Sarcoidosis is an inflammatory multisystem disorder of unknown etiology with a worldwide distribution that can affect lungs, lymphatic system, skin, liver, eyes, and nervous system 1 . We owe the first recorded and illustrated description of sarcoidosis to Jonathan Hutchinson in 1878, when he reported a patient with a dermatologic disease, which comprised purplish, symmetric, and non-tender skin plaques, initially considered a manifestation of gout 2 . The term sarcoidosis comes from histological studies performed by Cesar Boeck, in 1899, who described pathological findings of skin lesions that resembled those of sarcoma, which he called 'sarkoid ' or 'sarcoma-like' 3 . Involvement of the nervous system was first recognized, in 1905, by Winkler, and, in 1909, Heerfordt described three patients in the context of facial nerve palsies, uveitis, parotid enlargement, and fever 1,3 . Neurosarcoidosis (NS) may involve any part of the nervous system with acute and chronic courses 1,4 . Cranial nerves, hypothalamus, and pituitary gland are the most commonly regions involved, but meninges, parenchyma, brainstem, and spinal cord may also be affected 4 . Clinical differentiation from other neurological diseases may be difficult when an isolated involvement of the nervous system is present 3,4 . In this review, we highlighted its clinical forms, pathogenesis, and treatment guidelines for NS, as guidance for general neurologists. neUROLOGiCaL ManiFesTaTiOns OF saRCOidOsisNeurologic manifestations are found in 5 to 20% of cases and symptoms may be mild or even severe, requiring a more aggressive intervention. About one-half of patients with NS can develop neurologic manifestations before systemic sarcoidosis is evident absTRaCT Neurosarcoidosis (NS) more commonly occurs in the setting of systemic disease. The diagnosis is based on a clinical history suggestive of NS, presence of noncaseating granulomas, and supportive evidence of sarcoid pathology, laboratory, and imaging studies. NS could involve any part of the nervous system and often demands high doses of steroids for symptom control. It presents low response to isolated steroids administration and frequently requires immunosuppressive agents. In NS, lymphocytes are polarized toward an excessive Th1 response, leading to overproduction of TNF-alpha and INF-gama, as well as lL-2 and IL-15. Infliximab, a chimeric monoclonal antibody that neutralizes the biological activity of TNF-alpha, is a new option in the NS treatment. We revised pathophysiology, clinical manifestations, diagnostic work up, and treatment of NS as guidance for the general neurologist.Key words: sarcoidosis, neurosarcoidosis, methotrexate, azathioprine, cyclophosphamide, infliximab. ResUMOA neurosarcoidose (NS) ocorre frequentemente no contexto de doença sistêmica. O diagnóstico é baseado na história clínica sugestiva de NS, presença de granulomas não-caseosos e achados anatomopatológicos, laboratoriais e radiológicos de sarcoidose. A NS causa manifestações neurológicas variadas, que apresentam, em ge...

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We report a case of a non-Hodgkin’s lymphoma in a young woman presenting with an abdominal mass and an unusual instance of cranial nerve palsies mimicking Gradenigo’s syndrome. This condition is characterized by a triad of otorrhea, facial pain and diplopia, related to otitis media in the pre-antibiotic era. Incomplete and atypical clinical features of Gradenigo’s syndrome have been described and noninfectious causes may mimic this condition. Careful clinical history and physical examination, including neuroimaging, are necessary to make a differential diagnosis.

OBJECTIVE: It was to analyze clinical aspects of patients with blepharospasm, including outcomes of botulinum toxin treatment. Additionally, clinical characteristics of isolated blepharospasm were compared to those of blepharospasm plus other movement disorders. METHODS: Clinical data recorded during 17 years were reviewed. The variables included age, gender, age of onset, past medical history, head trauma, smoking history, family history of dystonia, severity, duration of botulinum toxin relief and adverse effects. RESULTS: A total of 125 patients were included and 75.2% were female. The mean age of onset was 54.3 years; 89.6% of the individuals started with contractions in eye region, and 39.2% of them spread to lower face or neck. Isolated blepharospasm group was compared with blepharospasm-plus group for demographic and clinical features, and therapeutic outcomes, without significant differences. Botulinum toxin treatment improved the severity of contractions (p=0.01) with low rate of side effects (14%). CONCLUSIONS: Both groups - isolated blepharospasm and blepharospasm-plus - shared similar results concerning epidemiology, clinical features and therapeutic response to botulinum toxin.

The suture of extensive wounds remains a major challenge for plastic surgeons. The objec tive of this article is to promote use of elastic sutures as an effective procedure for the closure of extensive wounds. Fourteen patients presenting with extensive wounds caused by trauma in the lower limbs were included in the study. The entire wound was sutured in eachpatientwithatwo-stepprocedure.Inthefirststep,theoppositeedgesofthewound were approximated using rubber circular elastic bands. In the second step, carried out a fewdayslater,theelasticbandswereremoved,followedbyasimplesuturewithmonofila ment nylon thread. Placement of elastic sutures proved to be a safe, functionally effective, easyt operform, and lowcost procedure for the closure of extensive wounds without using donor areas as skin grafts.