Adherbal Tolosa

Criptococose do sistema nervoso central. Registro de um caso

Report of a case of cryptococcosis of central nervous system the diagnosis being established by cerebrospinal fluid examination. Direct evidence of Cryptococcus was comproved by cultures. The patient, a white man, 29 years old, presented meningeal symptoms with late association of diffuse encephalic disturbances and intracranial hypertension. The course (4 months) was fatal; sulphamidic therapy was tried with no results. Necroscopic findings confirmed diffuse leptomeningitis, disseminated microabscesses of cerebral cortex; death was related to the presence of medullar compression by herniation of cerebellar tonsyles.

Síndromes do núcleo rubro. A propósito de três casos com etiologia sifilítica, um dos quais associado a mioclonias velofaringolaríngeas

Registrando tres casos de sindromes do nucleo rubro — dois de sindrome superior e um de sindrome inferior, tipo Claude — os autores reveem a anatomo-fisiologia dessa formacao mesencefalica. Ressaltam particularmente as alteracoes do tono verificadas pela lesao experimental do nucleo vermelho. A destruicao da porcao parvicelular, superior (neorrubro) determina o aparecimento de hipotonia, por liberacao da atividade inibidora do tono da porcao magnocelular, inferior ( paleorrubro ) ; a lesao desta ultima provoca hipertonia, devido a liberacao dos nucleos tonigenos romben cefalicos. Os autores, no sentido de correlacionar os fatos experimentais e anatomo-clinicos, lembram o conceito de De Giacomo sobre a topografia das lesoes nas sindromes rubricas: na de Benedikt, o processo patologico se situaria no paleorrubro, enquanto que, na de Claude e na superior, o neorrubro seria a porcao afetada.Os autores discutem tambem o problema das hipercinesias, destacando o carater intencional das mesmas; lembram a existencia de conexoes rubrocorticais reciprocas, diretas e indiretas, e ressaltam o fato de que o nucleo de Stilling e uma estacao obrigatoria do circuito ideado por Bucy para explicar a fisiopatologia do tremor intencional. Os autores assinalam a raridade das sindromes rubricas, das quais encontraram o registro de 5 casos na literatura brasileira, sendo que 4 se referema sindrome de Benedikt. Comentando seus casos, os autores salientam os seguintes pontos: a) a etiologia luetica das lesoes, em um caso do tipo mesenquimal e, em dois. do tipo parenquimatoso; b) a existencia de acentuada hipotonia em dois casos e de normalidade do tono no outro; c) a normalidade do eletrencefalograma em um caso de sindrome superior do nucleo rubro e em um caso de sindrome de Claude; d) a desarmonia das reacoes vestibulares observada em um dos casos; e) a existencia de disturbios da regulacao termica no caso 2, interpretados como decorrentes da lesao associada do tracto mamilotegmental central e/ou do fasciculo longitudinal dorsal; f) a associacao, em um caso de sindrome rubrica superior, de mioclonias velofaringolaringeas, consequencia provavel de lesao do tracto tegmental central ou da origem de seu contingente rubrolivar.

Tumores paradoxais do encéfalo: A proposito de 5 casos de glioblastomas multiformes operados

The Authors, studying the clinical progress in five cases of multiform glioblastomata, observed interesting features peculiar to this type of neoplasm. Symptoms can be classified into four groups: a) pseudomeningo-encephalitic, b) apopletic, c) psychotic, d) tumoral. Several explanations were considered to explain the pathogenesis of these groups. The latter group is the least frequent. As a result, it has been proposed to name the multiform glioblastomata, paradoxal brain tumors, due to the fact that only excepcionally and especially in the early stages, do these tumor offer local and general signs and symptoms of a typical intracranial tumor. All patients were operated but none survived. Even in those in which ample removal was possible, none survived for more than one year. Results following surgical or deep X-ray therapy are discussed. The Authors indicate a compromising procedure, i. e. treatment by both X-ray and surgery.

Compressões medicares provocadas por mielomas vertebrais

Report of 4 cases of vertebral myeloma with invasion of the epidural space and root cord compression. In case 2 there was multiple bone lesions; in case 3 there was, besides the vertebral myeloma, a destructive lesion of the 8th right rib; the other cases probably were instances of the solitary form of the disease. The vertebral myelomas were localized between C7 and T9, in the four cases; in none of the cases there was involvement of the subdural space. In 3 cases the neurological picture was that of a sensory-motor paraplegia; in case 4 radiculalgic symptoms prevailed over the spinal ones. The following laboratory data are stressed: Bence-Jones proteinuria was evidenced only in the case of multiple myelomatosis; bone marrow puncture of the sternum was carried out in three cases, plasmocytosis being found only in case 2; in this patient with disseminated illness it was also shown decrease of blood cholesterol, raised concentration of uric acid in blood and positiveness of some liver function tests; electrophoresis of plasma proteins, carried out only in case 4, evidenced decrease of albumin and slight increase of α1 and α2 globulin fractions; the cerebrospinal fluid examination always showed increase of protein contents and spinal block; this latter and its level were confirmed by iodizedoil perimyelography, though it suggested an intraspinal tumor in case 1. The patients were treated by laminectomy and withdrawal of the tumoral invasive tissue, complemented by roentgentherapy in doses varying between 2,880 and 4,000 r. Results were very encouraging in all but one patient, who died a year later with multiple bone lesions.