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Article ; Online: Myelopathy associated with intrathecal methotrexate.

Rodrigues, Pedro Gustavo Barros / Lima, Talles Tavares de / Duarte, Fernando Barroso / Nóbrega, Paulo Ribeiro

2021 Volume 22, Issue 2, Page(s) 141–144

Abstract: A 21-year-old man developed progressive and bilateral lower limb numbness, gait impairment and urinary incontinence over 10 days. He had received intrathecal methotrexate 20 days previously for acute lymphoblastic B-cell leukaemia, following 7 months of ... ...

Abstract	A 21-year-old man developed progressive and bilateral lower limb numbness, gait impairment and urinary incontinence over 10 days. He had received intrathecal methotrexate 20 days previously for acute lymphoblastic B-cell leukaemia, following 7 months of systemic chemotherapy. MR scan of the spinal cord showed bilateral symmetric and extensive T2/fluid attenuated inversion recovery (FLAIR) increased signal involving the dorsal columns in the thoracic cord. His serum folate concentration was at the lower end of the normal range. We stopped the intrathecal chemotherapy and gave folate; after a few days, he progressively improved. Myelopathy is an important adverse effect of intrathecal methotrexate, which may cause clinical and imaging features resembling subacute combined degeneration of the spinal cord. CNS infiltration must be excluded, intrathecal chemotherapy stopped and deficiency of folate or vitamin B12 treated as appropriate.
MeSH term(s)	Adult ; Humans ; Magnetic Resonance Imaging ; Male ; Methotrexate/adverse effects ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/chemically induced ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy ; Spinal Cord Diseases/chemically induced ; Spinal Cord Diseases/diagnostic imaging ; Subacute Combined Degeneration/chemically induced ; Subacute Combined Degeneration/diagnostic imaging ; Young Adult
Chemical Substances	Methotrexate (YL5FZ2Y5U1)
Language	English
Publishing date	2021-10-29
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2170881-2
ISSN	1474-7766 ; 1474-7758
ISSN (online)	1474-7766
ISSN	1474-7758
DOI	10.1136/practneurol-2021-003154
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Article ; Online: Intracranial mass lesions and skin discoloration in the armpits as unusual clues to Erdheim-Chester disease: a case report.

Rodrigues, Pedro Gustavo Barros / Pereira, Isabelle de Sousa / Lima Filho, Valter Barbalho / Dias, Daniel Aguiar / Nóbrega, Paulo Ribeiro / Braga-Neto, Pedro

BMC neurology

2021 Volume 21, Issue 1, Page(s) 81

Abstract: Background: Erdheim-Chester disease (ECD) is a non-Langerhans histiocytosis that results in multi-organ disease involving the skin, bones, lungs and kidneys. Central nervous system (CNS) involvement occurs in about 50 % of patients, and diabetes ... ...

Abstract	Background: Erdheim-Chester disease (ECD) is a non-Langerhans histiocytosis that results in multi-organ disease involving the skin, bones, lungs and kidneys. Central nervous system (CNS) involvement occurs in about 50 % of patients, and diabetes insipidus, visual disturbances, and cerebellar ataxia are the most frequent neurological signs. We report a case of Erdheim-Chester disease with central nervous system involvement in the form of enhancing intracranial mass lesions with massive edema. Case presentation: The patient presented with vertigo, ataxia, encephalopathy and pyramidal signs. Diagnosis was suggested by xanthomatous skin lesions and a biopsy was compatible with Erdheim-Chester disease demonstrating xanthogranulomas CD68 positive (clone KP1) and CD1a and S100 negative. Testing for BRAF mutation was negative, which precluded treatment with Vemurafenib. Treatment with steroids and interferon resulted in improvement of neurological signs and regression of edema on MRI. Conclusions: The diagnosis of Erdheim-Chester disease should be considered in intracranial mass lesions. Xanthomatous skin lesions are a clue to the diagnosis.
MeSH term(s)	Adult ; Axilla/pathology ; Biopsy ; Brain Diseases/etiology ; Brain Diseases/pathology ; Erdheim-Chester Disease/complications ; Erdheim-Chester Disease/diagnosis ; Erdheim-Chester Disease/pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Skin Diseases/etiology ; Skin Diseases/pathology
Language	English
Publishing date	2021-02-18
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1471-2377
ISSN (online)	1471-2377
DOI	10.1186/s12883-021-02107-w
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Article: Falls in Parkinson's disease: the impact of disease progression, treatment, and motor complications.

