Background:A possible strategy to reduce fatality rates of visceral leishmaniasis is to identify prognostic factors that can be easily assessed and used as an aid to clinical decision-making. Patients and Methods: A case-control study was developed in Teresina, Brazil, in which cases were patients who died during treatment (n = 12) and controls (n = 78) comprised a random sample of patients who were alive when treatment was finished. Results: Variables significantly associated with death were severe anemia, fever for more than 60 days, diarrhea and jaundice. The prognostic system had a sensitivity of 85.7% and a specificity of 92.5%. Conclusion: The prognostic model developed in this study had satisfactory performance and might be useful in developing countries, since it is simple and inexpensive. However, it is still preliminary and needs to be improved and validated using larger and more recent samples.

-Wicket spikes (WS) are a benign eletroencephalogram (EEG) variant, seen mainly in adults, during somnolence, in the temporal regions, in many clinical situations. WS can appear in trains or isolatedly, sometimes being difficult to differentiate from epileptiform activity. We reviewed 2,000 EEG's, found 65 with WS (3.25%) and compared them with 65 normal EEG without WS. There was statistically significant (SS) association between WS and age over 33; adolescent age was correlated to absence of WS and age over 65, to the presence of WS; there was an inverse correlation between WS and epilepsy, related to differences in age; a SS association with cerebrovascular disorders disappeared after controlling for age; a SS correlation with headache was also related to age; female predominance was not SS. There was a great variety of clinical situation associated with WS. We conclude that WS are a inespecific normal variant of the EEG that is age-related.KEY WORDS: Wicket spikes, benign variants, eletrotroencephalogram. "Wicket spikes": estudo de variante eletrográfica benignaRESUMO -As Wicket spikes (WS) são um padrão benigno, variante da normalidade do eletrencefalograma (EEG), vistas principalmente em adultos, durante a sonolência, nas regiões temporais, em situações clínicas variadas. WS aparecem em "trens" ou isoladamente, podendo ser difícil diferenciá-las de atividade epileptiforme. Nós revisamos 2.000 EEG e encontramos 65 com WS (3,25%) e os comparamos a 65 EEG 's normais sem WS. Encontramos associação estatisticamente significante (ES) entre WS e idade acima de 33 anos; adolescência e ausência de WS e idade acima de 65 e presença de WS. Houve correlação inversa entre WS e epilepsia, explicada por diferenças nas médias de idade. A correlação ES entre WS e doença cerebrovascular desapareceu após controlarmos a idade. A correlação ES a cefaléia dependeu de sua relação à idade. A predominância do sexo feminino não foi ES. Houve maior variedade de situações clínicas associadas a WS. WS são uma variante normal do EEG, idade-relacionada.

Severe hypoglycemia may occur as a complication of insulin therapy or as a consequence of accidental or suicidal insulin injections 1 . It may result in a variety of neurological symptoms such as focal deficits, epileptic crisis, coma state and death. There is a relative rarity of reports about hypoglycemic-induced brain lesions 2 . In newborns, the parieto-occipital region is the most affected 3 . In adults, there is a greater variability, with reports of lesions in basal ganglia, hippocampus, temporal and occipital gray matter, insula cortex, corona radiata and splenium of the corpus callosum 1,4 .The aim of this study is to report the case of a patient presenting coma, with left hemiparesis and brain lesions detected by computerized tomography scan (CT) and conventional magnetic resonance imaging (MRI). He had insulin-dependent diabetes mellitus and had a record of severe hypoglycemic episode. CASEA 31-year-old male, insulin-dependent diabetic patient, which left his home after a family brawl, at about 8 o'clock p.m when he had a capillary glycemia, which resulted 212 mg%. He was met unconscious in the morning by his wife at a car, near their home, with many empty flasks and syringes of insulin. The last register of glycaemia in the dosimeter was 34 mg%, at about 3 o' clock a.m.He was taken to the hospital by the urgency medical care service. On admission, he showed stable vital signs and capillary glycemia of 82 mg%. On neurological examination, the patient was comatose and with left hemiparesis. He was submitted to orotracheal intubation, mechanical ventilation and supportive care. A cerebral computerized tomography (CT) scan showed a slight parietal high-density area and MRI (Figure) showed cortical lesions with hypointensity and hyperintensity in T1-and T2-weighted images, respectively, affecting the insula bilaterally, but more evident on the right side, the hippocampus (more accentuated on the right side), the medial part of frontal lobe, bilaterally but more accentuated on the right side, and the parietal lobe, almost exclusively on the right side.

