Clinical characteristics and surgical outcome of patients with temporal lobe tumors and epilepsy

This is a retrospective study of 21 surgically treated patients with temporal lobe tumors and epilepsy. Evaluation included clinical data, EEG findings, structural scans, pathological diagnosis and post-surgical follow-up. There were 9 cases of ganglioglioma, 5 pilocytic astrocytoma, 3 ganglioneuroma, 2 dysembryoplastic neuroepithelial tumor, 1 pleomorphic xantoastrocytoma, and 1 meningioangiomatosis. Mean follow-up time was 22 months and outcome was evaluated according to Engel's classification; 76.2% were classified in class I and 23.8% in II and III. All patients classes II and III had been submitted to mesial and neocortical resections. There were no differences related to clinical characteristics, pathological diagnosis or duration of follow-up in patients seizure-free or not. All patients had abnormal MRI and ten of these had normal CT; the MRI characteristics were compared to pathological diagnosis and specific histological characteristics of the tumors were not discernible by MRI. We concluded that MRI was essential for the diagnosis and precise location of TL tumors. Ganglioglioma was the most frequent tumor and lesionectomy associated to mesial resection doesn't guarantee a better prognosis.

Pleomorphic xanthoastrocytoma of the cerebellum

We report a clinicopathologic case of a pure cerebellar pleomorphic xanthoastrocytoma occurring in a 68-year-old male patient. The occurrence of pleomorphic xanthoastrocytoma outside the cerebral hemispheres is exceedingly rare. In the cerebellum only five cases have been reported so far, four of which are composite pleomorphic xanthoastrocytoma-gangliogliomas. This observation reinforces the argument that pleomorphic xanthoastrocytomas should be included in the differential diagnosis of cerebellar neoplasms.

Subacute sclerosing panencephalitis. Clinical aspects and prognosis. The Brazilian registry

Subacute sclerosing panencephalitis (SSPE) is an inflammatory neurodegenerative disease related to the persistence of measles virus. Although its frequency is declining because of measles eradication, we still have some cases being diagnosed. With the aim to describe epidemiological aspects of SSPE in Brazil, we sent a protocol to Child Neurologists around the country, 48 patients were registered, 27 (56%) were from the southeast region, 34 (71%) were male and 35 (73%) white, 27 (56%) had measles, 9 (19%) had measles and were also immunized, 7 (14%) received only immunization, 1 patient had a probable neonatal form. Mean time between first symptoms and diagnosis was 12 months (22 started with myoclonus or tonic-clonic seizures, 7 (14%) with behavioral disturbances); 36 patients (75%) had EEG with pseudoperiodic complexes. Follow up performed in 28 (58%) patients showed: 12 died, 2 had complete remission and the others had variable neurological disability. Our data shows endemic regions in the country, a high incidence of post-immunization SSPE and a delay between first symptom and diagnosis.

Psychotic symptoms in dementia associated with motor neuron disease: a pathophysiological hypothesis

Three patients with neuropathologically confirmed frontotemporal dementia, motor neuron disease type, manifested hallucinations. In this dementia, the superficial layers of the frontal and temporal cortices are predominantly affected. Hallucinations may emerge as release phenomena secondary to selective laminar cortical involvement.

[Diagnosis of metabolic diseases of the nervous system in children through ultrastructural analysis of non cerebral tissue]

Although biochemical and molecular genetic analysis are the most precise methods for the diagnosis of metabolic diseases, morphological studies remain a very important diagnostic method mainly in countries like Brazil, where clinical laboratories are unable to perform most of the exams required for the diagnosis of these diseases. Moreover, pathologic evaluation is the single diagnostic method for some disorders whose metabolic defect is unknown such as neuronal ceroid-lipofuscinosis, infantile neuroaxonal dystrophy or Lafora disease. We present our experience with ultrastructural analysis in 582 exams of ocular conjunctiva (n = 320), skin (n = 92) or peripheral nerve (n = 170) performed between 1975 and 1996, in 486 children. In 112 cases there were definite ultrastructural changes. In 59 cases, the sole ultrastructural exam allowed the diagnosis. In 29, the changes were less specific, and the final diagnosis was performed by a combination of clinical and pathological analysis. In the remaining 24 cases, a generic diagnosis of mucopolysaccharidosis was done in 8 cases, oligosaccharidosis in 4 cases and GM2 gangliosidosis in 12 cases. Whenever a biochemical test was performed in overseas laboratories, the initial diagnosis was confirmed. These results stress the importance of ultrastructural analysis in non-cerebral tissues for the diagnosis of many metabolic disorders mainly when biochemical tests cannot be performed.

