Pub Date : 2023-01-01DOI: 10.5327/1516-3180.141s1.487
Rafael de Almeida, Sayuri Aparecida Hirayama, Francine de Paula Roberto Domingos, Lucas Silva Dias, Lorena Dias de Araújo, Paulo Henrique Martinelli Oliveira, Raderi Luiz Cardoso dos Santos, Larissa Miyashiro, Rushansky Vilela de Azevedo, Gustavo Carvalho Costa
Introduction: Radiculopathy is a common condition whose symptoms can include pain, sensory change, and motor weakness owing to mechanical and chemical irritation of the spinal nerve root. The aim is to report atypical clinical presentation of radiculopathy secondary to neoplasia. Case report: A 62-year-old male patient was admitted with pain in the right scapular region of onset 2 months ago and progressive worsening. On patient admission, he presented isolated loss of strength in the right hand with force grade V in the proximal right upper limb and right dropped hand and living reflexes in the right upper limb. Thoracic/cervical spine magnetic resonance imaging with expansive formations in the thoracic bone marrow of neoplastic aspect, compressive fracture of the vertebral body of T1 with impairment of the thoracic cord, reduction of the vertebral canal at level C3-C4. Electroneuromyography: bilateral acute C8-T1 radiculopathy, worse right and chronic radiculopathy on the left. Subsequently, he evolved with brachial paraparesis, exalted global osteotendinous reflexes, and inexhaustible clonus in the lower limbs. C4-T5 posterior cervical arthrodesis was performed. Discussion: Cervical radiculopathy may leave the clinician perplexed by lack of clinical-radiological correlation. Of special interest is the weakness of the intrinsic hand muscles without radiological evidence for C8 radiculopathy. Overlapping with the T1 root, the C8 root innervates the finger flexors and all the intrinsic hand muscles. C8 radiculopathy is characterized by radicular neck pain, hand weakness, and sensory deficit of the ulnar fingers and medial forearm. Conclusion: The lack of clinical-radiological correlation should not mislead the clinician from the correct diagnosis, and should not delay the surgical decompression of the cord and the roots.
{"title":"Radiculopathy C8-T1 atypical initial presentation: a case report","authors":"Rafael de Almeida, Sayuri Aparecida Hirayama, Francine de Paula Roberto Domingos, Lucas Silva Dias, Lorena Dias de Araújo, Paulo Henrique Martinelli Oliveira, Raderi Luiz Cardoso dos Santos, Larissa Miyashiro, Rushansky Vilela de Azevedo, Gustavo Carvalho Costa","doi":"10.5327/1516-3180.141s1.487","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.487","url":null,"abstract":"Introduction: Radiculopathy is a common condition whose symptoms can include pain, sensory change, and motor weakness owing to mechanical and chemical irritation of the spinal nerve root. The aim is to report atypical clinical presentation of radiculopathy secondary to neoplasia. Case report: A 62-year-old male patient was admitted with pain in the right scapular region of onset 2 months ago and progressive worsening. On patient admission, he presented isolated loss of strength in the right hand with force grade V in the proximal right upper limb and right dropped hand and living reflexes in the right upper limb. Thoracic/cervical spine magnetic resonance imaging with expansive formations in the thoracic bone marrow of neoplastic aspect, compressive fracture of the vertebral body of T1 with impairment of the thoracic cord, reduction of the vertebral canal at level C3-C4. Electroneuromyography: bilateral acute C8-T1 radiculopathy, worse right and chronic radiculopathy on the left. Subsequently, he evolved with brachial paraparesis, exalted global osteotendinous reflexes, and inexhaustible clonus in the lower limbs. C4-T5 posterior cervical arthrodesis was performed. Discussion: Cervical radiculopathy may leave the clinician perplexed by lack of clinical-radiological correlation. Of special interest is the weakness of the intrinsic hand muscles without radiological evidence for C8 radiculopathy. Overlapping with the T1 root, the C8 root innervates the finger flexors and all the intrinsic hand muscles. C8 radiculopathy is characterized by radicular neck pain, hand weakness, and sensory deficit of the ulnar fingers and medial forearm. Conclusion: The lack of clinical-radiological correlation should not mislead the clinician from the correct diagnosis, and should not delay the surgical decompression of the cord and the roots.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70951667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5327/1516-3180.141s1.565
Evelliny Gomes da Silva, A. Holanda, V. Arca, Daniel Alves de Oliveira, Anna Paula Paranhos Miranda Covaleski, Letícia Klabinske Marques Monteiro, Eduardo Sousa de Melo
Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in the world. There are variants. Of the cranial forms, the following stand out: the classic form, facial diplegia with distal paresthesias, pharyngo-cervico-brachial form, polyneuritis cranialis, Miller-Fisher syndrome and Bickerstaff encephalitis. This study aimed to report the case of a 73-year-old male patient, diabetic, former smoker and alcoholic, who presented at the Neurology outpatient clinic of a tertiary hospital in Pernambuco, after emergency care and 19 days of symptoms, reported as sudden cervical weakness, dysarthrophonia, dysphagia and weakness in the right hemiface, three weeks after vaccination (influenza and triple viral) and flu syndrome. He had dyspnea since the onset of the condition, with no progression or fluctuating complaints. The neurological examination showed multiple cranial nerve syndrome (right peripheral pattern facial palsy, reduced elevation of the soft palate and cervical extension paresis) associated with global hypo/arreflexia. Complementary exams showed, in addition to leukocytosis and signs of bronchopathy on chest tomography, cerebrospinal fluid with 00 cells and 48 proteins and electroneuromyography with predominantly sensitive axonal polyneuropathy, decrease in bilateral facial motor amplitude, needle with myopathic pattern. Brain magnetic resonance imaging without alterations. With the possibility of cranial polyradiculoneuritis and a history of dyspnea raised, he was admitted to the intensive care unit to monitor his breathing pattern and dysautonomia. He received antibiotic therapy for seven days due to pneumonia and pulse therapy with IVIG (2 g/kg for five days). He maintained progressive improvement of symptoms. He was discharged with a multidisciplinary outpatient follow-up scheduled. It is concluded, therefore, that the recognition of GBS and variant forms is necessary.
{"title":"“Wake-up” onset of pharyngocervicobrachial variant of Guillain-Barré syndrome: a case report","authors":"Evelliny Gomes da Silva, A. Holanda, V. Arca, Daniel Alves de Oliveira, Anna Paula Paranhos Miranda Covaleski, Letícia Klabinske Marques Monteiro, Eduardo Sousa de Melo","doi":"10.5327/1516-3180.141s1.565","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.565","url":null,"abstract":"Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in the world. There are variants. Of the cranial forms, the following stand out: the classic form, facial diplegia with distal paresthesias, pharyngo-cervico-brachial form, polyneuritis cranialis, Miller-Fisher syndrome and Bickerstaff encephalitis. This study aimed to report the case of a 73-year-old male patient, diabetic, former smoker and alcoholic, who presented at the Neurology outpatient clinic of a tertiary hospital in Pernambuco, after emergency care and 19 days of symptoms, reported as sudden cervical weakness, dysarthrophonia, dysphagia and weakness in the right hemiface, three weeks after vaccination (influenza and triple viral) and flu syndrome. He had dyspnea since the onset of the condition, with no progression or fluctuating complaints. The neurological examination showed multiple cranial nerve syndrome (right peripheral pattern facial palsy, reduced elevation of the soft palate and cervical extension paresis) associated with global hypo/arreflexia. Complementary exams showed, in addition to leukocytosis and signs of bronchopathy on chest tomography, cerebrospinal fluid with 00 cells and 48 proteins and electroneuromyography with predominantly sensitive axonal polyneuropathy, decrease in bilateral facial motor amplitude, needle with myopathic pattern. Brain magnetic resonance imaging without alterations. With the possibility of cranial polyradiculoneuritis and a history of dyspnea raised, he was admitted to the intensive care unit to monitor his breathing pattern and dysautonomia. He received antibiotic therapy for seven days due to pneumonia and pulse therapy with IVIG (2 g/kg for five days). He maintained progressive improvement of symptoms. He was discharged with a multidisciplinary outpatient follow-up scheduled. It is concluded, therefore, that the recognition of GBS and variant forms is necessary.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70953322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5327/1516-3180.141s1.568
R. Maffei, A. Barbosa, A. Amorim, Gabriel Pinheiro Martins de Almeida e Souza, P. Fraiman, J. Ferrer, V. Faria, M. Lima, Ruan Gambardella Rosalina de Azevedo, S. Matas
Introduction: Optic perineuritis is a rare disorder with multiple possible etiologies, including systemic autoimmune or infectious syndromes and, more rarely, neurosyphilis. The aim of this report is to describe an uncommon manifestation of this reemerging infectious disease. Case report based on a retrospective analysis of the medical records of the patient. Case report: A previously healthy 35-year-old female presented to the hospital with a seven-day history of progressive right eye vision loss and pain on extraocular movement, with development of a pink maculopapular rash on the trunk. On the sixth day of her disease, similar symptoms appeared in the contralateral eye. Physical examination showed reduced fotomotor reflex and finger counting at 50 cm in both eyes. Magnetic resonance imaging revealed bilateral and circumferential thickening with enhancement of the optic nerve sheath, suggesting bilateral optic nerve perineuritis. Serum Venereal Disease Research Laboratory (VDRL) was 1/64 and cerebrospinal fluid (CSF) showed 440 cells (86% lymphocytes), proteins 97 mg/dL, glucose 47 mg/dL, lactate 21 mg/dL and VDRL 1/4. She was treated with IV crystalline penicillin for 21 days and had partial improvement of bilateral vision within two months. At follow-up, her visual acuity was 20/40 in the right eye and 20/100 in the left; her CSF normalized, with nonreactive VDRL. Conclusion: Neurosyphilis is a treatable cause of optic perineuritis, and its recognition is important to establish the right antibiotic treatment.
