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1610 Neurological manifestations of the intermittent acute porphyria: case report
$508
Friday, November 11, 2005
pyramidal cells appear on layer V at the tenth day and on both layer V and III after culturing 12 days. In the control group, NFH positive pyranfidal cells appear on layer V in 5-day-old rats, and in over 3-week-old rats which appear on both layer V and III. In cultured cerebral slices, the number of pyramidal neurons in layer V of M1 area is invariable fi'om 12 days to 2 months. Conclusions: Orgaotypic cerebral culture can be used to study postnatal development of neocortex and build some in vitro models of neurodegenerative diseases. 1605 Tau protein, but not 14-3-3 protein, is elevated in rdapsing reurtting MS Frederiksen JL 1, Kristensen K 1, Milthers ja, Chtistiansen M 2, Csarna, JM 3. ~Department of Neurology, Glostrup Hospital, University o f Copenhagen, Denmark; 2Department o f clinical biochemistry and Department of Autoimmunity, Statens Serum Institute, Copenhagot, Denmark Background: The progress in treatments possibilities in nmltiple sclerosis (MS) has increased the need of biomarkers to make an early diagnosis of MS and to monitor the disease course and the effect of treatment. Small, retrospective studies have suggested that Tau protein and 14-3-3 protein may be valuable biomarkers of mxonal damage in MS. Methods: Tau protein and 14-3-3 protein were analysed with the routine metod used in the department of autoimmmfity and the department of clinical biochemistry, respectively. The refence values of Tau protein was divided according to age: Below 40 years, 40-70 years and above 70 years. We studied 61 patients divided into relapsingremitting (RR) MS (in -- 27) and acute ON (n - 34), either isolated or as part of MS. These results were correlated to the results IgG index and oligoclonal bands in the CSF and to findings on brain MRI. Results: The concentration of tau protein was significantly elevated in patients with RRMS and in patients with ON who went on to develop clinically definite MS, but not in patients with isolated ON. The concentrationen of Tau protein was significantly correlated to the EDSS score. The 14-3-3 proetin was not present in any patient. Conclusions: Increased concentration of tau protein may be of prognostic value for developing MS and Tau protein seems a useful marker to monitor neurolocal deficits in RRMS and may thereby correlate to the degree of mxonal skade. The relationship of Tau values with MRI and IgG status in the CSF findings will be presented at the congress. 14-3-3 protein cannot be used as a biomarker in MS.
1606 Multiple Sclerosis: evaluation of 100 cases: diagnosis, trea_hnent and evolution over the period of 1998 to 2003 Gomes, S2, Luna, AST, Pizzatto, R, Valle, ELR, Dantas, TN, Campanella, CAD, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. ~Hospital Real e Benemdrita Sociedade Portuguesa de Ben@'cigncia HRBSPB; 2Faculdade de Medicina da Universidade de Sdo Paulo FMUSP, Sao Paulo, Brazil," 3Hospital Geral Exdreito de S~o Paulo - HGESP, Brazil Objective: Clinical evaluation of the patients concerning sex, race, medium age, of the symptoms onset and ssanptoms. Methods: Clinical analysis, LCR, RNM, evoked potential and clinical evolution. Pulsetherapy with metil prednisolona and interferon B1A. Results: Female gender predominance, 20-40 age ranging, pyramidal symptoms/optical nerve/sensitive. Conclusion: The RNM works as a marker in the disease diagnosis.
