José Luiz Furtado de Mendonça

Human lagochilascariasis: about three cases found in the Federal District, Brazil

Three new cases of human infection with Lagochilascaris minor are reported. All the patients were from the state of Pará (Brazil), living in rural areas or close to the forest. They were admitted to hospitals in the Federal District due to the presence of abscesses in the region of the neck, ear, mastoid process and, in two of them, to the involvement also of the central nervous system. Microscopic examination of tissue samples taken from the lesions showed sections of eggs and worms--in different evolutive stages--identified as Lagochilascaris minor. Larvae and adult worms obtained from existing fistulae proved also to be of the same species. The three patients were treated with anthelmintic drugs and surgical excision of the lesions, with good clinical results. In two of them, however, relapsing occurred, suggesting that the drugs do not destroy the worm eggs, in spite of the apparent healing of the lesions.Three new cases of human infection with Lagochilascaris minor are reported. All the patients were from the State of Para (Brazil), living in rural areas or close to the forest. They were admitted to hospitals in the Federal District due to the presence of abscesses in the region of the neck, ear, mastoid process and, in two of them, to the involvement also of the central nervous system. Microscopic examination of tissue samples taken from the lesions showed sections of eggs and worms - in different evolutive stages - identified as Lagochilascaris minor. Larvae and adult worms obtained from existing fistulae proved also to be of the same species. The three patients were treated with autihelmintic drugs and surgical excision of the lesions, with good clinical results. In two of them, however, relapsing occurred, suggesting that the drugs do not destroy the worm eggs, in spite of the apparent healing of the lesions.

Cavernous angioma of the cavernous sinus: imaging findings

Cavernous angiomas (cavernomas) of the cavernous sinus are uncommon, with only scattered reports in literature. Unlike their parenchymatous counterparts, they are intensely enhancing para-sellar masses, iso/hypointense in T1- and hyperintense in T2-weighted images. Differential diagnosis with para-sellar meningiomas and schwannomas can be difficult. We report three cases of this condition, describing findings of diffusion-weighted imaging in this kind of lesion for the first time in literature.

The “Crowned Dens” Revisited: Imaging Findings in Calcium Crystal Deposition Diseases Around the Odontoid

The so‐called “crowned dens” is a peculiar manifestation of calcium crystal deposition diseases, either caused by calcium pyrophosphate dihydrate or caused by calcium hydroxiapatite crystals, characterized by the presence of calcific deposits around the odontoid, often showing a crown‐like configuration on imaging. It has protean clinical and radiological pictures, and care should be taken to avoid misinterpretation and diagnostic errors. Although asymptomatic in many patients, this entity may present as a predominantly algic or febrile condition, and in some cases, signs of compression of the spinal cord may be the major complaint. The detection of calcifications in the periodontoid tissues is the key to the diagnosis, erosive osseous changes, and variably calcified soft‐tissue masses being occasionally associated. Computed tomography is the most important imaging study to be performed in this setting.

Aneurisma gigante parasselar simulando tumor de hipófise

Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicating artery, are reported. The main findings were: headache (7/7), complex ophthalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicating artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar region remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results.Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicant artery, are reported. The main findings were: headache (7/7), complex ophtalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicant artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar egion remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results.