Luis Fabiano Marin

Epidemiology of primary and secondary headaches in a Brazilian tertiary-care center

OBJECTIVE To analyze the demographic features of the population sample, the time of headache complaint until first consultation and the diagnosis of primary and secondary headaches. METHOD 3328 patients were analyzed retrospectively and divided according to gender, age, race, school instruction, onset of headache until first consultation and diagnosis(ICHD-II, 2004). RESULTS Sex ratio (Female/Male) was 4:1, and the mean age was 40.7+/-15 years, without statistical differences between sexes. Approximately 65% of the patients were white and 55% had less than eight years of school instruction. Headache complaint until first consultation ranged from 1 to 5 years in 32.99% patients. The most prevalent diagnosis were migraine (37.98%), tension-type headache-TTH (22.65%) and cluster headache (2.73%). CONCLUSION There are few data on epidemiological features of headache clinic populations, mainly in developing countries. According to the literature, migraine was more frequent than TTH. It is noteworthy the low school instruction of this sample and time patient spent to seek for specialized attention. Hypnic headache syndrome was seen with an unusual frequency.

Bilateral horizontal gaze palsy with unilateral peripheral facial paralysis caused by pontine tegmentum infarction.

Clinical features of pontine infarction depend on the topography of vascular lesion and most remarkably sometimes the same topographic region can lead to different clinical syndromes (e.g., dorsal pontine tegmentum). In this report we describe an elderly patient with acute dorsal pontine infarction leading to a unique syndrome of bilateral horizontal gaze palsy and unilateral peripheral facial paralysis. We propose that this syndrome could be included as a part of a continuum that involves one-and-a-half syndrome, eight-and-a-half syndrome, and other variants of pontine tegmentum infarction.

Restless legs syndrome in post-polio syndrome: a series of 10 patients with demographic, clinical and laboratorial findings.

BACKGROUND Few studies have described the occurrence of restless legs syndrome in post-polio syndrome. METHODS We studied 10 consecutive patients with post-polio syndrome and symptoms of restless legs syndrome. We look at demographic, clinical and laboratorial data. RESULTS A remarkable finding was the concomitant onset of symptoms of both diseases, suggesting a possible underlying mechanism. Severity of restless legs symptoms was moderate to very severe. CONCLUSION Epidemiological studies with larger samples are needed to better establish the relationship and the incidence of restless legs syndrome in post-polio syndrome.

Circadian variation of fatigue in both patients with paralytic poliomyelitis and post-polio syndrome

OBJECTIVE It was to evaluate the degree of fatigue in patients with paralytic poliomyelitis (PP) and with post-polio syndrome (PPS), and correlate it with parameters of sleep and the circadian cycle. METHODS Thirty patients, 17 female (56.7%), participated in the study: they answered the Revised Piper Fatigue Scale and performed a nocturnal polysomnographic study. Eleven had PP (mean age±standard deviation of 47.9±6.4 years), and 19 had PPS (mean age±standard deviation of 46.4±5.6 years). RESULTS Our study showed that fatigue was worse in the afternoon in the PP Group and had a progressive increase throughout the day in the PPS Group. We also observed compromised quality of sleep in both groups, but no statically significant difference was found in the sleep parameters measured by polysomnography. CONCLUSION Fatigue has a well-defined circadian variation, especially in PPS Group. Poor sleep quality is associated with fatigue and, therefore, sleep disturbances should be evaluated and treated in this group of PPS.

Clinical correlates of the restless legs syndrome

OBJECTIVE To determine the clinical correlates of the restless legs syndrome (RLS) in a Brazilian sleep disorders center. METHODS We retrospectively studied 118 patients with RLS from January, 2004, to December, 2010. The analyzed variables were: age at disease onset, gender, race, years of school instruction, primary and secondary RLS, and treatment options. RESULTS Among the studied patients, 83.9% were women with a female/male sex ratio of 5:1. Mean age of the patients at symptom onset ± standard deviation was 41.7±17.9 years-old. The primary RLS was found in 85% of patients. The other 15% remainders consisted of secondary forms, and they were associated with neuropathy, iron deficiency anemia, end-stage renal disease, or Parkinsons disease. Drug therapy for RLS was introduced in 67% of patients. CONCLUSIONS Most patients presented primary RLS with an early disease onset. Further epidemiological studies are welcomed to provide better information on secondary RLS in Brazil.