1607 Isaacs Syndrome: ease report Gomes, S2, Pizzato, R, Valle, ELR, Dantas, TN, Campanella, CAD, Luna, AST, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira,
Poster Abstracts PGD, Montanaro, AC. 1Hospital Real e BenemOrita Soeiedade Portuguesa de Benefieidneia - HRBSPB; 2Faeuldade de Medieina da Universidade de Sdo Paulo F M U S P , Sao Paulo, Brazil," 3Hospital Geral Ex~rcito de Sdo Paulo HGESP, Brazil Objective: Isaacs Syndrome neuro-physiological and clinical report. Methods: PAL, 35 years old, female, with a scenario of proximal muscular strength reduction in lower and upper limbs associated with cramps, muscular contractures. Presenting over exam, distal muscular atrophy of the upper limbs, generalized cereous hypertony, grade 3+ global nmscular strength, hyporeflexy and fasciculation presence. Results: Enzimatic disturbances, ENMG evidentiating spontaneous discharges of motor unity potentials, normal neuro-conduction, pharmacological proposal done with carbamazepina obtaining improvement in the scenario. Conclusion: The Isaacs Syndrome is an autoinmmne disease developed in the kation canals through the presence of potassium attticanals antibodies. Presence of continuous nmscular activity and myokymia. Response to fenitoine and carbamazepina. 1608 Tropical Spastic Paraparesis - Hamtsp: ease report Gomes, S2, Dantas, TN, Campanella, CAD, Luna, Pizzato, R, Valle, ELR, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. ~Hospital Real e Benem~rita Sociedade Portuguesa de Beneficidneia HRBSPB; 2Faculdade de Medieina da Universidade de Sdo Paulo - F M U S P , Sao Paulo, Brazil," 3Hospital Geral Ex~reito de S~.o Paulo - HGESP, Brazil Objective: To give an account of medullar disease with retroviral etlfiology. Method: SAP, 60 years old, with lower limbs progressive motor deficit scenario for three years. Sphincteral disturbances presence. Presented paraparesis, overexdted reflexes, pallesthetic disturbances, pyramidal syndrome over exam. Positive serology for HTLVI, thoracic, cohinn RNM evidentiating T2-T9 levels increase. Condasion: Commentary on the tropical spastic myelopathies.
1609 Dis~nyelinating Polineuropathy in patient with Chrotdcal kidney ins~lfliciency Gomes, S2, Valle, ELR, Dantas, TN, Campanella, CAD, Luna, Pizzato, R, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 1Hospital Real e Benem~rita Sociedade Portuguesa de Beneficigncia HRBSPB; 2Faculdade de Medicina da Universidade de Sdo Paulo F M U S P , Sao Paulo, Brazil," 3Hospital Geral Ex~reito de S~o Paulo - HGESP, Brazil Objective: Report the response after use of gamaglobulin in chronical kidney patient. PC, 30 years old, with clinical scenario of IRC with kidney transplant and benefitting with hemodialysis. Developed flacid tetraparesis with hyporeflexy. During the neurophysiological investigation, presented sensitivemotor polineuropathy scenario with dismyelinating standard. LCR evidentiates protein increase. Use of gamaglobulin preconized. Results: GamaglobulJn in the 24g/day dosis for five days with good response to the neurological symptoms. Conclusion: The sensitive, motor, mixed, autonomic neuropattfic process with mxonal characteristics and uremia increase is the manifestation of what occurs in the chronical kidney insufidency. The incresase in the uremia complicates the diagnosis of the mxonal neuropathy. The neurophysiological study contributes greatly in the evaluation and the gamaglobulin in the improvement of the clinical scenario. 1610 Neurological Matfitestations of the Internfittent Acute Porphyria: Case Report
Friday, November 11, 2005
Poster Abstracts
Gomes, Sz, Dantas, TN, Campanella, CAD, Luna, Pizzato, R, Valle, ELR, Rodrignes, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 1Hospital Real e Benem&ita Sociedade Portuguesa de Ben@'cidncia HRBSPB; 2Faculdade de Medicina da Universidade de Sdo Paulo FMUSP, Sao Paulo, Brazil; 3Hospital Geral Exdrcito de Sdo Paulo HGESP, Brazil Objective: Report one intermittent acute porphyria in patient 18 years of age, caucasian, with clinical scenario of peripheral polineuropathy, abdominal pains and behavioural disturbance. Methods: Results of the ENMG, LCR, general laboratory (ALA+PBE) urinary described the approach way. Results: Intensive hydroelectrolytic replacement, hypercaloric diet, hypertonic glucose with good clinical response. Conclusion: The previously described pathology is a disorder characterized by the lffgh production and excretion of porphyrin precursors. The differential diagnosis are important.
