Color discrimination in fixed saturation level of patients with acute traumatic injury.

Introduction: Traumatic brain injury (TBI) is an important public health concern and that may lead to severe neural sequels, such as color vision deficits. Methods: We evaluated the color vision of 10 TBI patients with normal cognitive function using a color discrimination test in a fixed saturation level. We also analyzed computerized tomography scans to identify the local of the brain damages. Results: Four TBI patients that had lesions in brain areas of the ventral visual streams, five TBI patients had lesions inferred in brain areas of the dorsal visual stream, and one TBI patient had lesion in the occipital area. All the patients had cognitive and color vision screened and they had characterized the chromatic discrimination at high and low saturation. All participants had no significant cognitive impairment in the moment of the color vision test. Additionally, they had perfect performance for discrimination of chromatic stimulus at high saturation and similar to controls (n = 37 age-matched participants). Three of four TBI patients with lesions in the ventral brain and one patient with lesion in the occipital area had impairment of the chromatic discrimination at low saturation. All TBI patients with lesions in the dorsal brain had performance similar or slightly worse than the controls. Conclusion: Chromatic discrimination at low saturation was associated to visual damage in the ventral region of the brain and is a potential tool for functional evaluation of brain damage in TBI patients.

Hemifacial Spasm Associated with Chiari Type I Malformation: Surgical Considerations and Case Report

Hemifacial spasm (HS) is a movement disorder characterized by paroxysmal and irregular contractions of the muscles innervated by the facial nerve. Chiari malformation type I (CM I) is a congenital disease characterized by caudal migration of the cerebellar tonsils, and surgical decompression of foramen magnum structures has been used for treatment. The association of HS with CM I is rare, and its pathophysiology and therapeutics are speculative. There are only a few cases reported in the literature concerning this association. The decompression of the posterior fossa for the treatment of CM I has been reported to relieve the symptoms of HS, suggesting a relation between these diseases. However, the possible complications of posterior fossa surgery cannot be underrated. We report the case of a 66-year-old patient, in ambulatory follow-up due to right HS, no longer responding to botulinum toxin treatment. Magnetic resonance imaging (MRI) of the skull revealed compression of the facial nerve and CM I. The patient underwent surgery for HS by neurovascular microdecompression of the facial nerve via right lateral suboccipital craniectomy, but presented significant clinical worsening in the postoperative period even though the cerebellum edema related to surgical manipulation was mild. Due to the clinical worsening, the patient underwent a median suboccipital craniectomy with decompression of the foramenmagnum structures. After this second surgery, the patient had progressive improvement and was discharged from the hospital for ambulatory care.

Using sellar region tumor's size as a predictor of psychophysical and electrophysiological perimetric visual losses: a logistic regression approach.

BACKGROUND: Sellar region tumor growth represents an important cause of visual loss due to mechanical compression of the optic nerve apparatus. Many investigations have used non-invasive tools to evaluate the visual field consequences of this damage, and good associations have been reported between psychophysical and electrophysiological perimetries. Few reports have considered the tumor size as a predictor of visual field loss. AIMS: In the present study, we evaluated the association between the visual perimetry measured by Humphrey visual field analyzer and multifocal visual evoked cortical potential (mfVECP) and the tumor size. METHODS: Our sample was composed of 14 patients diagnosed with sellar tumors by magnetic resonance imaging. We accounted the number of sectors with negative visual responses for both methods. A simple logistic regression analysis was used to evaluate the association between the tumor dimensions and the visual field features RESULTS: Three patients had preserved visual fields, three patients showed hemianopic defects, and eight patients had generalized visual field losses at both evaluations. We observed that the three maximum diameters of the tumor and total tumor volume had different predictive abilities regarding the extent of visual field loss when using psychophysical and mfVECP data. The maximum craniocaudal diameter of the tumor was the better predictor of the psychophysical measurements, whereas for the mfVECP results, all tumor dimensions and volumes had similar values that predict visual field losses. CONCLUSION: Tumor size as a predictor of visual loss has potential to assist in the clinical intervention and to prevent the irreversible visual impairment caused by tumors of the sellar region.

