Aristides Cheto de Queiroz

Toxoplasma gondii myelitis in a patient with adult T-cell leukemia-lymphoma

Adult T cell leukemia-lymphoma (ATL) caused by HTLV-I may be associated with severe immunosupression and several opportunistic infections. Toxoplasmic encephalitis is a common central nervous system opportunistic infection in severely immunosupressed patients, however spinal cord involvement by this parasite is rare. In this paper, we report a case of toxoplasmic myelitis in a patient with ATL.

Meningorradiculite esquistossomótica estudo clínico-laboratorial de três casos tratados

The authors present three cases of myeloradiculitis caused by Schistosoma Mansoni with clinical and laboratory evaluation, discuss physiopathological aspects, and stress the efficacy of therapeutical scheme adopted.The authors present three cases of myeloradiculitis caused by Schistosoma Mansoni with clinical and laboratory evaluation, discuss physiopathological aspects, and stress the efficacy of therapeutical scheme adopted.

Pseudotumoral form of neuroschistosomiasis: report of three cases

Central nervous system (CSN) involvement in schistosomiasis is an ectopic manifestation with a large variety of clinical forms, including pseudotumoral, which occurs in isolated cases and is rare. Three patients with epidemiological indications of this pathology were examined; the clinical picture included lower-back pain irradiating to lower limbs, associated with progressive flaccid paraparesis and sphincterial disturbances in cases in which the spinal chord was involved; while in cases with encephalitic impairment, headache, dizziness and cerebellar syndrome, characterized by dysarthria and right-side dysgraphia, were present. Magnetic resonance imaging (MRI) showed a growing process in all cases; cerebrospinal fluid (CSF) characteristics and biological markers were compatible with neuroschistosomiasis (NS). Biopsy of the lesions confirmed this diagnosis in one case. After specific treatment with schistosomicides and corticosteroids, clinical, radiological and laboratorial improvement was observed.

Calcificação de núcleos da base do cérebro: estudo anatomopatológico de 4 casos

The paper reports the pathological study of 4 autopsied cases of massive basal ganglia calcifications, an entity that although related to hypoparathyroidism or pseudohypoparathyroidism, some times can be considered as idiopathic. In our cases no metabolic disturb or any common related disease could be found in association. Interesting is to point out that the lesion is confined to the central nervous system, with no foci of calcification outside the brain. There is a characteristic perivascular distribuition of the deposits that, as demonstrated by histochemical study are composed by ron besides calcium.O trabalho consta do estudo anatomopatologico de 4 casos de calcificacao de nucleos da base do cerebro, entidade que esta mais relacionada a disturbio metabolico endocrino do tipo hipoparatireoidismo e pseudohipoparatireoidismo. O estudo mostra a associacao da deposicao calcica nos nucleos da base com lesao calcificada do cerebelo (cortex e nucleo denteado) em 2 casos. Demonstra tambem a presenca nao so de calcio mas tambem de ferro nas lesoes e a distribuicao de manguito perivascular, caracteristica dos depositos. A ausencia de uma doenca basica comum e a falta de qualquer disturbio metabolico associado, permite caracterizar estes casos como sendo de natureza idiopatica ou pelo menos de causa nao determinada.The paper reports the pathological study of 4 autopsied cases of massive basal ganglia calcifications, an entity that although related to hypoparathyroidism or pseudohypoparathyroidism, sometimes can be considered as idiopathic. In our cases no metabolic disturb or any common related disease could be found in association. Interesting is to point out that the lesion is confined to the central nervous system, with no foci of calcification outside the brain. There is a characteristic perivascular distribution of the deposits that, as demonstrated by histochemical study are composed by iron besides calcium.

Estudo anátomo-patológico do encéfalo na cardiomegalia idiopática

The pathological findings in the brain of patients who died with idiopathic cardiomegaly are reported. The major findings in the 38 studied cases were cerebral infarcts (10,5%) and cerebral atrophy (7,9%) besides the nonspecific histological changes represented by neuronal ischemic alteration, satellitosis of nerve cells and swollen and hyperplasia of endothelial cells in capilaries of the cerebral cortex. These findings were considered a consequence of the venous stasis of the congestive heart failure. These data were compared to those seen in the brain of patients with heart failure in the course of chronic Chagas disease. The morphological findings were similar. The frequence of infarcts and atrophy was higher in the cases of Chagas disease and the cerebral atrophy was seen in an younger group of patients compared to the cases of idiopathic cardiomegaly. It seems that there is another factor also responsible for the occurrence of cerebral atrophy in Chagas disease, since from the clinical and hemodynamic point of view both cardiopathies have many similarities.The pathological findings in the brain of patients who died with idiopathic cardiomegaly are reported. The major findings in the 38 studied cases were cerebral infarcts (10,5%) and cerebral atrophy (7,9%) besides the nonspecific histological changes represented by neuronal ischemic alteration, satellitosis of nerve cells and swollen and hyperplasia of endothelial cells in capilaries of the cerebral cortex. These findings were considered a consequence of the venous stasis of the congestive heart failure. These data were compared to those seen in the brain of patients with heart failure in the course of chronic Chagas disease. The morphological findings were similar. The frequence of infarcts and atrophy was higher in the cases of Chagas disease and the cerebral atrophy was seen in an younger group of patients compared to the cases of idiopathic cardiomegaly. It seems that there is another factor also responsible for the occurrence of cerebral atrophy in Chagas disease, since from the clinical and hemodynamic point of view both cardiopathies have many similarities.

Necrose primária do corpo caloso (doença de marchiafava-bignami) relato de cinco casos

The clinicopathological study of five autopsied cases of Marchiafava-Big-nami disease is reported. The demielination of the central portion of the. corpus callosum is the major characteristics of the disease. In two cases the demielination also involved the anterior and posterior commissures. There is a clear relationship to alcoholism land malnutrition in the cases reported in the present study.