We describe a sixteen years old male patient that suffered a craniocerebral trauma and presented at the emergency room, with ocular pain, palpebral hematoma and left eye proptosis. Orbital computed tomography showed left subperiosteal orbital hematoma. A surgical drainage was performed. Subperiosteal hematoma of the orbit is a rare cause of proptosis; its early diagnosis must be made in order to avoid possible complications.

-We reviewed the laboratorycards of 200 analysis of cerebrospinal fluid (CSF) performed to evaluate acute alterations of consciousness in adult patients attended in a neurological emergency room. 61% were men; the mean age was 46 years. The most common clinical data were infective and neurologic. The CSF was abnormal in 149 (74.5%) patients and the most common syndromes were: compressive (21%), hemorrhagic (11.5%), "viral" (8.5%), septic (7.5%), moderate hyperglycorrachia (6.5%), hydroelectrolytic disturbances (5.5%). There were some statistically significant correlations between CSF syndromes and clinical data: septic syndrome and fever and meningeal signs, hemorrhagic syndrome and headache and meningeal signs, CSF hydroelectrolytic disturbance syndrome and seizures, severe hyperproteinorrachia and headache, fever, meningeal signs and vomiting, moderate hyperproteinorrachia and age over 65 and male sex. We classified the abnormal results in two groups: 1 -sufficient for an immediate clinical decision; 2 -nonspecific. The former group was found in 27.5% of the patients and in 36.9% of the abnormal CSF results. In patients attending to neurologic emergency rooms with acute alterations of consciousness, the examination of the CSF frequently could contribute to an etiologic diagnosis. It must be performed after a rigorous clinical evaluation of the patient.KEY WORDS: cerebrospinal fluid, consciousness, emergency room. Síndromes liquóricas em pacientes com comprometimento agudo da consciênciaRESUMO -Nós revisamos os registros de 200 exames de líquido cefalorraquidiano (LCR) realizados para avaliar alterações agudas da consciência em pacientes adultos atendidos em um pronto-socorro neurológico. 61% eram homens e a idade média era 46 anos. Os dados clínicos mais comuns foram infecciosos e neurológicos. O LCR foi anormal em 149 (74,5%) pacientes e as síndromes mais comuns foram: compressiva (21%), hemorrágica (11,5%), "viral" (8,5%), séptica (7,5%), hiperglicorraquia moderada (6,5%), distúrbio hidro-eletrolítico (5,5%). Nós classificamos os resultados anormais em dois grupos: 1 -suficientes para uma decisão clínica imediata; 2 -inespecíficos. O primeiro grupo foi encontrado em 27,5% dos pacientes e em 36,9% dos resultados anormais. Houve algumas correlações estatisticamente significantes entre dados clínicos e síndromes liquóricas: síndrome séptica e febre e sinais meníngeos, síndrome hemorrágica e cefaléia e sinais meníngeos, distúrbio hidro-eletrolítico no LCR e convulsões, hiperproteinorraquia acentuada e cefaléia, febre, sinais meníngeos e vômitos, hiperproteinorraquia moderada e idade acima de 65 anos e sexo masculino. Em pacientes atendidos em prontosocorro neurológico com alterações agudas da consciência, o exame do LCR frequentemente pode contribuir para um diagnóstico etiológico. Deve ser solicitado após rigorosa avaliação clínica do paciente. PALAVRAS-CHAVE: líquor, consciência, emergência.Patients with consciousness impairment are frequently seen in the emergency room. In this setting, a detailed me...

-We describe a case of non-ketotic hyperglycemia (NKH), heralded by complex partial seizures and aphasia of epileptic origin, besides versive and partial motor seizures. This clinical picture was accompanied by left fronto-temporal spikes in the EEG. The seizures were controlled by carbamazepine only after the control of the diabetes. A month later, carbamazepine was discontinued. The patient remained without seizures, with normal language, using only glybenclamide. Complex partial seizures, opposed to simple partial seizures, are rarely described in association to NKH. Epileptic activity localized over language regions can manifest as aphasia.KEY WORDS: aphasia, seizures, diabetes mellitus. Crises parciais complexas e afasia como manifestações iniciais de hiperglicemia não cetótica: relato de casoRESUMO -Descrevemos um caso de hiperglicemia não-cetótica (HNC) cujas manifestações iniciais foram crises parciais complexas e afasia de origem epiléptica, além de crises versivas e parcias motoras. Este quadro clínico foi acompanhado por atividade epileptiforme na região fronto-temporal esquerda ao eletrencefalograma. As crises epilépticas foram controladas com carbamazepina (CBZ) apenas após o controle do diabetes mellitus. Após um mês, a CBZ foi suspensa, permanecendo a paciente com linguagem normal, sem novas crises epilépticas, em uso apenas de glibenclamida. Crises parciais complexas, ao contrário de crises parciais simples, são raramente descritas como manifestação de HNC. Atividade epileptiforme nas regiões relacionadas a linguagem podem manifestar-se como afasia. PALAVRAS-CHAVE: epilepsia, crises epilépticas, diabetes mellitus, afasia.Non-ketotic hyperglycemia (NKH) is classically associated to simple partial seizures and partial motor status epilepticus (SE) and rarely to complex partial seizures (CPS) 1,2 . We present a case that was heralded by CPS and aphasia of epileptic origin, before systemic signs and symptoms of diabetic decompensation. CASE REPORTA 60 year old black woman, right-handed, was brought by relatives to the neurological emergency room because of altered behaviour for a week. She presented irritation and moments of staring, that seemed to "turn off", stopping domestic work. At other times, she stopped speaking, or forgot the names of her relatives and objects, answering only monosyllables. Besides these episodes, she looked completely well. The patient and relatives denied other neurologic and systemic complaints, including fever, polyphagia, polydipsia, polyuria and Escola Paulista

