Kinematic characteristics of arm and trunk when drinking from a glass in children with and without cerebral palsy.

BACKGROUND: Children with cerebral palsy (CP) often have difficulty with activities that require the upper extremities secondary to deficits in strength and range of motion, spasticity, and poor timing and coordination of movement. This study aimed to identify and compare timing and coordination of the trunk and upper extremity in children with and without CP during a functional task. METHODS: Eighteen children, N = 9 with CP and N = 9 with typical development were enrolled. Participants were seated in a standard chair and instructed to drink from a glass placed at a distance of 75% of available arm length. The task was divided into 3 Phases: 1) reaching to the glass, 2) transporting the glass to the mouth, and 3) returning the glass to the table. The spatiotemporal and angular variables were analyzed with 3D kinematics of movement using a 4-camera Qualysis Motion System. FINDINGS: Children with CP demonstrated poor upper extremity timing and coordination. Despite significant trunk displacement used as a compensation in Phase 1, children with CP demonstrated a significantly lower mean velocity and velocity peak during Phases 2 and 3; and demonstrated less straight motion which required more time and movement units in all phases. INTERPRETATION: Children with CP demonstrated poor upper extremity timing and coordination when drinking (even when they successfully completed the task) measured by more trunk displacement, slower, less straight movements, and more movement units. Current rehabilitation strategies could consider training speed and use functional tasks that require different strategies across multiple phases.

The role of conventional MR imaging sequences in the evaluation of neurocysticercosis: impact on characterization of the scolex and lesion burden.

BACKGROUND AND PURPOSE: There are few studies comparing the capacity of lesion detection of conventional MR imaging in neurocysticercosis (NCC). This study was designed to clarify its role in the evaluation of this disease, focusing on the total number of lesions identified and the characterization of the scolex. MATERIALS AND METHODS: MR images from 115 patients were prospectively collected during a 3-year interval, including axial spin-echo (SE) T1-weighted; axial fast SE T2-weighted; axial fluid-attenuated inversion recovery (FLAIR); and gadolinium-enhanced axial, coronal, and sagittal SE T1-weighted sequences. They were compared regarding the potential for detection of NCC lesions and specifically of the scolex. RESULTS: Comparing all sequences, we found that FLAIR images were more sensitive to the detection of the scolex (P < .003), whereas the last gadolinium-enhanced T1-weighted series (coronal or sagittal) identified the highest number of lesions (P < .001). CONCLUSION: When dealing with NCC, optimal MR imaging protocols should include FLAIR images to obtain maximal rates of scolex detection. Special attention should be paid to the last gadolinium-enhanced sequence, which maximizes the quantification of lesion load.

Fatal meningoencephalitis caused by reactivation of Trypanosoma cruzi infection in a patient with AIDS.

We report a case of fatal chagasic meningoencephalitis in an AIDS patient. Acute exacerbation of chronic Chagas' disease with involvement of the CNS is uncommon and occurs only in immunocompromised patients. This is the third such reported reactivation and it underscores the importance of considering Chagas' disease in HIV-positive patients from endemic regions.

Pediatric multiple sclerosis report of 14 cases.

We present clinical data from 14 multiple sclerosis (MS) patients who have been admitted to our hospital between January 1980 and May 1992, whose age of onset ranged from 2-15 years. Our patients could be classified as having a clinically definite form of the disease. Initial symptoms varied from minor, such as motor or sensory impairment, bladder dysfunction, to the worst clinical presentation, suggesting diffuse encephalopathy. All the patients had a relapsing-remitting course. We report the paraclinical and laboratory examinations that were done in these patients. Over the period 1980 to 1992 these patients had 39 attacks. CSF analysis was performed in the phase of activity of the disease on 23 occasions and was normal in 12. At least one brain CT scan was performed in 9 patients and showed white matter abnormalities in 6. Cranial magnetic resonance imaging was done in 6 patients and were abnormal in 5. Visual evoked potential (EP) was abnormal in 7 of 8 patients; brainstem acoustic EP was abnormal in 4 of 8 patients and somatosensory EP in 4 of 8. MS is not so rare in childhood and although its diagnosis is essentially a clinical one, paraclinical investigations are of great value in the identification of demyelinating disorders in childhood.

