Search

Foram analisados os perfis eletroforéticos das proteínas dos líquidos contidos em cistos de astrocitoma (13 casos) e de glioblastoma multiforme (10 casos), sendo os resultados comparados àqueles obtidos nos líquidos de cistos de craniofariogeoma (7 casos) e de coleções subdurais de origem inflamatória (12 casos). Considerando a participação da albumina no perfil protêico eqüivalente à unidade, foi calculada a participação de cada globulina segundo os grupos de casos. Em relação aos dados obtidos para as coleções subdurais, foi verificado que nos LCT de glioblastomas multiformes era maior a participação da globulina gama, comparável à encontrada no LCT de craniofaringeomas e que, nos LCT de astrocitomas, era menor a participação das globulinas alfa-1 e alfa-2. Esta última verificação se mostrou altamente significativa quando comparada à participação dessas globulinas no LCT de astrocitomas e de glioblastomas. Os dados obtidos foram discutidos, permitindo atribuir as diferenças encontradas especialmente a fatôres locais, relacionados à diferente constituição das paredes dos cistos nos astrocitomas e nos glioblastomas multiformes. The differences in the protein composition of cyst fluids from tumors of the central nervous system have been explained by the conditions in which the exchanges between the blood and the cyst fluid occur as well by metabolic aspects related to the malignancy of the tumor cells. In order to explore the influence of these factors the protein fractions from cyst fluids of astrocytoma (13 cases) and from glioblastoma multiforme (10 cases) were studied and the results were compared to those obtained for the protein fractions of two other series of cases: the first was represented by the results obtained for protein fractions of cyst fluids from craneopharyngeoma (7 cases) and, the second, by those concerning to the fluids from inflammatory subdural collections (12 cases). The protein fractions were studied by paper electrophoresis and the results are presented in table 1. The participation of each globulin fraction was calculated and the unit for comparison was the percent value of the albumin fraction for each given case and the mean values and their standard deviations are presented in table 2. The data were discussed and it was possible to show that the differences found are more able to be explained on the basis of the conditions in which the protein exchanges between blood and cyst fluid occur possibly related to the structural characteristics of the wall of the cysts.

Tendo como objetivo analisar a hiperproteinorraquia que ocorre na neuropatia diabética, foi estudado o proteinograma do LCR de 22 pacientes portadores dessa afecção. Para fins comparativos, em 17 dêles foi feito na mesma ocasião o estudo do proteinograma do sôro. A sintomatologia neurológica foi avaliada de modo semiquantitativo. Foi verificado aumento discreto da concentração protêica total do LCR em 7 casos (32%). O perfil eletroforético (eletroforese em papel) das proteínas foi do tipo encontrado no LCR normal, em todos os casos. Discretas alterações quanto ao teor de uma ou outra fração foram registradas. O perfil protêico não apresentava particularidades relacionadas ao fato de ser normal ou aumentada a concentração protêica total do LCR. A relação entre a percentagem no LCR e no sôro de cada uma das frações mostrou alterações do balanço protêico entre LCR e sôro. As alterações eram devidas a modificações globulínicas do proteinograma do sôro. Não foi encontrada correlação significativa entre a concentração protêica do LCR e a do sôro. O resultado da avaliação semiquantitativa da sintomatologia neurológica de cada caso foi correlacionado à concentração protêica total e de cada fração protêica do LCR. Não foi demonstrada correlação estatisticamente significante entre os dados analisados. Entretanto, os valôres obtidos sugerem: correlação da proteinorraquia total com a sintomatologia neurológica; dentre as frações protêicas, maior participação da globulina nessa correlação. Em vista dos resultados obtidos para os casos estudados, os autores consideram que o aumento da proteinorraquia total na neuropatia diabética não pode ser pôsto na dependência de alterações peculiares a uma ou outra fração protêca do LCR. Igualmente, não depende de modificações do proteinograma do sôro e não pode ser explicado em função direta da intensidade do quadro neurológico. É discutida a possibilidade de estar a hiperproteinorraquia relacionada às alterações da barreira hemoliquórica, secundárias às lesões vasculares que acompanham o diabetes mellitus. The present study was carried out in order to investigate the nature of the increase in the cerebrospinal fluid (CSF) protein content described in diabetic neuropathy. The CSF proteins were studied in 22 patients with clinical signs of diabetic neuropathy. The total protein content and the electrophoretic pattern (paper electrophoresis) of the proteins were studied in one CSF sample of each patient. The CSF sample was collected through lumbar puncture. For comparative purposes, the total protein content and the electrophoretic pattern of the blood serum proteins were determined in 17 patients. For the same purpose the impairment of the nervous system was evaluated in a semi-quantitative way. The CSF protein concentration was increased in 7 cases (32%). The increases were slight. The electrophoretic patterns were found to be similar to those found in normal conditions. The relative values found for each of the protein fractions were increased in some instances. Such increases were slight and did not change the protein pattern of the CSF. Among these changes, that regarding the y-globulin was observed in 3 cases. The CSF protein pattern did not show changes related to the total protein content of the sample. Changes in the serum protein pattern did not induce changes in the CSF protein pattern. The correlation between the total protein content of CSF and serum was not statistically significant. In the cases studied no statistically significant correlation between the degree of neurological involvement and the CSF proteins was found. However, the data suggest a trend to correlation between the neurological picture and the total protein content of the CSF, particularly with β-globulin.The results show that the increase in the total protein content of the CSF in diabetic neuropathy is not related to changes regarding one or more of the protein fractions of CSF. It is not dependent also on the protein concentration in the blood serum and/or the changes found in its protein pattern. The degree of the nervous impairment in itself cannot be directly related to the increase in the CSF proteins. The importance of damage in the blood-CSF barrier is pointed out by data of the literature concerning the protein fractions in diabetic patients. Such damage cannot be excluded in the discussion of the results found. Its presence would enhance the passage of proteins to the CSF, thus resulting an increase in the total protein content. Changes in the protein pattern in such conditions are absent or slight, as it was found in the cases studied.

Estudo do perfil eletroforético das frações protêicas de líquidos de cistos de tumores do sistema nervoso central (6 astrocitomas, um ependimoma, um meningeoma e dois craniofaringeomas). Os achados foram homogêneos para o grupo de astrocitomas, caracterizando-se por elevado teor albumínimo e pequeno teor de α-globulinas. Em relação às proteínas destes líquidos císticos, que constituem o maior grupo estudado, foi encontrado comportamento variável para os líquidos dos outros tipos de tumor: o perfil eletroforético apresentava caracteres semelhantes no caso de ependimoma e diversos nos demais. Estas diferenças se caracterizam especialmente por um teor albumínico menor, achado mais evidente nos casos de craniofaringeoma. Os achados comprovam o valor do estudo eletroforético das proteínas dos líquidos de cistos de tumores do S.N.C, e apontam a possibilidade de serem obtidos dados para compreender a patogenia dessas coleções líqüidas e para auxiliar no diagnóstico da espécie do tumor. The protein fractions of 10 fluids from cysts associated with tumours of the central nervous system were studied by paper electrophoresis; histologic diagnosis were those of astrocitoma (6 cases), ependimoma (one case), meningioma (one case) and craniopharyngioma (two cases). Results of electrophoretic analysis are summarised in table 2. The findings concerning astrocitomas were similar, specially when albumin and α-globulins were considered; in comparison to blood serum protein fractions, albumin content was found to be elevated and α-globulins content to be low. Differences among this group and the other cases of this series are illustrated in chart 4; the albumin content was lower in the case of meningioma and in those of craniopharyngioma; the low concentration of α-globulins was not found in these cases. Electrophoretic findings showed similar results in the case of ependimoma cyst fluid when compared to those of astrocitoma. Considerations are traced on the importance of systematic analysis of protein fractions of these cyst fluids and its significance as a diagnostic aid.

Background: Dystonia is a heterogeneous disorder that, when refractory to medical treatment, may have a favorable response to deep brain stimulation (DBS). A practical way to have an overview of a research domain is through a bibliometric analysis, as it makes it more accessible for researchers and others outside the field to have an idea of its directions and needs. Objective: To analyze the 100 most cited articles in the use of DBS for dystonia treatment in the last 30 years. Methods: The research protocol was performed in June 2019 in Elsevier’s Scopus database, by retrieving the most cited articles regarding DBS in dystonia. We analyzed authors, year of publication, country, affiliation, and targets of DBS. Results: Articles are mainly published in Movement Disorders (19%), Journal of Neurosurgery (9%), and Neurology (9%). European countries offer significant contributions (57% of our sample). France (192.5 citations/paper) and Germany (144.1 citations/paper) have the highest citation rates of all countries. The United States contributes with 31% of the articles, with 129.8 citations/paper. The publications are focused on General outcomes (46%), followed by Long-term outcomes (12.5%), and Complications (11%), and the leading type of dystonia researched is idiopathic or inherited, isolated, segmental or generalized dystonia, with 27% of articles and 204.3 citations/paper. Conclusions: DBS in dystonia research is mainly published in a handful of scientific journals and focused on the outcomes of the surgery in idiopathic or inherited, isolated, segmental or generalized dystonia, and with globus pallidus internus as the main DBS target. RESUMO Introdução: A distonia é uma doença heterogênea que, quando refratária ao tratamento medicamentoso, pode ter uma resposta favorável à estimulação encefálica profunda (EEP). Uma forma prática de ter uma visão desta área de pesquisa é por meio de análise bibliométrica, pois permite aos pesquisadores e terceiros a terem uma ideia das tendências e necessidades da área. Objetivo: Analisar os 100 artigos mais citados no tratamento de distonia pelo uso de EEP nos últimos 30 anos. Métodos: O protocolo de pesquisa foi realizado em junho de 2019 através da base de dados Scopus da Elsevier, em que se obteve os artigos mais citados na área de tratamento de distonia com EEP. Analisaram-se variáveis como autores, ano de publicação, país, afiliação, e alvos de EEP. Resultados: Os artigos foram principalmente publicados principalmente na Movement Disorders (19%), no Journal of Neurosurgery (9%), e na Neurology (9%). Os países europeus oferecem contribuições significativas (57% da amostra). A França (192,5 citações/artigo) e a Alemanha (144,1 citações/artigo) possuem as mais altas taxas de citações dentre todos os países. Os Estados Unidos contribuem com 31% dos artigos da amostra (129,8 citações/artigo). As publicações focaram em Desfechos gerais (46%), seguido de Desfechos a longo prazo (12,5%), e Complicações (11%). O principal tipo de distonia pesquisado foi distonia generalizada ou segmentar, idiopática ou hereditária, isolada, abrangendo 27% dos artigos e 204,3 citações/artigo. Conclusões: A pesquisa de EEP em distonia é publicada em seletos periódicos científicos e foca nos desfechos da cirurgia, nas distonias generalizadas ou segmentares, idiopáticas ou hereditárias, isoladas, sendo o globus pallidus internus o principal alvo da EEP.

