LUIZ HENRIQUE MARTINS CASTRO

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Departamento de Neurologia, Faculdade de Medicina - Docente
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 21
  • article 1 Citação(ões) na Scopus
    Vestibular migraine
    (2022) SILVA, Viviane Passarelli Ramin; CASTRO, Luiz Henrique Martins; CALDERARO, Marcelo
    Vestibular migraine (VM) remains an underdiagnosed condition, often mistaken with brainstem aura. VM is defined by recurrent vestibular symptoms in at least 50% of migraine attacks. Diagnosis is established by clinical criteria based on the International Classification of Headache Disorders (ICHD-3). Estimated prevalence of VM is 1 to 2.7% of the adult population.Vestibular symptoms usually appear after the headache. VM pathophysiology remains poorly understood. Vertigo may occur before, during, after the migraine attack, or even independently, and may last seconds to hours or days. Pathophysiological mechanisms for VM are still poorly understood and are usually extrapolated from migraines. Differential diagnoses include Meniere's disease, benign paroxysmal positional vertigo, brainstem aura, transient ischemic attack, persistent perceptual postural vertigo,and episodic type 2 ataxia. Specific treatment recommendations for vestibular migraine are still scarce.
  • article 14 Citação(ões) na Scopus
    The importance of recognizing faciobrachial dystonic seizures in rapidly progressive dementias
    (2016) SIMABUKURO, Mateus Mistieri; NÓBREGA, Paulo Ribeiro; PITOMBEIRA, Milena; CAVALCANTE, Wagner Cid Palmeira; GRATIVVOL, Ronnyson Susano; PINTO, Lécio Figueira; CASTRO, Luiz Henrique Martins; NITRINI, Ricardo
    ABSTRACT Background: Creutzfeldt-Jakob Disease (CJD) is the prototypical cause of rapidly progressive dementia (RPD). Nonetheless, efforts to exclude reversible causes of RPD that mimic prion disease are imperative. The recent expanding characterization of neurological syndromes associated with antibodies directed against neuronal cell surface or sympathic antigens, namely autoimmune encephalitis is shifting paradigms in neurology. Such antigens are well known proteins and receptors involved in synaptic transmission. Their dysfunction results in neuropsychiatric symptoms, psychosis, seizures, movement disorders and RPD. Faciobrachial dystonic seizure (FBDS) is a novel characterized type of seizure, specific for anti-LGI1 encephalitis. Objective: In order to improve clinical recognition we report the cases of two Brazilian patients who presented with characteristic FDBS (illustrated by videos) and anti-LGI1 encephalitis. Methods: We have included all patients with FBDS and confirmed anti-LGI1 encephalitis and video records of FDBS in two tertiary Brazilian centers: Department of Neurology of Hospital das Clínicas, Sao Paulo University, Sao Paulo, Brazil and Hospital Geral de Fortaleza, Fortaleza, Brazil between January 1, 2011 and December 31, 2015. Results: Both patients presented with clinical features of limbic encephalitis associated with FBDS, hyponatremia and normal CSF. None of them presented with tumor and both showed a good response after immunotherapy. Conclusion: FBDSs may be confounded with myoclonus and occurs simultaneously with rapid cognitive decline. Unawareness of FDBS may induce to misdiagnosing a treatable cause of RPD as CJD.
  • article 15 Citação(ões) na Scopus
    Small calcified lesions suggestive of neurocysticercosis are associated with mesial temporal sclerosis
    (2014) OLIVEIRA, Marcos C. B.; MARTIN, Maria G. M.; TSUNEMI, Miriam H.; VIEIRA, Gilson; CASTRO, Luiz H. M.
    Recent studies have suggested a possible relationship between temporal lobe epilepsy with mesial temporal sclerosis (MTS) and neurocysticercosis (NC). We performed a case-control study to evaluate the association of NC and MTS. Method: : We randomly selected patients with different epilepsy types, including: MTS, primary generalized epilepsy (PGE) and focal symptomatic epilepsy (FSE). Patients underwent a structured interview, followed by head computed tomography (CT). A neuroradiologist evaluated the scan for presence of calcified lesions suggestive of NC. CT results were matched with patients' data. Results: : More patients in the MTS group displayed calcified lesions suggestive of NC than patients in the other groups (p=0.002). On multivariate analysis, MTS was found to be an independent predictor of one or more calcified NC lesions (p=0.033). Conclusion: : After controlling for confounding factors, we found an independent association between NC calcified lesions and MTS.