Tophaceous gout of the spine: a neurosurgical standpoint / Tofo gotoso de coluna vertebral: um ponto de vista neurocirúrgico

Objective: The study aim is to present the clinical, radiological aspects and treatment of this disease from the neurosurgical standpoint using a literature review and an illustrative case. Methods: A PubMed research was done with the terms ?tophaceous gout?, ?spine?, and ?diagnosis?. We reviewed these articles and compared it with an illustrative case here presented. Results: According to a research done, this is the fifty-second case of tophaceous gout of the spine described in the English literature. The case and literature review presented demonstrate the difficulty in diagnosis, especially when the patient has no previous history of gout. Conclusion: It is important to consider tophaceous gout of the spine among the differential diagnoses that occur in the spine. Clinical and neurosurgical treatment may be required considering each case...

Objetivo: O objetivo deste estudo é apresentar a clínica, os aspectos radiológicos e o tratamento dessa afecção do ponto de vista neurocirúrgico, utilizando uma revisão da literatura e um caso ilustrativo. Métodos: Foi realizada uma pesquisa no PubMed com os termos ?tophaceous gout?, ?spine?, e ?diagnosis?. Analisamos os artigos e comparamos com um caso ilustrativo aqui apresentado. Resultados: De acordo com pesquisa realizada, este é o 52º caso de tofo gotoso de coluna vertebral descrito na literatura. O caso ilustrativo e a revisão de literatura aqui apresentados demonstram a dificuldade no diagnóstico, especialmente quando o paciente não tem história prévia de gota. Conclusão: É importante levar em consideração o tofo gotoso de coluna entre os diagnósticos diferenciais de doenças que acometem a coluna vertebral. Tratamentos clínicos e neurocirúrgicos podem ser necessários considerando cada caso...

Cisto ósseo aneurismático da coluna vertebral: Aspectos neurocirúrgicos / Aneurysmatic bone cyst of the spine: Neurosurgical aspects

Introdução: O cisto ósseo aneurismático é uma patologia óssea rara, benigna, de etiologia desconhecida, localmente agressivae hipervascularizada. Trata-se de lesão de apresentação solitária e expansiva, com cavidades contendo material hemáticoem seu interior. Relato de Caso: Paciente do sexo masculino, 16 anos de idade, com quadro de lombalgia e dor irradiadapara os membros inferiores de piora progressiva. Exame neurológico evidenciando paresia e parestesia no trajeto da raiz deL2 e hiporreflexia patelar bilateralmente, sendo pior à esquerda. RM da coluna vertebral evidenciou lesão óssea expansivaacometendo o corpo vertebral, pedículos e elementos posteriores da vértebra L3. O paciente foi submetido à ressecção cirúrgicada lesão, descompressão raquidiana, vertebroplastia aberta de L3 com cimento acrílico e fixação dos segmentos L2 a L5.Discussão: A ressecção cirúrgica é o tratamento mais indicado para esse tipo de lesão. Em casos em que há instabilidade dacoluna deve-se associar a artrodese, o que promove, além do controle local da lesão, a prevenção de deformidades da coluna.Conclusão: No caso aqui apresentado, a realização da ressecção do cisto ósseo aneurismático associado à vertebroplastiaaberta e artrodese da coluna permitiu adequado tratamento da instabilidade da coluna e efetivo controle da dor relacionada àdoença...

Background: Aneurysmatic bone cyst is a rare bone disease of unknown etiology, it is benign, locally aggressive, andhypervascularized. It is a solitary expansive lesion with cavities containing haematic material inside. Case Report: A 16-year-oldmale patient with progressive low back pain irradiating to the lower limbs presented at our service. Neurological examinationshowed bilateral paresia and paresthesia of L2 root, and bilateral patellar hyporeflexia. These alterations were more pronouncedin the left lower limb. MRI of the spine showed expansive bone lesion involving the vertebral body, pedicles and posterior elementsof L3. The patient was submitted to resection of the lesion, radicular decompression, open vertebroplasty with acrylic cementof L3, and fixation of segments L2 to L5. Discussion: Surgical resection is the best treatment for this pathology being able topromote local disease control. In cases of spinal instability caused by the lesion, spinal arthrodesis must be performed to preventspinal deformity. Conclusion: At the presented case, an aneurysmatic bone cyst resection associated with open vertebroplastyand spinal arthrodesis promoted adequate spinal instability and effective pain control related to the disease...

