[Cervical and intracranial arterial dissection: review of the acute clinical presentation and imaging of 48 cases]. / Dissecções arteriais cervicais e intra-cranianas: revisão da apresentação aguda clínica e imagiológica de 48 casos.

INTRODUCTION: Arterial dissections result from longitudinal tear of the vessel wall produced by an intramural haematoma. MATERIAL AND METHODS: We have retrospectively review 48 consecutive patients with 53 arterial dissections diagnosed by cerebral angiography and/or magnetic resonance imaging. RESULTS: Arterial dissections were extracranial in 88% (carotid in 58% and vertebral in 30%) and intracranial in 12% of cases, with 19% of multiple dissections. Extracranial dissections presented with infarct (82%) (major 52%, multifocal 16%, focal 28% e watershed 4%), cervical pain and/or headache (38%) incomplete Horner syndrome (14%). The intracranial dissections presented with infarct, intracranial hypertension and hydrocephalus, subarachnoid hemorrhage and brain haematoma. Most common angiographic findings in the extracranial carotid dissections were stenosis with slow flow (66%), occlusion (34%) and dissecting aneurysm (7%). In the extracranial vertebral dissections the angiograms depicted stenosis with slow flow (82%), occlusion (18%) and dissecting aneurysm (18%). In the intracranial dissections stenosis and dissecting aneurysm were equally found. CONCLUSION: Extracranial arterial dissections have are an important cause of stroke in the younger population. Anti thrombotic drugs are used for the treatment of dissections presenting with infarct. Refractory extracranial dissections and intracranial dissection with haemorrhage presentation and/or dissecting aneurysms should be managed by endovascular treatment.

[Primary dural intracranial arteriovenous lesions]. / Lesões artério-venosas durais primárias intra-cranianas.

Vascular lesions with arteriovenous shunts are a heterogeneous group of diseases composed of three distinct pathological entities: adult type dural arteriovenous fistula, dural sinus malformations with arteriovenous shunts and juvenile type of dural arteriovenous fistula. We review the imaging and clinical features of a series of 51 patients, 48 with adult type dural arteriovenous fistula and 3 with dural sinus malformations. It is emphasized the dynamic nature of these lesions and the role of the venous drainage type in the adult type of dural AVF and veno-oclusive phenomena in the pediatric dural diseases as major determinants of the clinical presentation, prognosis and treatment decision.

Multiple dural arteriovenous fistulas presenting as rapidly progressive dementia.

INTRODUCTION: Dural arteriovenous fistulas (DAVFs) are important causes of neurological dysfunction and are many times misdiagnosed. Particularly in older populations, DAVFs may present with a selective cognitive dysfunction. CASE REPORT: The authors describe a 70-year-old woman presenting with a rapidly progressive dementia, very similar in presentation to prion disease. Neuroimaging showed multifocal DAVFs associated with venous thrombosis and white matter changes, suggesting that impaired cerebral circulation due to venous hypertensive encephalopathy caused the patient's dementia. Prompt treatment of some of the abnormal shunts with endovascular embolization resulted in a clinically relevant improvement. Subsequent clinical improvement was achieved with anticoagulation, although no cause or predisposing factor was documented that could have led to the development of the venous thrombosis. CONCLUSIONS: Neurologists should maintain a high degree of suspicion to avoid missing the diagnosis of DAVFs that are potentially treatable lesions.

High-output heart failure in a newborn.

High-output cardiac failure is rare in newborns. Emergent diagnosis and management of this pathology is crucial. We report the case of a child, currently 12-months old; obstetric background is non-contributory. Clinic observation on D1 was normal except for the presence of a systolic cardiac murmur; cardiological evaluation revealed mild ventricular dysfunction of the right ventricle. On the third day of life, she developed cardiac failure with gallop rhythm, hepatomegaly and a murmur in the anterior fontanel; an echocardiogram confirmed clinic aggravation with biventricular dysfunction and right cavities and superior vena cava dilatation. The cranial MRI confirmed the presence of a pial arteriovenous malformation (AVM) involving the anterior and middle cerebral arteries with an associated fronto-parietal ischaemic lesion. The infant underwent embolisations of AVM with successful flow reduction and cardiac failure improvement. The multidisciplinary follow-up showed no cardiac dysfunction or permanent lesions but confirmed a severe psycho-motor delay and left hemiparesia.

Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature.

INTRODUCTION: Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery. METHODS: Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm. RESULTS: The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome. CONCLUSION: Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children.

[Advanced neuroimaging in the diagnosis of cerebrovascular disease]. / Novas modalidades diagnósticas na investigação da doença cerebrovascular.

This article highlights the MR imaging techniques of CT angiography, MR angiography, diffusion weighted images, perfusion MR and CT imaging in the evaluation of stroke acute phase. From a pathophysiologic point of view, advanced computed tomography techniques and stroke magnetic resonance imaging provide much more information about the acute stroke patient as the basis of decision making in acute stroke treatment.

[Central nervous system abnormalities namely secondary brain tumors]. / Tumor do sistema nervoso central secundário a radioterapia e quimioterapia.

A 22 year-old-man with acute lymphoblastic leukaemia had received prophylactic cranial irradiation and intrathecal chemotherapy. Eighteen years later a cerebellar glioblastoma multiforme was diagnosed. The authors speculate about the possibility that this tumor may have been radiation and/or chemotherapy induced. Improvement in neuroimaging techniques, in particular magnetic resonance imaging, has helped characterize Central Nervous System abnormalities, namely secondary brain tumours.