Search

We characterized the impact of the metabolic syndrome (MetS) and its components on cardiovascular adverse events in patients with symptomatic chronic multivessel coronary artery disease, which have been followed prospectively for 2 years.Patients enrolled in the MASS II study were evaluated for each component of the MetS, as well as the full syndrome.The criteria for MetS were fulfilled in 52% of patients. The presence of MetS (P0.05), glucose intolerance (P=0.007), and diabetes (P=0.04) was associated with an increased mortality in our studied population. Moreover, despite a clear tendency for each of its components to increase the mortality risk, only the presence of the MetS significantly increased the risk of mortality among nondiabetic study participants in a multivariate model (P=0.03, relative risk 3.5, 95% confidence interval 1.1-6). Finally, MetS was still associated with increased mortality even after adjustment for diabetes status. These results indicate a strong and consistent relationship of the MetS with mortality in patients with stable coronary artery disease.Although glucose homeostasis seems to be the major force driving the increased risk of MetS, the operational diagnosis of MetS still has information for stratifying patients when diabetes information is taken into account.

Phenobarbital plasma levels were studied in a group of 25 newborn infants. Phenobarbital was administered i.v. in all cases throughout the study period. The mean loading dose was 19.4 mg/kg, ranging from 16.4 to 20.5, and the mean maintenance dose was 4.0 mg/kg/day, varying from 2.6 to 5.0. We obtained mean plasma levels of 22.9 micrograms/ml, 24 h after administering the loading dose. Mean plasma levels at 4, 7, 14 and 21 days were in the therapeutic range (15-40 micrograms/ml), with only a few cases falling outside of it. There was no difference in plasma phenobarbital levels between term and pre-term infants. Side effects were not seen in infants without a severe neurological impairment prior to drug administration.

HTLV-l antibodies were investigated in serum and in CSF of 150 patients with neurologic disorders mainly myelopathies. The patients were considered into three groups according to the possible relationship of their disease to the presence of HTLV-l antibodies: no relationship risk (control group), occasional risk group, and possible risk group. In this latter are 56 patients with crural spastic paraparesis or paraplegia of unknown etiology (SP). HTLV-l antibodies were tested by the passive particle-agglutination method for anti-ATLA antibody detection. The search was negative in all patients of the control group, and positive (serum and/or CSF) in 16.5% of the patients from the second group and in 55.4% of the SP patients group. Clinical patterns in SP cases with HTLV-l antibodies were those of tropical spastic paraparesis (TSP). CSF patterns considered (cytology, protein content and gamma-globulins rate) were different between TSP group with HTLV-l antibodies in CSF and SP group with no HTLV-l antibodies detection either in serum or in CSF. The difference was significant. Results of this investigation confirm the high incidence of TSP in Brazil, and bring additional indication for searching HTLV-l antibodies in the CSF.

Esperamos, com essas medidas, manter em ascensao o nivel cientifico e editorial de ANP. Para isso, contamos com todos, leitores, autores e avaliadores, cujas sugestoes serao bem-vindas. Acreditamos que, assim, poderemos crescer e ganhar maior visibilidade na comunidade cientifica brasileira e internacional.

PUBLICACAO – Em 2005 (Vol. 63) foram publicados todos os numeros trimestrais de Arquivos de NeuroPsiquiatria: Marco (N. 1), Junho (Ns. 2-A e 2-B), Setembro (Ns. 3-A e 3-B) e Dezembro (N. 4). Os numeros foram publicados nos respectivos meses de capa, mantendose assim a regularidade e a periodicidade desta revista, absolutas desde sua criacao (1943) ate o presente. O total de paginas do volume e 1120, assim distribuidas por numero: No 1, 194; No 2-A, 180 ; No 2-B, 184; No 3-A, 174; No 3-B, 174; [...]

