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3.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(3): 151-154, mayo-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-192419

RESUMO

El papiloma del plexo coroideo es un tumor poco frecuente del sistema nervioso central, que representa menos del 1% de todas las neoplasias intracraneales. Las ubicaciones habituales son el ventrículo lateral en bebés y niños y el cuarto ventrículo en adultos. El tercer ventrículo es una localización inhabitual, con pocos casos recogidos en la bibliografía. Describimos el caso de un niño de 3 meses que ingresó en nuestro centro con signos de aumento de la presión intracraneal. Los estudios de neuroimagen mostraron una lesión en el tercer ventrículo, con hidrocefalia asociada. Al paciente se le extirpó completamente el tumor mediante abordaje transfrontal y cirugía de derivación ventriculoperitoneal. El curso postoperatorio del niño transcurrió sin incidentes y la imagen de resonancia magnética de seguimiento no reveló tumor residual. La histopatología de la lesión resecada confirmó el diagnóstico de papiloma del plexo coroideo. Discutimos las características clínicas, radiológicas e histológicas de este tipo infrecuente de tumores


Choroid plexus papilloma is an uncommon tumour of the central nervous system, accounting for less than 1% of all intracranial neoplasm. The usual locations are the lateral ventricle in infants and children and the fourth ventricle in adults. The third ventricle is a rare location, with few cases reported in the literature. We describe the case of a 3-month-old boy who was admitted to our centre with signs of raised intracranial pressure. Neuroimaging studies showed a third ventricular mass with associated hydrocephalus. The patient underwent complete tumour removal through a transfrontal approach and ventriculo-peritoneal shunt surgery. Postoperative course of the child was uneventful and follow-up magnetic resonance imaging revealed no residual tumour. Histopathology of the resected lesion confirmed the diagnosis of choroid plexus papilloma. We discuss the clinical, radiological and histological features of this infrequent type of tumours


Assuntos
Humanos , Masculino , Lactente , Papiloma do Plexo Corióideo/diagnóstico por imagem , Papiloma do Plexo Corióideo/cirurgia , Terceiro Ventrículo/cirurgia , Neuroendoscopia/métodos , Terceiro Ventrículo/patologia , Derivação Ventriculoperitoneal/métodos , Ultrassonografia , Cérebro/diagnóstico por imagem , Cérebro/patologia
4.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 37(5): 543-546, 2020 May 10.
Artigo em Chinês | MEDLINE | ID: mdl-32335882

RESUMO

OBJECTIVE: To explore the clinical features and genetic variant in a child featuring megalencephalic leukoencephalopathy with subcortical cyst (MLC) type 2B. METHODS: Clinical and imaging data of the child was collected. Potential variant of hepatocyte adhesion molecule (HEPACAM) gene was detected by Sanger sequencing. The growth and development of her mother and uncle was also reviewed. RESULTS: The patient, a 1-year-and-7-month female, presented with convulsion, mental retardation and abnormally increased head circumference. Cranial MRI revealed extensive long T1 long T2 signals in the white matter of bilateral cerebral hemisphere, right anterior sac cyst, cerebral gyrus widening, and shallow sulcus. Sanger sequencing identified a c.437C>T missense variant in exon 3 of the HEPACAM gene. The same variant was detected in her mother but not father. Her mother and maternal uncle both had a history of increased head circumference when they were young. In their adulthood, the head circumference was in the normal range but still greater than the average. CONCLUSION: The heterozygous variant of the HEPACAM gene probably underlies the MLC2B in this child. The variant has derived from her asymptomatic mother, which suggested incomplete penetrance of the MLC2B.


Assuntos
Proteínas de Ciclo Celular , Cistos , Variação Genética , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central , Adulto , Proteínas de Ciclo Celular/genética , Cérebro/diagnóstico por imagem , Cistos/diagnóstico por imagem , Cistos/genética , Feminino , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/diagnóstico por imagem , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/genética , Humanos , Lactente
5.
World Neurosurg ; 138: e478-e485, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32147552