{"title":"Neurosyphilis causing bilateral optic perineuritis","authors":"R. Maffei, A. Barbosa, A. Amorim, Gabriel Pinheiro Martins de Almeida e Souza, P. Fraiman, J. Ferrer, V. Faria, M. Lima, Ruan Gambardella Rosalina de Azevedo, S. Matas","doi":"10.5327/1516-3180.141s1.568","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.568","url":null,"abstract":"Introduction: Optic perineuritis is a rare disorder with multiple possible etiologies, including systemic autoimmune or infectious syndromes and, more rarely, neurosyphilis. The aim of this report is to describe an uncommon manifestation of this reemerging infectious disease. Case report based on a retrospective analysis of the medical records of the patient. Case report: A previously healthy 35-year-old female presented to the hospital with a seven-day history of progressive right eye vision loss and pain on extraocular movement, with development of a pink maculopapular rash on the trunk. On the sixth day of her disease, similar symptoms appeared in the contralateral eye. Physical examination showed reduced fotomotor reflex and finger counting at 50 cm in both eyes. Magnetic resonance imaging revealed bilateral and circumferential thickening with enhancement of the optic nerve sheath, suggesting bilateral optic nerve perineuritis. Serum Venereal Disease Research Laboratory (VDRL) was 1/64 and cerebrospinal fluid (CSF) showed 440 cells (86% lymphocytes), proteins 97 mg/dL, glucose 47 mg/dL, lactate 21 mg/dL and VDRL 1/4. She was treated with IV crystalline penicillin for 21 days and had partial improvement of bilateral vision within two months. At follow-up, her visual acuity was 20/40 in the right eye and 20/100 in the left; her CSF normalized, with nonreactive VDRL. Conclusion: Neurosyphilis is a treatable cause of optic perineuritis, and its recognition is important to establish the right antibiotic treatment.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70953507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5327/1516-3180.141s1.611
M. Costa, João Pedro de Sá Pereira, Laura Victória Miranda Silveira
Neurology in São Paulo was initiated at the beginning of the XX century, with the creation of the Paulista School of Medicine. This article aims to analyze the emergence of Neurology in the state of São Paulo and the influences it received. To this end, we conducted a systematic search in an electronic database, Scielo. In this context, in the 20th century, neurology studied in São Paulo was greatly influenced by the science practiced in France, since in 1882 the specialty was initiated at the University of Paris. Discussions about the diseases in this area were discussed at the Santa Casa de Misericórdia in São Paulo. Another important place for the development of neurology in São Paulo was the creation of the neuropathology and cerebrospinal fluid laboratory, in 1924, at the Hospital de Juqueri. In the 1920s, the teaching of clinical neurology was created at the Faculty of Medicine by Enjolras Vampré, known as the father of neurology in São Paulo. In the 1930s, there were major changes in the areas of brain pathology, diagnosis of diseases that affect the central nervous system, and therapy. All of this was used at Hospital de Juqueri and Faculdade Paulista de Medicina. Among the prominent methods used were pneumoencephalography, cerebral arteriography, and cerebral leucotomy. Some literary works were fundamental for the dissemination of knowledge of Neurology in the society of São Paulo, namely “Memories of the Hospital of Juqueri” from 1924 and “Archives of Assistance to Psychopaths” from 1936. Neurology underwent a major evolution at the end of the first half of the twentieth century, however, it became expensive and inaccessible to a large part of the population, especially at a time before the creation of the Unified Health System, making the poorest marginalized concerning the treatment of neurological diseases that affected the society of São Paulo at the time.
