Introdução: O processo de senescência leva ao declínio da capacidade funcional cognitiva e de respostas adaptativas que são necessárias para a execução de atividades de vida diária, levando ao maior risco de morbidade e mortalidade. Estudos comprovam que o envelhecimento pode estar associado ao isolamento social, no qual leva a diversos prejuízos para saúde física e mental. Em dezembro de 2019, o primeiro caso do novo coronavírus foi registrado e, para conter a transmissão, foram adotadas medidas sanitárias, dentre elas o isolamento social. Objetivo: Investigar os efeitos do isolamento social para a saúde física e mental em pessoas idosas durante a pandemia de COVID-19. Métodos: Trata-se de um estudo de revisão integrativa, realizado de forma sistemática elaborado a partir da pergunta norteadora “Quais os efeitos do isolamento social da pandemia de COVID-19 para a saúde física e mental em pessoas idosas?”. Resultados: Os estudos priorizaram os efeitos na saúde mental da população idosa, havendo necessidade de ampliar a investigação para a saúde física da população idosa, no contexto de isolamento social.

Introduction: Cryptococcoma is a rare CNS infection caused by Cryptococcus neoformans, with a granulomatous lesion. It’s even rarer in immunocompetent patients. Diagnosis requires histopathological analysis and treatment with amphotericin B, often with surgical resection. The aim is to report four cases of cerebral cryptococcoma In Immunocompetent Patients. This is a case report study. The information of this work was obtained through review of the medical record. Case report: We report on four cases of cerebral cryptococcoma in immunocompetent patients. All cases presented with images of expansive lesions and compatible histopathological analysis. The first case was a 62-year-old man with dysphasia and decreased strength on the right side, and underwent total surgical resection, followed by 23 days of amphotericin B treatment. The second case was a 62-year-old woman who presented with orofacial dyskinesia and decreased strength on the right side, and underwent stereotactic surgery, followed by antifungal treatment. After 10 days of hospitalization, the patient developed respiratory insufficiency, progressed to cardiorespiratory arrest and brain death. The third case was a 54-year-old woman who presented with a skin infection caused by Cryptococcus. During treatment with fluconazole, the patient experienced altered sensory perception and left hemiparesis. Surgical resection of the lesion was performed, followed by 30 days of antifungal treatment. The fourth case was a 54-year-old man who presented with pulsatile headache and right hemiparesthesia, and underwent stereotactic neurosurgery, followed by 12 days of amphotericin B treatment. Conclusion: Cryptococcus neoformans infection in the CNS, manifested in the form of cryptococcoma, although rare, should be considered as a differential diagnosis for brain expansive lesions in immunocompetent individuals.

Introduction: Tumor necrosis factor (TNF) antagonists have emerged as one of the most effective treatment options for patients with autoimmune diseases, including psoriatic arthritis. However, these agents carry a risk of severe adverse effects, including demyelinating disorders. The aim to report a case of multiple sclerosis associated with the use of adalimumab. This is a case report study. The information of this work was obtained through review of the medical record. Case report: A 40-year-old female with psoriatic arthritis on adalimumab (ADM) treatment. She developed paresthesia in her lower limbs, which was initially attributed to anxiety. Six months later, she presented with decreased visual acuity in her left eye, which was diagnosed as optic neuritis. She received pulse therapy with methylprednisolone and underwent investigation for multiple sclerosis (MS). Magnetic resonance imaging (MRI) of the brain revealed multiple lesions with high signal intensity in T2/FLAIR on periventricular regions bilaterally. Furthermore, MRI of the thoracic spine showed high signal intensity on posterolateral cords at levels T5 to T9. These findings fulfilled the revised McDonald Criteria for MS and suggested a link to ADM treatment. On neurological examination, mild left lower limb paresis, bilateral plantar-cutaneous reflex, hyperreflexia in the lower limbs, and mild hypopalesthesia in her right leg. ADM treatment was discontinued, and although she reported a slight worsening of her skin condition, there were no further signs of psoriatic arthritis. Conclusion: Neurological adverse events associated with TNF antagonists are rare but must be considered. If neurological disorders develop during therapy, prompt discontinuation of the drug is recommended.

Introduction: Neurosarcoidosis (NS) is a rare and often underdiagnosed manifestation of sarcoidosis, which is an inflammatory disorder that can affect multiple organs, including the nervous system. The main clinical feature is cranial neuropathy, especially involvement of the optic nerve and facial nerve. These alterations make a differential diagnosis with Tolosa-Hunt syndrome. The aim is to report a case of neurosarcoidosis. This is a case report study. The information of this work was obtained through review of the medical record. Case report: Female, 39-year-old. In 2005, she started pain and paralysis of the lateral movement of the left eye, which was resolved with mucocele removal surgery. Presented three similar cases in 2010, 2015, and 2020, resolved with the use of anti-inflammatory drugs. In 2021, she presented left facial paralysis, left eyelid ptosis, visual blurring and headache. During hospitalization, the possibility of Tolosa-Hunt syndrome was investigated. Imaging exams and laboratory tests were performed without significant alterations. In 2022, she presented a similar clinical manifestation. Magnetic resonance imaging with angiography were performed, which showed thickening and enhancement of the pachymeninges in the occipital regions and cerebellar hemispheres, suggesting the possibility of meningeal granulomatous involvement. A biopsy with histopathological and immunohistochemical analysis was performed, confirming the diagnosis of neurosarcoidosis. Conclusion: This case report highlights the importance of considering neurosarcoidosis as a differential diagnosis in cases of multiple cranial neuropathy, such as in Tolosa-Hunt syndrome. Early recognition and diagnosis can lead to timely treatment and improved outcomes for patients.

A neurofibromatose tipo 1 (NF1), consiste em uma doença genética. Quando comparada às outras duas formas, neurofibromatose tipo 2 (NF2) e schwannomatose, a NF1 é a apresentação mais comum. O quadro clínico geralmente se apresenta como máculas, sardas axilares e/ou inguinais, nódulos de Lisch (hamartomas de íris) e neurofibromas. O presente estudo trata-se de um relato de caso, o qual tem como objetivo relatar as repercussões e achados raros em uma idosa diagnosticada com NF1. A clínica da paciente começou há cerca de 45 anos quando buscou um serviço de saúde devido crises recorrentes de diarréia e hérnia em região inguinal. Foi solicitada uma USG de abdome total que evidenciou uma massa em região retropancreática característica de paraganglioma. Após 4 anos, a paciente possuía hipertensão primária de difícil controle com picos paroxísticos, sendo em seguida diagnosticado um feocromocitoma por meio de exames de imagem e exames laboratoriais. Durante o acompanhamento de rotina, uma ressonância magnética (RM) de abdome e pelve identificou nódulo sólido mantendo íntima relação com alças intestinais de delgado, que na imunohistoquímica tratava-se de um Tumor do Estroma Gastrointestinal (GIST). A paciente segue com acompanhamento oncológico na sua cidade e encontra-se sem queixas. Ultimamente tem apresentado lapsos de memória intermitentes e alguns episódios de quedas. Dessa forma, após uma revisão da literatura, descobriu-se que o tema em questão raramente é discutido, verificando-se escassos registros da existência simultânea dos três tumores citados, o que reforça, portanto, a importância deste estudo.