Trombose de seio sigmoide secundária a fístula liquórica espontânea para osso temporal: um relato de caso / Sigmoid sinus thrombosis secondary to spontaneous temporal bone cerebrospinal fluid fistula: a case report

A fístula liquórica para o osso temporal constitui um evento raro que decorre da comunicação anormal entre o espaço subaracnóideo e as células da mastoide, permitindo que o líquido cefalorraquidiano flua para as porções pneumatizadas do osso temporal. Tem como consequência a hipotensão intracraniana espontânea, caracterizada por perda de líquor e pela manifestação clínica de cefaleia ortostática. Acredita-se que a hipotensão intracraniana espontânea crie condições hemodinâmicas favoráveis à ocorrência de trombose venosa cerebral, uma desordem potencialmente fatal e de difícil diagnóstico, visto a inespecificidade de sinais clínicos e sintomas. Dessa forma, é pertinente atentar para a possibilidade de trombose venosa cerebral em pacientes com fístulas liquóricas, especialmente quando houver mudança do padrão da cefaleia, que passa de ortostática a intensa e contínua.

Temporal bone cerebrospinal fluid fistula is a rare event that results from abnormal communication between the subarachnoid space and the mastoid cells, allowing the cerebrospinal fluid to flow into the pneumatized portions of the temporal bone. It leads to spontaneous intracranial hypotension, characterized by loss of cerebrospinal fluid and orthostatic headache as a clinical manifestation. Spontaneous intracranial hypotension is believed to create favorable hemodynamic conditions to the occurrence of cerebral venous thrombosis, a potentially fatal disorder of difficult diagnosis given the nonspecific clinical signs and symptoms. Therefore, it is pertinent to consider the possibility of cerebral venous thrombosis in patients with cerebrospinal fluid fistulas, especially when there is a modification in the headache pattern from orthostatic to intense and continuous pain.

Inflammatory markers are beneficial in the early stages of cerebral venous thrombosis / Los marcadores inflamatorios son beneficiosos en las primeras etapas de la trombosis venosa cerebral

ABSTRACT Cerebral vein thrombosis (CVT) is a rare but serious cause of acute stroke. Inflammation is a hypothetical etiological factor in CVT. Objective: The aim of this study was to evaluate inflammatory marker levels in CVT patients and compare these with healthy individuals. Methods: This prospective case-control study was conducted with 36 newly-diagnosed CVT patients age- and sex-matched with 40 healthy individuals. The laboratory investigations included a serum hemogram, full biochemistry profiles, high sensitivity C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-HDL cholesterol ratio (MHR) values were calculated and compared between the patients and healthy participants. Results: The mean age was 41.4 ± 11.8 years for patients, and 39.3 ± 12.5 for controls. Lymphocyte, total bilirubin, indirect bilirubin, and HDL levels were significantly lower in CVT patients (p < 0.05), while CRP, and ESR values were significantly higher. In the CVT patients the mean NLR and PLR values were significantly higher than in the control individuals. Smoking rates, alcohol consumption, white blood cell, neutrophil, platelet, and MHR values were similar in both groups (p > 0.05). Conclusions: We suggest that NLR, PLR, CRP, ESR, and bilirubin can be used in clinical practice for prediction of CVT in suspected patients as they are inexpensive parameters and widely available. However, further large-scale studies are required to confirm this relationship.

RESUMEN la trombosis de la vena cerebral (CVT) es una causa rara pero grave de accidente cerebrovascular agudo. La inflamación es un factor etiológico hipotético en CVT. Objetivo: El objetivo de este estudio fue evaluar los niveles de marcadores inflamatorios en pacientes con CVT y compararlos con los sujetos sanos. Métodos: Este estudio prospectivo de casos y controles se realizó con 36 pacientes con TVC recién diagnosticados y 40 sujetos sanos con edad y sexo similares. Las investigaciones de laboratorio incluyeron hemograma sérico, perfiles bioquímicos completos, proteína C-reactiva (CRP) de alta sensibilidad y velocidad de sedimentación eritrocitaria (ESR). Se calculó la relación de neutrófilos a linfocitos (NLR), relación de plaquetas a linfocitos (PLR) y monocitos a HDL-colesterol (MHR) y se compararon entre pacientes y sujetos sanos. Resultados: La edad media fue de 41,4 ± 11,8 años para los pacientes y de 39,3 ± 12,5 para los controles. Los niveles de linfocitos, bilirrubina total, bilirrubina indirecta y HDL fueron significativamente más bajos en pacientes con CVT (p ≤ 0.05), mientras que los valores de CRP y ESR fueron significativamente más altos. En los pacientes con CVT, los valores medios de NLR y PLR fueron significativamente más altos que en los sujetos control. Las tasas de tabaquismo, consumo de alcohol, glóbulos blancos, neutrófilos, plaquetas y MHR fueron similares en ambos grupos (p > 0.05). Conclusiones: Sugerimos que la NLR, la PLR, la CRP, la ESR y la bilirrubina se pueden usar en la práctica clínica para la predicción de la CVT en pacientes sospechosos, ya que son parámetros económicos y están ampliamente disponibles. Sin embargo, se requieren más estudios a gran escala para confirmar esta relación.