随着圣保罗医学院的建立，圣保罗的神经病学始于20世纪初。本文旨在分析神经学在圣保罗州的出现及其所受到的影响。为此，我们在Scielo电子数据库中进行了系统的检索。在这种背景下，在20世纪，在圣保罗学习的神经学深受法国科学实践的影响，因为该专业于1882年在巴黎大学创立。在圣保罗圣之家Misericórdia讨论了这一领域的疾病。神经学在圣保罗另一个重要的发展地点是1924年在Juqueri医院建立的神经病理学和脑脊液实验室。在20世纪20年代，临床神经学的教学在医学院由安灼拉·万普拉斯创立，他被称为圣保罗神经学之父。在20世纪30年代，脑病理学、影响中枢神经系统疾病的诊断和治疗领域发生了重大变化。所有这些都在Juqueri医院和Paulista de Medicina学院使用。其中使用的主要方法是气脑造影，脑动脉造影和脑白质切开术。一些文学作品是圣保罗社会传播神经学知识的基础，即1924年的《Juqueri医院的回忆》和1936年的《精神病患者援助档案》。神经病学在20世纪上半叶经历了一次重大的发展，然而，它变得昂贵，大部分人无法获得，特别是在统一卫生系统建立之前，使得最贫穷的人在神经疾病的治疗方面被边缘化，这种疾病当时影响了圣保罗社会。
{"title":"History of neurology in São Paulo at the first half of the 20th century: a systematic review","authors":"M. Costa, João Pedro de Sá Pereira, Laura Victória Miranda Silveira","doi":"10.5327/1516-3180.141s1.611","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.611","url":null,"abstract":"Neurology in São Paulo was initiated at the beginning of the XX century, with the creation of the Paulista School of Medicine. This article aims to analyze the emergence of Neurology in the state of São Paulo and the influences it received. To this end, we conducted a systematic search in an electronic database, Scielo. In this context, in the 20th century, neurology studied in São Paulo was greatly influenced by the science practiced in France, since in 1882 the specialty was initiated at the University of Paris. Discussions about the diseases in this area were discussed at the Santa Casa de Misericórdia in São Paulo. Another important place for the development of neurology in São Paulo was the creation of the neuropathology and cerebrospinal fluid laboratory, in 1924, at the Hospital de Juqueri. In the 1920s, the teaching of clinical neurology was created at the Faculty of Medicine by Enjolras Vampré, known as the father of neurology in São Paulo. In the 1930s, there were major changes in the areas of brain pathology, diagnosis of diseases that affect the central nervous system, and therapy. All of this was used at Hospital de Juqueri and Faculdade Paulista de Medicina. Among the prominent methods used were pneumoencephalography, cerebral arteriography, and cerebral leucotomy. Some literary works were fundamental for the dissemination of knowledge of Neurology in the society of São Paulo, namely “Memories of the Hospital of Juqueri” from 1924 and “Archives of Assistance to Psychopaths” from 1936. Neurology underwent a major evolution at the end of the first half of the twentieth century, however, it became expensive and inaccessible to a large part of the population, especially at a time before the creation of the Unified Health System, making the poorest marginalized concerning the treatment of neurological diseases that affected the society of São Paulo at the time.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"231 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70954321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5327/1516-3180.141s1.594
Ana Flavia Andrade Lemos, M. C. Foloni, Rebeca Aranha Barbosa Sousa, Yasmim Nadime José Frigo, T. Alvarenga, Patrick Emanuell Mesquita Sousa Santos, Gilberto Bento Magioni Junior, Ana Beatriz Baston, Helio Aquaroni Farão Gomes, L. C. Lopes, N. Nakao
Case report: Woman, 34 years old, with paresis that started four years ago during pregnancy, predominantly distal in the lower limbs and progression to the upper limbs. No involvement of cranial nerves and sensitivity. Initially considered a diagnosis of Myasthenia Gravis and clinical gain was observed with the use of pyridostigmine. After a few months, the patient’s symptoms recurred with asymmetric flaccid tetraparesis, predominantly in the lower limbs, associated with global areflexia and oral immunosuppressive therapy was initiated, with improvement. Electroneuromyography with normal sensory nerve conduction studies, but reductions in amplitudes in proximal compound muscle action potentials, with markedly reduced persistence in F-wave studies of the four limbs. Diffuse neurogenic changes were observed on exertion and activities such as positive sharp waves, fibrillation, fasciculations and myokymia at rest. Repetitive nerve stimulation at 3Hz without changes. A hypothesis of multifocal motor neuropathy (MMN) was then made. Treatment with intravenous immunoglobulin was performed, with significant recovery of symptoms. Discussion: MMN is a rare disease (prevalence of 0.6 per 100,000 individuals), with a predominance in men and a mean age of onset around 40 years. The differential diagnosis includes motor neuron disease and other demyelinating neuropathies. It is immune-mediated by antianglioside antibodies (anti-GM1), but they are not identified in all patients and may be present in other neuropathies. It is defined by muscle weakness predominantly distal, asymmetrical, predominantly in the upper limbs, slowly progressive, associated with reduced deep reflexes in the affected regions. The main electrophysiological characteristic is the presence of motor nerve conduction blocks (CB) outside the usual sites of compression. Conclusion: The finding that CB presents in patients with MMN suggests that nerve conduction should be extensively studied in every patient with a lowermotor-neuron syndrome to identify patients who might respond favorably to immunomodulating treatment.