Leukemic changes of the brain: the involvement of the choroid plexus

In the study of 38 cases of leukemia, neoplastic infiltration of the brain was the most frequent lesion, occuring in 70,5%, compared to 48,5% for hemorrhage. The leptomeninges were the most frequent site of leukemic infiltration followed by the choroid plexus (57,8%) and the nervous tissue (50%). In few cases leukemic infiltration of choroid plexus was seen in the absence of meningeal involvement. Very often the leukemic infiltration of the CNS courses without clinical manifestations. The paper points out the importance of the cytologic study of the cerebro-spinal fluid as a routine procedure in cases of leukemia, since it is well known that the therapeutic agents have difficulty in penetrating the blood-brain barrier and that foci of CNS leukemic infiltration may represent points of reactivation of the disease even during the therapeutic remission.In the study of 38 cases of leukemia, neoplastic infiltration of the brain was the most frequent lesion, occuring in 70,5%, compared to 48,5% for hemorrhage. The leptomeninges were the most frequent site of leukemic infiltration followed by the choroid plexus (57,8%) and the nervous tissue (50%). In few cases leukemic infiltration of choroid plexus was seen in the absence of meningeal involvement. Very often the leukemic infiltration of the CNS courses without clinical manifestations. The paper points out the importance of the cytologic study of the cerebro-spinal fluid as a routine procedure in cases of leukemia, since it is well known that the therapeutic agents have difficulty in penetrating the blood-brain barrier and that foci of CNS leukemic infiltration may represent points of reactivation of the disease even during the therapeutic remission.: In the study of 38 cases of leukemia, neoplastic infiltration of the brain was the most frequent lesion, occuring in 70,5%, compared to 48,5% for hemorrhage. The leptomeninges were the most frequent site of leukemic infiltration followed by the choroid plexus (57,8%) and the nervous tissue (50%). In few cases leukemic infiltration of choroid plexus was seen in the absence of meningeal involvement. Very often the leukemic infiltration of the CNS courses without clinical manifestations. The paper points out the importance of the cytologic study of the cerebro-spinal fluid as a routine procedure in cases of leukemia, since it is well known that the therapeutic agents have difficulty in penetrating the blood-brain barrier and that foci of CNS leukemic infiltration may represent points of reactivation points of reactivation of the disease even during the therapeutic remission.

Micoses do sistema nervoso central: dados anatomopatologicos da criptococose e aspergilose cerebrais

: The pathological findings of the cerebral involvement in deep-seated fungal infections in routine autopsy is reported. In 42 cases of mycotic infections studied among 3.966 autopsies, there were 8 cases of cryptococcosis and 2 of aspergillosis of the brain, showing a very low frequency of central nervous system involvement, occurring in a proportion of 1:400 autopsies. The histopathological findings of the brain in cases of cryptococcosis showed the spectrum of inflammatory reactions already described, although most of the cases presented with mild to severe meningitis with large number of giant cells, and slight degree of involvement of the nervous tissue. The cases of aspergillosis showed a pattern of severe necrotizing meningo-encephalitis with large number of fungi. The paper points out the role of the histological examination in the identification of the fungi in tissues and their morphologic reactions.O trabalho mostra o envolvimento do SNC em 42 casos de micoses oportunistas em material de autopsia, sendo enfatizada a baixa frequencia do comprometimento encefalico, o que apareceu na proporcao aproximada de 1/400 casos de autopsia. A criptococose apareceu como a micose mais frequente no envolvimento do SNC sendo encontrada em 8 dos 9 casos estudados, seguido pela aspergilose que comprometeu o encefalo em 2 dos 5 casos estudados. Apesar do grande numero de casos de candidiase examinados nao hauve lesao encefalica por esta micose. O estudo das alteracoes histologicas observadas nos casos de criptococos mostrou aspectos diferentes daqueles classicamente descritos nesta micose, com referencia particular a existencia de grande reacao inflamatoria com formacao de celulas gigantes em grande numero e, mais ainda, com referencia ao envolvimento do plexo coroide observado em 2 casos. O trabalho chama atencao para a possibilidade da caracterizacao morfologica dos fungos nos tecidos, mostrando a importncia do papel desempenhado pelo histopatologista no diagnostico de micoses no material de autpsia, particularmente nos casos em que os fungos representam achado incidental no estudo de rotina.

Neurocisticercose estudo neuropatológico de caso fatal tratado com praziquantel

The neuropathological findings in a fatal case of neurocisticercosis treated with praziquantel are reported in this paper. The extensive necrosis of the parasites besides the exuberant inflammatory response evidence the efficacy of the drug. The severe and necrotizing type of the inflammatory response to the dead parasites may have played an important role in the cause of death of this patient, by developing severe intracranial hypertension.

O envolvimento do plexo coróide e epêndima na tuberculose sua importância na disseminação da doença no sistema nervoso central

It is reported in this paper, the study of the choroid plexus and ependyma in 42 cases of tuberculous meningitis. Granulomatous lesions were found as a very frequent lesion in the choroid plexus (75%). In some cases detached granulomas were found free among the villi. The ependymal lesions seen in 97% of the cases are characteristic of the tuberculous granular ependymitis. The report points out the role of these lesions, played in the pathogenesis of the tuberculous meningitis.It is reported in this paper, the study of the choroid plexus and ependyma in 42 cases of tuberculous meningitis. Granulomatous lesions were found as a very frequent lesion in the choroid plexus (75%). In some cases detached granulomas were found free among the villi. The ependymal lesions seen in 97% of the cases are characteristic of the tuberculous granular ependymitis. The report points out the role of these lesions, played in the pathogenesis of the tuberculous meningitis.