Foram estudados 120 pacientes, 71 do sexo masculino e 49 do sexo feminino, que apresentaram eletrencefalograma com as características de hipsarritmia. A maioria (39%) teve o seu eletrencefalograma realizado com a idade de 10 meses 3 anos e a primeira crise convusiva foi registrada predominantemente nos 4 primeiros meses de vida (54%). Em 56% dos pacientes foi assinalada, pela anamnese, mais de um tipo de crise convulsiva, sendo a associação mais freqüente a de espasmo infantil e crise convulsiva motora generalizada. Em 44% dos pacientes foi registrado apenas um tipo de crise convulsiva, sendo o espasmo infantil o mais freqüente. Dezoito pacientes (16%) não apresentaram espasmo infantil. As alterações eletrencefalográficas foram as mais diversas. O aspecto de hipsarritmia assimétrica foi assinalado em 22% e a fragmentação em 11% dos casos. Em nenhum de nossos pacientes houve resposta à foto-estimulação.

The study of 120 patients, 71 male and 49 female, with electroencefalographic pattern of hypsarhythmia is reported. The electroencephalogram of most of them (39%) was performed when the patients were from 10 months to 3 years old and the first convulsion was registered predominantly in their first four months of life (54%). In 56% of the patients more than one type of convulsion was registered by the anamnesis, the association of infantile spasm and generalized motor convulsion being the most common. In 44% of the patients only one type of convulsion was registered, the most frequent one being the infantile spasm; 18 patients (16%) having not presented infantile spasm. The electroencephalographic alterations were the most varied. The assymetric hypsarhythmia was registered in 22% and the fragmentation in 11% of the cases. There was no response to photostimulation in any one of the patients.

Visando ao estudo da ação do sono como ativador do eletrencefalograma em pacientes epilépticos, foram estudados 1.868 pacientes com síndromes convulsivas (572 com crises generalizadas, 121 com crises temporais não psicomostras, 118 com crises psicomotoras, 410 com crises focais não temporais, 314 com crises noturnas, 165 com crises febris, 168 com crises convulsivas associadas a retardo psicomotor). Em todos os pacientes foram feitos eletrencefalogramas em vigília (repouso e hiperpnéia) e durante o sono (fase lenta) sendo os achados comparados. Em nosso material não encontramos diferença significativa de resposta entre o sono espontâneo e o medicamentoso. Na maioria de nossos pacientes o traçado realizado durante o sono confirmou os achados registrados em vigília. A ação ativadora do sono foi evidenciada em um número relativamente pequeno de casos, tendo atingido o seu máximo no grupo de pacientes com crises psicomotoras (26%). Nas crises generalizadas, temporais não psicomotoras, focais não temporais e noturnas o sono funcionou mais como desativador do que como ativador das anormalidades registradas em vigília.

In order to study the influence of sleep on the electroencephalograms of epileptic patients the tracings obtained of 1.868 such patients were analised (572 generalized seizures; 121 non-psychomotor temporal; 118 psychomotor; 410 non-temporal focal; 314 noctural seizures; 165 febrile seizures; 168 convulsive seizures associated with psychomotor retard). The electroencephalograms were made with the patients awake (rest and hyperpnea) and sleeping (slow phase), the findings being compared. There was not found any significant difference between the EEG tracings obtained during spontaneous sleep and medically induced sleep. In the majority of the cases the records obtained while the patients were asleep merely confirmed the ones made while the patients were awake. The activator action of sleep appeared only in small number of the cases, having it's peak on the group with psychomotor seizures (26%). In the generalized non-psychomotor temporal, non-temporal focal and noctural seizures the sleep acted as an antiactivator instead of an activator of the abnormalities recorded while the patients were awake.

Após comentários sobre a literatura, os autores apresentam o material composto de 28 pacientes sem queixa neurológica ou psiquiátrica, que estavam fazendo uso de anticoncepcional oral, e nas quais foi realizado um eletrencefalograma. Este se mostrou anormal em 7 (25%). As anormalidades foram predominantemente paroxísticas e difusas. Em nenhum caso foi encontrada lentificação do fuso do sono.