Multiple sclerosis (MS) is a chronic neurological disease that typically affects young adults. A recent publication suggested that MS might originate from insufficient blood drainage in certain areas of the central nervous system. The condition was named chronic cerebrospinal venous insufficiency (CCSVI). Other papers have not confirmed these findings and, therefore, the matter remains controversial. Nineteen months after the original publication on CCSVI and MS, another 22 papers have been published addressing the matter. No clinical trials have been carried out on the subject and there is no evidence-based indication to perform surgical vascular procedures in MS patients. However, over the same nineteen-month period, the internet discussion on the subject of CCSVI and MS has led to countless websites advertising treatment using vascular surgery for patients with MS all over the world. The treatment based on the CCSVI theory has appealingly been called "liberation treatment", thus making it difficult to explain to patients why a treatment that has been highly praised (on the internet) cannot be recommended based on partial medical results that await confirmation.

The author presents a report of the first meeting of the Brazilian Academy of Neurology, which took place in Curitiba, Paraná, 45 years ago, between June 30 and July 05, 1963. A total of 103 papers were presented in the scientific sessions, predominantly in the following sub-areas: epilepsy, brain neoplasia, vascular diseases of the brain and infections of the nervous system. The São Paulo and Rio de Janeiro schools presented 85.43% of these scientific papers. Twenty-two Brazilian Congress of Neurology have been held in the 45 years since the first meeting of the BAN.

Studies on peripheral neuropathies by investigators residing in the State of Sao Paulo, Brazil, and published since the 1930 and 1940 decades until 1985 were revised in the present survey. Investigations in the area were greatly encouraged by the appearance of the journal Arquivos de Neuro-Psiquiatria(Sao Paulo). Oswaldo Freitas Juliao may be considered the author who began these studies in the State and his most important contributions were related to leprosy and to Andrade disease, although he also published papers on other types of peripheral neuropathies. Horacio Martins Canelas also made a very important contribution to the study of different neuropathies, especially those due to vitamin B12 deficiency. A series of papers on neuropathies published by neurologists residing in the State is summarized. We also present a catalogue of the major university centers where groups of neurologists preferentially devote their time to the study of neuromuscular disease in Sao Paulo and a selected bibliography about neuropathies by investigators from this State.

OBJECTIVE: Early neurodevelopment disabilities (END) such as cerebral palsy (CP), deafness, blindness, epilepsy, and mental retardation (MR) are very important public health concerns. Although no strong data on END can be obtained in Mexico, the few papers concerning END epidemiology deserve systematic and critical review. Thus, this was the objective of the present paper. METHOD: We performed a systematic review of papers published reporting on the prevalence of END in Mexico. We performed a search in several medical data bases such as PubMed, Artemisa, ImBioMed, and LiLaCS. Each paper was downloaded, read and discussed. We only selected papers published between 1999 and 2008. RESULTS: No data on CP and epilepsy prevalence in infants have been found. Data on deafness prevalence report hearing loss in 0.65/1,000 healthy newborns, and in 2.6/100 in high-risk very premature infants. With regard to blindness, prevalence of retinopathy of premature infants in any stage was reported at ca 10.61 and 22.2/100 in high-risk premature infants. Congenital hypothyroidism (CH) prevalence in infants was found in 4.2/10,000 live newborns after a national universal screening survey. CONCLUSION: No universal data regarding the prevalence of END in Mexico have been investigated, with the exception of CH. Mexico needs more research to determine epidemiologic data focused on designing actions to prevent, treat, and rehabilitate END.

Tectal plate is a rare location for a tumor. Many papers have described different types of pathology arising in that location including tumors, vascular lesions, inflamatory and infectious processes. In this paper we describe our experience in treating seven patients with tectal plate lesions, with different ages and types of pathology: five patients presented with low grade gliomas, one with lung cancer metastasis and the last presenting with a tectal plate cavernoma. Open surgery was performed in three cases (due to tumor enlargement or need for the exact diagnosis). In the other cases, the treatment of non-comunicating hydrocephalus was the only treatment employed. The prognosis is of course dependent on the underlining pathology. In our series, except in the metastatic tumor case and the cavernoma, the other types of lesion consisted of low grade gliomas. These lesions represent a different type of brain stem tumor sharing a common good prognosis, with a benign behavior. We believe that tectal tumors must be managed case by case. When a patient presents with a benign lesions in the tectal region, treating the main symptom - hydrocephalus - should be the first attempt in management of these lesions. Tumores na região do teto mesencefálico são raros. Vários tipos de lesões como tumores, lesões vasculares, inflamatórias e infecciosas localizam-se nesta região. Nós revimos o tratamento adotado em sete pacientes com diferentes tipos de lesões tectais: cinco pacientes apresentando gliomas de baixo grau, um paciente com lesão metastática proveniente de câncer de pulmão e um com cavernoma. O tratamento cirúrgico com abordagem direta da lesão foi realizado em três casos (devido ao aumento do volume tumoral ou quando houve necessidade da confirmação diagnóstica). Nos demais casos o tratamento para a hidrocefalia não-comunicante foi o método empregado. O prognóstico dessas lesões é baseado no tipo de patologia em questão. Em nossa série, com exceção do caso de metástase e do paciente com cavernoma, as demais lesões foram gliomas de baixo grau. Estas lesões representam um subgrupo diferenciado de tumores de tronco encefálico, apresentando bom prognóstico e tendo comportamento benigno com sobrevida elevada. Acreditamos que tumores da região tectal devam ser avaliados caso a caso. Na hipótese diagnóstica de uma lesão benigna, o tratamento do principal complexo sindrômico - hidrocefalia não-comunicante - é provavelmente a melhor conduta a ser empregada.

This paper reviews some aspects of the life and work of Professor Johann Friedrich Horner, on the occasion of the 190th anniversary of his birthday and 152 years after the publication of “Uber eine Form von Ptosis”. It also shows the importance of the historical description of ptosis, myosis and anhidrosis associating those symptoms with sympathetic cervical damage. He pharmacologically confirmed the impairment of sympathetic innervation to the eye and preserved parasympathetic function. Horner syndrome: tribute to Professor Horner [...]

Dear editors, In his recent paper published in this journal, Matas addresses one important and well-studied aspect of postdural puncture headache prevention, i.e., the use of atraumatic spinal needles. On the other hand, when focusing on standard post-lumbar puncture recommendations, particularly 24 hours bed rest and controlled fluid ingestion, the author refers to four papers in which not only these recommendations are not enforced but, indeed, are explicitly disregarded – as in the case of bed rest – or, at least, considered as unproved, as in the case of fluid ingestion. Although a remark is made about the lack of “experimental support” to the above recommendations, the author does not mention the existence of positive evidence showing the lack of effect of post-lumbar puncture bed rest on the incidence of post-puncture headache, gathered during the last years and analyzed in recent systematic and non systematic reviews. Considering that the inefficacy of these measures had by now been consistently demonstrated by consecutive prospective trials, as already acknowledged by the headache community, we think that scientific evidence must prevail and the standard bed rest and fluid intake advices following lumbar puncture should be abandoned, instead of reinforced.

Epilepsy is one of the most dreaded and terrifying human afflictions. One of the many names it has received was Sacred Disease, during Greek times. Heracles served as a source of the divine connotation that epilepsy received in ancient times, as he was one of the most important demigods in Greek mythology. However, several authors have attributed Heracles’ actions to a seizure, including Hippocrates, who described the sacred disease on his “Corpus Hippocraticum.” This paper reviewed some of the publications on the myth and content of the text of Hippocrates, in relation to the current knowledge of the disease.

Central alveolar hypoventilation syndrome has been known for decades as Ondine’s curse. It was named as such after a German myth. Although most of the stories resemble one another, word of mouth has led to misinterpretation of this tale among the medical community. The present paper reviews the original narrative, its characters, and how it is linked to the most relevant aspects of the disease. RESUMEN El síndrome de hipoventilación alveolar central (por sus siglas en inglés) se conoce desde hace décadas como la maldición de Ondine. Fue nombrado como tal por un antiguo mito alemán. Aunque la mayoría de las historias se parecen, la tradición oral ha llevado a una mala interpretación de esta historia entre la comunidad médica. El presente artículo revisa la narrativa original, sus personajes y su relación con los aspectos más relevantes de la enfermedad.

