Challenges for learning neuroradiology in undergraduate medical school: analysis from the students' point of view / Desafios para o aprendizado de neurorradiologia na graduação médica: análise do ponto de vista discente

Abstract: Introduction: The teaching of neuroradiology in undergraduate medical school must be seen as an integration tool for the interdisciplinary study of radiology, anatomy and neurology. In practice, there is a limitation on the part of students in acquiring such knowledge, either due to "neurophobia", or due to the lack of previous anatomical-radiological knowledge and also due to the lack of integrated didactic materials aimed at undergraduate school. However, there are few studies reporting the difficulties encountered by students in learning neuroradiology. Objective: To assess the perception of medical students about learning difficulties in neuroradiology. Method: Quantitative study, carried out with medical students enrolled in the second and seventh semesters of a university in Fortaleza. Data were obtained through a structured questionnaire with 12 yes or no answer questions. The questions addressed the possible difficulties encountered in acquiring neuroradiological knowledge, among them: the lack of targeted didactic material, the lack of integration with neurology, the need for basic radiological and anatomical knowledge, the large volume of content to study, and the limitations of active and traditional methodologies. Results: 181 questionnaires were analyzed. Most students report as difficulties: the need for basic knowledge of radiology (80.1%); neuroanatomy (77.5%); and to correlate radiology and neuroanatomy (70.9%). When comparing the 2nd semester and 7th semester groups, there was a greater tendency to point out the lack of practical knowledge of neurology by 2nd-semester students as a factor of greater difficulty in learning neuroradiology (82.6% versus 67.4 %, with p <0.0018). When asked about the usefulness of creating an e-book aimed at undergraduate students for learning neuroradiology, 85.6% of the students answered affirmatively; in the case of a mobile application, 92.3% agreed. As for the correlation between neuroradiology and medical practice, 98.3% answered that it is useful and necessary knowledge. Conclusion: In the students' opinion, previous knowledge of neuroanatomy and clinical neurology is important for learning neuroradiology. The development of material such as an e-book or mobile application focused on integrating the teaching of these disciplines is considered a good alternative to facilitate the understanding of neuroradiology.

Resumo: Introdução: O ensino da neurorradiologia na graduação médica deve ser encarado como uma ferramenta de integração para o estudo interdisciplinar de radiologia, anatomia e neurologia. Na prática, percebe-se uma limitação dos alunos em adquirir tais conhecimentos, seja pela "neurofobia", seja pela falta de conhecimentos anatômico-radiológicos prévios e também pela carência de materiais didáticos integrados direcionados para a graduação. Contudo, há poucos trabalhos relatando as dificuldades encontradas pelos alunos no aprendizado de neurorradiologia . Objetivo: Avaliar a percepção dos estudantes de medicina sobre as dificuldades do aprendizado em neurorradiologia. Método: Estudo quantitativo, realizado com estudantes de medicina matriculados no segundo e no sétimo semestres de uma universidade de Fortaleza. Os dados foram obtidos por meio de questionário estruturado com 12 questões de respostas sim ou não. As questões versaram sobre as possíveis dificuldades encontradas para aquisição do conhecimento neurorradiológico, dentre elas: à carência de material didático direcionado, à falta de integração com a neurologia, à necessidade de conhecimentos básicos radiológicos e anatômicos, ao volume de assunto, e às limitações das metodologias ativas e tradicionais. Resultados: Foram analisados 181 questionários. Grande parte discente refere como dificuldade a necessidade de ter conhecimentos básicos prévios de radiologia (80,1%); de neuroanatomia (77,5%); e de correlacionar radiologia e neuroanatomia (70,9%). Quando comparados os grupos do 2o semestre e do 7o semestre, houve uma tendência maior a apontar a ausência de conhecimento prático de neurologia pelos alunos do 2o semestre como um fator de maior dificuldade para o aprendizado de neurorradiologia (82,6% versus 67,4%, com p<0,0018). Quando perguntados sobre a utilidade da criação de um e-Book direcionado para a graduação para o aprendizado de neurorradiologia, 85,6% dos alunos responderam afirmativamente; no caso de um aplicativo, 92,3% concordaram. Quanto à correlação entre a neurorradiologia e a prática médica, 98,3% responderam que é um conhecimento útil e necessário. Conclusão: Na opinião dos estudantes, os conhecimentos prévios de neuroanatomia e de neurologia clínica são importantes para o aprendizado de neurorradiologia. A elaboração de um material como e-book ou aplicativo com foco em integrar o ensino dessas disciplinas é considerada uma boa alternativa para facilitar a compreensão da neurorradiologia.