Stabbing headache as the initial manifestation of herpetic meningoencephalitis

Stabbing headache (SH) is a short-lasting and painful headache that may happen as a primary headache, develop concurrent with other headache types, or may be associated with several conditions [1–3]. We describe a case of a woman who developed a SH as the first manifestation of herpes zoster (HZ) meningoencephalitis. A 79-year-old woman was admitted to the emergency department with a 1 day history of stabbing pain paroxysms in the right temporal and frontal regions lasting a few seconds (the duration of each stab was between 1 and 3 s). The stabs of pain started suddenly and were repetitive and very intense. Physical examination revealed itchy red macules, papules and vesicles on her right chest. Neurological examination showed spatial and temporal disorientation and neck stiffness, without altered consciousness or focal neurological signs. The cerebral spinal fluid (CSF) analysis revealed 106 leukocytes/mm (62% lymphocytes), protein: 63 mg/dL and glucose 52 mg/dL. Endovenous acyclovir treatment was promptly initiated (10 mg/kg/8 hourly). Brain magnetic resonance imaging and electroencephalogram were normal. Varicella zoster virus IgG by enzymelinked immunosorbent assay test in the CSF was positive. After 2 days of acyclovir treatment, the stabs of pain completely disappeared and 60 days after symptoms onset, the patient remained asymptomatic. To our knowledge, this is the first case reporting SH as the initial symptom of HZ meningoencephalitis, alongside with headache improvement after intravenous acyclovir. In previous studies, the authors were able only to report the association with HZ, but no direct relationship between SH and HZ meningoencephalitis [3]. Headache is one of the most frequent symptoms of HZ meningoencephalitis, usually characterized by severe pain [4, 5]. In our case, the headache characteristics were compatible with SH [1] that ameliorated with acyclovir, reinforcing its relationship with an infectious agent. Interestingly, another report showed a patient with herpes simplex encephalitis presenting with a migraine-like headache, which also improved after acyclovir therapy [6]. This case shows the importance of careful evaluation for underlying causes of SH, demonstrating that this uncommon type of headache may be the initial symptom of HZ meningoencephalitis, a potentially life-threatening disease without early recognition and prompt treatment.

Guillain-Barré syndrome associated with H1N1 vaccination

Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo SP, Brazil; Department of Neurology, Hospital e Maternidade Sao Camilo Pompeia, Sao Paulo SP, Brazil; Medical Student, Federal University of Sao Paulo, Sao Paulo SP, Brazil. Guillain-Barre syndrome (GBS) has been described as adverse event following different types of vaccines, such as influenza, varicella, polio virus and hepatitis B. Since 2009 with the emergence of the pandemic H1N1 influenza virus infection in humans, new vaccines have been developed for influenza A (H1N1) as a preventive strategy to reduce transmission, protect groups at increased risk of infection, and decrease complications and death. In this context, we report two adults who developed GBS after H1N1 immunization.

Clinical findings in Creutzfeldt-Jakob disease mimicking dementia with Lewy bodies

Chefe do Setor de Disturbios do Movimento da Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo SP, Brasil.Received 13 February 2008, received in final form 19 June 2008. Accepted 10 July 2008.Dr. Luis Fabiano Marin – Rua Maranhao 192 / 101 - 01240-000 Sao Paulo SP - Brasil. E-mail: luisfabianom@gmail.com

Frequency and clinical manifestations of post-poliomyelitis syndrome in a brazilian tertiary care center

OBJECTIVE To determine the frequency and clinical manifestations of patients with post-poliomyelitis syndrome (PPS) in a Brazilian division of neuromuscular disorders. METHODS A total of 167 patients with prior history of paralytic poliomyelitis was investigated for PPS, based on international diagnostic criteria. Other variables analyzed were: gender, race, age at poliomyelitis infection, age at PPS onset, and PPS symptoms. RESULTS One hundred and twenty-nine patients presented PPS, corresponding to 77.2% of the studied population. 62.8% were women and 37.2% were men. Mean age of patients with PPS at onset of PPS symptoms was 39.9±9.69 years. Their main clinical manifestations were: new weakness in the previously affected limbs (69%) and in the apparently not affected limbs (31%); joint pain (79.8%); fatigue (77.5%); muscle pain (76%); and cold intolerance (69.8%). CONCLUSIONS Most patients of our sample presented PPS. In Brazil, PPS frequency and clinical features are quite similar to those of other countries.

Sexual intercourse and masturbation: potential relief factors for restless legs syndrome?

To the Editor: Restless legs syndrome (RLS) is a distressing neurologic condition characterized by urgency to move the legs usually associated with unpleasant sensations in the lower limbs. The symptoms are worst at night and at rest, and patients must move their legs or walk to get relief from their symptoms [1]. Herein, we report a 41-year-old man with a history of severe RLS for 10 years causing him difficulty falling asleep and staying asleep. He fulfilled the four essential criteria established by the International RLS Study Group and he scored 32 in the International RLS Rating Scale [2]. The patient reported that he would get complete relief from RLS symptoms, granting him a normal sleep following sexual intercourse or masturbation. Pramipexole was introduced 2 h before bedtime with significant improvement of RLS symptoms, but whenever he was without medication, he returned to sexual behavior to get relief from RLS symptoms. There are anecdotal reports that sexual activity and orgasm may relieve RLS symptoms, although in some cases sexual activity may worsen RLS [3]. One may speculate that the release of orgasmrelated dopamine and opioid may play a role in the relief of RLS symptoms [4]. Additionally, there is a previous report of a RLS patient showing repetitive, rhythmic pelvic body movements resembling coital behavior at the wake–sleep transition [5].