{"title":"Multifocal motor neuropathy atypical presentation: case report","authors":"Ana Flavia Andrade Lemos, M. C. Foloni, Rebeca Aranha Barbosa Sousa, Yasmim Nadime José Frigo, T. Alvarenga, Patrick Emanuell Mesquita Sousa Santos, Gilberto Bento Magioni Junior, Ana Beatriz Baston, Helio Aquaroni Farão Gomes, L. C. Lopes, N. Nakao","doi":"10.5327/1516-3180.141s1.594","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.594","url":null,"abstract":"Case report: Woman, 34 years old, with paresis that started four years ago during pregnancy, predominantly distal in the lower limbs and progression to the upper limbs. No involvement of cranial nerves and sensitivity. Initially considered a diagnosis of Myasthenia Gravis and clinical gain was observed with the use of pyridostigmine. After a few months, the patient’s symptoms recurred with asymmetric flaccid tetraparesis, predominantly in the lower limbs, associated with global areflexia and oral immunosuppressive therapy was initiated, with improvement. Electroneuromyography with normal sensory nerve conduction studies, but reductions in amplitudes in proximal compound muscle action potentials, with markedly reduced persistence in F-wave studies of the four limbs. Diffuse neurogenic changes were observed on exertion and activities such as positive sharp waves, fibrillation, fasciculations and myokymia at rest. Repetitive nerve stimulation at 3Hz without changes. A hypothesis of multifocal motor neuropathy (MMN) was then made. Treatment with intravenous immunoglobulin was performed, with significant recovery of symptoms. Discussion: MMN is a rare disease (prevalence of 0.6 per 100,000 individuals), with a predominance in men and a mean age of onset around 40 years. The differential diagnosis includes motor neuron disease and other demyelinating neuropathies. It is immune-mediated by antianglioside antibodies (anti-GM1), but they are not identified in all patients and may be present in other neuropathies. It is defined by muscle weakness predominantly distal, asymmetrical, predominantly in the upper limbs, slowly progressive, associated with reduced deep reflexes in the affected regions. The main electrophysiological characteristic is the presence of motor nerve conduction blocks (CB) outside the usual sites of compression. Conclusion: The finding that CB presents in patients with MMN suggests that nerve conduction should be extensively studied in every patient with a lowermotor-neuron syndrome to identify patients who might respond favorably to immunomodulating treatment.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"7 8 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70954551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5327/1516-3180.141s1.621
A. Novais, Beatriz Santos Rogério, R. Branco
Introduction: Renal factors are known as important, and a controllable factor, to define prognosis,mortality and hospitalization time in most of diseases. It still lacks studies that clarify in a specific way the role of this factors. Objectives: This study aims to elucidate the impact of renal factor in outcomes of stroke patients (hospitalization time, CTI time, delirium, infection and death during internment). Methods: We performed a transversal study, part of a cohort. Data of previous renal insufficiency,admission,highest and last creatinine and urea and the highest creatinine clearance during hospitalization. We performed univariate analysis, with T test, Mann-Whitney or chi-square tests;after, multivariate analysis with logistic regression (considering P < 0.05). Results: We obtained 190 patients. Admission creatinine was significant to death (P = 0.05), delirium (P = 0.07) and infection (P = 0.06); highest creatinine to hospitalization time, delirium, infection (P < 0.001) and death (P = 0.008);and last creatinine to death (P < 0.001), delirium (P = 0.003), infection (P = 0.01) and CTI time (P = 0.1). Previous renal insufficiency showed significance to death (P = 0.03), delirium and infection (P < 0.001). ). Highest urea showed significance to all outcomes (P < 0.001), including CTI time (P = 0.004); admission urea to death (P = 0.01); and last urea to death (P < 0.001), hospitalization time (P = 0.1) and delirium (P = 0.06). Clearance only did not show significance to CTI time.Multivariate analysis to each outcome obtained: last creatinine to death (P = 0.03); highest creatinine to hospitalization time (P = 0.02); admission (P = 0.01), highest (P = 0.01) creatinine, admission urea (P = 0.03) and clearance (P = 0.01) to delirium; renal insufficiency (P = 0.009), admission (P = 0.007), highest (P = 0.002) and last (P = 0.02) creatinine, highest urea (P = 0.005) and clearance (P = 0.003). None was significant to CTI time. Conclusion: All parameters of renal function showed to be important measures of prognosis in stroke patients; thus, it is a factor we need to be aware of during hospitalization time.