Trombosis de Senos Venosos, experiencia en un hospital pediátrico en Buenos Aires, Argentina / Venous sinus thrombosis: Experience at a pediatric hospital in Buenos Aires, Argentina

Introducción: La trombosis de senos venosos cerebrales (TSVC) es infrecuente en pediatría. Está asociada a condiciones como infecciones, deshidratación, fallo renal, traumatismo de cráneo, neoplasias, trastornos hematológicos, etc. Cefalea, vómitos, alteración del sensorio y hemiparesia son los síntomas más frecuentes. El diagnóstico es confirmado por TC con angio y/o RM con angio. La anticoagulación es el tratamiento de elección. Los pacientes suelen evolucionar favorablemente. Materiales y Métodos: Estudio descriptivo observacional de pacientes con TSVC atendidos en el Hospital Garrahan desde 2010 a 2017. Las variables registradas fueron: edad, sexo; manifestaciones clínicas, factores de riesgo; estudios diagnósticos, tratamiento y evolución. Resultados: Se describen 34 pacientes con TSVC. Los adolescentes fueron el grupo mayor. La cefalea fue el síntoma más frecuente. Angio TC, RM y/o angio RM confirmaron el diagnóstico; los senos transverso, sagital superior y sigmoideo fueron los más comprometidos. 21 pacientes tenían patología oncológica y 14 procesos infecciosos. El tratamiento de elección fue la anticoagulación. Tuvieron buena evolución el 82%. Conclusiones: Debemos sospechar esta entidad en dos grupos: el primero formado por lactantes y pre-escolares con patología infecciosa; y un segundo integrado por escolares y adolescentes con patología oncológica, especialmente aquellos que reciben L-ASA.Es importante resaltar el valor de la TC y angio TC para hacer diagnóstico oportuno, resultando accesible las 24 horas en el hospital

Introduction: Cerebral venous sinus thrombosis (CVST) is uncommon in children. CVST is associated with conditions, such as infections, dehydration, renal failure, head trauma, cancer, and hematological disorders. Headache, vomiting, sensory alterations, and hemiparesis are the most common symptoms. Diagnosis is confirmed by angio CT and/or MRA. Anticoagulation is the treatment of choice. Outcome is generally good. Material and Methods: An observational, descriptive study of patients with CVST seen at Garrahan Hospital between 2010 and 2017. The following variables were recorded: age, sex; clinical manifestations, risk factors; diagnostic studies, treatment, and outcome. Results: 34 patients with CVST were studied. Most patients were adolescents. Headache was the most common symptom. Angio CT, MRI, and/or MRA confirmed the diagnosis; the transverse, superior sagittal, and sigmoid sinuses were most frequently affected. Of the patients, 21 had oncological disease and 14 infections. Anticoagulation was the treatment of choice. Outcome was good in 82%. Conclusions: CVST should be suspected in the following two groups: A first group consisting of infants and preschool children with infections and a second group of school-age children and adolescents with cancer, especially those receiving L-ASA. It is important to highlight the role of CT and angio CT for early diagnosis as the study is available day and night at the hospital.

