O quadro de vasculite do sistema nervoso central (SNC) associada à infecção criptocócica é raro, tendo como manifestação clínica infartos cerebrais em cápsula interna, tálamo e núcleos da base. O quadro clínico se caracteriza por um início subagudo ou crônico, o que geralmente pode levar a atrasos no diagnóstico e tratamento adequados. Apresentamos um relato de caso em que a paciente com diagnóstico prévio de lúpus eritematoso sistêmico cursou com diplopia súbita, sendo diagnosticada com acidente vascular cerebral (AVC) mesencefálico. Foi realizado ampla investigação etiológica, confirmando-se neurocriptococose através da coleta do líquido cefalorraquidiano. Após o tratamento com antifúngico, paciente evoluiu com remissão completa dos sintomas. Apesar de rara, é importante o conhecimento dessa apresentação na neurocriptococose, uma vez que o diagnóstico e a conduta precoces propiciam redução na morbimortalidade do paciente.

Introduction: Striatopathy or non-ketonic hyperglycemia is a rare etiology, but well reported in the literature, of involuntary movements in patients with diabetes mellitus, being characterized by affecting, in general, elderly patients with hemicorrea-hemiballismus. The aim is to report a clinical case of the development of movement disorder caused by hyperglycemia. Case report: Patient E.J.D.O, 71-year-old, male, hypertensive and dyslipidemic. Admitted to the emergency room with a history of involuntary movements in the upper left limb for about two months, with recent worsening. Upon admission, a hyperglycemic state (capillary blood glucose HI) was observed, until then, the patient had not been diagnosed with diabetes. The movements were present at rest, worsened on intention and were present during sleep, being characterized as clonic/myoclonic movements. In view of the clinical picture on admission, the hypothesis of subtle focal status epilepticus was suggested, and therefore Diazepam 2 mg EV was performed as a therapeutic test, with notable improvement of the picture. As a complementary propaedeutic, brain magnetic resonance imaging was performed. An electroencephalogram was also requested, which showed no epileptiform activity in status epilepticus. Cerebrospinal fluid collection was performed, showing possible reduction of diffusion. The patient was discharged after receiving valproic acid and clobazam, however, he returned later, reporting worsening of movements to which he associated the interruption of medications. The hypothesis of autoimmune encephalitis was raised, but no immunosuppressive therapy was instituted. During the second hospitalization, he had complications, including CRA, progressing to a state of hypoxic-ischemic encephalopathy. Conclusion: In this report, we describe a patient with focal involuntary movements who made a differential diagnosis between epileptic seizures/focal status evil with movement disorders of metabolic etiology such as hyperglycemia, with the topographic radiological finding corroborating such differential diagnosis. In the literature, there is a consistent association between movement disorders and hyperglycemia, especially in elderly patients, which adds strength to the present case report. Korea.

Introduction: Primary headaches are more common in females until the 5th decade of life and should be properly diagnosed to ensure appropriate management, as they can cause significant socioeconomic impairment and psychological damage. Objectives: To describe migraine and other painful headaches (MPH) cases and costs in Brazilian National Health System (SUS) from 2010 to 2020. Methods: This is a descriptive epidemiological study. Data was collected from the Brazilian National Health System’s (DATASUS) database, describing MPH’s morbidity (CID-10) between 2010 and 2020. As this is a public domain database, there was no need for ethics committee approval. Results: The total number of hospitalizations for MPH in Brazil during the study period (2010–2020) was estimated at 89,372, with 65.6% being female patients. The number of hospitalizations increased each year since 2010, reaching its peak in 2019 (12,120 cases), and presenting a new drop in 2020 to 67% of its value, potentially indicating an impact of the coronavirus pandemic. The age group with the highest number of hospitalizations was between 30– 49 years. In relation to the values of hospital services, a total of R$35,538,127.81 was spent in this time interval, with 63.9% of the funding allocated to the treatment of female patients. The region with the highest cost during the study period was the South (31.9%), while the lowest was the North (3.9%), which also presented the lowest number of hospitalizations among all regions of the country (5.1%). Conclusion: Between 2010 and 2020, hospitalizations and costs of hospital services related to the treatment of migraine and other painful headaches were predominantly directed towards female patients. Middle-aged adults were the age group with the highest number of hospitalizations. The region with the lowest hospitalizations and hospital costs for this condition was the North.

Introduction: Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease in the world. Its incidence increases with advancing age. Therefore, in Brazil, a country in transition of age structure, it is relevant to assess the progression of hospitalizations and hospital costs for PD over the years. Objective: Describe the progression of hospitalizations and hospital costs for PD in Brazilian’s public health system, SUS, between 2008-2020. Design and setting: Descriptive ecological observational study made in Brazil, Salvador – BA. Methods: Data from hospitalization and hospital costs were collected from DATASUS in the 5 Brazilian regions. Statistical analysis was based on measures of dispersion and central tendency. Results: Between 2008-2020, 11,565 admissions for PD were notified. The highest numbers of hospitalizations corresponded to the Southeast region (annual average = 370.1), while the smallest to the North region (annual average = 28.4). Regarding the high expenses resulting from hospitalizations, it was observed that the Southeast obtained higher costs with hospital services (annual average = 1,417,716.8), while the North had the lowest (annual average = 18,611.01). Conclusion: Southeast region stood out for having the highest numbers in costs and hospitalizations, the opposite of what happened in North. Brazilian regional disparities, especially regarding to demographic density, HDI, socioeconomic development and access to health care, may explain these demographically uneven.