Optic pathways and brainstem involvement in posterior reversible encephalopathy syndrome.

Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome manifesting with acute focal signs, and concomitant neuroimaging findings of vasogenic oedema. It affects the parieto-occipital regions in a vast majority of cases, although atypical variants have been described comprising the brainstem, basal ganglia or spinal cord. We report the case of a 41-year-old woman, admitted for persistent headache and inferior altitudinal field defect in the right eye. She presented with severe, non-medicated, hypertension. Brain MRI showed findings compatible with atypical PRES, involving the brainstem and optic pathways. With antihypertensive therapy the headache remitted, although visual field remained and was interpreted in the context of a vascular aetiology-non-arteritic anterior ischaemic optic neuropathy. MRI was repeated 3 weeks later and showed almost complete reversal of the previous changes.

MR and CT Imaging of the Normal Eyelid and its Application in Eyelid Tumors.

T-staging of most eyelid malignancies includes the assessment of the integrity of the tarsal plate and orbital septum, which are not clinically accessible. Given the contribution of MRI in the characterization of orbital tumors and establishing their relations to nearby structures, we assessed its value in identifying different eyelid structures in 38 normal eyelids and evaluating tumor extension in three cases of eyelid tumors. As not all patients can receive an MRI, we evaluated those same structures on CT and compared both results. All eyelid structures were identified on MRI and CT, except for the conjunctiva on both techniques and for the tarsal muscles on CT. Histopathology confirmed the MRI findings of orbital septum invasion in one patient, and the MRI findings of intact tarsus and orbital septum in another patient. Histopathology could not confirm or exclude tarsal invasion seen on MRI on two patients. Although imaging the eyelid is challenging, the identification of most eyelid structures is possible with MRI and, to a lesser extent, with CT and can, therefore, have an important contribution to the T-staging of eyelid tumors, which may improve treatment planning and outcome.

Dynamics of a haemodynamic headache: A case report and literature review of headache secondary to flow inversion of the internal jugular vein.

BACKGROUND: Haemodialysis arteriovenous fistulas have common local and regional complications, but are rarely associated with neurological symptoms. CASE REPORT: A 43-year-old woman presented with short acute episodes of unilateral, non-throbbing, severe headache, vertigo and left lateropulsion. She had undergone renal transplantation and had a still-functioning left brachial arteriovenous fistula. No abnormality was detected on neurological examination or on brain parenchymal imaging. Colour Doppler ultrasonography showed a subclavian steal syndrome of the left vertebral artery and reversed flow in the left internal jugular vein. Ligation of the arteriovenous fistula had to be delayed as a result of renal graft dysfunction. Six months later she developed a headache attributed to intracranial hypertension. All symptoms subsided after ligation of the arteriovenous fistula. LITERATURE REVIEW: We identified 16 case reports of central neurological complications attributed to haemodialysis brachial fistulas. Headache descriptions were scarce and were not fully detailed. CONCLUSIONS: The case of our patient suggests that unilateral, episodic, non-throbbing, non-postural headache with transient neurological symptoms can be caused by combined arterial and venous flow abnormalities secondary to a high-flow arteriovenous brachial fistula. In this setting, this pattern of headache may precede overt signs of intracranial hypertension and may be used as a warning sign of cerebral venous congestion.

Disseminated Nocardiosis: A Successful Blind Strategy of Treatment in an HIV Infected Patient.

Background. Nocardiosis is a rare disease that mainly affects severely immunocompromised patients. Symptoms are nonspecific and microbiological isolation is difficult, hiding the diagnosis. Treatment should be guided by species and susceptibility testing. Findings. We report a clinical case of a disseminated nocardiosis in a patient with HIV and HVB infections. Interpretation. Diagnosis should be presumed early and microbiological conditions should be optimized, in order to identify the species and achieve antibiotic susceptibility testing. This is a very important step to choose an effective therapeutic regimen or alternative options.

The electroclinical-imagiological spectrum and long-term outcome of transient periictal MRI abnormalities.

