We report less disability accumulation than previous series on patients with neuromyelitis optica, two-thirds presenting no disability accumulation along follow-up. Continued azathioprine used from early disease onset was strongly associated to maintenance of neurological function and should be offered as a viable option for low-income scenarios.
Multiple sclerosis (MS) and neuromyelitis optica (NMO) are the most important and common inflammatory autoimmune diseases that affect the central nervous system (CNS) and can lead to sustained neurologic disability and financial burden for the society 1,2 . Both diseases can cause visual impairment, pyramidal deficits, sensation loss, neuropathic pain, coordination problems, gait impairment and cognitive problems (more MS than NMO). While MS has a Conclusion:We identified that 15% of patients seen have NMO. As patients with NMO have a more severe disease than MS, this data may be important for planning local health care policies.Keywords: multiple sclerosis, neuromyelitis optica, epidemiology, Sao Paulo. RESUMOObjetivo: Descrever a casuística de pacientes atendidos no setor de Neuroimunologia da Universidade Federal de São Paulo (UNIFESP) de 1994 a 2013. Método: Analisamos o diagnóstico final de todos os pacientes atendidos de 1999 a 2013, sendo o diagnóstico revisado na última consulta e estabelecido de acordo com os critérios específicos para cada doença. O volume de atendimentos clínicos e não clínicos (relatórios e receitas) foram contabilizados para avaliar a carga de trabalho da equipe. Resultados: 1.599 pacientes foram avaliados: 816 com esclerose múltipla (EM), 172 com síndromes clínicas isoladas, 178 com neuromielite óptica (NMO), 216 com outras doenças desmielinizantes, 20 com doenças metabólicas, 42 com doenças vasculares e 155 com outros diagnósticos ou diagnósticos indefinidos. Identificamos uma média de 219 consultas e 65 solicitações de relatórios por mês. Conclusão: Identificamos que 15% dos pacientes atendidos tem NMO. Por ser uma doença mais incapacitante que a EM estes dados podem ser importantes para o planejamento de políticas de saúde locais.Palavras-chave: esclerose múltipla, neuromielite óptica, epidemiologia, São Paulo.
Esclerose múltipla é uma doença crônica que afeta o sistema nervoso, causando destruição da mielina, proteína fundamental na transmissão do impulso nervoso. Embora as características clínicas sejam bem conhecidas, os aspectos etiológicos continuam alvo de exaustivos estudos. Com o aprofundamento dos conhecimentos imunopatológicos, têm-se ampliado as perspectivas terapêuticas.
-Glossopharyngeal neuralgia with syncope as a sign of neck cancer is a very rare condition. A review of the literature revealed only 29 cases formerly reported. We present the first Brazilian case of such association. A 68-year-old man presented with paroxysmal excruciating pain over the right side of the neck, sometimes followed by syncope. Given the suspicion of recurrent tumor from a previously treated neck malignancy, a computed tomography scan was performed and a right parapharyngeal tumor was shown. Pain and syncope were successfully controlled with carbamazepine and the patient underwent palliative radiotherapy.KEY WORDS: glossopharyngeal neuralgia, syncope, neck cancer, recurrence.Neuralgia glossofaríngea com síncope como um sinal de recidiva de câncer do pescoço RESUMO -Neuralgia glossofaríngea com síncope como um sinal de câncer do pescoço é uma condição muito rara. Uma revisão da literatura revelou apenas 29 casos relatados anteriormente. Apresentamos o primeiro caso brasileiro de tal associação. Um homem de 68 anos se apresentou com dores paroxísticas insuportáveis no lado direito do pescoço, algumas vezes seguidas de síncope. Dada a suspeita de recidiva tumoral derivada de uma malignidade cervical tratada previamente, realizou-se um exame de tomografia computadorizada que evidenciou um tumor parafaríngeo direito. As dores e as síncopes foram controladas satisfatoriamente com carbamazepina e o paciente foi submetido à radioterapia paliativa.PALAVRAS-CHAVE: neuralgia glossofaríngea, síncope, câncer do pescoço, recidiva. Dr. According to the second edition of the International Classifi cation of Headache Disorders 1 , glossopharyngeal neuralgia is a brief severe stabbing pain felt in the ear, base of the tongue, tonsillar fossa or beneath the angle of the jaw. Thus, the pain is located in the distributions of the auricular and pharyngeal branches of the vagus nerve plus of the ipsilateral glossopharyngeal nerve. It is commonly incited by swallowing, talking or coughing and may remit and relapse in the manner of trigeminal neuralgia.Glossopharyngeal neuralgia was estimated to be 75 times less frequent than trigeminal neuralgia 2 , and its association with syncope was estimated to occur in 1,84% of the cases 3 . Although generally cryptogenic, this condition sometimes have a demonstrable cause, including neoplasms, infections, infl ammations, trauma, elongated styloid process and vascular compression 2 . Glossopharyngeal neuralgia with syncope as a sign of neck tumor is a very rare condition. A fairly diligent review of the literature revealed only 29 cases formerly reported (Table). We present the fi rst Brazilian case of such association. CASEA 68-year-old white man with a history of paralaryngeal and pyriform sinus lymphoepithelioma was treated with radical surgery and radiotherapy about 2 years ago. His tumor was stage T3 N2b M0 and he underwent bilateral neck dissection, right hemithyroidectomy, pharyngolaryngectomy with later reconstruction by means of a free microvascular right thigh fl ...
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