Fernando Menezes Braga

'Raccoon eyes' (periorbital haematoma) as a sign of skull base fracture

This is a study of the relationship between skull base fracture and the raccoon eyes sign in a prospective study in cadavers. Fifty cadavers were analysed with cranio encephalic trauma and skull base fracture or the raccoon eyes sign. Both conditions were present in 24 (48.0%) cases. The association was significantly higher in cases with a frontal basal fracture and epidural haematoma. The raccoon eyes sign is easily recognised and can be associated with basal fractures.

Giant intrathoracic meningoceles associated with cutaneous neurofibromatosis type I: case report.

BACKGROUND Intrathoracic meningocele is a rare pathology, almost always associated with neurofibromatosis type I and with a few cases related in the literature. In the majority of cases cysts are small or asymptomatic, and the surgery is indicated when big or symptomatic cysts are present. We report a case of giant intrathoracic cysts surgically extirpated through out thoracotomy. CASE A 59-year-old male with familiar Von Recklinghausens disease which developed thoracic radicular pain after a fall. On examination he presented some difficulty in walking fast and dyspneia on small efforts. The chest plain x-ray showed the presence of 3 huge left side intrathoracic cysts (10 to 15cm). The patient was submitted to a surgical treatment and complete extirpation of the cysts was performed through a left side thoracotomy. During the surgery a fourth smaller cyst was detected and also extirpated. Evolution was uneventful and the patient remains well in these last 12 years. This finding of intrathoracic cysts related to neurofibromatosis type I is rare and is probably unique in the literature the presence of 4 huge cysts in one side of the thorax.

Familial trigeminal neuralgia

The authors present the cases of four brothers and sisters, two women and two men, who had trigeminal neuralgia, with the onset of pain occurring between the ages of 24 and 31 years. Three of them were treated surgically. A review of the literature reveals that familial trigeminal neuralgia is a very rare condition.

Cavernoma gigante: relato de dois casos

Cavernous angiomas or haemangiomas or yet cavernomas are malformations of the central nervous system classified as occult vascular brain lesions. These rare lesions are clinically silent. They are defined by the presence of abnormally large vascular cavities or sinusoids channels of variable size, with sharp walls, located inside but not invading the brain parenchyma. They can occur at any age, including the neonatal period. Most of the small lesions are located inside the brain parenchyma. No abnormal circulation can be demonstrated in angiography and CT scan can be helpful for diagnosis only in rare occasions. Magnetic resonance is the best exam to demonstrate the lesion. Despite the benign character some lesions may cause neurologic dysfunction when their removal may be difficult. Complete extirpation is the best treatment if the lesion is favorable located and is causing neurological dysfunction. Two cases of giant cavernomas with good outcome after total removal are present. Only three cases of giant cavernomas were reported in the literature.

Forma edematosa da neurocisticercose: registro de 4 casos

: Four cases of the oedematous form of neurocysticercosis are reported. This form is relatively rare and characterized by symptoms of intracranial hypertension and severe bilateral papilledema. Focal convulsive disorders are common. CSF studies show positive reaction for cysticercosis and ventriculography, the presence of small, narrowed lateral ventricles. Treatment based on ACTH and dexamethasone revelead good evolution as far as intracranial hypertension is concerned, not requiring surgical decompression as used before.Four cases of the oedematous forme of neurocysticercosis are reported. This forme is relativelly rare and caracterized by symptons of intracranial hypertension and severe bilateral papiloedema. Focal convulsive disorders are common. CSF studies show positive reaction for cysticercosis and ventriculography, the presence of small, narrowed lateral ventricles. Treatment based on ACTH and dexametasone revelead good evolution as far as intracranial hvpertension is concerned, not requering surgical decompression as used before.

Cervical epidural haematoma with clivus fracture: case report

Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, although the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic), whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review.

Epidermoid tumor of the pineal region

The authors report a case of a successfully removed epidermoid tumor of the pineal region. It became possible to diagnose this kind of cyst when the contrast medium injected during ventriculography penetrated inside the tumor, thus delineating its lamellae.

Schwanoma intracerebral talâmico: relato de caso

The intracranial schwannomas cover about 8% of all the brain tumors, although, those localized inside the encephalic parenchyma are rare only 55 cases being reported in the literature. The histopathologic diagnosis is based on the cellular type and arrangement common to the nervous sheath tumors, the immunohistochemical findings (GFAP, S-100 protein, EMA) and electronmicroscopic findings as well. The clinical presentation related to the intraparenchimatous schwannoma is variable, depending on its localization, the image diagnosis does not show any typical aspect. The surgical treatment is curative once a complete extirpation is obtained. These tumors are benign but one case reported presented malignant signs. We present a patient that had a thalamic schwannoma with histological confirmation. We found no case with this localization in the literature.

Aneurisma dissecante de artéria vertebral intracraniana fenestrada submetido ao tratamento endovascular: relato de caso

Dissecting aneurysms of the vertebral artery at its intracranial segment are uncommon lesions, mainly when associated to subarachnoid hemorrhage, being also rare fenestrations of the vertebral artery. They present high morbidity and mortality, with high rebleeding rate and difficulty of surgical approach. We present a 19 years old man who was victim of physical aggression in the occipto-cervical region, presenting subarachnoid hemorrhage and a dissecting aneurysm of the right vertebral artery, which had a fenestration, being submitted to endovascular treatment. We accomplished a literature review about this subject, proposing endovascular treatment as a therapeutic option for these cases.

Actinomicose do sistema nervoso central: uma rara complicação da actinomicose cervicofacial

Central nervous system actinomycosis is a rare but treatable chronic suppurative bacterial infection. The case of a young immunocompetent male with actinomycosis of the CNS is presented. The abscess originated from a primary cervico-facial infection and was located in the left parasellar region. After excision of the mass, that showed Actinomyces colonies, the patient was treated with intravenous Penicillin for 42 days followed by oral administration of the drug for 30 days. After surgery the patient was left with mild sequelae that had improved by the last follow-up, 7 months later. A new CT scan at that time revealed no residual disease or recurrence. The early diagnosis of cerebral actinomycosis relies essentially on a clinical suspicion. Hence it is imperative to be aware of the natural history of this infection and its various modes of presentation.