Hemangioblastoma do ventrículo lateral: relato do sétimo caso na literatura / Hemangiomablastoma of the lateral ventricle: seventh reported case in the literature

Introdução: Hemangioblastomas são tumores benignos, ricos em capilares, geralmente encontrados no compartimento infratentorial. Quando localizados no espaço supratentorial,raramente se situam no ventrículo lateral. Relatamos o caso de uma paciente do sexo feminino de 25 anos de idade tratada em nossa instituição com este diagnóstico. Relato de caso: A paciente veio ao nosso serviço com queixa de cefaléia de três meses de evolução, déficit visual progressivo e hemiparesia direita. TC e RM do crânio evidenciaram lesão heterogêneacaptante de contraste no ventrículo lateral esquerdo. Foi submetida à microcirurgia para ressecção tumoral por craniotomia craniotomiaparieto-occcipital, via sulco intraparietal, com boa evolução pós-operatória. O exame histopatológico confirmouo diagnóstico de hemangioblastoma. Foi feita pesquisa paradoença de von Hippel-Lindau, mas a paciente não tinha história familiar para a síndrome ou qualquer sinal desta nos exames realizados. No momento, encontra-se em acompanhamento ambulatorial totalmente integrada a sua vida familiar e profissional. Discussão: De acordo com pesquisa realizada na PubMed, este é o sétimo relato de hemangioblastoma de ventrículo lateral descrito na literatura de língua inglesa. Ocaso aqui apresentado se difere dos demais por apresentar áreas císticas e volume maior do que os anteriores.

Introduction: Hemangioblastomas are capillary-rich benigntumors mainly found in the infratentorial compartment. Whenat the supratentorial space, they are rarely located at the lateralventricle. We report on a case of a 25 years-old femalepatient treated at our institution. Case report: The patientcame to our service with a three months history of progressiveheadache, bilateral visual loss, and right hemiparesis. BrainCT-scan and MRI showed a heterogeneous intraventricularcontrast-enhancing lesion at the left lateral ventricle. Von Hippel-Lindau was investigated but she had neither family historyof the disease nor any signs of it. She was submitted to microsurgicaltumor resection with a parieto-occipital craniotomyvia the intraparietal sulcus, with an uneventful recovery. Hystologicalexamination confirmed the diagnosis of hemangioblastoma.The patient is in outpatient clinic follow-up completelyintegrated to her familiar and professional life. Discussion: Accordingto a PubMed search, this is the seventh case of lateralventricle hemangioblastoma reported on English literature. It has a cystic characteristic that differs from other cases, and abigger volume compared to the previous ones.

Cerebral biopsy: comparison between frame-based stereotaxy and neuronavigation in an oncology center.

Treatment of intracranial tumoral lesions is related to its correct histological diagnostic. We present a retrospective analysis of 32 patients submitted to 36 cerebral biopsies using neuronavigation and 44 patients using frame-based stereotaxy. Mean age was 46.6 and 49.3 years old respectively. Sex distribution in both groups was 50% for each. Most of lesions were lobar in both groups. Diagnostic yielding was 91.7% and 83.4%, respectively (p=0.26). We found in the postoperative CT scans intracranial hemorrhages in 13.8% cases of the first group and 9.8% cases in the second. Most of them were mild post-operative hemorrages in the biopsy site. There was one death related to the procedure in each group. Astrocytomas and metastatic adenocarcinomas were the most frequent diagnosis. Diagnostic yielding and the number of postoperative hemorrhage and death were similar on both groups and the same found in the literature.

