Arquivos de neuro-psiquiatria最新文献

White matter hyperintensities (WMH) are commonly detected on brain magnetic resonance imaging (MRI) scans of migraine patients, but their clinical relevance and underlying mechanisms remain uncertain.To systematically review the relationship between WMH and migraine, focusing on prevalence, progression, and associations with clinical and demographic characteristics.We conducted a systematic review of observational studies published between 1990 and May 2025, including adult patients with migraine (with or without aura) who underwent brain MRIs with at least 1.5T scanners. Data extraction was performed by two independent reviewers, with disagreements resolved by a third. Study quality was assessed using the Newcastle-Ottawa scale for observational studies.A total of 25 studies were included, comprising approximately 3,600 participants, of whom 1,725 had migraine. Most participants were women and reported age means or medians typically between 30 and 60 years. Frequently, WMHs were observed in migraine patients, particularly in those with aura, longer disease duration, and higher headache frequency. No consistent association was found between WMH and comorbidities. Significant heterogeneity in imaging protocols, lesion quantification methods, and study design limited data comparability and precluded meta-analysis.Migraine patients often present with WMHs, but their clinical significance remains unclear. Future studies should employ standardized MRI protocols, volumetric lesion quantification, and consistent migraine phenotyping to clarify its pathophysiological role in migraine and potential implications for diagnosis and management.

Cisplatin, a potent platinum-based chemotherapeutic, effectively treats various cancers. However, it is limited by cisplatin-induced peripheral neuropathy (CIPN), driven by oxidative stress and neuroinflammation.The present study investigates the neuroprotective potential of Taraxacum officinale L. leaf extract (TOE), rich in polyphenols such as luteolin and quercetin, known for their antioxidant and antiinflammatory properties.Molecular docking of 10 polyphenols against NF-κB1 revealed that luteolin and quercetin outperform synthetic inhibitors, forming strong interactions with key residues. These compounds exhibited favorable pharmacokinetics, including high gastrointestinal absorption and nontoxicity. The CIPN was induced in male Wistar albino mice (3 mg/kg cisplatin, i.p., weekly for 5 weeks), with TOE (500 mg/kg, intragastric, daily) or saline administered concurrently. A TOE-only group served as a control. Behavioral assessments (rotarod, hot plate, cold plate, tail flick) evaluated sensory and motor function, while biochemical assays measured antioxidant enzymes (CAT, GPx1, SOD2), oxidative stress markers (MDA, TOS, IMA), and proinflammatory cytokines (NF-κB, TNF-α, IL-6) in serum and sciatic nerve tissues.Cisplatin induced significant behavioral deficits, reduced antioxidant capacity, and elevated oxidative and inflammatory markers. The TOE significantly ameliorated these effects, restoring behavior, enhancing antioxidant status, and reducing inflammation, consistent with the in silico predictions of NF-κB1 inhibition.These findings highlight T. officinale as a promising, safe, complementary therapy for CIPN, warranting further clinical exploration.

Migraine is a common neurological disorder associated with an increased risk of cardiovascular conditions, including arrhythmias. Although autonomic dysfunction is considered a key mechanism linking migraine and cardiac abnormalities, its impact during pain-free intervals remains unclear.To investigate the association between migraine and cardiac arrhythmias, focusing on the prevalence of premature ventricular contractions (PVCs) and autonomic dysfunction during pain-free periods.A total of 50 migraine patients and 51 age- and sex-matched healthy controls were enrolled in the present observational, cross-sectional study. All participants underwent 24-hour Holter monitoring, standard electrocardiographic and echocardiographic evaluation. The frequencies of PVCs, PR interval, QT interval (QTc), heart rate variability, and sinus tachycardia prevalence were compared between groups. Migraine-related disability was assessed using the Migraine Disability Assessment Scale (MIDAS) and the Headache Impact Test-6 (HIT-6).At least 1 PVC was detected in 40% of migraine patients, although no significant difference was observed compared with controls (p > 0.05). However, migraine patients showed a significantly higher prevalence of sinus tachycardia (p < 0.05). Additionally, a positive correlation was found between PVC burden and MIDAS scores, suggesting a potential link between migraine severity and arrhythmia risk. No significant differences were observed in QTc intervals or other major arrhythmic parameters.Migraine patients may exhibit increased sinus tachycardia and subtle electrocardiographic changes even during pain-free intervals, possibly reflecting underlying autonomic dysfunction.