RESUMO

OBJECTIVE: The objective of this study was to compare transcortical and posterior interhemispheric approaches to the atrium using a combined approach of white matter fiber dissections and magnetic resonance (MR) tractography. METHODS: Ten cerebral hemispheres were examined and dissected from the lateral-to-medial surface and from the medial-to-lateral surface, with special attention to the white matter tracts related to the atrium. MR tractography was used to show the relationship of three-dimensional white matter fibers with the atrium of the lateral ventricle and to compare with cadaveric dissection results. RESULTS: The atrium was related laterally to the superior longitudinal fasciculus II and III, middle longitudinal fasciculus, arcuate fasciculus, vertical occipital fasciculus, and sagittal stratum. Medially, it is related to the superior longitudinal fasciculus I, cingulum, sledge runner, and forceps major. CONCLUSIONS: A combined approach of cadaveric white matter fiber dissections and MR tractography were used to describe the main white matter tracts related to the posterior interhemispheric approach and the transcortical approach, providing an in-depth understanding of the three-dimensional anatomy of white matter fibers and the atrium. In the present study, among approaches examined, the posterior interhemispheric parasplenial transprecuneus approach placed fewer eloquent tracts at risk; however, traversing the sledge runner and the forceps major is unavoidable by this approach.


Assuntos
Cérebro/cirurgia , Ventrículos Laterais/cirurgia , Substância Branca/cirurgia , Cérebro/diagnóstico por imagem , Imagem de Tensor de Difusão , Dissecação , Humanos , Imageamento Tridimensional , Ventrículos Laterais/diagnóstico por imagem , Imagem por Ressonância Magnética , Substância Branca/diagnóstico por imagem
6.
Med. intensiva (Madr., Ed. impr.) ; 44(1): 1-8, ene.-feb. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-188790

RESUMO

Objetivo: Evaluar la factibilidad del empleo de la minigammacámara portátil Sentinella(R), para el diagnóstico de muerte encefálica (ME). Diseño: Estudio observacional, prospectivo, de factibilidad. Ámbito: Unidad de cuidados intensivos de un hospital de tercer nivel. Pacientes: Desde enero a diciembre de 2017 se registraron de forma consecutiva los pacientes mayores de edad que tras su ingreso en unidad de cuidados intensivos fueron diagnosticados de ME según criterios clínicos. Intervenciones: El procedimiento se realizó a la cabecera del paciente tras la administración intravenosa de tecnecio 99 metaestable-hexametil-propilen-amino-oxima. La ausencia de perfusión a nivel de hemisferios cerebrales y fosa posterior se describía como patrón compatible con ME. Se correlacionó el diagnóstico con doppler transcraneal y/o electroencefalograma. Resultados: Cincuenta y seis pacientes presentaron exploración física compatible con ME. Un 66,1% fueron hombres con una mediana de edad de 60 (RIQ: 51-72) años. La causa más frecuente que precipitó la ME fue el ictus hemorrágico en el 48,2% (27) seguido por traumatismo craneoencefálico grave en el 30,4% (17), ictus isquémico en el 10,7% (6) y encefalopatía anóxica tras parada cardiorrespiratoria en el 7,1% (4). En todos los casos se realizó el diagnóstico clínico de ME y posteriormente una gammagrafía portátil que confirmó dicho diagnóstico en el 100% de los pacientes. Se contrastó el resultado con doppler transcraneal en 46 de ellos que confirmaba la presencia de reverberación diastólica y/o picos sistólicos. En 10 casos se registró el electroencefalograma, con aparición de silencio eléctrico, debido a la ausencia de ventana acústica en el doppler transcraneal. Conclusiones: El uso de minigammacámara portátil puede resultar una herramienta útil y factible para el diagnóstico de ME


Objective: To evaluate the feasibility of using the Sentinella(R) portable gamma-camera for the diagnosis of brain death (BD). Design: A prospective, observational feasibility study was carried out. Setting: Intensive Care Unit of a third level hospital. Patients: Consecutive recording was made of the adults diagnosed with brain death based on clinical criteria following admission to the Intensive Care Unit in the period from January to December 2017. Interventions: The procedure was performed at the patient bedside with the intravenous administration of technetium 99 metastable hexamethylpropylene amine oxime. The absence of perfusion in the cerebral hemispheres and brainstem was described as a pattern consistent with BD. The diagnosis was correlated to the transcranial Doppler and / or electroencephalographic findings. Results: A total of 66.1% of the patients were men with an average age of 60 years [IQR: 51-72]. The most frequent causes resulting in BD were hemorrhagic stroke (48.2%, n=27), followed by traumatic brain injury (30.4%, n=17), ischemic stroke (10.7%, n=6) and post-cardiac arrest anoxic encephalopathy (7.1%, n=4). A clinical diagnosis of BD was made in all cases, and the portable gamma-camera confirmed the diagnosis in 100% of the patients with a pattern characterized by the absence of brain perfusion. In addition, the results were compared with the transcranial Doppler findings in 46 patients, confirming the presence of diastolic reverberation and / or systolic peaks. The electroencephalographic tracing was obtained in 10 cases, with the appearance of electrical silence, due to the absence of an acoustic window in the transcranial Doppler study. Conclusions: A portable gamma-camera could be a useful and feasible tool for the diagnosis of BD


