Diagnóstico e tratamento de convulsões / Diagnosis and treatment of convulsions

As características, as causas, os cursos e os tratamentos dos vários tipos de convulsões serão aqui apresentados. Os tipos mais comuns de desordens convulsivas são: 1. grande mal, às vezes chamada tônico-clônica generalizada; 2. ausência ou pequeno mal; 3. psicomotora ou complexa parcial; 4. mioclônica ou espasmo convulsivo; e 5. febril, em crianças pequenas. Os tipos de convulsões mais raras são: status epilepticus; atônica; parcial; jacksoniana; e espasmo infantil.

The characteristics, causes, treatment and courses of various types of convulsive disorders are presented here. The most common types of convulsive disorders are: 1. great evil, sometimes called generalized tonic-clonic; 2. absence or petit mal; 3. psychomotor or complex partial; 4. myoclonic or convulsive spasm; and 5. febrile, illness in young children. The types of convulsions are rare: status epilepticus; atonic; partial; jacksonian; and infantile spasms.

Diagnóstico e tratamento de dores de cabeça / Diagnosis and treatment of headaches

Os vários tipos de dores de cabeça são: 1. cefaléias 1. cefaléias causadas por tensão na camada fina de músculos entre os ossos e o couro cabeludo; 2. enxaquecas; 3. dores de cabeça pós-traumáticas; 4. cefaleias que envolvem problemas especiais e crianças com menos de sete anos de vida; e 5. outros tipos, como cefaleias em cachos (cluster) crianças com menos de sete anos de vida; e 5. outros tipos, como cefaléias em cachos (cluster), dores produzidas por sinusite e dores de cabeça durante a gravidez ou a velhice. São apresentados os diagnósticos e tratamentos de todas estas cefaléias.

The varios kinds of headaches are: 1. headache produced by tension in thin layer o muscles between the bones and the skin of the head; 2. migraine headaches; 3. postraumatic headaches; 4. headaches involving special problems in children who are less than seven years old; and 5. miscellaneous other types such as cluster headaches, sinus infection headaches and headaches during pregnancy and old age. The diagnosis and treatment of each of these kinds of headaches are discurssed.

Doença do aniversário com sintomas psiquiátricos e neurológicos / Birthday disease with psychiatric and neurological symptoms

Este caso apresenta uma doença de três semanas, com sintomas psiquiátricos e neurológicos, em uma mulher com 32 anos de idade, que exatamente no 10º aniversário da morte de sua avó, que a havia criado, teve início súbito de uma depressão severa, ansiedade e sintomas dissociativos e conversivos. Apresentou ataxia severa. Recuperou-se rapidamente quando a natureza de sua doença foi esclarecida. Ela e sua família, até então, não tinham consciência desta conexão. A literatura médica sobre a doença do aniversário será apresentada.

The case is presented of a three week illness with psychiatric and neurological symptoms of a 32-years-old woman who on exactly the 10th anniversary of the death of her grandmother, who had reared her, had the sudden onset of severe depressiveness, anxiety and dissociative and conversion symptoms. She had marked ataxia. She recovered quickly when the nature of her illness was clarified. She and her family had until this time been unaware of this connection. The medical literature on anniversary illness is revied.

Machado de Assis's own writings about his epilepsy: a brief clinical note

Machado de Assis's own writings about his epilepsy are here given. They come from his correspondence with his friend Mario de Alencar during the last 8 months of Machado de Assis's life. These are the only places where Machado de Assis dealt clearly with his epilepsy during his entire life

Uso e abuso de EEGs / Use and abuse of EEGs

Médicos no Brasil e também nos Estados Unidos adquirem, durante seus anos de treinamento, conhecimentos adequados sobre eletrocardiogramas, exames de raio X, tomografia computadorizada, ultra-sonografia e outros exames. Em geral, eles não obtêm informações semelhantes da natureza, uso e limitações de eletroencefalogramas (EEGs). Este artigo trata de algumas das falhas mais comuns de médicos não-especialistas em Neurologia e Psiquiatria: 1. EEGs não dão informações sobre as personalidades e os estados emocionais e intelectuais dos pacientes; 2. EEGs podem ser úteis na avaliação e tratamento de pacientes com dores de cabeça somente se o médico enfatiza que a maioria das cefaléias não está relacionada ao cérebro, mas tem as suas causas nas tensões das camadas musculares da cabeça e em outras estruturas não-cerebrais da cabeça; 3. EEGs são de muito valor no diagnóstico de ausências (epilepsia pequeno mal) mas para obter este valor o médico tem de entender bem a natureza deste tipo de convulsão; 4. EEGs têm utilidade no diagnóstico de epilepsia grande mal, mas eles possuem limitações neste campo; 5. EEGs são úteis no tratamento de pacientes com traumatismo craniano leve, mas neste caso eles também têm de ser utilizados nos contextos da situação total da vida do doente, e o significado do seu traumatismo craniano deverá ser explicado. O artigo trata ligeiramente de outros assuntos semelhantes