{"title":"Renal predictors of mortality in stroke patients: partial results of a transversal study","authors":"A. Novais, Beatriz Santos Rogério, R. Branco","doi":"10.5327/1516-3180.141s1.621","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.621","url":null,"abstract":"Introduction: Renal factors are known as important, and a controllable factor, to define prognosis,mortality and hospitalization time in most of diseases. It still lacks studies that clarify in a specific way the role of this factors. Objectives: This study aims to elucidate the impact of renal factor in outcomes of stroke patients (hospitalization time, CTI time, delirium, infection and death during internment). Methods: We performed a transversal study, part of a cohort. Data of previous renal insufficiency,admission,highest and last creatinine and urea and the highest creatinine clearance during hospitalization. We performed univariate analysis, with T test, Mann-Whitney or chi-square tests;after, multivariate analysis with logistic regression (considering P < 0.05). Results: We obtained 190 patients. Admission creatinine was significant to death (P = 0.05), delirium (P = 0.07) and infection (P = 0.06); highest creatinine to hospitalization time, delirium, infection (P < 0.001) and death (P = 0.008);and last creatinine to death (P < 0.001), delirium (P = 0.003), infection (P = 0.01) and CTI time (P = 0.1). Previous renal insufficiency showed significance to death (P = 0.03), delirium and infection (P < 0.001). ). Highest urea showed significance to all outcomes (P < 0.001), including CTI time (P = 0.004); admission urea to death (P = 0.01); and last urea to death (P < 0.001), hospitalization time (P = 0.1) and delirium (P = 0.06). Clearance only did not show significance to CTI time.Multivariate analysis to each outcome obtained: last creatinine to death (P = 0.03); highest creatinine to hospitalization time (P = 0.02); admission (P = 0.01), highest (P = 0.01) creatinine, admission urea (P = 0.03) and clearance (P = 0.01) to delirium; renal insufficiency (P = 0.009), admission (P = 0.007), highest (P = 0.002) and last (P = 0.02) creatinine, highest urea (P = 0.005) and clearance (P = 0.003). None was significant to CTI time. Conclusion: All parameters of renal function showed to be important measures of prognosis in stroke patients; thus, it is a factor we need to be aware of during hospitalization time.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"141 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70954981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5327/1516-3180.141s1.640
Laís Ciribelli Yamaguchi, Jéssica Cristina Silveira Damasceno, Bruna Queiróz Vieira, Laura Altomare Fonseca Campos, Marcelo Sobrinho Mendonça, T. Vale
Introduction: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune disease with many possible etiologies. There are only a few reports of CIDP secondary to the use of immune checkpoint inhibitor therapy. The aim is to describe a case of CIDP secondary to the treatment of metastatic melanoma with immune checkpoint inhibitors (ipilimumab and nivolumab). Case report: A 52-year-old male patient, with arterial hypertension and hypothyroidism, presented with paresthesia and pain in the hands and forearms in November/22, that progressively spread and affected the feet in a one-month period. He then presented proximal and distal tetraparesis in January/23, leading him to depend on a wheelchair. At the time, he was being treated with immunotherapy for metastases in the pectoral muscles due to a melanoma. Symptoms’ onset and progression coincided with the therapy infusions. On examination, there were a grade 4 strength in flexion, extension, abduction and adduction of the thighs and grade 5 in other movements, with global areflexia and tactile hypoesthesia in the feet. Cerebrospinal fluid examination (CSF) showed 11 cells, predominantly with lymphocytes, and 283 mg/dL of proteins. Electromyographic studies revealed focal demyelinating neuropathy of the medians at the wrist level, with moderate to severe intensity on the right and moderate on the left, suggestive of pure motor-variant CIDP. Methylprednisolone 1g/day was given for five days with significant improvement of the condition. Results: The 2021 EFNS/PSN criteria provide diagnostic guidelines for CIDP based on clinical, electromyographic and CSF studies. Conclusion: CIDP secondary to the use of immune checkpoint inhibitors has distinct characteristics such as lymphocytic pleocytosis with slightly increased CSF cellularity and severe neuropathic pain as an initial symptom.
