Hematoma epidural tardio

Introdução: O hematoma epidural (HE) tardio é definido como o hematoma que é insignificante ou não está presente no exame de tomografia computadorizada (TC) inicial após o trauma, mas no exame seguinte se apresenta como significativo em tamanho. Método: Paciente masculino, 35 anos de idade, vítima de acidente de trânsito. ECG na admissão 15. Exame neurológico: normal. TC de crânio realizado três horas após o trauma revelou pequena contusão no lobo frontal direito. Após 12 horas de observação desenvolveu baixa do nível de consciência e cefaleia. ECG 13. Novo exame de TC foi realizado e demonstrou HE frontal direito. Submetido a craniotomia osteoplástica e drenagem do hematoma. Recebeu alta bem. Conclusão: O HE em sua fase inicial pode ser pequeno e não necessitar de tratamento cirúrgico. Pode evoluir e apresentar sinais neurológicos focais e um novo exame de TC demonstrar aumento de volume do hematoma. Portanto, estes casos de hematoma ausente ou de pequeno volume, necessitam de vigilância neurológica intensa e, em caso de piora clínica, novo exame de TC. O tratamento cirúrgico tem sido indicado na presença de aumento de volume do hematoma com resultado excelente.

Moyamoya disease

Background: Moyamoya disease (MMD) is a rare pathology caused by a progressive unilateral or bilateral stenosis of the terminal portion of the internal carotid artery, leading to the development of collateral vessels. Case Presentation: We report a rare case of a 46-year-old male, born in the city of São Paulo, Brazil, with sudden muscular strength deficit and right hemiparesis, associated with headache and emesis. A priori, the initial diagnosis was arteriovenous malformation (AVM) after performing a series of complementary tests during the patient’s follow-up, also considering the clinical picture similar to that of Moyamoya disease (MMD). The conclusive diagnosis of MMD was finally established when the magnetic resonance imaging (MRI) showed a network of tortuous and dilated collateral vessels, with a hazy “smoke cloud” aspect with stenosis of the M1 segment of the middle cerebral artery (MCA), branch of the artery internal carotid artery (ICA). Conclusion: The recommended treatment was surgical revascularization with extracranial-intracranial bypass, with a favorable prognosis to the patient.

Analysis of myelomalacia and posterior longitudinal Ligament ossification as prognostic factors in patients with cervical spondylotic myelopathy submitted to laminoplasty

Background: Cervical spondylotic myelopathy is a degenerative disease of the intervertebral disc and vertebral body of the spine that causes cervical spinal cord injury due to central vertebral canal stenosis. Its prevalence is higher in the elderly. Treatment is usually surgical when the spinal cord is affected either clinically with pyramidal release or radiologically with the altered spinal cord. Objective: The rationale of this study is to analyze the myelomalacia and the ossification of posterior longitudinal ligament as prognostic factors in the postoperative evolution of patients with cervical canal compression who underwent laminoplasty by open-door or french-door techniques. Methods: We performed a retrospective analysis of 18 surgical cases of spondylotic cervical myelopathy of the same senior neurosurgeon, using the chi-square test to analyze prognostic factors for patients’ postoperative evolution in the Nurick scale, after open-door or french-door laminoplasty. Results: The comparison between pre and postoperative showed an improvement of 71.43% of cases that did not have ligament ossification compared to 45.45% of cases that presented posterior longitudinal ligament ossification. Also, there was a better prognosis in patients without myelomalacia, as 71.43% of them improved their condition against only 45.45% improvement in those with myelomalacia. Conclusion: There is a need for further studies with larger samples to expressively prove that the presence of longitudinal ligament ossification and the previous presence of myelomalacia are factors of worse prognosis in the postoperative evolution of patients with cervical spondylotic myelopathy submitted to laminoplasty.

Schwannoma vestibular em menores de 10 anos

Schwannomas vestibulares (SV) são entidades oncológicas benignas raras, sobretudo em pacientes pediátricos menores de dez anos, principalmente quando não associados a neurofibromatose tipo 2. O objetivo deste estudo é relatar um caso de SV não associado a NF2 em um paciente de oito anos com revisão na literatura. Utilizando a base de dados PubMed foram selecionados oito relatos de caso para revisão, chegando a maior prevalência no sexo masculino, maior frequência de paralisia do nervo facial como apresentação clínica e maior tendência à piora neurológica como desfecho pós-operatório.

Bilateral thalamus stroke due to percheron artery

Bilateral thalamus ischemic stroke is a rare condition that carries significant morbidity and mortality in comparison to other forms of stroke. It is usually associated with an anatomical variant with the thalamic paramedian arteries arising from a common trunk from the posterior cerebellar artery, known as Percheron artery. This infarct is difficult to be recognized and early recognition of this syndrome improves survival and functional recovery. We report a case of bilateral thalamic stroke after cardiac surgery.