[The cerebrospinal fluid and neurocysticercosis: evolutional aspects of the cellular inflammatory response]. / Líquido cefalorraqueano e neurocisticercose: aspectos evolutivos da resposta inflamatória celular.

In order to evaluate the cellular component of the inflammatory chronic response, 357 cerebrospinal fluid (CSF) samples from 40 patients with neurocysticercosis (NC) were studied. All patients were treated with usual doses of praziquantel (50 mg/kg/day during 21 days) associated with dexamethasone (12 mg/day). NC diagnosis has been performed considering three basic criteria: the clinical evaluation, the CSF examination, the computed tomography findings. A total of 13 samples from each case for a follow-up period of two years was scheduled. Total cell count, cytomorphologic profile, B and T cells, and T-active, T-sensitized and T-avid subpopulations were considered. T-cell receptor was studied by rosette-forming capacity with sheep red blood cells; normal values were previously characterized in a normal control group. Normal values were demonstrated for B and T-cell levels in the first CSF sample for all cases; no significant alterations occurred during two years evolution. Neutrophil cells, although influenced by previous CSF shunts, could show qualitative indication of improvement six months after treatment. T-active (median: 29.7; range: 8.1 to 59.8) and T-sensitized (median: 44.4; range: 16.0 to 67.0) lymphocyte subpopulations could show effective qualitative and quantitative indications of inflammatory improvement 12 to 15 months after treatment. Regression study as well as Kendall concordance tests were not significative for all components in all samples. This can demonstrate a particular significance and information content for each cellular component of inflammatory response in neurocysticercosis.

[Lymphocyte subpopulations in the cerebrospinal fluid: II. Technics]. / Subpopulações linfocitárias do líquido cefalorraqueano: II. Técnica.

In order to achieve a low dispersion and a high reproductibility of results in the determination of cerebrospinal fluid lymphocyte subpopulations a more accurated methodology is described, and some variants of technique are registered.

[Lymphocyte subpopulations in the cerebrospinal fluid: III. Normal values]. / Subpopulações linfocitárias do líquido cefalorraqueano: III. Valores normais.

For cerebrospinal fluid (CSF) samples from 50 subjects previously selected to represent suitably a normal control group and for a methodology that may be actually used for CSF samples even with normal cell count, it is possible to characterize lymphocyte subpopulations with normal statistical distribution and low dispersion of results for all lines considered. Data (mean +/- standard deviation) here estimated were (%): for B-lymphocyte subpopulation 7.0 +/- 1.44; for T lymphocyte subpopulation 76.0 +/- 2.92; for T-active lymphocytes 53.7 +/- 3.26; for T-avid lymphocytes 19.2 +/- 4.32 when all T subpopulation is considered, and 11.1 +/- 2.04 when only T-active subpopulation is studied; for T-sensitized or actually activated 22.3 +/- 3.95. These data may suggest that lymphocytes actually related to immunological activation will be properly represented by the difference between T-lymphocytes and its T-active line in each case. In every samples T and T-active lymphocytes are different subpopulations when surface receptor density is considered, by evidence of avidity for sheep erythrocytes. It is also possible that killer lymphocytes, or antibody mediated cytotoxic cells, may be related to modified lymphoid cells identified in the CSF normal cytomorphological profile.

[Lymphocyte subpopulations in the normal cerebrospinal fluid: I. Major reports in the literature]. / Subpopulações linfocitárias do líquido cefalorraqueano normal: I. Principais registros da literatura.

Data concerning the characterization of lymphocytes in the cerebrospinal fluid are reviewed, markedly those on T and B subpopulations. Special attention is given to T-lymphocyte subpopulations actually related to the immune response and to the immune regulation within the central nervous system.

Cysticercosis of the central nervous system and cerebrospinal fluid. Immunodiagnosis of 1573 patients in 63 years (1929-1992).