PUBLICACAO – Em 2004 (Vol. 62) foram publicados todos os numeros trimestrais de Arquivos de Neuro-Psiquiatria: Marco (No 1), Junho (Nos 2-A e 2-B), Setembro (Nos 3-A e 3-B) e Dezembro (No 4). Os numeros foram publicados nos respectivos meses de capa, mantendo-se assim a regularidade e a periodicidade desta revista, absolutas desde sua criacao (1943) ate o presente […] Arquivos de neuro-psiquiatria 2004

No decorrer de 2003, houve outro fato que tambem o homenageia: a divulgacao de SciELO do posicionamento das revistas que compoem o seu elenco, o fator de impacto registrado no ISI Jounal of Citation Reports 2002. O fator de Arquivos de Neuro-Psiquiatria e 0.257. Este numero situa este periodico entre as revistas mais citadas de SciELO. Dentre as 52 revistas das areas medicas e biologicas, esse fator de impacto so e ultrapassado por tres revistas biologicas e uma da area medico-biologica. Fora de qualquer [...]

In this preliminary report the results of PCR for detection of DNA sequences (65 KDa antigen) of Mycobacterium tuberculosis in CSF samples from 20 patients are registered. In 10 patients there were clinical and laboratory findings suggesting the diagnosis of tuberculous meningitis (test group). In the other 10 patients, clinical and laboratory findings suggested meningitis or meningo-encephalitis from other etiologies (control group). In 7 patients from the test group antigenic DNA sequences of Mycobacterium tuberculosis were found in CSF by PCR; positive results were not registered in the control group.

Attention given to prophylaxis of neurocysiticercosis (NC) is far beyond minimal needs among several regions of the in-development world, and for this reason incidence of the disease persists high among them. This investigation was carried out to show the extent of the problem by analysing the incidence of NC in a region of Brazil (São Paulo). CSF immunodiagnosis of NC by detecting antibodies to Cysticercus cellulosae in a neurodiag-nostics laboratory is evaluated for this purpose. Cases studied in a 63-year period (1929-1992) are reviewed. Total cases in this period is 139,000, and for 1,573 (1.13%) diagnosis is NC. Special characteristics were not detected for colour and sex prevalence. Age bracket prevalence is from 21 to 40 years old (55.3%) high rates occurring for women between 21 to 30 years old, and for men between 31 to 40. Cases distribution in five consecutive decades (1942-1991) shows no decreasing tendency: average incidence is 1% for the 50 years, and it is over this average for the last three decades. Data confirm that incidence continues expressively high throughout the 50 years covered by this study. A atenção dada à profilaxia da neurocisticercose (NC) encontra-se aquém do mínimo necessário em várias regiões do terceiro mundo, motivo pelo qual nelas a incidência da doença continua alta. Esta investigação foi feita para mostrar a importância do problema pela análise da incidência da NC em uma região do Brasil (São Paulo). Para tanto foram considerados os dados de um laboratório de neurodiagnóstico em que o imunodiagnóstico de NC é baseado na detecção de anticorpos a Cystioercus cellulosae no líquido cefalorraqueano (LCR). Os casos estudados no período de 63 anos (1929-1962) são revistos. O número de casos nesse período foi 139.000, o diagnóstico sendo NC em 1.573 deles (1,13%). Não foram encontradas características especiais de prevalência para cor e idade. A prevalência quanto a faixa etária se encontra entre 21 e 40 anos de idade (55,3%), sendo maior para mulheres entre 21 e 30 anos de idade e, pana homens entre 31 e 40. A distribuição dos casos em 5 décadas consecutivas (1942-1991) não mostra tendência a decréscimo: a incidência média foi 1% para os 50 anos, encontrando-se acima da média a incidência nas 3 últimas décadas. Esses dados confirmam que a incidência se mantém expressivamente alta nos 50 anos abrangidos pelo estudo.

