-This case report describes the findings of a 45-year-old white woman from Brazil, who developed myalgia, fever and macular rash. She was diagnosed as having dengue, based on clinical manifestations and specific IgM titers. One week after the first symptoms of dengue, the patient developed muscle weakness, followed by tetraplegia with areflexia, and respiratory insufficiency. The electromyography had evidence of demyelinating neuropathy and the cerebrospinal fluid showed albuminocytologic dissociation. These neurologic findings were consistent with the diagnosis of Guillain-Barré syndrome. The patient was treated with immunoglobulin and metylprednisolone. Mechanical ventilation was started one week after hospital admission and maintained for four weeks. After six weeks of hospitalization the patient was discharged from the hospital on wheel chair, presenting mild muscle weakness and loss of patellar and ankle reflexes. When the patient was seen at the outpatient service three weeks after hospital discharge she was able to walk with help. This case report suggests a possible association between dengue and Guillain-Barré syndrome.KEY WORDS: Guillain-Barré syndrome, dengue, radiculoneuritis. Síndrome de Guillain-Barré no curso de dengue: relato de casoRESUMO -Este relato de caso descreve os achados de uma mulher de 45 anos, branca, que desenvolveu mialgia, febre e eritema macular. Ela recebeu o diagnóstico de dengue, tomando por base os achados clíni-cos e títulos específicos de IgM. Uma semana depois do início dos primeiros sintomas de dengue, a paciente desenvolveu fraqueza muscular, tetraplegia e insuficiência respiratória. A eletromiografia mostrou evidên-cia de uma neuropatia desmielinizante e o liquor apresentou quadro de dissociação albuminocitológica. Os achados neurológicos foram consistentes com o diagnóstico de síndrome de Guillain-Barré. A paciente foi tratada com imunoglobulina e metilprednisolona. Ventilação mecânica foi iniciada uma semana após a admissão hospitalar, sendo mantida por quatro semanas. Após seis semanas de internamento a paciente teve alta em cadeira de rodas, apresentando fraqueza muscular e perda dos reflexos patelar e aquileu. Quando a paciente foi vista no ambulatório, três semanas após a alta hospitalar, ela já era capaz de andar com ajuda do acompanhante. Este relato de caso sugere uma possível associação entre dengue e síndrome de Guillain-Barré. PALAVRAS-CHAVE: síndrome de Guillain-Barré, dengue, radiculoneurite.

This study suggests that epilepsy and epileptic seizures in the elderly inpatients have etiological association with stroke, neoplasias and dementias.

People with epilepsy and epileptic seizures are at an increased risk of dying when compared to the general population mostly in special groups such as those with acute symptomatic seizures or status epilepticus (SE). Patients over 75 years have higher incidence of acute symptomatic seizures, epilepsy and SE compared to other age groups 1 . Acute symptomatic seizures represent 40% of all seizures and 50%-70% of SE and are more commonly seen at extreme ages, with the highest incidence rates seen in children below 1 year of age and adults 60 years and above 2,3 .Notwithstanding its high incidence, epilepsy in old-aged people often goes unrecognized and neglected. In contrast, the prevalence is relatively low possibly because of the increased mortality rates for old-aged people due to its etiology 4 . Studies reported that neurological disorders such as cerebrovascular disease and neoplasias, contribute to excess mortality in patients with epilepsy 5 . Studies on mortality in epilepsy have been reported from a few developed countries. In high-income countries, the mortality rate in elders with epilepsy is two to three times higher than in the general population, and the highest excess mortality is ABSTRACT Epilepsy and epileptic seizures are common brain disorders in the elderly and are associated with increased mortality that may be ascribed to the underlying disease or epilepsy-related causes. Objective: To describe mortality predictors of epilepsy and epileptic seizures in elderly inpatients. Method: Retrospective analysis was performed on hospitalized elderly who had epilepsy or epileptic seizures, from January 2009 to December 2010. One hundred and twenty patients were enrolled. Results: The most common etiology was ischemic stroke (37%), followed by neoplasias (13%), hemorrhagic stroke (12%), dementias (11.4%) and metabolic disturbances (5.5%). In a univariate analysis, disease duration (p = 0.04), status epilepticus (p < 0.001) and metabolic etiology (p = 0.005) were associated with mortality. However after adjustment by logistic regression, only status epilepticus remained an independent predictor of death (odds ratio = 13; 95%CI = 2.3 to 72; p = 0.004). Conclusion: In this study status epilepticus was an independent risk factor for death during hospitalization.Keywords: elderly, epilepsy, epileptic seizures, mortality, status epilepticus. RESUMOEpilepsia e crises epilépticas são transtornos cerebrais comuns em idosos e estão associadas com uma taxa de mortalidade elevada que pode ser atribuída à etiologia ou a causas relacionadas à epilepsia. Objetivo: Descrever preditores de mortalidade em pacientes idosos internados com epilepsia e crise epiléptica. Método: Estudo retrospectivo, envolvendo idosos hospitalizados, de 60 anos ou mais, que foram admitidos de janeiro de 2009 a dezembro de 2010 por terem apresentado epilepsia e crises epilépticas durante a hospitalização. Cento e vinte pacientes foram incluídos no estudo. Resultados: A etiologia mais comum foi o acidente vascular cerebral isquêmico (37%), segu...