[Dysembryoplastic neuroepithelial tumor. An epidemiological study from a single institution]

The true incidence of dysembryoplastic neuroepithelial tumor (DNT) is unknown. Variable estimations have been advanced according to the type of recruitment of patients. In series of patients with tumors who were operated on for pharmacoresistant epilepsy, the rates varied widely, from 5% to 87%. Among 600 pediatric tumors in a series, 9 DNT (1.5%) were found. Since DNT was identified only in 1988, we reviewed our cases (1975-1991) of gangliogliomas (n = 25), oligoastrocytomas (n = 9), temporal oligodendrogliomas (n = 11), temporal astrocytomas grade II (OMS 1993) (n = 44) irrespective to age, as well as all astrocytomas grade II (n = 61) and oligodendrogliomas (n = 10) in patients up to 20 years of age. Seven DNT were encountered. Four cases had been formerly diagnosed as gangliogliomas and 3 as astrocytomas grade II. From 1992 on, 4 more DNT were diagnosed, making up a total of 11 cases. Eight patients were under age 17 (6 y to 17 y, mean 10.3 y) and 3 were 27, 42 and 51 year-old. Eight tumors were temporal, 1 frontal and 2 occipital. All patients have had pharmacoresistant epilepsy. Among all neuroepithelial tumors diagnosed in our Division in the last 22 years, DNT comprises 1.2% in patients under age 20 (n = 660), 0.24% in patients over 20 years (n = 1254), and 0.63% all ages considered (n = 1914).

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.

Double pathology in Rasmussen's encephalitis: etiologic considerations

In a 7-year-old girl with epilepsia partialis continua (EPC) involving the left face, arm, and leg for 1 year, serial neuroimaging studies showed progressive, brain atrophy. Because medical treatment was ineffective, she underwent a large fronto-temporal surgical resection. Neuropathological examination showed loss of lamination and dysplastic neurons, gliosis, microglial nodules, and perivascular cuffing. Such "double pathology" (dysgenesia and a chronic inflammatory process) may have implications for the pathophysiology of Rasmussen's syndrome.

Intractable complex partial seizures associated with posterior cerebral artery giant aneurysm: a case report

Giant aneurysms have rarely been reported in association with intractable complex partial seizures (CPS). We report a 30-year-old man with intractable CPS since age 18 years. Seizure onset was electrically localized to right temporal lobe. Preoperative neuroimaging studies showed a partially thrombosed giant aneurysm of the right posterior cerebral artery. Selective amygdalohippocampectomy and occlusion of the posterior cerebral artery did not cause deficits. The patient has been seizure-free for 15 months after operation. We review the relevant literature on aneurysms as a cause of epilepsy.

Primary malignant rhabdoid tumor of the spinal dura

We report a case of an intradural extramedullary malignant rhabdoid tumor (MRT) occurring in a 2-year-old girl. Histologically, immunohistochemically and ultrastructurally, the tumor fulfilled the diagnostic criteria for MRT. Many tumor cells contained typical cytoplasmic eosinophilic hyaline inclusions which were filamentous by electron microscopy. Positive vimentin staining was observed immunohistochemically but epithelial markers were negative. Extrarenal MRT are rare. Ten instances in the central nervous system have been reported. This case is the first intradural MRT of the spinal canal. The differential diagnosis from other tumors of this region is important because the prognosis and therapeutic approaches are greatly different.

