ABSTRACT
Objective Glomus jugulare tumors, or tympanojugular paragangliomas, are rare, highly vascularized skull base tumors originated from paraganglion cells of the neural crest. With nonabsorbable embolic agents, embolization combined with surgery has become the norm. The authors assess the profile and outcomes of patients submitted to preoperative embolization in a Brazilian tertiary care hospital. Methods The present study is a single-center, retrospective analysis; between January 2008 and December 2019, 22 embolizations were performed in 20 patients in a preoperative character, and their medical records were analyzed for the present case series. Results Hearing loss was the most common symptom, present in 50% of the patients, while 40% had tinnitus, 30% had dysphagia, 25% had facial paralysis, 20% had hoarseness, and 10% had diplopia. In 7 out of 22 embolization procedures (31%) more than a single embolic agent was used; Gelfoam (Pfizer, New York, NY, USA) was used in 18 procedures (81%), in 12 of which as the single agent, followed by Embosphere (Merit Medical, South Jordan, UT, USA) (31%), Onyx (Medtronic, Minneapolis, MN, USA) (9%), and polyvynil alcohol (PVA) and Bead Block (Boston Scientific, Marlborough, MA, USA) in 4,5% each. The most common vessel involved was the ascending pharyngeal artery, involved in 90% of the patients, followed by the posterior auricular artery in 15%, the internal maxillary artery or the occipital artery in 10% each, and the superficial temporal or the lingual arteries, with 6% each. Only one patient had involvement of the internal carotid artery. No complications from embolization were recorded. Conclusions Preoperative embolization of glomus tumors is safe and reduces surgical time and complications, due to the decrease in size and bleeding.
Subject(s)
Paraganglioma/surgery , Paraganglioma/pathology , Embolization, Therapeutic/methods , Glomus Jugulare/pathology , Paraganglioma/diagnostic imaging , Medical Records , Retrospective Studies , Data Interpretation, Statistical , Skull Base Neoplasms/surgery , Endovascular Procedures/methodsABSTRACT
ABSTRACT André Brouillet's (1857-1914) famous group tableau 'A Clinical Lesson at La Salpêtrière' (French: Une leçon clinique à la Salpêtrière) is possibly the most celebrated painting in the history of neurology. His depiction of one of Jean-Martin Charcot's legendary "Tuesday Lessons" includes portraits of not only one of the master's most famous patients, but also of his pupils, the heirs to the founder of modern neurology. However, the painter himself has long been neglected, and even his other paintings on medical subjects are little acknowledged. The authors aim to bring attention to Brouillet's life and times, as well as the remainder of his notable works; and in giving a proper context to the famous painting, neurologists today may be able to appreciate better the early history of our field and its cultural impact.
RESUMO A famosa pintura 'Une leçon clinique à la Salpêtrière', de André Brouillet's (1857-1914), é possivelmente a representação mais célebre da história da Neurologia. Seu retrato de uma das lendárias "lições de terça-feira" dirigidas por Jean-Martin Charcot inclui ainda não apenas uma das pacientes mais famosas do mestre como também seus pupilos, os fundadores da Neurologia moderna. Entretanto, o pintor propriamente dito é ainda negligenciado, e mesmo outras pinturas suas sobre temas médicos são pouco reconhecidas. Os autores trazem à atenção a vida e época de Brouillet, bem como o restante de seus outros trabalhos notáveis; dando contexto apropriado à pintura, neurologistas atuais podem compreender melhor a própria história de nossa especialidade e seu impacto cultural.
Subject(s)
Humans , History, 19th Century , Paintings , Neurology , FranceABSTRACT
ABSTRACT In the beginning of modern Neurology, between the 19th and the 20th centuries, neurologists often assumed simultaneous positions of intellectual prominence and gained significant cultural credentials. Not only observers and admirers of music, literature, and the fine arts, many neurologists and neuroscientists worldwide developed significant cultural careers. When studying the careers and lives of the founders of Brazilian Neurology, one finds only sparse information on their cultural activities, which are often relegated to side notes. Therefore, the author aims to focus on the literary output of some of the most important early Brazilian neurologists, who excelled in poetry or longer written forms and were eventually immortalized by the Academia Brasileira de Letras: Antônio Austregésilo, Aloysio de Castro, Deolindo Couto, and Miguel Couto, contextualizing their artistic production in their respective academic lives.
Resumo No princípio da Neurologia moderna, entre os séculos XIX e XX, neurologistas frequentemente assumiam simultaneamente posições de destaque intelectual e ganhavam credenciais intelectuais significativas. Não meros observadores e admiradores de música, literatura e artes visuais, muitos neurologistas e neurocientistas do mundo todo desenvolveram carreiras culturais paralelas. Ao estudar a vida e a carreira dos fundadores da Neurologia Brasileira, encontra-se apenas informação esparsa sobre suas atividades culturais, frequentemente relegadas a notas de rodapé. Logo, o autor objetiva focar na produção literária de alguns dos mais importantes neurologistas brasileiros, que se destacaram em poesia ou formas escritas em prosa e foram eventualmente imortalizados pela Academia Brasileira de Letras: Antônio Austregésilo, Aloysio de Castro, Deolindo Couto e Miguel Couto, contextualizando suas produções literárias em suas vidas respectivas.