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Morte Encefálica/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Neuroimagem/métodos , Câmaras gama , Cérebro/diagnóstico por imagem , Estudos Prospectivos , Estudos de Viabilidade , Unidades de Terapia Intensiva , Ultrassonografia Doppler Transcraniana , Eletroencefalografia
8.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(2): 78-88, feb. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-187432

RESUMO

Introduction: Protocol for prescribing hormone replacement therapy in isolated growth hormone (GH) deficiency includes magnetic resonance imaging of the brain. There is controversy on the frequency of structural pituitary abnormalities and on the importance of abnormal MRI findings on prognosis and response to GH replacement. Methods: A descriptive, retrospective study of children of both sexes aged 0-14 years, who had undergone brain MRI, diagnosed with isolated GH deficiency at a tertiary hospital in the past 14 years, aimed at reporting the frequency of abnormal MRI findings in isolated GH deficiency, and to establish whether differences exist in height diagnosis and evolution according to MRI findings. MRI findings were also compared with the findings reported in healthy children in order to establish incidence. Results: 96 patients were studied, of whom 74/96 (77%) reached adult age. Abnormal MRI findings were seen in 11.5% of them (8/11 of pituitary origin). No brain or pituitary tumor was seen in any case. Patients with abnormal images had a mean age at treatment start of 8 years, a target height of -0.8SD, and a final height of 1.04SD, while patients with normal MRI findings had an age at treatment start of 10 years old, a target height of -1.44SD, and a final height of -1.75SD, with statistically significant differences. Conclusions: Patients with abnormal MRI findings show a more favorable response to GH replacement therapy


Introducción: El protocolo de prescripción de hormona sustitutiva en el déficit aislado de hormona del crecimiento (GH) incluye la realización de una resonancia cerebral. Hay controversia sobre la frecuencia de anomalías hipofisarias y la importancia de los hallazgos anormales de resonancia magnética en el pronóstico y la respuesta al tratamiento de GH. Métodos: Estudio descriptivo retrospectivo de niños de 0 a 14 años, de ambos sexos, con imágenes de resonancia magnética cerebral, que fueron diagnosticados de deficiencia aislada de GH en un hospital terciario en los últimos 14 años, para describir la frecuencia de las anomalías en la resonancia magnética y establecer si existen diferencias en el diagnóstico de talla y evolución de acuerdo con los hallazgos de la resonancia magnética. Además, comparamos los hallazgos en la resonancia con los hallazgos publicados en niños sanos, con el fin de establecer la incidencia. Resultados: Se estudiaron 96 pacientes, alcanzando 74/96 (77%) la edad adulta. El 11,5% tenía imágenes de resonancia magnética anormales (8/11 de origen hipofisario). En ningún caso se observó tumor cerebral o hipofisario. Los pacientes con imágenes anormales mostraron una edad media al inicio de tratamiento de 8 años, talla diana de -0,8 DE y una talla final de 1,04 DE; mientras que los pacientes con imágenes de resonancia magnética normal muestran una edad de inicio de tratamiento de 10 años, una talla diana de -1,44 DE y una talla final de -1,75 DE, con diferencias estadísticamente significativas. Conclusiones: Los pacientes con alteraciones en la resonancia magnética muestran una respuesta más favorable al tratamiento sustitutivo de GH


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Hormônio do Crescimento Humano/deficiência , Cérebro/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Índice de Gravidade de Doença , Hormônio do Crescimento Humano/análise , Estudos Retrospectivos , Estudos Longitudinais , Estatura , Sela Túrcica/diagnóstico por imagem
13.
Neuroimaging Clin N Am ; 30(1): 15-23, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31759568

RESUMO

Resting state functional connectivity (RSFC) has been widely studied in functional magnetic resonance imaging (fMRI) and is observed by a significant temporal correlation of spontaneous low-frequency signal fluctuations (SLFs) both within and across hemispheres during rest. Different hypotheses of RSFC include the biophysical origin hypothesis and cognitive origin hypothesis, which show that the role of SLFs and RSFC is still not completely understood. Furthermore, RSFC and age studies have shown an "age-related compensation" phenomenon. RSFC data analysis methods include time domain analysis, seed-based correlation, regional homogeneity, and principal and independent component analyses. Despite advances in RSFC, the authors also discuss challenges and limitations, ranging from head motion to methodological limitations.