An electroencephalogram was made in 28 women who had been using oral anticonceptional for at least three menstrual cycles and had no neurological or psychiatric complaint. The electroencephalogram was abnormal in 7 (25%). No slowness of the sleep spindle was found in any of the cases.

Foram estudados 31 pacientes com crises clínicas tipo P.M. cujos eletrencefalogramas revelaram disritmia centrencefálica secundária a atividade irritativa focal. A sua freqüência entre as disritmias centrencefálicas foi de 27% (19% secundárias a foco de localização profunda e 8% secundárias a foco de localização cortical). O tipo clínico das crises foi analizado, sendo ressaltado o fato de que 8 pacientes não apresentaram crise tipo P.M. puro (ausência): 4 apresentaram P.M. mioclônico e 4 P.M. acinético. A alta incidência de antecedentes pessoais de valor (33%) foi enfatizada.

Thirty one patients with P.M. epileptic crisis whose EEG showed centrencephalic disrythmia secondary to focal irritating activity where thoroughly observed. 19% of the cases showed centroencephalic disrythmia secondary to deeply situated focus and 8% to focus of cortical situation; in these cases the temporal projection was predominant. The clinical type of the crisis was analysed with emphasis on the fact that 8 patients did not show a "sheer" P.M. type crisis (absence): 4 showed mioclonic P.M. and 4 akynetic P.M. The high incidency of personal antecedents (33%) is emphasized.

São apresentados 60 casos de tumores metastáticos intracranianos, diagnosticados clinicamente ou pela neurocirurgia (28 casos operados, 26 com exames radiológicos contrastados e 6 com diagnóstico clínico). Os exames eletrencefalográficos tinham sido feitos previamente e na mesma época do diagnóstico e da intervenção. Os resultados do EEG, interpretados previamente ao conhecimento do diagnóstico clínico, são apresentados em 5 quadros, nos quais os casos são catalogados segundo a topografia da metástase. Os dados fornecidos pelo EEG são analisados e a possibilidade do diagnóstico topográfico é discutida. Os resultados são concordantes com os da literatura. Os AA. concluem: 1) nos pacientes com suspeita de metástase cerebral o EEG normal permite, com grande probabilidade, excluir essa possibilidade; 2) nos pacientes com tumores malignos os sinais eletrencefalagráficos indicando sofrimento do parênquima nervoso são os mais importantes para um diagnóstico afirmativo de metástase cerebral; 3) nos casos de metástases desenvolvendo-se na fossa posterior o EEG se mostra normal ou, então, revela sinais indicativos de processo nessa região; 4) os sinais eletrencefalográficos de processo irritativo no córtex cerebral foram pouco frequentes e, na maioria dos casos, apareceram nas áreas temporais ou parietais; 5) os sinais de envolvimento das estruturas mesodiencefálicas em tumores dos hemisférios cerebrais aparecem nos casos de localização na parte mediana do hemisfério cerebral (lobos temporais ou parietais); 6) os sinais de depressão da ativodade elétrica cerebral de base nas áreas afetadas aparecem raramente em casos de tumores parietais ou occipitais; 7) a atividade elétrica cerebral em outras áreas do hemisfério envolvido pelo tumor e nas do hemisfério oposto se apresentou normal na maioria dos casos. Considerando os resultados da literatura e os seus próprios os AA. pensam que o EEG é um método semiológico que deva ser usado em todos os casos de pacientes com tumores malignos e candidatos a um terapêutica cirúrgica. A evidenciação de uma metástase cerebral, por este método semiológico, evitará que o paciente seja submetido a intervenção cirúrgica penosa e inútil.

