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R Nitrini

Publications and source records attributed to R Nitrini.

At least 37 records · Page 2Linked to original sources
PubMed1998

Structural correlates of cognitive deficits in a selected group of patients with Alzheimer's disease.

OBJECTIVE: The objective of this study was to correlate the densities of neurofibrillary tangles (NFTs) and senile plaques (SPs) in 10 patients with Alzheimer's disease (AD) with comprehensive neuropsychological data obtained within 1 year of death. BACKGROUND: Clinicopathologic studies in AD have been essentially limited to correlate neuropathologic data with severity of dementia. Very few studies have addressed the correlations between distribution of lesions and specific cognitive deficits. This is partly due to the limitation imposed by the interval between the last neuropsychological evaluation and death. METHODS: Ten patients with a postmortem diagnosis of AD, with a mean age at death of 80.4+/-6.6 years and a mean duration of symptoms of 5.6+/-2.9 years, were selected for the study. All of these patients were submitted to neuropsychological testing within 1 year of death, including 17 tests assessing memory, language, visuoperceptual, visuospatial, and constructional abilities as well as limb praxis. The neuropathologic study was performed using a modified Bielschowsky technique. Mean densities of SPs and NFTs were determined in the hippocampal formation (CA1, subiculum, and parasubiculum) and in six neocortical areas (midfrontal, orbitofrontal, cingulum, fusiform gyrus, superior and inferior parietal cortices). Statistical correlations were determined between cognitive scores and SP and NFT densities. RESULTS: For NFTs, significant correlations emerged only between tangle density in CA1 and visuoperceptual scores. For SP density values, significant correlations were found between visuoperceptual tests and lesions in the subiculum and in the fusiform gyrus, significant correlations were found between language scores and SPs in the superior parietal cortex and between visuospatial deficits and lesions in the superior parietal cortex and fusiform gyrus. CONCLUSIONS: SPs in specific brain areas displayed a good correlation with the cognitive deficits detected in this selected group of AD patients. The association of fusiform gyrus and superior parietal lobule involvement with visuoperceptual and visuospatial deficits, respectively, is in agreement with current knowledge of the anatomic basis of visual processing.

Aged↗
PubMed1997

Familial spongiform encephalopathy associated with a novel prion protein gene mutation.

Human prion diseases include Creutzfeldt-Jakob disease, Gerstmann-Stráussler-Scheinker disease, fatal familial insomnia, and kuru. Each of these diseases has a specific clinical presentation while spongiform encephalopathy, neuronal loss, and gliosis are their neuropathological hallmarks. We studied a Brazilian family with an autosomal dominant form of dementia. Nine members of the family were affected by a dementia with frontotemporal clinical features, with a mean age at onset of 44.8 +/- 3.8 years and a mean duration of symptoms of 4.2 +/- 2.4 years. Neuropathological examination of 3 patients showed severe spongiform change and neuronal loss in the deep cortical layers and in the putamen, but minimal gliosis in the most severely affected areas. The putamen and cerebellum, but not other areas of the affected brain, displayed prion protein immunoreactivity. A novel prion protein gene mutation causing a nonconservative substitution at codon 183 was identified in 2 neuropathologically confirmed affected individuals (mother and son). The mutation was transmitted in a mendelian fashion to 12 members of the family. Therefore, we identified a novel prion disease variant characterized by an early onset and long duration of the symptoms, severe spongiform change with minimal gliosis, associated with a prion protein gene mutation at codon 183.

Adult↗
PubMed1996

[Arachnoid cyst and pseudotumor cerebri: case report].

Report on a 12 years old patient with an arachnoid cyst of posterior cranial fossa and pseudotumor cerebri. This patient is a shunt dependent of his cyst-peritoneal shunt. This association and evolution of this pacient suggest a common and specifical pathogenic mechanism of these two pathologies based in a disturbance of the cerebral fluid circulation.

Arachnoid Cysts↗
PubMed1996

Brain SPECT in dementia. A clinical-scintigraphic correlation.

