulation, rearing, grooming, and latency. In comparison with non-deprived rats there was a significant increase in ambulation and rearing, a response that appeared again after a second REM SD period on day 21th after the surgery. These data of improvement of two parameters of an experimental model of Parkinsons disease suggest that SD may be useful in this condition.

Ectasia da artéria basilar e acidente vascular cerebral: aspectos clínicos de 21 casos

A ectasia da arteria basilar (EB) e a dilatacao do calibre em toda ou parte de sua extensao, e/ou quando for anormalmente tortuosa em seu trajeto. As manifestacoes clinicas sao decorrentes de compressao de nervos cranianos, fenomeno isquemico ou hemorragico, sindrome de pseudo-tumor ou hidrocefalia. Procuramos descrever casos da associacao de EB e acidente vascular cerebral (AVC), analisar sua frequencia, aspectos clinicos e os mecanismos envolvidos nas diferentes formas de apresentacao clinica desta entidade. Encontramos 21 pacientes com AVC e EB. A associacao de EB e AVC foi prevalente em individuos do sexo masculino apos 50 anos. Os principais sintomas observados foram hemiparesia, alteracao de nervos cranianos e ataxia cerebelar. Na instalacao do AVC foram importantes as tonturas rotatorias e a cefaleia. Os infartos relacionados a EB puderam ser atribuidos a diferentes mecanismos: trombose da arteria, embolia arterio-arterial, efeito de massa com angulacao e obstrucao de ramos das arterias vertebrais e basilar.Ectasia of the basilar artery (EB) occurs when its diameter is greater than normal along all or part of its course, and/or when it is abnormally tortuous. EB may cause cranial nerve dysfunction, ischemic stroke or subarachnoid hemorrhage, pseudotumor or hydrocephalus. We tried to describe cases of stroke associated with EB, analyze its frequency, clinical aspects, and the mechanisms involved in different forms of its presentation. We found 21 patients with stroke and EB. The association between EB and stroke was more prevalent in males over the age of fifty. Main symptoms were hemiparesia, cranial nerves dysfunction, and cerebellar ataxia. Cerebral infarcts associated with EB were due to different mechanisms: arterial thrombosis, artery-to-artery embolism, mass effect with angulation and obstruction of the vertebral and basilar branches.

Atypical clinical and electroencephalographic pattern in a patient with subacute sclerosing panencephalitis

We describe an atypical clinical and electroencephalographic (EEG) pattern observed during the course of subacute sclerosing panencephalitis in a 14 year-old boy. In this patient with a two weeks history of partial complex seizures, the atypical EEG pattern was characterized by an initial left temporal focus which evolved to periodic lateralized epileptiform discharges (PLEDs) and, only during the 3rd and 4th weeks the typical bilateral and generalized periodic complexes appeared.

Juvenile systemic lupus erythematosus: neurological involvement

With the purpose of analyzing the neurological involvement due to systemic lupus erythematosus (SLE), we evaluated 17 female patients who were seen regularly at the hospital and had been diagnosed as having SLE according to classification criteria proposed by the American College of Rheumatology revised in 1982, before the age of 16. Neurological involvement was detected in 12 patients (71%): headache (35%), extrapyramidal syndrome (35%), epileptic syndrome (24%) pyramidal syndrome (24%), peripheral neuropathy (12%) and optic neuritis (6%). The findings of CT scan (58%) and cerebrospinal fluid (50%) were most closely correlated to clinical neurological involvement.

Agenesis and lipoma of corpus callosum: Case report

The agenesis and lipoma of the corpus callosum is a very rare association. We report the case of a 18-years old woman with rare epileptic seizures since the age of 6 years, normal neurological examination, as well as normal electroencephalogram. The brain computed tomography scanning and the magnetic resonance showed the lipoma and the agenesis of the corpus callosum.

Aspectos electrencefalográficos da cisticercose encefálica

The present study has the purpose of showing the possible value of the EEG in the diagnosis of brain cysticercosis. The diagnosis of cysticercosis was based on (1) radiological calcification, (2) characteristic spinal fluid findings (increase of cells, increase of eosinophils and positive test for cysticercosis) and/or (3) neurosurgical findings. The total number of cases was 118 (14 verified by surgical approach, 35 diagnosed by X ray examination and 42 by the spinal fluid examination) : in 16 cases there were association of surgical and spinal fluid positive findings; in 4 cases there were surgical findings and X ray positive findings; in 7 cases there were spinal fluid and radiological positive findings. The surgical cases were mostly of cysticercus of the posterior fossa because of the spinal fluid blocking that asks such therapy. The patients were divided according to the localization of the cysticercus (1) on the cortical surface, (2) at the base of the brain and the posterior fossa, and (3) diffuse cysticercosis. The localization of the cysticercus was possible by the evaluation of the clinical signs, the radiological calcification or the neurosurgical finding of the cysticercus. The EEG records were analysed according to the changes possibly due to the lesion caused by the cysticercus (chronic and diffuse meningo-encephalitis of the brain surface, arachnoiditis of the base and of the posterior fossa, inflammatory reaction inside the fourth ventricle, with subsequent spinal fluid blocking and intracranial hypertension). The analysis showed: 1 - Focal paroxysmal changes have indicated the great incidence of epileptic seizures in these patients; 2 - δ waves were more frequent when the lesion was located in the posterior fossa. The meningo-encephalitis on the cerebral surface did not show EEG signs of acute brain involvement; 3 - θ waves were seen very seldom and were present only on those patients with signs of basal or posterior fossa involvement (due to intracranial hypertension probably) due to involvement of mesencephalic structure; 4 - The normal EEG was very rare in patients with cerebral cysticercosis and did not give any information regarding the localization of the cysticercus; 5 - Changes on background activity (disorganization or discrete slow waves) have been noticed in all groups of patients; 6 - In patients with diffuse cerebral cysticercosis the EEG changes (disorganization on background activity, slow waves or signs of focal activity) did not show striking difference from those patients with localized cerebral cysticercosis; 7 - The calcified cysticercus on the cerebral surface (chronic cysticercosis) was coincident more often with focal activity on the EEG, than on the group of not calcified cysticercus (recent, cysticercosis); 8 - The incidence of pathological EEG was the same on both groups (calcified and non calcified cysticercosis). The EEG on the last group showed very often δ waves.

Tratamento da criptococose do sistema nervoso pelo Amphotericin B

The authors made a review of the diagnostic difficulties in meningoencephalitis by the Criptococcus neoformans, in vivo, today easier by special methods such as China ink and culture in the CSF. From their diagnosed 14 cases, 2 have been treated by Amphotericin B. The first was a chronic case with acute episodes which were less severe when Amphotericin B was used. This case has been alive for 20 months. The second case was an acute one with clinical and spinal fluid normalization and has a follow-up of 11 months. In both cases Amphotericin was used intravenously (50 mg in 500 ml of a solution of glycose at 5%) in the first case 4 series and in the second case 2 series. There were no complications. The authors consider that the use of Amphotericin B has given those cases a better prognosis.

Dipole reversal: an ictal feature in a patient with benign partial epilepsy of childhood with centrotemporal spike

We describe the case of a 15-year-old boy who had the diagnosis of benign partial epilepsy of childhood with centro-temporal spike. During the EEG a subclinical electrographic seizure was recorded. The discharges were clearly electropositive in T4 with positive phase reversal between derivations F8-T4 and T4-T6. The whole episode lasted less than one minute (45 sec). The interictal right medio-temporal spikes reemerged after 60 sec and were electronegative in the same location after the end of the electrographic seizures. The mechanisms underlying this uncommon pattern on EEG is not well established.