Hildo Rocha Cirne de Azevedo Filho

Hypertonic saline more efficacious than mannitol in lethal intracranial hypertension model

Abstract Background: Medical management of brain edema and elevated intracranial pressure (ICP) is a crucial challenge in neurosurgical practice. Depending on the cause, the treatments for brain edema fall into three categories: stabilization of the blood-brain barrier, depletion of brain water and surgical decompression. Although mannitol is the mainstay of hyperosmolar therapy, hypertonic saline (HS) is emerging as an effective alternative to traditional osmotic agents. Methods: Experimental elevated ICP (50 mmHg) was induced in rabbits using an intracranial balloon. The effects of mannitol and HS (10% NaCl) were compared in this specific physiopathological model. Twelve animals were divided into three groups (control, HS and mannitol) according to intravenous administration of 0·9% NaCl, 10% NaCl or 20% mannitol 5 minutes after the elevation of ICP. The doses of 10% NaCl and 20% mannitol were iso-osmolar. During 90 minutes, continuous recording of ICP, mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) was realized. Results: The control group had a median survival of only 53 minutes, significantly lower than the treated groups (p = 0·0002). There was statistical difference between mannitol and HS; the 10% NaCl group had lower values of ICP (p = 0·0116) and higher values of MAP (p<0·0001) and CPP (p<0·0001). Conclusion: The findings demonstrate higher efficacy of the 10% NaCl treatment in this comparison with 20% mannitol. Further efforts should be directed toward development of clinical studies using iso-osmotic doses of mannitol and HS in specific etiologies of intracranial hypertension.

Sudden death in a patient with a third ventricle colloid cyst.

Neurosurgical Department, Democritus University of Thrace Medical School, Alexandroupolis, Greece.Correspondence: Danilo Silva; Weill Cornell Medical College, New York NY, USA; Department of Neurological Surgery; Skull base fellow; 124 west 60th street Apt 37L; New York NY - USA; E-mail: daniloncr@gmail.comConflict of interest: There is no conflict of interest to declare.Received 21 October 2011; Received in final form 09 November 2011; Accepted 16 November 2011

ESPECTROSCOPIA MULTIVOXEL COM TEMPO DE ECO CURTO A razão colina/N-acetil-aspartato e a graduação dos astrocitomas cerebrais

The choline/N-acetyl-aspartate (Cho/NAA) ratio, obtained by the multivoxel spectroscopy with short echo time (TE), was evaluated, in the histological grading of the brain astrocytomas (grades I, II and III-IV) in comparison with the normal cerebral parenchyma. A significant increase (p<0.05) in the average ratios of Cho/NAA was observed in the three astrocytoma groups studied in relation to normal tissue, having a tendency to increase with the increase in grading, without any statistic significance, which corresponded to: 0.53+/-0.24 in the control group, 1.19+/-0.49 in grade I, 1.58+/-0.65 in grade II and 5.13+/-8.12 in the high grade group (grades III-IV), with variation in the values encountered. There was an increase in the Cho/NAA ratio in 4/5 (80%) in grade I, 5/6 (83%) in grade II and 10/20 (50%) in grades III and IV. We conclude that multivoxel spectroscopy with short TE can be used in discriminating between normal parenchyma and neoplasm tissue. However, not all neoplasm tissue studied presented an increase in Cho/NAA, especially in the group with higher grade of malignancy.

Portal Doppler ultrasound evaluation in myelitis by Schistosoma mansoni

UNLABELLED The mechanism for development of schistosomal myelitis has not yet been completely understood. Few publications have tried to establish a link between the general clinical presentation of the illness and its neurological manifestations. OBJECTIVE To evaluated the portal blood flow in patients with schistosomal myelitis and controls. METHOD Forty-three individuals were evaluated using portal Doppler ultrasound. Group I consisted of 13 patients with the spinal form of schistosomiasis. Group II included 10 patients with intestinal and hepatointestinal forms of schistosomiasis, but no neurological symptoms; while group III involved 20 healthy controls. RESULTS Portal venous speed and portal venous flow were significantly elevated in group I (p<0.001) compared with the others. CONCLUSION Doppler ultrasound demonstrated a situation of high flow within the portal venous system of patients with schistosomal myelitis.

Epilepsia parcial associada a tumores cerebrais primários

OBJECTIVE: To characterize the epileptic syndrome of patients with primary cerebral tumor of slow growth. METHOD: Clinical evaluation of fourty two patients with refractory epilepsy associated with cerebral tumor of slow growth were operated between June 1992 and September 1999. RESULTS: Almost 75% of the patients were less than 15 years old when they began the epileptic crises, 67.7% had normal neurological exam in the first evaluation. More than 90% of the total had seizures of the partial complex type, frequently inferior to 16 per month. The seizures were partial simple (PS) developing for partial complex (PC) in 10 patient and only PC in 11 Partial complex associated with generalized tonic-clonic seizure (GTC) happened in 11patients, PS for PC and GTC in 4 patients. CONCLUSION: The crises of the partial type, with not very high frequency, can suggest a precocious manifestation of the tumor in the children, even with normal neurological exam.

