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Normal pressure hydrocephalus (NPH) has been a topic of debate since its introduction in publications. More frequent in the elderly population, it is characterized by gait disturbance, urinary urge incontinence and cognitive decline. Therefore, it is a clinical-radiological entity with relatively common findings for the age group, which together may have greater specificity. Therefore, its diagnosis must be careful for an adequate selection of patients for treatment with ventricular shunt, since the symptoms are potentially reversible. The tap test has a high positive predictive value as a predictor of therapeutic response, but a negative test does not exclude the possibility of treatment. Scientific efforts in recent years have been directed towards a better understanding of NPH and this narrative review aims to compile recent data from the literature in a didactic way for clinical practice. RESUMO A hidrocefalia de pressão normal (HPN) é tema de debate desde sua introdução na literatura. Mais frequente na população idosa, caracteriza-se por distúrbio de marcha, urge-incontinência urinária e declínio cognitivo. Portanto, trata-se de uma entidade clínico-radiológica com achados relativamente comuns para a faixa etária, que em conjunto, podem ter maior especificidade. Sendo assim, seu diagnóstico deve ser criterioso para uma adequada seleção de pacientes para tratamento com a derivação ventricular, uma vez que os sintomas são potencialmente reversíveis. O tap test possui valor preditivo positivo alto preditor de resposta terapêutica, mas um teste negativo não exclui a possibilidade de tratamento. Esforços científicos nos últimos anos têm sido direcionados para melhor entendimento da HPN e essa revisão narrativa se propõe a compilar dados recentes da literatura de forma didática para a prática clínica.

Background: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Results: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.

A 76-year-old woman presented with a three-month history of faciobrachial dystonic seizures associated with cognitive impairment and hyponatremia. Cerebrospinal fluid analysis was unremarkable. A whole-body CT scan demonstrated no malignancies. Brain MRI revealed involvement of the mesial right temporal lobe, right striatum and globus pallidus and bilateral supratentorial white matter (). Leucine-rich glioma inactivated protein 1 (LGI-1) antibodies were detected in the serum. The patient received immunosuppressive treatment, with a partial response. LGI-1 encephalitis is an immune-mediated encephalitis characterized by [...]

A 66-year-old Brazilian woman presented with fever, malaise, and myalgia, followed 10 days later by left hemiparesis and altered mental status. Brain MRI revealed bilateral intracerebral hemorrhages (figure, A and B) and CSF showed mild lymphocytic pleocytosis. Serologic testing for dengue fever was positive. Brain biopsy demonstrated nonspecific inflammatory changes and areas of recent hemorrhage and necrosis (figure, C). After 1 month, partial clinical and radiologic improvement occurred (figure, D). Expanded dengue syndrome1 refers to atypical manifestations of dengue such as intracerebral hemorrhage, which is a rare presentation usually reported a week after fever onset, possibly related to release of cytokines with vasogenic activity.2

Background Clinicopathological studies are important in determining the brain lesions underlying dementia. Although almost 60% of individuals with dementia live in developing countries, few clinicopathological studies focus on these individuals. We investigated the frequency of neurodegenerative and vascular-related neuropathological lesions in 1,092 Brazilian admixed older adults, their correlation with cognitive and neuropsychiatric symptoms, and the accuracy of dementia subtype diagnosis. Methods and findings In this cross-sectional study, we describe clinical and neuropathological variables related to cognitive impairment in 1,092 participants (mean age = 74 y, 49% male, 69% white, and mean education = 4 y). Cognitive function was investigated using the Clinical Dementia Rating (CDR) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE); neuropsychiatric symptoms were evaluated using the Neuropsychiatric Inventory (NPI). Associations between neuropathological lesions and cognitive impairment were investigated using ordinal logistic regression. We developed a neuropathological comorbidity (NPC) score and compared it to CDR, IQCODE, and NPI scores. We also described and compared the frequency of neuropathological diagnosis to clinical diagnosis of dementia subtype. Forty-four percent of the sample met criteria for neuropathological diagnosis. Among these participants, 50% had neuropathological diagnoses of Alzheimer disease (AD), and 35% of vascular dementia (VaD). Neurofibrillary tangles (NFTs), hippocampal sclerosis, lacunar infarcts, hyaline atherosclerosis, siderocalcinosis, and Lewy body disease were independently associated with cognitive impairment. Higher NPC scores were associated with worse scores in the CDR sum of boxes (β = 1.33, 95% CI 1.20–1.46), IQCODE (β = 0.14, 95% CI 0.13–0.16), and NPI (β = 1.74, 95% CI = 1.33–2.16). Compared to neuropathological diagnoses, clinical diagnosis had high sensitivity to AD and high specificity to dementia with Lewy body/Parkinson dementia. The major limitation of our study is the lack of clinical follow-up of participants during life. Conclusions NFT deposition, vascular lesions, and high NPC scorewere associated with cognitive impairment in a unique Brazilian sample with low education. Our results confirm the high prevalence of neuropathological diagnosis in older adults and the mismatch between clinical and neuropathological diagnoses., In a postmortem analysis, Lea Grinberg and colleagues examine neuropathological diagnoses in a sample of older adults from Brazil., Author summary Why was this study done? Fifty-eight percent of people with dementia live in low- and middle-income countries (LMICs), and this percentage is expected to increase to 71% by 2050. Definitive diagnosis of dementia etiology requires a neuropathological exam. In high-income countries (HICs), Alzheimer disease (AD) is the most common cause of dementia, usually coexisting with other neurodegenerative and vascular lesions. Almost no neuropathological information is available for LMICs; therefore, we investigated the frequency of neurodegenerative and cerebrovascular lesions and their correlation with cognitive and neuropsychiatric symptoms in a clinicopathological study with 1,092 admixed older participants from Brazil. What did the researchers do and find? In a cross-sectional study, we described the frequency of the most common causes of dementia, as well as the correspondence between clinical and neuropathological diagnosis, in a large population-based series with 1,092 older adults from a LMIC. We developed a comorbidity neuropathological score to account for the association between the coexistence of cerebral lesions and cognitive and neuropsychiatric symptoms. Forty-four percent of participants had enough neuropathological lesions to fulfill the criteria for at least one neuropathological diagnosis. AD was the most common diagnosis (50%), followed by vascular dementia (35%). Higher neuropathological comorbidity associated with worse cognition and a higher burden of neuropsychiatric symptoms. What do these findings mean? In a large sample from a LMIC, dementia subtypes were similar to those seen in series from HICs. Although vascular dementia was not as frequent as AD, its frequency was relatively higher than in HIC series.