SummaryObjective. To report on 9 patients presenting with sporadic motor neuron disease , who over a long period of time evolved with a symmetrical proximal brachial amyotrophic diplegia. methOdS. Nine patients were followed-up who , displayed, since onset, a progressive limitation of arm flexion/abduction resulting in a peculiar posture with both hands hanging loosely beside the trunk. Electrophysiological test results were consistent with lower motor neuron disease. Cervical MRI was performed in all patients. reSultS. Nine male subjects with ages ranging from 38 to 73 years at onset of symptoms, developed bilateral and symmetric paresis and atrophy of upper limb muscles. Proximal muscles were more involved than the distal groups. In most patients tendon reflexes were absent or hypoactive in the upper limbs. Needle electromyography (EMG) revealed positive sharp waves and fibrillations and high amplitude polyphasic potentials with an incomplete recruitment pattern in most upper limb muscles. EMG of lower limb muscles was normal in some cases while abnormal in others. MRC did not disclose cervical spinal cord abnormalities from C5-T1. cOncluSiOn. Attention is called to the Man-in-the-Barrel syndrome in some motor neuron diseases, especially in patients with progressive spinal atrophy and amyotrophic lateral sclerosis Key words: motor neuron diseases. man-in-the-Barrel Syndrome. Brachial amyotrophic diplegia. Progressive spinal atrophy. Amyotrophic lateral sclerosis.
Cryptococcal Meningitis (CM) is a rare infection in immunocompetent patients. A kind of central nervous system infection caused by encapsulated yeast-like fungus Cryptococcus neoformans. A 59-year-old man presented to the Neurology Department of Nova Iguacu General Hospital, complaining has felt "muddled" recently and feeling diaphragmatic spasm without any apparent cause. In addition, at neurological examination, the patient was slightly confused and during the mini-mental state examination he scored less than 20 points, feeling "slowed down", no cranial nerve dysfunction, "rigidity of gait as well as of hand movements, more pronounced on the right one, pyramidal signs bilaterally were more intensely noted on the left". His MRI, lumbar puncture, fungal isolation and Nakin Ink were positive to Cryptococcosis while, in turn, HIV tests I and II were both negative. The treatment was started with Amphotericin B 50 mg IV, once a day, plus Dexamethashone. From our clinical case, we decided to do a brief review about Cryptococcoal Meningitis in immunocompetents and Cryptococcoma, researching at MedLine and Pubmed, using terms "Cryptococcal meningitis", "Cryptococcal meningitis in immunocompetent" and "Cryptococcomas". It is concluded that CM in immunocompetents is uncommon, but an important cause of non-acute meningitis, that should be included in the range of causes of preventable blindness. In this sense, this article purposes advertise clinicians and specialists, to recognize the clinical manifestation and diagnosis of cryptococcal meningitis in immunocompetents, trying to avoid a later diagnosis and the following complications.
Há um número crescente de pacientes submetidos à hemodiálise no Brasil, muitos destes se queixam de cefaléia durante as sessões. A perda de cafeína consequente ao procedimento dialítico, pode ser um dos fatores desencadeadores da cefaléia. Objetivo. O objetivo deste trabalho é relatar o caso de um paciente que apresenta cefaléia durante as sessões de hemodiálise, que respondeu a reposição de cafeína. Relato de caso. PFM, 36 anos, feminino, branca, natural do Rio de Janeiro, com história de hidrocefalia, sendo submetida a derivação ventrículo peritoneal (DVP), apresentou glomerulonefrites recorrentes com evolução para insuficiência renal crônica iniciando tratamento com hemodiálise há aproximadamente 2 anos. Apresentou quadro de cefaléia na segunda metade das sessões de hemodiálise com melhora do quadro clínico após o uso de cafeína. Discussão. Segundo a Sociedade Internacional de Cefaléia (IHS) durante a diálise ocorre depuração de várias substâncias, sendo uma das responsáveis pela cefaléia a depuração da cafeína sérica levando à crises de enxaqueca. Conclusão. O uso profilático de cafeína antes das sessões pode reduzir a ocorrência de cefaléia durante a diálise.
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