RESUMO
A female patient with a juvenile pilocytic astrocytoma and a pituitary adenoma is described. The patient also has alcaptonuria, a rare inborn error of metabolism with autosomal recessive mode of inheritance. The association of these three disorders has never been reported previously. The possible existence of a common genetic factor in the development of both tumors and alcaptonuria is discussed.
Assuntos
Adenoma/complicações , Alcaptonúria/complicações , Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Fossa Craniana Posterior , Neoplasias Primárias Múltiplas/complicações , Neoplasias Hipofisárias/complicações , Adenoma/genética , Adulto , Alcaptonúria/genética , Astrocitoma/genética , Neoplasias Encefálicas/genética , Feminino , Genes Supressores de Tumor , Predisposição Genética para Doença , Humanos , Neoplasias Primárias Múltiplas/genética , Neoplasias Hipofisárias/genéticaRESUMO
Chronic perineal pain is an often encountered problem that is difficult to evaluate. Based on a series of 17 patients in whom urological, gynecological, and anorectal pathology was excluded, the authors compared magnetic resonance imaging (MRI) with computed tomographic (CT) scan with myelography in the investigation of chronic perineal pain. After a clinical neurological examination, patients underwent radiodiagnostic imaging of both techniques. Thirteen patients (76%) had one or more sacral meningeal cysts (MC) on MRI scan, whereas CT scan with myelography of the lumbar and sacral region revealed 7 patients (41%) with sacral MC. Sacral MC may be the etiology of chronic perineal pain in many instances, and MRI scan appears to be superior to CT scan with myelography in demonstrating sacral MC. Ten patients with sacral MC were operated on with moderate to excellent results 6 months after operation. Early postoperative results are encouraging, but further follow-up and larger series are required.
Assuntos
Cistos Ósseos/complicações , Meninges , Dor/etiologia , Períneo , Sacro , Raízes Nervosas Espinhais , Adulto , Idoso , Cistos Ósseos/diagnóstico , Cistos Ósseos/cirurgia , Doença Crônica , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielografia , Doenças do Sistema Nervoso Periférico/complicações , Tomografia Computadorizada por Raios XRESUMO
Intracranial hemorrhage is an uncommon complication of dural puncture. In most instances, hematomas are subdural; they may be unilateral or bilateral. Rarely are intraparenchymal cerebral hemorrhages related to dural puncture. This report describes a delayed occurrence of bilateral intraparenchymal hemorrhages in a 38-year-old woman 7 days after lumbar myelography with iohexol. A review of the literature is presented.
Assuntos
Hemorragia Cerebral/etiologia , Iohexol , Mielografia/efeitos adversos , Punção Espinal/efeitos adversos , Adulto , Feminino , HumanosRESUMO
The case is presented of a 59-year-old man with cerebral amyloid angiopathy and three consecutive hemorrhages in the occipital lobes. The clinicopathological features and the relationship to Alzheimer's dementia are discussed. The correct treatment of intracerebral hemorrhage related to cerebral amyloid angiopathy is a matter of controversy.
Assuntos
Amiloidose/complicações , Encefalopatias/complicações , Hemorragia Cerebral/etiologia , Amiloidose/diagnóstico , Encéfalo/irrigação sanguínea , Encefalopatias/diagnóstico , Hemorragia Cerebral/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A case of familial oligodendroglioma, occurring in a mother and her daughter, is presented.
Assuntos
Neoplasias Encefálicas/genética , Oligodendroglioma/genética , Adulto , Feminino , HumanosRESUMO
Postoperative magnetic resonance imaging (MRI) findings are described in selected patients with cervical radiculopathy and a cervical soft disc herniation, treated by anterior cervical discectomy (ACD) without fusion. Six months postoperatively, 45 patients underwent MRI examination using a 0.5 T superconductive unit. T1- and T2-weighted spin echo sequences were acquired on sagittal and axial planes. A low signal intensity on T2-weighted images was visualized at the ACD level in all patients. Five patients were found to have a slight kyphosis at the discectomy level. There was no residual disc material at any ACD level. In 5 patients, areas of diminished signal intensity on T1- and T2-weighted images on adjacent vertebrae was noticed, indicating sclerosis of the cortical bone adjacent to the ACD level. In 3 patients, cervical disc protrusions without impression on the dura were visualized postoperatively: 2 below and 1 above the ACD level. One patient developed a cervical disc herniation without complaints one level above the operated one. No patient developed infolding or degenerative swelling of the ligamenta flava and no intrinsic cord abnormalities were present. MRI provided useful information on pathology, allowing a non-invasive evaluation following ACD and enabling a better understanding of surgical consequences.