Neuroparacoccidioidomicose em mulher adulta jovem

Introdução: A paracoccidioidomicose é uma doença sistêmica causada por fungos do gênero Paraccocidioides spp., sendo a micose profunda mais predominante da América Latina. O envolvimento do sistema nervoso central ocorre em 10-27% dos casos e apresenta difícil diagnóstico, necessitando de exames complementares de imagem e histopatológicos para confirmação diagnóstica. Objetivo: Relatar caso raro de neuroparacoccidioidomicose, destacando os achados nos exames de imagem, anatomopatológico e tratamento. Metodologia: Paciente do sexo feminino, 30 anos, que após atendimento inicial, observação das manifestações clínicas e de neuroimagem, houve hipótese diagnóstica sugestiva de pseudotumor intracraniano. Todos os dados foram descritos e interpretados com base nas informações contidas do prontuário da paciente, exames de neuroimagem e laudo anatomopatológico. Resultado: Foi observada a confirmação diagnóstica de neuroparacoccidioidomicose em mulher jovem, a qual inicialmente teve hipótese diagnóstica para tumor intracraniano. As descrições do relato de caso aqui apresentadas são atípicas, visto que, as características ocupacionais e perfil etário da paciente não a colocavam como grupo de risco para tal condição. Conclusão: O relato de caso de neuroparacoccidioidomicose foi considerado atípico devido aos biomarcadores associados, sendo aqui descrita a discussão sobre a construção diagnóstica.

Reversible Cerebral vasoconstriction syndrome associated with the use of sibutramine

The reversible cerebral vasoconstriction syndrome, also known as Call-Fleming syndrome, was initially described in 1988, and is characterized by a clinical syndrome of headaches episodes, generally the “thunderclap” pattern, due to a deregulation of the vascular tonus, leading to segmentary cerebral vasoconstriction and secondary neurological deficits, including those by ischemic or hemorrhagic stroke. In this paper, we present two illustrative cases of this syndrome due to the use of sibutramine. To our knowledge, this situation hasn’t been described as related drug before.

Large cavernous malformations in infant

Cavernous malformations are rare vascular malformations in the central nervous system. We present the case of a 2-month-old female patient who presented tonic-clonic seizures, with no previous history of seizures. Magnetic resonance imaging showed a 5.6 cm tumor in the left parieto-occipital region. The radiological aspect of the tumor initially suggested an anaplastic meningioma. After surgical treatment and anatomopathological analysis, it was found to be a cavernous malformation. Cavernous malformations, or cavernomas, are rare lesions and even more rare is the occurrence of large cavernomas. In the pediatric population, although still quite rare, they usually are presented as larger cavernomas. Surgical resection is considered the most effective treatment.

Sudep: risk factors, protective factors and pathophysiological mechanisms

Introduction: Sudden Unexpected Death In Epilepsy (SUDEP) is the main cause of premature death in patients with epilepsy. The pathophysiology is not clear, however there are risks and protective factors described in the literature. Objective: To gather the data of these variables and elucidate the pathophysiological mechanisms. Methods: Literature review of free full articles from PubMed database from 2000 to 2019, in English, with an impact factor higher than 1, carried out in humans. As keywords were used “SUDEP”; “Epilepsy”; “Sudden Death”; “Seizure” resulting in 130 articles, and 44 reflecting the objectives. Results: A total of 11 case control and 10 cohort studies was analyzed and the risks and protective factors were presented. Among the risks were found: nocturnal seizure, frequencies, young adults, generalized tonic-clonic (GTCS) type and others. Some of protective factors were adherence to treatment, night supervision and having pets. Discussion: There are evidences that cardiorespiratory and autonomic systems interfere on the phisiopatology. Conclusion: More studies are necessary to elucidate all the involved mechanisms.

Microsurgery for Multiple Intracranial Aneurysms

Background: A total of 23 patients with 52 aneurysms were surgically treated in single surgery at a Neurosurgical Service of the Health Service of the State of São Paulo from 2009 to 2011. Method: Retrospective analysis of patients undergoing clipping of two or more cerebral aneurysms in a single stage, from January 2007 to July 2012. Results: Twenty-nine patients underwent two or more clipping cerebral aneurysms in a single surgery – 28 with a single craniotomy and one through two craniotomies. Of these, 20, 7, 1 and 1 were submitted to the clipping of 2, 3, 4 and 5 cerebral aneurysms, respectively. Five were male and 24 were female, and the age range was 40 to 66-years-old. Eight left craniotomies were performed to approach 17 lateralized brain aneurysms to the left and five to the right, as well as three anterior communicating complex aneurysms. Twelve craniotomies were performed on the right to approach 23 intracranial aneurysms lateralized to the right and six on the left, as well as 15 anterior communicating artery complex aneurysms and 1 on the basilar artery. Of the 29 patients, 28 evolved with 1-3 pts and only one with 4-5 pts on the Rankin scale, six months after surgery. Conclusion: We advocate microsurgical approach for most of the cases of multiple intracranial aneurysms aiming the microsurgical clipping of all intracranial aneurysms if feasible through a single stage and a single craniotomy.