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Sessenta e dois casos de neurossífilis sintomática foram tratados com penicilina G, na dose diária de 20 ou 24 milhões de UI. por via intravenosa, durante 15 a 30 dias. O tempo médio de acompanhamento foi de 30 meses. Antes do tratamento, 41 pacientes apresentavam pleocitose ao exame do LCR. Seis meses e doze ou mais meses depois, foi constatada pleocitose em 4 (9,8%) e em 3 pacientes (7,3%), respectivamente. A proteinorraquia e os títulos das reações de Wassermann do soro e do LCR reduziram-se lentamente depois do tratamento. O teor de globulinas gama do LCR e os índices de imunoprodução local do sistema LCR ainda encontravam-se elevados depois do primeiro ano após tratamento. Os resultados da penicilinoterapia intravenosa em altas doses constatados neste estudo não diferiram daqueles obtidos com penicilinoterapia intramuscular em baixas doses registrados na literatura.

Investigation on the behavior of immunoglobulins IGG, IGA and IGM in the CSF in cases of cysticercosis of the CNS, based on data pertaining to two different series of cases. The first series comprises 30 samples of CSF, and the second one, 5 samples. It was demonstrated that IGG is the one representing the largest contingent. IGG concentration keeps in proportion with the gamma globulin concentration, of which it represented an 88% average in the cases studied. Participation of IGG in the protein profile of the CSF is greater than the usually referred; the results for the material analyzed showed 16%. It was verified a proporcionality also between IGG concentration and the titer of positive complement fixation test for cysticercosis; there is a positive correlation, whose numerical expression was found to be significant, in the samples studied.

Foram estudadas 133 amostras de LCR provenientes de 115 pacientes para verificar o teor da PBM, fragmento P1 43-88. Os casos foram subdivididos em subgrupos de acordo com o diagnóstico nosológico. No grupo controle (50 casos de pacientes com cefaléia crônica) não houve detecção de PBM em qualquer das amostras; dos casos de neurocisticercose (44), em 4 havia presença da PBM; nos de esclerose múltipla (8) em três havia PBM; em um caso de neuroes-quistossomose, forma medular, também foi detectada a presença da PBM. Considerações de ordem neuroimunológica são tecidas sobre os resultados encontrados. Cerebrospinal fluid (CSF) from 115 patients with several neurological disorders were tested for the presence of myelin basic protein (MBP), fragment P1 43-88. Cases were divided into groups according to neurological diagnosis. The control group (50 patients with chronic headache) presented normal CSF composition and presented no evidence of the presence of MBP. MBP was found in: four cases of the 44 of neurocysticercosis; three of the 8 cases of multiple sclerosis; one case of schistosomiasis with spinal cord involvement. Neuroimmunological data are discussed considering results found in this investigation.

Six cases of meningeal melanomatosis are reported. The cytomorphological analysis of cerebrospinal fluid lead to diagnosis in all of them. Emphasis is given to morphological characteristics of the tumor cells and specially to the melanin dark brown pigment, observed in all cases here reported.

Foi estudado sistematizadamente o LCR de 50 pacientes com AIDS que apresentavam sintomatologia passível de ser atribuída a comprometimento do SNC. Somente 5 apresentavam o quadro do LCR dentro dos limites normais. Em um, ocorriam células neoplásicas (linfoma); em 10, Cryptococcus neoformans; reações imunológicas foram positivas para sífilis em três e para toxoplasmose em 4. Um dos casos de criptococose apresentava simultaneamente toxoplasmose e desenvolveu sífilis, ulteriormente. Em outro dos casos de criptococose durante a evolução surgiram leveduras do gênero Candida. Considerando os achados, são discutidos quanto ao LCR aspectos: da reação inflamatoria na vigência de imunodeficiência; do comprometimento da BHE; do comprometimento do SNC; de efeitos de massa que podem ocorrer, como aqueles provocados por tumores e granulomas. Cerebrospinal fluid (CSF) was analysed in 50 AIDS patients in this investigation. CSF analysis included: pressure, aspect, colour, cytology (cell number, cytomorphology, and lymphocyte subpopulations), proteins concentration and their electrophoretic distribution, chloride and glcosis concentration, GOT and LDH activity, immunology for cysticercosis, syphilis and toxoplasmosis, bacteriology, and mycological examinations (direct, cultures, Cryptococcus neoformans antigen test). Diagnostic changes were: lymphoma cells in one patient, cryptococcosis in 10, toxoplasmosis in 4, candidiasis in 1, and syphilis in 3. Cryptococcosis occurred in association with toxoplasmosis in one patient who developed syphilis in the follow-up; oligoclonal distribution of gamma globulins ocurred in this case. In another case of cryptococcosis, candidiasis appeared during the course of the disease. Changes in the CSF composition observed are discussed in order to evaluate: aspects of CSF inflammatory response in report to immunodeficiency; blood-brain barrier involvement; CNS damage; intracranial mass effects.

Com o objetivo de padronizar modelo experimental de imunossupressão foram selecionados dois lotes de 50 camundongos impúberes, cada um dividido em grupos de 10, e submetidos a ação de dexametasona. O estudo foi dividido em dois experimentos. No primeiro experimento foi utilizado o primeiro lote de animais e foram estabelecidas as condições para obtenção de modelo de imunossupressão em camundongos mediante administração de dexametasona diluída na água de consumo e ingerida ad libitum pelos animais. Entre os critérios utilizados para avaliar a vigência de imunossupressão são realçados: a ocorrência de eriçamento de pelos, leucopenia por diminuição do número de linfócitos e hipotrofia do baço comparativamente aos controles, com hipoplasia intensa de todas as estruturas linfóides. No segundo experimento foi empregado o segundo lote de animais e foi estudado o comportamento do modelo experimental estabelecido. Os animais receberam, por via intraperitonial, número aproximado delO6 leveduras com os caracteres morfológicos do Cryptococcus neoformans, provenientes de culturas de cepas patogênicas ao homem e isoladas do líquido cefalorraqueano de pacientes com neurocriptococose. Apesar de haverem sido identificadas leveduras em cortes histológicos de pulmão, fígado e baço em todos os camundongos inoculados, somente ocorreu o óbito naqueles em que havia acometimento do sistema nervoso central pela levedura (aproximadamente 50% dos animais). A discussão dos resultados obtidos e seu significado inclui considerações sobre o possível papel desempenhado pela função barreira hêmato-encefálica no evento constatado.

