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RESUMO Objetivo: A hemorragia subaracnóidea é uma doença prevalente com alta morbidade e mortalidade. Inúmeras complicações contribuem para a lesão cerebral e desafiam o médico no diagnóstico e tratamento. A encefalopatia hiperamonêmica associada ao valproato é uma entidade rara, subdiagnosticada, grave e importante a ser considerada. Apresentamos o caso de um paciente com hemorragia subaracnóidea que recebeu profilaxia anticonvulsivante com valproato e evoluiu com piora neurológica associada a níveis plasmáticos elevados de amônia e descargas periódicas no eletroencefalograma, sem outras causas identificáveis. A interrupção do tratamento com ácido valproico e a normalização dos níveis plasmáticos de amônia resultaram em melhora do quadro neurológico e eletroencefalográfico.

Objective: This study analyzed the relation between brain injury topography and bladder dysfunction in patients with ischemic and hemorrhagic stroke by comparing the brain region affected with lower urinary tract symptoms (LUTS). Material and Methods: A retrospective study developed by the SARAH Network of Rehabilitation Hospitals in Brazil, involving 132 patients with chronic stroke attended by an adult neurological rehabilitation program, from January 2008 to December 2011. Results: 106 patients (80.3%) showed ischemic stroke sequelae and 26 (19.7%) hemorrhagic stroke sequelae. Patient mean age was 56.0±13.1 years and the mean period since stroke occurrence was 21.4 months. Regarding voiding behavior, 35.6% (n=47) showed bladder continence, 45.5% (n=60) presented LUTS, and 18.9% (n=25) presented continuous urinary incontinence. The presence of continuous urinary incontinence was significantly associated with extensive lesions in the frontal-parietal-temporal-occipital regions (p=0.001), cognitive deficits (p=0.001) and aphasia (p=0.001). In patients with frontoparietal lesions, associations were observed for urgency (p=0.05), urge urinary incontinence (p=0.042), urinary incontinence (p=0.019) and pollakisuria (p=0.042). Conclusion: Data showed that cognitive impairment and aphasia were correlated with continuous urinary incontinence. Regarding brain injury topography, associations were determined between lesions to the frontal-parietal region and symptoms of urgency, urge urinary incontinence, stress urinary incontinence and pollakisuria, while extensive brain injury was associated with continuous urinary incontinence. [ABSTRACT FROM AUTHOR]

This study describes the adaptation of a revised Brazilian version of the Patient Competency Rating Scale (PCRS-R-BR), which focuses on executive, mnemonic, and attention functions. Evidence of content-based and external validity is also reported. The cross-cultural adaptation was conducted in five phases: 1) translations and back translations; 2) item analysis by authors; 3) classification by experts; 4) revisions and reformulations by authors; 5) pilot study with a sample of patients with mild and moderate/severe traumatic brain injury (TBI). Data were analyzed descriptively, and the PCRS-R-BR scores of groups with mild vs. moderate/severe TBI were compared using the Mann-Whitney test. Patients and their relatives were divided into groups and compared using repeated-measures analysis. The results of the PCRS-R-BR questionnaire for relatives and discrepancy scores of patients with moderate/severe TBI revealed significantly more impairment than that found in the group of patients with mild TBI. There were significant differences between item and total scores of both groups of patients and relatives. Results indicated a high level of item content agreement between experts. This study found initial evidence of PCRS-R-BR content-based and external validity when the questionnaire was applied to patients with mild and moderate/severe TBI and their relatives.

