A case review of the MRI features in alternating Tolosa-Hunt syndrome.

Tolosa-Hunt syndrome (THS) consists of a painful ophthalmoplegia with typical features in magnetic resonance imaging (MRI). The recurring nature of this affliction has been known since its first description. However, compromise of the contralateral cavernous sinus, known as alternating THS, is very rare and has never been examined using MRI. We report clinical data, laboratory data and imaging features of a patient with alternating THS. According to our literature review, this is the first MRI study of THS.

Cluster-tic syndrome: report of five new cases.

The so-called short lasting primary headaches include heterogenic entities that can be divided between those without pronounced autonomic activation and those where this activation is evident, which includes the cluster-tic syndrome. We report five new cases with age closer to the trigeminal neuralgia's one, and concomitance of cluster headache and trigeminal neuralgia, which is less frequent in the literature. We also discuss briefly the pathophysiology of these clinical entities, suggesting that the trigeminus nerve is a common pathway of pain manifestation.

[Use of chlorpromazine in the treatment of headache at an emergency service]. / Uso de clorpromazina para tratamento de cefaléia no serviço de emergência.

Therapeutic measures, with intravenous chlorpromazine, taken during acute headache are evaluated in fourteen patients at the emergency room in Santa Casa de São Paulo. Four patients had the diagnosis of migraine with aura and five patients migraine without aura. Four patients had diagnosis of chronic daily headache with intermittent and superimposed migrainous events. Finally one patient had the diagnosis of chronic paroxysmal hemicrania. All patients were diagnosed according to International Headache Society criteria. The intravenous chlorpromazine dose used was 0.7 mg/Kg diluted in 5% glucose solution and the dose never exceeded 50 mg. The time of drug administration was never less than 60 minutes. The results were considered excellent in all cases. Some patients presented side effects, particularly orthostatic hypotension, always moderate and transitory. This study has clearly demonstrated that intravenous chlorpromazine (0.7 mg/Kg) was highly effective in terminating episodes of primary headache.

[Cluster-tic syndrome: two case reports]. / Síndrome da cefaléia em salvas-nevralgia do trigêmeo a propósito de dois casos.

Two patients with cluster-tic syndrome are reported. The first, a 43-years-old man, complaining of trigeminal pain in the right side of the face, accompanied by homolateral autonomic signs, such as ocular injection, sweating and drooped eyelid. The cluster attack was triggered by chewing, shaving and washing the face. The periodicity of bouts was six months. The pain was relieved by carbamazepine (800 mg/day). The second patient, a 43-year-old man, with an excruciant, neuralgic pain in the left side of the face, accompanied by tearing, conjuntival injection, drooped eyelid, rhinorrhea, photophobia and phonophobia. The neurologic examination showed triggered points in the first and second division of the trigeminal nerve. The patient was treated with verapamil (160 mg/day) and prednisone (60 mg/day), with relief of his symptoms. The periodicity of bouts was once a year. The literature was reviewed and 37 cases previosly reported are considered. We conclude that there are two different groups of patients. In the first group, the patients had cluster and trigeminal bouts in different time. In the second group, with only nine cases, the patients presented both cluster and trigeminal type of pain at the same time, as in the two cases reported here.

The epidemiology of migraine in medical students.

The purpose of this study was to investigate the prevalence of migraine in medical students, as well as its clinical aspects and impact. All 595 medical students of Santa Casa School of Medicine of São Paulo, Brazil were asked if they had experienced any kind of headache in the past year. Those who responded positively were further investigated by an appropriate questionnaire. Diagnosis of migraine was based on the International Headache Society criteria of 1988. Forty percent of students suffered from some kind of headache; 40.2% of these headaches were migraine. The prevalence of migraine was 54.4% in women and 28.3% in men. Migraine headaches were unilateral in 24.2%, had a gradual onset in 69%, and were of a throbbing type in 88.3%. Migraine was considered incapacitating by 53.9% of students. Migraine with aura caused more disability than migraine without aura. Women experienced more intense migraine than men, and migraine with aura was especially more severe than migraine without aura. Photophobia, phonophobia, and nausea were more commonly encountered in migraine with aura. Despite the high prevalence, the high rate of disability, and the need for analgesic medication, only 7.1% of students with migraine had sought medical treatment.

[Biological versus artificial intelligence: a critical approach]. / Inteligência biológica versus inteligência artificial: uma abordagem crítica.

After brief considerations about intelligence, a comparative study between biologic and artificial intelligence is made. The specialists in Artificial Intelligence found that intelligence is purely a matter of physical symbol manipulation. The enterprise of Artificial Intelligence aims to understand what we might call Brain Intelligence in terms of concepts and techniques of engineering. However the philosophers believed that computer-machine can have syntax, but can never have semantics. In other words, that they can follow rules, such as those of arithmetic or grammar, but not understand what to us are meanings of symbols, such as words. In the present paper it is stressed that brain/mind complex constitutes a monolithic systemic that functions with emergent properties at several levels of hierarchical organization. These hierarchical levels are non-reducible to one another. They are at least three (neuronal, functional, and semantic), and they function within an interactional plan. The brain/mind complex, which transform informations in meanings, deals with problems by means of both logical and non-logical mechanisms; while logic allows the mind to arrange the elements for reasoning, the non-logical mechanisms (fuzzy logic, heuristics, insights) allows the mind to develop strategies to find solutions. The model for construction of the "intelligent machine" is the operating way of the brain/mind complex, which does not always use logical processes. The role of information science in Artificial Intelligence is to search for knowledge itself (virtual knowledge), rather than to simply attempt a logico-mathematical formalization of knowledge.