Attention given to prophylaxis of neurocysticercosis (NC) is far beyond minimal needs among several regions of the in-development world, and for this reason incidence of the disease persists high among them. This investigation was carried out to show the extent of the problem by analysing the incidence of NC in a region of Brazil (São Paulo). CSF immunodiagnosis of NC by detecting antibodies to Cysticercus cellulosae in a neurodiagnostics laboratory is evaluated for this purpose. Cases studied in a 63-year period (1929-1992) are reviewed. Total cases in this period is 139,000, and for 1,573 (1.13%) diagnosis is NC. Special characteristics were not detected for colour and sex prevalence. Age bracket prevalence is from 21 to 40 years old (55.3%) high rates occurring for women between 21 to 30 years old, and for men between 31 to 40. Cases distribution in five consecutive decades (1942-1991) shows no decreasing tendency: average incidence is 1% for the 50 years, and it is over this average for the last three decades. Data confirm that incidence continues expressively high throughout the 50 years covered by this study.

[Cerebrospinal fluid signalization in chronic inflammatory diseases of the central nervous system]. / Sinalização do líquido cefalorraqueano em doenças inflamatórias crônicas do sistema nervoso central.

Dynamics of cerebrospinal fluid (CSF) cyto-proteic dual obeys to different models when central nervous system (CNS) inflammatory diseases are considered. In order to evaluate these models data pertinent to multiple sclerosis (20 cases), neurosyphilis (20 cases), neurocysticercosis (20 cases), subacute sclerosing panencephalitis (20 cases), neuroschistosomiasis (18 cases) and neuro-cryptococcosis (20 cases) are compared in report to a control group: chronic vascular headache (50 cases). CSF data on cytology and proteins were considered. Cytology was evaluated as to the total cell count (cumm); the cytomorphological profile (%) and as to lymphocytes subpopulations (B, T, T-active, T-sensitized, and T-avid for T-total and for T-active). Proteins were evaluated as to the total content (mg/dl) and protein fractions (agar gel electrophoresis). Antibodies determinations were studied for comparative purposes and diagnosis. Results were analyzed according to the groups considered and comparatively. Analyses support conclusions on cells and proteins dual interaction. This interaction is expressed by phenomena that obey similar parameters. These parameters permit to consider two models of chronic inflammatory signalization: the continuous model and the repetitive model. Neurosyphilis and subacute sclerosing panencephalitis obey the chronic continuous inflammatory model. Neurocysticercosis and multiple sclerosis obey the repetitive model.

[Syndrome of calcifications of basal ganglia, leukodystrophy and chronic lymphomonocytic pleocytosis of the cerebrospinal fluid: report of a case]. / Síndrome de calcificações dos gânglios da base, leucodistrofia e pleocitose linfomonocitária crônica do líquido cefalorraqueano: registro de um caso.

Norman & Tingey (1966) reported a new syndrome of micrencephaly, strio-cerebellar calcifications and leucodystrophy and in 1968, Lyon & col. reported the same syndrome plus dwarfism. These authors did not describe cerebrospinal fluid (CSF) alterations. In 1984, Aicardi & Goutièrres described 8 children from 5 different families with a syndrome like above referred to but with chronic CSF lymphocytosis; all patients had a progressive evolution, with familial character, with probable autosomic recessive heritage. It is the purpose of this report to relate a case similar to Aicardi & Goutièrres' cases in a male caucasian patient of jewish ashkenazim origin with 6 and a half month of age, but with a study of CSF lymphocytes T and B. Diminished T-subpopulations of active and avid-T were found suggesting local signalization of antibodies in the central nervous system. The differential diagnosis and that strange combination of a probable genetic etiology and an immunitary process revealing a local inflammatory process are discussed.

Neurotoxoplasmosis and AIDS. Cerebrospinal fluid analysis in 96 patients.

The behavior of CSF inflammatory pattern in patients with AIDS and/or toxoplasmosis of the CNS is studied in 176 patients, divided in three groups. In the first group, 96 patients with toxoplasmosis and AIDS are considered; in the second group, 50 patients with toxoplasmosis without AIDS; in the third group, 30 AIDS patients without toxoplasmosis nor any other opportunistic infection. It is possible to conclude that patients with toxoplasmosis associated to AIDS exhibit CSF inflammatory pattern similar to patients with neurotoxoplasmosis without AIDS, except in respect to gamma globulin rates for which a cumulative effect can be detected.