Lima, Danielle Pessoa / de-Almeida, Samuel Brito / Bonfadini, Janine de Carvalho / Carneiro, Alexandre Henrique Silva / de Luna, João Rafael Gomes / de Alencar, Madeleine Sales / Viana-Júnior, Antonio Brazil / Rodrigues, Pedro Gustavo Barros / Pereira, Isabelle de Sousa / Roriz-Filho, Jarbas de Sá / Sobreira-Neto, Manoel Alves / Braga-Neto, Pedro

Dementia & neuropsychologia

2022 Volume 16, Issue 2, Page(s) 153–161

Abstract: The prevalence of Parkinson's disease (PD) tends to increase worldwide in the coming decades. Thus, the incidence of falls is likely to increase, with a relevant burden on the health care system.: Objective: The objective of this study was to evaluate ...

Abstract	The prevalence of Parkinson's disease (PD) tends to increase worldwide in the coming decades. Thus, the incidence of falls is likely to increase, with a relevant burden on the health care system. Objective: The objective of this study was to evaluate clinical factors and drug use associated with falls in PD patients. Methods: We conducted a cross-sectional study at the Movement Disorders outpatient clinic of a tertiary hospital in Northeast Brazil. We performed structured interviews to collect sociodemographic and clinical data. Functional capacity was assessed using the Schwab and England Activities of Daily Living Scale and the modified Hoehn and Yahr Staging Scale. We divided the study sample into non-fallers (no falls) and fallers (≥1 fall), and non-recurrent (≤1 fall) and recurrent fallers (>1 fall). Results: The study population comprised 327 PD patients (48% women), with a mean age of 70 years. The mean disease duration was 9.9±6.9 years. The most prevalent comorbidities were depression (47.2%), hypertension (44.0%), and type 2 Conclusions: Health care providers play an essential role in fall prevention in PD patients, particularly by identifying older adults experiencing dyskinesia and visual hallucinations. Prospective studies should investigate the use of amantadine as a risk factor for falls in PD patients.
Language	English
Publishing date	2022-04-29
Publishing country	Brazil
Document type	Journal Article
ISSN	1980-5764
ISSN	1980-5764
DOI	10.1590/1980-5764-DN-2021-0019
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Article ; Online: Moyamoya associated with Turner syndrome in a patient with type 2 spinocerebellar ataxia-Occam's razor or Hickam's dictum: a case report.

Nóbrega, Paulo Ribeiro / da Costa, Francisco Bruno Santana / Rodrigues, Pedro Gustavo Barros / de Maria Frota Vasconcelos, Thais / Soares, Danyela Martins Bezerra / Araújo, Jéssica Silveira / Dias, Daniel Aguiar / Sobreira-Neto, Manoel Alves / de Paiva, Anderson Rodrigues Brandão / Braga-Neto, Pedro / Kok, Fernando / Fontenele, Eveline Gadelha Pereira

BMC neurology

2022 Volume 22, Issue 1, Page(s) 381

Abstract: Background: Turner syndrome (TS) is a rare condition associated with a completely or partially missing X chromosome that affects 1 in 2500 girls. TS increases the risk of autoimmune diseases, including Graves' disease (GD). Moyamoya disease is a rare ... ...

Abstract	Background: Turner syndrome (TS) is a rare condition associated with a completely or partially missing X chromosome that affects 1 in 2500 girls. TS increases the risk of autoimmune diseases, including Graves' disease (GD). Moyamoya disease is a rare cerebral arteriopathy of unknown etiology characterized by progressive bilateral stenosis of the internal carotid artery and its branches. Both TS and GD have been associated with Moyamoya. Type 2 spinocerebellar ataxia (SCA2) is an autosomal dominant cerebellar ataxia caused by a CAG repeat expansion in ATXN2. We present the first case of Moyamoya syndrome in a patient with a previous diagnosis of TS and GD who tested positive for SCA2 and had imaging findings compatible with an overlap of SCA2 and Moyamoya. Case presentation: A 43-year-old woman presented with mild gait imbalance for 2 years. Her family history was positive for type 2 spinocerebellar ataxia (SCA2). She had been diagnosed with Turner Syndrome (45,X) and Graves disease three years before. Brain MRI revealed bilateral frontal and parietal cystic encephalomalacia in watershed zones, atrophy of pons, middle cerebellar peduncles and cerebellum. MR angiography showed progressive stenosis of both internal carotid arteries with lenticulostriate collaterals, suggestive of Moya-Moya disease. Molecular analysis confirmed the diagnosis of SCA2. Conclusions: With increased availability of tools for genetic diagnosis, physicians need to be aware of the possibility of a single patient presenting two or more rare diseases. This report underscores the modern dilemmas created by increasingly accurate imaging techniques and available and extensive genetic testing.
MeSH term(s)	Adult ; Constriction, Pathologic ; Female ; Humans ; Moyamoya Disease/complications ; Moyamoya Disease/diagnostic imaging ; Spinocerebellar Ataxias/complications ; Spinocerebellar Ataxias/diagnostic imaging ; Spinocerebellar Ataxias/genetics ; Turner Syndrome/complications
Language	English
Publishing date	2022-10-08
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2041347-6
ISSN	1471-2377 ; 1471-2377
ISSN (online)	1471-2377
ISSN	1471-2377
DOI	10.1186/s12883-022-02912-x
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Article ; Online: Steroid responsive cavernous sinus syndrome due to Rosai-Dorfman disease: beyond Tolosa-Hunt syndrome - a case report.