Congenital insensitivity to pain with anhidrosis (hereditary sensory and autonomic neuropathy type IV)

Congenital insensitivity to pain with anhidrosis (CIPA, hereditary sensory and autonomic neuropathy type IV) is an exceedingly rare disease. Only 31 cases have been reported. We report a 4-year-old girl with CIPA and include a complete review of the literature. CIPA is a severe autosomal recessive condition that leads to self-mutilation in the first months of life and to bone fractures, multiple scars, osteomyelitis, joint deformities, and limb amputation as the children grow older. Mental retardation is common. Death from hyperpyrexia occurs within the first 3 years of life in almost 20% of the patients. Ultrastructural and morphometric studies of the peripheral nerves demonstrate a loss of the unmyelinated and small myelinated fibers. The actual physiopathologic mechanism of this developmental disorder remains unknown.

Brain tumors in the first two years of life: a review of forty cases

From 1962 to 1989, 40 infants with brain tumors and less than 2 years old were treated at the Department of Neurology of the Clinical Hospital of the University of São Paulo Medical School. The clinical and neuropathological findings were reviewed as to histological diagnosis, age, sex, signs and symptoms, therapy and outcome. Medulloblastoma was the most common histological type (n = 11), followed by ependymoma (n = 9), choroid plexus tumor (n = 6), astrocytoma (n = 3) and primitive neuroectodermal tumor (n = 2). The tumor was infratentorial in 21 infants, supratentorial in 18 and disseminated in 1.

[The neuropathology of the acquired immunodeficiency syndrome (AIDS)]

The nervous system is frequently involved in patients with AIDS. The lesions can be due to the human immunodeficiency virus (HIV), to opportunistic agents, to the development of tumours, and to occasional nonspecific factors, such as circulatory, metabolic and degenerative changes. The changes directly related to the presence of the HIV include the HIV encephalitis and leucoencephalopathy, the diffuse polydystrophy and the vacuolar myelopathy. The pathogenesis of these lesions is not yet completely clear. Macrophages are the main cells infected by the HIV, and it seems that the cytotoxic effects on the nervous tissue are indirect, may be due to the release of substances by infected macrophages. Among the opportunistic infections, the most frequent is toxoplasmosis followed by cryptococcosis and cytomegalovirus infection, with some differences in series from various countries. Many other agents have been observed in the brain of patients with AIDS. B-cell lymphoma is the most frequent tumour found in the brain and it is not uncommon the association of infections and/or tumours.

Brain metastasis of a malignant fibrous histiocytoma of the lung

Sarcomas metastatic to the brain as well as primary malignant fibrous histiocytomas of the lung are very unusual tumors. The authors report a case of a 52-year-old man who presented with neurological symptoms due to cerebral metastasis of a malignant fibrous histiocytoma of the lung and provide a review of the literature on the subject.

Acute encephalopathy with bilateral striatal necrosis. A distinctive clinicopathological condition

Two patients with acute encephalopathy with bilateral striatal necrosis are presented and the literature on the subject is reviewed. The disease is characterized by abrupt onset following a systemic infectious illness, with disturbance of consciousness, absence of speech, dystonic movements of the limbs, general stiffness, opisthotonus, tremor, facial grimacing, and stereotyped reaction to painful stimuli. After a variable period of time, there is gradual improvement of the neurological status with clearing of consciousness and recovery of motor functions. Mild CSF pleocytosis is the only abnormal laboratory test encountered. Cranial imaging shows from the beginning of the illness, bilateral involvement of the striatum that may persist indefinitely. The pathogenesis of this disorder remains unknown although an infectious or para-infectious mechanism seems to be the most likely possibility.

Pathology of the central nervous system in patients infected with the human immunodeficiency virus (HIV): a report of 252 autopsy cases from Brazil