Sixty cases of intracranial metastatic tumors diagnosed either clinically or by neurosurgery (28 operative cases, 26 with radiological contrast examinations and 6 with clinical diagnosis only) are reported. The EEG tests had been made previously to the diagnosis of metastasis. The EEG results are analysed according to the previous impression gained from this test and are presented in 5 tables, on which the cases are divided as per the brain topography of the metastasis. The positive EEG data are analysed and the possibility of topographic diagnosis discussed. The results agree with those presented in the literature. The AA. reach the following conclusions: 1) in patients with suspect brain metastasis the normal EEG allows with great probability to exclude the possibility; 2) in patients with malignant tumor the EEG signs of involvement of the nervous parenchyma are the most important elements for positive diagnosis of brain metastasis; 3) in the cases of metastasis developing at the posterior fossa, either there were indicative signs of the process at that level or the EEG was normal; 4) the EEG signs of an irritant process at the brain cortex were less frequent and, in the majority of cases, appeared in the temporal and parietal areas; 5) the signs of involvement of the mesodiencephalic structures in tumors of the brain hemispheres appeared only when the tumor was located in the median part of the hemisphere (temporal or parietal lobes); 6) signs of depression of the basal electric brain activity in the affected areas appeared rarely and in cases of parietal or occipital tumors; 7) the electric brain activity of other areas of the involved hemisphere or in the opposite hemisphere was normal in the majority of the cases observed. Considering the results of the literature and their own the AA. believe that the EEG could be a semiological method to be used at the preoperative examinations of patients with malignant tumors, with a view at establishing the possible existence of brain metastasis even in the absence of clinical symptoms. The evidence is obviously most important for orientation of the therapy in such cases, whether surgical or not.

In the past few years somewhat new yet often differing points of view have been affirmed refering to Petit Mal epilepsy, with regard to its clinical, eletrencephalographic and evolutive aspects. The classical concept of PM epilepsy as established by Lennox and Gibbs, with its well defined clinical and EEGraphic characteristics is continually being modified with new research work on clinical and EEGraphic aspects. Numerous clinical cases have been published whose evolution clashes with that classically described and likewise numerous are those cases where the EEG shows signs of focal electric activity besides spike and wave dis-rythmia. Cases have been known where surgical exerese on the focus causes temporary desappearance of the spike and wave disrythmia. The present concept now holding sway is that PM epilepsy is a kind of reaction of infantile encephalon to diverse harmful causes. From this it will be seen we are very far from the concept that PM epilepsy is a pure form of idiopathic epilepsy. For these reasons we decided to re-examine those cases observed between 1950 and 1960. With this in mind we chose 141 PM epilepsy cases, from among over 23000 epileptics, all examined under a standard criterion by a small group of senior assistants. All cases suspected of Psm epilepsy were excluded. The analysis of this group of patients was compared to that of another group with GM as well as PM seizures (104 patients); in 52 of these cases, studies were made concerning the evolutive, clinical and EEGra-phic aspects. METHOD: Clinical criterion was used for selection of the cases. The results of the analysis from the clinical and EEGraphic point of view were exhibited in demonstrative graphs. From the clinical point of view we strove to find out positive hereditary elements, organic cerebral injury factor (intellectual deficit, mood and behaviour disturbances, neurologic or somatic signs, as well as other development anomalies), the presence of febrile convulsions before the setting in of clinical PM syndrome and the eventuality of abnormal birth. We listed the patients according to their sex and investigated the statement that there is a prevalence of PM seizures among women. We attempted to analyse the incidence of cases according to the patient's age, as well as the incidence regarding the onset age of the illness. With regard to the EEG we likewise attempted to analyse those elements enabling us to weigh up the lesional factors in the brain (abnormalities in the background activity, disrythmias with focal characteristics or other paroxysmal abnormalities of a lesional type) and the bilateral and synchronous paroxysmal disrythmias classically known as forming part of the Petit Mal epileptic picture. Out the group of patients presenting pure PM seizures (141 cases) we obtained a clinical and EEGraphic sequence in 37, during a period of time ranging from 1 to 13 years. Of the group of patients presenting GM seizures as well as PM (104 patients) we investigated, in a comparative manner, 15 cases in a cliincal and EEGraphic sequence, during a period ranging from 1 to 9 years. RESULTS: The analysis of the clinical and electroencephalographic aspects in the first group of patients (141 cases with PM seizures) has enabled us to point out - a) A greater occurrence of this disease between the ages 6 and 12 - though there were 48 patients between the ages of 11 and 20 and 16 patients above 20 years old; b) in the majority of cases the disease set in between the age of 6 and 10 (47 cases); in some cases however the disease started up under two years of age; in 31 patients the onset was after 11 years of age; c) as far as sex distribution, there was no significant difference; d) barely 1 case proved to be abnormal in the somatic examination congenital cardiopathy) ; e) the occurrence of psychic disturbances among patients was extremely low; f) there were no cases with past history of abnormal birth; g) back-ground activity was with in the limits of normality in the great majority of cases; h) incidence of bilateral and synchronous spike and wave 3 c/s, was fairly high; slower disrythmia of this type was present in 4 cases only; i) larval disrythmias by spikes or multiple-spikes and slow ware occurred quite often and appeared both in the mioclonic form of PM as well as in the other forms of the disease; j) diffuse and irregular slow sharp waves, were found in 7 patients and sharp focal waves in 4; these alterations would always seem to appear associated with bilateral and synchronous disrythmias. The analysis of these same elements in the second group (104 patients with PM plus GM seizures) has enabled us to note the following details: a) later age of onset; b) in 5 cases there was child-birth asphyxia; c) higher incidence of cases presenting bilateral and synchronous disrythmias with a frequency below 3 c/s. The development aspects of our patients was not uninteresting. Out of 37 patients with pure PM seizures we noted: a) that the age of onset did not on the whole favour or unfavour the evolution; b) the great majority of cases developed favorably: 18 patients have no more seizures, 11 still present a very minimum number of seizures; 6 later had GM seizures associated; one patient showed a rather serious impairment of his seizures; c) in cases of favorable development,' synchronous disrythmias by spike and wave 3 c/s disappeared, which was not what happened in the group of cases showing unfavorable development; d) total disappearance of disrythmias was only noted in those cases of favorable development; e) there were cases, both among the favorable and unfavorable development groups, where the initial disrythmias perceptibly modified with time and became diffuse sharp waves; f) background activity was normal in the great majority of cases; g) some of our patients developed with clinical fits even over the age of 30. Out of 15 patients with GM plus PM seizures and on whom development studies were made, we noted that the results differed very little from those of the previous group. We should like to point out, however, that disappearance of the spike and wave 3 c/s disrythmias did not occur, even in those cases presenting favorable clinical development. COMMENTS: After discussing the most interesting facts stated in the analysis of their cases and co-relating them to litterature data found, with particular reference to the works presented at the Congress of Brussels by Jung, Bickford, Droogleever-Fortuyn, Gibbs and Walker, the AA have come to the following conclusions: 1) there are clinical and electroence-phalographic indications that the syndrome "Petit Mal Epilepsy" is a clinical manifestation of diverse brain affections; 2) the starting up of the Petit Mal syndrome occurred at an age below 11 years in the majority of cases; however, there are others where the onset occurred after this age and in some cases even above the age of 20; 3) the persistence of Petit Mal clinical syndrome with electroencephalographic manifestations of the complex spike and wave 3 c/s. type can occur in many patients after the age of 15 and up to the age of 40, which fact is in complete disaccord with the classical idea of Petit Mal epilepsy good prognosis after puberty.