Aneurisma de la vena de Galeno: diagnóstico prenatal y manejo / Vein of Galen aneurysm: prenatal diagnosis and management

RESUMEN Las malformaciones vasculares cerebrales son infrecuentes, dentro de ellas, el aneurisma de la vena de Galeno (AVG) tiene una incidencia de 1 en 25.000 recién nacidos. El ultrasonido obstétrico de rutina ha permitido el diagnóstico prenatal de dicha alteración, permitiendo establecer el pronóstico del recién nacido. En la exploración mediante ultrasonido del cerebro fetal, la presencia de una imagen quística supratentorial con flujo turbulento al Doppler color permite establecer el diagnóstico. La asociación con signos de insuficiencia cardiaca ha mostrado altas tasas de mortalidad neonatal. Se presenta el caso de un feto al que se realiza el diagnóstico prenatal mediante ultrasonido y su confirmación por neuroimagenes al nacimiento.

ABSTRACT Cerebral vascular abnormalities are rare. The vein of Galen aneurysmal malformation (VGAM) has an incidence of 1 in 25,000 newborns. The routine obstetric ultrasound has allowed the prenatal diagnosis and establish the prognosis of the newborn. In the ultrasound examination of the fetal brain, the presence of a supratentorial cystic image with turbulent flow to the color Doppler makes the diagnosis. The association with signs of heart failure have shown high neonatal mortality. We present a case of a fetus with prenatal diagnosis of VGAM by 2D ultrasound and confirmation by neuroimaging at birth.

Características clínicas y radiológicas de una cohorte de niños con trombosis venosa intracraneal / Clinical and radiological features of cerebral venous thrombosis in a children cohort

Resumen: Introducción: La trombosis venosa intracraneal (TVI) es una condición infrecuente y poco estudiada en población pediátrica. Objetivos: Describir y comparar características clínicas/radiológicas de ni ños no neonatos con TVI según edad y analizar la asociación de estas variables con deterioro funcio nal al alta o mortalidad aguda. Metodología: Estudio observacional de una cohorte de niños > 30 días con una primera TVI diagnosticada con imágenes/venografía por resonancia magnética encefálica. Medimos funcionalidad con la escala modificada de Rankin definiendo compromiso funcional mar cado con 3 a 5 puntos. Comparamos los promedios de edades entre grupos con y sin las diferentes variables estudiadas con la prueba U-Mann-Whitney (significancia < 0,05). Realizamos análisis de regresión logística para estimar el riesgo de resultado adverso de cada variable expresado en Odds Ra tios (ORs) e intervalos de confianza (IC) al 95%. Resultados: De 21 pacientes, 42.8% eran niñas, me diana de edad 6,27 años (rango intercuartil: 0,74-10). El promedio de edad fue menor en niños con retardo diagnóstico > 48 h (p = 0,041), puntaje < 12 en la escala coma de Glasgow (p = 0,013), crisis epilépticas (p = 0,041), trombosis de seno recto (p = 0,011) y hemorragia intracraneal (p = 0,049); mientras que fue mayor en niños con síndrome de hipertensión endocraneal (p = 0,008). La presen cia de alguna condición crónica sistémica (OR = 11,2; IC = 1,04-120,4), TVI profunda (OR = 14; IC = 1,3-150,8) e infarto encefálico (OR = 15,8; IC = 1,4-174,2) se asoció a compromiso funcional marcado o mortalidad al alta. Conclusiones: Las características clínicas/radiológicas de la TVI varían según la edad. Las patologías crónicas, compromiso del sistema venoso profundo e infarto encefálico predicen mal pronóstico a corto plazo.

Abstract: Introduction: Cerebral venous thrombosis (CVT) is an uncommon and poorly studied condition in the pediatric population. Objectives: To describe and compare the clinical and radiological features of non-neonatal children with CVT according to age and to analyze their association with functional impairment or mortality at hospital discharge. Methodology: An observational cohort study of chil dren older than 30 days with a first CVT diagnosed with imaging/venography by magnetic resonance (IMR/VMR). We measure functionality with the modified Rankin scale defining marked impairment with 3 to 5 points. We used U-Mann-Whitney test to compare ages averages between groups with and without the different studied variables (significance < 0.05). We used logistic regression analyses to estimate the risk of adverse outcome for each variable expressed in Odds Ratios (ORs) and 95% confidence intervals (CI). Results: Among 21 patients recruited, 42.8% were girls, median age 6.27 years (Interquartile range: 0.74-10). The average age was lower in children with diagnostic delay > 48 hours (p = 0.041), score < 12 in the Glasgow coma scale (p = 0.013), seizures (p = 0.041), sinus rectus thrombosis (p = 0.011), and intracranial hemorrhage (p = 0.049); while it was significantly higher in children with intracranial hypertension syndrome (p = 0.008). The presence of some chro nic systemic condition (OR = 11.2; CI = 1.04-120.4), deep CVT (OR = 14; CI = 1.3-150.8), and brain ischemia (OR = 15.8; CI = 1.4-174.2) was associated with marked functional impairment or mor tality at discharge. Conclusions: Clinical and radiological features of CVT are age-related. Chronic illnesses, deep venous system involvement, and brain ischemia predict adverse short-term outcomes.