$509
Physical examination: temperature, tetraparesthesia, preserved muscular strength, overexcited reflexes in upper and lower limbs, sensitive level on T4, and unaltered cutaneous planta reflex. LCR with protein electroforese: unaltered. Encephalic RMN presenting dismyelinating lesions in right fi'ont region, smaller than 1 cm. Cervical spine RMN showing 2cm cephalo-caudal intramedullar lesion on the medulla's rear portion at the level of c3-cd with contrast captioning with minimum medulla broadening at this level, suggesting acute dismyelinating lesion. Conclusion: the clinical signals and the exams that took place are compatible with ADEM (Acute Disseminated Encephalo Myelites) according to the researched worldwide literature. 1613 Multiple Cavernoma: case report
C-OIIlOA;,S 2, Luna, AST, Pizzatto, R, Valle, ELR, Dantas, TN, 1611 Neurological Scenario in the Behcet Disease: Case Report Gomes, S 2, Cumpanella, CAD, Luna, Pizzato, R, Valle, ELR, Dantas, TN, Rodrignes, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 1Hospital Real e Benemdrita Soeiedade Portuguesa de Beneficidncia HRBSPB; 2Faculdade de Medicina da Universidade de Sdo Paulo F M U S P , Sao Paulo, Brazil," 3Hospital Geral Ex&cito de Sdo Paulo HGESP, Brazil Objective: To describe the case of Behcet disease with neurological manifestations. AAG, 30 years old, with AVCi scenario for 2 years, showing visual disturbances, intense cephalea and motor deficit on the left. Reported the presence of oral and genital ulcers. Developed left peripheral facial paralysis 60 days ago and evolved with temperature, diplopia, with meningitis diagnosis. Unsuccesful use of antibiotic.therapy. Results: Altered LCR, RNM encephahis with hypersignal in T2 in bridge and ganglia of the basis. Conclusion: Behcet disease with recurrent meningoencephalitis presence. 1612 ADEM (Acute Dissenlinated Eneephalo Myelites) Gomes, Sz, Pizzato, R, Valle, ELR, Dantas, TN, Campanella, CAD, Luna, AST, Rodrignes, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 1Hospital Real e Benern&ita Sociedade Portuguesa de Beneficidncia HRBSPB; 2Faculdade de Medicina da Universidade de Sdo Paulo FMUSP, Sao Paulo, Brazil; 3Hospital Geral Ex(rcito de Sdo Paulo HGESP, Brazil The acute disseminated encefalomyelites is a rare, monophasic dismyelinating disease, which affects the central nervous system and that appears shortly after either a exanthematous, non-exanthematous or vaccination. It attacks mainly clffldren and young adults. The severe form has great importance due to the lffgh rate of mortality or morbidity on those who pull through. The clinical scenario is constituted of: convulsion, confusion, sleepiness, cephalea, temperature, nuchalgia, para or tetraplegia; para or tetraparestesia, hyperreflexia, splffncterial disturbance among others. Therefore, it is, in certain cases, very hard to differentiate from multiple sclerosis. Case Report: T.E.V. 15 years old, male, caucasian, born in Silo Paulo. Clinical Scenario: Patient presented paresthesia on the feet planta which evolved ascending to the perineal region and evolved after ten days, with paresthesia on upper limbs. Personal Background: Denies other diseases, as well as medication use; refers to viral infection episode on past fortnight.