A brief history of the syndrome discovered by Andreas Rett is reported in this paper. Although having been described in 1966, the syndrome was only recognized by the international community after a report by Hagberg et al. in 1983. Soon, its importance was evident as a relatively frequent cause of severe encephalopathy among girls. From the beginning it was difficult to explain the absence of male patients and the almost total predominance of sporadic cases (99%), with very few familial cases. For these reasons, it was particularly difficult to investigate this condition until 1997, when a particular Brazilian family greatly helped in the final discovery of the gene, and in the clarification of its genetic mechanism. Brief references are made to the importance of the MECP2 gene, 18 years later, as well as to its role in synaptogenesis and future prospects. RESUMO Uma breve história de uma síndrome neurológica descoberta por Andreas Rett é relatada neste artigo. Embora tenha ocorrido em 1966, a síndrome só foi reconhecida pela comunidade internacional após um relato de Hagberget al, em 1983. Logo, sua importância ficou evidente como causa relativamente frequente de encefalopatia grave entre as crianças do sexo feminino. Desde o início, foi difícil explicar a ausência de envolvimento de pacientes do sexo masculino e a quase absoluta preponderância de casos esporádicos (99%), com muitos poucos casos familiares. Por essas razões, foi difícil investigar essa condição até 1997, quando uma família brasileira em particular ajudou muito na descoberta final do gene e no esclarecimento de seu mecanismo genético. São feitas referências sucintas à importância do gene MECP2, dezoito anos depois, bem como ao seu papel na sinaptogênese e nas perspectivas futuras.

Introduction: Although the 2019 severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2, COVID-19) pandemic poses new challenges to the healthcare system to provide support for thousands of patients, there is special concern about common medical emergencies, such as stroke, that will continue to occur and will require adequate treatment. The allocation of both material and human resources to fight the pandemic cannot overshadow the care for acute stroke, a time-sensitive emergency that with an inefficient treatment will further increase mortality and long-term disability. Objective: This paper summarizes the recommendations from the Scientific Department on Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Society of Cerebrovascular Diseases and the Brazilian Society of Neuroradiology for management of acute stroke and urgent neuro-interventional procedures during the COVID-19 pandemic, including proper use of screening tools, personal protective equipment (for patients and health professionals), and patient allocation.

Objective: The treatment of multiple sclerosis (MS) has quickly evolved from a time when controlling clinical relapses would suffice, to the present day, when complete disease control is expected. Measurement of brain volume is still at an early stage to be indicative of therapeutic decisions in MS. Methods: This paper provides a critical review of potential biases and artifacts in brain measurement in the follow-up of patients with MS. Results: Clinical conditions (such as hydration or ovulation), time of the day, type of magnetic resonance machine (manufacturer and potency), brain volume artifacts and different platforms for volumetric assessment of the brain can induce variations that exceed the acceptable physiological rate of annual loss of brain volume. Conclusion: Although potentially extremely valuable, brain volume measurement still has to be regarded with caution in MS.Keywords: multiple sclerosis; brain; atrophy; gray matter. RESUMO Objetivo: O tratamento da esclerose multipla (EM) evoluiu rapidamente de um tempo onde o controle clinico dos surtos era suficiente para o momento atual, quando se almeja o completo controle da doenca. Medidas de volume cerebral ainda estao em fases iniciais para utilizacao nas decisoes terapeuticas na EM. Metodos: Este artigo fornece uma revisao critica de potenciais vieses e artefatos na volumetria cerebral utilizada no seguimento de pacientes com EM. Resultados: Condicoes clinicas (como hidratacao ou ovulacao), hora do dia, tipo de maquina de ressonância magnetica (fabricante e forca do campo) artefatos de volume e diferentes plataformas de avaliacao volumetrica cerebral podem induzir variacoes que excedem a taxa aceitavel de perda anual fisiologica do volume cerebral. Conclusao: Embora seja potencialmente de grande valor, a medida de volume cerebral ainda deve ser vista com cautela na EM.Palavras-chave: esclerose multipla; encefalo; atrofia; substância cinzenta.

Epilepsy is a potentially devastating brain disorder characterized by a predisposition to spontaneous epileptic seizures. In patients with medically refractory epilepsy, new non-pharmacological therapeutic approaches may be considered. In this scenario, palliative surgery such as vagus nerve stimulation (VNS) or deep brain stimulation (DBS) may be indicated in a subset of patients. In this paper we make recommendations for the use of VNS and DBS in patients in Brazil with refractory epilepsy.

Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with intractable epilepsy. Probably, optimization of seizure control will prevent some of these deaths. Briefly, we integrated in this paper some data about the epidemiology, risk factors, etiology, and preventative measures in the management of SUDEP. RESUMO A morte súbita nas epilepsias (SUDEP) é a causa mais comum de morte em indivíduos com epilepsia refratária. Provavelmente, o controle das crises epilépticas irá evitar algumas dessas mortes. Resumidamente, nós descrevemos nesse artigo alguns dados sobre a epidemiologia, fatores de risco, etiologia e medidas preventivas na SUDEP.

Objectives: To explore the relationship between severe/serious mental illness (SMI) and the behavioral variant of frontotemporal dementia (bvFTD), as the patterns of symptoms and cognitive performance that characterize both disorders share similarities. Methods: We performed a systematic review investigating what has already been published regarding the relationship between bvFTD and SMI. Studies were selected from PubMed and LILACS databases, including those published up to February 12, 2018. The search strategy included the following terms: “frontotemporal dementia” plus “bipolar”, OR “frontotemporal dementia” plus “schizophrenia”, OR “frontotemporal dementia” plus “schizoaffective”. Publications without abstracts, case reports with absent genetic or histopathological confirmation, reviews and non-English language papers were excluded across the search process. Results: The search on PubMed retrieved 186 articles, of which 42 met eligibility criteria. On the LILACS database, none met the requirements. Generally, three major research aims were identified: 1) to look for frontotemporal lobar degeneration-associated genetic abnormalities in patients with prior SMI; 2) to compare the cognitive profile between patients affected by neurodegenerative disorders and schizophrenic patients; 3) to highlight the association between bvFTD and preceding psychiatric conditions and/or distinguish them both. The investigated mutations were found infrequently in the studied SMI samples. Cross-sectional studies comparing cognitive performance between bvFTD and psychiatric disorders mostly found no remarkable differences. There were only a few case reports identifying definite frontotemporal lobar degeneration in patients with previous psychiatric diagnoses. Conclusions: The available evidence demonstrates how fragile the current understanding is regarding the association between bvFTD and prior SMI.

Patients with epilepsy face innumerable obstacles in daily life, related to work, permission to drive and interpersonal relationships, which require medical guidance. This paper reports a literature review based on scientific articles and civil and traffic system, as a way to resolve doubts about medical obligations in the patient’s permission to drive and work. An employment agreement requires the contractor to guarantee safety conditions as well as requiring the patient, at the pre-employment medical examination, to let the physician know previous medical conditions, including epilepsy. More than 90% of patients with epilepsy omit this information during the application assessment, thus being subject to imputation of ideological falsehood crime as disposied on article 299 of Brazilian Penal Code. Medical confidentiality breaches may only occur in specific situations. In Brazil, the authorization and driver’s license renewal is governed by the Brazilian Traffic Code (Federal Law n° 9503/1997). For patient evaluations, two groups are considered: those on antiepileptic medication and those on medication withdrawal. A favorable report from the attending physician is also required, in both categories. Seizures that occur exclusively during sleep, and focal aware events or prolonged aura are not differentiated from other seizure types disposed in the traffic law. It is the responsibility of the attending physician to analyze each patient individually to resolve conflicts between public safety and the individual patient’s independence. A frank and honest doctor-patient relationship is essential for the patient to understand the public and individual consequences of epileptic seizures and to feel comfortable seeking medical help. RESUMO O paciente com epilepsia enfrenta inúmeros impasses na vida diária, relacionados à autorização para dirigir e relações interpessoais, os quais requerem orientação médica. Este artigo apresenta revisão bibliográfica baseada em artigos científicos e nas legislações cível e de trânsito brasileiras, como forma de solucionar dúvidas que envolvam obrigações médicas na permissão do paciente para dirigir e trabalhar. A admissão do trabalhador exige que o contratante garanta condições de segurança, além da necessidade do paciente, no exame de admissão, informar ao médico as condições médicas prévias, inclusive a epilepsia. Mais de 90% dos pacientes com epilepsia omitem essas informações na avaliação de aptidão, podendo consequentemente, estarem sujeitos à imputação de crime de falsidade ideológica (artigo 299 do Código Penal brasileiro). A violação do sigilo médico pode ocorrer apenas em situações específicas. No Brasil, a autorização e a renovação da carteira de habilitação são regidas pelo Código de Trânsito (Lei Federal n° 9503/1997). Para avaliação dos pacientes, dois grupos são considerados: aqueles em uso de medicação antiepiléptica e aqueles em retirada de medicação. É também necessária a opinião favorável do médico assistente, em ambas as categorias. As convulsões que ocorrem exclusivamente durante o sono, eventos focais perceptivos ou com aura prolongada não são diferenciadas de outros tipos de crises no Código de Trânsito Brasileiro. É responsabilidade do médico assistente analisar cada caso para resolver conflitos entre segurança pública e independência do paciente. Um relacionamento médico-paciente franco e honesto é essencial para que o paciente entenda as consequências individuais e coletivas das crises epilépticas e se sinta à vontade para procurar ajuda médica.

