Context: Behçet’s Disease (BD) is a multisystem chronic disorder characterized by perivasculitis within several tissues, including the Central Nervous System – Neuro-Behçet’s Disease, which accounts for 3 – 9 % of the BD patients. Neuro- Behçet’s Syndrome may present as brainstem or pyramidal syndromes, myelopathies, meningoencephalitis, intracranial hypertension and movement or psychiatric disorders. The objective of the present work is to report a case of Neuro-Behçet’s Disease, a rare and disabling disorder. Case report: 24-year-old male presenting focal neurological deficits – hemiparesis on the right side and motor aphasia, associated with unstoppable hiccups and visual blurring. His previous pathological history featured several self-limiting episodes of the same neurological presentation, as well as acute exacerbations of oral and genital ulcers. Erythema Nodosum and Folliculitis were his main skin lesions. The ophthalmological evaluation showed bilateral cicatricial chorioretinitis. Laboratorial diagnostic procedures revealed left shift leukocytosis, high ESR, high protein level in the CSF and negative serology for B and C hepatitis, HTLV, HIV and toxoplasmosis. P-ANCA, C-ANCA, ANA and Rheumatoid factor were all found negative. Magnetic Resonance Imaging of the brain showed multiple oval- shaped T2- hyperintensity foci, with adjacent vasogenic edema, in the brainstem and basal ganglia areas – suggesting vasculitis. Treatment involved pulse therapy with Methylprednisolone, followed by Azathioprine and Prednisone. The patient has had full recovery and no other relapses. Conclusions: This case illustrates the importance of investigating Neuro-Behçet’s Disease in patients with neurological symptoms and oral/genital ulcers. The goal is to establish adequate and early treatment to improve the quality of life.

Introduction: Cerebrovascular accident (CVA) is a medical emergency and it is the second cause of mortality worldwide. Due to high prevalence, systematic analyzes should be performed in order to help improve mortality curves. Objectives: Analyze current scenario of CVA treatment procedures performed in Brazil during 12 years and correlate with results. Methods: Literature review associated to an observational, descriptive and horizontal collection of hemorrhagic or ischemic CVA treatment data, available at DATASUS - SUS Hospital Information System (SIH / SUS) - from January 2008 to December 2019 - was carried out evaluating number of hospitalizations, public spending, complexity, mortality rate, permanence, character of care. Results: 2,173,466 hospitalizations were reported, total expenditure of R$ 2,659,605,859.72. The highest number of hospitalizations and the highest amount spent occurred in 2019. Considering total procedures, 67,141 were performed as elective and 2,105,861 were urgent basis. 700,063 were performed in public services and 670,230 in the private sector, both of medium complexity. Total mortality rate was 16.62% - decreasing over the 12 years, with 2019 having the lowest rate, 15.72%. Mortality rate for elective procedures was 13.14% compared to 16.73% for urgent, whereas in the public sector it was 18.79% compared to 14.91% for the private. Conclusion: Despite decreasing mortality over years, there is discrepancy between private and public services. In this scenario, high mortality rate was found in both services although highlighted at the public sector. Better investments are needed, aiming to reduce global mortality.

Apesar de que a biópsia hépatica, seja considerada padrão-ouro no estadiamento e  diagnostico da fibrose hepática, podemos também utilizar outros mecanismos menos invasivos e de menor custo para conseguir estimativas para tal. Dentre eles podemos citar o APRI e o FIB-4, metodos que utilizam apenas a coleta sanguinea e com dados de laboratorio hepatico e hemograma conseguimos aplicar em escores sensiveis, porem pouco especificos para o estadiamento da fibrose.  Objetivo avaliar a acuracia de ambos escores com a biópsia hepática atraves de um estudo restrospectivo, onde 74 pacientes submetidos a fibrose, tiveram seus escores APRI e FIB-4 calculados, após isso seus valores de acuracia foram comparados  com os valores da biopsia hepática. Com isso constatamos uma acuracia de 85% no APRI P<0,05 e aproximadamente 88% no FIB-4 P<0,05). Portanto os scores podem ser utilizados, mas devido a baixa especificidade, não podem ser utilizados de forma isolada, devendo ser associado a historia clinica, uma boa anamnese, exame clinico, complementares e em ultima instância, a propria biópsia hepática.

Context: Schistosomiasis is a prevalent disease in Brazil whose medullary form can be a serious and disabling condition. Diagnosis is clinical and laboratorial, based on neurological symptoms besides Schistosoma infection exams. Spinal Cord Schistosomiasis (SCS) can be associated with cauda equina syndrome (CES) adding “saddle” anesthesia and low back pain as symptoms. Case Report: A 22- year-old male presenting progressive bilateral and proximal pelvic weakness associated with urinary and fecal incontinence besides mild low back pain during 4 months. Patient reports daily swimming practice in rivers. Neurological examination revealed grade 3 weakness of the proximal muscles, patellar hyporeflexia, saddle anesthesia and hypotonia of the proximal muscles. Magnetic resonance imaging of the lumbar spine showed conus medullaris fusiform enlargement, associated with T2 and STIR hyperintensity (edema), hyposignal in T1, findings suggestive of an inflammatory / infectious etiology. Laboratory tests revealed a complete blood count with mild leukocytosis and eosinophilia; positive IgG serology for schistosomiasis; increased protein levels in the cerebrospinal fluid; stool analysis was normal. The diagnosis of CES and conus medullaris syndrome due to SCS was established and treatment with prednisone and praziquantel was initiated, with significant improvement in clinical symptoms. Conclusion: This case emphasizes the importance of early diagnosis and the initiation of appropriate therapy in order to prevent irreversible injuries in cases of CES and conus medullaris syndrome, both conditions of high morbidity that are often overlooked.