Campanella, CAD, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 2Hospital Real e Benem~rita Sociedade Portuguesa de Benefieidneia - HRBSPB," 2Faeuldade de Medicina da Universidade de Sdo Paulo - F M U S P , Sao Paulo, Brazil," 3Hospital Germ Ex&cito de S~.o Paulo - HGESP, Brazil Background: With the advent of magnetic resonance, the differential diagnosis of expansive behavior pathologies has been more specific and in many cases precise. We have discussed the case of a female patient of 30 years of age with Epyleptic Syndrome associated with cephalea and behavior disturbance. Her tomography showed expansive left front temple lesion, and the magnetic resonance evidentiated countless lesions difusedly spread. After surgery submission, it was concluded that a cavernoma was the case. Our aim is to show how tiffs pathology incidence has increased and in tiffs case it is about nmltiple lesions. 1614 Precocious surgical treatment for post brain Aneurism Subaraehnoid Haemorrhage. Service Casuistry Goines, Sz, Pizzato, R, Valle, ELR, Dantas, TN, Campanella, CAD, Luna, AST, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 2Hospital Real e Benemdrita Sociedade Portuguesa de Benefieidncia - HRBSPB; 2Faeuldade de Medicina da Universidade de Sdo Paulo - F M U S P , Sao Paulo, Brazil," 3Hospital Geral Ex&cito de Sdo Paulo HGESP, Brazil Background: The precocious surgical treatment for post-subaradmoidhaemorrhage aneurism dipping is still controversial. The risk of intraoperative aneurismatic rupture, a greater necessity of the encephalic tissue contraction and the presence of solid clots, are limiting factors for the frequent employ of this operative technique. Aiming to prevent re-bleeding, the easing to the treatment of the vasoespasm and the intra-operative cleansing of vasoespasmogenic agents, we present the service casuistry in precociously approached ruptured brain aneurisms. The cases with ictus under 48hs and grading by Hunt and Hess scale under three were retrospectively analysed, in which it was opted for the precocious surgical treatment. The present study has as aim to show the acquired experience in service concerning the indication of tiffs operative tedmique. 1615 Deeompressive Craniectomy in Isdleinic Brain Vascular accident advantages of the Magnetic-Resonance-Oriented Precodous treahnent: comparative study and service casuistry Gomes, Sz, Luna, AST, Pizzatto, R, Valle, ELR, Dantas, TN, Campanella, CAD, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 2Hospital Real e Benem~rita Sociedade Portuguesa de BeneficiCncia HRBSPB; 2Faculdade de
Friday, November 11, 2005
pyramidal cells appear on layer V at the tenth day and on both layer V and III after culturing 12 days. In the control group, NFH positive pyranfidal cells appear on layer V in 5-day-old rats, and in over 3-week-old rats which appear on both layer V and III. In cultured cerebral slices, the number of pyramidal neurons in layer V of M1 area is invariable fi'om 12 days to 2 months. Conclusions: Orgaotypic cerebral culture can be used to study postnatal development of neocortex and build some in vitro models of neurodegenerative diseases. 1605 Tau protein, but not 14-3-3 protein, is elevated in rdapsing reurtting MS Frederiksen JL 1, Kristensen K 1, Milthers ja, Chtistiansen M 2, Csarna, JM 3. ~Department of Neurology, Glostrup Hospital, University o f Copenhagen, Denmark; 2Department o f clinical biochemistry and Department of Autoimmunity, Statens Serum Institute, Copenhagot, Denmark Background: The progress in treatments possibilities in nmltiple sclerosis (MS) has increased the need of biomarkers to make an early diagnosis of MS and to monitor the disease course and the effect of treatment. Small, retrospective studies have suggested that Tau protein and 14-3-3 protein may be valuable biomarkers of mxonal damage in MS. Methods: Tau protein and 14-3-3 protein were analysed with the routine metod used in the department of autoimmmfity and the department of clinical biochemistry, respectively. The refence values of Tau protein was divided according to age: Below 40 years, 40-70 years and above 70 years. We studied 61 patients divided into relapsingremitting (RR) MS (in -- 27) and acute ON (n - 34), either isolated or as part of MS. These results were correlated to the results IgG index and oligoclonal bands in the CSF and to findings on brain MRI. Results: The concentration of tau protein was significantly elevated in patients with RRMS and in patients with ON who went on to develop clinically definite MS, but not in patients with isolated ON. The concentrationen of Tau protein was significantly correlated to the EDSS score. The 14-3-3 proetin was not present in any patient. Conclusions: Increased concentration of tau protein may be of prognostic value for developing MS and Tau protein seems a useful marker to monitor neurolocal deficits in RRMS and may thereby correlate to the degree of mxonal skade. The relationship of Tau values with MRI and IgG status in the CSF findings will be presented at the congress. 14-3-3 protein cannot be used as a biomarker in MS.