  • article 9 Citação(ões) na Scopus
    A patient with a long history of relapsing psychosis and mania presenting with anti-NMDA receptor encephalitis ten years after first episode
    (2015) SIMABUKURO, Mateus Mistieri; FREITAS, Christian Henrique de Andrade; CASTRO, Luiz Henrique Martins
    Anti-N-methyl- D-aspartate receptor (NMDAR) encephalitis is a recently discovered autoimmune disorder, in which antibodies target NMDARs in the brain, leading to their removal from synapses. Early in the disease course, patients often present with marked psychosis and mood disturbances (i.e. mania, depression), explaining why most of these patients are first seen by psychiatrists. Hence, autoimmune encephalitis is receiving growing attention from psychiatry, mainly owing to concerns over misdiagnosing immunomediated and potentially curable disorders as primary psychiatric disorders, such as schizophrenia or major depressive disorder. Although anti-NMDAR encephalitis occurs in the context of new-onset psychiatric symptoms, there is a lack of information on differential diagnosis and treatment of this disorder after a long-term diagnostic history of functional psychiatric disorders. We report a case of a patient with a long history of bipolar affective disorder evolving with anti-NMDAR encephalitis, initially misdiagnosed as non-organic psychosis.
  • article 9 Citação(ões) na Scopus
    Gender and age influence in daytime and nighttime seizure occurrence in epilepsy associated with mesial temporal sclerosis
    (2015) PASSARELLI, Valmir; CASTRO, Luiz Henrique Martins
    Objectives: The aim of this study was to analyze the daytime and nighttime seizure distribution during video-EEG monitoring in patients with epilepsy associated with unilateral mesial temporal sclerosis (MTS) and the role of gender, age, and lesion side on 24-hour seizure distribution. Methods: We studied 167 consecutive adult (age >= 16 years) patients with epilepsy associated with unilateral mesial temporal sclerosis that had three or more recorded seizures during continuous video-EEG monitoring with a minimum recording time period of 24 h. Seizure onset time was classified according to occurrence in six 4-hour periods. Results: Seven hundred thirty-five seizures were evaluated. We observed two higher seizure occurrence periods: 08: 01-12: 00 (p = 0.001) and 16: 01-20: 00 (p = 0.03). Significantly fewer seizures were observed between 0: 01 and 4: 00 (p = 0.01). Nonuniform seizure distribution was noted in women (p < 0.0001), in young patients (less than 45 years of age) (p < 0.0001), and in both patients with left (p = 0.03) and patients with right mesial temporal sclerosis (p = 0.008). Men presented uniform seizure occurrence distribution (p = 0.15). Women had fewer seizures than expected and fewer seizures than men between 0: 01-04: 00 (p < 0.0001 and p = 0.0015, respectively) and 04: 01-08: 00 (p = 0.01 and p = 0.03, respectively). Young patients (age b 45 years) had two seizure occurrence peaks, 08: 01-12: 00 (p = 0.016) and 16: 01-20: 00 (p = 0.004). Middle-aged/old patients (>= 45 years) had only one seizure occurrence peak, 08: 01-12: 00 (p = 0.012). Young patients had more seizures than middle-aged/old patients between 16: 01-20: 00 (p = 0.04). No differences were noted between left and right MTS. Significance: We observed two seizure occurrence peaks: morning and late afternoon/evening. We encountered variations in daytime and nighttime seizure distribution according to gender and age, but not according to side of MTS. Future studies are needed to confirm these findings and to unravel the neurobiological substrate underlying daytime and nighttime variations of seizure occurrence in different age groups and between genders.
