Sensory Neuropathy in Parkinson Disease: Electrodiagnostic Evaluation.

The relationship between Parkinson Disease (PD) and peripheral neuropathy (PN) has gained attention in recent years. There is increasing evidence of a-synuclein deposition and pointing to a form of small fiber neuropathy intrinsic to PD, medium-large fiber PN is also a relatively frequent and potentially severe complication in advanced levodopa-treated PD, but degenerative factors and vitamin deficiency were related. Objective: To determine the neurophysiological characteristics of patients with PD and the clinical manifestations of suspected PN. Methods: We performed a cross-sectional study between January 2014 and December 2017, of 36 patients diagnosed with PD who were referred for electrodiagnostic studies (EDX) with suspected clinical PN. We performed electromyography of five muscle or more (brachial biceps, first dorsal interosseous, thumb abductor, anterior tibial, medial gastrocnemius and short finger extensor), and nerve conduction/velocity studies on fibular and tibial nerves (motor) sural and superficial fibular nerves (sensory) and median and ulnar, (both motor and sensory). Results: Twenty-one females (58.3%) with an average age of 69.6 years and fifteen males (41.7%) with an average age of 68.0 years who were submitted for EDX were included in this study. All had a tremor and the average evolution of PD was 5 years. Thirty-two patients were receiving oral levodopa treatment. EDX of twenty-two patients demonstrated neuropathy abnormalities, and in 90.9% of these patients, sensory neuropathy was confirmed. The most common nerve found to be compromised was the superficial fibular nerve (55.0%), followed by the sural (50.0%). Conclusions: Sensory neuropathy was the main finding. Diagnosing PN based on symptom prevalence assessed by checklists and questionnaire has a risk of overestimating the prevalence of PN. The age and the time of disease evolution were factors related to neuropathy. In our study we found that 39% of the patients did not have neuropathic alterations despite clinical suspicion, which opens up new questions about the mechanisms of PD neuropathy and the possibility of fine fiber neuropathy in these patients, motivating further research.

In-Hospital Mortality From Cerebrovascular Disease.

Introduction Cerebrovascular disease (CVD) is the second most common cause of death. Despite the advances made in recent years with the introduction of specific treatment units and thrombolytics, CVD remains the leading cause of neurological hospitalization and adult disability. Objective Our objective is to determine the frequency and causes of early mortality, during hospitalization, of patients with acute CVD. Methods We conducted a retrospective, descriptive study of 704 patients treated for acute CVD at the Neurology Service of the Hospital in Curitiba, Brazil, over a period of three years, to whom the CVD Program protocol was applied. We checked the conditions at hospital discharge, obtaining the mortality rate and its causes. Results We studied 463 men and 241 women, over 14 years of age with an average of 64 years; 57 patients died. Of the 614 with ischemic CVD, nine males and four females died, establishing a mortality rate of 1.9%. Of the 90 patients with hemorrhagic CVD, 44 died: 26 male and 18 female. The main causes of death were arrhythmias, pneumonia with acute respiratory failure, acute myocardial infarction, and multiple organ failure. Conclusion We found no relationship between mortality and specific risk factors, except for age over 65 years. The low rate of deaths obtained in ischemic stroke reflects the multidisciplinary work involved in caring for patients with cerebrovascular disease in our center, which allows us to obtain results as low in mortality as those described in the literature.

Chorea as the First Manifestation of Cerebral Infarction.

Cerebrovascular disease (CVD), which usually manifests as a focal neurological deficit, is presented here as a movement disorder. This unusual manifestation corresponds to 1% of the CVDs and 8% of the striatal lesions. We report a 37-year-old right-handed woman who developed choreic movements as the first manifestation of an acute stroke. The computed tomography (CT) scan revealed a cortical/subcortical hypodense lesion in the right middle cerebral artery territory. This picture slowly improved and remitted completely after six weeks. Basal ganglia infarcts are crucial for the development of hemichorea, however, in spite of its frequency, movement disorders are disproportionally rare. In the majority of cases, the prognosis is good with spontaneous remission after two to four weeks.