1606 Multiple Sclerosis: evaluation of 100 cases: diagnosis, trea_hnent and evolution over the period of 1998 to 2003 Gomes, S2, Luna, AST, Pizzatto, R, Valle, ELR, Dantas, TN, Campanella, CAD, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. ~Hospital Real e Benemdrita Sociedade Portuguesa de Ben@'cigncia HRBSPB; 2Faculdade de Medicina da Universidade de Sdo Paulo FMUSP, Sao Paulo, Brazil," 3Hospital Geral Exdreito de S~o Paulo - HGESP, Brazil Objective: Clinical evaluation of the patients concerning sex, race, medium age, of the symptoms onset and ssanptoms. Methods: Clinical analysis, LCR, RNM, evoked potential and clinical evolution. Pulsetherapy with metil prednisolona and interferon B1A. Results: Female gender predominance, 20-40 age ranging, pyramidal symptoms/optical nerve/sensitive. Conclusion: The RNM works as a marker in the disease diagnosis.
1607 Isaacs Syndrome: ease report Gomes, S2, Pizzato, R, Valle, ELR, Dantas, TN, Campanella, CAD, Luna, AST, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira,
Poster Abstracts PGD, Montanaro, AC. 1Hospital Real e BenemOrita Soeiedade Portuguesa de Benefieidneia - HRBSPB; 2Faeuldade de Medieina da Universidade de Sdo Paulo F M U S P , Sao Paulo, Brazil," 3Hospital Geral Ex~rcito de Sdo Paulo HGESP, Brazil Objective: Isaacs Syndrome neuro-physiological and clinical report. Methods: PAL, 35 years old, female, with a scenario of proximal muscular strength reduction in lower and upper limbs associated with cramps, muscular contractures. Presenting over exam, distal muscular atrophy of the upper limbs, generalized cereous hypertony, grade 3+ global nmscular strength, hyporeflexy and fasciculation presence. Results: Enzimatic disturbances, ENMG evidentiating spontaneous discharges of motor unity potentials, normal neuro-conduction, pharmacological proposal done with carbamazepina obtaining improvement in the scenario. Conclusion: The Isaacs Syndrome is an autoinmmne disease developed in the kation canals through the presence of potassium attticanals antibodies. Presence of continuous nmscular activity and myokymia. Response to fenitoine and carbamazepina. 1608 Tropical Spastic Paraparesis - Hamtsp: ease report Gomes, S2, Dantas, TN, Campanella, CAD, Luna, Pizzato, R, Valle, ELR, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. ~Hospital Real e Benem~rita Sociedade Portuguesa de Beneficidneia HRBSPB; 2Faculdade de Medieina da Universidade de Sdo Paulo - F M U S P , Sao Paulo, Brazil," 3Hospital Geral Ex~reito de S~.o Paulo - HGESP, Brazil Objective: To give an account of medullar disease with retroviral etlfiology. Method: SAP, 60 years old, with lower limbs progressive motor deficit scenario for three years. Sphincteral disturbances presence. Presented paraparesis, overexdted reflexes, pallesthetic disturbances, pyramidal syndrome over exam. Positive serology for HTLVI, thoracic, cohinn RNM evidentiating T2-T9 levels increase. Condasion: Commentary on the tropical spastic myelopathies.