Immunomodulator therapy migration in relapsing remitting multiple sclerosis: a study of 152 cases

NEUROLOGIA CLINICA. GILSON EDMAR GONCALVES E SILVA E MARCO OTAVIO SARAIVA VALENCA. UMVOLUME (16X23 CM) COM 622 PAGINAS. RECIFE, 2003: EDITORA UNIVERSITARIA DA UNIVERSIDADE FEDERALDE PERNAMBUCO (UFPE).Este livro foi preparado por dois docentes de daDisciplina de Neurologia da UFPE, Gilson Edmar Gon-calves e Silva e Marco Otavio Saraiva Valenca. Dele parti-cipam seus organizadores e muitos do membros e cola-boradores dessa Disciplina, como salientam ambos naIntroducao, lembrando que a materia e enfocada doponto de vista do Curso de Graduacao. A isto acrescentaGeraldo Pereira, Reitor em Exercicio da UFPE, na Intro-ducao, que desse livro consta o conjunto do conhecimen-to que alimenta tal ensino, de forma a servir como fontede busca de conhecimentos neurologicos dos futurosprofissionais de Medicina. Com os Organizadores, so-mam vinte e cinco os autores dos diferentes capitulos,cada qual com destaque na area sobre que escrevem,muitos com projecao em todo o Brasil e fora dele, gracasao alcance de pesquisas por eles desenvolvidas. Nao d e-signo aqui os nomes dos demais autores, pois o verda-deiro autor e o ensino da neurologia no Recife propria-mente dito. Esse ensino e uma tradicao no panoramabrasileiro e dele resultaram vultos e feitos que so temhonrado a universidade nacional como um todo. Igualmente, e desnecessario listar o conteudo decada um dos vinte e dois capitulos do livro, pois abra-nge os grandes temas da materia neurologica e, a meuv e r, em medida suficiente para atender ao ensino danobre missao - ciencia e arte - do assistir pacientes comtranstornos neurologicos. Alem das muitas licoes medicas deste compendio,ele aponta uma necessidade no ensino universitariobrasileiro: o de preparar cada uma das disciplinas decada escola seus proprios livros de texto da materia aqual ela esta voltada.

Foram estudadas as imunoglobulinas IgG, IgA e IgM no soro e no LCR de 36 recém-nascidos no segundo dia de vida. Para caracterização prévia da normalidade, tanto para as amostras de soro, como para as amostras de LCR, foram realizados estudos comparativos com dados já estabelecidos anteriormente no nosso meio. O estudo das imunoglobulinas no soro e no LCR foram realizados por dois métodos: imunodifusão radial e nefelometria. Os valores encontrados (média ± desvio padrão) são os que se seguem (mg/dl). Para o soro: pelo método de IDR IgG 1346 ± 299,1; IgM 10,4 ± 2,26; IgA 1,1 ± 1,06; pelo método de nefelometria IgG 1372 ± 319,7; IgM 10,6 ± 4,10; IgA 1,5 ± 0,31. Nas amostras de LCR ambos os métodos não permitiram detectar IgA e IgM; IgG foi detectada por ambos e os valores observados (média ± desvio padrão) foram (mg/dl): por imunodifusão radial 11,1 ± 2,52; por nefelometria 9,6 ± 7,04. Foram estudadas também as relações e o índice de IgG; deles, salienta-se que ò índice de IgG, apresenta valores normais de 0,5 ± 0,14. Immunoglobulins IgG, IgA and IgM were studied in serum and cerebrospinal fluid (CSF) samples from 36 newborn infants in the second day of life. According to parameters previously established in the same laboratory for normal newborn infants, serum proteins were normal in all samples and CSF composition was normal as to blood pigments, cells, total proteins and protein fractions in all samples. Immunoglobulins concentrations were determined by two methods: radial immunodifusion (RID) and nephelometry. Concentrations found (mean ± standard deviation) were as follows (mg/dl). Serum: through the RID method IgG 1346 ± 299.1, IgM 10.4 ± 2.26, IgA 1.1 ± 1.06; through nephelometry IgG 1372 ± 319.7, IgM 10.6 ± 4.10, IgA 1.5 ± 0.31. Cerebrospinal fluid: IgA and IgM were not detected by the methods employed; IgG was detected by both methods, and values were 11.1 ± 2.52 by RID and 9.6 ± 7.04 by nephelometry. IgG relations and IgG index were also evaluated; values of the IgG index (0.5 ± 0.14) are emphasized. Considerations are made in order to point out data obtained as to characterize normal values for immunoglobulins in the cerebrospinal fluid of normal newborn infants.