Assuntos
Mapeamento Encefálico/métodos , Imagem por Ressonância Magnética/métodos , Fatores Etários , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Cérebro/diagnóstico por imagem , Humanos , Vias Neurais/diagnóstico por imagem , Testes Neuropsicológicos , Descanso , Lobo Temporal/diagnóstico por imagem
14.
Stroke ; 51(3): 1002-1005, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31884909

RESUMO

Background and Purpose- Stroke is the leading cause of disability in United States, and aphasia is a common sequela after a left hemisphere stroke. Functional imaging and brain stimulation studies show that right hemisphere structures are detrimental to aphasia recovery but evidence from diffusion tensor imaging is lacking. We investigated the role of homologous language pathways in naming recovery after left hemispheric stroke. Methods- Patients with aphasia after a left hemispheric stroke underwent naming assessment using the Boston Naming Test and diffusion tensor imaging at the acute and chronic time points. We analyzed diffusion tensor imaging of right arcuate fasciculus and frontal aslant tracts. We used Wilcoxon rank-sum test to evaluate structural lateralization patterns and partial Spearman correlation/multivariate generalized linear model to determine the role of right arcuate fasciculus and frontal aslant tracts in naming recovery after controlling for confounders. Results were corrected for multiple comparisons. Results- On average, the structural integrity of left language pathways deteriorated more than their right homologs, such that there was rightward lateralization in the chronic stage. Regression/correlation analyses showed that greater preservation of tract integrity of right arcuate fasciculus was associated with poorer naming recovery. Conclusions- Our study provides preliminary evidence that preservation of right homologs of language pathways is associated with poor recovery of naming after a left hemispheric stroke, consistent with previous evidence that maintaining greater reliance on left hemisphere structures is associated with better language recovery.


Assuntos
Afasia , Cérebro , Imagem de Tensor de Difusão , Idioma , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Afasia/diagnóstico por imagem , Afasia/fisiopatologia , Cérebro/diagnóstico por imagem , Cérebro/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia
15.
Clin Ter ; 170(1): e7-e10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31850477

RESUMO

Whiplash injuries, a common sequel of road traffic accidents, may be defined as a musculo-ligamentous sprain resulting from forced acceleration/deceleration and flexion/ extension neck injury. We report a non-fatal case of vertebral right artery dissection after a minor rear-lateral collision. The injury was detected twenty-four days after trauma when a computerized tomography (CT) scan and cerebral angiography revealed multiple ischemic lesions of the right cerebellum. Digital subtraction angiography (DSA) has been the most sensitive imaging modality to describe the types and degree of vascular injury. The accuracy of such imaging allows linking several injuries with minor car crash avoiding patients seeking litigation for correct financial compensation.


Assuntos
Cérebro/diagnóstico por imagem , Artéria Vertebral/cirurgia , Traumatismos em Chicotada/diagnóstico , Traumatismos em Chicotada/cirurgia , Acidentes de Trânsito , Adulto , Humanos , Itália , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
16.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(6): 305-308, nov.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186961

RESUMO

Presentamos el caso de una mujer de 52 años, sin antecedentes de interés, que fue derivada a nuestro centro tras ser diagnosticada de una lesión ocupante de espacio en el hemisferio cerebeloso derecho. La sospecha inicial era de metástasis. En la RMN cerebral, sin embargo, se apreciaba una marcada restricción en la secuencia de difusión concordante con un absceso cerebeloso. La paciente se había sometido a una limpieza dental tres semanas antes. El análisis microbiológico tras la evacuación quirúrgica de la lesión mostró la presencia de Streptococcus intermedius


A 52-year-old woman with no relevant previous medical history was diagnosticated of an infratentorial bulky cerebellar mass. The mass showed restricted diffusion on MR images, which was consistent with cerebellar abscess. The patient had undergone a minor dental procedure three weeks before. Microbiological analysis after surgical evacuation of the mass confirmed the presence of Streptococcus intermedius


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Profilaxia Dentária/efeitos adversos , Streptococcus intermedius/patogenicidade , Fossa Craniana Posterior/diagnóstico por imagem , Abscesso/microbiologia , Fossa Craniana Posterior/patologia , Cérebro/diagnóstico por imagem , Cérebro/patologia , Craniotomia/métodos , Neuroimagem/métodos , Abscesso/tratamento farmacológico
18.
BMJ Case Rep ; 12(11)2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31753820