The central nervous system (CNS) was studied in 252 HIV-infected patients from the States of Rio de Janeiro and São Paulo in Brazil, the regions with the highest incidence of AIDS in the country. We compared the frequency and morphology of opportunistic infections and CNS changes caused by the HIV, with those described in other series and briefly analysed the risk factors involved in our cases. There were CNS lesions in 230 cases (91.3%), 30 (11.9%) with multiple infections and/or tumours. Most infections were opportunistic (65.4%), including 15.4% viral and 50% bacterial, fungal or protozoal infections. The most frequent was toxoplasmosis (34.1%), followed by cryptococcosis (13.5%), cytomegalovirus (CMV) infection (7.9%) and nodular encephalitis (6.7%). Primary lymphomas were observed in 4% of the cases and HIV encephalitis or leukoencephalopathy in 10.7%. Other opportunistic and HIV associated lesions were present in a limited number of cases and there were also vascular and non-specific lesions. Our study confirms the high frequency of CNS lesions in HIV infected patients. They are morphologically similar to those previously described. However, the higher incidence of toxoplasmosis and cryptococcosis, a lower incidence of viral opportunistic and HIV-associated lesions, and the presence of rarer lesions such as histoplasmosis and chagasic encephalitis, differ from other series, and may reflect geographical and/or socio-economic factors.

[Krabbe's disease (globoid cell leukodystrophy). Apropos of 5 cases]

A clinical study on five cases of Krabbe's disease (globoid cell leukodystrophy) was performed. A final diagnosis was done either with post-mortem study (two cases) or by enzymatic assays carried on cultured fibroblasts (two cases). Peripheral nerve biopsy for electron microscopy was performed in all cases, and the ultrastructural alterations characteristics of Krabbe's disease were always found. The authors emphasize the suggestive clinical and laboratory data which enable the diagnosis of Krabbe's disease in the absence of the ultrastructural exam of peripheral nerve, or the enzymatic assays not performed in this country.

Expression of developmentally defined retinal phenotypes in the histogenesis of retinoblastoma

Retinoblastoma, the most common intraocular tumor of childhood, is a malignant neoplasm that arises during retinal development. The embryonal cell target for neoplastic transformation is not yet clearly defined. To better understand the histogenetic potential of this tumor, the expression of photoreceptor and glial cell-associated proteins were examined in 22 primary retinoblastomas. Interphotoreceptor retinol-binding protein (IRBP), cone and rod opsins were selected as the photoreceptor specific proteins due to their different temporal patterns of expression during normal retinal development. Neoplastic Müller cell differentiation, and non-neoplastic reactive astrocytes were identified using cellular retinaldehyde binding-protein (CRAlBP), and glial fibrillary acidic protein (GFAP), respectively. Photoreceptor proteins were present in 16 cases and showed different cellular patterns of expression. IRBP and cone opsin were usually abundant. Although rod opsin was clearly identified in eight tumors, its expression was more restricted than either IRBP or cone opsin. This differential pattern of expression, opposite to the normal pattern of photoreceptor gene expression in the adult retina, corresponded to a marked decrease in mRNA for rod opsin. Cone opsin and IRBP colocalized in fleurettes demonstrating that neoplastic human cone cells are capable of IRBP synthesis. Müller cell differentiation was present in 12 of the 16 cases in which photoreceptor proteins were detected. In contrast, GFAP was only present in reactive, stromal astrocytes associated with blood vessels. Our data suggest that the retinoblastoma has the histogenetic potential of the immature neural retinal epithelium which can give rise to both photoreceptor and Müller cell lineages. The differential expression of cone and rod phenotypes in retinoblastoma is consistent with the "default" mechanism of cone cell differentiation.

[Neurologic changes in congenital heart diseases: a neuropathologic study]

A neuropathologic study in 190 consecutive autopsies of patients with congenital cardiopathy was performed: 116 cases underwent a surgical procedure (S group) and the remaining 74 were non-surgical (NS group). Neuropathologic alterations were observed in 71 cases (41 in the S group and 30 in the NS group). However, most of the 129 cases with a normal examination had died in the first 72 hours either after surgery or the clinical events responsible for the death. Almost all the neuropathologic alterations were hypoxic ischemic. Infarctions, single or multiple, were found in 41 cases (23 in the S and 18 in the NS group). An embolic mechanism could be detected in 12 cases. Diffuse hypoxic changes were present in 17 cases (10 in the S and 7 in the NS group). Hemorrhages were found in 11 (6 in the S and 5 in NS group), 4 of which were related to a disseminated intravascular coagulation. In 17 cases (5 in the NS and 12 in the S group), the picture was of a periventricular leukomalacia. All these cases concerned children under 6 months of age. In 7 cases inflammatory alterations were present (diffuse micro-abscesses in 6 and a frontal lobe abscess in 1). Almost all cases in both groups presented clinical complications, isolated or associated, potentially harmful to the brain, as cardiac arrest, cardiac low output, hypoxemia, and respiratory distress. If was impossible to determine in each case the magnitude of the factor or factors responsible for the correspondent pattern of neuropathologic damage. There was no difference as to the neuropathologic pattern between congenital cardiopathies leading to increased or decreased pulmonary blood flow.