Neonato con malformación de la vena de Galeno con diagnóstico oportuno: reporte de caso / Timely diagnosis of a Newborn wth Vein of Galen aneurysmal malformation: a case report

RESUMEN La malformación de la vena de Galeno a pesar de ser una patología poco frecuente representa un desafío clínico, por lo que debe ser detectada de forma temprana y manejada por un grupo multidisciplinario, iniciando desde los médicos generales quienes son los encargados de realizar el reconocimiento durante los controles prenatales, y así continuar el manejo de la mano de perinatólogos, pediatras, neonatólogos y radiólogos intervencionistas, todos ellos encargados de supervisar la evolución del paciente y dar tratamiento oportuno para mejorar el pronóstico de vida. A continuación, se presenta un caso clínico cuyo diagnóstico prenatal y manejo medico logró disminuir las complicaciones y comorbilidades resultantes, y así garantizar su preparación para una intervención endovascular posterior.

SUMMARY The vein of Galen malformation is a clinical challenge despite its low frequency, this disease must be detected early during the prenatal age and managed by a multidisciplinary group, beginning with the general physician in the antenatal medical appointment and later receiving treatment with perinatologists, pediatricians, neonatologists and interventional radiologists; all of this in order to ensure a better outcome and neurologic and systemic consequences. This report shows a female patient with an early and accurate antenatal diagnosis of vein of Galen malformation; during the postnatal period multidisciplinary approach and rationale medical management lowered the risk and possible complications, allowing the preparation for a late endovascular intervention.

Cranial venous sinus dominance: what to expect? Analysis of 100 cerebral angiographies / Dominância dos seios venosos cranianos: o que esperar? Análise de 100 angiografias cerebrais

ABSTRACT We report an analysis of the cranial venous sinuses circulation, emphasizing morphological and angiographic characteristics. Methods Data of 100 cerebral angiographies were retrospectively analyzed (p = 0.05). Results Mean age was 56.3 years, 62% female and 38% male. Measurements and dominance are shown in the Tables. There was no association between age or gender and dominance. Right parasagittal division of the superior sagittal sinus was associated with right dominance of the transverse sinus, sigmoid sinus and internal jugular vein; and left parasagittal division of the superior sagittal sinus was associated with left dominance of the transverse sinus, sigmoid sinus and internal jugular vein. Conclusion A dominance pattern of cranial venous sinuses was found. Age and gender did not influence this pattern. Angiographic findings, such as division of the superior sagittal sinus, were associated with a pattern of cranial venous dominance. We hope this article can add information and assist in preoperative venous analysis for neurosurgeons and neuroradiologists.

RESUMO Relatamos uma análise da circulação dos seios venoso cranianos, enfatizando características morfológicas e angiográficas. Métodos Dados de 100 angiografias cerebrais foram retrospectivamente analisados (p = 0,05). Resultados Média de idade 56,3 anos, 62% feminino e 38% masculino. Medições e dominância expostos em tabelas. Sem associação entre idade ou sexo e dominância. Divisão parassagittal direita do Seio Sagital Superior (SSS) foi associada com dominância direita do Seio Transverso (ST), Seio Sigmóide (SS) e Veia Jugular Interna (VJI), e divisão parassagittal esquerda do SSS foi associada com dominância esquerda do ST, SS e VJI. Conclusão Um padrão de dominância dos seios venosos do crânio foi encontrado. Idade e sexo não influenciaram esse padrão. Achados angiográficos, como divisão do SSS, foram associados com o padrão de dominância venoso cerebral. Esperamos que este artigo acrescente informações e auxilie na análise venosa pré-operatória para neurocirurgiões e neuroradiologistas.