The electroclinical-imagiological spectrum and long-term outcome of transient periictal MRI abnormalities (TPMA) remains largely unclear. This prompted us to perform a prospective observational cohort study, including electroencephalography (EEG) and multi-sequence MRI, in 19 consecutive patients (8 female, mean age 51.7 years) with TPMA induced by convulsive and non-convulsive status epilepticus (n=14) or isolated seizures. TPMA were associated with focal, lateralized or diffuse EEG abnormalities, and were mostly focal unilateral and cortico-subcortical (n=11), less frequently cortically restricted, bilateral, hemispheric and with remote lesions (pulvinar, cerebellum); 66.7% had cortico-pial contrast enhancement and 93.7% restriction on diffusion-weighted imaging, with cortical cytotoxic edema on apparent-diffusion coefficient, only tumor-like TPMA (n=5) presenting noticeable subcortical vasogenic edema. The heterogeneity of clinical, EEG and MRI findings contributed to a 38.6% strict focal topographic concordance between them, with the more widespread findings also attributable to the time lag between studies, seizure dynamics/etiologies and cerebral reserve. At follow-up (mean duration 29.6 months, 3-120), the brain damage induced by TPMA was responsible for a high incidence of clinical and MRI sequelae (63.2%), only tumor-like/small TPMA induced by acute symptomatic seizures presenting good clinical outcomes. Our findings may contribute to a better definition and comprehension of the TPMA electroclinical-imagiological spectrum, pathophysiology and long-term outcome.

Chronic treatment with cyclosporine affects systemic purinergic parameters, homocysteine levels and vascular disturbances in rats.

Vascular disease is a major cause of morbidity and mortality among transplanted recipients and cyclosporine (CsA) treatment has been consistently implicated in this event. In this study we assessed total blood homocysteine levels (tHcy), ecto-nucleotidase activities and adenine nucleotide/nucleoside levels searching for parameters related to the mechanisms of vascular damage induced by chronic CsA treatment in non-transplanted rats. Thirty male Wistar rats were divided in three groups: control group treated with corn oil, CsA 5mg/kg and CsA 15 mg/kg, administered by daily gastric gavage during 8 weeks. CsA 15 mg/kg treatment increased blood levels of tHcy. Both CsA treatments (5mg/kg and 15 mg/kg) decreased adenine nucleotides hydrolysis by ecto-nucleotidases in serum, which negatively correlated with tHcy levels (r: -0.74, r: -0.63 and r: -0.63, p<0.004, for ATP, ADP and AMP, respectively). CsA 15mg/kg induced a statistically significant increase in ADP and decrease in adenosine (ADO) plasma levels compared to control group. THcy levels were positively correlated with plasma ADP levels and negatively correlated with ADO levels (r: 0.84, p<0.0001 and r: -0.68, p<0.0001, respectively). Rats under CsA 15 mg/kg treatment presented cell injury and inflammatory responses in the endothelium and intima layer of the aorta artery. In conclusion, blood ecto-nucleotidases activity, tHcy, and ADP and ADO levels may be implicated in vascular injury induced by CsA treatment.

[Central nervous system abnormalities namely secondary brain tumors]. / Tumor do sistema nervoso central secundário a radioterapia e quimioterapia.

A 22 year-old-man with acute lymphoblastic leukaemia had received prophylactic cranial irradiation and intrathecal chemotherapy. Eighteen years later a cerebellar glioblastoma multiforme was diagnosed. The authors speculate about the possibility that this tumor may have been radiation and/or chemotherapy induced. Improvement in neuroimaging techniques, in particular magnetic resonance imaging, has helped characterize Central Nervous System abnormalities, namely secondary brain tumours.

[Advanced neuroimaging in the diagnosis of cerebrovascular disease]. / Novas modalidades diagnósticas na investigação da doença cerebrovascular.

This article highlights the MR imaging techniques of CT angiography, MR angiography, diffusion weighted images, perfusion MR and CT imaging in the evaluation of stroke acute phase. From a pathophysiologic point of view, advanced computed tomography techniques and stroke magnetic resonance imaging provide much more information about the acute stroke patient as the basis of decision making in acute stroke treatment.

Community-acquired pneumonia by Legionella pneumophila serogroups 1-6 in Brazil.

A prospective cohort study of adult patients hospitalized due to community-acquired pneumonia was carried out for 1 year in a Brazilian university general hospital to detect the incidence of community-acquired pneumonia by Legionella pneumophila serogroups 1-6. During a whole year, a total of 645 consecutive patients who were hospitalized due to a initial presumptive diagnosis of respiratory disease by ICD-10 (J00-J99), excluding upper respiratory diseases, were screened to detect the patients with community-acquired pneumonia. Fifty-nine consecutive patients hospitalized due to community-acquired pneumonia between July 19, 2000 and July 18, 2001, were included in the study. They had determinations of serum antibodies to L. pneumophila serogroups 1-6 by indirect immunofluorescence antibody test at the Infectious Diseases Laboratory of University of Louisville (KY, USA) and urinary antigen tests for L. pneumophila serogroup 1. Three patients had community-acquired pneumonia by L. pneumophila serogroups 1-6, two patients being diagnosed by seroconversion and positive urinary antigen tests; the other had negative serologies but strongly positive urinary antigen test. The incidence of community-acquired pneumonia by L. pneumophila serogroups 1-6 in our hospital was 5.1%.