  • article 5 Citação(ões) na Scopus
    Extratemporal abnormalities in phosphorus magnetic resonance spectroscopy of patients with mesial temporal sclerosis
    (2016) PARK, Eun Joo; OTADUY, Maria Concepcion Garcia; LYRA, Katarina Paz de; ANDRADE, Celi Santos; CASTRO, Luiz Henrique Martins; PASSARELLI, Valmir; VALERIO, Rosa Maria Figueiredo; JORGE, Carmen Lisa; TSUNEMI, Miriam Harumi; LEITE, Claudia da Costa
    Objective: We evaluated extratemporal metabolic changes with phosphorus magnetic resonance spectroscopy (P-31-MRS) in patients with unilateral mesial temporal sclerosis (MTS). Method: P-31-MRS of 33 patients with unilateral MTS was compared with 31 controls. The voxels were selected in the anterior, posterior insula-basal ganglia (AIBG, PIBG) and frontal lobes (FL). Relative values of phosphodiesters-PDE, phosphomonoesters-PME, inorganic phosphate - Pi, phosphocreatine-PCr, total adenosine triphosphate [ATP(t=) gamma- + a- + b-ATP] and the ratios PCr/ATP(t), PCr/gamma-ATP, PCr/Pi and PME/PDE were obtained. Results: We found energetic abnormalities in the MTS patients compared to the controls with Pi reduction bilaterally in the AIBG and ipsilaterally in the PIBG and the contralateral FL; there was also decreased PCr/gamma-ATP in the ipsilateral AIBG and PIBG. Increased ATP(T) in the contralateral AIBG and increased gamma-ATP in the ipsilateral PIBG were detected. Conclusion: Widespread energy dysfunction was detected in patients with unilateral MTS.
  • article 1 Citação(ões) na Scopus
    What's new in insomnia? Diagnosis and treatment
    (2022) PENTAGNA, Alvaro; CASTRO, Luiz Henrique Martins; CONWAY, Barbara Araujo
    Although, insomnia is one of the most common diseases that health professionals face in their practice, it receives little attention in medical training. Diagnosis is based on a careful history taking, and physicians must be aware of the diagnostic criteria. Insomnia should not be considered a symptom, but a comorbid condition.Although cognitive behavioral therapy (CBT) has been the mainstay treatment for insomnia for many years, it is usually regarded as a novel therapeutic strategy, both because of scarcity of qualified psychologists and of limited knowledge about insomnia among physicians. GABA receptor acting drugs are being abandoned in the treatment of insomnia because of abuse and dependence potential and accident risk. Two main current therapeutic options with the best scientific evidence are the tricyclic antidepressant,doxepin,and a new melatoninergic receptor agonist,ramelteon. Newer drugs to treat insomnia are in the pipeline.Hypocretine blocking agents will be marketed in the near future.
  • article 8 Citação(ões) na Scopus
    Ictal SPECT in Psychogenic Nonepileptic and Epileptic Seizures
    (2021) GALLUCCI-NETO, Jose; BRUNONI, Andre Russowsky; ONO, Carla Rachel; FIORE, Lia Arno; CASTRO, Luiz Henrique Martins; MARCHETTI, Renato Luiz
    Background: Psychogenic nonepileptic seizures (PNES) are a common and debilitating problem in patients with epilepsy. They can be virtually indistinguishable from epileptic seizures, demanding video-electroencaphalogram monitoring, which is costly and not widely available, for differential diagnosis. Specific functional brain correlates of PNES have not been demonstrated so far. We hypothesized that PNES and epileptic seizures have distinct brain activation patterns, assessed by functional neuroimaging during ictal events of both conditions. Objective: Compare ictal brain activation patterns of PNES and epileptic seizures using single-photon emission computerized tomography. Methods: We prospectively assessed brain functional activation using single-photon emission computerized tomography 99mTc-ethyl cysteinate dimer in 26 patients with PNES, confirmed by trained psychiatrists in epileptology, who had their seizures induced by provocative tests compared with 22 age- and sex-matched subjects with temporal lobe epilepsy who underwent prolonged intensive video-electroencaphalogram monitoring. Results: In PNES patients compared with temporal lobe epilepsy group, we found a consistent increase in regional cerebral blood flow in the right precuneus (Brodmann area 7; P = 0.003) and right posterior cingulate cortex (Brodmann area 31; P = 0.001), as well as a decrease in regional cerebral blood flow in the right amygdala (P = 0.027). Conclusions: Activation of default mode network brain areas and temporoparietal junction may be a distinct feature of ictal PNES and could be explained by a disruption between movement prediction input and sensory outcome. Such information mismatch might be the neurobiological underpinning of dissociative episodes.