Assuntos
Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/cirurgia , Imageamento por Ressonância Magnética , Adulto , Feminino , Seguimentos , Humanos , Cifose/diagnóstico , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Esclerose , Fusão VertebralRESUMO
A 46-year-old woman suffered a meningococcal meningitis followed by a rapidly progressive lumbosacral pluriradicular syndrome. Myelography showed multiple nodules on the lumbar radices. A biopsy showed tissue with numerous Verocay-like bodies, spindle shaped and lymphocytoid cells which was diagnosed as schwannoma. There was a small group of polygonal cells with somewhat irregular and hyperchromatic nuclei. Postoperatively, she developed intracranial hypertension and died. CT scan and MRI revealed multiple occipital lesions consistent with metastases. At autopsy the cauda equina showed multiple nodular lesions with morphology comparable to the biopsy. However, pigment producing cells were also present. There were metastases with distinct morphological features in the brain, myocardium, thyroid gland and pancreas. Some consisted of pigmented, large, pleomorphic cells, others of non-pigmented, spindle-shaped and less pleomorphic cells. In this case, the diagnosis of metastasizing pigmented schwannoma is the most plausible hypothesis.
Assuntos
Neoplasias Encefálicas/secundário , Neurilemoma/secundário , Lobo Occipital/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Raízes Nervosas Espinhais/patologia , Neoplasias Encefálicas/patologia , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/secundário , Humanos , Microscopia Eletrônica , Pessoa de Meia-Idade , Miocárdio/patologia , Neurilemoma/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/secundário , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/secundárioRESUMO
The authors describe their initial experience with stereotactic radiosurgery of 22 cases with vestibular schwannomas using a linear accelerator. 14 of them with a follow-up of at least one year were studied. 6-9 months after treatment 86% had central tumour necrosis, 71% tumour shrinkage and none of them evidence of tumour growth 3 patients developed reversible facial nerve impairment, 2 had permanent facial numbness. Hearing diminished in one case out of three with normal hearing and in two out of three with already diminished hearing. Although there is a general consensus that microsurgery is the treatment of choice for these benign tumours, stereotactic radiosurgery challenges this opinion. Stereotactic radiosurgery not only proves to be a valuable alternative for selected cases not suitable for microsurgery, but it is conceivable that it will become the treatment of choice for small vestibular tumours. Tumour control can be obtained in the majority of treated patients with fewer complications and with a higher rate of cranial nerve sparing. This series indicates that linear accelerators can achieve results similar to the Gamma Unit in the treatment of vestibular schwannomas.
Assuntos
Neoplasias da Orelha/cirurgia , Orelha Interna/cirurgia , Neurilemoma/cirurgia , Radiocirurgia , Vestíbulo do Labirinto/cirurgia , Adulto , Idoso , Neoplasias da Orelha/patologia , Orelha Interna/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/patologia , Doses de Radiação , Radiocirurgia/efeitos adversos , Resultado do Tratamento , Vestíbulo do Labirinto/patologiaRESUMO
A general review of the physical principles and the applications of transcranial Doppler (TCD) sonography is given. This new non-invasive technique is presented as an important diagnostic tool in neurology, neurosurgery and intensive care medicine. The applications are documented using our own patient material.
Assuntos
Circulação Cerebrovascular , Transtornos Cerebrovasculares/diagnóstico , Humanos , Ultrassom , Ultrassonografia/métodosRESUMO
Based on the experience with 15 patients operated for craniostenosis in our hospital, guidelines were determined for the anesthetic and postoperative management with optimal maintenance of vital parameters. Subgaleal accumulation of blood may cause a spectacular drop of hemoglobin level during the first postoperative days. Since it is better to prevent than to cure, systematic anti-convulsive and antibiotic prophylaxis must be considered.
Assuntos
Anestesia Geral/métodos , Craniossinostoses/cirurgia , Crânio/anormalidades , Anestesia por Inalação , Criança , Pré-Escolar , Disostose Craniofacial/cirurgia , Humanos , Lactente , Complicações Pós-Operatórias/mortalidade , Choque/mortalidade , Crânio/cirurgiaRESUMO
MR imaging with surface coils is currently the preferred method for the evaluation of cervical soft disc herniation. However, the differentiation between soft disc herniation and osteophytic spurs in the neural foraminal canal is not always obvious on a 0.5 Tesla unit. Therefore the specificity for neural foraminal canal pathology has been reported not to be very high. We evaluated MRI in selected patients without major foraminal spurs or important spondylosis on plain radiography. This prospective study includes 100 patients with cervical radicular symptoms, not subsiding after conservative treatment. All patients underwent plain radiograms. Patients without spinal instability, spondylosis or major osteophytes on plain radiograms and without clinical findings of myelopathy underwent MRI (n = 59) on a 0.5 Tesla superconducting system. All 41 other patients underwent CT myelography. On MRI, a cervical soft disc herniation was observed in 55 out of 59 investigated patients and the localization corresponded well with the clinical symptoms. CT myelography demonstrated a foraminal herniation in 1 of 4 selected patients with negative MRI. Fifty out of 55 patients underwent anterior cervical discectomy without fusion. All herniations were confirmed at operation, but in two patients there were important foraminal spurs, not seen on MRI. The specificity of MRI in this study is 94%. It is concluded that 0.5 T MRI, combined with plain films offers an accurate, noninvasive test in the assessment of selected patients with cervical radiculopathy.