Cavernomatosis múltiple y aneurisma cerebral trombosado: una asociación inusual / Cavernous haemangioma multiple and brain aneurysm thrombosed: an unusual association

Los cavernomas son malformaciones angiográficamente ocultas, pueden ser únicos o múltiples y esporádica o familiar.Suelen asociarse a otras malformaciones vasculares como las anomalías de drenaje venoso, sin embargo no es habitual su asociación con aneurismas cerebrales. Los aneurismas son malformaciones evidenciables en angiografía, sin embargo cuando se encuentran trombosados puede dificultarse su diagnostico, observándose en algunos casos como lesiones pseudotumorales. Nuestro objetivo es exponer una rara asociación entre cavernomatosis múltiple y aneurisma cerebral trombosado en un paciente pediátrico. Presentamos una paciente de 2 años de edad con diagnóstico de cavernomatosis múltiple y aneurisma cerebral trombosado. Se realiza una revisión de la literatura de ambas entidades y su rara asociación, medianteuna búsqueda exhaustiva en la base de datos de PUBMED Y COCHRANE utilizando las siguientes palabras claves: Cavernous angioma. Familial cavernomatosis. Hemorrhagic stroke. Multiple cavernomatosis. Cerebral aneurysm. Thrombosed aneurysm. Se discute la epidemiologia, diagnóstico y manejo quirúrgico de la cavernomatosis múltiple y sus asociaciones, preconizando fundamentalmente la evaluación pre quirúrgica de estos pacientes. No encontramos ningún caso de asociación entre cavernomatosis múltiple y aneurismas en nuestra revisión bibliográfica. Dado que se pueden presentar como lesiones pseudotumorales, la tomografía computada, resonancia magnética y la angiografía cerebral son métodos fundamentales para llegar a un diagnostico prequirúrgico certero. La indicación quirúrgica debe ser evaluada individualmente en cada paciente, y se debe realizar un seguimiento clínico-imagenologico.

Cavernomas are angiographically occult malformations may be single or multiple and sporadic or familial. Usually associated with other vascular malformations such as venous drainage anomalies, however it is not common its association with brain aneurysms. Aneurysms are into evidence malformations in angiography, however when they meet their diagnosis can be difficult thrombosed observed in some cases as pseudotumoral injuries. Our goal is to present a rare association between multiple cavernous haemangioma and thrombosed cerebral aneurysm in a pediatric patient. We present a patient 2 years old diagnosed with multiple cavernous haemangioma and thrombosed cerebral aneurysm. A review of the literature of both entities and its rare association is done through an exhaustive search in the database PUBMED and COCHRANE using the following keywords: Cavernous angioma. Familial cavernous haemangioma. Hemorrhagic stroke. Multiple cavernous haemangioma. Brain aneurysm. Thrombosed aneurysm. The epidemiology, diagnosis and surgical management of multiple cavernous haemangioma and their associations is discussedessentially advocating the presurgical evaluation of these patients. No case of association between multiple cavernous haemangioma and aneurysms in our literature review. Because can be presented as pseudotumoral lesions, computed tomography, magnetic resonance imaging and cerebral angiography are fundamental methods to reach an certain diagnosis preoperatively. The surgical indication should be evaluated individually for each patient, and should be performed a clinical-imaging follow-up.

Trombosis de seno venoso secundaria a traumatismo encéfalo craneano: caso clínico / Cerebral vein thrombosis secondary to closed head injury: Report of one case

Intracranial sinus thrombosis (1ST) after closed head injury is an uncommon but potentially serious complication. It has no correlation with the severity of the injury. The symptoms and clinical course are highly variable. The most frequent but least specific symptom is severe headache. Cerebral lesions and neurologic signs develop in half of patients with IST. We report a 29 year-old male who had an IST after a severe closed head injury. The patient initially developed headache and had later 2 secondarily generalized seizures. The magnetic resonance imaging showed a superior sagittal sinus thrombosis. Anticoagulation with unfractionated heparin and intravenous phenytoin was started. At the moment of this report he is asymptomatic and continues with oral anticoagulants and phenytoin.