Cerebrospinal fluid (CSF) changes in brain cysticercosis have long been known. Its characteristic features are a mild or moderate pleocytosis with eosinophils, a slight or moderate protein increase with an elevated gammaglobulin concentration, and a positive complement fixation test. Unfortunately all these abnormalities are not always present together and difficulties may be encountered in the diagnosis. This paper presents a study based on the experience acquired in the CSF Laboratory of the Neurological Department of Escola Paulista de Medicina (Sao Paulo, Brasil) after 35 years' work, and 120.000 CSF specimens examined. The material consists of 147 cases of brain cysticercosis confirmed by necropsy, surgery, subcutaneous or intraocular cysticercus, x ray of the skull, and of 509 clinical observation with suggestive CSF changes. It is the purpose of this paper to appreciate the importance of each of the CSF tests and to observe the CSF abnormalities during the course of this disease. The results of the study of the 79 cases verified by necropsy or surgery showed that the characteristic CSF changes that make the diagnosis of brain cysticercosis were observed in 54 per cent of the cases. The eosinophils were present in 82 per cent, protein changes in 78 per cent, complement fixation test in 70 per cent, hypertension in 55 per cent, and decreased sugar content in 27 per cent of the cases. In two cases the CSF was normal. As the eosinophils and the protein abnormalities may be seen in several other diseases, the complement fixation test for cysticercus should be regarded as the most important CSF test in the diagnosis of brain cysticercosis. The successive CSF specimens withdrawn of 40 patientes during the course of this disease have shown that the abnormalities went on for 4 to 18 years observation, suggesting that the parasites were alive. On the contrary, in 11 other cases it was verified the final CSF normalization after 5 to 14 years, suggesting that the parasites were dead. The CSF was normal in 31 out of 42 patients with opaque nodules visible in skull films (calcified cysticercus). in the remaining 11 cases, the characteristic CSF findings were observed in 3, but in 8 cases the only abnormalities were positive complement fixation test or eosinophils. In 14 out of 26 patients with subcutaneous or intraocular cysticercus there were the usual CSF changes but in the other remaining cases the CSF was normal. The absence of treatment for brain cysticercosis is consistent with the persistence of CSF abnormalities in the specimens examined during the course of this disease. This calls for an integrated prophylactic to all Latin-American countries in order to exterminate this serious disease for the well-being of the next generation.

Em trabalho anterior, baseado no estudo comparativo do LCR cisternal e lombar de pacientes com neurocisticercose em atividade, com permeabilidade normal ou com bloqueio do espaço subaracnóideo espinhal, foi apresentada evidência de que o gradiente de concentração das proteínas ao longo do neuro-eixo tem sua origem na saída seletiva de água. Em prosseguimento a esse estudo foi feito este segundo trabalho apoiado nas observações de 11 pacientes com neurocisticercose, que apresentaram no decurso de sua doença hipertensão endocraniana grave que exigiu a derivação ventrículo-atrial do LCR para permitir a sobrevivência. Após a intervenção cirúrgica, foi observada uma melhoria surpreendente do quadro clínico. O exame do LCR lombar revelou aumento da taxa das proteínas totais na maioria dos pacientes, verificando-se valores muito elevados, quando comparados estes resultados com aqueles existentes antes da derivação ventrículo-atrial. Entretanto, neste segundo exame foi observada atenuação da reação inflamatória, revelada pela melhoria da modificação citológica. Este acréscimo da concentração das proteínas totais resultou muito provavelmente da menor movimentação do LCR no espaço subaracnóideo, como consequência do desvio para o sangue de grande parte do LCR produzido. A diminuição da intensidade da resposta imunitária e da reação inflamatória do sistema nervoso central, avaliada pelo exame de LCR feito depois da cirurgia, indica que a drenagem ventricular e a conseqüente normalização da pressão endocraniana permitiram uma melhoria evidente das condições encefálicas. Uma pesquisa bibliográfica especializada não revelou ter sido assinalada esta ocorrência de um acentuado aumento da taxa das proteínas totais no LCR subaracnóideo após a derivação ventrículo-atrial ou peritoneal, quer em pacientes com neurocisticercose, quer em pacientes com outros processos não tumorais que evoluem para o bloqueio do quarto ventrículo ou cisternas da base. On a previous paper, based upon the data obtained from comparative studies of cerebrospinal fluid samples of two groups of patients with neuro-cysticercosis in activity, one with patency, the other one with blockage of the spinal subarachnoid space, evidence was presented that the concentration gradient of proteins along the neuraxis was the consequence of the escape of water from cerebrospinal fluid. The second paper is a continuance of that one. The material for this survey consisted of the clinical records of 11 patients with neurocysticercosis who during the course of the disease presented severe intracranial hypertension which required ventriculoatrial shunt as an emergency operation in order to allow survival. After surgery, it was observed a marked improvement in the clinical picture. Later, it was noticed a large increase in the protein content of the spinal fluid of the majority of the patients, as compared with the results verified prior to surgery. However, in these spinal fluid samples the increase in protein content was observed without a simultaneous rise in cell count, suggesting an improvement in the inflammatory condition. It seems very likely that this large elevation of the protein content in the subarachnoid fluid is the consequence of a reduction in the spinal fluid flow rate due to the ventricle-venous shunt. The decrease in the intensity of the central nervous system immune response and inflammatory reaction, estimated on the basis of the spinal fluid changes after surgery, indicates a restored normal state of cerebrospinal fluid pressure due to the beneficial effect of the ventriculoatrial shunt. In search of the world literature we have been unable to find previous description of this marked increase in the protein content of the spinal fluid after ventriculoatrial or peritoneal shunts, either in patients with neurocysticercosis or in patients with other disease processes of no tumoral origin that later develloped blockage of the fourth ventricle and basal cisterns.

Lithium was introduced into medicine more than one hundred years ago and into psychiatry 25 years ago. In spite of this long history, it is only within the last 5-10 years that the unique properties and particular advan­tages of lithium as a drug have become recognized. Its usage is now sprea­ding rapidly, and almost every month we hear of new uses being claimed for lithium. I want to emphasize, however, that at the present time only two uses of lithium are fully established: the therapeutic use in mania, and the prophylactic use in recurrent endogenous affective disorders. All other uses are based on evidence which is not yet fully conclusive even though in some instances it is quite strong. Systematic trials are required fox further substantiation. We must keep our minds open to new developments in the field, for there is presumably still much to be learned about this deceptively simple and yet so enigmatic drug, the lithium ion. This paper deals with indications for lithium treatment, the proven, the tentative, and the disproven. Another paper (Schou, 1975) describes the practical problems of lithium treatment. Lithium medication should be continued until the time when spontaneous remission of the manic episode could be expected. In patients with previous manic episodes, the history may yield information as to the length of this time period; in patients with a first manic episode, lithium administration for 1-2 months may be appropriate in most cases. For patients with frequent previous manic or depressive episodes or both, prophylactic lithium treatment should be considered; this may then be administered as a continuation of the antimanic lithium treatment.

Os autores apresentam um caso com sintomatologia dolorosa nos territórios de distribuição do 5º, 9º e 10º nervos cranianos à direita, de etiologia não elucidada, e rotulado como neuralgia essencial. O tratamento realizado foi o cirúrgico, sendo praticada, num primeiro tempo, a cavólise9, seguida de neurotomia intracraniana do glossofaríngeo e da porção anterior do pneumogástrico. Como houvesse recidiva 6 meses depois, sugerindo que a neuralgia decorresse da irritação da porção restante do nervo pneumogástrico, foi feita nova intervenção cirúrgica, sendo seccionado o restante dêste nervo, com excelente resultado. In this paper a case of multiple neuralgia of the essential type is reported. The patient complained of pain on the skin and mucous area of the 5th, 9th and 10th cranial nerves on the right side and no organic lesion could be found. The patient was operated upon; as first step a "cavolysis" was performed. Twenty five days later the 9th cranial nerve was divided intracranially; the anterior 1/3 of the 10th cranial nerve was then sectioned too. Pain disappeared for a period of 6 months; when this period had ellapsed the pain returned. As the recurrence was thought to be referred to the remainder of the 10th nerve complete transection of this nerve was performed. Pain disappeared soon after this last operation. Two months had ellapsed when this paper was send to publication and the patient referred no pain.

