Guillain-Barré Syndrome, Acute Disseminated Encephalomyelitis and Encephalitis Associated with Zika Virus Infection in Brazil: Detection of Viral RNA and Isolation of Virus during Late Infection.

Zika virus (ZIKV) emerged in Brazil in 2015, which was followed by an increase of Guillain-Barre Syndrome (GBS) cases. We report the epidemiological, clinical, and laboratory findings of the first six neurological cases associated with ZIKV in Brazil seen in a reference neurology hospital in Pernambuco, Brazil. In all cases, ZIKV was detected in serum and/or cerebrospinal fluid (CSF) samples. In this case series, four cases were defined as GBS, one as acute disseminated encephalomyelitis (ADEM) and the other as encephalitis. ZIKV was detected in all cases by RT-PCR and virus isolation was successful in two patients. The time between ZIKV acute symptoms and the development of neurological manifestations varied from 3 to 13 days and ZIKV was detected between 15 and 34 days after the initial symptoms. Our results highlight the need to include ZIKV as a differential diagnosis for neurological syndromes in countries with circulation of this arbovirus. Because the viremia in these patients appears to persist longer, direct diagnostic techniques such as RT-PCR and viral isolation should be considered even if it is after the acute phase of viral infection.

Pediatric multiple sclerosis: analysis of clinical and epidemiological aspects according to National MS Society Consensus 2007.

OBJECTIVE: To describe the epidemiological and clinical characteristics of child/adolescence multiple sclerosis (MS). METHOD: According to a descriptive, cohort study, with comparison of groups, data of 31 cases of child/adolescent MS, diagnosed at State Reference Center for Demyelinating Diseases-Hospital da Restauração, Recife, Pernambuco, Brazil, from 1987 to July 2007, were analyzed. The variables were: sex, initial symptoms, time for diagnosis, time of disease onset (early childhood, later childhood and adolescence), time of follow-up, number of relapses, relapses index and disability. Using SPSS software, version 13.0, t Student and Mann-Whitney tests were performed, with significance level of 0.05. RESULTS: There were 3 (9.7%) cases of early childhood MS, 9 (29%), of late childhood MS, and 19 (61.3%), of adolescence MS. The general sex rate female: male was 1.8:1, varying according to age of onset. The predominant deficits were motor (12; 38.7%) and brainstem/cerebellum (7; 22.5%) especially on subsequent relapses of relapsing/remitting form. Time for diagnosis and average relapses index were higher in early childhood than in adolescence class (p=0.049 and p=0.028, respectively). Disability was higher for primary and secondary MS, as well as for early childhood. CONCLUSION: Early childhood MS presents proper and different characteristics from adults, consisting in a difficult diagnosis that demands aid of expert neurologist on MS.

Pediatric multiple sclerosis: analysis of clinical and epidemiological aspects according to National MS Society Consensus 2007 / Esclerose múltipla pediátrica: análise de aspectos clínicos e epidemiológicos de acordo com o Consenso de 2007 da Sociedade Americana de Esclerose Múltipla

OBJECTIVE: To describe the epidemiological and clinical characteristics of child/adolescence multiple sclerosis (MS). METHOD: According to a descriptive, cohort study, with comparison of groups, data of 31 cases of child/adolescent MS, diagnosed at State Reference Center for Demyelinating Diseases - Hospital da Restauração, Recife, Pernambuco, Brazil, from 1987 to July 2007, were analyzed. The variables were: sex, initial symptoms, time for diagnosis, time of disease onset (early childhood, later childhood and adolescence), time of follow-up, number of relapses, relapses index and disability. Using SPSS software, version 13.0, t Student and Mann-Whitney tests were performed, with significance level of 0.05. RESULTS: There were 3 (9.7 percent) cases of early childhood MS, 9 (29 percent), of late childhood MS, and 19 (61.3 percent), of adolescence MS. The general sex rate female: male was 1.8:1, varying according to age of onset. The predominant deficits were motor (12; 38.7 percent) and brainstem/cerebellum (7; 22.5 percent) especially on subsequent relapses of relapsing/remitting form. Time for diagnosis and average relapses index were higher in early childhood than in adolescence class (p=0.049 and p=0.028, respectively). Disability was higher for primary and secondary MS, as well as for early childhood. CONCLUSION: Early childhood MS presents proper and different characteristics from adults, consisting in a difficult diagnosis that demands aid of expert neurologist on MS.