Fatal meningoencephalitis caused by reactivation of Trypanosoma cruzi infection in a patient with AIDS

We report a case of fatal chagasic meningoencephalitis in an AIDS patient. Acute exacerbation of chronic Chagas' disease with involvement of the CNS is uncommon and occurs only in immunocompromised patients. This is the third such reported reactivation and it underscores the importance of considering Chagas' disease in HIV-positive patients from endemic regions.

Clinical analysis in nine Brazilian cases of the Rett syndrome

The author reports on the clinical and laboratory findings of 9 cases of the Rett syndrome (RS) diagnosed in Brazil. All patients are female. The age of onset varied from 6 months to 2 years. The onset of the manual stereotypies varied from 6 months to 3 years. Hyperventilation was observed in only 3 cases. Epilepsy was present in all cases. EEGs were always abnormal and the CT scan showed mild atrophy in the majority of the cases. EMG lysosomal enzymes analysis, and conjunctival biopsy, whenever performed, did not show abnormalities. In spite of the lack of epidemiological data, RS in Brazil must be as frequent as in the first-world countries.

Cerebellar desmoplastic medulloblastomas. A further immunohistochemical characterization of the reticulin-free pale islands

We studied by immunohistochemistry the features of differentiation in 24 desmoplastic and 16 classic medulloblastomas (median patient ages, 18 and 6.5 years, respectively) with the use of a panel of cytoskeletal and synaptosomal markers. A distinctive pattern of immunoreactivity with a series of monoclonal antibodies (Mabs) was documented in the polar tumor cells forming the reticulin-free pale islands of the desmoplastic variant, denoting overt neuritogenesis. These comprised the following: (1) Mab Tp-NFP1A3 recognizing an epitope in the high-molecular-weight (Mr) isoform of neurofilament protein; (2) Mab AP18 to the high-Mr microtubule-associated protein 2; (3) Mab TUJ1 recognizing the class III beta-tubulin isotype (human h beta 4); and (4) Mab SY38 to synaptophysin. Immunoblot analysis confirmed the expression of h beta 4 in three medulloblastomas, yielding strong single bands in two desmoplastic medulloblastomas and a considerably weaker band in one classic medulloblastoma. Glial fibrillary acidic protein-positive tumor cells frequently formed an integral component of the pale islands. Oligodendrogliallike areas in one classic and in three desmoplastic medulloblastomas were immunopositive for the Mabs to synaptophysin, microtubule-associated protein 2, and h beta 4, indicating a neuroblastic nature. We propose that the reticulin-free structures of desmoplastic medulloblastomas constitute neoplastic foci with features of predominantly neuronal and, to a lesser degree, astroglial differentiation.

Glial fibrillary acidic protein and cytokeratin in choroid plexus tumors. An immunohistochemical study

Ten cases of choroid plexus tumors (3 papillomas and 7 carcinomas) were tested for the presence of glial fibrillary acidic protein (GFAP) and cytokeratin. None of the papillomas and one of the carcinomas were positive with GFAP antisera. Cytokeratin-positive cells were present in 2 of 7 carcinomas and in all papillomas. There seems to be a positive correlation between the degree of the tumor differentiation and the expression of intermediate filaments.

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.

Extraneural metastasis of a brainstem astrocytoma in a child: clinicopathological report

Extraneural metastases of brainstem gliomas are exceedingly rare. Only four such cases are reported in the literature. We report on a case of a 3-year-old girl with an anaplastic astrocytoma of the brainstem which metastasized to the cervical lymph nodes.

