RESUMO
La Enfermedad Moyamoya es una arteriopatia oclusiva progresiva de los vasos cerebrales, específicamente de la porción distal de las arterias carótidas internas, por lo general con compromiso bilateral. Esta oclusión trae como consecuencia dilatación de los vasos sanguíneos colaterales con el objetivo de convertirse en vías de circulación colateral, de donde la enfermedad adopta su nombre, debido a la apariencia angiográfica de nube de humo de estos pequeños vasos dilatados. Clínicamente se manifiesta como eventos cerebrovasculares isquémicos debido a la oclusión de los vasos mencionados o como eventos hemorrágicos debido a la ruptura de los pequeños vasos sanguíneos dilatados. Presentamos el caso de una paciente femenina de 38 años, que acude al hospital en estado de coma, cuya tomografía computarizada revela hemorragia intraventricular que fue tratada con derivación ventricular externa más activador de plasminógeno tisular. Posterior a su estabilización clínica se realizó angiografía cerebral diagnóstica con hallazgos compatibles con Enfermedad Moyamoya. Se decidió realizar subduro-sinangiosis con el fin de inducir la formación de circulación colateral cerebral. Debido a la baja incidencia de la Enfermedad Moyamoya en Latinoamérica, generalmente no es incluida en el diagnóstico diferencial de los eventos cerebrales vasculares, por lo que recomendamos su sospecha en pacientes jóvenes y sin factores de riesgo que debutan con este tipo de eventos cerebrales.
Moyamoya disease is a progressive occlusive disease of the cerebral vessels, specifically the distal portion of the internal carotid arteries, usually with bilateral involvement. This occlusion results in dilatation of collateral blood vessels in order to form collateral circulation pathways, from which the disease takes its name due to the angiographic appearance of puff of smoke of these small dilated vessels. Clinically it manifests as ischemic cerebrovascular events due to occlusion of the vessel mentioned or hemorrhagic events due to rupture of small dilated blood vessels. We report the case of a female patient of 38 years old who was admitted to the hospital in coma state, the CT scan revealed intraventricular hemorrhage that was treated with an external ventricular derivation and tissue plasminogen activator. After clinical stabilization diagnostic cerebral angiography was performed with findings consistent with Moyamoya disease. We decided to perform a subduro-sinangiosis, in order to induce the formation of cerebral collateral circulation. Due to the low incidence of Moyamoya disease in Latin America, generally it is not included in the differential diagnosis of cerebral vascular events, we recommend suspect it in young patients without risk factors who present with this type of brain events.
Assuntos
Humanos , Adulto , Feminino , Isquemia Encefálica , Hemorragia Cerebral , Revascularização Cerebral , Diagnóstico por Imagem , Doença de Moyamoya/cirurgia , Doença de Moyamoya/complicações , Doença de Moyamoya/diagnóstico , Doença de Moyamoya/etiologia , Ventrículos Cerebrais/irrigação sanguíneaRESUMO
The subventricular zone (SVZ) is recognized as one of the neurogenic regions in the adult mammalian central nervous system and the presence of cells that share similar characteristics with developmental radial glia, the radial glia-like cells (RGLCs) has been demonstrated in this region. In this study, we investigated whether and how SVZ cells respond to global ischemia and/or to the intravenous transplant of bone-marrow mononuclear cells (BMMCs). Adult rats were subjected to bilateral common carotid ligation (BCCL) and after 1 day 2×10(7) BMMCs or saline injection. The BMMC transplant stimulated a transitory increase in the proliferation of SVZ cells in the BCCL group. We observed a significant increase in the number of RGLCs 3days after ischemia, in both BCCL and BCCL+BMMC groups. However, this increase persisted in the subsequent days only in BCCL animals that received the transplant. BMMC transplantation also inhibits the reduction of NG2-positive oligodendrocyte progenitors in the SVZ observed in the BCCL group. Interestingly, brain-derived neurotrophic factor (BDNF) expression was up-regulated in the SVZ in the treated animals, but not in the other groups. These data thus suggest that BMMC transplantation modulates the phenotype of RGLCs/progenitors in the SVZ and could have a protective role after ischemia.
