RESUMO
Introducción: El neumoencéfalo (sinonimia: aerocele o neumatocele intracerebral), se define como la presencia de gas dentro de cualquiera de los compartimentos intracraneales (intraventricular, intraparenquimatosa, subaracnoidea, subdural y epidural). Objetivo: Describir los hallazgos clínicos, estudios complementarios, conducta terapéutica y evolución de un caso con neumoencéfalo como complicación de bloqueo regional epidural por radiculopatía lumbosacra. Presentación de caso: Se presentó un paciente masculino de 57 años de edad que comenzó con un cuadro súbito de desorientación, excitabilidad psicomotriz y convulsiones tónico-clónicas, a partir de una inyección epidural de metilprednisolona como método analgésico. Conclusiones: El caso presentado exhibió manifestaciones neurológicas inespecíficas, la aparición súbita posterior al proceder invasivo hizo sospechar en un evento neurológico agudo o fenómeno tromboembólico. Los estudios complementarios como la tomografía axial computarizada craneal simple, permitió su diagnóstico para tener una conducta consecuente. El manejo conservador del neumoencéfalo como complicación del uso de anestesia epidural, constituyó una conducta terapéutica eficaz y repercutió en la satisfactoria evolución del paciente(AU)
Introduction: Pneumocephalus (synonym: aerocele or intracerebral pneumatocele), is defined as the presence of gas within any of the intracranial compartments (intraventricular, intraparenchymal, subarachnoid, subdural and epidural). Objective: To describe the clinical findings, complementary studies, therapeutic conduct and evolution of a case with pneumocephalus as a complication of regional epidural block due to lumbosacral radiculopathy Case presentation: A 57-year-old male patient was presented who began with a sudden episode of disorientation, psychomotor excitability and tonic-clonic seizures, following an epidural injection of methylprednisolone as an analgesic method. Conclusions: The case presented exhibited non-specific neurological manifestations, the sudden appearance after the invasive procedure raised suspicion of an acute neurological event or thromboembolic phenomenon. Complementary studies such as simple cranial computed axial tomography, allowed its diagnosis to have a consistent conduct. The conservative management of pneumocephalus as a complication of the use of epidural anesthesia constituted an effective therapeutic approach and had an impact on the patient's satisfactory evolution(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Radiculopatia/complicações , Metilprednisolona/uso terapêutico , Pneumoencefalografia/métodos , Tomografia Computadorizada Espiral/métodos , Anestesia Epidural/métodosRESUMO
Walter Edward Dandy did pioneering work in Neurosurgery in the early part of the 19th century. He worked all his life at the Johns Hopkins Hospital in USA and contributed extensively to research in hydrocephalus, the physiology of the cerebrospinal fluid and devised the technique of pneumoencephalography, apart from performing the first clipping operation in cerebral aneurysm and the division of the trigeminal nerve in neuralgic pain. This article summarizes his immense contributions in the field of Neurosurgery.
Assuntos
Hidrocefalia/história , Hidrocefalia/cirurgia , Neurocirurgia/história , Neurocirurgia/métodos , Pneumoencefalografia/história , História do Século XIX , História do Século XX , Estados UnidosRESUMO
Computed tomography (CT) scan of the brain transitioned clinical neurology from the educated-guess world to the real computer-age world. One of the first CT scans-published by the British neuroradiologist James Ambrose-showed an intracranial hemorrhage and also suggested the use of iodine to demonstrate abnormal blood-brain barrier. In the USA, CT scans were rapidly commercialized and first placed at Mayo Clinic and Massachusetts General Hospital in the summer of 1973. CT scanning of the brain has revolutionized diagnostic acute neurology and neurosurgery and was the overture to an even larger revolution-magnetic resonance imaging. This historical vignette discusses the development of CT scanning of the brain and its connection with neurocritical care.
