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Introduction: Type 2 diabetes mellitus is one of the diseases that is most associated with chorea, and although it is a rare complication, it is necessary tobe aware of it so that the correct diagnosis and early treatment can be made. Case report: Male patient, 78 years old, diabetic and uncontrolled hypertension. Began uncontrolled glycemic 7 days before admission. Evolves with imbalance when walking and with involuntary movements in the left upper limb. At admission, dextro 682 mg/dl and at neurological exam the presence of asymmetric choreoathetotic movements, more evident in the left dimidium. Investigation with neuroimaging, brain tomography showed the presence of hyperdensity in bilateral basal nuclei, confirmed by brain MRI. Other differential diagnoses were ruled out, such as hyperthyroidism, liver failure and rheumatic fever. The most likely diagnosis was generalized choreoathetosis secondary to a non-ketotic hyperglycemic disorder. During hospitalization, adequate glycemic control was performed and clonazepam was introduced as an aid, with significant improvement of movements and absence of the same at discharge. Conclusions: Cases of non-ketotic hyperglycemia are associated with the onset of chorea, and although it is a rare complication, it is not uncommon given the high incidence of diabetes mellitus in the Brazilian population, and clinical improvement may take weeks to months, even after adequate glycemic control.

Context: Recently, with the advance of neuroimaging modalities, the windows of reperfusion therapy in patients with acute stroke have been reviewed and extended, especially for mechanical thrombectomy. Case report: 81 year old patient, previously hypertensive and dyslipidemic, fully functional (modified Rankin scale = 0), admitted to the emergency room of a tertiary hospital with global aphasia, right hemiparesis, right homonymous hemianopsia and severe hypoesthesia of the right upper limb, scoring 26 on the NIHSS, with report of having contacted family members for the last time 15 hours before admission. She was treated according to the institution’s acute stroke protocol, and underwent non-contrast brain computed tomography (CT), perfusion CT with Rapid CT protocol and cerebral artery + neck angio-CT, which ruled out bleeding and showed an ASPECTS of 8, an estimated ischemic core volume of 17 mL, and an area with hypoperfusion of 118 mL (perfusional mismatch of 101 mL), besides occlusion of the M1 segment of the left middle cerebral artery. Thus, she was submitted to chemical thrombolysis, with a decrease in NIHSS score to 15 and evolving without complications upon hospitalization. Conclusions: In patients with uncertain ictus, the use of advanced neuroimaging modalities, such as perfusion tomography with Rapid CT protocol, may assist in the indication of reperfusion therapies safely.

Context: Moyamoya disease or chronic occlusive cerebrovascular disease is characterized by proximal occlusion of the internal carotid artery and its branches bilaterally, generating an angiographic “smoke” pattern (moyamoya, from Japanese “something hazy”) and by diverse ischemic manifestations. Case report: The sample consists of three female patients, aged between 13 and 46 years, followed in our service due to the diagnosis of Moyamoya Disease. Among the clinical manifestations presented, ischemic cerebrovascular events with neurological deficit predominated, and one of the patients presented two episodes compatible with stroke and one episode compatible with transient ischemic accident. The youngest patient presented with a choreic picture initially interpreted as Sydenham’s chorea. Although the gold standard for the diagnosis of chronic occlusive cerebrovascular disease is cerebral arterial angiography, it was possible to observe a pattern compatible with the disease in other modalities of examination, such as cerebral arterial angiotomography and cerebral arterial angioresonance. From the therapeutic point of view, one of the patients underwent surgical intervention (encephaloduromyosinangiosis), with improvement of symptoms after treatment. Conclusions: In this paper, we emphasize the importance of complementary imaging tests in the evaluation of patients with cerebrovascular syndromes and the diversity of clinical presentation of Moyamoya disease.

Introduction: Guillain-Barré syndrome is an acute / subacute inflammatory polyradiculoneuropathy that classically results in flaccid areflex palsy. However, there are other possibilities of clinical presentation that must be remembered so that an adequate diagnosis and treatment is carried out. Case report: Female patient, 23 years old, without comorbidities, with complaint of paresthesia in extremities and right peripheral facial paralysis, having diagnosis until then of Bell’s Palsy. She denied previous or current infectious complaints. The neurological examination revealed facial diparesis, proximal weakness of the lower limbs that made walking difficult, tactile and painful hypoesthesia in the feet, with reflexes 1+/4+ in the lower limbs and 3+/4+ in the upper limbs. An investigation was started with CSF collection that showed albuminocytological dissociation (proteins 440 mg/dl and leukocytes 01 mm3). Neuroimaging exams showed contrast impregnation in facial and trigeminal nerves. A diagnosis of acute inflammatory polyradiculoneuropathy was made and treatment with human immunoglobulin was initiated for 5 days. Electroneuromyography showed peripheral, sensory-motor polyradiculoneuropathy and questioned the physiopathological possibility of juxtaparanodopathy. The patient presented a significant and early improvement after treatment. Conclusions: It is essential to consider that Guillain-Barré syndrome has symptom variability, especially according to its pathophysiology and clinical and electrophysiological variant, thus avoiding that conditions such as this one are underdiagnosed.