{"title":"Pure motor-variant CIDP associated with immune checkpoint inhibitor therapy","authors":"Laís Ciribelli Yamaguchi, Jéssica Cristina Silveira Damasceno, Bruna Queiróz Vieira, Laura Altomare Fonseca Campos, Marcelo Sobrinho Mendonça, T. Vale","doi":"10.5327/1516-3180.141s1.640","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.640","url":null,"abstract":"Introduction: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune disease with many possible etiologies. There are only a few reports of CIDP secondary to the use of immune checkpoint inhibitor therapy. The aim is to describe a case of CIDP secondary to the treatment of metastatic melanoma with immune checkpoint inhibitors (ipilimumab and nivolumab). Case report: A 52-year-old male patient, with arterial hypertension and hypothyroidism, presented with paresthesia and pain in the hands and forearms in November/22, that progressively spread and affected the feet in a one-month period. He then presented proximal and distal tetraparesis in January/23, leading him to depend on a wheelchair. At the time, he was being treated with immunotherapy for metastases in the pectoral muscles due to a melanoma. Symptoms’ onset and progression coincided with the therapy infusions. On examination, there were a grade 4 strength in flexion, extension, abduction and adduction of the thighs and grade 5 in other movements, with global areflexia and tactile hypoesthesia in the feet. Cerebrospinal fluid examination (CSF) showed 11 cells, predominantly with lymphocytes, and 283 mg/dL of proteins. Electromyographic studies revealed focal demyelinating neuropathy of the medians at the wrist level, with moderate to severe intensity on the right and moderate on the left, suggestive of pure motor-variant CIDP. Methylprednisolone 1g/day was given for five days with significant improvement of the condition. Results: The 2021 EFNS/PSN criteria provide diagnostic guidelines for CIDP based on clinical, electromyographic and CSF studies. Conclusion: CIDP secondary to the use of immune checkpoint inhibitors has distinct characteristics such as lymphocytic pleocytosis with slightly increased CSF cellularity and severe neuropathic pain as an initial symptom.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70955329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5327/1516-3180.141s1.669
Ana Marina Dutra Ferreira da Silva, Igor Dias Brockhausen, Alessandra Lima Nogueira Tolentino, Ana Laura Moura, A. A. Carvalho
Introduction: Variations in the POLG gene are the most common causes of mitochondrial disease of autosomal inheritance, and may be present in about 2% of the population. Case report: Case 1. CMAM, male, 48-year-old, complaining of bilateral eyelid ptosis with onset in adolescence. Since the age of six, he has been diagnosed with epilepsy. After five years of follow-up, he developed sensory ataxia. After 10 years he began to present dysarthria, dysphagia, tremor and pyramidal syndrome. Case 2. ASB, female, 42 years old, at 20 years old presented generalized clonic tonic crisis during the second and third trimesters of pregnancy; at 35 years of age she complained of tingling in plants and legs; at 37 years she noticed bilateral eyelid ptosis and at 39 years she noticed the presence of slurred speech and fatigue on small efforts. He has 3 siblings with similar symptoms and great difficulty walking. No history of consanguinity. Propedeutics: Normal serum lactate and CPK dosage; muscle biopsy showed variation in the caliber of muscle fibers, with the presence of “ragged red fibers” in Gomori’s Trichrome stain. Cranial magnetic resonance imaging: mild cerebellar atrophy in patient 1 and normal in patient 2. Electroneuromyography reveled absence of sensory action potentials in all nerves studied in both cases. New generation sequencing myopathy panel revealed pathogenic variant in homozygosis in the POLG c.1399G>A gene (p.Ala467Thr). Results: The patients received the diagnosis of mitochondrial disease, presenting complex clinical phenotype. Conclusion: DNA polymerase gamma is the enzyme responsible for replicating and maintaining mitochondrial DNA, encoded by nuclear DNA. The c.1399G>A variant in exon7 causes a replacement of an alanine with threonine (A467T), and is one of the causes of ataxia, such as spinocerebellar ataxia with epilepsy; autosomal recessive mitochondrial ataxia, sensory neuropathy, dysarthria and ophthalmoparesis and myoclonic epilepsy, myopathy and sensory ataxia. However, most of the time, they present a continuum between the phenotypes described.
{"title":"A467T variant of the polg gene: description of two clinical cases","authors":"Ana Marina Dutra Ferreira da Silva, Igor Dias Brockhausen, Alessandra Lima Nogueira Tolentino, Ana Laura Moura, A. A. Carvalho","doi":"10.5327/1516-3180.141s1.669","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.669","url":null,"abstract":"Introduction: Variations in the POLG gene are the most common causes of mitochondrial disease of autosomal inheritance, and may be present in about 2% of the population. Case report: Case 1. CMAM, male, 48-year-old, complaining of bilateral eyelid ptosis with onset in adolescence. Since the age of six, he has been diagnosed with epilepsy. After five years of follow-up, he developed sensory ataxia. After 10 years he began to present dysarthria, dysphagia, tremor and pyramidal syndrome. Case 2. ASB, female, 42 years old, at 20 years old presented generalized clonic tonic crisis during the second and third trimesters of pregnancy; at 35 years of age she complained of tingling in plants and legs; at 37 years she noticed bilateral eyelid ptosis and at 39 years she noticed the presence of slurred speech and fatigue on small efforts. He has 3 siblings with similar symptoms and great