Assuntos
Barreira Hematoencefálica/diagnóstico por imagem , Angiografia Cerebral/história , Hemorragias Intracranianas/diagnóstico por imagem , Pneumoencefalografia/história , Tomografia Computadorizada por Raios X/história , História do Século XX , HumanosRESUMO
Throughout history, neurosurgical procedures have been fundamental in advancing neuroscience; however, this has not always been without deleterious side effects or harmful consequences. While critical to the progression of clinical neuroscience during the early 20th century, yet, at the same time, poorly tolerated by patients, pneumoencephalography is one such procedure that exemplifies this juxtaposition. Presented herein are historical perspectives and reflections on the role of the pneumoencephalography in the diagnosis and treatment of neuropsychiatric illnesses.
Assuntos
Transtornos Mentais/história , Procedimentos Neurocirúrgicos/história , Pneumoencefalografia/história , Ventrículos Cerebrais/diagnóstico por imagem , História do Século XIX , História do Século XX , Humanos , Transtornos Mentais/diagnóstico por imagem , Transtornos Mentais/cirurgia , Procedimentos Neurocirúrgicos/métodos , Pneumoencefalografia/métodosRESUMO
Se presenta el caso clínico de una paciente que ingresó en el Hospital Clinicoquirúrgico Hermanos Ameijeiras con antecedentes de etilismo crónico y cuadro clínico progresivo de deterioro cognitivo-conductual, trastornos de la marcha y esfinterianos, a quien se le realizó una cisternografía radioisotópica con el objetivo de comprobar su eficacia en el estudio de la dinámica del líquido cefalorraquídeo para diagnosticar la hidrocefalia oculta normotensa. La resonancia magnética de cráneo evolutiva evidenció hidrocefalia y la cisternografía radioisotópica confirmó el diagnóstico de hidrocefalia oculta normotensa. A la paciente se le realizó una derivación ventrículo peritoneal con la que se obtuvo una respuesta clínica evolutiva favorable. Se concluye que la cisternografía radioisotópica continúa siendo una herramienta útil para confirmar este diagnóstico y predecir la respuesta al tratamiento derivativo(AU)
A female patient who was admitted to Hermanos Ameijeiras Clinical and Surgical Hospital is presented here. She had a history of chronic alcohol abuse and progressive clinical deterioration of cognitive behavioral, abnormal gait and sphincter disorders. This patient had a radioisotope cisternography in order to test its effectiveness in the study of the dynamics of cerebrospinal fluid, and to diagnose normotensive hidden hydrocephalus. This MRI revealed hydrocephalus and skull evolutionary radioisotope cisternography confirmed the diagnosis of normal pressure hidden hydrocephalus. This patient received a shunt with a favorable evolutionary clinical response. It is concluded that cisternography radioisotope remains a useful tool to confirm this diagnosis and predict response to derivative treatment(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Pneumoencefalografia/métodos , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Líquido Cefalorraquidiano/diagnóstico por imagem , Hidrocefalia de Pressão Normal/diagnósticoAssuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirurgia , Imageamento por Ressonância Magnética , Neuronavegação/métodos , Procedimentos Neurocirúrgicos/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Ultrassonografia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Neuroendoscopia/métodos , Neurocirurgia/tendências , Procedimentos Neurocirúrgicos/tendências , Pneumoencefalografia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Técnicas Estereotáxicas , Cirurgia Assistida por Computador/tendências , Ultrassonografia Doppler , Ultrassonografia Doppler em Cores , Ultrassonografia de IntervençãoRESUMO
We report a case of a 37-year-old woman with severe headache provoked by postural changes who was referred to the nuclear medicine department for radionuclide cisternography to demonstrate suspected cerebrospinal fluid leakage. There was an increased uptake laterally on the left paraspinal region of upper thoracal spine and posteriorly on the upper cervical region. Fused SPECT/CT images located the exact leakage site as at the first costovertebral junction level on the left side laterally and on the posterior region of the first and second cervical spine. The treatment with epidural blood patch was successful.
