Neurology in Brazil

Neurology is a branch of medicine that focuses on the diagnosis and the treatment of diseases of the nervous system. The nervous system is a complex and sophisticated system that regulates and coordinates our body activities. It is divided into two major parts:

• The central nervous system: the brain and spinal cord
• The peripheral nervous system: all nerves branching out from the brain and spinal cord, and extend to other parts of the body, including organs and muscles.

Since the nervous system is complex, there are numerous subspecialties within the field of neurology, including:

• Neurodevelopmental disabilities
• Pediatric or child neurology
• Neuromuscular medicine
• Pain medicine
• Hospice and palliative care neurology
• Headache medicine
• Vascular Neurology (stroke care)
• Sleep medicine
• Autonomic disorders
• Brain injury medicine
• Neuropsychiatry
• Epilepsy
• Neurointensive care

A doctor who specializes in treating diseases of the nervous system is called a neurologist. Symptoms that often require a neurologist help may include coordination problems, muscle weakness, confusion, dizziness, and a change in sensation. People who are having problems with their senses, such as vision, touch, or smell, may also require to see a neurologist since problems with senses are sometimes caused by disorders of the nervous system.

A neurologist may also treat patients with:

• Stroke
• Seizure disorders, such as epilepsy
• Migraines and headaches
• Brain aneurysms
• Brain tumors
• Peripheral neuropathy
• Multiple sclerosis
• Infections of the nervous systems, such as meningitis, encephalitis, or brain abscesses
• Neuromuscular disorders, such as myasthenia gravis
• Neurodegenerative disorders, such as Alzheimer’s disease and Lou Gehrig’s disease
• Sleep disorders
• Spinal cord disorders, such as autoimmune and inflammatory disorders
• Speech and language disorders

Keep in mind that neurologist does not perform surgery. If you need surgery, you will be referred to a neurosurgeon.

What does Neurology Involve?

A wide variety of different tests and procedures are used to diagnose and treat neurological conditions. On your first appointment with a neurologist, a physical and neurological exam is likely to be performed. A neurological exam is done to test muscle strength, coordination, and reflexes.

Because different diseases can have similar symptoms, more than one testing may be required for your neurologist to make a diagnosis.

Some of the procedures that fall into the field of neurology may include:

Electromyography

Electromyography (EMG) is used to measure how well your muscles react to electrical stimulation from motor neurons, which are specific nerves controlling muscle movement. It can help neurologists diagnose general muscle or nerve dysfunction, as well as spinal cord disease.

During an EMG, small needles called electrodes are inserted into the muscle by a specially trained technician. The electrodes can measure the different electrical activity occurring in muscle tissue during periods of movement and rest.

Electroencephalogram

Electroencephalogram (EEG) is performed to assess and record electrical activity in your brain. Neurons in our brain communicate with other neurons through electrical impulses, which an EEG can record. Brain wave patterns can also be tracked by an EEG. It is used to help diagnose conditions of the brain, including tumors, inflammation, injuries, as well as psychiatric disorders, epilepsy, and seizures.

During an EEG, electrodes are placed on your head. The electrodes are connected to a computer, which converts electrical signals into patterns that can be seen from a screen or printed on a piece of paper.

Lumbar puncture

Lumbar puncture is done to test your spinal fluid. It involves inserting a needle into your spine after numbing it with an anesthetic. Using the needle, a sample of your spinal fluid is taken.

A lumbar puncture can help diagnose the following conditions:

• Meningitis
• Encephalitis
• Leukemia
• Myelitis
• Dementia
• Autoimmune diseases, such as multiple sclerosis (MS)
• Bleeding in the brain

The procedure can also be used to treat conditions affecting the spinal cord. Your neurologist may inject anesthetics, cancer treatments, or antibiotics using a lumbar puncture needle.

Tensilon test

To help diagnose myasthenia gravis, your neurologist may perform a tensilon test. It involves the injection of a medicine called Tensilon. Then, your neurologist observes how medicine affects your muscle movements.

Sleep study

Chronic sleep problems are diagnosed in a Sleep Study. Also known as a Polysomnogram (PSG), this procedure involves monitoring patients during sleep and physiological data is recorded electronically.

Other tests

Other types of tests may be used by your neurologist to make a diagnosis. These may include:

• Magnetic resonance imaging (MRI scan)
• Computed tomography (CT scan)
• Positron emission tomography (PET scan)
• Biopsy
• Genetic testing
• Angiography

Botox injections

Botox injections can be done to treat some neurological conditions, such as cerebral palsy, that can cause your limbs to pull in toward your center. Sometimes, these contracted muscles can be relaxed with Botox injections.

Botox injections involve injecting tiny amounts of botulinum toxin into your skin of muscles using a thin needle.

Brain tumor treatment

A range of treatments can be done to treat a brain tumor. If your neurologist believes that you need surgery, you will be referred to a neurosurgeon who will remove as much of the brain tumor as possible through surgery.

A brain tumor may also be treated with radiation therapy, which uses high-energy beams to kill tumor cells.

Brain tumor treatment may be integrated between the departments of neurology and oncology.

