João Fernandes

TransienT ischemic aTTacks in a child wiTh posT-varicella arTeriopaThy and mThFr homozigoTic muTaTion c677T

A three year-old boy was admitted to the emergency room (ER) with sudden onset of transient motor deficit of both left limbs. The neurological and general examination was normal. His past medical history was remarkable for primary varicella infec-tion occurring five months before. In the ER he underwent blood tests, brain CT and EEG which displayed normal results. While performing EEG, he presented another deficit episode lasting for five minutes and similar to the one previously described. In the light of multiple TIA’s, anticoagulation with heparin was initiat-ed. However, he had three more TIA’s in the same territory, and at the fifth day after admission had sudden onset of a left pyra-midal syndrome with discrete hemiparesis. The heart evaluation including electrocardiogram and echo-cardiogram was normal. Noteworthy, concearning the analyti-cal work-up, we underscore the serologic evidence of a non-re-cent VVZ infection (IgG+, IgM–) and the presence of a MTHFR homozigotic mutation C677T with normal homocystein and folic acid. All the remaining study was normal or negative and includ-ed hemogram, biochemistry, immunologic study, metabolic, pro-trombotic and CSF (cytochemistry, serologic, microbiologic and virus PCR including VVZ). The MRI with Angio-MRI performed at the second day after admission showed a recent stroke in the territory of right lenticulostriate arteries and a decreased flow on the M1-M2 transition of right MCA (Fig 1). A brain conven-tional angiography was performed to better study all the brain vascular system including the distal vessels. The intracranial es-

Epidemiological and Demographic Characteristics of Patients with Head and Neck Tumours in the Northern Portugal: Impact on Survival

INTRODUCTION In Portugal there are still no epidemiological and demographic studies conducted in patients with of the head and neck tumors. The objectives of this analysis are to describe the epidemiological and demographics of patients with malignant tumors of the head and neck referred to an Ear, Nose and Throat department of an oncology center in the North of Portugal and also assess the impact of these characteristics on survival. MATERIAL AND METHODS Retrospective study of patients referred between January 2011 and December 2013 to the Ear, Nose and Throat Department of an oncology center (Instituto Português de Oncologia do Porto),. Five hundred sixty six patients were included. The analyzed variables were the anatomical location of the tumor, staging, gender and age of patients, the district of origin, the alcohol and tobacco consumption, educational level, occupation, marital status and family structure. RESULTS The 566 patients studied (498 men and 68 women) presented a mean age of 58.1 ± 12.2 years. The majority (80.5%) were referenced in advanced stage of disease (III and IV). Seventy eight per cent of patients had moderate or excessive alcohol consumption and 69% were smokers. The vast majority of patients (82.3%) had only basic education. Patients with tumors of the hypopharynx and excessive drinking habits were referenced in more advanced stages and had a poorer survival (p < 0.001). Married patients were referred at earlier stages (p = 0.020) and patients without family support had poorer survival (p = 0.030). DISCUSSION Epidemiological data are in agreement with the international literature. The high rate of patients referred with advanced stage of disease can be attributed to the patient´s delay in seeking medical care or by factors inherent to the referral system. Surveillance and family support play a key role in early referral and survival of these patients. CONCLUSION This study features a population profile that can benefit from a higher degree of surveillance, awareness campaigns and/ or screenings. Some of the variables can significantly influence the tumor stage and survival.

Brown Tumor of the Mandible: Magnetic Susceptibility Demonstrated by MRI

We present a case of a 75-year-old woman with right mandible cystic lesion and primary hyperparathyroidism. The MRI demonstrated marked loss of signal intensity on T2 gradient-echo images, suggesting intralesional hemossiderin. After an open biopsy, histology was consistent with “brown tumor.” The finding of susceptibility on T2 gradient-echo images in a mandible lesion adds considerable specificity to the differential diagnosis.