This paper is based on a review of 209 female patients admitted to the 5th. Pavillion, at the Juqueri State Hospital, São Paulo, Brazil, observed between February 1936 anti December 1945. One hundred and sixty-one patients were operated on by the Egas Moniz's method of leucotomy and 48 by the Freeman and Watts's technique of prefrontal lobotomy. Since January 1946, we are performing the Freeman and Watts's prefrontal lobotomy in three stages for the purpose of determining the effets of incisions in different parts of the prefrontal region as regards mental condition. The available data about this subject are not sufficient to warrant any conclusion and are not discussed here. The majority of our patients were chronic schizophrenics already treated by two or more of the most recent shock therapy methods. The operations were performed by the chief neurosurgeon Dr. A. Mattos Pimenta and his assistants Drs. A. Sette Junior and A. C. Barretto. The results of the Egas Moniz's leucotomy are listed as follows: Schizophrenia (135 cases) - failures (108), complete or social recovery (21), deaths (2), improved (4); Feeble minded with other symptoms as prolonged episodes, excitement states (13 cases) - failures (7), complete recovery (5), improved (1); Manic-depressive psychosis (5) cases) - failures (3), complete recovery (2) psychopathic personality (3 cases) - failure (1), improved (1), complete recovery (1); Severe neurosis (2 cases) - complete recovery (2); Dementia paralytica (1 case) - improved (1); Encephalitis sequellae (2 cases) - improved (1), greatly improved (1). The results of the Freeman and Watts's prefrontal lobotomy are charted as follws: Schizophrenia (45 cases) - complete or social recovery (3), improved (2), failures (39), deaths (1); Typhoid encephalitis sequellae (1 case) - unchanged; Chrome mania excitation (1 case) - unchanged; Psychopathic personality (1 case) - unchanged. It is important to note that in 30 schizophrenic patients out of 45 subjected to Freeman and Watts's prefrontal lobotomy, Egas Moniz's leucotomy had failed. One in this group had social recovery after lobotomy and the two others greatly improved, what performs 10 percent of good results over the total number of operated patients. The results in the 15 schizophrenics whom only the prefrontal lobotomy was performed on are following: 1 death, 2 complete or social recovery (14 percent) .and 12 failures. We fell to be of value to compare the incidence of 10 per cent of patients influenced by the Egas Moniz's leucotomy plus Freeman and Watts's operation to that of 14 per cent influenced by the Freeman and Watts's prefrontal lobotomy alone and to that of 18 per cent influenced by the Egas Mofliz's leucotomy alone. The differences in these results may be explained by the unequal deal of the material among the various groups, which warrants only a relative value to the conclusions based on the comparison of those data. One of the deaths occurred at the 22nd hour after the operation ami necropsy revealed cerebral hemorrhage. The other death was due to kystic purulent meningitis, as proved by necropsy. This paper affords us an opportunity to show a table comparing the results obtained in the treatment of schizophrenia by several methods as metrazol, electroshock, insulin and cerebral leucotomy. This table (quadro 1) has been presented at the Congress of Neurology and Psychiatry, met in Buenos Aires at November, 1944. The table discloses the kind of our material, composed mainly by chronic patients, and points out psychosurgery's possibilities too. As may be noted, 155 of the 835 schizophrenic patients were less than 13 months ill; an incidence of 18,5 per cent of acute and subacute cases results. It is equally important to note that the illness time of 190 (or 23 per cent) is unknown, what is explained by the fact that a great number of our inmates are abandoned indigents, met in the streets and sent to this State Hospital by the police, thus causing us a great lack of data. It is useles for the scant material, a statistical analysis of the other groups. The criteria for diagnosis of schizophrenia and our concept concerning the evaluation of complete or social recovery are not discussed, as this subjetc has been already covered by us and Dr. Mariz de Oliveira Netto in a previous paper where the statistical results of the first 400 cases treated by von Meduna's method are reviewed. We used to apply to our patients a series of 20 convulsive shocks or insulin comas, at least. Only in the case of early recovery the series was not completed. Although 209 patients were operated on till the end of 1945, as stated, previous by only 93 who were operated on up to end of 1943 are included in this table, because the others have not been followed up as sufficiently yet. As for time of illness only the groups comprising a number of cases sufficiently observed are suitable to be compared. In the group ranging from 0 to 6 months, only 40 cases subjected to metrazol and 27 to insulin are considered, for those treated by electroshock therapy were very few in number. The rate of recoverries was 77 per cent with insulin and 45 per cent with metrazol. In the group ranging from 7 to 12 months of illness, 40 cases treated by metrazol and 30 subjected to insulin therapy are compared. The rate of recoveries with insulin is the same as in the anterior group (77 per cent) while that of metrazol decreased to 20 per cent. In this group are already included 2 patients treated by leucotomy, one of them recovered. This conforms to our previous statement that we used to apply leucotomy only to patients for whom other methods of treatment failed. Again the group including patients whose time of illness ranges from 13 to 18 months is not discussed on account of the little amount of cases. The next group, the largest of our estatistics, including chronic patients more than 13 months ill, is more interesting. Therein the incidence of recoveries was 22 per cent with insulin therapy, the largest as compared to that obtained with other methods. The leucotomy comes second, with 10 per cent of recoveries. It is amazing the result of analysis of the uninfluenced cases in this group. The rate of failures was 50 per cent with insulin, 69 per cent with metrazol, 82 per cent with electroshock and 83 per cent with leucotomy, which in this comparison comes as the last. But we must remember that the Egas Moniz's operation was carried out only on patients whose severe mental condition was not changed by other treatments. We wish to emphasize that before undergoing leucotomy, chronic schizophrenic patients altready treated by all the methods available were considered clinically hopeless cases. These data show also the value of the insulin therapy for chronic cases as compared to other methods. The incidence of mortality was 7 per cen«t with insulin, 3 per cent with electroshock and 1 per cent with leucotomy. We fell of interest to note the low incidence of fatalities with leucotomy as compared to that of 7 per cent with insulin therapy. This high incidence of fatalities in our clinical material, as confronted to those reported in the world literature (5 per cent) is due to the fact that here are included our earlier cases, treated in 1936, when we were tentatively applying the Braunmüll's technic of prolonged comas for the extremely severe cases. The only tabulated death with leucotomy was due to operative hemorrhage as stated before. At last, we wish to emphasize the rate of 14 per cent of recoveries and 6 per cent of great improvements performed by leucotomy, notwithstanding the poor conditions of the material so treated. Simple leucotomy quieteness and other minor changes behavior without any alteration in the structure of the psychosis are not considered. Inasmuch an easy, unexpensive and nearly dangerless method of treatment, leucotomy is doubtless apt to improve the conditions of the chronic patients. This was one of the reasons that induced us to carry out the psychosurgical method of treatment.

Dear Editors, The paper by van der Linden et al., “Discordant clinical outcomes of congenital Zika virus infection in twin pregnancies” provides additional information in a story that has placed Zika firmly in the company of other infections such as cytomegalovirus and toxoplasmosis that can cause birth defects in the central nervous system. Unlike these other congenital infections, however, Zika virus regularly causes a particularly severe brain phenotype, rarely seen even by specialists in brain malformations. While microcephaly, central nervous [...]

The year of 2014 is the birth centenary of Aristides Azevedo Pacheco Leão (1914-1993), and also marks seventy years of the publication of his discovery of the novel electrophysiological phenomenon, named by him “spreading depression” (SD), soon designated “Leão’s wave” or “Leão’s spreading depression”. This was a remarkable scientific milestone, and the author must be celebrated for this achievement, as the studies he triggered proceeded worldwide, with new concepts, as spreading depolarization, until the present days. Robust experimental and clinical evidence emerged to suggest that these and related electrophysiological phenomena are involved in the mechanisms of migraine aura, acute cerebrovascular diseases, traumatic brain injury, transient global amnesia, epileptic seizures, and their pathophysiological characteristics come to offer new therapeutic perspectives. He was a remarkable and complex personality, and the authors remit the readers to a paper where his personal life is contemplated. O ano de 2014 é o centenário de nascimento de Aristides Azevedo Pacheco Leão (1914-1993), e também assinala setenta anos da publicação de sua descoberta, que ele denominou “depressão alastrante” (DA), logo designada “onda de Leão” ou “depressão alastrante de Leão”. Foi um notável marco científico e o autor deve ser celebrado por esse feito, considerando que estudos que desencadeou continuaram no mundo todo, com novos conceitos, como a despolarização alastrante, até os dias atuais. Evidência experimental e clínica robusta emergiram sugerindo que esses fenômenos eletofisiológicos e outros relacionados encontram-se envolvidos nos mecanismos da aura da enxaqueca, doenças cerebrovasculares agudas, lesão cerebral traumática, amnésia global transitória, crises epiléticas, sendo que suas características fisiopatológicas vêm oferecer novas perspectivas terapêuticas. Foi uma personalidade complexa e notável, e os autores remetem os leitores para um artigo no qual sua vida pessoal é contemplada.

Analysis on cerebrospinal fluid (CSF) in neurological diagnosis has always been considered to be a strong point among the main complementary examinations in Brazil. The present paper reviews the main events in the history of CSF in the neurological sciences, with emphasis on the founders of several CSF schools in our country from the beginning of the 20th century to the present time. No Brasil o estudo do líquido cefalorraquidiano (LCR) como arsenal diagnóstico para a neurologia sempre foi considerado um ponto forte entre os principais exames complementares. Neste artigo são revisados os fatos principais da história do LCR dentro das ciências neurológicas, com ênfase aos fundadores das diversas escolas de LCR do nosso país desde as primeiras décadas do século XX até o momento atual.

Among the many risk factors suggested for sudden unexpected death in epilepsy (SUDEP), higher frequency of seizures is a very consistent issue. Furthermore, it has been established that hemodialysis-associated seizure is a complication of the dialysis procedure. Thus, since a possible relation between cardiovascular abnormalities and SUDEP among patients with chronic renal insufficiency in regular hemodialysis program should not be neglected, we propose in this paper that omega-3 fatty acids offer opportunities for prevention of sudden cardiac death or improved treatment in people with epilepsy under the regular hemodialysis program. Dentre os fatores de risco sugeridos para a morte súbita inesperada em epilepsia (SUDEP), maior frequência de crises epilépticas é uma questão muito consistente. Além disso, tem sido estabelecido que as crises epilépticas associadas à hemodiálise são uma complicação do procedimento dialítico. Desse modo, como a existência de uma possível associação entre as alterações cardiovasculares e a SUDEP entre indivíduos com insuficiência renal crônica em tratamento dialítico não deve ser negligenciada, foi proposto neste artigo que o ômega 3 pode atuar na prevenção da morte súbita cardíaca ou melhorar o tratamento de pessoas com epilepsia inseridas em um programa regular de hemodiálise.

Pleomorphic xanthoastrocytoma (PXA) is a rare glioma. This paper aimed to analyze magnetic resonance imaging (MRI) characteristics in a series of patients diagnosed with PXA. We analyzed MRI findings in 9 patients with histopathologic diagnosis of PXA in our department over the last 12 years. The mean age of patients was 27.3 years. Cortical location was observed in all cases. The lesion imaging was solid-cystic in six cases. In eight cases, the solid component presented hypo or isointense on T1 and iso or hyperintense on T2. Contrast enhancement in the solid component was observed in eight cases. The observed imaging pattern of PXA was superficial location with leptomeningeal involvement, solid-cystic pattern and contrast enhancement in the solid component. We should consider that the association between PXA and other cortical tumors may occur, particularly, with gangliogliomas, which tend to be the main differential diagnosis in MRI.