Folie à deux dissociative disorder in prepubertal children: report of two cases with EEGs

A case of folie à deux dissociative (dissociative hysteria) disorder in an 8 and 12 year-old sister and brother is presented. Illnesses of this type are very rare and there is little medical literature on this subject. Our patients, almost simultaneously, abruptly had complete loss of memory, desorientation. loss of awareness about who they were, and much anxiety, which lasted about 15 hours. Both patients were physically well and no abnormalities were found on physical examination, routines laboratory tests and EEG studies. Speculations about the emotional and interpersonal causes of this illness in these two patients are given.

The concept of nemesis in psychoneurosis

A patient who has a nemesis fear as the basic process in his psychoneurosis feels that he is destined to repeat the life course of one of his parents to eventual long-term psychosis, or incapacitating physical illness or death by illness or accident. He feels that this will occur at about same age as that at which his parent suffered his misfortune. The patient during his childhood and adolescence had a traumatic relationship with this parent, and is haunted by guilt feelings about it, and fears that avenging destiny, or nemesis, requires that he pay with a similar misfortune for that which he feels he caused. Thse patients improve much in psychotherapy, but the underlying nemesis fear, though much reduced in severeity, is not entirely eliminated.

Obsessions of infanticide and imminent psychosis

In young mothers an obsession of infanticide, that is, fear that they may murder their children, may be coupled with an obsession of imminent psychosis, that is, fear that the first obsession is a sign of approaching insanity. Sixteen mothers with this clinical picture were evaluated in interviews. Seven of them entered psychotherapy and improved. The causative factors in childhood and adolescence wich led to the later development of these obsessive difficulties are analyzed. Even when psychotherapy was not possible, as was the case in nine patients, they should be strongly reassured and explanations should be given about the nature of the problem, for such encouragement and clarification helps them to improve to a significant extent. The prognosis of patients who have systematic psychoterapy is good.

The use of humor in psychotherapy

O humor pode ser uma técnica terapêutica útil nas mäos de alguns psicoterapeutas. O humor pode ajudar um doente a ver episódios e situaçöes dolorosas de sua vida sob perspectivas menos ameaçadoras e pode retirar sentimentos de ansiedade e culpa provenientes de muitos acontecimentos e situaçöes. O humor pode ser valioso quando o terapeuta está conversando com mäes e pais sobre os problemas dos seus filhos adolescentes, em diálogos com adolescentes, na análise das dificuldades no trabalho e em outros ambientes sociais, para desfazer temores em relaçäo ao terapeuta, para reduzir a ansiedade relativa ao tratamento em si mesmo, no tratamento de impotência sexual e em muitos outros problemas e tipos de doentes. Todavia, alguns terapeutas näo usam bem o humor e nas mäos deles acaba dando errado ou deixa de produzir os efeitos desejados; estes terapeutas näo devem utilizar-se do humor

Tentative interpretations in psychotherapy

A natureza e o método da interpretaçäo tentativa säo descritas. A sua utilidade e as suas vantagens säo esboçadas e o seu uso em psicoterapia é examinado

Creutzfeldt-Jakob disease. A case report, with special attention to the electroencephalogram in this disorder and to its possible relationships to kuru, scrapie and mad cow disease

A case of Creutzfeldt-Jakob disease in a 58-year-old Brazilian cattle rancher and businessman is presented. The EEG was normal, which is consistent with the fact that it was made during the first half of his illness; in a later stage suppression of normal rhythms by slow moderate voltage waves would be expected. The resemblances of kuru, scrapie and "mad cow disease" to C-J disease are discussed. In each of these 4 illnesses the patient or affected animal (scrapie and "mad cow disease") (a) has a widespread spongiform encephalopathy and consequent dementia, myoclonic epilepsy and cerebellar and corticospinal symptoms. (b) Each illness is caused by a virus (or virus-like organism called a PrP or prion) which is unusually resistant to heat and entirely resistant to ultraviolet light and x-rays. (c) This causative agent can be transmitted to other mammals by intracerebral injection or, in the proved cases of 3 of them, by the oral route. Unresolved questions about C-J disease include the following: Are C-J disease, kuru, scrapie and "mad cow disease" essentially similar illnesses caused by the same virus or by subtle variants of it? What is the incubation period of C-J disease, and does its virus exist for long periods of time in some asymptomatic persons, some of whom may never become neurologically ill? How does this virus enter the bodies of most persons with C-J disease, and why does the clinical disease characteristically occur only in middle age?