difficulty walking. No history of consanguinity. Propedeutics: Normal serum lactate and CPK dosage; muscle biopsy showed variation in the caliber of muscle fibers, with the presence of “ragged red fibers” in Gomori’s Trichrome stain. Cranial magnetic resonance imaging: mild cerebellar atrophy in patient 1 and normal in patient 2. Electroneuromyography reveled absence of sensory action potentials in all nerves studied in both cases. New generation sequencing myopathy panel revealed pathogenic variant in homozygosis in the POLG c.1399G>A gene (p.Ala467Thr). Results: The patients received the diagnosis of mitochondrial disease, presenting complex clinical phenotype. Conclusion: DNA polymerase gamma is the enzyme responsible for replicating and maintaining mitochondrial DNA, encoded by nuclear DNA. The c.1399G>A variant in exon7 causes a replacement of an alanine with threonine (A467T), and is one of the causes of ataxia, such as spinocerebellar ataxia with epilepsy; autosomal recessive mitochondrial ataxia, sensory neuropathy, dysarthria and ophthalmoparesis and myoclonic epilepsy, myopathy and sensory ataxia. However, most of the time, they present a continuum between the phenotypes described.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70956264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.5327/1516-3180.141s1.679
I. Teixeira, Vanessa Pereira de Alencar Souza, V. Borges, H. Ferraz
Introduction: Many cognitive screening tests have been investigated for the diagnosis of Parkinson’s disease dementia (PDD), due to its prevalence and its interference in the evolution of the disease, quality of life and in the treatment response of the patients with Parkinson’s disease (PD). Therefore, more effective and faster cognitive screening tests are needed. Objectives: To evaluate the usefulness of the NINDS-CSN 5-minutes protocol assessment (NC5MPA) in PD patients as screening test for the detection of PDD, as well as to test if the association with the cube drawing test (CDT) can increase the test accuracy. Methods: A total of 98 patients with PD were evaluated using the NC5MPA, combined with the CDT, Mini Mental State Examination and the Montreal Cognitive Assessment (MoCA). These patients were also evaluated for mild cognitive impairment (MCI) and dementia by the Clinical Dementia Rating Scale (CDR). Results: There was a good correlation (with P value < 0.00) between the test scores and PDD, but the results of the 3 tests for MCI was > 0.05. The NC5MPA test has had sensitivity of 78.5%, specificity of 85.7%, accuracy of 82.6%, positive predictive value of 80.4% and negative predictive value of 84.2%, in addition to demonstrate an average performance time of 3.2 minutes (3.08–3.31). The association with the CDT has led to a little significant increase in sensitivity and has showed a decrease in specificity and accuracy, besides increase the test performance time. In assessing the interference of education level, the results were influenced by the small sample size of the 5 to 8 years of education group. Conclusion: The NC5MPA test has proven up to be a good screening test for PDD, being even faster and easier to perform, but more tests with larger populations are necessary to assess the accuracy of this test for MCI and to assess if there is interference of education level in the test accuracy.
{"title":"Evaluation of the NINDS-CSN 5-minutes protocol as a cognitive screening test to detect Parkinson’s disease dementia: a study of a Brazilian sample","authors":"I. Teixeira, Vanessa Pereira de Alencar Souza, V. Borges, H. Ferraz","doi":"10.5327/1516-3180.141s1.679","DOIUrl":"https://doi.org/10.5327/1516-3180.141s1.679","url":null,"abstract":"Introduction: Many cognitive screening tests have been investigated for the diagnosis of Parkinson’s disease dementia (PDD), due to its prevalence and its interference in the evolution of the disease, quality of life and in the treatment response of the patients with Parkinson’s disease (PD). Therefore, more effective and faster cognitive screening tests are needed. Objectives: To evaluate the usefulness of the NINDS-CSN 5-minutes protocol assessment (NC5MPA) in PD patients as screening test for the detection of PDD, as well as to test if the association with the cube drawing test (CDT) can increase the test accuracy. Methods: A total of 98 patients with PD were evaluated using the NC5MPA, combined with the CDT, Mini Mental State Examination and the Montreal Cognitive Assessment (MoCA). These patients were also evaluated for mild cognitive impairment (MCI) and dementia by the Clinical Dementia Rating Scale (CDR). Results: There was a good correlation (with P value < 0.00) between the test scores and PDD, but the results of the 3 tests for MCI was > 0.05. The NC5MPA test has had sensitivity of 78.5%, specificity of 85.7%, accuracy of 82.6%, positive predictive value of 80.4% and negative predictive value of 84.2%, in addition to demonstrate an average performance time of 3.2 minutes (3.08–3.31). The association with the CDT has led to a little significant increase in sensitivity and has showed a decrease in specificity and accuracy, besides increase the test performance time. In assessing the interference of education level, the results were influenced by the small sample size of the 5 to 8 years of education group. Conclusion: The NC5MPA test has proven up to be a good screening test for PDD, being even faster and easier to perform, but more tests with larger populations are necessary to assess the accuracy of this test for MCI and to assess if there is interference of education level in the test accuracy.","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70956369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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