Childhood Degos disease with prominent neurological symptoms: report of a clinicopathological case

Degos disease is a rare disorder, characterized by a vasculopathy of unknown origin that leads to typical skin lesions and involves other organ systems. It is frequently a lethal condition; death occurs as a consequence of intestinal perforation. In about 20% of cases, the central nervous system is involved and the neurological symptoms can be prominent. The incidence of the disease in children is very uncommon. We report the case of teenage girl who had Degos disease with prominent neurological involvement.

[Rett's syndrome: analysis of the 1st 5 cases diagnosed in Brazil]

Five cases of patients with the Rett syndrome are reported. The criteria for this diagnosis in these cases are discussed. These are the first cases of the Rett syndrome reported in Brazil and the authors call attention to the fact that this syndrome seems to be in our country as frequent as in USA, Europe and Japan where it has been more studied.

[Ultrastructural study of conjunctival biopsies in metabolic diseases of the nervous system]

Forty conjunctival biopsies from children suffering from metabolic diseases of the CNS were studied ultrastructurally. In 20 cases they were abnormal (8 mucopolysaccharidosis, 6 GM1 gangliosidosis, 4 infantile neuroaxonal dystrophy, 1 GM2 gangliosidosis, 1 late infantile ceroid lipofuscinosis). In the 20 remaining cases the biopsies did not show abnormalities. From these, 2 were proven as Leigh disease and Hallervorden-Spatz disease in which there is no conjunctival ultrastructural alterations; in 2 cases (one metachromatic leukodystrophy and one adrenoleukodystrophy) the results were false negative); in 4 clinically suspected cases of late infantile ceroid lipofuscinosis no alterations were observed and the results were not conclusive. In the remaining 12 cases the negatives allowed to rule out lysosomal disorders. The ultrastructural study of the conjunctival biopsy is an important tool for the diagnosis of neurological metabolic diseases of children mainly when sophisticated biochemical procedures are not available.

Neuropathology of acquired immunodeficiency syndrome (AIDS). Analysis of 22 Brazilian cases

The neuropathologic study of 22 Brazilian cases of acquired immuno-deficiency syndrome (AIDS) was performed. Thirteen cases (59%) showed neuropathologic lesions. These included infection by Toxoplasma (n = 4), Cryptococcus neoformans (n = 3), viral encephalitis (n = 4), primary lymphomas (n = 2), isolated cerebral infarct (n = 1), and reactive gliosis (n = 1). In 2 cases, primary lymphoma and viral encephalitis were associated. Axonal spheroids in the gracilis and cuneatus nuclei were present in a case of toxoplasmosis. Mammillary bodies lesions consistent with Wernicke's encephalopathy were found in a case of viral encephalitis. In addition, circulatory changes (focal cortical infarcts) were associated lesions in 3 cases. These findings were compared with the main series reported in American and European literature.

Fatal encephalopathy due to Lagochilascaris minor infection

A 14-year-old boy with a tetralogy of Fallot showed a subacute, progressive encephalopathy characterized by headache, stupor and coma. Death occurred three months after the beginning of the illness. Neuropathologic examination revealed diffuse foci of necrosis of the cerebral hemispheres and cerebellum, and the presence of the nematode Lagochilascaris minor in the parenchyma and in the cisterns at the base of the brain. In almost all 28 cases of human lagochilascaris previously reported, the worms were located in the soft tissues of the neck and throat, tonsils, mastoids and paranasal sinuses. This is the first reported case in which Lagochilascaris infected the brain. Since the life cycle of the worm is unknown the pathogenesis of the central nervous system lesions is obscure.

A Brazilian girl with the Rett syndrome

A Brazilian girl with the Rett syndrome is reported. The criteria for this diagnosis in this case are discussed. This is the first reported case of the Rett syndrome in the Southern Hemisphere.

[Infantile neuroaxonal dystrophy: diagnosis during life by biopsy of the conjunctiva]

Three cases of infantile neuroaxonal dystrophy diagnosed by conjunctival biopsy are reported. Some axons of the conjunctival nerves showed aggregates of tubular and membranous structures identical to the spheroids of the CNS. The visualization of these structures is the only diagnostic tool in this disease of unknown metabolic basis. Conjunctival biopsy which is ease to perform is the preferential technique for the diagnosis of this disease. Clinically, the intense hypotonia with pyramidal tract signs, the absence of seizures, the cerebellar atrophy observed at the computerized tomography suggest strongly the diagnosis of infantile neuroaxonal dystrophy.

