RESUMO
A 15-year-old boy presented with a gunshot wound in the left cerebellar hemisphere. He was confused and left cerebellar signs were noted. The patient underwent the first surgery for debridement of the entry wound in the left parietal region and second surgery to remove the bullet. However, the bullet could not be located via a left unilateral suboccipital craniectomy in the park bench position, because it had migrated to the opposite side due to the effects of gravity in just a few hours. Skull radiography obtained just before the third surgery showed that the bullet had returned to the left side, and it was removed easily via the previous craniectomy in the sitting position. The clinical course suggests that in removing a bullet, skull radiography or computed tomography should be obtained just before surgery, or even intraoperatively, and that those findings should be the basis for the surgical procedure and operative position.
Assuntos
Cerebelo/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Ferimentos por Arma de Fogo , Adolescente , Cerebelo/cirurgia , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
The authors describe a case of cerebellar abscess by Nocardia in a patient with the acquired immunodeficiency syndrome (AIDS) that was submitted to a posterior fossa craniectomy for diagnosis and treatment. Pathological and neuroimage findings are discussed as well as the surgical approach taking into account literature data on the subject.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Abscesso Encefálico/complicações , Nocardiose/complicações , Nocardia asteroides , Adulto , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/cirurgia , Cerebelo/microbiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios XRESUMO
Two seriously injured trauma patients presenting with intense and progressive neutropenia are described. Bone marrow examination in both cases showed virtually absent granulopoiesis but normal erythropoiesis and megakaryopoiesis, allowing the diagnosis of acute agranulocytosis. Discontinuation of only one drug (dipyrone) with no further treatment was required for normalization of blood parameters. The association of dipyrone with neutropenia is still debatable. The recent medical literature on dipyrone generation of agranulocytosis is reviewed.
Assuntos
Agranulocitose/induzido quimicamente , Dipirona/efeitos adversos , Adolescente , Adulto , Lesões Encefálicas/terapia , Dipirona/administração & dosagem , Humanos , MasculinoRESUMO
The authors describe two patients with the association of polyposis-coli and central nervous system tumor (Turcot's syndrome). Clinical, genetic and therapeutic aspects are discussed.
Assuntos
Polipose Adenomatosa do Colo/cirurgia , Neoplasias Encefálicas/cirurgia , Glioblastoma/cirurgia , Polipose Adenomatosa do Colo/genética , Polipose Adenomatosa do Colo/patologia , Adolescente , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Feminino , Glioblastoma/genética , Glioblastoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , ReoperaçãoRESUMO
The topodiagnosis allows the physician to determine the topographic localization of pathology involving the facial nerve. It is based on clinical tests that evaluate the function of each one of the rami of the facial nerve. With a statistic of 873 patients, the Facial Nerve Group of Hospital das Clínicas, São Paulo University, found that suprageniculate lesions are responsible for 50% of the facial nerve involvement of several etiologies. Based on these results, the physician is able to develop a rationale for therapy and surgical access for facial nerve lesions.
Assuntos
Paralisia Facial/diagnóstico , Paralisia Facial/cirurgia , Paralisia Facial/terapia , Humanos , Exame NeurológicoRESUMO
A abordagem operatoria das lesoes traumaticas do nervo optico e raramente descrita E relatado caso de doente submetido a descompressao cirurgica do canal optico para tratamento da compressao mecanica do nervo optico provocada por fragmento osseo.Com o tratamento houve melhora imediata da visa
Assuntos
Adulto , Humanos , Feminino , Lesões Encefálicas , Doenças do Nervo Óptico , Craniotomia , Fraturas CranianasRESUMO
A correcao dos defeitos de parede das grandes meningomieloceles e de execucao tecnica dificil. Os autores propoem o emprego de enxerto de dura-mater homogena conservada em glicerina, como alternativa para o fechamento da aponeurose muscular ou do plano musculo-aponeurotico, em doentes protadores de meningomieloceles baixas com grandes dimensoes. Os resultados do tratamento de 10 criancas e as vantagens dometodo sao apresentados