Nóbrega, Paulo Ribeiro / Rodrigues, Pedro Gustavo Barros / de Sousa Pereira, Isabelle / de Figueiredo Santos, Carolina / Gerson, Gunter / de Arruda, José Arnaldo Motta / Júnior, José Wagner Leonel Tavares / de Araújo Coimbra, Pablo Picasso / Braga-Neto, Pedro

BMC neurology

2021 Volume 21, Issue 1, Page(s) 264

Abstract: Background: The term "Tolosa-Hunt syndrome" (THS) has been used to refer to painful ophthalmoplegia associated with nonspecific inflammation of the cavernous sinus and many processes can result in a similar clinical picture, including infectious, ... ...

Abstract	Background: The term "Tolosa-Hunt syndrome" (THS) has been used to refer to painful ophthalmoplegia associated with nonspecific inflammation of the cavernous sinus and many processes can result in a similar clinical picture, including infectious, inflammatory and neoplastic diseases. Rosai-Dorfman disease (RDD) is a lymphoproliferative disorder that rarely affects the central nervous system. We report a case of isolated CNS Rosai-Dorfman disease involving the cavernous sinus and presenting as "Tolosa-Hunt syndrome". Case presentation: Our patient presented with horizontal diplopia due to impairment of cranial nerves III, IV and VI and a stabbing/throbbing headache predominantly in the left temporal and periorbitary regions. There was a nonspecific enlargement of the left cavernous sinus on MRI and the patient had a dramatic response to steroids. Biopsy of a frontal meningeal lesion was compatible with RDD. Conclusions: We highlight the importance of including Rosai-Dorfman disease as a differential diagnosis in cavernous sinus syndrome and demonstrate a satisfactory long-term response to steroid treatment in this disease.
MeSH term(s)	Cavernous Sinus/physiopathology ; Diagnosis, Differential ; Diplopia ; Headache ; Histiocytosis, Sinus ; Humans ; Magnetic Resonance Imaging ; Steroids/therapeutic use ; Tolosa-Hunt Syndrome
Chemical Substances	Steroids
Language	English
Publishing date	2021-07-05
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1471-2377
ISSN (online)	1471-2377
DOI	10.1186/s12883-021-02255-z
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Article: Stiff-Eye Syndrome-Anti-GAD Ataxia Presenting with Isolated Ophthalmoplegia: A Case Report.

Belém, Abel Dantas / Vasconcelos, Thaís de Maria Frota / Paula, Rafael César Dos Anjos de / Costa, Francisco Bruno Santana da / Rodrigues, Pedro Gustavo Barros / Pereira, Isabelle de Sousa / Tavares, Paulo Roberto de Arruda / Galdino, Gabriela Studart / Dias, Daniel Aguiar / Santos, Carolina de Figueiredo / Sobreira-Neto, Manoel Alves / Braga-Neto, Pedro / Nobrega, Paulo Ribeiro

Brain sciences

2021 Volume 11, Issue 7

Abstract: Anti-GAD ataxia is one of the most common forms of immune-mediated cerebellar ataxias. Many neurological syndromes have been reported in association with anti-GAD. Ophthalmoparesis has been described in stiff person syndrome. We report a case of anti-GAD ...