Assuntos
Placa de Sangue Epidural , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Pneumoencefalografia , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Vazamento de Líquido Cefalorraquidiano/terapia , Feminino , Humanos , Compostos Radiofarmacêuticos , Pentetato de Tecnécio Tc 99m , Tomografia Computadorizada por Raios XRESUMO
The surgical management of cerebrospinal fluid (CSF) rhinorrhoea has changed significantly after the introduction of functional endoscopic sinus surgery. The clear anatomical exposure of the roof of the nasal and paranasal sinus cavities by the endoscope offers the surgeon a golden chance to identify the area of CSF leak, and thus enables one to adequately plan the management. The aim of this work is to evaluate the use of facia lata sandwich graft technique for endoscopic endonasal repair of CSF rhinorrhoea. Forty patients with CSF rhinorrhoea were treated endoscopically using 2 layers of facia lata (underlay and onlay) interposed with a layer of septal cartilage or conchal bone in-between (sandwich technique) for repair. Fifty-five percent of cases were regarded as spontaneous CSF leaks with no obvious cause, 30% following head injury and 15% were iatrogenic. The ethmoidal roof was the commonest location of CSF leak (60%) followed in frequency by the cribriform plate and the sphenoid sinus (20% each). Follow-up period was 12-24 months. We have achieved a 95% success rate in managing CSF leaks in our 40 patients in the first attempt repair and 100% success rate after second attempt repair. Endoscopic endonasal repair of CSF leaks is quite safe and effective procedure with high success rate and avoid the morbidity associated with craniotomy. Using the three-layer, sandwich-grafting technique of facia lata further adds more security to the sealing of CSF and augments the results of repair.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Aloenxertos Compostos/cirurgia , Endoscopia/métodos , Fascia Lata/transplante , Adulto , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Seio Etmoidal/patologia , Seio Etmoidal/cirurgia , Feminino , Fluoresceína , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pneumoencefalografia , Estudos Prospectivos , Seio Esfenoidal/patologia , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The skull base is an intricate interface between the cranium and face allowing the passageway of vital structures. Anatomic conceptualization forms the platform for surgical approaches and solutions to skull base pathology. Understanding embryogenesis provides further depth into the pathophysiology of congenital defects. This chapter aims to highlight skull base anatomy and embryology along with cerebrospinal fluid physiology and diagnostic evaluation of cerebrospinal fluid leaks.
Assuntos
Rinorreia de Líquido Cefalorraquidiano , Pressão Intracraniana , Base do Crânio/anatomia & histologia , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/fisiopatologia , Diagnóstico Diferencial , Endoscopia/métodos , Humanos , Imageamento por Ressonância Magnética/métodos , Nariz , Exame Físico/métodos , Pneumoencefalografia/métodos , Prognóstico , Tomografia Computadorizada por Raios X/métodosRESUMO
An eponymous lecture at the Australian and New Zealand Association of Neurologists Annual Scientific Meeting commemorates E. Graeme Robertson (1903-75), and some neurologists will know that particular Australian practices in clinical neurology, so far as they exist, have origins in his career. This is a historical article on the literary record of a man who had his own sense of history--an affinity with the past as well as an awareness of future generations of readers. He wrote authoritative texts on pneumoencephalography before new technology made it obsolete, and he produced a series of books on decorative architectural cast iron in Australian cities. A talent for visual interpretation seems to have drawn him to both of these topics; a common theme is contrast between light and dark, which is expatiated in images and in clear, well-written prose in his publications. We review his medical writings, including some largely forgotten principles of cerebrospinal fluid physics that he discovered when researching pneumoencephalography. We also explore his obsession with cast iron--its architectural historical significance, his techniques for photographing it, and some of the ways that it related to his life's work as a clinical neurologist.
Assuntos
Arquitetura/história , Neurologia/história , Austrália , História do Século XX , Humanos , Doenças do Sistema Nervoso/história , Pneumoencefalografia/históriaRESUMO
Un paciente varón de 45 años fue sometido a una derivación ventrículoperitoneal por una hidrocefalia secundaria a neurocisticercosis. Cuatro meses después desarrolló un neumoencéfalo intraventricular y una cavidad poroencefálica del lóbulo temporal derecho. El estudio neuroradiológico no localizó algún defecto óseo en la base del cráneo, pero la tomografía cerebral muestra un quiste poroencefálico al lado del segmento timpánico derecho. Una derivación ventricular externa es colocada y la derivación ventrículo-peritoneal retirada, con mejora neurológica. Después, se realizó una mastoidectomia derecha y el retiro de la derivación externa. Las tomografías de control muestran una disminución progresiva del aire intraventricular. El paciente deja el hospital asintomático y permanece así hasta hoy. Dos meses después, el neumoencéfalo desapareció.