RESUMO

There are many examples in the literature of Hashimoto's encephalopathy (HE) presenting with heterogeneous manifestations to include stroke-like episodes, seizures, myoclonus and psychiatric symptoms. The pathogenesis is poorly understood but is thought to involve an autoimmune-mediated vasculitis. Here, we present a novel case showing hemispheric hyperaemia which created a diagnostic challenge and insinuated a vascular mechanism for the condition. The patient presented with left-sided stroke-like symptoms and had head CT angiography notable for asymmetric vasculature initially interpreted radiographically as decreased left middle cerebral artery (MCA) flow. An MRI brain demonstrated right-sided holohemispheric fluid-attenuatedinversion recovery (FLAIR) hyperintensity with right insula contrast enhancement. She was found to have elevated anti-thyroid peroxidase (TPO) antibodies with an otherwise negative encephalitis workup. The patient was diagnosed with HE and acutely progressed to have focal seizures during a prolonged intensive care unit stay. She ultimately required intravenous Ig and antiepileptic medications to gain control of her disease. This case appears to be the first described presentation of hemiencephalitis with local hyperaemia, and may represent local autoregulatory loss as a result of vasculitis. This supports the existing literature implicating inflammatory microvascular infiltration in the mechanism of the disease. HE must be considered in a broad range of unexplained neurological symptoms.


Assuntos
Cérebro/diagnóstico por imagem , Encefalite/complicações , Encefalite/diagnóstico por imagem , Doença de Hashimoto/complicações , Doença de Hashimoto/diagnóstico por imagem , Hiperemia/diagnóstico por imagem , Hiperemia/etiologia , Anticonvulsivantes/uso terapêutico , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Quimioterapia Combinada , Encefalite/tratamento farmacológico , Feminino , Doença de Hashimoto/tratamento farmacológico , Humanos , Hiperemia/tratamento farmacológico , Imunoglobulinas Intravenosas/uso terapêutico , Pessoa de Meia-Idade , Convulsões/tratamento farmacológico , Convulsões/etiologia , Acidente Vascular Cerebral/diagnóstico por imagem
20.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 38(5): 312-315, sept.-oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-189259

RESUMO

La neuroimagen funcional de la PET con 18F-FDG y la SPECT de perfusión son exploraciones cada vez más imprescindibles para la localización prequirúrgica del foco epileptógeno. Presentamos el caso de un paciente varón de 18 años con crisis epilépticas refractarias a tratamiento antiepiléptico. La RM mostró displasia en córtex insular posterior derecho. El SISCOM detectó un aumento focal de captación en cíngulo frontoparietal izquierdo y en la PET-FDG se visualizaba una distribución normal del radiotrazador. Se realizó resección insular posterior derecha, cuyo resultado anatomopatológico fue ganglioglioma grado I de la clasificación de la OMS. El paciente mostró una evolución posquirúrgica favorable, encontrándose libre de crisis desde hace 5 años (Engel I). Un análisis retrospectivo de este caso con 2 nuevos métodos de procesamiento de imágenes: PET-Analysis y PISCOM, permitió localizar correctamente el foco epileptógeno en córtex insular posterior derecho


Functional neuroimaging with positron emission tomography with 18F-fluorodeoxyglucose (PET-18F-FDG) and perfusion single photon emission computerized tomography (SPECT) are increasingly more essential for presurgically locating the epileptogenic focus. We present the case of an 18-year-old male with epileptic seizures refractory to antiepileptic treatment. Magnetic resonance (MR) showed dysplasia in the posterior right insular cortex. Subtraction of ictal SPECT co-registered to MR (SICOM) detected a focal increase of uptake in the left fronto-parietal cingulate and PET-FDG showed normal distribution of the radiotracer. The posterior right insula was resected with histopathological results of grade I ganglioglioma according to the World Health Organization classification. The patient made favourable post-surgical progress, and remains seizure-free after 5 years (Engel I). Retrospective analysis of this case with two new image processing methods (PET analysis and PET interictal subtracted ictal SPECT coregistered with MR [PISCOM]) correctly localized the epileptogenic focus in the posterior right insular cortex


Assuntos
Humanos , Masculino , Adolescente , Cérebro/diagnóstico por imagem , Epilepsia/diagnóstico por imagem , Neuroimagem/métodos , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos
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