Quadrigeminal cisterna lipoma: report of two cases and literature review / Lipoma da cisterna quadrigeminal: relato de dois casos e revisão da literatura

Intracranial lipomas are congenital, benign and slow-growing tumors. The incidence were 0.1 to 0.5 percent of all primary brain tumors and are often diagnosed in incidental findings of neuroradiological investigation. Lipoma in quadrigeminal region occurs in 25 percent of intracranial lipomas and has been reported as lipomas in quadrigeminal cistern (perimesencephalic cistern), quadrigeminal plate, ambiens cistern or superior medullary velum. MRI is the most major exam. The treatment is conservative in most cases, surgical removal is hampered by their deep location and contiguous with adjacent neurovascular structures. The authors report two cases of lipoma in the quadrigeminal region, incidental findings and discuss the clinical findings, neuroimaging and treatment.

Lipomas intracranianos são tumores congênito, benigno e de crescimento lento. Sua incidência é de 0.1 a 0.5 por cento de todos os tumores cerebrais primários e são frequentemente diagnosticados em achados incidental de investigação neuroradiológica. Lipoma na região quadrigeminal ocorre em 25 por cento dos lipomas intracranianos e tem sido relatados como lipomas na cisterna quadrigeminal (cisterna perimesencefálica), placa quadrigeminal, cisterna ambiens ou véu medular superior. O exame de eleição é ressonância magnética. O tratamento é conservador na maioria dos casos, a remoção cirúrgica é dificultada pela sua localização profunda e da contiguidade com estruturas neurovasculares adjacentes. Os autores relatam dois casos de lipoma na região quadrigeminal achados incidentalmente e discutem os achados clínicos, imagem e tratamento.

Avaliação dos achados clínicos e radiográficos em cães com fraturas e luxações vertebrais toracolombares / Evaluation of clinical and radiographic findings in dogs with thoracolumbar spinal fractures and luxations / Evalución de los cambios clínicos y radiográficos en perros con fracturas y luxaciones de vértebras toracolumbares

O objetivo deste trabalho foi avaliar os principais achados clínicos eradiográficos em 38 cães com fraturas e luxações vertebrais toracolombares. Trinta e três animais apresentaram fraturas instáveis , e cinco, fraturas estáveis. O exame radiográfico teve 100% de sensibilidade no diagnóstico. No entanto , observou-seuma parcela significativa de animais com lesões vertebrais detectadas no transcirúrqico que não foram visibilizadas no exame radiográfico. Comparando o grau de deslocamentovertebral com o grau de disfunção neurológica e com os resultados da terapia, houve uma diferença estatisticamente significante ao se comparar os graus de deslocamentode O a 25% com os de 76 a 100%. O exame radiográfico foi suficiente para diagnosticar fraturas e luxações vertebrais, mas sem permitir a visibilização de todas as alteraçõesósseas.(AU)

The aim of this work is to evaluate the clinical and radiographic findings in38 dogs with thoracolumbar vertebral fractures and luxations. Regarding the degree of spinal stability, 33 animals had unstable fractures and five had stable fractures. Radiographic examination scored 100% diagnostic sensitivity. However, a significantportion of animals with trans-surgical vertebral lesions were not diaqnosed onconventional radiographs. There was a statistically significant difference in terms of the degree of vertebral displacement, neurological dysfunction and response to therapy, when comparing 0-25% with 76-100% vertebral displacement. Radiographicexamination was sufficient to diagnose vertebral fractures and luxations, but did not allow visualization of all bone changes.(AU)

El objetivo del presente trabajo fue evaluar los principales hallazgosclínicos y radiográficos de 38 perros con fracturas vertebrales y luxacionestoracolumbares. Treinta y tres de esos animales presentaron fracturas inestables, y cinco fracturas estables . El examen radiográfico tuvo un 100% de sensibilidad diagnóstica. No obstante, se observó un número significativo de animales con lesiones vertebrales que se detectaron durante el transoperatorio que no fueron visualizadas en el examen radiográfico. Comparando el grado de desplazamiento vertebral con el grado de disfunción neurológica y los resultados de la terapia, hubo una diferencia estadísticamente significativa al comparar los grados dedesplazamiento de O a 25% con los de 76 a 100%. El examen radiográfico fuesuficiente para diagnosticar fracturas vertebrales y luxaciones, aunque no permitió visualizar todas las a1teraciones óseas.