Subject(s)
Humans , History, 20th Century , Art , Music , Neurology , Brazil , NeurologistsABSTRACT
ABSTRACT Aloysio de Castro (1881-1959) is now remembered as one of Brazil's greatest physicians and is considered the father of Brazilian neurological semiology. However, his interests went far beyond the realm of Medicine, and he became one of the most illustrious intellectuals of his time. In 1927, he gave a speech at the São Paulo Society of Artistic Culture on Frédéric Chopin and embarked on a journey across the composer's life and times, discussing the medical issues involving his death, as well as his lovers, his compositions, and the spiritual aspects of musical interpretation. Thus, Castro reinforced the bonds of music and Medicine and provided lessons on Musicology that may very well be as suited to a hospital as they are to a concert hall.
RESUMO Aloysio de Castro (1881-1959) é hoje lembrado como um dos maiores médicos do Brasil, bem como o pai da semiologia neurológica brasileira. Entretanto, seus interesses iam muito além dos domínios da Medicina, e ele se tornou um dos mais ilustres intelectuais de sua era. Em 1927, Castro deu uma palestra na Sociedade de Cultura Artística de São Paulo sobre Frédéric Chopin, e embarcou em uma jornada pela vida e época do compositor, discutindo o aspecto médico de sua morte, bem como suas amantes, composições e aspectos espirituais da interpretação musical. Assim, Castro reforçou os laços entre música e Medicina e ensinou lições de Musicologia que podem muito bem ser tão aplicadas à Medicina quanto a uma sala de concertos.
Subject(s)
Humans , Male , Drama , Famous Persons , Music , Beauty , BrazilABSTRACT
ABSTRACT The illustrious Colombian Professor Salomón Hakim provided the annals of neurology with one of the most brilliant and original bodies of research on record, developing the concept of normal pressure hydrocephalus, as well as proving that ventricular shunting is an effective treatment. Thus, Professor Hakim proved that some of the dementias, at that time considered senile, could be successfully treated. Here the authors present an historical review of his main contributions, which continue to influence the study of dementia to this day.
RESUMO O ilustre professor colombiano Salomón Hakim deixou como legado nos anais da neurologia uma das mais brilhantes e originais séries de pesquisa da história, desenvolvendo o conceito de hidrocefalia de pressão normal, bem como introduzindo a derivação ventricular como tratamento efetivo. Assim, Hakim provou que algumas das demências até então consideradas senis tinham possibilidade de tratamento bem-sucedido. Aqui os autores apresentarão uma revisão histórica de suas maiores contribuições, que continuam a influenciar o estudo de demências até os nossos dias.
Subject(s)
History, 20th Century , History, 21st Century , Hydrocephalus, Normal Pressure/history , Neurology/history , Ventriculoperitoneal Shunt/history , ColombiaABSTRACT
ABSTRACT Throughout history, neurosyphilis has victimized many people, including classical composers, with a wide range of clinical presentations. Methods: Six articles with descriptions of composers with possible neurosyphilis were reviewed. Results: Neurosyphilis is a possible diagnosis for composers like Beethoven, whose progressive hearing loss influenced his career, culminating in complete deafness. In his autopsy, cochlear nerve atrophy and cochlear inflammation were described. Donizetti developed behavioral changes, as well as headaches, general paresis and seizures. Both Schumann and Wolf suffered from personality changes, persecutory delusions and general paresis. Joplin and Delius also had symptoms attributed to syphilis. Autopsy findings confirmed the diagnosis of Smetana, who developed dementia, deafness and auditory hallucinations with rapid progression. His tinnitus was musically represented in his first String Quartet. Conclusion: Neurosyphilis victimized several notorious composers. It can be argued that neurosyphilis was a major source of inspiration as well, being responsible for the genesis of musical masterpieces.
RESUMO Através da história, a neurossífilis vitimou milhares de pessoas, incluindo compositores clássicos, com uma grande gama de manifestações. Métodos: Seis artigos com descrições de compositores com possível neurossífilis foram revisados. Resultados: Neurossífilis é um diagnóstico possível para compositores como Beethoven, cuja perda auditiva progressiva influenciou sua carreira, culminando com surdez completa. Em sua autópsia foram descritas inflamação e atrofia dos nervos cocleares. Donizetti desenvolveu alterações comportamentais, bem como cefaleias, paresia e convulsões. Tanto Schumann quanto Wolf sofreram com alterações comportamentais, delírios persecutórios e paresia. Joplin e Delius também tiveram sintomas relacionados a sífilis. Achados de autópsia confirmaram o diagnóstico de Smetana, que desenvolveu demência, surdez e alucinações auditivas rapidamente progressivas. Seu tinito foi musicalmente representados em seu Quarteto de Cordas No. 1. Conclusão: Neurossífilis vitimou diversos compositores de destaque. Pode-se argumentar que a doença chegou a ser grande fonte de inspiração e mesmo responsável pela gênese de diversas obras-primas.