Comparison between transsylvian-transinsular and transcortical-transtemporal approach for evacuation of intracerebral hematoma

PURPOSE: Hypertensive cerebral hemorrhage in the basal ganglia is a potentially life-threatening cerebrovascular disease with high mortality. Surgical evacuation is an important treatment for intracerebral hemorrhage. However, little is reported about the comparison on the efficacy of various approaches on the prognosis. METHODS: Clinical data of 80 cases of intracerebral hemorrhage which surgically treated via transsylvian-transinsular approach or transcortical-transtemporal approach were collected. The proportion of post-surgery tracheostomy, incidence of digestive tract hemorrhage, revision surgery, the average length of hospital stay, and the six-month efficacy (defined by an ADL score) rate between these two groups were compared. RESULTS: The six-month efficacy rates were 75% and 50% in patients receiving transsylvian-transinsular and transcortical-transtemporal surgery, respectively (p<0.05). Compared to the transcortical-transtemporal group, the proportion of revision surgery was statistically significantly lower in the transsylvian-transinsular group, (p<0.05). The proportion of post-surgery tracheostomy, the incidence of digestive tract hemorrhage, and the average length of hospital stay were lower in the transsylvian-transinsular group, compared to the transcortical-transtemporal group, but no statistically significant differences were noted in them between the two groups. CONCLUSION: The transsylvian-transinsular approach for evacuation of intracerebral hematoma demonstrates limited complications, shorter length of hospital stay, and improved long-term efficacy and prognosis. These findings suggest this operative approach has potential for wider application.

Abordaje transilviano transinsular / Transsilvian trans-insular approach

Objetivo: describir el abordaje transsilviano para lesiones del sector anterior de la región temporal mesial. Descripción: luego de un abordaje pterional, la fisura silviana es abierta ampliamente, de distal a proximal. La rama temporal de la arteria cerebral media es desplazada medialmente, y una vez ubicado el surco limitante de la ínsula, en el mismo se realiza una corticotomía de 1cm de longitud; se profundiza la disección por la sustancia blanca hasta acceder al sector anterior del cuerno temporal. Finalmente se realiza la exérsis de la lesión. Conclusión: la vía transsilviana nos permite realizar la resección selectiva de una lesión ubicada en el sector anterior de la región temporal mesial, sin necesidad de lesionar la corteza lateral o basal del lóbulo temporal.

Lactante menor con malformación dela vena de galeno y malformaciones cardiacas asociadas / Newborn with vein of galen malformation and concurrent cardiac malformation

La malformación aneurismática de la vena de Galeno (MAVG) es poco frecuente, pues tiene una prevalencia calculada en menos de uno en 25 000 nacidos vivos. Puede causar una alta morbilidad y mortalidad en neonatos y, con menor frecuencia, en niños mayores. Está ubicada en el plexo coroideo, en el techo del tercer ventrículo, en la región del velum interpositum. Se presenta como una fístula arteriovenosa, usualmente entre las arterias coroidales y el saco aneurismático, lo que lleva a una dilatación de la vena de Galeno. Cuando los neonatos son sintomáticos, la presentación clínica usual de la MAVG es una falla cardiaca de alto gasto, que se ha reportado hasta en el 94 % de los neonatos a quienes se les diagnostica una MAVG. En el pasado, dicha falla progresaba rápidamente a falla multiorgánica y muerte; sin embargo, actualmente las técnicas endovasculares y las unidades de cuidado intensivo han mejorado el mal pronóstico de la MAVG. Se presenta el caso de un recién nacido con diagnóstico antenatal de MAVG con malformaciones cardiacas, que en el momento vive, a pesar del pronóstico reportado en la literatura...

Vein of Galen Aneurysmal Malformations(VGAM) is a rare malformation with a prevalenceestimated at less than one in 25,000 live births.This malformation can cause high morbidity andmortality in neonates and less frequently in olderchildren. Is a complex vascular malformation ofthe choroid, in the roof of the third ventricle, inthe region of the velum interpositum. It is presentedas an arteriovenous fistula, usually betweenthe choroidal arteries and the aneurysm sac, leadingto a dilated vein of Galen. When infants aresymptomatic, the usual clinical presentation ofheart failure VGAM is high output, which hasbeen reported in up to 94 % of infants who arediagnosed with a VGAM. In the past, such failurerapidly progressed to multiorgan failure anddeath, with mortality reported up to 100 %, butnow advances in endovascular techniques andintensive care units have improved the poor prognosisof VGAM...

Diagnóstico diferencial de malformação vascular encefálica em umacriança: relato de caso / Differential diagnosis in encephalic vascular malformation in a child: case report

Aims: To report a case of encephalic venous malformation, which is not commonly described in the literature, despite its importance as one of the main differential diagnosis in intracranial hemorrhage in children.Case Description: A five-year old girl presented chronic headache and had the first episode of seizure. Possible intracranial alterations were investigated as etiological factors, and an alteration in the Labbé vein was identified, possibly associated to a cavernoma in the left temporal region, which caused the hemorrhage.Conclusions: Primary seizures and headaches are relatively common in children. However, secondary seizures such as those caused by hemorrhage, despite being less common, must be suspected and investigated, as they may lead to severe complications.