Abstract	Anti-GAD ataxia is one of the most common forms of immune-mediated cerebellar ataxias. Many neurological syndromes have been reported in association with anti-GAD. Ophthalmoparesis has been described in stiff person syndrome. We report a case of anti-GAD ataxia presenting initially with isolated ophthalmoplegia and showing complete resolution after immunotherapy. A 26-year-old male patient presented with ophthalmoparesis characterized by tonic upwards deviation of the right eye. In the following month, he developed progressive ataxia with anti-GAD titers of 1972 UI/mL. After treatment with methylprednisolone and immunoglobulin, there was complete resolution of symptoms and anti-GAD titers decreased. This is the first report of isolated ophthalmoparesis due to tonic eye deviation associated with anti-GAD antibodies without stiff-person syndrome. Tonic eye deviation has been reported in SPS, possibly secondary to continuous discharge in gaze holding neurons in the brainstem (similar to what occurs in spinal motor neurons). With growing evidence for ocular abnormalitites in SPS, anti-GAD associated neurological syndromes should be included in the differential diagnosis of isolated ophthalmoplegia.
Language	English
Publishing date	2021-07-14
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2651993-8
ISSN	2076-3425
ISSN	2076-3425
DOI	10.3390/brainsci11070932
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Article ; Online: Characterization of Headache in COVID-19: a Retrospective Multicenter Study.

Dos Anjos de Paula, Rafael César / de Maria Frota Vasconcelos, Thaís / da Costa, Francisco Bruno Santana / de Brito, Lara Albuquerque / Torres, Danielle Mesquita / Moura, Alissa Elen Formiga / Oliveira, Danilo Nunes / de Lima Henn, Guilherme Alves / Rodrigues, Pedro Gustavo Barros / de Sousa Pereira, Isabelle / Braga, Ianna Lacerda Sampaio / Rocha, Felipe Araújo / Frota, Norberto Anízio Ferreira / Carvalho, Fernanda Martins Maia / Pitombeira, Milena Sales / Tavares-Junior, José Wagner Leonel / Montenegro, Raquel Carvalho / Braga-Neto, Pedro / Nóbrega, Paulo Ribeiro /

Sobreira-Neto, Manoel Alves

Molecular neurobiology

2021 Volume 58, Issue 9, Page(s) 4487–4494

Abstract: Headache is the most common neurological symptom in COVID-19, reported in 6.5 to 34% of patients. Few studies have analyzed its characteristics, and some of them included cases without laboratory confirmation or reported only critical patients. We aimed ... ...

Abstract	Headache is the most common neurological symptom in COVID-19, reported in 6.5 to 34% of patients. Few studies have analyzed its characteristics, and some of them included cases without laboratory confirmation or reported only critical patients. We aimed to analyze the clinical characteristics of COVID-19 associated headache in laboratory-confirmed cases. We conducted a retrospective evaluation of patients with COVID-19 and neurological symptoms. Patients who reported headache answered an interview about its clinical characteristics. Twenty-four patients with COVID-19 associated headache completed the interview. Mean age of patients was 53.8 (standard deviation-17.44), and 14 out of 24 (58.3%) were male. The majority (75%) had no previous history of headache. Fever was documented in 19 out of the 24 patients (79.1%). Headache was predominantly bifrontal or holocranial, in pressure, during hours, worsening with cough or physical activity. COVID-19 headache tends to appear in the first days of symptoms, be either frontal or holocranial and last for days. The quality of pain in pressure and the worsening with cough or physical activity were reported in most cases. We have not found any characteristic that could differentiate COVID-19 associated headache from other causes of headache, possibly because of its multifactorial mechanism.
MeSH term(s)	Adolescent ; Adult ; Antihypertensive Agents/therapeutic use ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19 Testing ; Comorbidity ; Cytokines/physiology ; Endothelium, Vascular/physiopathology ; Endothelium, Vascular/virology ; Female ; Fever/etiology ; Headache/etiology ; Headache/physiopathology ; Humans ; Inflammation ; Male ; Models, Biological ; Neoplasms/epidemiology ; Retrospective Studies ; SARS-CoV-2 ; Symptom Assessment ; Trigeminal Nerve/virology ; Young Adult
Chemical Substances	Antihypertensive Agents ; Cytokines
Language	English
Publishing date	2021-05-25
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	645020-9
ISSN	1559-1182 ; 0893-7648
ISSN (online)	1559-1182
ISSN	0893-7648
DOI	10.1007/s12035-021-02430-w
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Article ; Online: Effects of a power strength training using elastic resistance exercises on the motor and non-motor symptoms in patients with Parkinson's disease H&Y 1-3: study protocol for a randomised controlled trial (PARK-BAND Study).