The aim of this study was to compare the accuracy of computed tomography (CT) and single photon emission computerized tomography (SPECT) in the diagnosis of dementia. Fifty-two patients with clinical diagnosis of dementia and 11 controls were studied. The scans were interpreted by one experienced neuroradiologist and one nuclear radiologist, both blinded to the clinical data. In the diagnosis of dementia, CT and SPECT showed equal sensitivity (82.7%) and statistically similar specificity (63.8 and 81.8%, respectively). The specificity of SPECT in diagnosing Alzheimer's disease (100%) was statistically superior to CT (69%). However, both methods showed similar sensitivity in detecting Alzheimer's disease. In conclusion, SPECT and CT showed similar accuracy in the diagnosis of dementia. The quite high specificity of SPECT in Alzheimer's disease may be useful for confirming that diagnosis, particularly for patients with presenile onset of the disease.

Adult↗
PubMed1996

[Which patients does the neurologist assist? Basis for a curriculum in neurology].

OBJECTIVE: To present the most frequent diagnosis of patients referred to a neurologist and to discuss the importance of this finding for the definition of the curriculum in Neurology. BACKGROUND: The development of subspecialties of Neurology is interfering in the definition of what should be taught to train a physician or a neurologist. The knowledge of which are the most common neurological diseases may contribute to construct these curricula. METHOD: The initial diagnosis in 1815 outpatients referred to the neurologic service of an university-affiliated public hospital in São Paulo, Brazil, were analyzed. RESULTS: The most common diagnosis, in decreasing order of frequency were: headache, epilepsy, mental disorders, cerebrovascular disease, head injury, polyneuropathy, vestibular syndrome, spastic crural paraparesis, extrapyramidal syndrome, dementia, intracranial hypertension and facial palsy. CONCLUSION: The importance of the subspecialties in the curriculum should be related to the frequency of the neurologic diseases in the community.

Adult↗
PubMed1995

Evaluation of 100 patients with dementia in São Paulo, Brazil: correlation with socioeconomic status and education.

One hundred consecutive outpatients with dementia were prospectively studied to investigate the diagnoses of dementing diseases and to correlate these diagnoses with socioeconomic status and with education. Alzheimer disease was the most common cause of dementia (54%), followed by vascular dementia (20%). Eight patients presented with potentially reversible causes of dementia. These frequencies are similar to those reported by case register studies from Western Europe and the United States. We did not find differences in the frequencies of the dementing diseases according to socioeconomic status or education. Alzheimer disease was the most common cause of dementia in all socioeconomic classes. Potentially reversible dementias, vascular dementias, and other secondary dementias were not more frequent in the lower socioeconomic strata. There was a trend to a higher frequency of vascular dementia among patients with less education, but this was not statistically significant.

Adult↗
PubMed1994

[Neuropsychological tests of simple application for diagnosing dementia].

Thirty patients with dementia defined by DSM-III-R criteria (Alzheimer's disease (22), vascular dementia (3), Parkinson's disease, frontal lobe dementia, possible diffuse Lewy body dementia, normal pressure hydrocephalus and uncertain diagnosis), with scores below 24 points in the Mini-Mental Status Examination and more than 4 years of education were submitted to a neuropsychological evaluation. The scores in the neuropsychological tests were compared to those obtained by thirty normal volunteers paired for age, sex and education. Sensitivity, specificity and accuracy of the tests in the distinction of demented and normal volunteers were determined. The accuracies were calculated using ROC curves. Blessed's information-memory-concentration test showed greatest accuracy, followed by copy of simple figures, delayed memory of 10 figures (after 5 minutes), recognition of 10 figures and verbal fluency test (animals). A linear discriminant function, composed by 6 tests: visual perception, incidental memory, delayed memory (after 5 minutes), drawing of a clock, verbal fluency (animals) and calculation tests, was able to discriminate all controls from patients and only one patient was wrongly classified as normal control. These tests were chosen because they can be applied in less than 10 minutes and are very easy to interpret. This discriminant function must be applied in another group of patients and controls in order to demonstrate its value. When associated to the MMSE it may be useful to discriminate patients with dementia from normal people in epidemiological studies.

Age Distribution↗
PubMed1990

Neurosarcoidosis: therapeutic success with methotrexate.

Sarcoidosis affects the nervous system in 5% of cases. Treatment with corticosteroids is usually effective. We describe the case of a patient with neurosarcoidosis in which therapy with prednisone failed whereas the result of methotrexate administration was satisfactory.