Behavior of inflammatory markers of myocardial injury in cardiac surgery: laboratory correlation with the clinical picture of postpericardiotomy syndrome.

OBJECTIVE: To verify the association of serum markers of myocardial injury, such as troponin I, creatinine kinase, and creatinine kinase isoenzyme MB, and inflammatory markers, such as tumor necrosis factor alpha (TNF-alpha), C-reactive protein, and the erythrocyte sedimentation rate in the perioperative period of cardiac surgery, with the occurrence of possible postpericardiotomy syndrome. METHODS: This was a cohort study with 96 patients undergoing cardiac surgery assessed at the following 4 different time periods: the day before surgery (D0); the 3rd postoperative day (D3); between the 7th and 10th postoperative days (D7-10); and the 30th postoperative day (D30). During each period, we evaluated demographic variables (sex and age), surgical variables (type and duration, extracorporeal circulation), and serum dosages of the markers of myocardial injury and inflammatory response. RESULTS: Of all patients, 12 (12.5%) met the clinical criteria for a diagnosis of postpericardiotomy syndrome, and their mean age was 10.3 years lower than the age of the others (P=0.02). The results of the serum markers for tissue injury and inflammatory response were not significantly different between the 2 assessed groups. No significant difference existed regarding either surgery duration or extracorporeal circulation. CONCLUSION: The patients who met the clinical criteria for postpericardiotomy syndrome were significantly younger than the others were. Serum markers for tissue injury and inflammatory response were not different in the clinically affected group, and did not correlate with the different types and duration of surgery or with extracorporeal circulation.

Comportamento dos marcadores inflamatórios e de injúria miocárdica na cirurgia cardíaca: correlaçäo laboratorial com quadro clínico de síndrome pós-pericardiotomia / Behavior of inflammatory markers of myocardial injury in cardiac surgery: laboratory correlation with the clinical picture of postpericardiotomy syndrome

OBJECTIVE: To verify the association of serum markers of myocardial injury, such as troponin I, creatinine kinase, and creatinine kinase isoenzyme MB, and inflammatory markers, such as tumor necrosis factor alpha (TNF-alpha), C-reactive protein, and the erythrocyte sedimentation rate in the perioperative period of cardiac surgery, with the occurrence of possible postpericardiotomy syndrome. METHODS: This was a cohort study with 96 patients undergoing cardiac surgery assessed at the following 4 different time periods: the day before surgery (D0); the 3rd postoperative day (D3); between the 7th and 10th postoperative days (D7-10); and the 30th postoperative day (D30). During each period, we evaluated demographic variables (sex and age), surgical variables (type and duration , extracorporeal circulation), and serum dosages of the markers of myocardial injury and inflammatory response. RESULTS: Of all patients, 12 (12.5 percent) met the clinical criteria for a diagnosis of postpericardiotomy syndrome, and their mean age was 10.3 years lower than the age of the others (P=0.02). The results of the serum markers for tissue injury and inflammatory response were not significantly different between the 2 assessed groups. No significant difference existed regarding either surgery duration or extracorporeal circulation. CONCLUSION: The patients who met the clinical criteria for postpericardiotomy syndrome were significantly younger than the others were. Serum markers for tissue injury and inflammatory response were not different in the clinically affected group, and did not correlate with the different types and duration of surgery or with extracorporeal circulation

[Unusual cause of tetraparesis in an adult]. / Causa rara de tetraparésia no adulto.

A 61 year old male developed progressive spastic tetraparesis and paresis of the lower cranial nerves (IX, X and XI) after a minor spine-head trauma. Magnetic resonance depicted a partially cystic IV ventricular mass, extending to C1/C2 level. Neuropathology was compatible with choroids plexus papilloma (CCP). This case shows a rare clinical presentation of an infrequent adult tumour.

[Extracranial metastasis of glioblastoma multiforme]. / Metastização extracraniana de glioblastoma multiforme.

The authors report a biopsy proven case of skin and subcutaneous tumour seeding three years after craniotomy for a supra-tentorial multiform glioblastoma in 42 y old male without intracranial recurrence.

[Significance of neuroimaging in the diagnosis of Boucher-Neuhauser syndrome]. / A importância da neuroimagem no diagnóstico da Síndrome de Boucher-Neuhauser.

The authors report a case of a young patient with the clinic triad of cerebellar ataxia, retinal dystrophy and hypogonadotropic hypogonadism (Boucher Neuhauser Syndrome), of probable autosomal recessive inheritance, in which the brain MRI has a major role to the diagnosis.

