Vitreous Hemorrhage after Aneurismal Rupture: Terson Syndrome

Introduction Terson syndrome is described as an intraocular hemorrhage consequent to a spontaneous subarachnoid hemorrhage (SSAH). In the present article, we describe cases of patients who underwent neurosurgical treatment of ruptured cerebral aneurysmat our institution over a period of one year, and who were diagnosed with Terson syndrome. Methods The present study included patients with a diagnosis of SSAH by rupture of a cerebral aneurysm who underwent treatment in our neurosurgical service from December 2009 to December 2010. The patients were followed-up for a minimum of 20 months.We have also performed a literature review and compared the data with those available in the current literature. Results The present study included 34 patients, 18 (53%) of which underwent endovascular treatment, and 16 (47%) who underwent microsurgical clipping. In the sample, the mortality was 14.7% (5 patients), the same percentage of patients who were diagnosed with Terson Syndrome, which is an incidence of 14.7%. Regarding the ophthalmologic evaluation, all patients had vitreous hemorrhage detected by an ultrasound examination, which was unilateral in only two patients. Visual acuity improved in all patients, being incomplete in only one of them. Conclusion Terson syndrome is relatively common and is associated with higher mortality. With the existence of an effective treatment, it should be investigated in all patients with SSAH.

Revascularização cerebral na doença de moyamoya / Cerebral revascularization in moyamoya disease

Objetivo: Relatar uma série de casos de doença moyamoya/síndrome de moyamoya (DMM/SMM) tratados por revascularização cerebral no período de 2001 a 2013. Método: Estudo retrospectivo de 12 pacientes portadores de DMM/SMM submetidos à revascularização cerebral. Resultados: Trêspacientes foram operados por meio de by-pass de alto fluxo, três com by-pass de baixo fluxo e seis por revascularização indireta (encefaloarteriossinangiose associada à galeossinangiose). Realizamosdurante o seguimento: análise da ocorrência de novos acidentes vasculares cerebrais (AVC), avaliação funcional (utilizando a Escala de Rankin Modificada) e das complicações cirúrgicas. O tempo de acompanhamento para o grupo de by-pass de alto fluxo foi de quatro a dez anos, para o grupo de baixo fluxo e revascularização indireta de três meses a três anos. Nenhum paciente apresentou outro AVC no hemisfério operado tampouco piora funcional. As taxas de morbimortalidade e de infecção foram nulas. Conclusão: A revascularização cerebral foi efetiva, prevenindo a ocorrência de novos AVC e evitando piora funcional.

Objective: To report a case series of moyamoya disease/moyamoya syndrome (DMM/SMM) treated by cerebral revascularization in the period 2001-2013. Method: Retrospective study of twelve patients with DMM/SMM submitted to cerebral revascularization. Results: Three patients were operated through high-flow by-pass, three with low flow by-pass and six with indirect revascularization (encephaloarterio-sinangiosis associated with galeo-sinangiosis). Analyzed during follow-up: the occurrence of new strokes, functional assessment (using the modified Rankin scale) and surgical complications. The follow up to the group of high-flow by-pass was 4-10 years for the group of low flow and indirect revascularization of three months to three years. No patient had another cerebrovascular accident (CVA) in the hemisphere operated nor functional worsening. Rates of morbidity and mortality and infection were nil. Conclusion: Cerebral revascularization was effective, preventing the occurrence of new strokesand preventing functional deterioration.

Role of the emergency extra-intracranial bypass in acute occlusive arterial disease: evidence in the literature as to the benefit to young patients and an illustrative case of a patient with extra- and intracranial traumatic internal carotid artery occlusion / Anastomose extraintracraniana de emergência na doença arterial oclusiva aguda: evidências na literatura quanto ao benefêcio para pacientes jovens e caso ilustrativo de um paciente com oclusão traumática da artéria carótida interna

The extra-intracranial bypass has been used in the treatment of patients with chronic cerebrovascular insufficiency. More recent studies have demonstrated the benefit of this technique to patients with arterial occlusion in the acute phase. We relate the case of a 19-year-old patient, victim of cervical trauma, who presented evidence of intra- and extracranial internal carotid artery (ICA) occlusion and progressive intra hospital clinical worsening. He underwent a high-flow bypass surgery with NIHSS at 17, progressing with progressive intra hospital improvement and in the outpatient segment achieved a NIHSS of 2 in 6 months of follow-up. We discuss the role of high- and low-flow bypass in chronic occlusive arterial disease, based on a review of the literature. We conclude that in spite of there being a divergence as to the indication for, and benefits of, these techniques in chronic occlusive arterial disease, in the acute phase, there appears to be a more evident benefit mainly in the young patients, whose etiology is the dissection of the ICA...

A anastomose extraintracraniana tem sido utilizada no tratamento de pacientes com insu!ciência vascular cerebralcrônica. Estudos mais recentes têm demonstrado os benefícios dessa técnica para pacientes com doença arterialoclusiva em sua fase aguda. Relatamos o caso de um jovem de 19 anos, vítima de trauma cervical fechado,que apresentou oclusão da artéria carótida interna (ACI) extra e intracraniana, evoluindo com piora neurológica progressiva. Foi submetido a anastomose de alto "uxo em fase aguda, evoluindo com melhora neurológica,progredindo de um NIHSS de 17 para NIHSS de 2 no seguimento após seis meses. Discutimos, ainda, o papelda anastomose de alto e baixo "uxo na doença arterial oclusiva crônica, com base em revisão da literatura.Concluímos que, embora haja divergência na indicação e nos possíveis benefícios, as técnicas de anastomosespodem proporcionar maior benefício para pacientes jovens, cuja principal etiologia é a dissecção arterial....

Modified abbreviated transcavernous approach to basilar artery aneurysms--case report.

BACKGROUND: Endovascular procedures and direct surgical clipping are the main therapeutic modalities for managing of BAAs. Furthermore, giant or wide-necked aneurysms and those that involve the PCA or perforators at its neck usually are not embolized. CASE DESCRIPTION: A 55-year-old man presented to the emergency room complaining of sudden and intense headache. Neurological examination evidenced meningismus. Computed tomography disclosed a subarachnoid hemorrhage (Fisher grade III). Arteriograms revealed BAA, whose neck was partially obscured by the PCP. A standard pterional craniotomy was performed, followed by extensive drilling of the greater sphenoid wing. The neck was partially hidden by the PCP, and no proximal control was obtained without drilling the PCP and opening the CS (modified TcA). Drilling of the PCP was begun by cutting the overlying dura and extended caudally as much as possible. Next, opening of the roof of the CS was performed by incising the dura in the oculomotor trigone medial and parallel to the oculomotor nerve and lateral to ICA; the incision progressed posteriorly toward the dorsum sellae. Further resection of the dorsum sellae and clivus was carried out. After performing these steps, proximal control was obtained, aneurysm was deflated, perforators were saved, and aneurysm was clipped. CONCLUSIONS: This study has demonstrated the clinical usefulness of an abbreviated form of the TcA, which led the "modified TcA," in approaching complex low-lying BAA. It provides additional surgical room by removing the PCP and partially opening the CS, which permits further bone removal and improves exposure.

Enfermedad de Chagas y embolia cerebral / Chagas disease and brain embolism

Se presenta la experiencia clínica del AVC de naturaleza cardioembólica, en un período de siete años (1986-1994). Se reconoce y responsabiliza a la miocardiopatía chagásica crónica como la principal etiología, se consideran las repercusiones del déficit neurológico y su evolución clínica se enfatiza la repercusión secioeconómica y familiar de esta invalidante patología.