Objetivo: Estima-se que haja aproximadamente 50.000 pessoas com a forma remitente-recorrente da esclerose múltipla na América Latina. Os algoritmos de tratamento norte-americanos e europeus não levam em consideração nossas peculiaridades regionais, nem a dificuldade no acesso ao tratamento por parte dos pacientes. Métodos: O Fórum Latino-americano de Esclerose Múltipla é um grupo de especialistas independente e suprainstitucional, que avaliou as mais recentes evidências científicas sobre a eficácia e a segurança das drogas modificadoras do curso da doença. Foram avaliados também o acesso ao tratamento e os programas de farmacovigilância de cada um dos oito países representados no Fórum. Resultados: Uma lista específica de recomendações baseadas em evidências científicas foi estabelecida para a América Latina. Também foram discutidas perspectivas de futuros tratamentos para esclerose múltipla. Conclusões: O presente estudo representou um esforço dos representantes de oito países latino-americanos em discutir um assunto que não pode ser adaptado para uso em nossa região diretamente a partir de recomendações de tratamento europeias ou norte-americanas. Objective: It is estimated that circa 50,000 individuals have relapsing-remitting multiple sclerosis in Latin America. European and North- American algorithms for the treatment of multiple sclerosis do not foresee our regional difficulties and the access of patients to treatment. Methods: The Latin American Multiple Sclerosis Forum is an independent and supra-institutional group of experts that has assessed the latest scientific evidence regarding efficacy and safety of disease-modifying treatments. Accesses to treatment and pharmacovigilance programs for each of the eight countries represented at the Forum were also analyzed. Results: A specific set of guidelines based upon evidence-based recommendations was designed for Latin America. Future perspectives of multiple sclerosis treatment were also discussed. Conclusions: The present paper translated an effort from representatives of eight countries discussing a matter that cannot be adapted to our region directly from purely European and North-American guidelines for treatment.

OBJECTIVE: This paper aimed at studying presentations of the central nervous system (CNS) lymphoma using structural images obtained by magnetic resonance imaging (MRI). METHODS: The MRI features at presentation of 15 patients diagnosed with CNS lymphoma in a university hospital, between January 1999 and March 2011, were analyzed by frequency and cross tabulation. RESULTS: All patients had supratentorial lesions; and four had infra- and supratentorial lesions. The signal intensity on T1 and T2 weighted images was predominantly hypo- or isointense. In the T2 weighted images, single lesions were associated with a hypointense signal component. Six patients presented necrosis, all of them showed perilesional abnormal white matter, nine had meningeal involvement, and five had subependymal spread. Subependymal spread and meningeal involvement tended to occur in younger patients. CONCLUSION: Presentations of lymphoma are very pleomorphic, but some of them should point to this diagnostic possibility.

It was suggested that intravenous thrombolysis (IT) leads to larger extent recanalization in cardioembolic stroke. In this work we assess if this has beneficial clinical traduction. METHOD: We evaluated 177 patients undergoing IT, which were categorized into cardioembolic (CE) and non-cardioembolic (NCE). National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale were compared. RESULTS: The mean age was 67.4±12.01 and 53.8% were male. The mean NIHSS was: 14 (admission), 9 (24 h) and 6 (discharge), similar in subgroups. The difference between NIHSS at admission and 24 hours was 4.17±4.92 (CE: 4.08±4.71; NCE: 4.27±5.17, p=0.900) and at admission and discharge there was an average difference of 6.74±5.58 (CE: 6.97±5.68; NCE: 6.49±5.49, p=0.622). The mRS at discharge and 3 months was not significantly different by subtype, although individuals whose event was NCE are more independent at 3 months. CONCLUSION: Ours findings argue against a specific paper of IT in CE. It can result from heterogeneity of NCE group.

OBJECTIVE: Describe the somatosensory function of the affected upper limb of hemiparetic stroke patients and investigate the correlations between measurements of motor and sensory functions in tasks with and without visual deprivation. METHOD: We applied the Fugl-Meyer Assessment (FMA), Nottingham Sensory Assessment (NSA), and several motor and sensory tests: Paper manipulation (PM), Motor Sequences (MS), Reaching and grasping (RG) Tests Functional (TF), Tactile Discrimination (TD), Weight Discrimination (WD) and Tactile Recognition of Objects (RO). RESULTS: We found moderate correlations between the FMA motor subscale and the tactile sensation score of the NSA. Additionally, the FMA sensitivity was correlated with the NSA total; and performance on the WD test items correlated with the NSA. CONCLUSION: There was a correlation between the sensory and motor functions of the upper limb in chronic hemiparetic stroke patients. Additionally, there was a greater reliance on visual information to compensate for lost sensory-motor skills. OBJETIVO: Descrever a função somatossensorial do membro superior afetado de hemiparéticos crônicos após acidente vascular encefálico (AVE) e verificar as correlações entre instrumentos de medida da função motora e sensorial em tarefas com e sem privação visual. MÉTODO: Aplicados o Protocolo de Desempenho Físico de Fugl-Meyer (FMA), Avaliação Sensorial de Nottingham (ASN), e os testes de: Manipulação de Papel (MP), Sequência Motora (SM), Alcance e Preensão (AP), Testes Funcionais (TF), Discriminação Tátil (DT), Discriminação de Peso (DP) e Reconhecimento Tátil de Objetos (RO). RESULTADOS: Foram encontradas correlações moderadas entre a FMA motora e itens da subescala sensação tátil da ASN; a FMA sensibilidade correlacionou-se a ASN total; e o teste DP se correlacionou com itens da ANS. CONCLUSÃO: Houve correlação entre a função sensorial e motora do membro superior em pacientes hemiparéticos crônicos pós- AVE; e maior dependência das informações visuais para compensar a perda sensório-motora.

In the present paper, we investigated the 5HTTLPR and STin2 polymorphisms in the promoter region of the serotonin transporter gene (SLC6A4), the G861C polymorphism (rs6296) of the serotonin receptor 1D beta (HTR1B), the T102C (rs6113) and C516T (rs6305) polymorphisms of the serotonin receptor gene subtype 2A (HTR2A), the DAT UTR, DAT intron 8 and DAT intron 14 of the dopamine transporter gene (SLC6A3), the Val-158-Met (rs4680) polymorphism of the COMT and the silent mutation G1287A (rs5569) in the norepinephrine transporter gene (SLC6A2). We genotyped 41 obsessive-compulsive disorder (OCD) outpatients, classified as good-responders (n=27) and poor-responders (n=14) to treatment with clomipramine according to the Yale Brown Obsessive-Compulsive Scale (YBOCS). Patients who achieved a reduction in symptoms of 40% or more in YBOCS after 14 weeks of treatment were considered good-responders. Genotypes and alleles distribution of the investigated polymorphisms were compared between both groups. We did not find association between the studied polymorphisms and clomipramine response in our sample. No presente estudo, investigaram-se os polimorfismos 5HTTLPR e STin2 da região promotora do gene transportador de serotonina (SLC6A4), o G861C (rs6296) do receptor de serotonina 1D beta (HTR1B), os polimorfismos T102C (rs6113) e C516T (rs6305) do gene do receptor da serotonina subtipo 2A (HTR2A), os polimorfismos UTR, intron 8 e intron 14 do gene transportador de dopamina (SLC6A3), o Val-158-Met (rs4680) da COMT e a mutação G1287A (rs5569) do gene do transportador de norepinefrina (SLC6A2). Foram genotipados 41 pacientes com transtorno obsessivo-compulsivo (TOC), classificados como bons-respondedores (n=27) e maus-respondedores (n=14) ao tratamento com clomipramina, por meio do uso da Escala de Sintomas Obsessivos-Compulsivos Yale Brown (YBOCS). Foram considerados bons-respondedores os pacientes que tiveram redução nos sintomas em 40% ou mais na YBOCS, após 14 semanas de tratamento. A distribuição dos genótipos e alelos estudados foi comparada entre os dois grupos. Não foi encontrada associação entre estes polimorfismos investigados e a resposta à clomipramina na amostra estudada.

Multiple sclerosis (MS) is an autoimmune, demyelinating and degenerative disease that affects the central nervous system. Its prevalence and clinical aspects vary according to the continent considered, being more frequent in Caucasians and young individuals aged 20 to 40 years. Epidemiological data from Brazil show that prevalence is variable, being more frequent in the Southern and Southeastern areas of the country, rather than in the Northern and Northeastern areas. The purpose of this paper is to describe MS clinical and epidemiological features in the State of Bahia, in the Brazilian Northeastern region. Thus, we held a cross-sectional study over the period from February to May, 2005, in the Multiple Sclerosis Patient Support Center ("Núcleo de Apoio aos Pacientes com Esclerose Múltipla") of Bahia, which included all patients with a diagnosis of MS seen over this period of time. A total of 121 patients were investigated, being 80.2% females (female:male ratio=4:1), with higher frequency in mulatto individuals (64%), and the relapsing-remitting type (91.3%). Most patients (68.7%) had mild MS, and blacks were prone to worse prognosis compared to other patients. A esclerose múltipla (EM) é doença auto-imune, desmielinizante e degenerativa que afeta o sistema nervoso central. Sua prevalência e seus aspectos clínicos variam de acordo com o continente estudado, sendo mais freqüente em caucasianos e indivíduos jovens entre a terceira e quarta décadas de vida. Dados epidemiológicos sobre o Brasil demonstram que a prevalência é variável, sendo mais freqüente nas regiões sul e sudeste que no norte e nordeste. O objetivo desse estudo é descrever as características clínicas e epidemiológicas da EM no Estado da Bahia, nordeste brasileiro. Assim, realizamos estudo de corte transversal durante o período de fevereiro a maio de 2005, no Núcleo de Apoio ao Pacientes com Esclerose Múltipla da Bahia, incluindo todos os pacientes consecutivos, com diagnóstico de EM, atendidos nesse período. Foi estudado um total de 121 pacientes, 80,2% do gênero feminino com uma relação de 4:1 com o gênero masculino, sendo observado maior freqüência de mulatos (64%) e da forma surto-remissão (91,3%). A maioria dos pacientes (68,7%) foi classificada como EM leve, sendo que os negros apresentaram indícios de pior prognóstico em relação aos outros pacientes.

