Arquivos de neuro-psiquiatria最新文献

Cerebral amyloid angiopathy (CAA) is a small vessel disease characterized by the deposition of amyloid-beta in small cerebral vessels, which can lead to intracerebral hemorrhages and cognitive impairment. Rare variants, such as cerebral amyloid angiopathy-related inflammation (CAA-ri) and iatrogenic CAA (ICAA), may mimic other neurological conditions and challenge diagnosis in clinical practice. We present three cases that illustrate distinct CAA syndromes, along with CSF biomarker analysis. One patient experienced recurrent hemorrhagic strokes with a history of dural graft, raising concerns about amyloid transmission. Two patients presented with rapidly progressive dementia that fulfilled CAA-ri criteria. All cases exhibited decreased levels of CSF Aβ40 and Aβ42, with one showing elevated p-tau, suggesting comorbid Alzheimer's pathology. Cerebrospinal fluid biomarkers complement neuroimaging in the diagnosis of CAA, aiding in differentiation from other dementias. Early recognition and diagnosis of CAA-ri variants is crucial, because immunotherapy may improve outcomes. Further research is necessary to establish biomarker thresholds and their clinical applicability.

Sir Isaac Newton is widely regarded as one of the greatest scientific minds in history, with seminal contributions across mathematics, physics-particularly optics-and the formulation of the law of universal gravitation. Less well known, however, is his extraordinary and rarely recognized contribution to the field of neurology: the early conceptualization of fiber decussation within the optic chiasm. Through his studies on light and vision, Newton proposed that optic nerve fibers cross at the chiasm-a hypothesis that would later be anatomically confirmed and provided the basis for understanding the classic patterns of visual field deficits.

Secondary headaches arise from underlying medical conditions and are associated with significant morbidity and mortality. Their diagnosis relies primarily on a comprehensive clinical history and a thorough physical examination, both aimed at identifying key warning signs. The SNNOOP10 mnemonic is a widely-recognized tool used to screen for potential secondary causes of headache. It consists of a structured checklist of 15 red flags, with validated sensitivity, specificity, and predictive values. However, the original English version may present challenges for healthcare providers who are non-native English speakers.To introduce a culturally-adapted version of the SNNOOP10 mnemonic in Portuguese: "NÃO É PRIMÁRIA" ("IT IS NOT PRIMARY").The authors reorganized the SNNOOP10 red flags into "NÃO É PRIMÁRIA" by semantically grouping related items, assigning each letter to a corresponding clinical element and matching the original red flags into each letter of the new acronym. A comparative table and image were developed to ensure clarity.The new mnemonic covers all reorganized items of the SNNOOP10 adapted for Portuguese speakers."NÃO É PRIMÁRIA" is a practical mnemonic that adapts THE SNNOOP10 for Portuguese-speaking settings, based on clinical experience. It requires formal validation, and future studies should assess its diagnostic accuracy and applicability.

The present narrative review delves into the multifaceted roles of the cerebellum, highlighting its significance beyond traditional motor functions to encompass cognitive and behavior-related processes, as evidenced by advancements in functional neuroimaging. We provide a comprehensive summary of the cerebellum's embryological development, intricate microanatomy, macroanatomy, and vascular anatomy of the cerebellum, revealing how these aspects contribute to its unique circuitry and operational capabilities. A non-systematic literature search was conducted using the PubMed database, focusing on landmark and recent studies addressing the embryology, anatomy, clinical correlations and radiological aspects of the cerebellum. Ultimately, this review underscores the cerebellum's complex structure and diverse function, advocating for a deeper understanding to improve diagnostic and therapeutic approaches for cerebellar disorders.

The increasing screen time among the pediatric population is a detrimental factor for cognitive and psychosocial development, especially for children with autism spectrum disorder (ASD). However, there are still many questions regarding its negative effects on behavior and sleep in this population group and, as of the writing of this study, there are no specific recommendations regarding screen use for children with ASD.To synthesize and analyze the current evidence on the association between screen exposure time, behavioral symptoms, and sleep disorders in ASD children.The authors provided a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist adapted review of studies that examined the association between screen time and both autistic symptoms and sleep disturbances in this patient population.Research indicates that excessive screen use among ASD children, particularly in preschool-aged children, may be associated with significant behavioral, emotional, and sleep quality impacts. The screen time recommendations set by the World Health Organization for the general pediatric population could also be applied to these children, at least until new studies can clarify specific guidelines, taking their particularities into account.This review article explores the current evidence on the association between excessive screen time and both autistic symptoms and sleep disturbances in ASD, underscoring the relevance of further clinical investigation.

