Pseudotumoral form of neuroschistosomiasis: report of three cases.

Central nervous system (CSN) involvement in schistosomiasis is an ectopic manifestation with a large variety of clinical forms, including pseudotumoral, which occurs in isolated cases and is rare. Three patients with epidemiological indications of this pathology were examined; the clinical picture included lower-back pain irradiating to lower limbs, associated with progressive flaccid paraparesis and sphincterial disturbances in cases in which the spinal chord was involved; while in cases with encephalitic impairment, headache, dizziness and cerebellar syndrome, characterized by dysarthria and right-side dysgraphia, were present. Magnetic resonance imaging (MRI) showed a growing process in all cases; cerebrospinal fluid (CSF) characteristics and biological markers were compatible with neuroschistosomiasis (NS). Biopsy of the lesions confirmed this diagnosis in one case. After specific treatment with schistosomicides and corticosteroids, clinical, radiological and laboratorial improvement was observed.

Pseudotumoral form of neuroschistosomiasis: report of three cases

Central nervous system (CSN) involvement in schistosomiasis is an ectopic manifestation with a large variety of clinical forms, including pseudotumoral, which occurs in isolated cases and is rare. Three patients with epidemiological indications of this pathology were examined; the clinical picture included lower-back pain irradiating to lower limbs, associated with progressive flaccid paraparesis and sphincterial disturbances in cases in which the spinal chord was involved; while in cases with encephalitic impairment, headache, dizziness and cerebellar syndrome, characterized by dysarthria and right-side dysgraphia, were present. Magnetic resonance imaging (MRI) showed a growing process in all cases; cerebrospinal fluid (CSF) characteristics and biological markers were compatible with neuroschistosomiasis (NS). Biopsy of the lesions confirmed this diagnosis in one case. After specific treatment with schistosomicides and corticosteroids, clinical, radiological and laboratorial improvement was observed.

Antibodies to Schistosoma mansoni in human cerebrospinal fluid.

Cerebrospinal fluid (CSF) and serum samples from patients suspected of having neuroschistosomiasis (NS) were evaluated by an enzyme-linked immunosorbent assay. Monoclonal antibodies of various immunoglobulin isotypes (IgM, IgA, IgE, total IgG, IgG1, IgG2, IgG3, and IgG4) were used to detect antibodies against Schistosoma mansoni soluble egg antigen (SEA) and soluble worm adult preparation (SWAP). Of the 83 CSF samples tested, 55% were reactive to SEA (26% were reactive only to SEA and 29% to both SEA and SWAP), 34% were reactive to SWAP (5% only to SWAP and 29% to both SEA and SWAP), and 40% were not reactive with any antigen. Cases that tested positive for SWAP in CSF and negative in serum were not found. Samples with high specific IgG antibody titers were selected for immunoglobulin isotype profiling. In the CSF samples, the antibodies against SEA and SWAP were mainly IgM, IgG1, and IgG4, although other immunoglobulins were also detected. Interestingly, nine patients had high levels of IgG1 only in the CSF. These results suggest that there is local synthesis of IgG1, and that this isotype could be an important immunologic marker in the diagnosis of NS.

Ataques isquêmicos transitórios em pacientes com síndrome da veia cava superior / Transient ischemic attacks in apatient with superio vena cava obstruction: case report

A síndrome da veia cava superior (SVCS) é condiçao relativamente rara. Relatamos o caso de um paciente de 42 anos, masculino, hipertenso há 15 anos, que evoluiu com dor cervical e torácica há um ano, sendo evidenciada oclusao de 95 por cento da coronária direita. Submetido a angioplastia, porém com persistência de dor torácica. Posteriormente evoluiu com episódios recorrentes de hemiplegia à direita associados a crises hipertensivas, que melhoravam com medicamentos anti-hipertensivos. Pela presença de coloraçao vinhosa na face e acentuaçao durante os períodos de ataques isquêmicos transitórios, foi feita a suspeita diagnóstica de provável acometimento do sistema de drenagem venosa, confirmada à venografia pelo achado de dilataçao da veia jugular direita e imagem de estreitamento importante na junçao com a veia cava superior. Em conclusao, nao foi possível definir com certeza a relaçao entre as duas patologias no caso aqui apresentado, porém chamou a atençao a melhora dos sintomas neurológicos após o controle da SVCS com o tratamento instituído.

Lamotrigina em epilepsia de difícil controle: estudo aberto e de adiçäo / Lamotrigin in epilpsy of hard control: open study and adition study

Os autores relatam um estudo de adiçäo da Lamotrigina em 15 pacientes portadores de epilepsia de difícil controle, com objetivo de avaliar eficácia e segurança da droga, fazendo acompanhamento ambulatorial por seis meses, mostrando ao final reduçäo da frequência e melhora no padräo das crises, com baixa incidência de efeitos colaterais e melhora no estado psicológico dos pacientes. Os achados säo correlacionados com a literatura mundial sobre a droga