The aim of the study was to review the epidemiology, clinical profile and discuss the etiology, prognosis and treatment options in patients aged 60 years or older presenting with status epilepticus. We performed a systematic review involving studies published from 1996 to 2010, in Medline/PubMed, Scientific Electronic Library on line (Scielo), Latin-American and Caribbean Center of Health Sciences Information (Lilacs) databases and textbooks. Related articles published before 1996, when relevant for discussing epilepsy in older people, were also included. Several population studies had shown an increased incidence of status epilepticus after the age of 60 years. Status epilepticus is a medical and neurological emergency that is associated with high morbidity and mortality, and is a major concern in the elderly compared to the general population. Prompt diagnosis and effective treatment of convulsive status epilepticus are crucial to avoid brain injury and reduce the fatality rate in this age group.

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-Objectives: To describe the clinical and CSF findings among patients with presumptive neuroschistosomiasis (NS) and to suggest a classification for the CSF diagnosis of presumptive NS. Method: The charts of all patients whose CSF exam was performed at the CSF Lab, José Silveira Foundation, Salvador, Brazil, from 1988 Aspectos clínicos e liquóricos e critérios para o diagnóstico liquórico de esquistossomose medular Aspectos clínicos e liquóricos e critérios para o diagnóstico liquórico de esquistossomose medular Aspectos clínicos e liquóricos e critérios para o diagnóstico liquórico de esquistossomose medular Aspectos clínicos e liquóricos e critérios para o diagnóstico liquórico de esquistossomose medular Aspectos clínicos e liquóricos e critérios para o diagnóstico liquórico de esquistossomose medular RESUMO -Objetivos: descrever aspectos clínicos e liquóricos de pacientes com diagnóstico presuntivo de neuroesquistossomose (NE) e sugerir uma classificação para o diagnóstico liquórico presuntivo da NE. Método: as fichas de todos os pacientes cujo exame de líquor (LCR) foi realizado no Laboratório de Líquor, Fundação José Silveira, Salvador, Brazil, entre 1988 e 2002, foram revistas. Aqueles com suspeita clínica de NE e teste de imunofluorescência indireta (IFI) e ou inibição da hemaglutinação (IHA) positivos para S. mansoni foram identificados. Resultados: dos 377 pacientes, 67,9% eram do sexo masculino, a mediana da idade foi 36 anos (média 37 + 16 anos, variação 3-82 anos). As queixas mais freqüentes foram paraparesia (59,9%), retenção urinária (36,2%), dor em membros inferiores (22,8%). A celularidade do LCR (células/mm 3 ) foi > 4 em 66,0% (média 83 + 124, mediana 40, variação 4,3 -1.100), a proteína (mg/dl) foi > 40 em 84,6% (média 185 + 519, mediana 81, variação 41-6.800) e eosinófilos estavam presentes em 46,9%. IFI e IHA foram positivas em 75,3%. Celularidade > 4 e presença de eosinófilos estiveram associadas com IFI e IHA positivas (67,3% versus 51,4%, p 0,014; 49,1% versus 23,0%, p 0,0001, respectivamente) e proteína > 40 não foi (85,4% versus 77,0%, p 0,09). Celularidade > 4, proteína > 40 e eosinófilos estiveram associados com IFI e IHA positivos (71,6% versus 38,2%, p 0,0003) mas a presença de eosinófilos e qualquer outra combinação de celularidade e proteína não estiveram. Conclusão: NE deve ser considerada uma possibilidade diagnóstica em pacientes que tiveram epidemiologia positiva para S. mansoni e desenvolveram uma mielopatia. A presença de IFI e IHA positivos para S. mansoni, celularidade > 4, proteína > 40 e presença de eosinófilos no líquor pode ser considerado critério de alta probabilidade para o diagnóstico presuntivo da NE. PALAVRAS-CHAVE: neuroesquistossomose, líquor, diagnóstico liquórico, mielite, mielorradiculite, Schistosoma mansoni.This investigation was conducted at the CSF Lab -José Silveira Foundation,