Brain rehabilitation therapy

Brain rehabilitation therapy is used to help you relearn functions that are lost as a result of a brain injury. Brain rehabilitation therapy is usually integrated between specialty teams in the departments of neurology, sports medicine, psychiatry and psychology, neuroradiology, and the vestibular/balance laboratory.

Deep brain stimulation

During deep brain stimulation, electrodes are implanted within certain areas of the brain. The electrodes generate electrical impulses that can regulate abnormal impulses. These electrical impulses may also affect certain chemicals and cells within the brain.

Deep brain stimulation can be done to treat numerous conditions, including dystonia, essential tremor, epilepsy, and Parkinson’s disease. It is also being studied as a potential treatment for multiple sclerosis and stroke recovery.

Spinal stenosis treatment

Spinal stenosis is a condition that occurs when the spinal canal narrows and pinches the nerves, leading to back and leg pain. Spinal stenosis may be treated with pain medications, physical therapy, steroid injections, decompression procedure, or surgery. Surgery is usually performed if other treatments have not helped.

How Long Should I Stay in Brazil?

Your length of stay depends on the type of procedure you have, you may be allowed to leave the hospital on the same day or you will stay for several days. For diagnostic procedures, you should be allowed to leave the hospital on the same day. However, you should wait until the results of the test are ready before you can fly home, which may take as long as 7 days, sometimes even longer. If you undergo brain tumor treatments or other types of treatment, especially treatments that involve surgical intervention, you should aim to stay in Brazil at least for 10 days.

What's the Recovery Time?

The recovery time can be different for each procedure. It may also depend on the reason why you are having the procedure and your overall health. Your neurologist and neurosurgeon will give you a recovery timeline for each procedure. The recovery period for diagnostic procedures is typically short and you may be able to resume your normal activities within a week or so. For surgical procedures, you may need to wait 4 weeks or months until you can go back to your daily routine, including work and exercise.

What About Aftercare?

A detailed aftercare instruction will be given to you following your procedure. While the instructions will be different for each procedure, they typically include a diet plan, exercise, restrictions, and wound care (if any surgical intervention is involved). You should follow these instructions carefully in order to have a speedy and smooth recovery.

You may also need to attend follow-up checkups to monitor your overall condition and healing. For brain tumors, you may need to attend regular checkups to ensure the tumor has not come back.

What's the Success Rate?

The field of neurology is constantly advancing. The success rate of each procedure is typically high, particularly when performed by highly skilled and experienced medical professionals. Still, some procedures may carry some risks, such as bleeding, infection, and nerve injury.

Are there Alternatives to Neurology?

Since neurology is the branch of medicine to diagnose and treat problems of the nervous system, there are no other alternatives. However, if your doctor found that your disease or illness is found to be caused by other problems unrelated to the nervous system, your doctor will recommend you to see the relevant doctor.

Neurology in and around Brazil

About Brazil

Occupying the title of the largest country in South America, Brazil embraces a diverse population of over 209 million people. The nation is globally renowned for its passion for football (also referred to as soccer in some parts of the world) and their dynamic, flamboyant carnival traditions, boasting a vibrant mix of music, dance, and colorful attire.

In addition to its vivacious culture, Brazil is a sanctuary of spectacular natural beauty. The country nurtures some of the world's most stunning natural wonders, including the dramatic Iguacu Falls and the world's largest tropical rainforest, the Amazon Rainforest, teeming with diverse plant and animal species. One can't miss the landmark figurine of Christ the Redeemer in Rio de Janeiro that towers 98-feet high, becoming a symbol of Brazil's deep-rooted religious faith and an iconic sight that captures hearts worldwide.

Brazil offers more than 60 JCI-accredited facilities and is one of the leading destinations in the world for cosmetic surgery, with Neurology procedures being especially popular. Doctors are often Western-trained and speak English on top of Portuguese and Spanish. Local accreditations include the Consortium of Brazilian Accreditation and the Brazilian Hospital Medical Quality Organization (ONA). Popular locations within Brazil include the capital Brasilia, Rio de Janeiro, Sao Paulo, and Curitiba.

Popular Parts of Brazil

• Rio de Janeiro is a combination of natural attractions and metropolis. It is known to be a party city that offers good times and an unforgettable experience. Lounge around in the world-famous beaches of Ipanema and Copacabana, sample Brazilian cuisine, hike the summit of Corcovado and see the high statue of Christ the Redeemer, dance in Rio Carnival, and see the spectacular views of Ipanema and Guanabara Bay from the Sugarloaf Mountain.
• São Paulo is the largest city in Brazil. It is a huge city that at first glance seems intimidating. It offers hundreds of museums, quirky urban art, delicious cuisine, lively nightlife, and intense cultural experience. Visit Avenida Paulista (Paulista Avenue), a street filled with shopping centers, parks, bars, restaurants, museums, theatres, and cultural spaces.
• Salvador is full of vibrant cultures. It is the heart of Brazil’s Afro-Brazilian community. The city’s charm lies in its pastel-colored neighborhood, centuries-old architecture, and freshly-cooked acarajé and completed with wild festivals and capoeira circles every night.
• Brasília is Brazil’s capital. It’s very modern with futuristic architecture that looks more like artworks than ordinary buildings. It’s a paradise for architecture buffs. Besides the architecture, the food and nightlife in this city is something that should not be missed.
• Manaus might be isolated in terms of location, but it’s actually a large city with a prospering industry and a rich culture. The city is also filled with natural beauty; green spaces, waterfalls, and ecological parks surround its colonial buildings. It is the gateway to the Amazon Rainforest.

