RESUMO
BACKGROUND: During the last decade of the 20th century, continuous invasive PtO(2) recording has become a widely accepted and well-established means of monitoring patients with acute traumatic or spontaneous cerebral lesions. It is considered a safe and reliable tool for the detection of hypoxia in the ICU setting. However, while invasive measurements of intracranial pressure are being used both in the ICU and in standard diagnostic protocols for suspected chronic adult hydrocephalus the same has not yet happened in relation to PtO(2) recordings. METHODS: We report our experience with the first 10 patients who have been evaluated for suspected CAH applying a protocol that includes continuous cerebral PtO(2) measurements. The relationship between PtO(2) and ICP including a characteristic wave pattern (inverse waves) on the PtO(2) curve is analyzed and clinical and outcome data are recorded. RESULTS AND CONCLUSIONS: 1. PtO(2) recording in awake patients is safe and reliable. 2. The combination of classical Lundberg waves in the ICP recording with phases of inverse waves in the PtO(2) recording may predict good outcome after shunting. 3. The effect of concomitant conditions on the brain oxygenation can be estimated for individual patients and used as a negative predictor for surgical outcome. 4. Invasive intracranial monitoring is not free of potentially serious bleeding complications and can only be performed with risk enhancing factors (AVM/haemorrhagic diathesis) excluded.
Assuntos
Hidrocefalia/diagnóstico , Monitorização Fisiológica , Óxidos , Platina , Vigília/fisiologia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Hidrocefalia/fisiopatologia , Hidrocefalia/cirurgia , Unidades de Terapia Intensiva , Pressão Intracraniana/fisiologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/efeitos adversos , Exame Neurológico , Óxidos/efeitos adversos , Platina/efeitos adversos , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
We present a case of blindness and Anton's syndrome in a psychiatric patient with late diagnosis of a giant frontal meningioma. The criteria for advanced diagnostic imaging in the psychiatric population are discussed. We conclude that MR or CT scan is indicated in psychiatric in-patients who fail to improve with standard psychiatric treatment. This strategy should be submitted to a cost-benefit analysis.
Assuntos
Cegueira Cortical/etiologia , Fossa Craniana Anterior/patologia , Erros de Diagnóstico , Deficiência Intelectual/etiologia , Neoplasias Meníngeas/complicações , Meningioma/complicações , Adulto , Cegueira Cortical/diagnóstico , Cegueira Cortical/fisiopatologia , Corpo Caloso/patologia , Corpo Caloso/cirurgia , Fossa Craniana Anterior/diagnóstico por imagem , Descompressão Cirúrgica , Progressão da Doença , Epilepsia/etiologia , Epilepsia/fisiopatologia , Lobo Frontal/patologia , Lobo Frontal/cirurgia , Hospitais Psiquiátricos/normas , Humanos , Deficiência Intelectual/diagnóstico , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/fisiopatologia , Meningioma/diagnóstico , Meningioma/fisiopatologia , Competência Mental , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/etiologia , Transtornos Mentais/fisiopatologia , Procedimentos Neurocirúrgicos , Nervo Óptico/patologia , Esquizofrenia Hebefrênica/diagnóstico , Esquizofrenia Hebefrênica/etiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We report a new case of low grade astroblastoma of pure type and consider the definition and the clinical, neuroimaging, intraoperative and pathological characteristics of this type of uncommon intracranial tumour. We analyse the differences found in the literature concerning the immunochemistry, genetics and electron microscopy. We point out the lack of protocols for treatment of this type of intracranial tumour, and comment the various hypothesis of its origin.