Objetivos: relatar um caso de malformação venosa encefálica, não comumente descrito na literatura, apesar de sua importância como um dos principais diagnósticos diferenciais em hemorragia intracraniana em crianças.Descrição do Caso: uma menina de cinco anos de idade apresentava cefaleia crônica e teve o primeiro episódio de convulsão. Possíveis alterações intracranianas foram investigadas como fatores etiológicos, e foi identificada uma alteração na veia de Labbé, possivelmente associada a um cavernoma na região temporal esquerda, o que provocou a hemorragia.Conclusões: convulsões primárias e cefaleia são relativamente comuns em crianças. No entanto, convulsões secundárias, tais como aquelas causadas por hemorragia, apesar de serem menos comuns, devem ser suspeitadas e investigadas, pois podem levar a complicações graves.

A systematic study of the brain base arteries inbroad-snouted caiman (Caiman latirostris)

The objective of this study was to describe and systematize the encephalic arterial vascularization of this reptile,by providing a standard irrigation model with its major variations. Thirty broad-snouted caiman heads andtwo whole specimens were used. The arterial system was filled with red-colored latex. Only a single source ofblood supply was observed in caimans and it originated from the left aortic arch. This vessel is called the azygoscarotid artery. At the caudal base of the skull, ventral to the first cervical vertebrae, it divided into two internalcarotid arteries. The internal carotid arteries divided into a rostral branch and a short caudal branch at thehypophysis level, which continued naturally as the caudal cerebral artery. The short caudal branch gave off itsmedium-caliber portion which, gave off the mesencephalic and the ventral rostral cerebellar arteries. Then thiscaudal branch anastomosed with its contralateral counterpart, forming the basilar artery. This artery followedthe ventral median fissure of the medulla oblongata, giving off the ventral caudal cerebellar and dorsal spinalarteries, and abandoning the cranial cavity through the foramen magnum as the ventral spinal artery. Therostral branch gave off the middle cerebral, rostral cerebral and rostral communicating arteries. The middlecerebral artery arose from a network originated from one to five collateral branches of the rostral branch of theinternal carotid artery. It was observed that the cerebral arterial circle was rostrally and caudally closed and,therefore, the cerebral blood supply was exclusively made by the carotid system.

Patología vascular en pacientes menores de un año / Cerebrovascular pathology in infants

Objetivo. Analizar nuestra experiencia en patología neuroquirúrgica vascular en los pacientes menores de un año.Material y método. Entre el 1/1/89 y el 1/6/09 se trataron en el Servicio de Neurocirugía del Hospital Nacional de Pediatría Juan P. Garrahan 235 pacientes con malformación vascular del SNC. De ellos 19 (8%) eran menores de un año;11 fueron varones y 8 mujeres, con una edad media de 4,5 meses al diagnóstico, en un rango desde prenatal a 1 año. Se analizaron las historias clínicas y los estudios neurradiológicos de cada uno de ellos.Resultados. Todos los pacientes fueron estudiados con TAC inicial excepto las malformaciones aneurismáticas de la vena de Galeno (MAVG) que se diagnosticaron en un principio, con ecografía. En 16/19 pacientes se realizó angiografía digital cerebral, y en uno de los casos se efectuó angiografía espinal, hallándose la malformación a ese nivel. Los tipos de lesiones halladas fueron: 6 MAVG (4 coroideas y 2 murales), 6 malformaciones arteriovenosas (MAV), 2 fístulas arteriovenosas (A-V) piales (1 cerebral y 1 medular), 1 fístula A-Vmedular, 1 cavernoma, 1 aneurisma sacular y 2 malformaciones embrionarias en fosa posterior. Conclusión. Es remarcable la variabilidad y complejidad de las malformaciones vasculares del SNC en el primer año de vida. Es necesaria la integración del equipo endovascular al neuroquirúrgico, no sólo para el diagnóstico, sino también para completar o facilitar el tratamiento de alguna de estas lesiones. Las malformaciónes vasculares más frecuentes en este grupo son la MAVG y las MAV , seguidas de las fístulas A-V.