[Prophylactic treatment of migraine: a prospective open study on 100 patients]. / Tratamento profilático da enxaqueca. Estudo prospectivo aberto com a flunarizina em 100 pacientes.

The prophylactic value of a daily dose of 10 mg flunarizine, a calcium antagonist, was analysed in 100 migraineurs during 4-month in an open study. Ninety-three patients completed the full 16-week course of therapy, and seven patients presented important adverse reactions requiring discontinuation of the drug. However, the seven patients who dropped out during flunarizine treatment were not considered in the analysis. Side-effects included weight gain, sleepiness, humor depression, paresthesias and dry mouth. Eighty-one patients experienced abolition or significant reduction in headache incidence and/or severity. We conclude that flunarizine may be an effective drug in migraine prophylaxis.

The brain/mind complex. An epistemological approach.

It is stressed that the brain/mind complex constitutes a monolithic system that functions with emergent properties at several levels of hierarchical organization. These hierarchical levels are non-reducible to one another; they are at least three (neuronal, functional, and semantic), and they function within an interactional plan. From the epistemological view-point, the brain/mind complex uses logical and non-logical mechanisms to deal with day-to-day problems. Logic is necessary for the thinking process, but it is not sufficient. Emphasis is given to non-logical mechanisms; fuzzy logic and heuristics, which allow the mind to develop strategies to find solutions, are analysed.

Unilateral neglect syndrome: clinical and topographic study of 20 subjects.

Twenty patients with unilateral neglect syndrome were studied. They were 10 males and 10 females, and they ranged from 29 to 76 years of age. All were submitted to a CAT scan of the brain. Based on the findings in our sample we drew the following conclusions: the extinction phenomenon was a constant manifestation of unilateral neglect; the line crossing test proved to be most efficient for the identification of visual neglect; the right parietal lobe was the anatomical region most often involved in the unilateral neglect syndrome.

[Complicated migraine: apropos of 3 cases]. / Enxaqueca complicada: a propósito de três casos.

After brief considerations about complicated migraine, three cases are reported. The diagnosis was made by the clinical features and by computed tomography. The term complicated migraine must be reserved for those cases in which the neurological symptoms and signs outlast migraine attack for more than 24 hours or in which permanent deficit develops because of cerebral or brainstem infarction. Other criteria for diagnosis is the presence of infarction in CT scanning, although prolonged or permanent deficit are absent. The possible role of platelet aggregation, vascular spasm and increased coagulability of the blood, as the cause of infarction, is discussed. All the patients in this report showed prolonged neurological deficit and infarction in CT scanning.

[Heidenhain's form of Creutzfeldt-Jakob disease: report of a case]. / Forma de Heidenhain da doença de Creutzfeldt-Jakob: relato de um caso.

A case of Creutzfeldt-Jakob disease, Heidenhain's form is reported. The first clinical manifestations were cortical blindness and visual agnosia. The patient here concerned, a woman aged sixty three, during the clinical course of the disease showed mental deterioration and pyramido-extrapyramidal manifestations. She died after five months. The electroencephalographic findings showed periodic activity. The anatomopathological examination showed neuronal degeneration, status spongiosus and proliferation of astroglial cells. The clinical, electroencephalographic, pathological and etiopathogenical aspects are discussed.

[Klüver-Bucy syndrome caused by viral encephalitis. Report of a case]. / Síndrome de Klüver-Bucy determinada por encefalite a virus. Relato de um caso.

A case of peculiar form of Klüver-Bucy syndrome is reported. The diagnosis of viral meningoencephalitis was made by the clinical features and by cerebrospinal fluid and histological examination (brain biopsy). The computed tomography and electroencephalographic aspects are analysed. The viral meningoencephalitis was possibly herpetic in nature (herpes simplex virus). The patient here concerned, a woman aged twenty-one years old, during the clinical course of the disease showed insatiable appetite, psychic blindness, oral tendencies, aberrant sexual behavior and hypermetamorphopsia (Klüver-Bucy syndrome). The significance of these features is discussed.

[Uveomeningoencephalitis: report of 2 cases]. / Uveomeningencefalites: registro de dois casos.