Forty four pacients with primary acute and subacute meningomyeloradiculopathies were studied in respect to the evolutive aspects of the cerebrospinal fluid (CSF) cell-protein dual in several periods of the disease. The tendency of CSF hypercytosis to normal values of cell count occurred in most cases (96%) at the end of the period in which the study was performed (60 days). The CSF protein levels had a similar but slower behavior pattern when compared with hypercytosis. The comparative analysis of clinical improvement of two groups of patients (treated and not treated with ACTH or corticosteroids) showed a statiscally significant difference between the two groups favouring the former. This fact enhances the possibility that an auto-immune process plays an important role in cases of primary meningomyeloradiculopathies.

Mural thrombi in the cavities of the heart are commonly found in chronic Chagas' cardiopathy and embolic phenomena may result from them. Acute cerebrovascular insults resulting from embolic occlusion of cerebral arteries are described in Chagas' disease since 1953. The purpose of this investigation was to evaluate the incidence of this type of cerebrovascular embolic insult. Two groups of patients successively admitted to a general hospital were studied: the first of 63 cases of chronic Chagas' cardiopathy; the second of 84 cases of acute cerebrovascular disease. The brain insult was non-hemorrghagic type in 59 cases of the second group. The evaluation pertinent to the first series showed that embolic cerebrovascular insult occurred in 3.17% of the cases. Concerning the second series the incidence of embolic cerebrovascular insult secondary to chronic Chagas' cardiopathy was 4.76% when all cerebrovascular insults were considered, and 6.78% when only non hemorrhagic cerebrovascular insults were considered.

O comportamento do dual citoproteico do LCR é instrumento adequado para a compreensão e o acompanhamento evolutivo de processos inflamatórios do sistema nervoso central. O surto inflamatório sinalizado por eosinófilos na cisticercose do sistema nervoso central é semelhante, quantitativa e qualitativamente, ao que ocorre em processos inflamatórios monofásicos de etiologia viral. No entanto, pode ocorrer dissociação de comportamento das globulinas gama, gradativa e persistentemente aumentadas com relação ao citoproteinograma clássico. Tal fato pode ser expressão de imunoagressão semelhante à que ocorre em processos inflamatórios do sistema nervoso central com componente autoimune, como a neurossifilis e a esclerose múltipla.

Foram estudadas a concentração proteica total e o perfil proteico de 40 RN-PT sadios. Os resultados encontrados foram comparados àqueles obtidos para 40 RN a termo igualmente sadios, selecionados segundo critérios semelhantes, cujo LCR foi analisado mediante os mesmos métodos e no mesmo laboratório. Os dados obtidos confirmam ser, em média, a concentração proteica total superior no RN-PT que no RN a termo e a diferença encontrada foi estatisticamente significativa. O perfil proteico mostrou-se, em média, também diverso. As diferenças encontradas permitiram caracterizá-lo como de "tipo misto", sendo salientada a ausência frequente da sub-fração táu. The total protein concentration and the protein profile were studied in 40 healthy premature newborn infants at the second day of life. The results were compared to those obtained for 40 full-term healthy newborn infants. Results pertinent to this last group were reported previously. Results here reported confirm that there is a higher total protein concentration in the cerebrospinal fluid of the premature newborn infant. Statistical analysis shows that the difference is significant (t : 2 -16) The mean protein profile shows a protein fractions distribution proper to the "mixed profile type". The absence of tau-fraction was the most commonly finding observed in this way. Data were compared to those reported in the literature, and they were also considered proper to immaturity conditions of blood brain barrier.

Anticorpos antitreponêmicos da classe IgM foram pesquisados no soro e no LCR de 9 casos de neurossífilis sintomática, antes e, em diversos momentos, depois do tratamento. Esses anticorpos foram investigados mediante reações de imunofluorescência (IgM-FTA-Abs), hemadsorção em fase sólida e imunoenzimática (ELISA). Os títulos das reações reduziram-se, mas houve persistência da reatividade no soro e no LCR no segundo ano após tratamento.