Com a finalidade de conhecer os elementos úteis que o EEG poderia trazer para o diagnóstico da forma clínica da cisticercose encefálica, foram reunidos 118 casos desta afecção, com diagnóstico confirmado pela verificação cirúrgica, pelo exame do liqüido cefalorraqueano (presença de leucocitose, eosinofilia e reação de desvio de complemento positiva) ou pela verificação radiológica de cisticercos calcificados. Os resultados electrencefalográficos foram analisados particularmente visando os dados que pudessem informar sôbre existência de processo difuso envolvendo o parênquima nervoso dos hemisférios cerebrais, ou a existência de focos epileptógenos ativos, ou ainda, sinais de sofrimento do parênquima em conseqüência da hipertensão intracraniana. Êstes resultados foram estudados separadamente no grupo dos casos com síndrome clínica da convexidade cerebral, com a presença ou não de síndrome convulsiva e no grupo dos casos com síndrome clínica de base e fossa posterior. Além disso os resultados electrencefalográficos foram estudados comparativamente no grupo de pacientes com cisticercos não calcificados, assim como também foram estudados, comparativamente, em grupos de pacientes com síndrome inflamatória verificável pelo exame do líqüido cefalorraqueano e no de pacientes com o liqüido cefalorraqueano normal. Êstes resultados, projetados nos quadros 1 e 2, permitiram conclusões de algum interêsse clínico, significativas para a importância do exame electrencefalográfico na avaliação dos processos patológicos encefálicos decorrentes da neurocisticercose.

