RESUMO
We report a series of 110 patients with acute traumatic subdural hematoma (ASDH) admitted at HBDF emergency within 1994 (January 1st to December 1st). All patients were treated according to the same protocol. There was a predominance of males (79%), with ages ranging from 14 to 70, being car accidents (20%) and car-pedestrian accidents (34%) the most frequent causes. The majority of patients (85.7%) was admitted in very serious condition, with a score of 8 points on the Glasgow Coma Scale (GCS) or lesser, which directly influenced the mortality rates. CT scan was the diagnostic procedure of choice, and it showed contusion and brain swelling to be the most frequent associated intracranial lesions. Surgery was carried out in 45.1% of cases and, in most instances, through an ample fronto-temporo-parietal craniotomy, with hematoma drainage and dural reconstitution. In 54.9% of cases, clinical conditions did not allow surgery and in this group, 69.6%.
Assuntos
Hematoma Subdural/mortalidade , Acidentes , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Escala de Coma de Glasgow , Traumatismos Cranianos Fechados/complicações , Hematoma Subdural/etiologia , Hematoma Subdural/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Tomografia Computadorizada por Raios XRESUMO
The authors report the case of a 45-years-old female patient, with progressive hemiatrophy of the left face and tongue. The laboratorial and image studies were normal, including routine blood exams, cerebral-spinal fluid, hepatic function tests, renal and rheumatic; besides X ray, computerized tomography and magnetic resonance of skull. The electroneuromyography showed peripheral neurogenic alterations of motor trigeminal and hypoglossal nerves, markedly on the left side. Those findings are compatible with Romberg's facial hemiatrophy diagnosis, motivating discussion of several aspects of this rare disease according to the account and literature.
Assuntos
Hemiatrofia Facial , Hemiatrofia Facial/diagnóstico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
O hospital de base é o centro de referência do Sistema Médico de Brasília e recebe pacientes admitidos nos Hospitais Regionais do DF, atendendo a uma populaçäo estimada na ocasiäo em torno de 1,5 milhöes de habitantes. Durante o ano de 1985, 159 pacientes foram admitidos com diagnóstico de acidente vascular cerebral hemorrágico. Desse total de pacientes, 60,58% tiveram como causa determinante a rotura de um aneurisma intracraniano. Levando-se em conta as características da organizaçao do Sistema de Saude de Brasília, esse número significa que aproximadamente 5,5 pacientes por 100.000 habitantes por ano säo admitidos com rotura de aneurisma intracraniano em Brasília
Assuntos
Aneurisma Intracraniano/epidemiologia , Hemorragia Subaracnóidea , Hemorragia Cerebral , Transtornos Cerebrovasculares/epidemiologia , Sistemas de SaúdeRESUMO
O Hospital de Base e o centro de referencia do Sistema Medico de Brasilia e recebe pacientes admitidos nos Hospitais Regionais do DF, atendendo a uma populacao estimada na ocasiao em torno de 1,5 milhoes de habitantes. Durante o ano de 1985, 159 pacientes foram admitidos com diagnostico de acidente vascular cerebral hemorragico. Desse total de pacientes, 60,58 por cento tiveram como causa determinante a rotura de um aneurisma intracraniano. Levando-se em conta as caracteristicas da organizacao do Sistema de Saude de Brasilia, esse numero significa que aproximadamente 5,5 pacientes por 100.000 habitantes por ano sao admitidos com rotura de aneurisma intracraniano em Brasilia.
Assuntos
Hemorragia Subaracnóidea , Aneurisma Intracraniano , Transtornos Cerebrovasculares , Hemorragia Cerebral , Sistemas de Saúde , Hemorragia Subaracnóidea , Aneurisma Intracraniano , Transtornos Cerebrovasculares , Hemorragia Cerebral , Sistemas de SaúdeRESUMO
Long term follow-up of patients submitted to treatment of parasellar tumours region is important for the detection of late therapeutic complications. In this study the authors conducted an evaluation of six patients with craniopharyngioma, one with germinoma, one with meningioma, and one epidermoid cyst. All above tumours were localized at parasellar region. Six out of nine patients had been treated both by surgery and by radiotherapy and the other three surgically only, on an average 3.8 +/- 3.2 years before this observation was carried out. Five patients were female with their ages average 24.3 +/- 18.8 years old. Evaluation consisted: in the first place, an intravenous infusion of thyrotropin-releasing hormone (TRH, 200 micrograms), gonadotropin-releasing hormone (GnRH, 100 micrograms), and insulin tolerance test (0.1 IU/Kg, regular insulin); and secondly, in measurements of pituitary hormones secretion at different time points--0, 20, 40, 60 and 80 minutes. We found both diminished response of growth hormone and cortisol in all the patients. Seven out of nine patients did not have adequate response to follicle-stimulating hormone. Three out of nine responded unsatisfactory to luteinizing hormone. Four out of nine showed inadequate responses to prolactin as well as, two out of eight to thyrotropin. We concluded that: (a) growth hormone and cortisol deficiency are the most frequent finding in these patients; (b) post-radiotherapy lesions can be located in the hypothalamus or pituitary, or even in both; (c) hypophysial and hypothalamic cells sensitivity to irradiation is different, according to their respective hormones; and (d) it is necessary a frequent endocrinologic follow-up of patients to detect late hormonal deficiencies.