Alzheimer's disease (AD) is a progressive neurodegenerative condition causing cognitive decline. Given the aging population and increasing prevalence, understanding hospital morbidity patterns is crucial for improving prevention strategies and public health planning.To analyze the epidemiological profile and temporal trend of AD hospitalizations in Brazil between 2012 and 2022.The present mixed ecological study used data from the Hospital Information System of the Unified Health system. We calculated the frequencies for sex, age group, and skin color, along with the average length of stay and total costs. Simple linear regression was used for the temporal trend analysis across sex, age groups by sex, and regions.A higher proportion of hospitalizations was observed in females (65.80%), individuals aged 80 years or older (60.12%), and white individuals (49.06%). The average hospital stay was 21.6 days, with a total cost of R$ 23,306,587.01. The hospitalization trend was stable across both sexes, all age groups, and most regions (4.88/100 thousand hospitalizations), except for the Northeast, which showed a significant increase (β = 0.408; p < 0.001).The profile of AD hospitalizations in Brazil is predominantly female, in individuals over 80 and white. While the trend remained stable nationally, there was an increase in the Northeast region. Additionally, a reduction in the average number of hospitalization days and hospital costs was observed throughout the period analyzed.

Multiple sclerosis (MS) is an inflammatory and neurodegenerative disorder whose prevalence varies across Brazil (from 15-27 cases per 100 thousand inhabitants), and the absence of an extensive national study limits the understanding of MS epidemiology in a nation as diverse as Brazil.To compare epidemiological data, including healthcare access, among people with MS across four Brazilian regions.Data from 2,974 Brazilian MS patients in the Collaborative Latin American Database for Multiple Sclerosis (BRANDO) were analyzed. We assessed demographic and clinical outcomes, as well as healthcare access, to elucidate regional differences.The cohort was predominantly composed of female patients (72.5%) with MS onset at a mean age of 30.6 years. Regarding the regional differences, there was a lower predominance of female patients (68.7%; p = 0.003) in the Southeast, a higher rate of subjects of mixed ethnicity (p < 0.001) in the Midwest (40.3%) and Northeast (63.7%), higher scores on the Expanded Disability Status Scale (EDSS) in the Northeast (4.0; p < 0.001), a higher prevalence of relapsing-remitting MS (RRMS) in the Southeast and Midwest (87%; p < 0.001), while the Northeast presented (p < 0.001) the highest rates of primary progressive MS (PPMS) and secondary progressive MS (SPMS) (PPMS = 15.8%; SPMS = 18%). The Northeast presented the longest time (5.9 years; p < 0.01) from disease onset until MS diagnosis (range for the other regions = 1.9-3.7 years). And the Midwest showed the shortest time (2.1 years; p < 0.01) from disease onset until first access to disease-modifying therapies (DMTs; range for the other regions = 3.5-5.1 years).The present is the first nationwide epidemiological study on people with MS in Brazil. It underscores regional epidemiological variations and differences in healthcare access, advocating for tailored approaches in MS management and research.

The association between levodopa treatment and neuropathy in Parkinson's disease (PD) remains controversial, particularly when comparing the oral and intestinal administration routes.To compare the electrophysiological and biochemical changes in patients receiving oral levodopa or levodopa/carbidopa intestinal gel (LCIG) and to determine their association with neuropathy development.The current prospective cross-sectional study included 32 PD patients (18 oral and 14 LCIG). Demographic features, disease duration, Hoehn and Yahr (H&Y) stage, Unified Parkinson's Disease Rating Scale (UPDRS) scores, biochemical parameters (vitamin B12, folate, homocysteine), and electrophysiological values were recorded. Nerve conduction studies (NCSs) of the median, ulnar, peroneal, tibial, and sural nerves were performed unilaterally, using reference values from our neurophysiology laboratory.The LCIG group presented significantly higher doses of levodopa (p < 0.001), levodopa equivalent daily dose (LEDD; p < 0.001), and homocysteine levels (p = 0.002) compared with the oral group. Electrophysiological tests revealed significantly reduced motor amplitudes and sensory conduction velocities in the median, ulnar, tibial, and sural nerves in the LCIG group. The median and tibial F-wave latencies were prolonged in the LCIG group. Correlation analyses indicated significant associations involving homocysteine elevation and conduction abnormalities.Patients receiving LCIG presented higher homocysteine levels and more frequent electrophysiological abnormalities than those on oral treatment, suggesting a higher risk of polyneuropathy. These findings highlight the importance of biochemical monitoring and individualized treatment strategies in advanced PD.