Jornal de Neurologia Clínica e Neurocirurgia

Central nervous system (CNS) tuberculosis (TB) remains a leading cause of morbidity and mortality in Immunocompetent and Immunocompromised patients in the developing world. Tuberculosis can involve the brain parenchyma (Subpial or Subependymal infective foci), meninges or adjacent bone with a wide variety of clinical and radiological manifestations. Intracranial tuberculomas are the most common neuro-radiological manifestation of TB. Neuroimaging features of tuberculous meningitis (TBM) include hydrocephalus, meningeal enhancement, infarction, tuberculomas, abscess, cerebral edema, and calcification. Here we report a case of a 25-year-old male presented to us with TBM with Magnetic resonance imaging (MRI) resemblance to the findings in Wilson disease, which is a rare entity in TBM Neuroimaging.

Background: Multiple Sclerosis (MS) is a progressive neurological disease that can lead to severe disability. It is one of the most prevalent causes of disability in young adults in the world. Over 1,000,000 people are affected across Europe. Management strategies include DMTs, symptomatic treatment and lifestyle interventions-all of which must be tailored to the individual with MS in order to be effective. The European Brain Council initiated in 2018 a project RETHINKING MS, calling for change in MS care.

Method: The study’s research included data mapping, expert interviews and national roundtable discussions utilising the care pathway concept and the result of the literature search. The care pathway implies an integrated care framework. A series of clinical and patient-oriented benchmarks along the care process were developed, focusing on multidisciplinary, timely integrated care as a key area which has been identified amongst the priorities for policy action to meet the needs of people living with MS.

Results: Highlight three main gaps in the management of MS across Europe. Firstly, providing multidisciplinary care is organisationally challenging. Secondly, access to specialist MS roles and programmes is limited. Thirdly, there is a lack of suitable information for people with MS. Today, it is not possible for the family physician or even many general neurologists to master the current treatment algorithm, and this calls for the establishment of multidisciplinary MS Care Units where there is an adequate infrastructure to provide proper monitoring of patients, comprehensive assessment, and detection of side effects and ability to promptly address them. A multidisciplinary MS Care Unit approach can be defined as the presence of a group of different specialists, who work together and with the MS neurologists and nurses with a formalized diagnostic workup procedure, protocols for initiation and follow-up of DMTs and management of complications.

Conclusion: Rethinking on how MS is managed in order to adequately provide care and support for all people with MS is needed. The RETHINKING MS in Europe report highlights that European and national policymakers should focus their efforts around these priorities and take specific actions. Similarly, the COVID-19 pandemic brings opportunities to re-think integrated care models across Europe.

The outbreak of Coronavirus Disease (COVID-19) is a Public Health Emergency of International Concern. While COVID-19 continues to spread, the protection of children and educational facilities is of prime importance. Limited data suggests children are low risk and get less severe COVID-19 infection. However, there is an increasing concern that patients with Duchenne and Becker Muscular Dystrophy (DBMD) may be at increased risk of developing multisystemic and severe complications of COVID-19 due to major comorbidities. As school and health care authorities prepare to open in person schooling this fall, the parents and caregivers of children with DBMD face new and challenging decisions about how their child will return to school this fall. When deciding between in-person and virtual learning, limited data is available for parents and health care providers to make this decision for children with DBMD. Here we will review some important considerations that can help make the best informed decision for this special population.

Background: The botulinum toxin type A (BoNT-A) is is safe and effective treatment that is used in diverse range of in neurologic  diseases. Patients satisfaction may affect successful treatment outcome.

Objective: To characterize overall patients /caregivers’ satisfaction with BoNT-A treatment for symptom control in different neurologic conditions at clinic.

Methods: A cross-sectional study included all patients of both genders and all age groups who had received at least two BoNT-A treatment sessions in our injection clinic. They were asked to rate overall treatment satisfaction at the peak of treatment effect on a 1 to 10 scale (1=not at all satisfied; 10=fully satisfied). Subjects with a rating of 1–3 were classified as not at all satisfied, those with a rating of 4–7 as somewhat satisfied, and those with a rating of 8–10 as very satisfied.

Results: 548 patients were identified for the studywith mean age 43.66+14.50. Most of participants 389 (71%)were female. At the end of observational period, the mean satisfaction was 7.28 +1.78. Majority of patients52.9%were very satisfied, while 42.2% of patients were somewhat satisfied and 4.9% of patients were not satisfied at all.  There was highly significant difference (p<0.0001) for treatment satisfaction among different neurological disorders. Overall treatment satisfaction with BoNTâ?A was the highest for axillary HH (9.20±0.86) and the least satisfaction was reported in writer’s cramp (4.40±1.67). Overall satisfaction with BoNTâ?A at beak of treatment effect was very satisfaction among patients with axillary HH (100%), palmar HH (94.4%), other neuropathic pain syndromes (85.7%), planter HH (90), trigeminal neuralgia (80). While somewhat overall satisfaction at beak of treatment effect was more reported among patients with cervical dystonia (86.7%), musculoskeletal pain (80) and 77.8% in headache patients. Not at all satisfaction was more recorded among writers cramp patients (40%). There was negative significant correlation between BoNT treatment satisfaction and age of patients, (r =-0.099, P,0.022.  We reported positive significant correlation between BoNT treatment satisfaction and disease duration and treatment adherence (r =0.185, P,0.0001; r =0.242, P=0.001respectively).

Conclusion: Patients satisfaction with BoNT-A therapy for different neurological disorders is overall good. The highest patient’s satisfaction observed with primary focal HH, and the least satisfaction with cervical dystonia and writer’s cramp. Treatment satisfaction improves adherence to treatment.

Headache with sexual activity has been classified as a primary benign headache in adults. Raised intracranial pressure remains on the differential for these headaches. These two cases reported here are rare presentations of idiopathic intracranial hypertension that presented with post-coital headaches in young teenagers. Headache with sexual activity is rare in children and should be a diagnosis of exclusion. Raised intracranial pressure should be considered as a possible etiology in addition to looking for identifiable causes on imaging.