Adult↗
PubMed1988

Lissauer form of paretic neurosyphilis with a cerebral mass lesion.

A 40-year-old male patient with progressive dementia presented adversive seizures, and CT scan showed an enlarging focal mass lesion in the right cerebral hemisphere. Cerebrospinal fluid examination and brain biopsy confirmed the diagnosis of neurosyphilis. After a course of penicillin therapy there was disappearance of the cerebral mass lesion and the CT scan showed focal atrophy in the right cerebral hemisphere. This case suggests that Lissauer form of paretic neurosyphilis may present as a focal mass lesion.

Adult↗
PubMed1987

Elementary motor perseveration in early diagnosis of progressive supranuclear palsy.

Three patients with progressive supranuclear palsy (PSP) with different symptoms at onset presented intense elementary motor perseveration before the appearance of the distinctive features of the illness. In elementary motor perseveration once an element of a movement has begun it is no longer inhibited at the right time and continues unchecked. Perseverations were observed in these patients during tests for dysdiadochokinesia, for reproduction of rhythmic structures and during the drawing of simple geometric shapes. Though this sign has not yet been described in PSP it is possible that an adequate search for its occurrence may show it to be an important sign for early diagnosis and an element for the clinical characterization of PSP.

Female↗
PubMed1987

[Intravenous penicillin therapy in high doses in neurosyphilis: study of 62 cases. I. Clinical evaluation].

Sixty-two patients with symptomatic neurosyphilis were treated with 20 or 24 megaunits of intravenous penicillin G daily for 15 to 30 days. The mean follow-up time after the treatment was 30 months. Thirteen patients developed new neurological signs after the treatment. Their diagnosis were: general paresis (9), taboparesis (2), tabes dorsalis (1) and meningovascular neurosyphilis (1). After the treatment, thirty-six patients (58.1%) improved, 22 patients (35.5%) were unchanged and 4 patients (6.4%) deteriorated on clinical grounds. In two patients there was a progression to other forms of neurosyphilis. The results of the treatment of these patients with high doses of intravenous penicillin G were not different from the results verified with classical intramuscular penicillin that were reported in the literature, from the clinical standpoint.

Adolescent↗
PubMed1987

[High-dose intravenous penicillin therapy in neurosyphilis: study of 62 cases. II. Evaluation of cerebrospinal fluid].

Sixty-two patients with symptomatic neurosyphilis were treated with 20 or 24 megaunits of intravenous penicillin G daily for 15 to 30 days. The mean follow-up time after the treatment was 30 months. Forty-one patients had pleocytosis in the CSF before treatment. Six months and twelve or more months later, abnormal cell count was observed in 4 (9.8%) and in 3 patients (7.3%), respectively. The CSF protein level and the titers of Wassermann reaction in the CSF decreased slowly after treatment. The gammaglobulin concentration of the CSF and the immunoglobulin production inside the blood-brain barrier were still increased beyond the first year after treatment. The results of the treatment of these patients with high doses of intravenous penicillin G were not different from the results verified with lesser doses of intramuscular penicillin that were reported in the literature.

Cerebrospinal Fluid Proteins↗
PubMed1987

[High-dose intravenous penicillin therapy in neurosyphilis. III. Evaluation of antitreponemal antibodies of the IgM class in cerebrospinal fluid and serum].

IgM antibodies against Treponema pallidum were investigated in the serum and in the CSF of 9 patients with symptomatic neurosyphilis, before the treatment and in several occasions after the treatment. Tests used were the FTA-Abs test, the IgM-solid phase hemadsorption test and an IgM-Elisa test. Titers of reactions decreased after treatment but they were still reactive in the blood and in the CSF during the second year after the treatment.

Antibodies, Bacterial↗
PubMed1985

[Neuropsychological semiology].

The authors present a version of the Luria's neuropsychological investigation from an initial battery comprising all the Luria's items, and according to Christensen. It is not an standardized procedure but the investigation of each area of the brain that can be regarded as a supplement to classical neurology. Each of the areas makes a highly specific contribution to ensure the operation of the functional system.

Brain↗