Arquivos de neuro-psiquiatria最新文献

Trigeminal neuralgia (TN) is a severe craniofacial pain disorder that significantly impacts patient quality of life. Microvascular decompression (MVD) is the sole surgical technique directly addressing the underlying neurovascular conflict, offering durable pain relief. However, data from Latin American populations remain limited.To evaluate pain improvement, recurrence, and complications in patients with classic TN undergoing MVD at a Mexican high-specialty center.We retrospectively analyzed 61 consecutive classic TN patients who underwent MVD (2010-2023). Their clinical records provided demographic data, pain characteristics, Barrow Neurological Institute Pain Scale (BNI-PS) scores, intraoperative findings, and long-term outcomes. The statistical analyses were performed through the McNemar and Cochran Q tests for longitudinal changes.The cohort was predominantly composed of women (80.3%; median age: 59 years). Preoperatively, most reported severe pain (BNI-PS score: IV-V). After MVD, 57.4% achieved complete pain relief (BNI-PS score: I) and 13.1% had occasional pain not requiring medication (BNI-PS score: II) at the long-term follow-up. Neurovascular compression was identified in 96.7% of the cases, most frequently by the superior cerebellar artery (49.2%). The overall recurrence rate was of 14.8%, with 8.2% requiring reoperation. Early complications included transient cerebellar syndrome (8.2%) and facial hypoesthesia (11.5%); 1 case of mortality occurred due to hypertensive hemorrhage.Microvascular decompression is a safe, effective, and durable treatment for classic TN, achieving long-term pain relief in more than 70% of the patients. The present study offers valuable clinical data from a Mexican cohort, reinforcing the efficacy and reproducibility of the procedure in diverse neurosurgical settings.

Cerebral palsy (CP), a term coined by William John Little in 1843, represents a group of non-progressive motor disorders resulting from early brain injury. Beyond its medical characterization, there were early artistic depictions, such as Egyptian reliefs and medieval religious scenes, portraying individuals with asymmetric or contracted limbs mainly through symbolic or moral lenses. During the Renaissance and Baroque periods, artists including Dürer and Velázquez subtly represented physical diversity, though without explicit medical context. Literary portrayals evolved from mythological or moral allegory (e.g., Hephaestus, hagiographies) to empathetic narratives of individuality and inclusion, as seen in Tiny Tim, present in A Christmas Carol, written by Charles Dickens, and Draper's Out of My Mind. In modern times, artists and writers living with CP transformed disability into a means of self-expression and social critique.

Duchenne muscular dystrophy is a rare, progressive neuromuscular disorder primarily affecting boys, and it follows a predictable course. Early intervention is essential for effective management, but disparities in the care of patients with rare diseases hinder access to optimal treatment.To identify unmet needs and challenges in the care of patients with Duchenne muscular dystrophy within the Brazilian public health system compared with the private system.A cross-sectional observational study using the Delphi method was conducted with ten neurologists specialized in Duchenne muscular dystrophy. The specialists participated in rounds of surveys to reach consensus on key issues, including diagnosis, treatment, and care. Data was analyzed using descriptive statistics.According to the Delphi panel, the public health system had an average diagnostic delay of 25 months compared with 10 months in the private sector. Although genetic testing is critical, it is not funded by the public health system. Other barriers included delayed corticosteroid treatment, limited access to multidisciplinary care, and insufficient medical devices. Patients in the public health system lost ambulation earlier (11-12 years of age) than those in the private sector (13-14 years of age). Life expectancy was significantly shorter in the public system, averaging 19 to 20 years compared with 26 to 27 years of age in the private sector.There are significant disparities in the care of patients with Duchenne muscular dystrophy within Brazil's public health system, resulting in worse outcomes. Enhancing access to genetic testing and early multidisciplinary care is crucial to improve the quality of life and survival of these patients.

We herein report the case of a 23-year-old man with a 3-year history of progressive right-hand weakness, leading to functional impairment. A neurological examination revealed signs of lower cervical motor neuron involvement, including the reverse split hand sign and the Wartenberg's sign. Electrophysiological studies showed reduced compound muscle action potentials (CMAPs) in the right ulnar and median nerves, with preserved sensory conduction and neurogenic changes in the myotomes from C7 to T1. A conventional cervical spine magnetic resonance imaging (MRI) scan was unremarkable, but a flexion MRI scan revealed anterior displacement of the posterior dura and spinal cord compression, confirming the diagnosis of Hirayama disease (HD), which is a rare, self-limiting cervical myelopathy in young male patients caused by dynamic compression during neck flexion. The diagnosis requires a high index of suspicion and flexion MRI scans. While cervical stabilization remains controversial, it may help prevent progression in selected cases. The current report highlights the clinical and radiological features of HD, discusses differential diagnoses, and underscores the importance of dynamic imaging in young patients with asymmetric upper-limb weakness.

