Congenital Zika syndrome phenotype in a child born in Brazil in December 2011.

We report a case of a Brazilian child born in 2011 with congenital Zika syndrome phenotype. Zika virus (ZIKV) may have been circulating in Brazil more than 4 years before the outbreak. ZIKV infection might be considered in children with this phenotype even without known circulation of ZIKV.

Botulinum toxin type A in the treatment of lower-limb spasticity in children with cerebral palsy.

We evaluated the safety and effectiveness of botulinum toxin A (BoNT/A) in the treatment of spasticity in 20 children with spastic diplegic cerebral palsy (CP). All the patients received injections in the gastrocnemius and soleus, and 15 received injections in the adductors. The total dose varied from 70 to 140 U (99.75+/-16.26 U), or 7.45+/-2.06 U/kg per patient. The treatment improved the patients' walking and gait pattern significantly. There was also a significant alteration in the heel-ground distance and increased motion of the ankle joint. These structural changes in the feet were sustained until the end of the follow-up, although the same was not observed for the functional parameters. Three patients complained of weakness in the lower limbs. In conclusion, BoNT/A is safe and effective when used in a single session of injections and produces a sustained structural modification of the lower limbs. However, functional changes are temporary and are only observed during the peak effect of the drug.

Botulinum toxin type A in the treatment of lower-limb spasticity in children with cerebral palsy / Toxina botulínica tipo A como tratamento para espasticidade de membros inferiores em crianças com paralisia cerebral

We evaluated the safety and effectiveness of botulinum toxin A (BoNT/A) in the treatment of spasticity in 20 children with spastic diplegic cerebral palsy (CP). All the patients received injections in the gastrocnemius and soleus, and 15 received injections in the adductors. The total dose varied from 70 to 140 U (99.75±16.26 U), or 7.45±2.06 U/kg per patient. The treatment improved the patients' walking and gait pattern significantly. There was also a significant alteration in the heel-ground distance and increased motion of the ankle joint. These structural changes in the feet were sustained until the end of the follow-up, although the same was not observed for the functional parameters. Three patients complained of weakness in the lower limbs. In conclusion, BoNT/A is safe and effective when used in a single session of injections and produces a sustained structural modification of the lower limbs. However, functional changes are temporary and are only observed during the peak effect of the drug.

Para avaliação da segurança e eficácia do tratamento com toxina botulínica A (TB-A) na espasticidade na paralisia cerebral (PC), foram selecionadas 20 crianças com a forma diplegia espástica. Todos os pacientes receberam injeções nos gastrocnêmios e sóleos, 15 receberam doses nos adutores da coxa. A dose total variou de 70 a 140 Us (99,75±16,26 U), 7,45±2,06 U/Kg por paciente. O tratamento com a TB-A melhorou significativamente a deambulação e o padrão de marcha. Houve também significativa alteração da distância tornozelo-solo e aumento da amplitude de movimento da articulação do tornozelo. Essas mudanças estruturais dos pés se mantiveram até o final do acompanhamento. O mesmo não foi observado com parâmetros funcionais. Três pacientes apresentaram fraqueza em membros inferiores. Conclui-se que a TB-A, em uma única aplicação, é segura e eficaz. Há modificação sustentada da estrutura motora dos membros inferiores, porém mudanças funcionais são temporárias, durante o pico de ação do medicamento.

Alterações do septo interatrial e acidente vascular cerebral isquêmico em adultos jovens / Abnormalities of interatrial septum and ischemic stroke in young people