'Kounis Syndrome' is an acute coronary artery event due to an artery spasm occurring during immediate hypersensitivity reactions or chronic spontaneous urticaria. Recently it has been reported in other systems, including the cerebral vasculature. We present a case series of three patients observed between January 2016 and December 2018 with acute and transient brain injury associated with concomitant exacerbation of chronic spontaneous urticaria, including one patient with multiple recurrences of neurologic symptoms during exacerbations of urticaria. Minor imaging defects were observed in two patients, but there were no apparent vascular risk factors or coagulation abnormalities that might explain neurologic symptoms. Chronic spontaneous urticaria, through activation of mast cells and mediator release, seems capable of inducing cerebral arterial aggression. The authors want to call the attention to this possible association, reinforcing the need to keep urticaria under control to prevent neurological manifestations. [ABSTRACT FROM AUTHOR]

During development, children become capable of categorically associating stimuli and of using these relationships for memory recall. Brain damage in childhood can interfere with this development. This study investigated categorical association of stimuli and recall in four children with brain damages. The etiology, topography and timing of the lesions were diverse. Tasks included naming and immediate recall of 30 perceptually and semantically related figures, free sorting, delayed recall, and cued recall of the same material. Traditional neuropsychological tests were also employed. Two children with brain damage sustained in middle childhood relied on perceptual rather than on categorical associations in making associations between figures and showed deficits in delayed or cued recall, in contrast to those with perinatal lesions. One child exhibited normal performance in recall despite categorical association deficits. The present results suggest that brain damaged children show deficits in categorization and recall that are not usually identified in traditional neuropsychological tests.No desenvolvimento, as crianças tornam-se capazes de associar estímulos em categorias e de se beneficiar dessas associações para sua recordação posterior. Lesões cerebrais na infância podem interferir nesse desenvolvimento. Neste estudo, essas habilidades foram avaliadas em crianças com lesões cerebrais. A etiologia, topografia e época de instalação da lesão variaram. As tarefas incluíram: nomeação e recordação imediata de 30 figuras relacionadas perceptual e semanticamente; associação livre; recordação tardia e recordação com pistas. Testes neuropsicológicos tradicionais também foram usados. Duas crianças com lesões adquiridas na fase escolar associaram as figuras baseadas em relações perceptivas e não categóricas e apresentaram déficits de recordação tardia e com pistas, ao contrario das outras duas com lesões perinatais. Uma criança apresentou bom desempenho na recordação independentemente de associação categórica. Os resultados sugerem que crianças com lesões cerebrais podem apresentar déficits de categorização e recordação, que não são frequentemente evidenciados em testes tradicionais.

O marco do nascimento da neurolingüística é considerado a publicação do livro A síndrome de Desintegração Fonética, em 1939, que teve como autores: um neurologista, um psicólogo e uma lingüista. Dez anos mais tarde foi publicado, pela mesma equipe de pesquisadores franceses, o distúrbio de fala do paciente portador de anartria pura. No presente artigo, situaremos as polêmicas históricas a respeito de um distúrbio seletivo de fala de origem telencefálica, apresentaremos o primeiro caso descrito, acompanhado da descrição anátomo-patológica do cérebro que estivera guardado em formol por 20 anos e, realizada por um de nós (ARL), e por fim, apresentaremos um caso brasileiro, cujas imagens tomográficas de seu cérebro e espectográficas de sua fala e voz confirmam o trabalho pioneiro de Alajouanine, Pichot e Durant.The mark of birth of neuro-linguistics is considered the publication of the book The Syndrome of Phonetic Disintegration, in 1939, that had as authors: a neurologist, a psychologist and a linguistics. Ten years later the same team of French researchers published about, the disturbance of speech of the patient carrier of pure Anartria. In the present article, we will place the historical polemics regarding a selective disturbance of speech of telencephalic origin and present the first described case, accompanied by the anatomic-pathological description of the brain that had been kept in formol by 20 years accomplished by one of us (ARL). Finally, we will present a Brazilian case, with tomographic images of its brain and spectrographic evaluation of its speech and voice that confirm the pioneer work of Alajouanine, Pichot and Durant.

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Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Tivemos a oportunidade de acompanhar com exames de TC caso de intoxicação por metanol. O paciente foi submetido ao exame no momento da internação e após seis dias, pela persistência de quadro neurológico grave. Observou-se nesta última a presença de lesões putaminais simétricas e da substância branca subcortical, apesar do tratamento adequado. A comprovação tomográfica de lesões cerebrais evidenciou efeito tóxico do metanol e pode orientar o prognóstico neurológico.