Registro de três casos de hidrocéfalo com pressão normal cuja etiopatogenia estava na dependência da reação inflamatória do sistema continente do líquido cefalorraqueano própria à neurocisticercose. Os aspectos clínicos, do líquido cefalorraqueano, da cintilografia isotópica, do pneumencefalograma são discutidos. Após a derivação ventrículo-jugular efetuada, houve melhora do quadro clínico próprio à síndrome de hidrocéfalo com pressão normal nos três casos. Trata-se do primeiro estudo em que a síndrome é descrita na dependência da neurocisticercose. Three cases of normal pressure hydrocephalus are reported. Cysticercosis of the central nervous system was found to be the main etiopathogenic factor responsible by the syndrome in these cases. Clinical and diagnostic aspects of the cases, and the good results of ventriculo-jugular derivation concerning the clinical aspects of the syndrome are pointed out. This is the first report in the literature concerning to normal pressure hydrocephalus resulting from cysticercosis of the central nervous system.

Cerebrospinal fluid (CSF) samples of 200 patients who presented central nervous system (CNS) pathologies were evaluated for antibodies to Trypanosoma cruzi (T. cruzi). The evaluation was made through: complement fixation test (CFT) in 69 patients, indirect (IgG) immunofluorescence test (IFT) in 118, and by CFT and IFT in 13. In 50 cases the IFT has been made also in concentrated (20 X) CSF samples. Results were evaluated in report to CNS pathology, CSF cells and proteins, and tests in the CSF for other CNS infections (syphilis, cysticercosis, schistosomiasis, toxoplasmosis). These tests were based on techniques similar to those adopted for the search of antibodies to T. cruzi, and were conducted concomitantly to tests for T. cruzi in the same CSF sample for everyone of the cases. Antibodies to T. cruzi were found in three patients. The first was a patient committed by the acquired immunodeficiency syndrome (AIDS) in whom there occurred exacerbation of the acute stage of Chagas' disease. The second is a patient who is committed by epilepsy, and an acute stroke occurred in the third patient: Chagas' disease had been previously diagnosed in them through the demonstration of antibodies to T. cruzi in the blood serum.

São apresentados 18 casos de criptococose do sistema nervoso central e são tecidos comentários a propósito do tratamento e das dificuldades respectivas, especialmente em pacientes transplantados renais. É chamada a atenção para as eventuais possibilidades de nova droga introduzida para o tratamento da afecção e empregada em um dos casos relatados, o miconazole. Results obtained in the treatment of cryptococcosis of the central nervous system with amphotericin-B, 5-fluorocytosine and miconazole are evaluated. The evaluation is based upon 18 cases. Emphasis is given to data pertinent to aspects proper to 7 of them, submitted to chronic immunossupressive treatment due to previous kidney transplantation. Side effects varied from case to case in the patients submitted to amphotericin-B and 5-fluorocytosine treatment. The intrathecal and the intraventricular administration of amphotericin-B was followed by complications of several types. Miconazole was used in one case. Its intravenous and its intrathecal administration did not provoke remarkable side effects.

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.

Para mostrar a utilidade da técnica de Suta no estudo da citologia do LCR são apresentados 4 casos nos quais foi demonstrada a presença de células de natureza neoplásicas. Os achados são analisados frente à citologia normal do LCR e classificados segundo variante da classificação de Papanicolaou aplicável à citologia do LCR.

Thirty one healthy people and 49 patients suffering from diseases of the nervous system were studied in order to evaluate the technique of eliciting Babinski's signal by means of cold stimulation as it was proposed by Dalsgaard-Nielsen. The patients were distributed in 4 groups. Patients of group 1 (7 cases) had clinical signs of peripheric nervous system impairment. Patients of groups 2, 3 and 4 had clinical signs of CNS impairment. In those of group 2 (12 cases) there were no evidences of central motor lesions. In the remaining patients these evidences were found and they were grouped considering the absence (group 3: 9 cases) or the presence (group 4: 21 cases) of Babinski's sign, when tactile stimulation was used. The results obtained were compared to those found in the same people by means of tactile plantar stimulation. For both methods, results were considered to be: absent, when any motor reflex activity was elicited; in-characteristic, when it was observed a rapid dorsiflexion of toes; normal, when the ventral flexion of toes proper to cutaneo-plantar reflex occurred and Babinski's sign, when it occurred the hallux dorsiflexion proper to this signal. The results obtained show that the plantar cold stimulation is not useful for eliciting the normal cutaneo-plantar reflex. It was elicited by this method only in 2 healthy people and in 3 patients of groups 1 and 2. Babinski's toe phenomenon was elicited by cold stimulation in 18 patients of group 4. It was observed that the response was more characteristic and remained by a longer period when cold stimulation was used. These aspects were observed specially in those patients that had bilateral Babinski's sign. The results show that cold stimulation of the plantar region is an useful method of eliciting Babinski's toe phenomenon. The qualitative aspects of the motor response which were refered show that cold stimulation is an useful method of investigation to be employed specially when doubtful responses are obtained by tactile stimulation techniques.