Multiphasic acute disseminated encephalomyelitis and differential with early onset multiple sclerosis.

Multiple sclerosis is considered the most frequent demyelinating disorder of the Central Nervous System (CNS) among young adults, yet is very rare before 10 years old. Acute disseminated encephalomyelitis is a monophasic, polysymptomatic disorder that involves the CNS white matter with demyelinating lesions, which usually occurs after systemic viral infections. These two demyelinating diseases can present initially as an acute focal neurological syndrome and they can be difficult to distinguish. We describe a case of a nine-year-old girl that presented initially with dysphonia, gait ataxia, eyelid myokymia and brainstem disturbances. This was her second episode; the first episode was at the age of four years old. She recovered without neurological sequelae. The brain magnetic resonance imaging (MRI) demonstrated multiple demyelinating lesions in the white matter, cortical regions of the frontal lobe, periventricular distribution, internal capsule, corpus callosum and cerebellum. The purpose of the presentation of this case was to highlight the similarities between these two entities, since the clinical picture and neuroimaging are difficult to distinguish, mainly in relation to the first episode.

Myasthenia Gravis with Elderly Onset at Advanced Age.

Myasthenia gravis (MG) in older adults has not been extensively studied. The prevalence of this disease in older people seems to be higher in recent epidemiological studies. In patients with disease onset after the age of 70, the diagnosis is more difficult as other conditions are more easily taken to be the causal element. The mortality is higher than in young patients, so prompt specific treatment can improve prognosis. We present an 85-year-old female patient with speech disturbance and difficulty in swallowing solids, and neurological examination with palpebral ptosis, disphonia, convergent strabismus and weakness and mild progressive fatigue in arms, with electroneuromyography and acetylcholine receptor antibody who was diagnosed with MG, emphasizing the importance of this entity in geriatric patients.

Amantadina: droga coadjuvante no tratamento das crises epilepticas refratarias? / Amantadine: a coadjuvant drug in the treatment of patients with refractory epilepsy?

Pelo fato de existir um grupo significativo de pacientes epilepticos de dificil controle medicamentoso e nao candidatos a neurocirurgia, muitos estudos experimentais e ensaios clinicos tem sido dirigidos a pesquisa de drogas ja vigentes em tratamento clinico que nao em epilepsias com finalidade de utilizar estas como drogas coadjuvantes. Objetivo: Levantar possibilidades para investigacoes clinicas futuras quanto ao uso de Amantadina como uma droga coadjuvante no tratamento de alguns tipos de epilepsias de dificil controle.

Historia de las epilepsias: apuntes historicos cubanos / History of the epilepsy: annotation of cuban history

Se presentam los hechos más significativos en el reconocimiento de la epilepsia y sus menifestaciones, desde las antiguas culturas faraónicas (más alliá de 3000 año ANE) hasta los principios de siglo actual. Señalando los hitos más importantes y sus autores en el camino histórico del conocimiento sobre esta enfermedad. Se refiere el acontecer histórico en el campo de las epilepsias en nuestro país a partir de la primera revista médica cubana en 1862 hasta nuestro días, señalando los hechos más relevantes (AU)

Historia de las epilepsias: apuntes historicos cubanos / History of the epilepsy: annotation of cuban history

Se presentam los hechos más significativos en el reconocimiento de la epilepsia y sus menifestaciones, desde las antiguas culturas faraónicas (más alliá de 3000 año ANE) hasta los principios de siglo actual. Señalando los hitos más importantes y sus autores en el camino histórico del conocimiento sobre esta enfermedad. Se refiere el acontecer histórico en el campo de las epilepsias en nuestro país a partir de la primera revista médica cubana en 1862 hasta nuestro días, señalando los hechos más relevantes