Studies on the association between pineal gland calcification (PGC) and non-breathing sleep-related symptoms are inconclusive.The present study aims to evaluate this association in middle-aged and older adults living in rural villages located in coastal Ecuador.Community-dwellers aged ≥ 40 years enrolled in the Three Villages Study cohort were interviewed with the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality and received head computed tomography for automated measurement of PGC volumes. Generalized linear and logistic regression models were used to assess the association between PGC volumes (exposure) and the PSQI score and sleep quality (as separate dependent variables), after adjusting for age and sex.The study included 1,009 participants (mean age: 56.5 ± 12.6 years; 57% women). The mean volume of PGC was 51 ± 53.5 µL. The mean score of the PSQI was 5.3 ± 2.8 points, with 399 (40%) participants having poor sleep quality. Locally-Weighted Scatterplot Smoothing showed a linear relationship between continuous PGC volumes and PSQI scores. An unadjusted generalized linear regression model showed a significant association between PGC volumes stratified in tertiles and the continuous PSQI score. However, this association lost statistical significance after adjustment for age and sex. The association between tertiles of PGC and poor sleep quality was non-significant in both unadjusted and multivariate logistic regression models.Study results did not find an association between increased PGC and sleep quality after adjusting for demographics, suggesting that PGC may not necessarily indicate pineal dysfunction but could reflect adaptive physiological mechanisms.

Eye tracking technology has emerged as a pivotal tool in neurology, providing objective insights into ocular motor function and cognitive processes across various neurological conditions, including mild traumatic brain injury, autism spectrum disorder, schizophrenia, attention deficit hyperactivity disorder, and neurodegenerative diseases like Alzheimer's and Parkinson's disease.The present systematic review evaluates the current applications and reliability of portable eye-tracking devices in clinical practice, highlighting their transformative potential for diagnosing and monitoring cognitive disorders.A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Observational studies using portable eye-tracking devices were included. Databases searched included PubMed, Embase, and Cochrane, with studies screened and reviewed by two independent authors. Outcomes assessed were eye movements and visual responses in neurological patients. The Critical Appraisal Skills Program (CASP) checklist was used to assess study quality and bias.A total of 62 studies were identified, with 27 included after screening. The findings reveal significant advancements in device accessibility, sampling rates, and accuracy, which enhance the ability to detect subtle cognitive changes through eye movement patterns. Portable devices such as Neurolign DX 100 (Neurolign USA, LLC) and Tobii (Tobii), which is a portable video-oculography (VOG) devices including Neurolign DX 100 and Tobii systems, were highlighted for their precision and applicability in clinical settings.Portable eye-tracking devices show promise for detecting cognitive impairments in neurological conditions like multiple sclerosis. Their portability and ease of use facilitate widespread clinical application, making cognitive assessments more accessible and effective in early diagnosis and monitoring of disease progression.

The Activity Limitation Measure (ACTIVLIM) is a self-reported instrument consisting of 22 daily activity items graded on 3 levels (easy, difficult, or impossible).To translate, culturally adapt, and validate the Brazilian Portuguese version of the ACTIVLIM for individuals with neuromuscular disorders.The present was a cross-sectional observational study. The translation process followed standardized guidelines, including steps such as forward translation, synthesis, back-translation, expert committee review, and pretesting (psychometric analysis). A total of 268 individuals with neuromuscular disorders filled out the Brazilian ACTIVLIM. Test-retest reliability was assessed in a subgroup of 60 participants, who were evaluated twice by the same physiotherapist with an interval of one month.The intraclass correlation coefficient (ICC) for intrarater reliability was of 0.95. Internal consistency was high (Cronbach's alpha = 0.940). External validity showed strong correlations involving ACTIVLIM scores and the scores on the Vignos scale (r = -0.907), the Brooke scale (r = -0.908), and the Functional Independence Measure (r = 0.864), all with p < 0.001. Proximal muscle strength in the upper (r = 0.748) and lower limbs (r = 0.793), measured through the Medical Research Council scale, also correlated significantly with ACTIVLIM scores. Linear regression identified that the scores on the Vignos (R² = 0.8236), and Brooke scales (R² = 0.8132), as well as proximal muscle strength in the lower (R² = 0.6480) and upper limbs (R² = 0.5805), were the main predictors of ACTIVLIM variance.The Brazilian Portuguese version of the ACTIVLIM demonstrated strong reliability and validity. Its scores were significantly associated with disability level, functional independence, and muscle strength in individuals with neuromuscular disorders.

Aging is accompanied by an increasing incidence of dementia. Alzheimer's disease (AD) is the leading cause of dementia, and it impairs autonomic function. Heart rate variability (HRV) is a marker of autonomic function, but findings in AD are conflicting, and there is scant information on the association of HRV with falls in dementia patients.To assess autonomic activity in older adults with AD, comparing these patients to older adults without dementia (the control group, CG), and to investigate the relationship between HRV and falls.The HRV was analyzed in older adults without dementia and in those with AD using a heart rate monitor. The measurements were made on a single day in the supine and orthostatic positions for 10 minutes each. The HRV components in the time and frequency domains were assessed, along with the history of falls in the past 3 years.The groups were homogenous, with a predominance of female individuals, and mean ages of 81 (AD) and 79 (CG) years. A reduction in the R-R interval upon changing from the supine to the orthostatic positions was evident in both groups, but the AD group showed reduced parasympathetic components in the orthostatic position. For the frequency domain, a reduction in high frequency (HF) and increases in low frequency (LF) and in the LF/HF ratio were observed, suggesting increased sympathetic and reduced parasympathetic activities. The AD group presented more falls, whose incidence was associated with HRV components.Alzheimer's disease was associated with worse autonomic dysfunction, increased sympathetic activity and greater parasympathetic impairment, a high incidence of falls and interaction with HRV components.