Assuntos
Neoplasias Encefálicas/radioterapia , Hipotálamo/efeitos da radiação , Hipófise/efeitos da radiação , Hormônios Adeno-Hipofisários/sangue , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Hormônio Liberador de Gonadotropina , Hormônio do Crescimento/metabolismo , Humanos , Insulina , Masculino , Pessoa de Meia-Idade , Prolactina/metabolismo , Hormônio Liberador de TireotropinaRESUMO
The case of a male child with Russel's syndrome due to a pilocytic astrocytoma located in the diencephalic region is presented. The diagnosis was made in the 16th month of age, but symptoms began in the 4th months of life, when he started losing weight. By the time he was admitted weight was 6150g and he was 74cm tall, with an emaciated aspect, no panniculus adiposus, irritated, and with symptoms of intracranial hypertension. There was convergent strabismus, vertical nystagmus of the left eye and bilateral papilledema. Tendinous reflexes were exacerbated and he had spastic tetraparesis. The endocrine evaluation showed a basal raise of GH (23ng/ml), TSH (6.2mUI/1) and prolactin (26ng/ml). The first two hormones did not respond to the acute test with TRH, while prolactin had a poor response. He was submitted to radiotherapy with linear acceleration (total dose of 4000 rads) and surgery, during which the tumor could not be completely removed due to its large size. After 9 months, the child is doing well, with a considerable weight gain (2500g).
Assuntos
Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Diencéfalo , Emaciação/etiologia , Astrocitoma/sangue , Astrocitoma/cirurgia , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/cirurgia , Humanos , Lactente , Masculino , Prolactina/sangue , Síndrome , Tireotropina/sangue , Hormônio Liberador de TireotropinaRESUMO
Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicating artery, are reported. The main findings were: headache (7/7), complex ophthalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicating artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar region remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results.
Assuntos
Aneurisma/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Adulto , Idoso , Angiografia Cerebral , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Neoplasias Hipofisárias/diagnóstico por imagemRESUMO
The case of a 46 year-old man who had a locked-in syndrome is reported. The patient had a haemorragic vascular accident with tetraplegia, anartria, vertical ocular movements and preservation of the consciousness. The EEG showed a projected disturbance possibly caused by a brain-stem lesion, that was confirmed by the CAT SCAN. Cerebral angiography showed high level of aterosclerosis. The lesion is located in the ventral part of the pons above the nucleus of the abducent nerve, without damaging the substantia reticularis of the mesencephalon and can be caused by thrombosis of the basilar artery and tumor, myastenia gravis, polyneurites, heroin overdose, after swine-flu inoculation and post-infectious polyneurites. The patient is still alive 2 years after the stroke with a good recovery. He can walk and speak fluently, but with cordonal ataxy of the limbs.
Assuntos
Transtornos Cerebrovasculares/complicações , Quadriplegia/etiologia , Transtornos Cerebrovasculares/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
E relatado um caso de sindrome do encarceramento (locked-in-syndrome) em paciente que apresentou quadro subito de tetraplegia,anartria, movimentos oculares verticais e piscar alem de preservacao do nivel de consciencia.Explicacao para tal quadro clinico e uma lesao na ponte junto ou sobre o nucleo do nervo abducente seccionando os tratos cortico-espinal e cortico-bulbar, sem atingir a substancia reticular de mesencefalo. Tres EEG revelaram disturbio projetado por provavel lesao do tronco cerebral, e que foi confirmada pelo CAT SCAN. Arteriografia vertrebral mostrou grau avancado de aterosclerose. Com tratamento clinico conservador o paciente teve otima evolucao
Assuntos
QuadriplegiaRESUMO
A case of blastomycotic granuloma of the spinal cord is reported. The patient had a Brown-Séquard syndrome. He was submitted to myelography and he was underwent a cervical laminectomy. The mass was removed being lately confirmed by histology as a blastomycotic granuloma. Despite the medical treatment with Amphotericin B and physical therapy there was no improvement of the condition.
Assuntos
Granuloma/diagnóstico , Paracoccidioidomicose/diagnóstico , Doenças da Medula Espinal/diagnóstico , Adulto , Ensaios Clínicos como Assunto , Erros de Diagnóstico , Granuloma/cirurgia , Humanos , Laminectomia , Masculino , Mielografia , Paracoccidioidomicose/cirurgia , Doenças da Medula Espinal/cirurgia , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/cirurgia , SíndromeRESUMO
The case of a three-years-old male with intracranial hypertension is reported. Without a clear clinical diagnosis, a gradual deterioration ocurred before his death, 8 days later. The neuropathological examination of the brain revealed a tumor with indistint borders at the right lateral ventricle, with granulous surface, pink-gray colour, irregular necrotic and hemorragic areas, invading the adjacent brain tissue. The histopathological study revealed a malignant variant of the choroid plexus tumor, of extreme rarity in the central nervous system. The biological and histological criteria accepted by Lewis, Rubinstein and Polak for the correct diagnosis of this type of tumour are discussed.