The purpose of this study was to determine the effect of functional limitations and fatigue on the quality of life (QoL) in people with multiple sclerosis (MS). A descriptive case series study at Lagoa Hospital - Rio de Janeiro, Brazil was carried. The main outcome measurements were demographic variables, QoL (SF-36 v.1), disability (EDSS), motor function of the upper limb (Box & Blocks test), Tone (Modified Ashworth Scale), gait (Hauser ambulatory index) and fatigue (Fatigue Severity Scale). Sixty one patients fulfilled the study criteria. The mean age of patients was 39 years and 74% of patients were female. The most of cases presented mild disability (EDSS<3.5). A decrease was found in all domains of QoL. It was found association between physical functioning and the variables of EDSS, fatigue, lower limb tone and gait. Gait, disability, hypertonia of the lower limbs and fatigue negatively affected QoL in people with MS.

Introdução. A Esclerose Múltipla (EM) é a mais frequente doença desmielinizante inflamatória idiopática do sistema nervoso central. Cerca de 10 a 20% apresentam a forma progressiva primária da Esclerose Múltipla (EMPP). Limitações funcionais e fadiga são queixas frequentes dos indivíduos com EM e estas influenciam negativamente na qualidade de vida. Objetivo. Analisar a limitação funcional, qualidade de vida e fadiga em indivíduos com EMPP. Método. Foram avaliados 30 pacientes com EMPP, atendidos no Hospital da Lagoa-RJ, no período entre março/2006 a junho/2008. Os principais itens avaliados foram: variáveis demográficas, qualidade de vida (Escala SF-36), Incapacidade (Escala Expandida do Estado de Incapacidade), função dos membros superiores (teste da caixa em blocos), tônus (Escala de Ashworth modificada), marcha (Índice Ambulatorial de Hauser), e fadiga (Escala de gravidade da Fadiga). Resultados. A média de idade dos pacientes foi de 49,3 anos. A maior parte apresentou incapacidade grave e 96% limitação funcional em membros superiores. Mais de 70% necessitava de auxílio unilateral para deambular (IAH >3,0). Cerca de 90% dos pacientes apresentaram fadiga. Uma baixa qualidade de vida foi observada em todas as dimensões da SF-36. Conclusão. Pacientes EMPP apresentaram incapacidade grave, disfunção na marcha, fadiga e uma baixa qualidade de vida.

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The relevance of the Brissaud reflex A 70-year-old man who was admitted to neurointensive care with spastic tetraparesis and altered level of consciousness due to acute subdural hematoma and who had a history of left forefoot amputation presented right Babinski sign and left Brissaud reflex (video at Neurology.org). The Brissaud reflex is characterized by a contraction of the tensor fasciae latae due to stimulus over the plantar aspect of the foot, which is better visualized on the lateral aspect of the thigh.

A 50-year-old woman started a 1-month history of progressive left hemiparesis and headache. Symptoms have progressed to mental deterioration, being necessary orotracheal intubation. A brain magnetic resonance imaging was performed (Figure 1). Eccentric target sign was found and cerebral toxoplasmosis suspected. HIV serologic test confirmed infection. Sulfadiazine, pyrimethamine, leucovorin, and adjunctive corticosteroids were started, with good clinical and radiological response. Eccentric target sign is characterized by a ring-shaped zone of peripheral enhancement with a small eccentric nodule along the wall. Although considered highly suggestive of toxoplasmosis, this sign is seen in less than one-third of cases. 1,2 ª The Author(s) 2018 Article reuse guidelines: sagepub.com/journals-permissions