Weather and Climate in Brazil

As a large country, the weather in Brazil varies from tropical in the north to temperate in the south. A large part of the country lies in the topics. Brazil is a year-round destination because it has a steady average annual temperature. The temperature rarely drops below 20 °C.

Winter in Brazil starts in May and ends in September. The weather remains tropical in the north with an average temperature ranging between 20 °C to 30 °C. In Rio de Janeiro, the temperature varies between 14 °C to 25 °C. However, the evenings usually feel a lot colder.

During this particular season, one can expect a fair amount of rainfall in Rio, leading to many wet and rain-soaked days. If you plan a visit at this time, it's wise to keep that in mind and prepare accordingly. In contrast, further inland, São Paulo experiences significantly cooler temperatures compared to Rio, reflecting the country's vast geographical expanse and diverse microclimates spread across its regions.

This temperature drop might require some warm clothing, especially during late evenings and nights. So, whether you wish to enjoy the rainy murmur in Rio or seek the cool retreat of São Paulo, there's something unique for every traveler in Brazil during this season.

The temperature in Rio rise between November and March, with the highest temperature of around 40 °C but with a thermal sensation of around 50 °C. The Rain rarely lasts long during these months. In the north of Brazil, the rainy season starts in December. March and May see the heaviest rainfall. It’s hot and humid with frequent rain throughout the year in the Amazon.

Getting Around in Brazil

The most popular international airports are Rio de Janeiro–Antonio Carlos Jobim International Airport (popularly known as Galeão International Airport) and São Paulo/Guarulhos–Governador André Franco Montoro International Airport. Both airports serve domestic and international flights to many cities around the globe. The airports mainly serve major airlines but there are budget airlines such as Norwegian Air UK. Tourists can take taxis, bus, train, or car rental from both airports to the city centers.

Brazil is really big, so there will be a lot of long-distance travel to get around the country. The easiest and fastest way to get from one city to another is by domestic flights. The only downside is that the tickets are very expensive. LATAM and GOL Airlines offer multi-trip tickets or air pass. The most economical option is to buy an air pass if you plan to visit a number of different cities.

Buses are popular in Brazil, servicing most areas of the country. The bus system is excellent and provides a comfortable and economical way of travel. Be aware that the distance can be really tiring and overwhelming; some trips can take over 40 hours. The buses are operated by hundreds of different private companies, but the price is standardized. The fare varies from 75 BRL to 240 BRL. There are luxurious buses too.

A good way to get around major cities like São Paulo and Rio is to use Brazil Metro (subway). The fares are around 3.50 BRL to 3.80 BRL. You can purchase rechargeable travel cards. The metro does not operate at night. Be sure to watch your belongings at all times when traveling on the metro.

Taxis run on a metered system, but if you travel a bit further out of town, you need to negotiate the price with the driver. It is best to phone for a taxi or pick one up at a taxi station and make sure to get into a licensed taxi. Ferries and other water travel are important in many parts of Brazil.

Tourist Visas in Brazil

Nationals of 72 countries and territories can enter and stay in Brazil for up to 90 days without a visa. In some cases, an identity document may be accepted instead of a passport. Citizens of other countries, including China and India, must apply for and obtain a visa before entering Brazil. It is recommended to contact the nearest Brazilian embassy or consulate for the most up-to-date visa information.

Brazil offers an electronic visa (e-Visa) for citizens of eligible countries. The e-Visa is valid for two years and allows multiple entries for stays of up to 90 days per year. Applicants can apply for the e-Visa online through the Brazilian government's website.

Additional Information

1. Local Currency: The official currency is the Brazilian Real (BRL). 1 USD will get you approximately 5.04 BRL.
2. Money & Payments: ATMs are widely available in Brazil and it is the easiest way of getting cash in big cities. ATMs in smaller towns usually don’t work for non-Brazilian cards. Credit cards (Visa and MasterCard) are accepted in numerous shops, restaurants, and hotels. It might be handy to always have cash with you, but always be extremely cautious. Tipping is optional for housekeepers, tip parking assistants 2 BRL, or more since they do not receive wages and depend on tips. Taxis do not expect tips. Restaurants usually include a 10% service charge in the bill.
3. Local Language: The official language is Portuguese. English is not widely spoken, especially outside Rio and São Paulo.
4. Local Culture and Religion: The largest religion in Brazil is Christianity with more than 60% of the population follows Roman Catholicism.
5. Public Holidays: Brazil celebrates major Christian religious holidays as well as Independence Day and Civil Servants Day. Festa Junina, Parintins Folklore Festival, and Oktoberfest are three of the biggest annual festival in the country.