OBJETIVO: Avaliar a freqüência de forame oval patente (FOP) em pacientes com acidente cerebrovascular isquêmico (AVCI) criptogênico ou de causa definida, investigados com doppler transcraniano (DTC) e ecocardiograma transesofágico. Paralelamente, examinar a validade diagnóstica do primeiro, comparado ao segundo método. MÉTODO: Retrospectivamente, foram estudados 124 pacientes (< 51 anos), vítimas de AVCI, submetidos a DTC e ou ecocardiograma transesofágico. Os pacientes foram classificados em dois grupos: com ou sem AVCI criptogênico. RESULTADOS: Encontramos importante associação entre AVCI criptogênico e FOP (razão de chance de 4,3; IC95 por cento 1,7 -10,7). Foram diagnosticados apenas 5 casos de aneurisma do septo interatrial entre aqueles com FOP, todos classificados como AVCI criptogênico. Tanto a sensibilidade, especificidade e os valores preditivos positivo e negativo exibiram valores superiores a 85 por cento, semelhantes, pelo menos com base nos intervalos de confiança. CONCLUSÃO: Constatamos, pela primeira vez em nosso meio, forte associação entre AVCI criptogênico e FOP. O DTC é importante recurso diagnóstico nesse contexto, já que sua validade foi considerada muito boa, podendo ser útil no rastreamento de fontes emboligênicas, particularmente alterações do septo atrial. Uma investigação minuciosa desses casos se impõe, notadamente pela perspectiva de fechamento do shunt intracardíaco.

[Abnormalities of interatrial septum and ischemic stroke in young people]. / Alterações do septo interatrial e acidente vascular cerebral isquêmico em adultos jovens.

OBJECTIVE: To verify the frequency of patent foramen ovale (PFO) among patients with ischemic stroke (cryptogenic or with a known cause) investigated by transcranial doppler (TCD) and transesophageal echocardiography. Secondarily, to determine the diagnostic validity of the former, compared with the later method. METHOD: Retrospectively, 124 patients (<51 years old) with ischemic stroke were submitted to TCD and or transesophageal echocardiography. The patients were classified as cryptogenic stroke or not. RESULTS: We could found an important association between cryptogenic ischemic stroke and PFO (odds ratio 4.3--CI 95% 1.7-10.7). Only five cases of interatrial septal aneurysm were diagnosed among patients with PFO. Sensitivity, specificity and positive and negative predictive values exhibited values upper of 85%, equivalents, at least based on confidence intervals. CONCLUSION: We could determine, for the first time in our country, a strong association between cryptogenic ischemic stroke and PFO. The TCD is a valuable diagnostic resource in this context since its validity was considered excellent. A detailed investigation in these cases should always be done due to the possibility of FOP closure.

Reversible posterior leucoencephalopathy syndrome associated with bone marrow transplantation

Reversible posterior leucoencephalopathy syndrome (RPLS) has previously been described in patients who have renal insufficiency, eclampsia, hypertensive encephalopathy and patients receiving immunosuppressive therapy. The mechanism by which immunosuppressive agents can cause this syndrome is not clear, but it is probably related with cytotoxic effects of these agents on the vascular endothelium. We report eight patients who received cyclosporine A (CSA) after allogeneic bone marrow transplantation or as treatment for severe aplastic anemia (SSA) who developed posterior leucoencephalopathy. The most common signs and symptoms were seizures and headache. Neurological dysfunction occurred preceded by or concomitant with high blood pressure and some degree of acute renal failure in six patients. Computerized tomography studies showed low-density white matter lesions involving the posterior areas of cerebral hemispheres. Symptoms and neuroimaging abnormalities were reversible and improvement occurred in all patients when given lower doses of CSA or when the drug was withdrawn. RPLS may be considered an expression of CSA neurotoxicity

O uso da toxina botulínica no tratamento da distonia laríngea (disfonia espasmódica): estudo preliminar com doze pacientes / Use of botulinum toxin in the treatment of laryngeal dystonia (spasmodic dysphonia): preliminary study of twelve patients

A distonia laríngea (disfonia espasmódica) é distúrbio do movimento caracterizado por contrações involuntárias da musculatura laríngea envolvida no processo de vocalização. A utilização da toxina botulínica no tratamento da distonia laríngea trouxe consideráveis benefícios clínicos. Descrevemos os resultados preliminares do uso terapêutico da toxina botulínica no tratamento da distonia laríngea em 12 pacientes. Após investigação clínica, os pacientes foram submetidos a videolaringoestroboscopia para confirmação diagnóstica e as injeções de toxina botulínica foram realizadas através de punção da membrana cricotireóidea em direção ao músculo tireoaritenóideo, com uso de eletromiografia. A maioria dos pacientes submetidos ao tratamento com toxina botulínica apresentou melhora significativa da distonia laríngea (83 por cento dos casos), com duração média do efeito de quatro meses, sem efeitos colaterais significativos