Recruitment of Contralateral Supplementary Motor Area in Functional Recovery Following Medial Frontal Lobe Surgery: An fMRI Case Study.

BACKGROUND AND OBJECTIVE: Supplementary motor area (SMA) syndrome, an executive disorder with motor and speech dysfunctions, is rather unpredictable with typically a complete or almost complete functional recovery within weeks or months. Compensatory mechanisms are associated with contralateral cortical recruitment of the lateral premotor circuitry. We sought to investigate the role of healthy SMA for motor recovery following surgery in the medial frontal lobe. METHODS: A 48-year-old right-handed man presented with focal motor seizures. The diagnostic work-up revealed a low-grade glioma at the superior frontal gyrus. The patient was operated on with intraoperative monitoring of motor pathways, and resection was taken to the functional boundaries. RESULTS: Postoperatively, the patient experienced a typical SMA syndrome that almost completely resolved in the long term. Motor recovery occurred concurrently with a shift of SMA activation to the healthy hemisphere together with an increased lateral premotor circuitry, especially for the hand map. CONCLUSION: Our results confirm brain remodeling of the lateral premotor cortex, as previously described, and indicate that functional improvement is also paralleled with a shift of SMA activation toward the healthy hemisphere.

Cerebellopontine angle subependymoma without fourth ventricle extension: an uncommon tumor in a rare location.

Subependymomas are benign tumors that occur predominantly in the ventricular system. We describe a case of a 57-year-old man with a large cerebellopontine angle (CPA) tumor which expanded into the jugular foramen. Complete surgical excision of the tumor was achieved through a retrosigmoid approach and the histopathological diagnosis was subependymoma. Subependymomas located exclusively in the CPA without extension into the fourth ventricle are extremely rare. The mainly pathological features and the difficulty in correctly diagnosing these cases preoperatively, even with MRI, are discussed.

Hemorragia subaracnoidea espontânea induzida por Warfarina / Spontenous subarachnoid hemorrhage indiced by warfarin use: case report and literature review

Introdução: A causa mais frequente de hemorragia subaracnoidea (HSA) espontânea é a ruptura de aneurisma cerebral. Em aproximadamente 5% dos casos de HSA espontânea não se observam alterações à angiografia ou ressonância magnética do sistema nervoso central que explique o sangramento. O objetivo deste trabalho é apresentar um caso de HSA espontânea induzida por warfarina, onde não foi evidenciado nenhuma malformação vascular no sistema nervoso central. Relato de Caso: Paciente do sexo masculino, com 59 anos, apresentou quadro súbito de cefaléia durante o banho. O paciente tinha história de valvulopatia mitral com troca de vávula há 23 anos e hipertensão arterial sistêmica acompanhado por cardiologista, em uso de warfarina sódica ( 5mg diários ). A tomografia computadorizada de crânio demonstrou HSA Fisher III. Os exames laboratoriais mostraram uma razão normalizada internacional (RNI) de 2.2 (normal 1 a 1,2). Foram realizadas ressonância magnética do neuroeixo e angiografia cerebral que não demonstraram aneurisma ou qualquer outra malformação vascular. Conclusão: A ocorrência de hemorragia cerebral associada ao uso de warfarina é um evento bem documentado na literatura. Entretanto a ocorrência de HSA isolada nesses pacientes rara. Para atribuir a hemorragia subaracnoidea ao uso de warfarina é necessário excluir a presença de aneurisma ou outras malformações vasculares pelos exames de imagem.

The orbitopterional approach for large and giant middle cerebral artery aneurysms: a report of two cases and literature review.

We report two cases of complex middle cerebral artery aneurysms that were surgically treated using the orbitopterional approach in a two-piece method. The objective of this work is to discuss the usefulness of the orbitopterional approach in the surgical management of large and giant middle cerebral artery aneurysms. A 32-year-old man with a giant aneurysm and a 50-year-old woman with a large and complex aneurysm presented with subarachnoid hemorrhages. Both aneurysms were successfully clipped through an orbitopterional approach. This approach permits a more basal view of the vascular structures with only a minor retraction of frontal lobe. It also increases the view angle and amount of working space available. This approach should be considered as an alternative to the classic pterional craniotomy for the surgical management of such complex lesions.

Acometimento do gânglio trigeminal na sarcoidose: relato de caso / Trigeminal ganglion involvement in sarcoidosis: case report

A sarcoidose é uma doença de causa desconhecida, vista comoinvasão tecidual por infiltrado granulomatoso não-caseoso.O sistema nervoso é afetado em casos raros, geralmente comodisseminação da doença situada em outros órgãos, principalmenteos pulmões. Apresentamos um caso no qual a pacienteapresentava apenas acometimento do sistema nervosocentral, exibindo uma lesão expansiva ao nível do gânglio deGasser direito e outra lesão no córtex parietal direito, observadasna ressonância magnética. O diagnóstico foi dado porestudo histopatológico da lesão, sendo que paciente obtevemelhora dos sintomas com terapia com corticosteróide.