Neuropatia vasculítica na granulomatose de Wegener: relato de caso

The neurologic involvement during Wegener granulomatosis reaches 15-50% of patients, however as initial symptomatology is not commented in the literature. We describe a patient with Wegeners granulomatosis and mononeuritis multiplex, emphasizing the fact that neurologic manifestations anticipated systemic symptoms, and also focusing on the diagnostic contribution of sural biopsy and the good outcome of neurologic disease.

Extensive spinal cord involvement in magnetic resonance imaging evaluation on schistosomal myelitis

UNLABELLED The diagnosis of schistosomal myelitis (SM) is frequently presumptive because no findings from any complementary examination are pathognomonic for this disease. The present report describes some abnormalities seen on magnetic resonance imaging (MRI) evaluation of a series of SM patients and discusses their etiopathogenesis. METHODS This study evaluated SM patients at the time of their diagnosis. These patients routinely underwent MRI on all segments of the spinal cord. RESULTS Thirteen patients were evaluated. The MRI was abnormal in 12 (92.3%) of them. In 11 patients (84.61%), the damage reached two or more spinal segments. CONCLUSIONS MRI was an important diagnostic aid in this sample, because of the high rate of abnormalities detected. The tissue damage observed on MRI was extensive in the majority of the patients.

Ocular melanoma: keep your eyes open for late brain metastases

Background: The most frequent intraocular malignant tumor is choroidal melanoma (CM). Although brain metastasis is a common feature of other types of cancers, metastasis of CM to the brain is a rare entity. Case Description: The authors report a case of a 28-year-old woman presenting with a single brain metastasis, 10 years after the treatment of a CM. She underwent a total en-bloc resection of the lesion, and the diagnosis was confirmed histopathologically. The patient concomitantly received whole-brain irradiation therapy combined with chemotherapy, with a survival period of 24 months. Conclusion: The present case report draws attention to the necessity of a close and lifelong follow-up of patients treated for this malignancy. The international literature is also reviewed.

Gunshot wounds to the spine: study of 246 patients

Gunshot wounds to the spine are a devastating calamity. Specific literature is scarce, as are large series. In the absence of extensive data, it is difficult to evaluate the complications and the effect of the several forms of treatment. The objective of this study was to add information to improve the handling of the pathology. This review was based on the analysis of 246 patients with gunshot wounds to the spine admitted to the Hospital da Restauração, Recife, Brazil, between January 1981 and June 1998. Eleven patients (4.5%) were female. The age of the patients ranged from 10 to 65 years. The neurologic condition was judged according to the classification of Frankel/ASIA/IMSOP. In grade A there were 147 (59.8%) patients; in B, 6 (2.4%); in C, 51 (20.8%); in D, 35 (14.2%); and in E, 7 (2.8%). All patients underwent radiologic investigation, and 51 (20.7%) underwent computed tomography. The hospital stay ranged from 3 to 182 days. Follow-up ranged from 3 to 397 days (mean 76.3 days). One hundred fifty-seven (63.8%) patients were managed conservatively and 89 (36.2%) underwent surgical treatment. Thirty-five (14.2%) patients died. Decompressive laminectomies were associated with a higher level of complications and did not improve patient outcome. The authors strongly recommend that a prospective multicenter study should be organized with a larger population of patients to allow a better understanding of the complexity of this pathology.

Métodos de avaliação do olfato em pacientes vítimas de hemorragia subaracnóidea: revisão sistemática

PURPOSE To systematically review the methods for evaluation of smell in aneurysmal subarachnoid hemorrhage victims and to identify the changes found with the use of these methods. RESEARCH STRATEGY The literature search was performed in PubMed search platform and in the databases Web of Science, Scopus, PsycINFO, CINAHL, and ScienceDirect in August and September 2014. SELECTION CRITERIA Original articles published in any language, which addressed smell changes in aneurysmal subarachnoid hemorrhage and addressed to evaluate this function through specific methods were included. Review studies, case studies, book chapters, editorial, and studies that address the nonaneurysmal subarachnoid hemorrhage were excluded. DATA ANALYSIS The following variables were considered in data analysis: author/year, country, sample/age, treatment, method, the moment of smell evaluation, and results. RESULTS The search for articles resulted in 1,763 articles, of which, 9 original articles were selected for this review. It was observed that all articles were from European and Asian countries. Standardized and nonstandardized tests and questionnaires were used in olfactory assessment, and the goals ranged from assessing the smell before and/or after surgery in this population. CONCLUSION Heterogeneity was observed in the methods used to evaluate the smell in aneurysmal subarachnoid hemorrhage and in the methods selected for application of evaluations. In addition, studies have demonstrated the existence of olfactory deficits in patients and the relationship between surgery and olfactory dysfunction.