Estudo comparado do proteinograma do LCR e do soro sanguíneo de 20 pacientes com esquistossomose mansoni. Foi possível verificar que as modificações do proteinograma do LCR decorriam das modificações do proteinograma do soro ou então de modificações da barreira hêmato-liquórica. Estas últimas foram caracterizadas em 6 casos. Reações inflamatórias da parede vascular, passíveis de ser observadas na doença são apontadas como a possível causa de alterações da barreira hêmato-liquórica, por acometimento de vasos da leptomeninge. O comportamento do teor de globulina gama no LCR encontrava-se aumentado em 10 pacientes: em 6 o aumento era secundário ao aumento do teor no sangue; em três decorria de modificações da barreira hêmato-liquórica; em um era sugestiva de haver reação inflamatória leptomeníngea na possível dependência da esquistossomose mansoni. The proteins of cerebrospinal fluid and blood sera were studied in 20 unselected cases of schistosomiasis mansoni. It was found that the changes in the CSF protein fractions are secondary to the changes in the protein fractions of blood sera or result from damage of the blood — CSF barrier. This mechanism explained the changes in protein fractions of CSF in 6 patients. The changes in the blood — CSF barrier were atributed to the impairment of leptomeningeal vessels due to vasculitis that may occur in schistosomiasis. The gamma globulin content in the CSF was elevated in ten cases: in six it depended of high gamma globulin content in blood sera; in three it depended on changes in the blood — CSF barrier. In one patient the CSF gamma globulin content was suggestive of local inflammatory changes in the leptomeninges, possibly dependent on schistosomiasis mansoni.

Registro de caso de paciente com polirradiculoneurite, forma ascendente, com comprometimento de nervos cranianos e distúrbios respiratórios. Houve remissão progressiva da sintomatologia, com desaparecimento completo das alterações neurológicas cêrca de 7 meses depois do início da doença. O quadro liquórico (LCR lombar) se caracterizava por dissociação proteíno-citológica e positividade de reações imunológicas para sífilis cujo título diminuiu progressivamente, à medida em que decrescia a hiperproteinorraquia. O perfil protêico do LCR era de tipo misto, com aumento de albumina, normalizando-se à medida em que decrescia a proteinorraquia. A positividade das reações para sífilis no LCR, observada no caso decorre da passagem para o LCR, de imunoproteínas do sôro no qual as reações para sífilis eram positivas. Com a redução da intensidade da estase, tornaram-se negativas tais reações no LCR, embora persistisse a positividade no sôro. A favor dessa hipótese são lembrados os dados referentes ao perfil protêico do LCR, não compatíveis com aquêles observados na neuros-sífilis. Report of a case of polyradiculoneuritis with positivity of immunologic tests for syphilis in the CSF in a 36 years old man. Sensitive disturbances first appeared soon followed by ascending impairment of the motricity. One month later there occurred respiratory changes, diplopia, disphagia and involvement of the left facial nerve. Diplopia and respiratory disturbances disappeared one week later. Progressive remission of the remaining symptoms occurred later. Two months later, the neurologic examination showed only absence of the deep reflexes of the extremities, muscular hypotony and some degree of paresthesic sensations. Voluntary movements and muscle power were normal. Objetive disturbances of sensibility had disappeared. Nine months after the onset of the disease the neurologic examination was normal. CSF changes (table 1) were characterized by protein-cytologic dissociation and by the positivity of immunologic tests for syphilis. The protein pattern of the CSF was of the "mixed type" and the relative concentration of the albumin fraction was increased (paper electroforesis). Immunologic tests for syphilis were positive in blood serum also. Repeated spinal taps showed progressive reduction of the CSF protein concentration. The changes in the protein pattern tend to disappear with the decrease of the total protein concentration. Two months after the onset of the disease, the disturbances in the protein pattern were no longer present. The titers of the immunologic tests for syphilis in the CSF decreased rapidly. This fall accompanied the decrease in the total protein concentration. One month after the first CSF examination the immunologic tests for syphilis in the CSF were negative. Data concerning to the positivity of the immunologic tests for syphilis in the CSF were discussed. The changes were correlated to the alterations in the protein balance between blood and the CSF occuring in polyradiculoneurites rather than to neurosyphilis. Some data are in agreement with this idea. First, the decrease in the total amount of CSF proteins was accompanied by the decrease in the titer of antibodies. Also, the changes found in the protein pattern of the CSF were not similar to the findings in neurosyphilis. A marked increase in the y-globulin fraction is the main change in neurosyphilis. This was not found even when the total protein content of the CSF was moderately increased. The findings indicate that in the case reported the positivity of immunologic tests for syphilis observed in the CSF was secondary to the disturbances in the protein balance between blood and CSF. The passage of the imuno-proteins present in the blood to the CSF was a manifestation of the altered protein balance occurring in polyradiculoneuritis.