1609 Dis~nyelinating Polineuropathy in patient with Chrotdcal kidney ins~lfliciency Gomes, S2, Valle, ELR, Dantas, TN, Campanella, CAD, Luna, Pizzato, R, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 1Hospital Real e Benem~rita Sociedade Portuguesa de Beneficigncia HRBSPB; 2Faculdade de Medicina da Universidade de Sdo Paulo F M U S P , Sao Paulo, Brazil," 3Hospital Geral Ex~reito de S~o Paulo - HGESP, Brazil Objective: Report the response after use of gamaglobulin in chronical kidney patient. PC, 30 years old, with clinical scenario of IRC with kidney transplant and benefitting with hemodialysis. Developed flacid tetraparesis with hyporeflexy. During the neurophysiological investigation, presented sensitivemotor polineuropathy scenario with dismyelinating standard. LCR evidentiates protein increase. Use of gamaglobulin preconized. Results: GamaglobulJn in the 24g/day dosis for five days with good response to the neurological symptoms. Conclusion: The sensitive, motor, mixed, autonomic neuropattfic process with mxonal characteristics and uremia increase is the manifestation of what occurs in the chronical kidney insufidency. The incresase in the uremia complicates the diagnosis of the mxonal neuropathy. The neurophysiological study contributes greatly in the evaluation and the gamaglobulin in the improvement of the clinical scenario. 1610 Neurological Matfitestations of the Internfittent Acute Porphyria: Case Report
Friday, November 11, 2005
Poster Abstracts
Gomes, Sz, Dantas, TN, Campanella, CAD, Luna, Pizzato, R, Valle, ELR, Rodrignes, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 1Hospital Real e Benem&ita Sociedade Portuguesa de Ben@'cidncia HRBSPB; 2Faculdade de Medicina da Universidade de Sdo Paulo FMUSP, Sao Paulo, Brazil; 3Hospital Geral Exdrcito de Sdo Paulo HGESP, Brazil Objective: Report one intermittent acute porphyria in patient 18 years of age, caucasian, with clinical scenario of peripheral polineuropathy, abdominal pains and behavioural disturbance. Methods: Results of the ENMG, LCR, general laboratory (ALA+PBE) urinary described the approach way. Results: Intensive hydroelectrolytic replacement, hypercaloric diet, hypertonic glucose with good clinical response. Conclusion: The previously described pathology is a disorder characterized by the lffgh production and excretion of porphyrin precursors. The differential diagnosis are important.
$509
Physical examination: temperature, tetraparesthesia, preserved muscular strength, overexcited reflexes in upper and lower limbs, sensitive level on T4, and unaltered cutaneous planta reflex. LCR with protein electroforese: unaltered. Encephalic RMN presenting dismyelinating lesions in right fi'ont region, smaller than 1 cm. Cervical spine RMN showing 2cm cephalo-caudal intramedullar lesion on the medulla's rear portion at the level of c3-cd with contrast captioning with minimum medulla broadening at this level, suggesting acute dismyelinating lesion. Conclusion: the clinical signals and the exams that took place are compatible with ADEM (Acute Disseminated Encephalo Myelites) according to the researched worldwide literature. 1613 Multiple Cavernoma: case report
C-OIIlOA;,S 2, Luna, AST, Pizzatto, R, Valle, ELR, Dantas, TN, 1611 Neurological Scenario in the Behcet Disease: Case Report Gomes, S 2, Cumpanella, CAD, Luna, Pizzato, R, Valle, ELR, Dantas, TN, Rodrignes, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 1Hospital Real e Benemdrita Soeiedade Portuguesa de Beneficidncia HRBSPB; 2Faculdade de Medicina da Universidade de Sdo Paulo F M U S P , Sao Paulo, Brazil," 3Hospital Geral Ex&cito de Sdo Paulo HGESP, Brazil Objective: To describe the case of Behcet disease with neurological manifestations. AAG, 30 years old, with AVCi scenario for 2 years, showing visual disturbances, intense cephalea and motor deficit on the left. Reported the presence of oral and genital ulcers. Developed left peripheral facial paralysis 60 days ago and evolved with temperature, diplopia, with meningitis diagnosis. Unsuccesful use of antibiotic.therapy. Results: Altered LCR, RNM encephahis with hypersignal in T2 in bridge and ganglia of the basis. Conclusion: Behcet disease with recurrent meningoencephalitis presence. 