Cerebrospinal fluid (CSF) changes in spinal shistosomiasis have been described. Its characteristic features are mild to moderate pleocytosis, presence of eosinophils, slight to moderate protein increase, elevated gamma globulin concentration and a positive immune assay. Nevertheless, these abnormalities are not always present together and therefore difficulties may arise in the assessment of the diagnosis. The purpose of this paper is to evaluate the importance of each CSF alteration concerning the diagnosis in 22 cases of spinal shistosomiasis. According to the results, only 20% of the cases had all the five feature that are considered to be characteristic of spinal shistomiasis. Abnormal cell count was present in 86%, protein increase in 77.3%, immunoglobulin G increase in 60,8%, eosinophils were present in 36.8% and indirect fluorescent antibody test was positive in 68.2%. In three cases all CSF parameters studied were within the normal limits. As the most specific test among those described was the indirect fluorescent antibody test, it should be regarded for the diagnosis.

William Richard Gowers (1845–1915) spent his career working at the National Hospital for the Relief and Cure for the Paralyzed and Epileptic at Queen Square, in London, United Kingdom, and at the nearby University College Hospital. His “Manual of the Diseases of the Nervous System” and many published lectures were based almost entirely on his own clinical observations meticulously recorded in shorthand. In this paper, we have focused on an analysis of his inpatient case records from 1878 to 1911 preserved in the archives at the National Hospital for Neurology and Neurosurgery, Queen Square. We reviewed all 42 volumes and analyzed 2,478 patients. Between 1897 and 1909, a mean of 129.7 cases per year were admitted to the hospital under Gowers' care. We grouped the diagnoses in 12 different categories. Epilepsy (16.5%), followed by spinal cord diseases (10.3%), cerebrovascular diseases (9.5%), and functional disorders (7.9%) were the most common diagnoses. William Richard Gowers (1845–1915) passou sua vida profissional trabalhando no National Hospital for the Relief and Cure for the Paralyzed and Epileptic e no University College Hospital na Queen Square, em Londres, Reino Unido. Seu livro Manual of the Diseases of the Nervous System, assim como suas várias aulas publicadas foram baseadas quase inteiramente em suas próprias observações clínicas, anotadas meticulosamente em estenografia. Neste artigo, o objetivo foi a análise das notas de casos clínicos de pacientes hospitalizados entre 1878 e 1911 armazenadas nos arquivos do National Hospital for Neurology and Neurosurgery, na Queen Square. Foram revisados 42 volumes e analisados 2.478 pacientes. Entre 1897 e 1909, uma média de 129,7 casos foram admitidos ao ano no hospital sob supervisão de Gowers. Os diagnósticos foram agrupados em 12 categorias diferentes. Epilepsia (16,5%), seguida de doenças da medula espinhal (12,7%), doenças cerebrovasculares (9,5%) e transtornos funcionais (7,9%) foram os diagnósticos mais encontrados nas notas dos casos clínicos.

It is reported the Brazilian Neurology birth (1912), that has as the hallmark its first Neurology Cathedra of Rio de Janeiro, and the links between Neurology and Psychiatry, besides the main medical protagonists at that time in Rio de Janeiro: João Carlos Teixeira Brandão (1854-1921), first professor of the cathedra of Clinical Psychiatry and Nervous Diseases (1883-1921); Juliano Moreira (1873-1933), the founder of the Brazilian scientific Psychiatry and director of the Hospício Nacional de Alienados (National Hospice for the Insane) (1903-1930); Antônio Austregésilo Rodrigues de Lima (1876-1960), first professor of the cathedra of Neurology, considered the father of the Brazilian Neurology. Aloysio de Castro (1881-1959) was a great Brazilian neurosemiologist at that time. Austregésilo practiced both disciplines, Neurology and Psychiatry, and like Jean-Martin-Charcot, he was very interested in a typically psychiatric disorder, the hysteria. It is also considered in this paper the first Brazilian authors of Neurology and/or Psychiatric texts and the places where Neurology was initially developed by the main founders: Hospício Nacional de Alienados, Santa Casa de Misericórdia do Rio de Janeiro and Policlínica Geral do Rio de Janeiro.

We have previously reported that subarachnoid hemorrhage due to ruptured intracranial aneurysm (SH) is associated with changes in the hormonal profile in the first 24 hours after the event. We proposed that the hormonal changes observed are due to the intense stress to which the patients are exposed. However, the thyroidal hormonal profile is indicative of the presence of a nonthyroidal illness syndrome (NTIS). In this paper, we examined whether the change in the thyroid hormone profile is compatible with a NTIS. Two groups of patients were included in the study: A) 30 patients with SH (21 females and 9 males; 41.7±11.4 years) and B) a control group including 25 patients with benign diseases of the spine (BDS) (lumbar disc hernia or stable spinal trauma) (8 females and 17 males; 41.3±14.2 years). In a subgroup of eight patients of each group serum triiodothyronine (T3) and reverse T3 levels were measured. The blood samples were obtained between 8:00 and 9:00 AM. The following results were obtained: The SH group had smaller serum T3 and free T4 levels than the BDS group (p

Intracranial aneurysms are frequently present with subarachnoid hemorrhage.Less often they produce suggestive symptoms of cranial nerve dysfunction or intracranial tumor when very large. Their association with epilepsy has rarely been reported; such concurrence may not be a coincidence. When the patient presents with epileptiforme attacks the presence of an intracranial aneurysm is rarely considered. In this paper we report the case of a 45-years-old patient with an unruptured aneurysm of the middle cerebral artery with a 10 years history of epileptic seizure. Aneurismas intracranianos freqüentemente se apresentam com hemorragia subaracnóidea quando rotos, porém quando gigantes sangram com menor freqüência e se comportam como verdadeiros tumores, comprimindo estruturas cerebrais adjacentes, apresentando sintomatologia peculiar. Relatamos o caso de um paciente de 45 anos que apresentava crises convulsivas generalizadas com evolução de 10 anos. A investigação radiológica revelou presença de aneurisma gigante da artéria cerebral média, não roto. É realizada revisão da literatura correlacionando a presença de aneurismas não rotos e epilepsia, pois esta associação é pouco freqüente na literatura.

A esclerose múltipla (EM) é doença inflamatória em que mecanismos imunológicos desempenham importante papel na patogênese das lesões do sistema nervoso central. Drogas que agem em diferentes etapas destes mecanismos têm sido usadas em seu tratamento. O presente artigo analisa com base nas classes de evidências científicas e tipos de recomendações propostos pela comunidade científica, os mais importantes ensaios clínico-terapêuticos com os glicocorticóides e os imunomoduladores, incluindo a imunoglobulina humana endovenosa, no tratamento da esclerose múltipla. Ele tem por objetivo fornecer subsídios para a formulação do Consenso Expandido para o Tratamento da Esclerose Múltipla. Multiple sclerosis is an inflammatory disease in which immunological mechanisms play an important role in causing demyelinating lesions in the central nervous system. A number of drugs acting in different stages of these mechanisms have been tested for its treatment. This paper analyses the most important clinical trials with glucocorticoids and immunomodulatory treatments, including human immunoglobulin, using the classes of evidences and types of recommendations as have been defined and widely accepted by the international scientific community. It aims to provide sufficient information to support the BCTRIMS Expanded Consensus on Treatment of MS.

BACKGROUND: The occipital lobe is an important region of the central nervous system and site of a wide variety of lesions. Different from others regions of the brain, whose anatomy has been already meticulously detailed, controversies about occipital lobe morphology can occasionally hinder the surgical approaches to it. METHOD: Twenty-six hemispheres were dissected, examining the distances of the medial structures of the posterior interhemispheric fissure region; identifying the sulci and gyri more frequently found in the lateral surface; and detailing the anatomy of the occipital horn of the lateral ventricle. Also, anatomical details of structures such as the calcarine sulcus and preoccipital notch were evaluated. RESULTS: Twenty-four hemispheres (92%) showed sulci with evident transverse trajectories in the lateral surfarce, and it was possible to identify marked longitudinal sulci in 16 (61%). All of the specimen presented a transverse sulcus in the inferior third of the lobe -- labeled in this paper as Inferior Transverse Occipital -- and 69% of the cases showed a transverse sulcus in the superior third -- labeled as Superior Transverse Occipital. The occipital horn was present in 53% of the cases at level of the anterior boundary of the lobe. It was a half moon shaped cavity, whose the medial wall was formed by the calcar avis and the lateral wall, roof and floor formed by fibers of the tapetum. CONCLUSION: The occipital lobe presents parameters that are often recognized in most of the dissected brain and can be useful for the planning and performance of surgery in this area of the brain. INTRODUÇÃO: O lobo occipital é uma importante região do sistema nervoso central e local de ocorrência de ampla variedade de patologias. Diferente de outras regiões do cérebro, cuja anatomia já foi meticulosamente detalhada, ainda existem controvérsias a respeito do pólo occipital que ocasionalmente podem dificultar cirurgias sobre esta região. MÉTODO: Foram dissecados 26 hemisférios cerebrais, examinando-se distâncias de algumas estruturas localizadas na região da fissura interemisférica posterior, identificando os sulcos e giros mais frequentemente encontrados na face lateral do lobo occipital, e detalhando-se a anatomia do corno occipital do ventrículo lateral. Também foram avaliados detalhes anatômicos de estruturas como o sulco calcarino e incisura pré-occipital. RESULTADOS: Em 24 hemisférios (92%) foram identificados sulcos com trajetos transversais evidentes na face lateral do lobo, sendo que sulcos longitudinais foram observados em 16 peças (61%). Em todas foi possível identificar um sulco transversal completo no terço inferior do lobo -- denominado neste estudo como sulco transverso inferior -- e 69% dos hemisférios demonstraram um sulco transverso no terço superior -- denominado sulco transverso superior. O corno occipital estendia-se até o lobo occipital em apenas 53% das peças, e em todas apresentava-se como uma cavidade em forma de meia-lua, cuja parede medial era formada pelo calcar-avis e a parede lateral, teto e assoalho do ventrículo formada por fibras do tapetum. CONCLUSÃO: O lobo occipital apresenta parâmetros anatômicos que são reconhecíveis e repetidos na maioria dos cérebros dissecados. Estes parâmetros podem ser úteis na orientação de cirurgias realizadas nesta região do encéfalo.

Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. Methods Retrospective data on patients with arterial dissection related to sports and recreation. Results Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. Conclusion Arterial dissection may be a complication from practicing sports. A dissecção das artérias cervicais é uma emergência médica. Embora de forma relativamente rara, certas atividades descritas como esportes e recreação podem ser a causa de dissecção arterial independentemente de trauma de crânio ou cervical. O propósito do presente estudo é apresentar uma série de casos de dissecção de artérias cérebro-cervicais em indivíduos durante ou logo após a prática destas atividades desportivas. Métodos Dados retrospectivos de pacientes com dissecção arterial relacionada à prática de esportes e recreação. Resultados Quarenta e um casos foram identificados. A artéria mais frequentemente afetada foi a vertebral. Uma grande variedade de atividades teve relação temporal com a dissecção arterial, sendo a corrida a mais frequente delas. Esta é a maior série de casos da literatura. Conclusão Dissecção arterial pode ser uma complicação da prática de esportes.

Durante período de 20 anos (1972-1992), 56 pacientes com diagnóstico de mielorradiculopatia esquistossomótica foram internados em três hospitais de Belo Horizonte -- Minas Gerais. Dados de cada paciente foram coletados retrospectivamente de seus prontuários. Em todos os casos, o diagnóstico foi presumido e baseou-se nos seguintes critérios: 1) quadro de comprometimento medular torácico baixo ou lombossacro (síndrome de cone medular e/ou cauda equina); 2) epidemiologia positiva para esquistossomose; 3) comprovação laboratorial de esquistossomose através de exame parasitológico de fezes ou biópsia retal; e 4) exclusão de outras patologias que pudessem causar quadro semelhante. Vários aspectos clínicos e epidemiológicos foram estudados para determinar o perfil diagnóstico da mielorradiculopatia esquistossomótica nesta amostra e são apresentados neste artigo. Reconhecendo os vários problemas no diagnóstico da mielorradiculopatia esquistossomótica, enfatizamos a importância de se pensar nesta entidade e sugerimos critérios para definição diagnóstica. During 20 year period (1972-1992) 56 patients with a diagnosis of schistosomotic myeloradiculopathy were admitted in three hospitals of Belo Horizonte - Minas Gerais. Data from pacients were collected retrospectively from their medical records. In all cases, the diagnosis was inferred in a presumably way and was based on the following considerations: 1) the finding of low thoracic/upper lumbar neurological symptoms; 2) positive epidemiology for schistosomiasis; 3) demonstration of exposure to schistosomiasis through parasitologic or serologic techniques; and 4) the exclusion of other known causes of transverse myelitis and myeloradiculitis. Several clinical and epidemiological aspects were studied to determine the diagnosis profiles of the schistosomotic myeloradiculopathy in this sample and are presented in this paper. In recognizing the many problems in diagnosis of schistosomotic myeloradiculopathy we emphasize how important is thinking about this entity and criteria to improve diagnostic evaluation are suggested.

We describe a 41 years old woman who 17 years ago presented hypotonia and proximal muscular weakness in the upper and lower limbs. On neurological examination, the biceps, triceps and Achilles reflexes were absent; the brachioradialis reflexes were decreased and the patellar reflexes were normal. There was bilateral Babinski sign. The remainder of the neurological examination was unremarkable. In the investigation a myopathic pattern was found in the electromyography. The nerve-conduction study was normal; a ELISA method for HTLV-I antibodies was positive in the blood and in the cerebral spinal fluid. The muscle biopsy showed inflammatory myopathy, compatible with polymyositis. This paper focuses the polymyositis in the beginning of an HTLV-I infection case.

Foram pesquisados aspectos históricos da miastenia grave desde as primeiras descrições da doença em 1672, pelo clínico inglês Thomas Willis. São descritas as dificuldades encontradas no manuseio dos primeiros pacientes diagnosticados. Pesquisaram-se fatos históricos ligados à investigação da doença, o tratamento, bem como curiosidades pouco citadas na literatura. We studied historical aspects of myasthenia gravis starting from its first description by the English physician, Sir Thomas Willis, in 1672. We also describe the difficulties in managing triating the first diagnosed patient. Historical facts related to the investigation and the initial treatment of this disorder as well as curiosities seldom mentioned in the literature are part of this paper.

The present paper reports the long-term use of clozapine in a prospective sample of 46 chronic schizophrenics. In six months, 21 subjects had been excluded for a number of reasons. In four of them the reasons for exclusion were related to lack of response or adverse effects. The median daily clozapine dose was 400 mg in the remaining 25 patients. As a whole, there were remarkable improvements in core dimensions of psychopathology, global cognitive status, and level of functioning. We confirmed that clozapine is effective in a subgroup of schizophrenics with the severest forms of the disease. If tolerated after the first few months it leads to progressive gains in several domains of behavior. Clozapine should be tried in every patient with schizophrenia in whom positive symptoms, disorganization, or bizarre behavior are a matter of incapacitation despite efforts to keep them under control with other drugs. O presente estudo, prospectivo, relata o uso de longo-prazo da clozapina em 46 esquizofrênicos graves, com mais de cinco anos de doença. Com seis meses de uso da droga, 21 indivíduos haviam sido excluídos por diversas razões. Em quatro, a exclusão se deveu a efeitos adversos ou ausência de resposta. A dose mediana de clozapina foi de 400 mg nos demais 25 pacientes. No todo, observamos melhora em dimensões de psicopatologia, estado cognitivo global, e nível funcional. Concluímos que a clozapina é eficaz em um subgrupo de esquizofrênicos com formas graves da doença. Se tolerada depois dos primeiros meses, produz benefícios progressivos em diversos domínios do comportamento. Clozapina deve ser tentada em todo paciente com esquizofrenia incapacitado por sintomas positivos, desorganização, e/ou comportamentos bizarros, que persistem a despeito de esforços para mantê-los sob controle com outras drogas.

reported that over the last two decades of stroke research only two findings really changed case-fatality and functional depen-dence of IS survivors: the first was the seminal paper “Stroke Unit Trialists”,published by Peter Langhorne in 1997, when it became clear that stroke units not only save lives but also re-duce functional dependence. The second was the discovery of intravenous use of tissue plasminogen activator (tPA) for hyperacute stroke reperfusion in 1995. These breakthroughs buried the nihilist approach to stroke and changed the par-adigm of IS treatment worldwide. The emergence of neuro-hospitalists as crucial professionals for inpatient care has become a reality. However, intravenous thrombolysis is less able than desirable, to open large vessels such as the inter-nal carotid artery or proximal branches of the middle cere-bral artery. In the last 10 years, many randomized clinical tri-als (RCT) of thrombectomy were “negative”. After December 2014, five new randomized controlled trials showed that intra-arterial treatment combined with IV lysis was more ef-fective than IV lysis alone, leading to

A demência do tipo Alzheimer (DA) é uma doença degenerativa que há até pouco tempo não tinha nenhum tratamento eficaz. Pesquisas realizadas a partir da década de 70 revelaram que os sistemas cerebrais que utilizam acetilcolina encontram-se gravemente comprometidos nesses pacientes, o que serviu de base para a introdução da terapêutica de base colinérgica da doença. Os inibidores da acetilcolinesterase foram os primeiros medicamentos que demonstraram ser úteis para o tratamento da DA em ensaios clínicos controlados contra placebo. Este artigo revê os principais estudos desenhados para investigar a eficácia e efeitos adversos da tacrina, donepezil, rivastigmina, e metrifonato em pacientes com DA. Discutem-se, ainda, os fatores que podem interferir na resposta do paciente ao tratamento com anticolinesterásicos, bem como as limitações inerentes a esse tipo de abordagem terapêutica. Alzheimer's disease (AD) is a neurogenerative disorder that had no effective treatment until a few years ago. Many studies published during the past 20 years showed that the disease is associated with the disruption of brain systems that use acetilcholine. These findings shaped the development of the cholinergic treatment strategies for AD. The cholinesterase inhibitors were the first class of drugs to show positive results in double-blind placebo controlled studies for the treatment of AD. This paper reviews efficacy and safety studies of tacrine, donepezil, rivastigmine, and metrifonate in patients with AD. Factors that may interfere with patients' response to treatment are also discussed, as well as the limitations associated with the use of this class of drugs.