Marcelo Moraes Valença

IDIOPATHIC FACIAL PARALYSIS (BELL'S PALSY): A STUDY OF 180 PATIENTS

The objective of this study was to analyze some clinical and epidemiologic aspects, as well as the follow up of 180 patients with Bells palsy. In the study population there was a predominance of female (66.7%). Two peaks of incidence in the age distribution were identified: third-fourth and sixth decades of life. In the group of 180 patients there were 198 events of facial paralysis, 17 recurrences and in one patient the paralysis was bilateral at the onset. In 15 patients (8.3%) there were recurrences of the facial paralysis, in 12 cases (70.6%) the recurrences were ipsilateral. The left side of the face was involved in 55.6% of the cases. In eight patients the paralysis occurred during pregnancy (n=5) or puerperium (n=3). As associated conditions we found: arterial hypertension (11.7%), diabetes mellitus (11.1%), pregnancy or puerperium (4.4%; 6.7% in the women), and neurocysticercosis (1.1%). In 72.8% of the cases no association with such conditions was found. In 22.8% of the patients some kind of sequelae were identified: hemifacial spasm (12.8%), partial recovery of the motor deficit (10.6%), syndrome of the crocodile tears (3.3%), sincinetic contraction (2.8%), and the Marcus Gunn inverse phenomenon (1.1%). In conclusion, this study shows that the idiopathic facial paralysis may lead to important sequelae in more than 20% of the patients.

Computed tomography scan of the head in patients with migraine or tension-type headache

A retrospective study was performed in order to evaluate the frequency of abnormalities found by computed tomography (CT) scan of the head in 78 patients with migraine or tension-type headache. In the present study CT scan was normal in 61.5% of the patients with migraine or tension-type headache. A number of abnormalities were encountered in more than one third of the patients studied, including inflammatory sinus disease (19.2%), cysticercosis (3.9%), unruptured cerebral aneurysm (2.6%), basilar impression (2.6%), intracranial lipoma (2.6%), arachnoid cyst (2.6%), empty sella (2.6%), intracranial neoplasm (2.6%), and others (2.6%). None of these lesions were symptomatic or responsible by the headache picture, therefore, considered incidental findings. In conclusion, the fortuitous encounter of some abnormalities on CT scan of the head is often higher than what we could predict in patients suffering migraine or tension-type headache. We briefly discuss clinical, epidemiologic, and practical management of some of the abnormalities detected by CT scan as well as the indication to request a neuroimaging investigation.

Role of Substance P in the Medial Preoptic Area in the Regulation of Gonadotropin and Prolactin Secretion in Normal or Orchidectomized Rats

The present studies were designed to evaluate the role of substance P (SP) in the control of the release of luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin (PRL). SP was microinjected into the medial preoptic area (MPOA) of conscious, freely moving intact or orchidectomized (ORCX; 21 days post-ORCX) adult male rats. Microinjection of SP into the MPOA induced a significant decrease in plasma LH and FSH concentrations, effects which were accompanied by an elevation in plasma PRL concentration. To examine the participation of endogenously secreted SP in the activity of the MPOA neurons controlling release of these cited pituitary hormones, another study was performed in which either a potent and specific antagonist to SP (D-Pro2, D-Trip7,9-SP; SP-ANT) or an antibody against SP (SP-AB), was injected into the MPOA. SP-ANT and SP-AB both elevated plasma LH, FSH and decreased plasma PRL concentration. These data suggest that endogenous SP within the MPOA exerts an important inhibitory tonus over LH and FSH release and an excitatory tonus over PRL release. In conclusion, SP seems to participate as a neurotransmitter or neuromodulater in the control of LH, FSH and PRL secretion, at least in part, by acting at the level of MPOA, a region in which the neuronal cell bodies that produce LH-releasing hormone and the associated gonadotropin-releasing hormone-associated peptide are located.

Inhibitory role of cholinergic agonists on testosterone secretion by purified rat Leydig cells

The effects of cholinometics on basal or hCG-induced testosterone (T) release by Percoll-purified Leydig cells of the rat were studied. Acetylcholine and carbachol as well as nicotine decreased basal and hCG-induced T secretion. The ganglionic nicotine antagonist hexamethonium promoted a partial reversal of the inhibitory effect of nicotine on basal or hCG-stimulated T secretion. Atropine also reduced the inhibitory effect of carbachol on basal or stimulated androgen release. These data indicate that, in short-term incubations, testosterone released by purified Leydig cells is inhibited by nicotinic and muscarinic cholinergic agonists, thus supporting the hypothesis that parasympathetic autonomic system may be involved in the negative regulation of testicular androgen secretion.

An Innovative Technique of Decompressive Craniectomy for Acute Ischemic Stroke

Currently, malignant hemispheric infarction is one of the main indications for DH (Chen et al., 2006; Delashaw et al., 1990; Rengachary et al., 1981; Schwab et al., 1998; Merenda & DeGeorgia, 2010) either when the intracranial hypertension does not respond to conservative therapies (i.e., osmotic therapy, hyperventilation, etc.); or when there is an important brain shift of the midline structures, or both (Gerriets et al., 2001).