A 45-year-old male with neurocysticercosis complicated by hydrocephalus underwent a ventriculo-peritoneal shunt procedure because of secondary hydrocephalus. Four months afterwards he developed an intraventricular pneumocephalus and a porencephalic cyst in the right temporal lobe. Neuroradiology imaging studies did not show any bone defect in the base of the cranium, but a brain CT scan showed a porencephalic cyst located next to the right tympanic segment. An external ventricular shunt was placed and the former ventriculoperitoneal shunt was taken out, and neurological signs and symptoms improved. Afterwards, a right mastoidectomy and excision of the external shunt were performed. Control CT scans showed a progressive reduction in the intraventricular air contents. The patient was discharged with no symptoms affecting him. Two months later, pneumocephalus disappeared.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Derivação Ventriculoperitoneal , Hidrocefalia , Pneumoencefalografia , Neurocisticercose , Ventrículos CerebraisRESUMO
Coaxial tomography (CT) and magnetic resonance imaging (MRI) scans are so much part of neurological investigation these days and provide such detailed information that even thorough neurological clinical examination may be neglected. The investigations in common use forty years ago were pneumoencephalography, ventriculography in babies with hydrocephalus, and carotid angiography with the injection of X-ray contrast to outline the arteries.
Assuntos
Anestesia por Inalação , Ventriculografia Cerebral/história , Hidrocefalia/diagnóstico , Pneumoencefalografia/história , Anestésicos Inalatórios/administração & dosagem , Artérias Carótidas/diagnóstico por imagem , Angiografia Cerebral , Pré-Escolar , História do Século XX , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Óxido Nitroso/administração & dosagem , Postura , Tomografia Computadorizada por Raios XRESUMO
OBJECT: The endoscopic treatment of a suprasellar arachnoid cyst (SAC) consists mainly of ventriculocystostomy (VC) and ventriculocystocisternostomy (VCC). However, the most appropriate treatment for these cysts has not been fully determined yet. The authors report on the effectiveness of endoscopic VC for SACs communicating with the basal cisterns, which is demonstrated by preoperative CT cisternography. METHODS: The authors retrospectively analyzed the surgical results of patients with an SAC treated using endoscopic fenestration. The patient charts were reviewed for demographic data, clinical presentations, surgical therapies, and clinical outcomes. RESULTS: Six consecutive patients with SAC were surgically treated using endoscopic fenestration (VC or VCC) between March 2004 and February 2011. The mean age was 18.5 months (range 5 days to 37 months). Five patients were previously untreated, and 1 patient had previously undergone ventriculoperitoneal shunt placement. Five patients underwent preoperative CT cisternography, and communication between the SAC and the basal cisterns was demonstrated in 3 patients, very slight communication in 1, and no communication in 1. Four patients, including the 3 with communication between the SAC and basal cisterns, underwent VC. Two patients with very slight or no communication underwent VCC. In all patients the SAC decreased in size and hydrocephalus improved postoperatively. Five patients (3 treated with VC and 2 with VCC [83%]) have been stable without reoperation (mean follow-up 32.7 months). All 3 patients with an SAC communicating with the basal cisterns have been stable without reoperation following VC. CONCLUSIONS: Preoperative cisternography may be useful for selecting the optimal endoscopic treatment method for SAC. If an SAC communicates with the basal cisterns, a VC could be an effective, safe, and simpler treatment option.
Assuntos
Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Endoscopia/métodos , Pré-Escolar , Cisterna Magna/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Pneumoencefalografia , Estudos Retrospectivos , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , VentriculostomiaRESUMO
Intracranial penetrating injury through the nose is rare. We present a case of a 79 year-old patient who had intracranial penetrating injury with a wooden object accompanied by massive bilateral pneumoencephaly with the presence of a foreign body in the ethmoid bone with fracture and displacement of crista galli. This is a hitherto unreported retained foreign body with fractured ethmoid resulting in bilateral pneumoencephaly.