-We report on the clinical and EEG features of 15 patients with the syndrome of "continuous spike waves during slow wave sleep" (CSWSS). The differential diagnosis of CSWSS includes benign epilepsy of childhood with centro-temporal spikes, and Landau-Kleffner and Lennox-Gastaut syndromes. We found normal CT and MRI features in 6 cases, periventricular leukomalacia with and without diffuse brain atrophy in 4 cases and hydrocephalus in 1 case. There was no association between specific neurological findings and CSWSS. Nine of our cases had relatively focal discharges, like some cases from the literature. The occurrence of CSWSS appears to be age-related, generaly between the ages of 5 to 12 years, with a strong temporal relation to the neupsychological deterioration in its nature, severity and prognosis. We believe that this striking disorder has been overlooked and that routine sleep EEG studies on epileptic children may disclose additional cases of CSWSS.KEY WORDS: electroencephalogram, sleep, epilepsy, continuous spike-wave.Ponta-onda contínua do sono lento: estudo clínico e eletrencefalográfico em quinze crianças RESUMO -Relatamos as características clínicas e eletroencefalográficas de 15 patientes com a síndrome de ponta-onda contínua do sono não-REM (POCSNR). O diagnóstico diferencial da POCSNR inclue a epilepsia benigna da infância com pontas centro-temporais e as síndromes de Landau-Kleffner e Lennox-Gastaut. Encontramos TC e RNM de crânio normais em 6 casos, leucomalácia periventricular em 4 e hidrocefalia em 1. Não houve associação de achados neurológicos específicos e a POCSNR. Nove dos nossos casos tinham descargas relativamente focais, como alguns casos da literatura. A ocorrência da POCSNR parece ser idade-dependente, geralmente entre 5 e 12 anos, com forte relação temporal à deteriorização neurocognitiva, em sua natureza, severidade e prognóstico. Acreditamos que esta síndrome tem sido pouco diagnosticada e que a realização rotineira de EEG em sono em crianças epilépticas possa revelar novos casos de POCSNR.

RESUMO -A neuro c i s t i c e rcose é grave problema de saúde pública que acomete predominantemente locais com condições sanitárias e de higiene precárias. O Piauí não faz parte do mapa da neuro c i s t i c e rcose no Brasil mas, como ilustra este estudo, apenas por falta de dados epidemiológicos. Demonstramos a pre s e n ç a desta patologia no Estado através do relato de caso de um homem de 39 anos, acompanhado por 17 meses. O diagnóstico foi realizado através de tomografia tomputadorizada de crânio (TC) e o paciente foi tratado com albendazol por 10 dias. Uma nova TC mostrou ausência de lesões. Ele precisou ser tratado novamente após re c o rrência do quadro clínico, ocorrida 6 meses após o primeiro tratamento, com posterior desaparecimento das novas lesões.PALAVRAS-CHAVE: cisticercose, neurocisticercose, epidemiologia. Neurocysticercosis in a State of Piauí urban area: case reportABSTRACT -Neuro c y s t i c e rcosis is a serious public health problem that predominately affects places with poor sanitary and hygiene conditions. The Piaui State is out of the neuro c y s t i c e rcosis map in Brazil but, as this study illustrates, it is just by lack of epidemiologic data. We demonstrate the presence of this pathology in the State of Piaui based on a case report of a 39 years old man, followed for 17 months. The diagnosis was made by CT scan and the patient was treated with albendazol for 10 days. A new CT scan show absence of lesions. He needed to be treated again after a re c u rrence of clinical manifestations, 6 months after the first treatment, with the disappearance of the new lesions.