Erasmo Barros da Silva

Neuroesquistossomose medular avaliação clínico-laboratorial de 5 anos

A incidencia da esquistossomose no Brasil continua alta, atingindo cerca de 10% da populacao. Desde o primeiro relato da neuroesquistossomose (NE) em nosso pais, ha mais de 4 decadas, seu comparecimento na literatura nacional tem mostrado acrescimo significativo. O presente trabalho tem como substrato o estudo de 5 casos de NE medular. Estes casos foram avaliados sob o ponto de vista clinico-laboratorial e submetidos a tratamento medicamentoso. Alem disso, e nosso proposito incentivar a pesquisa de novos casos, em portadores de quadros sugestivos desta patologia, sobretudo pelos resultados obtidos neste estudo.Schistosomiasis mansoni is an endemic disease in Brazil. Cases of nervous system schistosomiasis have been referred in our medical literature for the past forty years. In this report five cases of schistosomiasis of the spinal cord are studied. A review of the literature has been made and some clinical, laboratory and therapeutical aspects are discussed.

Impressao basilar como causa de neuralgia do trigemeo: registro de um caso.

A case of basilar impression associated with Arnold-Chiari malformation and with trigeminal neuralgia is reported. The radiological examination of the skull showed marked asymmetry of the petrous bone with the tip of the odontoid apophysis located 30 mm above the McGregor line. Treatment consisted of craniectomy of the posterior fossa and cervical laminetomy (Ca to C3). The postoperative course was uneventful with total disappearance of the trigeminal neuralgia.A case of basilar impression associated with Arnold-Chiari malformation and with trigeminal neuralgia is reported. The radiological examination of the skull showed marked asymmetry of the petrous bone with the tip of the odontoid apophysis located 30 mm above the McGregor line. Treatment consisted of craiectomy of the posterior fossa and cervical laminetomy (C1 to C3). The postoperative course was uneventful with total disappearance of the trigeminal neuralgia.

Hot-water epilepsy , "warm-water epilepsy", or bathing epilepsy? Report of three cases and considerations regarding an old theme

Partial and generalized tonic-clonic reflex seizures related to hot water bathing have been described as temperature-related. We describe three cases of bathing epilepsy: a 28 year-old white male and a 30 year-old white female with spells triggered either by warm or hot water, and a 32 year-old female with spells triggered by hot water. The later two of the three cases presented localized epilepsy and a familial history of epilepsy. A complex tactile stimuli might play the most relevant role on seizure triggering, as well as water temperature with an additive effect over cutaneous stimulation.

Bilateral oculomotor nerve palsies due to vascular conflict.

Departament of Neurosurgery, Instituto de Neurologia de Curitiba, Curitiba PR, Brazil; Department of Neurology, Instituto de Neurologia de Curitiba, Curitiba PR, Brazil; Neurological Clinic of Paraiba, Joao Pessoa PB, Brazil. Oculomotor nerve palsy is frequently caused by an aneurismal compression and diabetes mellitus. Brainstem infarction, cavernous sinus tumors and other intracranial lesions are well known causes of oculomotor palsy also. However, neurovascular conflict causing oculomotor nerve disturbances are rare. After the advent of high quality MRI and neuroimaging improvements, the diagnosis of such atypical neurovascular conflicts in symptomatic patients became quite simple. The case of a patient with bilateral oculomotor disorder with MRI imaging of the head showing a right oculomotor nerve compression by the right posterior cerebral artery and a left oculomotor nerve compression by the left superior cerebellar artery is reported and discussed.

Tratamento cirúrgico da epilepsia do lobo temporal: análise de 43 casos consecutivos

Quarenta e tres pacientes com epilepsia refrataria ao tratamento medicamentoso foram submetidos a cirurgia de epilepsia do lobo temporal no Instituto de Neurologia de Curitiba, entre os anos de 1998 a 2003. Trinta e nove (90,6%) pacientes apresentavam esclerose mesial temporal, e quatro (9,4%), tumores cerebrais. Dos trinta e sete pacientes que possuiam avaliacao pos-operatoria completa, 83,7% apresentaram classificacao I, segundo Engel (livres de crises incapacitantes). Complicacoes pos-operatorias ocorreram em 18,6%: uma infeccao da ferida operatoria, um caso de hidrocefalia, um de fistula liquorica, dois casos de paralisia transitoria do IV nervo craniano e um de hemiparesia transitoria. Nao houve nenhum obito relacionado a cirurgia de epilepsia no presente estudo.Forty-three patients with epilepsy resistant to drug therapy were submitted to temporal lobe epilepsy surgery at the Instituto de Neurologia de Curitiba, from 1998 to 2003. Thirty-nine patients (90.6%) had mesial temporal sclerosis, and four had brain tumors. According to Engels rating, 83.7% from 37 patients with complete postoperative evaluation were classified as Class I (free of disabling seizure). Postoperative complications (18.6%) were evaluated, with one case of surgical wound infection, one case of hydrocephalus, one case of cerebrospinal fluid fistula, two cases of transient palsy of the trochlear nerve and one case of transient hemiparesis. No death related to epilepsy surgery was found in our study.