[Trypanosoma cruzi antibodies in the cerebrospinal fluid: a search using complement fixation and immunofluorescence reactions]. / Anticorpos a trypanosoma cruzi no líquido cefalorraqueano: pesquisa pelas reações de fixação do complemento e de imunofluorescência.

Cerebrospinal fluid (CSF) samples of 200 patients who presented central nervous system (CNS) pathologies were evaluated for antibodies to Trypanosoma cruzi (T. cruzi). The evaluation was made through: complement fixation test (CFT) in 69 patients, indirect (IgG) immunofluorescence test (IFT) in 118, and by CFT and IFT in 13. In 50 cases the IFT has been made also in concentrated (20 X) CSF samples. Results were evaluated in report to CNS pathology, CSF cells and proteins, and tests in the CSF for other CNS infections (syphilis, cysticercosis, schistosomiasis, toxoplasmosis). These tests were based on techniques similar to those adopted for the search of antibodies to T. cruzi, and were conducted concomitantly to tests for T. cruzi in the same CSF sample for everyone of the cases. Antibodies to T. cruzi were found in three patients. The first was a patient committed by the acquired immunodeficiency syndrome (AIDS) in whom there occurred exacerbation of the acute stage of Chagas' disease. The second is a patient who is committed by epilepsy, and an acute stroke occurred in the third patient: Chagas' disease had been previously diagnosed in them through the demonstration of antibodies to T. cruzi in the blood serum.

[Cerebrospinal fluid abnormalities in 170 cases of AIDS]. / Anormalidades do líquido cefalorraqueano em 170 casos de AIDS.

Cerebrospinal fluid (CSF) was analysed in 170 AIDS patients. All of them showed HIV positive serological tests. All of them showed neurologic syndromes related to AIDS. The time period of the investigation was July 1984-April 1989. In 8 cases (4.7%) CSF composition was normal. Lymphoma cells were observed in three cases. Aseptic meningities occurred in 34 cases (20.1%). Aetiological diagnosis of associated infection was established in 88 cases: cryptococcosis in 28 (35.9%); toxoplasmosis in 20 (25.6%); syphilis in 10; candidiasis in 3; Chagas disease in 2; tuberculosis in 1; nocardiosis in 1; schistosomiasis in 1. Antibodies for other virus were detected in 7. Bacteria were isolated in 5 cases. Anti-HIV antibodies were tested in CSF samples of 55 cases: they were found in 48 (87.3%). Two or more associated infections were observed in 15 cases. Changes of CSF composition in AIDS are discussed taking into account changes reported.

[Cerebrospinal fluid eosinophils in inflammatory processes of the central nervous system and its coverings]. / Eosinofilorraquia em processos inflamatórios do sistema nervoso central e seus envoltórios.

Eosinophil cells play an important role in the signalization of cerebrospinal fluid (CSF) by inflammatory diseases of central nervous system and its leptomeningeal coverings (CNS), according to present data on neuroimmunology. The extent of their participation in local immunological phenomena is evaluated, and data on other changes in the CSF cytoprotein dual were considered for comparative purposes. CSF of two types of inflammatory diseases of the CNS were studied for this purpose: samples of 35 patients in early stages of acute eosinophilic leptomeningites possibly of viral origin (first group) and 20 samples of 10 patients with neurocysticercosis (second group). Samples of the second group were collected in the early stages of each one of two episodes of exhacerbation in the inflammatory reaction observed at each one of the two series of administration of Praziquantel, a pirazino-isochinoleinic derivate which action upon cysticerci has been reported. Statistical analysis shows that participation of eosinophil cells in the inflammatory response does not differ in the two groups. Their participation is related to changes observed in the CSF cytoprotein dual rather than to the type of the inflammatory model: acute and monophasic in the first group, and chronic an repetitive in the second. Gamma globulins participe in the exhacerbation of CSF inflammatory reaction in neurocysticercosis but their behaviour not always is similar. In some instances it is similar to that found in other chronic and repetitive inflammatory models, as multiple sclerosis for instance.

[Demyelinating diseases and the cerebrospinal fluid cytoproteinogram]. / Afecções desmielinizantes e citoproteinograma do líquido cefalorraqueano.