The uveomeningoencephalitic syndromes are inflammatory diseases, more prevalent in oriental patients, without sexual predilection and with mean age of 30 years. From the clinical point of view they affect the uvea, retina, meninges, the central nervous system and skin and in most cases the onset is followed by three phases: the meningoencephalitic phase, the acute ophthalmic phase and the dermatologic phase. These includes the Harada disease, the Vogt-Koyanagi disease, the Behçet disease and the idiopathic forms. The Vogt-Koyanagi syndrome is a chronic and severa bilateral exudative uveitis associated with whitening of the hair and eyelashes and varying signs of meningeal irritation, less frequent than in Harada's disease. The Harada syndrome is a posterior uveitis accompanied by signs of meningeal irritation, increased protein levels and pleocytosis of the cerebrospinal fluid. The Behçet's disease is a relapsing illness, characterized by oral and genital aphtous ulcers and ocular inflammation. In many cases there are additional features; in 10 to 25 percent of the cases there are neurologic involvement, and any portion of the nervous system may be affected. The authors studied two cases of uveomeningoencephalic syndrome, one case of Vogt-Koyanagi-Harada disease (case 1) and another of Behçet disease (case 2). The case 1 was a white Brazilian forty-five year-old man, with a acute headache, mental confusion and signs of meningeal irritation. The cerebrospinal fluid was a inflammatory one, with increased lymphocytes and monocytes, the one month after the patient developed bilateral uveit. The patient complicated with amblyopia of the left eye and a Korsakoff syndrome. There was no correlation in the literature of the Korsakoff syndrome and the uveomeningoencephalitic syndrome. The case 2 was a white Brazilian, twenty-four year-old man, with two episodes of meningitis, genital recurrent aphtous ulcers and uveitis in the right eye, with latter blindness of this eye. Some considerations about the etiopathogenic aspects are done and about the controversial use of corticoids in the treatment of these syndromes.

Uveomeningencefalites. Registro de dois casos. / Uveomeningoencephalitis: report of 2 cases

Apos consideracoes a proposito das manifestacoes clinicas das uveomeningencefalitis, sao relatados dois casos com caracteristicas clinicas ligeiramente diferentes. No 1 tratava-se da doenca de Harada, tendo o paciente apresentado quadro meningitico agudo acompanhado de confusao mental. O exame do liquido cefalorraquidiano evidenciou um quadro inflamatorio do tipo linfomonocitario e o paciente evoluiu com disturbios acentuados da memoria e uveite bilateral. Apos alguns meses de evolucao, a doenca deixou como sequelas uma sindrome de Korsakoff e ambliopia acentuada no olho esquerdo. No caso 2 tratava-se de doenca de Behcet, tendo o paciente apresentado dois surtos de meningite do tipo linfomonocitario lesoes herpetiformes na genitalia e uveite no olho direito que evoluiu para amaurose. Sao feitas consideracoes sobre os aspectos etiopatogenicos destas afeccoes e sobre o controvertido uso dos corticosteroides em seu tratamento

Sindrome de Kluver-Bucy determinada por encefalite a virus: relato de um caso. / Kluver-Bucy syndrome caused by viral encephalitis: report of a case

E relatado um caso de encefalite a virus, tendo o paciente desenvolvido no decurso da evolucao a sindrome de Kluver-Bucy. Inicialmente sao feitas consideracoes a respeito da etiologia do processo virotico, ressaltando os autores a provavel participacao do virus "herpes simplex" na origem do quadro. Os exames complementares realizados (liquido cefalo cefalorraqueano, eletrencefalograma, tomografia computadorizada e biopsia cerebral) sao altamente sugestivos de etiologia virotica. A seguir a sindrome de Kluver-Bucy e analisada nas suas varias vertentes: baixa incidencia no ser humano, aspectos clinicos e fisiopatologicos

[Cluster headache: clinical and therapeutic aspects in 26 cases]. / Cefaléia em salvas: aspectos clínicos e terapêuticos em 26 casos.

The clinical and therapeutic aspects in 26 patients with cluster headache are reported. The patient's age ranged between 14 and 60 years old (average 31.5 years); 22 were male and 4 female. The patients constituted a consecutive series of typical cases (only one was a chronic cluster) with regular headache attacks; in 69.2 per cent of the cases there were associated symptoms and signs (ipsilateral lacrimation, stuffiness of the ipsilateral nostril and Horner's syndrome). In seven patients the cluster was induced by alcohol ingestion (during an active cluster period) and a cluster attack was reproduced by isosorbitol dinitrate (vasodilator drug) in one patient. All patients received orally either methysergide maleate, prednisone or both. The first drug used, in 20 patients, was methysergide maleate in a dosage of 3--6 mg daily over a four weeks period. Eight patients received prednisone only, which presented side-effects or no improvement with methysergide, in a dosage of 40--60 mg daily and tapered off over a period of four weeks. Methysergide maleate and prednisone were given to 11 patients in association, because of moderate effect of the first drug. The clinical effect of the treatment was judged according to the following three categories: freedom from the attacks; slight improvement of the attacks; no improvement of the attacks. In 57.6 per cent of the cases (15 patients) there was freedom of the attacks, in 30.7 per cent of the cases (8 patients) there was a slight improvement and in 3 patients there was no improvement.