The present study has the purpose of showing the possible value of the EEG in the diagnosis of brain cysticercosis. The diagnosis of cysticercosis was based on (1) radiological calcification, (2) characteristic spinal fluid findings (increase of cells, increase of eosinophils and positive test for cysticercosis) and/or (3) neurosurgical findings. The total number of cases was 118 (14 verified by surgical approach, 35 diagnosed by X ray examination and 42 by the spinal fluid examination) : in 16 cases there were association of surgical and spinal fluid positive findings; in 4 cases there were surgical findings and X ray positive findings; in 7 cases there were spinal fluid and radiological positive findings. The surgical cases were mostly of cysticercus of the posterior fossa because of the spinal fluid blocking that asks such therapy. The patients were divided according to the localization of the cysticercus (1) on the cortical surface, (2) at the base of the brain and the posterior fossa, and (3) diffuse cysticercosis. The localization of the cysticercus was possible by the evaluation of the clinical signs, the radiological calcification or the neurosurgical finding of the cysticercus. The EEG records were analysed according to the changes possibly due to the lesion caused by the cysticercus (chronic and diffuse meningo-encephalitis of the brain surface, arachnoiditis of the base and of the posterior fossa, inflammatory reaction inside the fourth ventricle, with subsequent spinal fluid blocking and intracranial hypertension). The analysis showed: 1 - Focal paroxysmal changes have indicated the great incidence of epileptic seizures in these patients; 2 - δ waves were more frequent when the lesion was located in the posterior fossa. The meningo-encephalitis on the cerebral surface did not show EEG signs of acute brain involvement; 3 - θ waves were seen very seldom and were present only on those patients with signs of basal or posterior fossa involvement (due to intracranial hypertension probably) due to involvement of mesencephalic structure; 4 - The normal EEG was very rare in patients with cerebral cysticercosis and did not give any information regarding the localization of the cysticercus; 5 - Changes on background activity (disorganization or discrete slow waves) have been noticed in all groups of patients; 6 - In patients with diffuse cerebral cysticercosis the EEG changes (disorganization on background activity, slow waves or signs of focal activity) did not show striking difference from those patients with localized cerebral cysticercosis; 7 - The calcified cysticercus on the cerebral surface (chronic cysticercosis) was coincident more often with focal activity on the EEG, than on the group of not calcified cysticercus (recent, cysticercosis); 8 - The incidence of pathological EEG was the same on both groups (calcified and non calcified cysticercosis). The EEG on the last group showed very often δ waves.

Após rápida revisão da literatura, os autores apresentam os resultados dos exames do liqüido cefalorraquidiano em 12 casos de parotidite epidêmica complicada por meningite. As punções foram tôdas realizadas com finalidade diagnostica e terapêutica (descompressiva) ; todos os pacientes apresentavam sintomas e sinais clínicos agudos de meningite. Da análise realizada concluiu-se o seguinte tipo médio de líquor: aspecto levemente opalescente; incolor; presença de retículo fibrinoso; pressão inicial média de 19 cm de água; 570 células por mm³, sendo 95% de linfomononucleares, 3% de neutrófilos e 2% de plasmócitos; 0,41 g/l de proteínas totais; reação de Pandy fortemente positiva; reação de Weichbrodt negativa; reação de Nonne positiva; reação do benjoim coloidal 00000.02222.00000.0; reação de Takata-Ara negativa; 7,05 g/l de cloretos; 0,62 g/l de glicose; reações sorológicas e provas bacteriológicas negativas. Os autores apresentam também considerações gerais sobre o diagnóstico diferencial, particularmente com a meningite tuberculosa.