Assuntos
Células da Medula Óssea/citologia , Transplante de Medula Óssea , Isquemia Encefálica/terapia , Diferenciação Celular , Ventrículos Cerebrais/patologia , Oligodendroglia/citologia , Células-Tronco/citologia , Animais , Células da Medula Óssea/metabolismo , Encéfalo/patologia , Isquemia Encefálica/patologia , Fator Neurotrófico Derivado do Encéfalo/genética , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Artéria Carótida Primitiva/patologia , Contagem de Células , Proliferação de Células , Ventrículos Cerebrais/irrigação sanguínea , Regulação da Expressão Gênica , Leucócitos Mononucleares/citologia , Leucócitos Mononucleares/transplante , Ligadura , Masculino , Oligodendroglia/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos , Células-Tronco/metabolismoRESUMO
It has been demonstrated that the exposure of biological systems to magnetic fields (MFs) can produce several beneficial effects: tissue recovery in chronic wounds, re-establishment of blood circulation after tissue ischemia or in necrotic tissues, improvement after epileptic episodes, angiogenesis, etc. In the current study, the effects of extremely low frequency (ELF) MF on the capillaries of some circumventricular organs (CVOs) are demonstrated; a vasodilator effect is reported as well as an increase in their permeability to non-liposoluble substances. For this study, 96 Wistar male rats (250 g body mass) were used and divided into three groups of 32 rats each: a control group (no treatment); a sham ELF-MF group; and an experimental group subjected to ELF-MF (120 Hz harmonic waves and 0.66 mT, root mean square) by the use of Helmholtz coils. All animals were administered colloidal carbon (CC) intravenously to study, through optical and transmission electron microscopy, the capillary permeability in CVOs and the blood-brain barrier (BBB) in brain areas. An increase in capillary permeability to CC was detected in the ELF-MF-exposed group as well as a significant increase in vascular area (capillary vasodilation); none of these effects were observed in individuals of the control and sham ELF-MF groups. It is important to investigate the mechanisms involved in the phenomena reported here in order to explain the effects of ELF-MF on brain vasculature.
Assuntos
Barreira Hematoencefálica/fisiologia , Capilares/efeitos da radiação , Permeabilidade Capilar/efeitos da radiação , Campos Magnéticos , Animais , Barreira Hematoencefálica/efeitos da radiação , Carbono , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/efeitos da radiação , Masculino , Ratos , Ratos WistarRESUMO
Cardiovascular responses elicited by the stimulation of kinin B2 receptors in the IV cerebral ventricle, paratrigeminal nucleus or in the thoracic spinal cord are similar to those observed during an exercise bout. Considering that the kalikrein-kinin system (KKS) could act on the cardiovascular modulation during behavioral responses as physical exercise or stress, this study evaluated the central B2 receptor densities of Wistar (W) and spontaneously hypertensive rats (SHR) after chronic moderate exercise. Animals were exercise-trained for ten weeks on a treadmill. Afterwards, systolic blood pressure decreased in both trained strains. Animals were killed and the medulla and spinal cord extracted for B2 receptor autoradiography. Trained animals were compared to their sedentary controls. Sedentary groups showed specific binding sites for Hoe-140 (fmol/mg of tissue) in laminas 1 and 2 of the spinal cord, nucleus of the solitary tract (NTS), area postrema (AP), spinal trigeminal tract (sp5) and paratrigeminal nucleus (Pa5). In trained W a significant increase (p<0.05) in specific binding was observed in the Pa5 (31.3%) and NTS (28.2%). Trained SHR showed a significant decrease in receptor density in lamina 2 (21.9%) of the thoracic spinal cord and an increase in specific binding in Pa5 (36.1%). We suggest that in the medulla, chronic exercise could hyper stimulate the KKS enhancing their efficiency through the increase of B2 receptor density, involving this receptor in central cardiovascular control during exercise or stress. In the lamina 2, B2 receptor might be involved in the exercise-induced hypotension.
Assuntos
Ventrículos Cerebrais/metabolismo , Condicionamento Físico Animal/fisiologia , Receptor B2 da Bradicinina/metabolismo , Animais , Pressão Sanguínea/fisiologia , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/fisiologia , Calicreínas/fisiologia , Cininas/fisiologia , Masculino , Bulbo/irrigação sanguínea , Bulbo/metabolismo , Bulbo/fisiologia , Ratos , Ratos Endogâmicos SHR , Ratos Wistar , Receptor B2 da Bradicinina/biossíntese , Medula Espinal/irrigação sanguínea , Medula Espinal/metabolismo , Medula Espinal/fisiologia , Estresse Fisiológico , Fatores de Tempo , Regulação para Cima/fisiologiaRESUMO
The choroidal fissure is a narrow cleft in the medial part of the lateral ventricle, in a C-shaped arc, between the fornix and the thalamus, where the choroidal plexus join. Due to absence nervous tissue between ependyma and pia-mater along this invagination, it is an important route in brain ventricles and cisterns. Five brains were studied by injecting colored silicone arteries and veins and five brains without colored silicone, in a total number of 20 brain hemispheres. It was analyzed and revised the neural, arterial and venous relationships and surgical approaches in all parts of the choroidal fissure. In conclusion, the previous knowledge detailed this microanatomy is primordial for neurosurgeons that will approach brain ventricular and cisternal lesions because the neurosurgeons gain a tridimensional notion that will be indispensable during surgery.