Cerebral biopsy: comparison between frame-based stereotaxy and neuronavigation in an oncology center / Biópsia cerebral: comparação entre estereotaxia com arco e neuronavegação em um centro de oncologia

Treatment of intracranial tumoral lesions is related to its correct histological diagnostic. We present a retrospective analysis of 32 patients submitted to 36 cerebral biopsies using neuronavigation and 44 patients using frame-based stereotaxy. Mean age was 46.6 and 49.3 years old respectively. Sex distribution in both groups was 50 percent for each. Most of lesions were lobar in both groups. Diagnostic yielding was 91.7 percent and 83.4 percent, respectively (p=0.26). We found in the postoperative CT scans intracranial hemorrhages in 13.8 percent cases of the first group and 9.8 percent cases in the second. Most of them were mild post-operative hemorrages in the biopsy site. There was one death related to the procedure in each group. Astrocytomas and metastatic adenocarcinomas were the most frequent diagnosis. Diagnostic yielding and the number of postoperative hemorrhage and death were similar on both groups and the same found in the literature.

O manejo das lesões intracranianas tumorais está relacionado ao seu diagnóstico histológico adequado. Foi realizado estudo retrospectivo com 32 pacientes submetidos a 36 biópsias cerebrais por neuronavegação e 44 pacientes por estereotaxia com arco. A idade média foi 46,6 e 49,3 anos respectivamente. Nos dois grupos a distribuição por sexo foi 50 por cento para cada. A maioria das lesões biopsiadas eram lobares nos dois grupos. A positividade diagnóstica foi 91,7 por cento para neuronavegação e 83,4 por cento para a estereotaxia com arco, respectivamente (p=0,26). Identificou-se hemorragia intracraniana na TC pós-operatória em 13,8 por cento dos casos no primeiro grupo e em 9,8 por cento no segundo, a maioria de pequena monta sem provocar piora neurológica. Ocorreu uma morte relacionada ao procedimento em cada grupo. Os diagnósticos mais freqüentes foram astrocitomas e adenocarcinomas metastáticos. A positividade diagnóstica, taxas de hemorragia pós-operatória e de mortalidade foram equiparáveis estatisticamente entre os dois métodos e se assemelham com as descritas na literatura.

Hematoma extradural agudo: uma complicação do tratamento de hematoma subdural bilateral após colocação de válvula ventriculoperitoneal para hidrocefalia: relato de caso / Acute extradural hematoma after surgical treatment of a chronic subdural hematoma ventriculoperitoneal shunt insertion: report of a case

As complicações da ventriculoperitoniostomia são bem conhecidas, entre elas infecções, distúrbios relacionados à posição e localização do cateter, hematomas subdurais (HSD) e extradurais (HED), hemorragias intracerebrais e intraventriculares, além de pneumoencéfalo. Os HSD bilaterais decorrentes dessa técnica não são infreqüentes e normalmente evoluem cronicamente. Neste trabalho é apresentado um caso de hematoma subdural bilateral, seguido de hematoma extradural, como consequência de ventriculoperitoniostomia em paciente portador de hidrocefalia obstrutiva, decorrente de meningoencefalite bacteriana com encefopatia infantil. É feita a revisão da literatura especializada, discutida a fisiopatologia e enfatizando o risco dessas complicações, principalmente nos pacientes que apresentam hidrocefalia com atrofia cerebral, que concluímos favorecer a formação dessas coleções hemorrágicas devido à redução volumétrica do encéfalo.

Malformação vascular retinoencefálica, síndrome de Wyburn-Mason: relato de caso / Retinal vascular malformation and Wyburn-Mason syndrome; report of a case

A síndrome de Wyburn-Mason constitui-se na presença demalformações arteriovenosas comumente localizadas na órbita,nos anexos oculares, na retina e no encéfalo, principalmente nomesencéfalo. Existem apenas 14 casos dessa rara doençacongênita relatados na literatura, sendo apresentados os achadosclínicos e radiológicos de um paciente de 31 anos de idade comesse diagnóstico desde os 7 anos. Ao exame neurológico apresentaamaurose à direita e visão normal à esquerda. Os exames deimagem evidenciaram malformação arteriovenosa envolvendovasos orbitários direitos e espessamento do nervo óptico direitoaté a região opticoquiasmática. Em virtude da grande morbidadedo tratamento cirúrgico, desde o momento do diagnóstico foiinstituído tratamento conservador, tendo até o momento ocorridoevolução sem intercorrências.