http://hdl.handle.net/11422/19626 Wed, 29 Jul 2026 17:27:05 GMT 2026-07-29T17:27:05Z http://hdl.handle.net/11422/29540 Title: O TDAH na prática neurológica do adulto: muito além da desatenção Author(s)/Inventor(s): Possidente, Giuliana Gonçalves Moreira Advisor: Fernandes, Rita de Cássia Leite Abstract: Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental condition that, although frequently associated with childhood, may extend into adulthood, impairing cognitive, emotional, and social functioning. This thesis aims to review the scientific literature on adult ADHD, with an emphasis on integrating neurobiological, clinical, and therapeutic aspects from a neurological perspective. This is a narrative review based on recent national and international publications that aim to understand the neuroanatomical and functional foundations of the disorder, its clinical presentation in adulthood, and the primary therapeutic approaches available. Evidence indicates that ADHD results from dysfunctions in frontostriatal, frontoparietal, and cerebellar circuits, associated with dopaminergic and noradrenergic alterations that compromise inhibitory control, sustained attention, and reward mechanisms. Clinically, the disorder manifests as inattention, impulsivity, executive dysfunction, and impaired emotional regulation, impacting occupational performance and interpersonal relationships. The recognition of ADHD in adults remains limited, due to both the symptomatic overlap with other disorders and the lack of specific diagnostic protocols. Treatment should be multimodal, combining pharmacological therapies — particularly stimulants and noradrenergic agents — with psychotherapeutic interventions and cognitive rehabilitation strategies. The integration between neuroscience and clinical practice enables the understanding of ADHD as a complex neurobiological condition that requires continuous and interdisciplinary management. It is concluded that improving the diagnosis and treatment of adult ADHD depends on acknowledging its cerebral basis and adopting individualized therapeutic approaches, thereby promoting functional improvement and quality of life. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/11422/29540 2025-01-01T00:00:00Z http://hdl.handle.net/11422/29537 Title: HIV e cérebro: do comprometimento neurocognitivo à encefalite por linfócitos T CD8+: relato de caso e revisão de literatura Author(s)/Inventor(s): Cecatto, Matheus Jorand Advisor: Lima, Marco Antonio Sales Dantas de Abstract: The introduction of Combination Antiretroviral Therapy (cART) dramatically reduced opportunistic infections affecting the central nervous system (CNS), thereby reshaping the landscape of HIV-related neurological disorders. With this epidemiological shift, HIV-Associated Neurocognitive Disorder (HAND) has become increasingly prevalent, ranging from Asymptomatic Neurocognitive Impairment to Mild Neurocognitive Disorder and HIV Associated Dementia. These conditions arise from persistent neuroinflammation and residual viral replication within the CNS, even under effective cART. Immune reconstitution induced by cART has also been accompanied by the emergence of inflammatory complications such as Immune Reconstitution Inflammatory Syndrome (IRIS). Within this context of immune dysregulation, CD8+ T-cell Encephalitis (CD8E) has been recognized as a rare and recently described entity, characterized by exuberant infiltration of CD8+ T lymphocytes within the brain parenchyma and vasculature, frequently associated with cerebrospinal fluid (CSF) viral escape. From a pathophysiological perspective, HIV enters the CNS early via infected monocytes, leading to chronic neuroinflammation driven by microglia and macrophages. In CD8E, however, the pathological pattern diverges from classical HIV encephalitis due to the absence of multinucleated giant cells and minimal p24 expression, with CD8-mediated cytotoxicity predominating. Diagnosis relies on the combination of clinical presentation, neuroimaging findings — typically diffuse white-matter hyperintensities and perivascular enhancement — and CSF analysis. Although definitive confirmation is histopathological, treatment must be initiated promptly with corticosteroid immunosuppression and optimization of cART.The case presented involves a 24-year-old patient with poor treatment adherence who developed a subacute neurological syndrome characterized by psychomotor slowing, tremor, and cognitive impairment. Brain MRI showed diffuse T2/FLAIR white-matter hyperintensities, while CSF analysis revealed marked lymphocytic pleocytosis with CD8+ predominance and significant dissociation between plasma and CSF viral loads. High-dose methylprednisolone therapy led to clinical improvement, although the patient experienced a relapse two years later, again associated with CNS viral escape. This study aims to broaden the recognition of HIV-related CNS manifestations, emphasizing CD8E within the spectrum of HIV-associated encephalitides, particularly in unexplained subacute neurological presentations. By integrating clinical, laboratory, and radiological findings, it highlights the need to develop diagnostic criteria that enable early identification and management of this rare condition, reducing reliance on brain biopsy — an especially relevant consideration in resource-limited settings. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/11422/29537 2025-01-01T00:00:00Z http://hdl.handle.net/11422/29528 Title: Desafios diagnósticos na paquimeningite hipertrófica: série de casos clínicos e revisão de literatura Author(s)/Inventor(s): Ribeiro, Ana Carolina Leite Advisor: Pereira, Victor Evangelista Rodrigues Abstract: Hypertrophic pachymeningitis (HP) is a rare inflammatory disease characterized by focal or diffuse thickening of the dura mater, with a heterogeneous etiology (idiopathic, immunomediated, infectious, or neoplastic). This study conducted a narrative literature review (2014–2024) and a retrospective series of seven cases evaluated at a tertiary center, aiming to analyze the diagnostic challenges of HP, correlate clinical, neuroimaging, cerebrospinal fluid, and histopathological findings, and compare the cohort with published series. Patients were included based on dural enhancement on contrast-enhanced MRI and histopathological investigation or robust clinical–radiological correlation; the assessment included contrast MRI, CSF analysis, extensive laboratory testing, and systemic imaging workup. In the cohort, females predominated (4/7), and the median age was 59 years. Headache (6/7) and cranial neuropathies (5/7) were the most frequent clinical manifestations; specific syndromes (Tolosa–Hunt, orbital pseudotumor) and signs of parenchymal involvement were also observed at considerable frequency. MRI most often demonstrated a diffuse and irregular pattern of dural thickening, with frequent leptomeningeal enhancement; the “Eiffel-by-night” sign was identified in one case. CSF analysis typically showed moderate hyperproteinorrachia and mild pleocytosis in immunomediated cases. Biopsy confirmed specific etiologies in three patients (Staphylococcus aureus, tuberculosis, and IgG4-related HP); three samples were nonspecific (idiopathic). The mean time to diagnosis was ≈15 months. Treatment followed etiology-based protocols (corticosteroid therapy and immunosuppressants in non-infectious forms; targeted therapy in infectious etiologies). Only one patient achieved complete remission; most had partial improvement with persistent neurological sequelae. HP requires multidisciplinary evaluation and targeted biopsy to establish an etiological diagnosis. This is the first case series published in Latin America, contributing to the limited international literature on clinical–radiological patterns and diagnostic challenges; limitations include the small sample size and difficulty obtaining representative biopsy specimens. Early detection and biopsy, preferably in less invasive sites, are essential for implementing targeted therapy and improving outcomes. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/11422/29528 2025-01-01T00:00:00Z