Assuntos
Ventrículos Cerebrais/anatomia & histologia , Cisterna Magna/anatomia & histologia , Artérias Cerebrais/anatomia & histologia , Veias Cerebrais/anatomia & histologia , Ventrículos Cerebrais/irrigação sanguínea , Plexo Corióideo/anatomia & histologia , Plexo Corióideo/irrigação sanguínea , Cisterna Magna/irrigação sanguínea , Humanos , MicrocirurgiaRESUMO
The choroidal fissure is a narrow cleft in the medial part of the lateral ventricle, in a C-shaped arc, between the fornix and the thalamus, where the choroidal plexus join. Due to absence nervous tissue between ependyma and pia-mater along this invagination, it is an important route in brain ventricles and cisterns. Five brains were studied by injecting colored silicone arteries and veins and five brains without colored silicone, in a total number of 20 brain hemispheres. It was analyzed and revised the neural, arterial and venous relationships and surgical approaches in all parts of the choroidal fissure. In conclusion, the previous knowledge detailed this microanatomy is primordial for neurosurgeons that will approach brain ventricular and cisternal lesions because the neurosurgeons gain a tridimensional notion that will be indispensable during surgery.
A fissura coroidéia é uma estreita fenda situada na parte medial dos ventrículos laterais, em formato de "C", entre o fórnix e o tálamo e onde o plexo coróide se adere. O fato de não haver tecido nervoso entre o epêndima e a pia-máter ao longo deste acidente anatômico torna-o uma importante via no acesso aos ventrículos e cisternas cerebrais. Foram estudados cinco cérebros, injetando-se artérias e veias com material siliconado colorido e cinco cérebros sem realce colorido dos vasos, num total de 20 hemisférios cerebrais. Foram analisadas e revisadas as relações neurais, arteriais e venosas, bem como as abordagens cirúrgicas em cada parte da fissura coroidéia. Concluiu-se que o conhecimento prévio detalhado desta microanatomia é fundamental para os neurocirurgiões que vão abordar lesões nos ventrículos e cisternas cerebrais, pois se obtém uma noção tridimensional que será indispensável durante o ato cirúrgico.
Assuntos
Humanos , Cisterna Magna/anatomia & histologia , Ventrículos Cerebrais/anatomia & histologia , Artérias Cerebrais/anatomia & histologia , Plexo Corióideo , Cisterna Magna/irrigação sanguínea , Microcirurgia , Veias Cerebrais/anatomia & histologia , Ventrículos Cerebrais/irrigação sanguíneaRESUMO
Headache as a chief complaint is rare in the paediatric emergency room. Actually, very seldom cases secondary to life threatening conditions as non-traumatic subarachnoid haemorrhage have been reported. A child with severe headache and nuchal rigidity and no other abnormalities on the physical examination is reported. Magnetic resonance angiography and cerebral angiography disclosed a ventricular arteriovenous malformation in the choroid plexus, supplied by the anterior choroidal artery, classified according to Spetzler grading system as grade 3 (deep venous drainage: 1; eloquence area: 0 and size: 2). The differences in the clinical presentations of the central nervous system arteriovenous malformation between children and adults are discussed.
Assuntos
Hemorragia Cerebral/etiologia , Ventrículos Cerebrais/irrigação sanguínea , Cefaleia/etiologia , Malformações Arteriovenosas Intracranianas/complicações , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico , Criança , Feminino , Humanos , Tomografia Computadorizada por Raios XRESUMO
Cefaléia como queixa principal raramente ocorre num serviço de emergência pediátrica. Quando isso acontece, casos de cefaléia secundária que trazem risco de vida, tais como a hemorragia subaracnóide são raramente relatados. Apresentamos o caso de uma criança que apresentou cefaléia de forte intensidade associada a rigidez de nuca, sem outras anormalidades no exame físico. A angioressonância e angiografia digital evidenciaram malformação arteriovenosa na topografia do plexo coróide do ventrículo lateral direito, nutrida pela artéria coroidéia anterior, grau III na classificação de Spetzler (drenagem venosa profunda: 1; área de eloqüência: 0 e tamanho: 2). Nós discutimos as diferenças na apresentação clínica das malformações arteriovenosas encefálicas nas crianças e adultos.
Assuntos
Humanos , Feminino , Criança , Hemorragia Cerebral/etiologia , Ventrículos Cerebrais/irrigação sanguínea , Cefaleia/etiologia , Malformações Arteriovenosas Intracranianas/complicações , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
De las hemorragias, la periventricular neonatal es una de las que ocurren con mayor frecuencia en prematuros con menos de 32 semanas de gestación. Asimismo, en este estudio se consideran otros factores de riesgo que incrementan la irrigación sanguínea cerebral y que provocan sangrado en la región subepindimaria de la matriz germinativa. Se distinguen dos síndromes clínicos fundamentales: el catastrófico y el saltatorio, determinados por la magnitud de la hemorragia. El diagnóstico definitivo se lleva a cabo mediante tomografía computada o ultrasonografía, aunque el tratamiento preventivo debe ser el de primera elección. En cuanto a la hidrocefalia posthemorrágica, la derivación ventriculo-peritoneal es el tratamiento final