Total cell count of cerebrospinal fluid (CSF) in normal newborn infants has shown no more than 12 leucocytes and 600 red cells by cubic millimeter, as it was previously reported by one of us5. Results on CSF cytomorphology are reported in this study. CSF cytomorphology was studied in 21 normal newborn infants: 2 days old (17 cases) and 7 days old (4 cases). The samples were collected through lumbar puncture. Cytomorphological examinations were carried out after preparing the samples by accelerated gravitational sedimentation in Suta's chamber; the sediments were stained by Leishman's technique. Cytomorphology was type II in most of the cases. Lymphocytes and reticulomonocytes were found in all cases, the relative proportion being 11-59% and 41-78% respectively. Polinuclear neutrophils were found in 12 cases, and the higher relative proportion observed for them was 17%. Eosinophil cells occurred in 3 cases, in the proportion of no more than 2%. Macrophages occured in 12 cases, and the higher proportion observed was 10%. The average values were: lymphocytes 34,6%, reticulomonocytes 60.4%, polinuclear neutrophils 2.9%, eosinophil cells 0.2%, macrophages 1.9%. Linear cell groupings occurred in 3 cases; their nature was morphologically related to choroid cells. Polymorph groupings of undiferenciated reticular cells were found also. They occurred in 5 cases, and their origin was related to cells of arachnoid membrane.

Registro de dois casos de criptococose do sistema nervoso central, em um deles associada a candidíase. Em ambos foram utilizados no tratamento anfotericina-B e 5-fluorocitosina. Em função dos resultados obtidos são feitas considerações quanto à utilidade de cada uma das drogas no tratamento da criptococose, bem como quanto ao uso associado de ambas. Two cases of cryptococcosis of the central nervous system are reported. The treatment was based on the association of amphotericin-B with 5-fluorocytosine. Details on the therapeutic proprieties of these drugs are discussed considering the results obtained. Amphotericin-B was administered intravenously and intrathecally in the two cases. The total amount of amphotericin administered intravenously in the first case was 5.375 mgm, and the oral doses of 5-fluorocytosine were not superior to 100 mgm/kg/of body weight. This patient died 130 days after the first symptoms of the disease. The second patient had been submitted previously to kidney transplantation after bilateral nephrectomy, and inmunossupressive drugs were administered to him since then. Candidiasis and cryptococcosis of the central nervous system developped two years later. 5-fluorocytosine was administered orally (200 mgm/kg of body weight) and amphotericin-B. The total amount of this drug administered intravenously was 2.00 mgm. There was complete clinical and laboratory remission of the mycoses in this case.

Cerebrospinal fluid (CSF) and serum samples of 10 patients with neurocysticercosis under treatment by praziquantel were studied in four occasions: before treatment (day 0) and during treatment on three occasions (days 1, 7 and 21). The immunological reaction analyzed were: ELISA-G and ELISA-M; immunofluorescence-G and immunofluorescence-M; complement fixation. The changes and the variability of results observed through these reactions in this study bring new data that confirm neuroimmunological findings already described in the disease. Acute phase response was found in CSF in 6 cases and only in one case in serum by ELISA-M and immunofluorescence-M. ELISA-G in CSF and serum showed a better sensitivity than the other reactions for diagnosis and for follow-up. Emphasis is given to the importance of the simultaneous realization of several immunological reactions in CSF and serum in patients with neurocysticercosis.

Data on 16 patients with spinal cord involvement by Schistosomiasis mansoni are evaluated as to the clinical course and the evolution of cerebrospinal fluid changes. According to evidences of radicular involvement cases were divided in two groups: myelitis (9 cases) and radiculomyelitis (7 cases). Cerebrospinal fluid changes were evaluated as to cytology, total protein content and gammaglobulins. Partial remission of clinical symptomatology was more common among patients of the second group than among those of the first group. There was not relationship of CSF changes and their course with the clinical course of the disease. Cerebrospinal fluid changes and their course were not related to clinical aspects of the disease and their course. Remission of hypercytosis was more common than the remission of protein changes along the evolution in the two groups of cases considered.

Estudo clínico e laboratorial de dois casos de meningorradiculomielopatia esquistossomótica. Considerações são feitas sobre a fisiopatologia e manifestações neurológicas desta parasitose. A positividade das reações imunológicas para Schistosoma mansoni no líquido cefalorraqueano e as melhoras obtidas mediante terapêutica adequada foram valorizadas para o diagnóstico. The clinical and laboratory findings in two cases of shistosomal meningoradiculomyelopathy due to Schistosoma mansoni are reported. In case 1 the onset and the evolution of the disease assumed a progressive character; the neurologic examination showed a picture similar to the Brown-Sequard syndrome. In case 2 the onset was acute and the neurologic examination has shown a complete transverse myelopathy syndrome at the middle toracic level. The cerebrospinal fluid examination showed in the two cases: cells counts increased, normal or low sugar and increased protein. The study of CSF protein profile showed increased gamma-globulin in the two cases. The immunological reactions in the blood and CSF were positive in the two cases. Good results were obtained with especific therapy.