1612 ADEM (Acute Dissenlinated Eneephalo Myelites) Gomes, Sz, Pizzato, R, Valle, ELR, Dantas, TN, Campanella, CAD, Luna, AST, Rodrignes, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 1Hospital Real e Benern&ita Sociedade Portuguesa de Beneficidncia HRBSPB; 2Faculdade de Medicina da Universidade de Sdo Paulo FMUSP, Sao Paulo, Brazil; 3Hospital Geral Ex(rcito de Sdo Paulo HGESP, Brazil The acute disseminated encefalomyelites is a rare, monophasic dismyelinating disease, which affects the central nervous system and that appears shortly after either a exanthematous, non-exanthematous or vaccination. It attacks mainly clffldren and young adults. The severe form has great importance due to the lffgh rate of mortality or morbidity on those who pull through. The clinical scenario is constituted of: convulsion, confusion, sleepiness, cephalea, temperature, nuchalgia, para or tetraplegia; para or tetraparestesia, hyperreflexia, splffncterial disturbance among others. Therefore, it is, in certain cases, very hard to differentiate from multiple sclerosis. Case Report: T.E.V. 15 years old, male, caucasian, born in Silo Paulo. Clinical Scenario: Patient presented paresthesia on the feet planta which evolved ascending to the perineal region and evolved after ten days, with paresthesia on upper limbs. Personal Background: Denies other diseases, as well as medication use; refers to viral infection episode on past fortnight.
Campanella, CAD, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 2Hospital Real e Benem~rita Sociedade Portuguesa de Benefieidneia - HRBSPB," 2Faeuldade de Medicina da Universidade de Sdo Paulo - F M U S P , Sao Paulo, Brazil," 3Hospital Germ Ex&cito de S~.o Paulo - HGESP, Brazil Background: With the advent of magnetic resonance, the differential diagnosis of expansive behavior pathologies has been more specific and in many cases precise. We have discussed the case of a female patient of 30 years of age with Epyleptic Syndrome associated with cephalea and behavior disturbance. Her tomography showed expansive left front temple lesion, and the magnetic resonance evidentiated countless lesions difusedly spread. After surgery submission, it was concluded that a cavernoma was the case. Our aim is to show how tiffs pathology incidence has increased and in tiffs case it is about nmltiple lesions. 1614 Precocious surgical treatment for post brain Aneurism Subaraehnoid Haemorrhage. Service Casuistry Goines, Sz, Pizzato, R, Valle, ELR, Dantas, TN, Campanella, CAD, Luna, AST, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 2Hospital Real e Benemdrita Sociedade Portuguesa de Benefieidncia - HRBSPB; 2Faeuldade de Medicina da Universidade de Sdo Paulo - F M U S P , Sao Paulo, Brazil," 3Hospital Geral Ex&cito de Sdo Paulo HGESP, Brazil Background: The precocious surgical treatment for post-subaradmoidhaemorrhage aneurism dipping is still controversial. The risk of intraoperative aneurismatic rupture, a greater necessity of the encephalic tissue contraction and the presence of solid clots, are limiting factors for the frequent employ of this operative technique. Aiming to prevent re-bleeding, the easing to the treatment of the vasoespasm and the intra-operative cleansing of vasoespasmogenic agents, we present the service casuistry in precociously approached ruptured brain aneurisms. The cases with ictus under 48hs and grading by Hunt and Hess scale under three were retrospectively analysed, in which it was opted for the precocious surgical treatment. The present study has as aim to show the acquired experience in service concerning the indication of tiffs operative tedmique. 1615 Deeompressive Craniectomy in Isdleinic Brain Vascular accident advantages of the Magnetic-Resonance-Oriented Precodous treahnent: comparative study and service casuistry Gomes, Sz, Luna, AST, Pizzatto, R, Valle, ELR, Dantas, TN, Campanella, CAD, Rodrigues, LC, Cassis, R, Sassine, S, Godoy, R, Oliveira, PGD, Montanaro, AC. 2Hospital Real e Benem~rita Sociedade Portuguesa de BeneficiCncia HRBSPB; 2Faculdade de