As we near the bicentenary of his birth, Jean-Martin Charcot (1825-1893) is remembered not only as the founder of modern neurology but also as a uomo universale. His multidisciplinary approach transcended 19^th-century medicine, establishing neurology as a distinct discipline while integrating art, psychology, and philosophy into his study of the nervous system. His work laid foundations for neurodegenerative diseases (amyotrophic lateral sclerosis [ALS], Parkinson's disease, multiple sclerosis [MS]), functional neurological disorders (FNDs), and psychoanalysis, foreshadowing neuroplasticity and the mind-body connection. His innovative teaching at Salpêtrière-merging anatomy with artistic documentation-revolutionized medical education, inspiring figures from Freud to modern neuroscientists. Two centuries later, Charcot's legacy endures not just in eponyms but in his unifying vision of brain, mind, and art - a timeless model for interdisciplinary medicine. The present paper explores his impact on neurodegenerative research, functional disorders, medical pedagogy, and the humanities.

Idiopathic spinal cord herniation (ISCH) is a rare condition caused by a defect in the dura mater, resulting in ventral displacement of the spinal cord. Its etiology is not fully understood, but it mainly affects middle-aged women and manifests as progressive myelopathy. Surgical treatment is the best option to avoid neurological worsening. This report presents a case of spinal cord herniation in a 45-year-old man, complaining of numbness for 4 months, with paraparesis that progressed to gait disorder. This condition was diagnosed by magnetic resonance imaging and computed tomography. The patient underwent T2 to T3 laminectomy, hernia reduction, and duroplasty, with successful resolution of the condition.

Chagas disease is an important cause of heart failure (HF) and stroke, affecting over 6 million people. High-intensity transient signals (HITS) are detected on transcranial Doppler (TCD) in patients with Chagas disease, but the effect of antithrombotic treatment on HITS is unknown.To evaluate whether acetylsalicylic acid (ASA) reduces the frequency and number of HITS in patients with Chagasic HF.Proof-of-principle pilot prospective, randomized, open, blinded endpoint (PROBE) clinical trial, in which patients with both Chagas and HITS were randomized 2:1 to ASA 300 mg for 7 days and standard HF treatment or standard HF treatment alone (control group). The primary outcome was the proportion of HITS after one week, analyzed using the Chi-squared test.A total of 373 patients with HF were evaluated, with HITS occurring in 22/190 (12%) Chagasic patients and in 16/183 (8%) non-Chagasic patients (p = 0.531). Twelve of the 22 (54%) Chagasic patients were randomized to treatment with (n = 8) or without ASA (n = 4). Two patients in the control group (50%) persisted with HITS after 7 days of treatment, compared to none in the ASA group, p = 0.028. The median number of HITS decreased from 3.5 to 0 with ASA (p = 0.012) and 4.0 to 0.5 in the control group (p = 0.095), with no significant between-group difference (p = 0.262). No adverse events were reported.In the present pilot clinical trial, ASA reduced the proportion of HITS in patients with Chagas disease HF.

Cefepime is an antibiotic widely used for severe infections in hospital . However, its use can lead to encephalopathy, which is detected by electroencephalogram (EEG).To establish the socioclinical pattern of cefepime encephalopathy and its correlation with EEG.Forty-one medical records of patients diagnosed with cefepime-induced encephalopathy were analyzed according to the criteria established by Naranjo et al.,¹ with socioclinical parameters being evaluated.All EEG tracings in the presence of cefepime-induced encephalopathy had generalized periodic discharges (GPD), and 70.7% of the exams met the criteria for a nonconvulsive status epilepticus. With the withdrawal of cefepime, 85.3% of patients had clinical improvement.Encephalopathy caused by cefepime is a clinical manifestation that should be considered among patients using this antibiotic, with a wide spectrum of manifestations. The use of EEG imaging is critical for diagnosis.

Amyotrophic lateral sclerosis (ALS) is a multifaceted neurodegenerative disorder with a poor prognosis. Weight loss and malnutrition emerge as significant clinical features during disease progression.To explore how demographic and clinical characteristics relate to survival in ALS patients, emphasizing the role of weight loss percentage at the time of diagnosis.We conducted a retrospective study that used the database of a multidisciplinary ALS care center in the city of Natal, Brazil.A total of 132 patients were included in the study. The mean age of the participants at symptom onset was of 56.9 years, and most of them were male (59.8%). Older age, bulbar onset, and faster disease progression were associated with weight loss ≥ 10% at diagnosis. Among 132 patients, 72% experienced death or tracheostomy, with a median survival of 34 months. Survival was notably reduced in patients aged ≥ 60 years, those with significant weight loss, rapid disease progression, or those submitted to gastrostomy. Weight loss and the rate of disease progression were the strongest predictors of reduced survival. Potential factors relating gastrostomy with reduced survival are discussed.The present study highlights the critical impact of weight loss and disease progression on survival in ALS patients, emphasizing the importance of early nutritional and clinical interventions. These findings underscore the need for comprehensive, multidisciplinary care strategies to address key prognostic factors and improve outcomes in ALS patients.