Manoel Baldoino Leal Filho

Hemodynamic parameters and neurogenic pulmonary edema following spinal cord injury: an experimental model

Neurogenic pulmonary edema is a serious and always life-threatening complication following several lesions of the central nervous system. We report an experiment with 58 Wistar-Hanover adult male rats. Two groups were formed: control (n=4) and experimental (n=54). The experimental group sustained acute midthoracic spinal cord injury by Fogartys balloon-compression technique containing 20 microL of saline for 5, 15, 30 or 60 seconds. The rats were anesthetized by intraperitoneal (i.p.) sodium pentobarbital (s.p.) 60 mg/Kg. The quantitative neurological outcome was presented at 4, 24 and 48 hours from compression to characterize the injury graduation in different groups. Poor outcome occurred with 60 seconds of compression. Six animals died suddenly with pulmonary edema. Using the procedure to investigate the pulmonary edema during 60 seconds of compression, followed by decompression and time-course of 60 seconds, 20 rats were randomly assigned to one of the following groups: control (1, n=4, anesthetized by i.p. s.p., 60 mg/Kg but without compression) and experimental (2, n=7, anesthetized by i.p. xylazine 10 mg/Kg and ketamine 75 mg/Kg) and (3, n=9, anesthetized by i.p. s.p., 60 mg/Kg). The pulmonary index (100 x wet lung weight/body weight) was 0.395 +/- 0.018 in control group, rose to 0.499 +/- 0.060 in group 2, and was 0.639 +/- 0.14 in group 3. Histologic examination of the spinal cord showed parenchymal ruptures and acute hemorrhage. Comparison of the pulmonary index with morphometric evaluation of edema fluid-filled alveoli by light microscopy showed that relevant intra-alveolar edema occurred only for index values above 0.55. The results suggest that the pulmonary edema induced by spinal compression is of neurogenic nature and that the type of anesthesia used might be important for the genesis of lung edema.

SCHWANOMA DE PLEXO BRAQUIAL Relato de dois casos

Schwannomas, neurinomas or neurilemmomas are benign peripheral nerve tumors. The literature report some cases associated with neurofibromatosis 2. We report two cases of cervical schwannoma originating from the brachial plexus unassociated with neurofibromatosis. A 31-year-old woman presented with a mass in the right supraclavicular region, irradiating pain and distal tingling to percussion (Tinels sign) for 6 months. And a 52-year-old woman presented with pain in the cervical region and right arm for one year. Both the patients underwent to a microsurgery with total resection of the lesion. Histology of the surgical specimen confirmed the diagnosis of schwannoma. Postoperatively, the patients had a good recovery.

Schwannoma of the craniocervical junction: surgical approach of two cases

We report two cases of craniocervical junction schwannomas with a special focus on the surgical approach. The patients underwent a far-lateral approach in the sitting position that facilitated the lesion removal. This report is meant to improve the understanding of this surgical technique as well as improve awareness of its usefulness for similar cases.

Espasmo hemifacial e impressão basilar associados a malformação de arnold-chiari relato de caso

The authors report a case of symptomatic basilar impression and Arnold-Chiari malformation being presented as the first symptom of hemifacial spasm. The surgical treatment of the malformation resulted in improvement of the clinical manifestation with reduction of the hemifacial spasm. The need for the aetiological therapy for the hemifacial spasm is emphasized, before symptomatic treatment with botulinum toxin is tried.

Fibroma condromixóide da coluna torácica: Relato de caso e revisão da literatura

A case of chondromyxoid fibroma (CMF) arising from the Sth right costovertebral junction and spreading into spinal canal causing spinal cord compression is presented. A myelotomography revealed a complete block at T5 level. The patient underwent a decompressive laminectomy with removal of an epidural tumor. This specimen was sent for pathological examination and interpreted as a CMF. The patient had a neurological improvement, post operative MRI revealed a spinal cord free of compression, and we decided on the follow up of the case. Two years later there was reccurrence of the tumor. A posterolateral access by costotransversectomy was made and the lesion was resected. The patient had a neurological improvement which persists on the follow up (two years, at present). Clinical, radiologic and histologic findings, surgical management and recurrence are discussed. The pertinent literature is reviewed.

Paracoccidioidomicose em hemisfério cerebral e tronco encefálico: relato de caso

We report on a 36 years-old man that had been at the Amazon forest four years before. Six months before the admission he had developed a progressive quadriparesis, gait ataxia, dysphagia, dysarthria, difficulty in breathing and hiccup. The gadolinium-enhanced T1-weighted MRI showed a lesion into the right parietoccipital area and another into the medulla, that was the largest. There was any evidence of tuberculosis or AIDS. The patient was submitted to microsurgical approach to the medulla. Pathological examination revealed paracoccidioidomycosis. Treatment with anphotericin B till 2100mg was administered followed by sulfamethoxazole-trimetoprim for three months plus physical therapy. The patient went back to his activities six months after the end of the treatment. Comments are presented about the participation of the immunological system and of the cytokines (interleukines).

Granuloma eosinofílico de coluna cervical: relato de caso

Eosinophilic granuloma (EG) is a benign condition of histocytes proliferation localized or multifocal. It is presents in the cervical spine in 1.5%-20% of the cases of EG. We report the case of a seven-year-old girl that presented with a one month history of cervical pain, persistent wryneck and vicious posture of the neck. A computerized tomography was performed and confirmed the presence of spreading lesion, ostheodestructive to the level of the left laminae of C2, with invasion of the spine and the muscular tissue. A laminectomy was underwent for removal of the lesion. The patient had a good post-operative recovery with improvement of the symptoms. Chemotherapy with prednisone, vinblastine and ethoposide was administred. After six months, this protocol was repeated associaded to methotrexate.The patient improved and had no new symptoms in a follow-up of 36 months.

Forma tumoral de neurocisticercose: relato de caso

The authors report a case of neurocysticercosis by giant cyst (3.9 x 3.4 cm), where there were clinical manifestations of increased intracranial pressure and characteristics of image in computed tomography of cranium of expansive process with mass effect in central nervous system (CNS). They comment the possibility of the tumoral form of this disease having clinical and radiological presentation similar to other expansive processes of CNS and stress the surgical procedure as a form of treatment and diagnostic confirmation.

Acidente vascular de tronco encefálico: estudo de 21 casos

A prospective study was designed to follow patients with syndromes of brain stem during 12 months (in 1991-1992). The aim was to correlate clinical and radiologic findings and comparing them with the classical descriptions of brain stem syndromes. Twenty one consecutive patients were admitted at the Hospital de Base do Distrito Federal. The diagnosis and the follow up were carried out by neurological examination and neuroradialogic images: CT (100%), angiography (24%, S) and MRI (5%, 1). Hypertension and old age were the most important risk factors and hemorrhage at pons with extension to midbrain was the most frequent finding. Coma at admission was associated to a poor outcome. The outcome was defined by the Glasgow Outcome Scale: 28% rated S, 24% rated 4, 5% rated 3; 28% rated 2 and 14% rated 1. Our results show that the clinical presentation of ischemic strokes and hemorrhages of the brain stem very frequently follow a mixed pattern, which do not conciliate with the classical descriptions of these syndromes.