The authors make a review of literature and present the results of the spinal fluid test in 12 cases of epidemic mumps complicated by meningitis. The spinal taps were performed for diagnosis and treatment (decompression) ; all patients had symptoms and clinical signs of acute meningitis. The authors found the following average type of spinal fluid: aspect, lightly opalescent; no color; fibrin clot; initial pressure 19 cm of water; 570 cells/cm (95 per cent), lymphomononuclear, 3 per cent, polymorphonuclear, 2 per cent, plasma cells; 41 mgm/100 ml of total protein; Pandy test ++; Weichbrodt test negative; Nonne test +; colloidal benzoin 00000.02222.-00000.0; Takata-Ara test negative; 705 mgm/100 ml of chlorides; 62 mgm/100 ml of glucose; serological tests and bacteriological tests negative. The authors make general considerations on the differential diagnosis, particularly with tuberculous meningitis.

Quanto à natureza (quadros 1 e 2) - 1) A classificação histológica traz em si fatores de êrro devido à existência, na mesma peça, de zonas de constituição celular diferente, e à diversa orientação seguida pelos patologistas. 2) Os gliomas constituem o grupo dominante, sendo que: a. o glioblastoma, tumor próprio da idade adulta, apareceu tanto em situação supratentorial como infratentorial ; b. o astrocitoma foi dominante no hemisfério cerebelar; c. o meduloblastoma apareceu como lesão de fossa posterior, nem sempre na linha média e excepcionalmente como lesão de hemisfério cerebral; d. o ependimoma só apareceu no 4º ventrículo, não aparecendo no hemisfério cerebral, como mostrou Tõnnis (temos um caso de neuroepitelioma de hemisfério cerebral que alguns patologistas classificam como ependimoma) ; e. os papilomas foram os tumores intraventriculares. 3) Os meningeomas foram raros em nosso material. 4) 0 neurinoma foi excepcional. 5) Nos tumores da região hipofisária, não tivemos casos de adenoma, mas apenas craniofaringeomas e gliomas do nervo óptico. 6) 0 hemangioblastoma, de freqüência desusada em nosso material geral, requerendo mesmo revisão de estudo histológico, não foi dominante nas duas primeiras décadas da vida. 7) Dos tumores malignos de início clínico no sistema nervoso dominou o reticulossarcoma. 8) Das afec-ções cirúrgicas não tumorais apareceram de preferência os hematomas, os abscessos e a cisticercose (em relação à cisticercose devemos dizer que foram relacionados apenas os casos verificados cirùrgicamente). Os tuberculomas foram raríssimos. O aneurisma arteriovenoso, lesão que começa com sintomas no início da 2ª década, é diagnosticado geralmente mais tarde. Em nosso material alguns casos apareceram após a análise deste grupo. Quanto à sede (quadro 3) - 1) Em conjunto, não houve dominância nítida das lesões infratentoriais sobre as supratentoriais, como é clássico na literatura médica. 2) Em relação ao grupo dos gliomas, a dominancia infratentorial foi evidente. 3) Nos infratentoriais dominaram, como tipo maligno, o meduloblastoma e, como benigno, o astrocitoma. 4) O astrocitoma foi dominante nos hemisférios cerebelares, enquanto o meduloblas- toma apareceu tanto na linha média como nos hemisférios cerebelares. 5) Na região hipofisária (optoquiasmálica) dominaram os craniofaringeomas e apareceram os gliomas do nervo óptico, não se registrando casos de adenoma. Como conclusões gerais: 1) A correlação dos fatôres idade, sede e natureza fornece elementos para o diagnóstico e prognóstico dos casos de afecções cirúrgicas intracranianas; 2) Em nosso material não houve a clássica dominancia das lesões infratentoriais sobre as supratentoriais, mas as demais distribuições de sede e natureza estão de acôrdo com os dados da literatura médica; 3) O meduloblastoma tanto apareceu nos hemisférios cerebelares como na linha média, sua sede preferencial de acôrdo com a literatura.

In patients with surgical intracranial lesions, correlation of age, localization and type is very important to diagnosis and prognosis. In our material we have not found the classical predominancy of infratentorial lesions over the supratentorial ; the localization and type of lesions agree with the literature. Medulloblastomata are so common in the cerebellar hemispheres as in the vermis, the latter being the most common site according to the literature.