SUMMARY -Magneti c resonanc e imagin g o f th e brai n an d spina l cor d wer e carrie d ou t fo r seventeen consecutiv e patient s wit h HTLV-1 associate d myelopath y (HAM) . Eigh t patient s The presen t stud y wa s designe d t o establis h th e type s o f MR I lesion s i n patients wit h HAM . METHODSThe subject s o f th e presen t stud y wer e 1 7 consecutiv e patient s wh o hav e bee n see n i n a hospital whic h assis t th e lowe r socioeconomi c clas s i n Salvador .

BackgroundThe burden of neurological disorders (NDs) in older adult inpatients is often underestimated. We studied diagnostic frequency and comorbidity of NDs among inpatients aged ≥60 years. We compared rates of hospital mortality, length of stay (LOS), and readmission with younger patient counterparts (aged 18–59 years) and older adult non-neurological patients.MethodsThis was a retrospective cross-sectional study of inpatients in a tertiary care center in Brazil. We compiled data for all patients admitted between 1 January 2009 and 31 December 2010, and selected those aged ≥18 years for inclusion in the study. We collected data for inpatients under care of a clinical neurologist who were discharged with primary diagnoses of NDs or underlying acute clinical disorders, and data for complications in clinical or surgical inpatients. Patients who remained hospitalized for more than 9 days were categorized as having long LOS.ResultsOlder adult inpatients with NDs (n = 798) represented 56% of all neurological inpatients aged ≥18 years (n = 1430), and 14% of all geriatric inpatients (n = 5587). The mean age of older adult inpatients was 75 ± 9.1 years. Women represented 55% of participants. The most common NDs were cerebrovascular diseases (51%), although multimorbidity was observed. Hospital mortality rate was 18% (95% confidence interval [CI], 15–21) and readmission rate was 31% (95% CI, 28–35), with 40% of patients readmitted 1.8 ± 1.5 times. The long LOS rate was 51% and the median LOS was 9 days (interquartile interval, 1–20 days). In younger inpatients mortality rate was 1.4%, readmission rate was 34%, and long LOS rate was 14%. In older adult non-neurological inpatients, mortality rate was 22%, readmission rate was 49%, and long LOS rate was 30%.ConclusionsOlder adult neurological inpatients had the highest long LOS rate of all patient groups, and a higher mortality rate than neurological patients aged 18–59 years. Readmissions were high in all groups studied, particularly among older adult non-neurological inpatients. Improved structures and concerted efforts are required in hospitals in Brazil to reduce burden of NDs in older adult patients.