Avaliação dos achados clínicos e radiográficos em cães com fraturas e luxações vertebrais toracolombares / Evaluation of clinical and radiographic findings in dogs with thoracolumbar spinal fractures and luxations / Evalución de los cambios clínicos y radiográficos en perros con fracturas y luxaciones de vértebras toracolumbares

O objetivo deste trabalho foi avaliar os principais achados clínicos eradiográficos em 38 cães com fraturas e luxações vertebrais toracolombares. Trinta e três animais apresentaram fraturas instáveis , e cinco, fraturas estáveis. O exame radiográfico teve 100% de sensibilidade no diagnóstico. No entanto , observou-seuma parcela significativa de animais com lesões vertebrais detectadas no transcirúrqico que não foram visibilizadas no exame radiográfico. Comparando o grau de deslocamentovertebral com o grau de disfunção neurológica e com os resultados da terapia, houve uma diferença estatisticamente significante ao se comparar os graus de deslocamentode O a 25% com os de 76 a 100%. O exame radiográfico foi suficiente para diagnosticar fraturas e luxações vertebrais, mas sem permitir a visibilização de todas as alteraçõesósseas.

The aim of this work is to evaluate the clinical and radiographic findings in38 dogs with thoracolumbar vertebral fractures and luxations. Regarding the degree of spinal stability, 33 animals had unstable fractures and five had stable fractures. Radiographic examination scored 100% diagnostic sensitivity. However, a significantportion of animals with trans-surgical vertebral lesions were not diaqnosed onconventional radiographs. There was a statistically significant difference in terms of the degree of vertebral displacement, neurological dysfunction and response to therapy, when comparing 0-25% with 76-100% vertebral displacement. Radiographicexamination was sufficient to diagnose vertebral fractures and luxations, but did not allow visualization of all bone changes.

El objetivo del presente trabajo fue evaluar los principales hallazgosclínicos y radiográficos de 38 perros con fracturas vertebrales y luxacionestoracolumbares. Treinta y tres de esos animales presentaron fracturas inestables, y cinco fracturas estables . El examen radiográfico tuvo un 100% de sensibilidad diagnóstica. No obstante, se observó un número significativo de animales con lesiones vertebrales que se detectaron durante el transoperatorio que no fueron visualizadas en el examen radiográfico. Comparando el grado de desplazamiento vertebral con el grado de disfunción neurológica y los resultados de la terapia, hubo una diferencia estadísticamente significativa al comparar los grados dedesplazamiento de O a 25% con los de 76 a 100%. El examen radiográfico fuesuficiente para diagnosticar fracturas vertebrales y luxaciones, aunque no permitió visualizar todas las a1teraciones óseas.

Reduction of contractility and reactivity in isolated lymphatics from hemorrhagic shock rats with resuscitation

PURPOSE: To evaluate the changes of contractility and reactivity in isolated lymphatics from hemorrhagic shock rats with resuscitation. METHODS: Six rats in the shock group suffered hypotension for 90 min by hemorrhage, and resuscitation with shed blood and equal ringer's solution. Then, the contractility of lymphatics, obtained from thoracic ducts in rats of the shock and sham groups, were evaluated with an isolated lymphatic perfusion system using the indices of contractile frequency (CF), tonic index (TI), contractile amplitude (CA) and fractional pump flow (FPF). The lymphatic reactivity to substance P (SP) was evaluated with the different volume of CF, CA, TI and FPF between pre- and post-treatment of SP at different concentrations. RESULTS: The CF, FPF, and TI of lymphatics obtained from the shocked rats were significantly decreased than that of the sham group. After SP stimulation, the ∆CF (1×10-8, 3×10-8, 1×10-7, 3×10-7 mol/L), ∆FPF (1×10-8, 3×10-8, 1×10-7 mol/L), and ∆TI (1×10-8 mol/L) of lymphatics in the shock group were also obviously lower compared with the sham group. In addition, there were no statistical differences in CA and ∆CA between two groups. CONCLUSION: Lymphatic contractility and reactivity to substance P appears reduction following hemorrhagic shock with resuscitation. .