Neuromyelitis of cyanocobalamin deficiency (group 1) post vaccination myelopathy (group 2), multiple sclerosis and neuromyelitis optica (group 3) are studied comparatively as to the respective cerebrospinal fluid changes on cytology, proteins and gamma globulins. Changes were found to be more intense and frequent in the last two groups. Local immunecompetent phenomena are considered in the interpretation of findings and related to modifications that may be induced in myelin macromolecules by factors of diverse order which may be involved in demyelination in each one of the three groups.

[Meningomyeloradiculopathy in schistosomiasis mansoni. Clinical and cerebrospinal fluid evaluation in 16 cases]. / Meningomielorradiculopatia na esquistossomose mansônica. Avaliação clínica e do líquido cefalorraqueano fm 16 casos.

Data on 16 patients with spinal cord involvement by Schistosomiasis mansoni are evaluated as to the clinical course and the evolution of cerebrospinal fluid changes. According to evidences of radicular involvement cases were divided in two groups: myelitis (9 cases) and radiculomyelitis (7 cases). Cerebrospinal fluid changes were evaluated as to cytology, total protein content and gammaglobulins. Partial remission of clinical symptomatology was more common among patients of the second group than among those of the first group. There was not relationship of CSF changes and their course with the clinical course of the disease. Cerebrospinal fluid changes and their course were not related to clinical aspects of the disease and their course. Remission of hypercytosis was more common than the remission of protein changes along the evolution in the two groups of cases considered.

[Histoplasmosis of the central nervous system. Clinical aspects in 8 patients]. / Histoplasmose do sistema nervoso central. Aspectos clínicos em oito pacientes.

Clinical approach has been made in eight patients with histoplasmosis of the central nervous system. All patients had no evidence of immunodepression. Time disease at diagnosis ranged from 6 to 108 months (median 36 months). Main signs and symptoms were: intracranial hypertension in 6 patients; impairment of memory in 4; confusion in 4; seizures in 2; urinary incontinence in 2; sexual impotency in 1. Meningo-encephalitic form was present in 6 patients, while the granulomatous form was found in 2. Diagnostic confirmation was based on: biopsy, in 1 case; necropsy, in 2 cases; cerebrospinal fluid (CSF) sediment culture, in 1; detection of antibodies against Histoplasma capsulatum in the CSF, in 5 cases. There was, in all patients, an expressive difference between CSF alterations (intense, merging acute and chronic phase elements) and clinical symptomatology (patients in general oligosymptomatic).

[Histoplasmosis of the central nervous system: study of cerebrospinal fluid in 8 patients]. / Histoplasmose do sistema nervoso central. Estudo do líquido cefalorraqueano em 8 pacientes.

One hundred and thirteen samples of CSF from eight patients with chronic meningitis were studied in a 12 years period (September, 1980-August, 1992). None of them had AIDS. In all, CNS histoplasmosis diagnosis was made by CSF examination. All cases tested positive for antibodies to Histoplasma capsulatum in CSF; in one case the yeast grew in Sabouraud culture in three different occasions. The main findings in CSF by the time of the diagnosis were: moderate hypercytosis marked by lymphocytes and monocytes, neutrophils-being present and in some cases eosinophil cells; moderate increase of total proteins content; decrease in the glucose content; and moderate increase of gamma globulins sometimes with oligoclonal reaction. Patients were followed-up from 7 to 102 months, and periodically submitted to CSF examinations according to clinics. Cell number and total protein content of CSF showed marked episodes of exacerbation in the follow-up, with a dissociated profile favoring total protein content which got higher with the chronification of the disease. Changes in the CSF pattern with treatment were: rapid decrease of hypercytosis; disappearence of neutrophil and eosinophil cells; increase in glucose content; and slow reduction of the increased contents of total proteins and gamma globulins.

AIDS. A CSF laboratory experience on 470 cases in a 7 year time period.

In a seven year time period (July 1984 to June 1991) were studied CSF samples of 36,216 new patients, 470 of them infected by HIV. Number of AIDS patients represents 1.30% of total cases examined in the laboratory during this time period. Normal CSF was observed in only 16 cases (3.4%). Associated pathologies occurred in 66% of cases. Opportunistic infections predominated among them (227 cases). Data support indication for CSF examination in HIV infected patients. This exam must be as complete as possible.