Assuntos
Osso Etmoide/diagnóstico por imagem , Corpos Estranhos , Pneumoencefalografia/métodos , Ferimentos Penetrantes/complicações , Idoso , Feminino , Corpos Estranhos/etiologia , Corpos Estranhos/patologia , Corpos Estranhos/radioterapia , HumanosRESUMO
Adequate removal of large pituitary tumors with significant suprasellar extension remains a challenge through the trans-sphenoidal corridor because of this route's limited working window. The application of intracisternal air and intraoperative fluoroscopy is explored as a form of intraoperative imaging to maximize tumor resection and to confirm adequate suprasellar tumor decompression. The authors confirmed adequate decompression of suprasellar space using this technique of fluoroscopy with the present intrathecal air for 10 of 12 patients with giant, non-functioning pituitary tumors. Intraoperative cerebrospinal fluid fistulae prevented the use of intrathecal air in the remaining two patients.
Assuntos
Neoplasias Hipofisárias/cirurgia , Pneumoencefalografia , Sela Túrcica/cirurgia , Anestesia Geral , Cateterismo , Derivações do Líquido Cefalorraquidiano , Descompressão Cirúrgica , Feminino , Fluoroscopia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osso Esfenoide/cirurgia , Cirurgia Assistida por Computador , Resultado do TratamentoRESUMO
We describe a patient with an intraspinal paraganglioma who presented with normal pressure hydrocephalus. A 70-year-old man presented with a 6-month history of gait disturbance and cognitive dysfunction. Computed tomography of the brain and magnetic resonance imaging of the spine revealed communicating hydrocephalus and a spinal mass at the T12-L1 level which proved to be a paraganglioma of the filum terminale. Radioisotope cisternography revealed a severe delay in cerebrospinal fluid circulation. Symptoms related to communicating hydrocephalus resolved after tumor resection.
Assuntos
Cauda Equina/patologia , Hidrocefalia de Pressão Normal/patologia , Paraganglioma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Neoplasias da Coluna Vertebral/patologia , Idoso , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Transtornos Neurológicos da Marcha/etiologia , Humanos , Hidrocefalia de Pressão Normal/líquido cefalorraquidiano , Hidrocefalia de Pressão Normal/etiologia , Imageamento por Ressonância Magnética , Masculino , Paraganglioma/complicações , Neoplasias do Sistema Nervoso Periférico/complicações , Pneumoencefalografia , Neoplasias da Coluna Vertebral/complicações , Tomografia Computadorizada por Raios XRESUMO
A previous study documented the effects of maternal corticosteroid treatment on structural growth and functional development in fetal lungs associated with pathogenic conditions such as oligohydramnios using immunohistochemical and morphometric analyses. The purpose of the present study was to examine the effect of maternal dexamethasone treatment the expression of lamellar body in type II pneumocytes of the fetal rabbit lungs with hypoplasia induced by oligohydramnios using electron microscopy. Using an amniotic shunting rabbit model, pregnant rabbits were injected intravenously with either 0.1 ml of saline or 0.25 mg/kg/day of dexamethasone in 0.1 ml of saline 48 and 24 h before the delivery of fetuses, at day 30 of gestation. The number of lamellar bodies per type II pneumocyte was counted in each group using electron micrographs. The number of lamellar bodies per type II pneumocyte in the lungs of the shunted group that received saline was consistently and significantly less than that of the other three groups (5.49 +/- 2.07 vs. 7.34 +/- 2.27: shunted group that received dexamethasone, 7.58 +/- 2.08: non-shunted group that received saline, 7.79 +/- 1.90: non-shunted group that received dexamethasone; P < 0.01). These results suggest that maternal dexamethasone treatment accelerates the maturation of the surfactant system, especially the expression of lamellar bodies in type II pneumocytes, even in hypoplastic lungs induced by oligohydramnios.