Estudo anátomo-clínico de caso de paciente com glioblastoma multiforme da porção cervicotorácica da medula espinhal. A partir da sede primitiva o tumor invadia o espaço sub-aracnóideo, formando manguito que envolvia a medula desde a dilatação cervical até a região lombar. Apesar do crescimento tão extenso no espaço sub-aracnóideo, não foram encontradas metástases leptomeníngeas à distância. Considerações são feitas sobre a freqüência com que o glioblastoma é observado entre os tumores medulares e sobre os modos pelos quais esse glioma costuma invadir as leptomeninges. Também no caso registrado foi verificada hipoglicorraquia, achado relatado com certa freqüência no comprometimento leptomeníngeo por neoplasias. The case of a 17 year old patient with glioblastoma multiformis of cervico-thoracic region of the spinal cord whose disease was first manifested almost 7 months prior to death is reported. Initial symptoms of sphincter disfunction were soon followed by clinical signs of transverse myelopathy in the upper thoracic region. A complete block of the spinal canal was found on manometric tests. The cerebrospinal fluid was xanthochromic and coagulated immediatly; total protein concentration was markedly increased and glycosis content was low. Descendent perimyelography showed that blocking was complete at the level of first thoracic vertebral body and that it was caused by an intramedullar expanding process. About two months before death symptoms referred to spinal cord impairment assumed an ascending character. Signs of peripheral motor neuron impairment appeared in the upper extremities. Progressive signs of intracranial hypertension appeared and preceeded death. A transient cardiac arrest and apnea occured. The patient, maintained under artificial respiration, remained in comatous state until death, two days later. Brain edema was found at post-morten examination. Cerebral meninges were normal. The upper portions of the spinal cord were enlarged and their consistency was increased. The structures of the inferior portion of cervical region were completely substituted by neoplasic tissue. The central portion of cervical enlargement as well as the upper and middle portions of thoracic region were also invaded by neoplasic tissue. Ischaemic necrosis occurred in the first cervical segments. Histologic examination showed that the tumor was a glioblastoma multiformis. In the inferior portion of cervical cord the neoplasy invaded the leptomeninges, growing extensively in the subarachnoid space, surrounding the spinal cord. Nerve roots were also invaded by neoplasic tissue. Literature data concerning to the low incidence of glioblastoma among tumors of the spinal cord were quoted. The leptomemeningeal invasion by the tumor found was discussed. In spite of its extension, meningeal gliomatosis was discarded since subarachnoid and medullar portions of the tumor were continuous, no metastatic tumoral growths related to other areas of subarachnoid space were found and tumor cells were not found in the cerebrospinal fluid.