Assuntos
Algoritmos , Vértebras Cervicais/patologia , Diagnóstico por Imagem , Deslocamento do Disco Intervertebral/diagnóstico , Adulto , Vértebras Cervicais/cirurgia , Discotomia , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielografia , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
The Narrowing of the lumbar canal by spondylosis appears as a frequent factor of cauda equina compression. There is a wide range of symptomatology : common low back pain and sciatalgia; neurogenic claudication with sensitive, motor or sphincter disturbance; radicular deficit at one or several levels. Radiological measurement of the anterior-posterior diameter of the lumbar canal does not give a good evaluation of the lesion. Qualitative analysis of spondylosis must be performed by special radiological investigation : plain X ray film and tomography shows the osteophytics spurs and articular hypertrophy; sacco-radiculography (Dimer X) with tomography and flexion-extension films shows the changes on the dural sac. Three types of lesions can be distinguish on anatomical and radiological grounds which carry a special operative management : the anterior type should be treated by discectomy, at one or more level; the posterior type needs facetectomy with or without laminectomy; the mixed type must be treated by combined operative procedures. Laminectomy only does not permit the cure of lateral radicular entrapment. Our results seem much better in our series since this diagnostic and therapeutic attitude is considered.
Assuntos
Canal Medular/diagnóstico por imagem , Osteofitose Vertebral/diagnóstico por imagem , Idoso , Feminino , Humanos , Disco Intervertebral/cirurgia , Laminectomia , Masculino , Métodos , Pessoa de Meia-Idade , Compressão da Medula Espinal/etiologia , Osteofitose Vertebral/complicações , Osteofitose Vertebral/cirurgia , Tomografia por Raios XRESUMO
This case report describes a patient presenting with symptoms of progressive paresis of both legs. An X-ray of the thorax demonstrated an aspect consistent with miliary tuberculosis. Magnetic resonance imaging (MRI) of the thoracic spine revealed medullary compression. The patient underwent a laminectomy and the diagnosis of spinal epidural tuberculoma was made. The patient has been treated with isoniazid, rifampicin and pyrazinamide. After a period of six months, she made a complete recovery.
Assuntos
Imageamento por Ressonância Magnética , Espondilite/diagnóstico , Vértebras Torácicas , Tuberculose da Coluna Vertebral/diagnóstico , Idoso , Antituberculosos/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Laminectomia , Vértebras Torácicas/patologia , Tuberculose da Coluna Vertebral/tratamento farmacológico , Tuberculose da Coluna Vertebral/cirurgiaRESUMO
A case of intrasacral meningeal cyst is reported in which radiculography and computed tomography were not conclusive in diagnosing the lesion. Sacral epidurography delineated the cyst very clearly and is proposed as a complementary imaging technique in lesions of the sacral canal.
Assuntos
Meningocele/diagnóstico por imagem , Sacro/diagnóstico por imagem , Adulto , Espaço Epidural/diagnóstico por imagem , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Espinha Bífida Oculta/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
MRI with surface coils is currently the preferred method for evaluating degenerative cervical spine disease. The differentiation between soft disc herniation and osteophytic spurs is not always obvious, however, on a 0.5 Tesla unit. The procedure of choice for soft disc herniation, MRI on a 0.5 T superconducting system associated with plain radiography of the cervical spine, in selecting patients for anterior cervical discectomy without interbody fusion (ACD), was evaluated. This prospective study comprised 100 patients with cervical radicular symptoms, not subsiding after conservative treatment. Plain radiographs were obtained for all patients. Patients without spinal instability, spondylosis, or major osteophytes on plain radiographs and without clinical findings of myelopathy underwent MRI (n = 59) on a 0.5 Tesla superconducting system. The other 41 patients underwent CT myelography. On MRI, herniation of a cervical soft disc was seen in 55 patients and the localisation corresponded well with the clinical symptoms. CT myelography showed a foraminal herniation in one of four selected patients with negative MRI. Fifty of 55 patients underwent ACD. All herniations were confirmed at operation, but in two patients there were important foraminal spurs not seen on MRI. It is concluded that 0.5 T MRI combined with plain radiographs offers an accurate, non-invasive test in the assessment of selected patients with cervical radiculopathy.