Infecções parasitárias e o hospedeiro imunocomprometido: diagnóstico laboratorial das enteroparasitoses / Parasitic infections and the compromised host: laboratory diagnostic of intestinal parasites

Neste artigo são revisados os diferentes parasitas que podem causar doenças infecciosas nos hospedeiros imunocomprometidos. São descritos, também, os procedimentos e o diagnóstico laboratorial destes organismos.

Evaluation of the respiratory function in myasthenia gravis: an important tool for clinical feature and diagnosis of the disease

Myasthenic gravis may affect both inspiratory and expiratory muscles. Respiratory involvement occurred in almost all patients with myasthenia gravis in all clinical forms of the disease: 332 lung function tests done in 324 myasthenic patients without respiratory symptoms (age 34.6 ñ 18.3 years) were examined. Lun volumes analysis showed that all the patients of both sexes with generalized or ocular myasthenia gravis showed "myasthenic pattern". Male patients with "ocular" form only presented the "myasthenic pattern" with lung impairment and had, from the lung function point of view, a more benign behaviour. Female patients with the "ocular" form exhibited a behaviour of respiratory variables similar to that of the generalized form. It was not observed modification of the variables that suggested obstruction of the higher airways. The "myasthenic pattern" was rarely observed in other neuromuscular diseases, except in patients with laryngeal stenosis.

Efeitos de um programa de atividades físicas para criança asmática, avaliados por provas de funçäo pulmonar / Effects of physical activities program for asthmatic children evaluated through pulmonary function tests

O presente estudo teve por objetivo investigar em que medida um programa de atividades físicas para crianças asmáticas pode modificar a funçäo pulmonar, observadas as seguintes variáveis: capacidade vital forçada (FVC, em litros), volume expiratório no primeiro segundo (FEV1, em litros), fluxo expiratório forçado entre 0,2 e 1,2 litros (FEG, em litros por segundo), fluxo expiratório entre 25 por ciento e 75 por ciento da FVC (FMF, em litros por segundo) e o tempo médio de trânsito do ar (MTT, em segundos). Participaram deste estudo 50 crianças na faixa etária de 5 anos e 8 meses a 15 anos. Os resultados mostraram que um programa regular de atividades físicas, com duraçäo de um ano, pode melhorar a mecânica respiratória e tornando mais eficaz a ventilaçäo pulmonar de crianças asmáticas. Observou-se uma melhora do fluxo expiratório forçado entre 0,2 e 1,2 litros (FEF) e do tempo médio de trânsito do ar (MTT). Esses resultados evidenciam que näo há alteraçäo significativa para capacidade vital forçada (FVC), volume expiratório no primeiro segundo (FEV1) e fluxo expiratório entre 25 por ciento e 75 por ciento da FVC (FMF), mas indicam uma tendência de melhora. Apesar dos dados terem mostrado uma melhora nas variáveis FEF e MTT é preciso que se realizem outros estudos envolvendo um grupo controle e com separaçäo de faixas etárias

Diagnostico da tricomonose urogenital pelo teste da imunofluorescencia indireta / Diagnostic of urogenital trichomonosis by the indirect fluoreccence antibody test

m diagnostico da tricomonoses urogenital e realizado pelo encontro do protozoario parasita atraves da microscopia de esfregaços a fresco e pelo exame cultual. Entretanto, nenhum destes procedimentos e indicado para estudo soroepidemiologicos e para a pesquisa de portadores assintomaticos. O teste da imunofluorescencia indireta (IFI) foi realizado em 200 mulheres pacientes de uma clinica de tratamento e controle de doenças sexualmente transmissiveis. Anticorpos anti-Trichomonas foram detectodos em 100% das pacvientes com tricomonose comprovada, emquanto que as mais alta diluiçao na qual os anticorpos foram demonstrados foi 1:80. Estes resultados sugerem que o teste da IFI pode ser util no aperfeicoamento do diagnostico

Diagnostico de laboratorio da criptosporidiose humana / Laboratory diagnostic of human cryptosporidiosis

No presente estudo sobre criptosporidiose humana sao apresentados os seus aspectos clinicos e descritos os metodos de laboratorio de diagnostico parasitologico e imunologico.

A dual arrangement pattern of the cells of corticotectal origin in the cat

Utilizando o transporte retrógrado da peroxidase da raiz forte (HRP) e a técnica de aplanamento do córtex cerebral, foi estudado o arranjo das células corticotectais nas diversas áreas visuais do gato. Demonstraram-se dois padröes diferentes de distribuiçäo, sendo um focal, evidenciado pela injeçöes de HRP no colículo superfícial, e outro difuso, revelado pela injeçäo de HRP no colículo profundo. Esses dados säo analisados tendo em vista a hipótese da existência de dois sistemas corticotectais, anatômica e fisiologicamente distintos