Habilidade auditiva em criança desnutrida / Auditory ability in malnourished child

Objetivo Caracterizar e comparar o desempenho de crianças com desnutrição e crianças eutróficas nas habilidades do processamento auditivo. Métodos A amostra foi composta por 30 crianças na faixa etária de 5 a 10 anos, de ambos os gêneros, sendo 15 crianças com desnutrição, que compuseram o grupo amostral (G1) e 15 crianças com estado nutricional adequado, como grupo controle (G2). Os grupos foram pareados segundo gênero, faixa etária e escolaridade. Ambos os grupos foram submetidos à avaliação auditiva periférica e central. Resultados As crianças desnutridas apresentaram maior índice de alterações na habilidade de sequencialização sonora para sons verbais e não verbais, quando comparadas com as crianças eutróficas. O mesmo ocorreu nas habilidades de fechamento e figura fundo. Quanto ao grau do distúrbio do processamento auditivo, houve maior severidade nas crianças desnutridas. Conclusão Crianças com desnutrição apresentaram maior frequência de alterações nas habilidades auditivas, quando comparadas a crianças eutróficas, sendo as habilidades de ordenação temporal, memória auditiva, atenção seletiva, figura fundo e fechamento, as habilidades mais afetadas. .

Purpose To characterize and compare the performance of malnourished children and normal children in auditory processing. Methods The sample comprised 30 children from five to ten years old, both genders, being 15 malnourished children (G1) and 15 children with adequate nutritional status, as a control group (G2). The groups were paired according to gender, age and grade level. Both groups underwent peripheral and central auditory assessment, noting that malnourished children had higher changes in the skill of sequencing score for verbal and nonverbal when compared to normal children, and the same occurred in closing skills and background figure. Results Regarding the degree of auditory processing disorder, it was more severe in malnourished children. Conclusion Children with malnutrition have higher frequency alterations in auditory abilities when compared to normal children, being the temporal ordering skills, auditory memory, selective attention, figure-ground and closing the most affected skills. .

Raupp: 50 years of neuroradiology.

OBJECTIVE: Evaluate the laboral and intellectual contributions of a founder of Brazilian Neuroradiology to the development of specialty. METHOD: Interviews were conducted with Dr. Raupp and contemporary doctors. Then we made a literature review with the Raupp search term aiming to identify those papers which included major changes in the diagnostic and therapeutic neurosurgical. RESULTS: The colleagues consulted were unanimous in recognizing the work of avant-garde and the importance of Dr. Raupp to the development of neuroradiological methods, especially in the pre-computed tomography fase. CONCLUSION: The work of Dr. Raupp was fundamental for the consolidation of Brazilian Neuroradiological School over the past five decades. He developed diagnostic and therapeutic techniques in congruence with the practices of the specialty on the global stage and he promoted education through medical residency programs.

Raupp: 50 years of neuroradiology / Raupp: 50 anos de neurorradiologia

OBJECTIVE: Evaluate the laboral and intellectual contributions of a founder of Brazilian Neuroradiology to the development of specialty. METHOD: Interviews were conducted with Dr. Raupp and contemporary doctors. Then we made a literature review with the Raupp search term aiming to identify those papers which included major changes in the diagnostic and therapeutic neurosurgical. RESULTS: The colleagues consulted were unanimous in recognizing the work of avant-garde and the importance of Dr. Raupp to the development of neuroradiological methods, especially in the pre-computed tomography fase. CONCLUSION: The work of Dr. Raupp was fundamental for the consolidation of Brazilian Neuroradiological School over the past five decades. He developed diagnostic and therapeutic techniques in congruence with the practices of the specialty on the global stage and he promoted education through medical residency programs.

OBJETIVO: Avaliar a contribuição laboral e intelectual de um dos fundadores da Neurorradiologia Brasileira para o desenvolvimento da especialidade. MÉTODO: Foram realizadas entrevistas com o Dr. Raupp e com médicos contemporâneos. Em seguida, foi feita uma revisão de literatura com o termo Raupp com o objetivo de identificar os trabalhos que definiram mudanças importantes na avaliação diagnóstica e terapêutica neurocirúrgica. RESULTADOS: Os colegas consultados foram unânimes no reconhecimento do trabalho de vanguarda e da importância do Dr. Raupp no desenvolvimento das técnicas neurorradiológicas, especialmente na fase pré-tomografia computadorizada. CONCLUSÃO: O trabalho do Dr. Raupp foi fundamental para a consolidação da Escola Neurorradiológica Brasileira ao longo das últimas cinco décadas. Ele desenvolveu técnicas diagnóstica e terapêutica em congruência com as práticas da especialidade no cenário mundial e promoveu o ensino através dos programas de residência médica.