OBJETIVO: Descrever características epidemiológicas e clínicas de casos de esclerose múltipla (EM) de início precoce. MÉTODO: Em estudo descritivo, prospectivo, tipo coorte, com comparação de grupos, foram analisados 31 portadores de EM de início precoce, diagnosticados no Centro Estadual de Referência para Atenção a Pacientes Portadores de Doenças Desmielinizantes do Hospital da Restauração, Recife, Pernambuco, entre 1987 e julho de 2007. As classes ao primeiro surto foram: infantil precoce, infantil tardia e juvenil, e as variáveis: sexo; sintomas iniciais; tempo para diagnóstico, de doença e de seguimento; número de surtos, índice de recidivas e EDSS. Com o programa SPSS, versão 13.0, foram utilizados os testes t de Student e Mann-Whitney com nível de significância de 0,05. RESULTADOS: Foram observados 3 (9,7 por cento) casos de EM infantil precoce, 9 (29 por cento), infantil tardia, e 19 (61,3 por cento), juvenil. A razão geral de sexo feminino:masculino igualou-se a 1,8:1, variando segundo idade de início. Predominou comprometimento motor (12; 38,7 por cento) e de tronco encefálico ou cerebelo (7; 22,5 por cento), especialmente nos surtos subseqüentes da forma surto-remissão. O tempo para diagnóstico e o índice médio de recidivas foram maiores na infantil precoce que na juvenil (p=0,049 e p=0,028, respectivamente. O grau de incapacidade foi maior nas formas primária e secundária progressiva, assim como na infantil precoce. CONCLUSÃO: A EM na infância e adolescência apresenta características próprias, diferentes daquelas do adulto, constituindo-se em diagnóstico difícil, que exige auxílio de especialista em EM.

[Circadian rhythm and encephalic vascular disease: a correlative study with risk factors]. / Ritmo circadiano e doença vascular encefálica: um estudo de correlação com fatores de risco.

The human biological mechanisms show a predictable clinical variability in time, which has allowed a deeper reevaluation of present-day medical practices, regarding the circadian rhythm (CR) and the mechanisms that produce the supported variations in all biological levels. We have made a study aiming to relate the CR and onset of the neurological clinic situation due to the encephalic vascular lesion, correlating with modifying risk factors. Fifty three patients were studied, 50,94% female (n=27) and 49,50% male (n=26), at average age 66.4 years old. Four intervals of six hours each (0-6; 6-12; 12-18; 18-24) were used to analyze the frequency of the ictus and the incidence in each interval. We found an incidence of 6(11.32%) patients in the 0-6 hs interval; 21 (39.62%) patients in the 6-12 hs interval; 10(18.86%) patients in the 12-18 hs interval; 16 (30.18%) patients in the 18-24 interval. A correlative study with the risk factors has shown that arterial hypertension [(81.25%)] and smoking habit [ (56.25)] were predominant during the 18-24 hs interval, while sedentary [11(52.38%)] stress [11(52.38%)] diabetes [(47.61%)] hyperlipidemia [8 (38.09%)] and alcoholism [8 (38.09%] were predominant during the 6-12 hs interval; and cardiac diseases in the 12-18hs interval.

Ritmo circadiano e doença vascular encefálica: um estudo de correlação com fatores de risco / Circadian rhythm and encephalic vascular disease: a correlative study with risk factors

Os mecanismos biológicos humanos exibem variabilidade clínica previsível no tempo, o que tem permitido reavaliação das práticas médicas atuais, do estudo mais aprofundado do ritmo circadiano (RC) e dos mecanismos que geram as oscilações sustentadas em todos os níveis biológicos. Fizemos um estudo procurando relacionar o RC e o momento do aparecimento do quadro clínico neurológico decorrente da lesão vascular do encéfalo com os fatores de risco modificáveis identificados no momento da internação. Foram estudados 53 pacientes, sendo 50,94 por cento (n =27) do sexo feminino e 49,50 por cento(n =26) do masculino, com média de idade de 66,4 anos. Quatro intervalos de 6 horas (0-6; 6-12; 12-18; 18-24) foram usados para análise da freqüência do ictus e da incidência em cada intervalo. Os resultados mostraram 6 (11,32 por cento) pacientes no intervalo 0-6 hs; 21 (39,62 por cento) no intervalo 6-12 hs; 10 (18,86 por cento) no intervalo 12-18 hs; 16 (30,18 por cento) no intervalo 18-24 hs. Estudo de correlação com os fatores de risco, baseado nos dados clínicos no momento da internação, mostrou que a hipertensão arterial [(81,25 por cento)] e o tabagismo[ (56,25 por cento)] predominaram no intervalo 18-24 hs, enquanto o sedentarismo[11; (52,38 por cento)] o estresse[11 (52,38 por cento)] o diabetes [(47,61 por cento)] a hiperlipidemia [8 (38,09 por cento)] e o alcoolismo[8 (38,09 por cento)] predominaram no intervalo 6-12 hs; as cardiopatias [(50,00 por cento)] predominaram no intervalo de 12-18 hs.