Objective. To analyze our experience in neurosurgical vascular disease in patients under one year. Materials and Methods. Between 1/1/89 and 1/6/09 we treated at the Department of Neurosurgery of the Hospital Nacional de Pediatría Juan P. Garrahan 235 patients with vascular malformation of the central nervous system. Of these19 (n = 19; 8%) were infants under one year, 11 were males and 8 females, mean age at diagnosis 4.5 months (range from prenatal to 1 year). We evaluated all charts and neuroradiologic studies of each patient. Results. All patients were studied with initial CT scan except one patient with Vein of Galen Aneurysmal Malformation (VGAM)who was diagnosed antenatal by ultrasound. The types of lesions were 6 VGAM (4 choroidal type and 2 mural type), 6 Arteriovenous Malformations (AVM), 2 Pial Arteriovenous Fistulas(1 brain and 1 spinal), 1 spinal Dural Arteriovenous Fistula, 1 Cavernoma, 1 Aneurysm and 2 Embryologic Dural Sinus Malformations at the posterior fossa. Conclusion. It is remarkable variability and complexity ofvascular malformations of the central nervous system in the first year of life. It is necessary to integrate the endovascular neurosurgical team, not only for diagnosis but also to complement or facilitate the treatment of any of theses vascular disease. The most frequent vascular malformations in our group were the VGAM and the AVM followed by AV Fistulas.

Dinámica de la córticoangiogénesis en el sistema nervioso central / Dinamics of the cortico-angiogenesis in the central nervous system

This study analyzes the temporal-spatial correlation between angio-and corticogenesis in the developing chick optic tectum (OT) by means of NADPH-diaphorase and immunolabeling methods. Qualitative and quantitative parameters were used to analyze a new vessels formation and growth of preexisting ones as a function of time and space...

Aspectos macroscópicos da desembocadura das veias facial, lingual e tireóidea superior, na veia jugular interna / Macroscopic aspects of the discharge of facial, lingual and superior thyroid veins into the internal jugular vein

A veia jugular interna, no seu trajeto descendente no pescoço, recebe tributárias como a veia facial, a veia lingual e a veia tireóidea superior. As veias da cabeça e do pescoço se anastomosam livremente, promovendo, com freqüência, variações anatômicas na sua distribuição, até mesmo diferenças nos antímeros de um mesmo indivíduo. Essa grande tendência das veias de sofrerem variações anatômicas nos motivou a ampliar as investigações com relação à desembocadura das veias facial, lingual e tireóidea superior na veia jugular interna, promovendo a identificação desses vasos em peças anatômicas cadavéricas utilizadas nos laboratórios de ensino de anatomia humana. Para este trabalho, foram feitas observações macroscópicas, na forma da desembocadura das veias facial, lingual e tireóidea superior, na veia jugular interna, em 37 antímeros de cabeças humanas, fixadas em formol a 10%, sendo 11 cabeças com antímeros direito e esquerdo, 9 cabeças com antímero esquerdo e 6 cabeças com antímero direito. Nossos resultados mostraram que a veia jugular interna recebe as veias tributárias facial, lingual e tireóidea superior de maneira variada, sendo 51% com desembocadura direta dessas tributárias na veia jugular interna, 38% com formação de um tronco venoso curto, denominado tíreo-línguo-facial, e em apenas 11% a formação do tronco línguo-facial.

The internal jugular vein, in its descending course at the neck, receives tributaries among which there are: the facial vein, the lingual vein and the superior thyroid vein. The veins from the head and neck anastomose freely, and this frequently causes anatomical variations in their distribution even between the two antimeres of the same individual. This great tendency of the veins of displaying anatomical variations prompted us to widen the investigations concerning the discharge of facial, lingual and superior thyroid veins at the internal jugular vein by identifying these vessels in anatomic pieces used at the teaching laboratories of human anatomy. For this paper, macroscopic observations were made by opening the facial, lingual and superior thyroid veins into the internal jugular vein in 37 antimeres of human heads fixed in 10% formol solution: 11 heads with right and left antimeres, nine with left antimere and six with right antimere. Our results showed that the internal jugular vein receives drainage from the facial, lingual and superior thyroid vein in varied ways: in 51% of the instances, these tributaries open directly into the internal jugular vein, in 38% they form a short venous trunk named thyro-lingual-facial trunk and in only 11% there is a lingual-facial trunk.