  • article 17 Citação(ões) na Scopus
    Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature
    (2020) LOPES, Cesar Castello Branco; BRUCKI, Sonia Maria Dozzi; PASSOS NETO, Carlos Eduardo Borges; CORAZZA, Luiza Alves; BAIMA, Jose Pedro Soares; FIORENTINO, Matheus Dalben; TATSCH, Joao Fellipe Santos; MARTIN, Maria da Graca Morais; LUCATO, Leandro Tavares; GOMES, Helio Rodrigues; ROCHA, Maria Sheila Guimaraes; FORTINI, Ida; NITRINI, Ricardo; CASTRO, Luiz H.
    Background: Neurological manifestations of COVID-19 are still incompletely understood. Neurological manifestations may be due to direct viral effect on neurons and glial cells, to an immune-mediated response to the virus, or to a hypercoagulable state and associated endothelial damage, as well as to severe systemic disease with prolonged intensive care unit stay. Objective: To describe two patients with severe SARS-CoV-2 infection and delayed recovery of consciousness after sedation withdrawal, in whom MRI disclosed multifocal white matter brain lesions, compatible with the diagnosis of acute disseminated encephalomyelitis. Methods: Observational report of two cases of severe COVID-19 infection in patients from two tertiary hospitals in Sao Paulo, Brazil. Results: These patients underwent neurologic and systemic evaluation for delayed awakening after sedation withdrawal. MRI displayed multifocal centrum semiovale lesions, suggestive of demyelinating inflammation. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for SARS-CoV-2 was negative in both cases. Conclusion: A recurrent pattern of multifocal white matter lesions can occur in COVID-19 patients, possibly associated with delayed awakening. Additional studies are necessary to elucidate the role of the viral infection and of inflammatory and immune-mediated associated changes in neurological manifestations of COVID-19.
  • article 3 Citação(ões) na Scopus
    Rapidly progressive dementia due to neurosarcoidosis
    (2013) FORTES, Gabriela Carneiro C.; OLIVEIRA, Marcos Castello B.; LOPES, Laura Cardia G.; TOMIKAWA, Camila S.; LUCATO, Leandro T.; CASTRO, Luiz Henrique M.; NITRINI, Ricardo
    ABSTRACT Rapidly progressive dementia (RPD) is typically defined as a cognitive decline progressing to severe impairment in less than 1-2 years, typically within weeks or months. Accurate and prompt diagnosis is important because many conditions causing RPD are treatable. Neurosarcoidosis is often cited as an unusual reversible cause of RPD. Methods: We report two cases of neurosarcoidosis presenting as RPD. Results: Case 1: A 61-year-old woman developed a RPD associated with visual loss. In seven months she was dependent for self-care. Magnetic resonance imaging (MRI) revealed temporal and suprasellar brain lesions. Treatment with high-dose intravenous prednisolone was associated with partial improvement. Case 2: A 43-year-old woman who was being treated for diabetes insipidus developed a severe episodic amnesia one year after onset of cognitive symptoms. Previous MRI had shown a hypothalamic lesion and she had been treated with oral prednisone and cyclophosphamide. There was reduction of the MRI findings but no improvement in the cognitive deficits. Brain biopsy disclosed noncaseous granulomas and granulomatous angiitis; treatment was changed to high-dose intravenous methylprednisolone, with poor symptomatic response. Conclusion: The diagnosis of RPD due to neurosarcoidosis can be challenging when the disease is restricted to the nervous system. In these cases, clinical presentation of RPD associated with neuroendocrine and visual dysfunction, imaging findings showing hypothalamic lesions and, in some cases, brain biopsy, are the key to a correct diagnosis. It is possible that earlier diagnoses and treatment could have led to a better outcome in these patients.