Surgical exposure of the internal auditory canal through the retrosigmoid approach with semicircular canals anatomical preservation

OBJECTIVE Evaluate the feasibility of an adequate exposure with anatomical preservation of labyrinth structures through retrosigmoid transmeatal approach (RSA) in surgeries for resection of acoustic neuromas/vestibular schwannomas (VS). METHOD Thirty patients underwent surgical resection and were preoperatively evaluated with fine slice high definition CT scans and 3D-MRI volumetric reconstructions. Extension of internal auditory canal (IAC) opening during surgery was measured using 3 mm right-angle calibrated hook and neuronavigation parameters. Postoperatively, the extension of IAC opening and integrity of the labyrinth were confirmed through preoperatively images procedures. RESULTS The preoperative length of IACs varied between 7.8 and 12.0 mm (mean 9.3 mm, SD 0.98, 95%CI 8.9 to 9.6, and median 9.0 mm). Postoperative images demonstrated adequate opening of the IAC and semicircular channels integrity. CONCLUSION A complete drilling of the posterior wall of IAC through the RSA is feasible and allows direct visualization of the IAC-fundus without damaging the semicircular canals.

Distal posterior inferior cerebellar artery aneurysm: case report

The majority of posterior inferior cerebellar artery (PICA) aneurysms are usually found on the bifurcation of the vertebral artery (VA) - PICA junction. Aneurysms arising from more peripheral PICA segments named distal PICA aneurysm are uncommon. The major clinical manifestation is that of an intracranial bleeding and the site of hemorrhage is related to the PICA segment originating the aneurysm. Lesions originating from distal PICA segments, particularly those arising from the telovelotonsillar segment, are associated with hemorrhage extending into the ventricular system, mainly the i.v. ventricle. A case of a 50-year-old woman with sudden headaches and vomiting, and intraventricular hemorrhage (four ventricles) caused by an aneurysm of the telovelotonsillar segment of the PICA, is presented. No signs of subarachnoidal hemorrhage were found in the computerized tomography. The aneurysm was clipped and the patient presented a favorable outcome. Anatomical aspects and clinical series are reviewed.

Infarto agudo do cerebelo simulando tumor da fossa posterior

We report a case of space-occupying infarction of the left cerebellar hemisphere with occlusive hydrocephalus and left to right shift of the fourth ventricle. The patient, a 58 years old man, underwent shunting and decompressive craniectomy of the posterior fossa and survived without neurological deficits.We report a case of space-occupying infarction of the left cerebellar hemisphere with occlusive hydrocephalus and left to right shift of the fourth ventricle. The patient, a 58 years old man, underwent shunting and decompressive craniectomy of the posterior fossa and survived without neurological deficits.

5-Aminolevulinic acid fluorescence-guided surgery for spinal cord melanoma metastasis: a technical note

BackgroundAccording to our research, just few studies described 5-Aminolevulinic acid (5-ALA) use for spinal injuries resection. 5-ALA is known to be especially useful in certain spinal tumor entities such as meningiomas, ependymomas, hemangiopericytomas, and metastasis of central nervous system primary tumors. In contrast, 5-ALA has limited value in other histopathological tumoral entities, as neurinomas and carcinoma metastasis.MethodWe describe a microsurgical resection of a spinal cord melanoma through fluorescence-guided technique using 5-ALA in a 36-year-old man.ResultsStrong 5-ALA tumor enhancement was evidenced, resulting in gross-total resection.ConclusionTo our knowledge, this is the first case of nonglial intramedullary metastasis with 5-ALA positive staining. We believe that this tool, 5-ALA, could aid in the resection, identification, and differentiation of medullary metastasis.

Neuronavigation for Intracranial Meningiomas

According to its location, the surgical treatment of intracranial meningioma can be of considerable challenge for the neurosurgeon. Image-guided surgery essencially provides intraoperative localization for dynamic navigation and, also, improves the surgical planning. The continuous development of neuroimaging and computated technology promotes continuous improvement of navigation techniques and applications. In the last ten years, frameless image-guided surgery, also popularized as neuronavigation, is considered standard of practice by most neurosurgical centers around the world. Its usage can range from a simple craniotomy flap localization to a deep brain tumor resection respecting tract fibers, eloquent areas and neurovascular structures. In some cases, neuronavigation may not be necessary, but, if avaliable, it should promotes a safer surgery, as it has yet to become an integral part of intracranial procedures.