[Human rabies. Neuropathological study of 30 cases]

O estudo epidemiológico e neuropatológico concernente a trinta autópsias de encefalite rábica foi realizado, tendo sido os dados obtidos comparados com aqueles da literatura. Não houve relação estatística entre a topografia lesional e o local da mordida, entre o período de incubação ou a duração da doença e a presença ou ausência de inclusões virais (IV) assim como entre a intensidade do processo inflamatorio (PI) e a presença de IV. A dispersão do PI e das IV através o SNC foi diretamente proporcional à sua intensidade. A estrutura mais freqüentemente comprometida pelo PI foi o mesencéfalo, seguido pelo bulbo, ponte e medula espinhal. A estrutura mais intensamente afetada foi o bulbo. As IV foram particularmente proeminentes no hipocampo e cerebelo.

Fibrochondrogenesis: lethal, autosomal recessive chondrodysplasia with distinctive cartilage histopathology

Fibrochondrogenesis is a rare, neonatally lethal rhizomelic chondrodysplasia distinguished from other forms of lethal dwarfism by broad long-bone metaphyses, pear-shaped vertebral bodies, and by microscopic changes of cartilage with unique interwoven fibrous septa and fibroblastic dysplasia of chondrocytes. We report the second and third well-documented cases of this apparently autosomal recessive disorder and discuss the differential diagnosis.

[Menkes syndrome: review of the pathogenesis apropos of a clinico-pathological case]

The authors report a case of Menkes' syndrome, probably the first one described in Brazil. The patient, a 15-month-old boy, showed pili torti, early progressive psychomotor deterioration and seizures. Serum levels of ceruloplasmin and copper were very low. Neuroradiological and roentgenological examinations revealed diffuse cerebral atrophy, arterial changes and bone abnormalities. At the post-mortem examination the more consistent findings were cerebral atrophy, neuronal loss in the thalamus and above all cerebellar cortical lesions. The disease has a sex-linked recessive inheritance and is believed to be caused by an inborn error of copper metabolism, perhaps subordinated to changes of proteins which carry copper to different tissues. The relevant literature in relation to the pathogenesis is reviewed.

Hypomelanosis of Ito. Case report with involvement of the central nervous system and review of the literature

A case of hypomelanosis of Ito in a ten-year-old black boy with mental retardation, epilepsy and abnormalities of the white matter of the cerebral hemispheres revealed by a computerized tomography is presented. This is the 41st reported case on this disease, a number of which have shown neurological signs. A review of the literature with emphasis on the neurological manifestations is performed.

Brief clinical report: chondroectodermal dysplasia (Ellis-van Creveld) with anomalies of CNS and urinary tract

We report on a 19-month-old girl with chondroectodermal dysplasia (Ellis-van Creveld) and other previously undescribed visceral and central nervous system anomalies. These anomalies include cerebral heterotopias, renal agenesis, and congenital megaureter.

Neuropathology of S. Paulo south coast epidemic encephalitis (Rocio flavivurus)

The neuropathology of 8 cases of S. Paulo south coast epidemic encephalitis (Rocio flavivirus), a new arbo B virus encephalitis, is described. The topographic pattern of the lesions appears to be almost specific. The gray matter is predominantly affected. Interstitial mononuclear infiltration, microglial proliferation and perivascular lymphocytic cuffing were seen. Neuronophagia was seldom seen except during the acute phases of the disease. Throughout the neuraxis, the gray matter was affected to a greater degree than white matter. The more damaged structures, in descending order, were as follows: thalamus, dentate nucleus, substantia inominata, brain stem, spinal cord and basal nuclei. Most of the cases exhibited thalamic inflammatory necrosis. Electron microscopy disclosed in one case virus-like particles, resembling those described in other arbo B viruses in the cytoplasm of thalamic neurons. In this case, virus was isolated from the brain and an immunofluorescence test also showed antigenic material in the thalamic neurons.