Lima, Danielle Pessoa / de Almeida, Samuel Brito / Bonfadini, Janine de Carvalho / Sobreira, Emmanuelle Silva Tavares / Damasceno, Patrícia Gomes / Viana Júnior, Antonio Brazil / de Alencar, Madeleine Sales / de Luna, João Rafael Gomes / Rodrigues, Pedro Gustavo Barros / Pereira, Isabelle de Sousa / Gadelha, André Luis de Castro / de Oliveira, Liliane Maria / Chaves, Érica Carneiro Barbosa / Carneiro, Vlademir Gomes / Monteiro, Rayane Rodrigues / Costa, Thatyara Almeida de Macedo / Helal, Lucas / Signorile, Joseph / Lima, Lidiane Andréa Oliveira /

Sobreira-Neto, Manoel Alves / Braga-Neto, Pedro

BMJ open

2020 Volume 10, Issue 10, Page(s) e039941

Abstract: Introduction: Parkinson's disease (PD) is the second most common neurodegenerative disorder in Brazil. Physical activity is a complementary intervention in managing inherent declines associated with the disease like strength, balance, gait, and ... ...

Abstract	Introduction: Parkinson's disease (PD) is the second most common neurodegenerative disorder in Brazil. Physical activity is a complementary intervention in managing inherent declines associated with the disease like strength, balance, gait, and functionality and benefit health-related outcomes. Here, we report the PARK-BAND Study protocol, which aims to investigate potential benefits of power training using elastic devices in participants with PD. Our intervention will be provided in patients with PD using elastic devices like elastic bands and tubes. Therefore, we used the term Park from Parkinson's disease and band from elastic bands. Methods and analysis: This randomised single-blind single-centre two-arm parallel, superiority trial will include 50 participants with PD attending the clinical setting. Those who meet the eligibility criteria and provide consent to participate will be randomised in a 1:1 ratio to either the exercise group, which will receive power training programme or the health education group, which will receive the education programme. Randomisation will be performed by permuted block randomisation with a block size of eight. Both groups will receive a 12-week intervention. The exercise group will have two sessions per week and the health education group will have one session per week. Changes from baseline in bradykinesia, as assessed by the Unified Parkinson's Disease Rating Scale motor examination subscore and physical functional performance, will be the primary outcomes. Secondary outcomes include other neurological, neurophysiological and physical variables, as well as the quality of life, depression, cognition, sleep quality and disturbances, assessed before and after interventions. We hypothesise that the exercise group will have greater improvement in primary and secondary outcomes than the health education group. Ethics and dissemination: The study is approved by the Research Ethics Committee of Hospital Universitário Walter Cantidio and all participants will provide their written informed consent (register number 91075318.1.0000.5045).Trial results will be disseminated via peer reviewed journal articles and conference presentations, reports for organisations involved with PD and for participants. Trial registration number: Registro Brasileiro de Ensaios Clínicos Registry (RBR-5w2sqt); Pre-results.
MeSH term(s)	Humans ; Parkinson Disease/therapy ; Quality of Life ; Randomized Controlled Trials as Topic ; Resistance Training ; Single-Blind Method
Language	English
Publishing date	2020-10-12
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-039941
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Article ; Online: Myelopathy associated with intrathecal methotrexate.

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Article ; Online: Intracranial mass lesions and skin discoloration in the armpits as unusual clues to Erdheim-Chester disease: a case report.

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Article: Falls in Parkinson's disease: the impact of disease progression, treatment, and motor complications.

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Article ; Online: Moyamoya associated with Turner syndrome in a patient with type 2 spinocerebellar ataxia-Occam's razor or Hickam's dictum: a case report.

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Article ; Online: Steroid responsive cavernous sinus syndrome due to Rosai-Dorfman disease: beyond Tolosa-Hunt syndrome - a case report.

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Article: Stiff-Eye Syndrome-Anti-GAD Ataxia Presenting with Isolated Ophthalmoplegia: A Case Report.

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Article ; Online: Characterization of Headache in COVID-19: a Retrospective Multicenter Study.

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Article ; Online: Effects of a power strength training using elastic resistance exercises on the motor and non-motor symptoms in patients with Parkinson's disease H&Y 1-3: study protocol for a randomised controlled trial (PARK-BAND Study).

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