Image fusion in neuroradiology: three clinical examples including MRI of Parkinson disease.

Image data fusion has been developed over the last decade as an important additional visual diagnostic tool to integrate the growing amount of imaging data obtained from different medical imaging modalities. The overwhelming amount of digital information calls for data consolidation to improve clinical treatment strategies based upon anatomical and physiological imaging. Three different low level image data fusion techniques are described and their characteristics are illustrated with some rare yet key examples. We used MR images to show neurodegeneration in the cerebral peduncle of the midbrain and found that image data fusion using colors can be a valuable tool to visually assess and quantify the loss of neural cells in the Substantia Nigra pars compacta in Parkinson's disease.

Strategies for the early diagnosis of cerebral palsy.

Abstract Strategies for the early detection and diagnosis of cerebral palsy include multiple measures of the underlying brain abnormalities and their neurodevelopmental consequences. These measures can be grouped into the categories of pathogenesis, impairment, and functional limitation. Neuroimaging techniques are the most predictive measures of pathogenesis of cerebral palsy in both the preterm and term infant. Measures of neurological impairment focusing on muscle tone, reflexes, and other features of the neurological examination are poorly predictive in the first months of life. Detection of functional limitations manifested by motor developmental delay is sensitive and specific for later cerebral palsy, but not until well into the second 6 months of life. Abnormal spontaneous general movements in the infant 16 to 20 weeks postterm and earlier reflect functional limitations in the first months of life and have been shown to predict later cerebral palsy. Recognition of abnormal spontaneous general movements may improve early detection and diagnosis of cerebral palsy if these techniques can be successfully incorporated into organized follow-up programs and developmental surveillance.

Neuroimaging in cerebral palsy.

Parents and clinicians concerned about high-risk infants and children with motor delay or cerebral palsy seek information on cause, treatment, prognosis, and recurrence risk. Used in combination with history and examination, neuroimaging studies can improve diagnosis and management. In premature infants, cranial ultrasound is a reliable, noninvasive diagnostic modality. Nuclear magnetic resonance techniques including magnetic resonance imaging and diffusion weighted imaging can be used effectively in neonatal encephalopathies. In children with motor delay and cerebral palsy syndromes including spastic diplegia, quadriplegia, hemiplegia, and extrapyramidal movement disorders, conventional magnetic resonance imaging has become an important determinant of diagnosis and management. The aim of this article is to help clinicians select and interpret imaging studies of benefit in clinical care.

Advances in neuroimaging of stroke

This article reviews the recent advances in the neuroradiological diagnosis of acute stroke, highlighting the perspectives for the next 10 years. Key words: Brain infarction; cerebral hemorrhage; early diagnosis; neuroimaging.

O artigo sumaria os avanços recentes no diagnóstico neuroradiológico do acidente vascular cerebral isquêmico e hemorrágico, discutindo as perspectivas para a próxima década.

Leucoaraiosis: imágenes diagnósticas / Leukoaraiosis: diagnostic images

La enfermedad vascular cerebral ha adquirido una gran importancia en las últimas décadas, en parte debido al incremento en su frecuencia y al desarrollo de técnicas diagnósticas precisas, especialmente de imagenología. La leucoaraiosis es un término neurorradiológico que expresa rarefacción de la sustancia blanca profunda de los lóbulos cerebrales, cuerpo calloso y comisura blanca anterior. Esta afección es causada por fenómenos isquémicos que conducen a desmielinización y gliosis. Con frecuencia se asocia a enfermedades que son factores de riesgo para enfermedad vascular cerebral, como la hipertensión arterial. El objetivo de esta investigación es informar sobre cinco casos en los cuales fue difícil diagnosticar esta patología debido a los hallazgos neurorradiológicos; se describen las características clínicas y de imagen, y se hace referencia al diagnóstico diferencial