Assuntos
Algoritmos , Vértebras Cervicais , Deslocamento do Disco Intervertebral/diagnóstico , Imageamento por Ressonância Magnética , Mielografia , Tomografia Computadorizada por Raios X , Adulto , Árvores de Decisões , Diagnóstico Diferencial , Discotomia , Feminino , Humanos , Deslocamento do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/cirurgia , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/métodos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Fusão Vertebral , Resultado do TratamentoRESUMO
A case of hamartoma of the tuber cinereum causing isosexual precocious puberty in a six-month-old boy, in whom the lesion was successfully extirpated, is presented. Our patient was relatively young, since hamartomas causing sexual precocity most often occur between the ages of one and three years. Hamartomas are discussed from the clinical and pathological points of view. The mechanisms of initiating pubertas praecox in cases of cerebral tumours, particularly hamartomas, are reviewed.
Assuntos
Hamartoma/patologia , Neoplasias Hipotalâmicas/patologia , Hipotálamo/patologia , Puberdade Precoce/patologia , Túber Cinéreo/patologia , Hamartoma/cirurgia , Humanos , Neoplasias Hipotalâmicas/cirurgia , Lactente , Masculino , Tomografia Computadorizada por Raios X , Túber Cinéreo/cirurgiaRESUMO
Methohexitone and propofol were compared when used as the sole induction agent for thermocoagulation of the Gasserian ganglion. Sleeping and apnoea times were not significantly different for both drugs, nor were they for the same drug during repetitive inductions. However, the haemodynamic data showed a better stability when propofol was used. Amnesia may be in favour of propofol. There were no significant differences concerning pre- and post-operative side-effects in both groups.
Assuntos
Anestésicos , Eletrocoagulação , Metoexital , Fenóis , Nervo Trigêmeo , Neuralgia do Trigêmeo/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propofol , Distribuição AleatóriaRESUMO
Four patients with leptomeningeal metastases documented by neuroradiological examinations are reported. All had central nervous system or systemic neoplasms and showed clinical signs of carcinomatous meningitis. Gadolinium-enhanced MRI (Gd-MRI) disclosed for each patient pathological foci, allowing delineation of the extent of meningeal disease. Although non-specific, these findings, combined with the clinical context and CSF analysis, may lead to a rapid diagnosis and treatment of carcinomatous meningitis, even when malignant cells are not detected in the cerebrospinal fluid.
Assuntos
Neoplasias Encefálicas , Neoplasias Pulmonares , Imageamento por Ressonância Magnética/métodos , Neoplasias Meníngeas/secundário , Meningioma/secundário , Compostos Organometálicos , Ácido Pentético , Adulto , Idoso , Criança , Feminino , Gadolínio DTPA , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-IdadeRESUMO
Gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N",N"'-tetraacetic acid (Gd-DOTA) is the first of a new class of macrocyclic paramagnetic magnetic resonance (MR) contrast agents (gadolinium cryptelates) to be used in clinical practice. Gadolinium-DOTA possesses relaxation properties similar to those of gadolinium diethylene triamine pentaacetic acid (Gd-DTPA). We report our initial clinical experience in 38 patients with intracranial lesions studied with MR before and after injection of Gd-DOTA. Diseases included primary and metastatic brain tumor, cerebral infarct, vascular malformation, meningioma, hemangiopericytoma, schwannoma, and pituitary macroadenoma. Gadolinium-DOTA was administered intravenously in a dosage of 0.1 mmol/kg body weight. All studies were performed on a superconductive 0.5 T system. As compared to noncontrast T1- and T2-weighted images (WI), Gd-DOTA enhanced T1 WI were useful in defining the anatomy of malignant intraaxial tumors (high-grade glioma, metastasis) and in tumor versus edema differentiation. Low-grade gliomas did not enhance; in these cases the precontrast T2-weighted sequence was found to be more informative. In post-operative patients, Gd-DOTA allowed us to demonstrate residual tumor or tumor recurrence. Extraaxial tumors (meningioma, hemangiopericytoma, neuroma) enhanced markedly, presumably reflecting tumor vascularity. In our experience, the use of Gd-DOTA improves the anatomic definition of cerebral lesions and in some cases increases both MR sensitivity and specificity. We found Gd-DOTA to be a well tolerated and effective paramagnetic contrast agent. Gadolinium-DOTA can be considered as an alternative water-soluble MR contrast agent to Gd-DTPA.