Nélio Garcia de Barros

Computed tomography in neurocysticercosis a 10-year long evolution analysis of 100 patients with an appraisal of a new classification

Three hundred and fifty seven computed tomography (CT) from 100 different patients with neurocysticercosis (NC) were studied between 1979 and 1988. All patients were treated with praziquantel (PZQ). A new classification attempting to recognize the CT evolution profile in NC as well as assigning a possible link between CT findings and biological conditions of cysts is evaluated. It was possible to conclude that: intact cysts remain unchanged in consecutive CTs by 11 months and exhibit signs of degeneration in about 18 months after PZQ drug therapy; degenerating cysts can be detected by 10.5 months, disappear in 11 months and become nodular calcifications in about 25 months. Therefore, a time period of at least 36 months can be estimated for the complete evolution profile of cysts in the brain parenchyma.

Transtornos depressivos associados à neurocisticercose: prevalência e correlações clínicas

OBJECTIVE: To determine the frequency and features of psychiatric morbidity in a cross-section of 38 outpatients with neurocysticercosis. METHODS: Diagnosis of neurocysticercosis was established by CT scan, MRI and CSF analysis. Psychiatric diagnoses were made by using the Present State Examination and the Schedule for Affective Disorders and Schizophrenia - Lifetime version; cognitive state was assessed by Mini-Mental State Examination and Strub & Blacks Mental Status Examination. RESULTS: Depression was the most frequent psychiatric diagnosis (52.6%) as shown by PSE. Active disease and intracranial hypertension were associated with higher psychiatric morbidity, and previous history of mood disorders was strongly related to current depression. CONCLUSIONS: Depression syndromes are frequent in patients with neurocysticercosis. The extent to which organic mechanisms related to brain lesions may underlie the observed mental changes is yet unclear, though the similar sex distribution of patients with and without depression, as well as the above mentioned correlations, provide further evidence of the role played by organic factors in the cause of these syndromes. The results of this study are discussed in the light of the data available for other organic psychiatric disorders.

Brain SPECT in dementia a clinical-scintigraphic correlation

The aim of this study was to compare the accuracy of computed tomography (CT) and single photon emission computerized tomography (SPECT) in the diagnosis of dementia. Fifty-two patients with clinical diagnosis of dementia and 11 controls were studied. The scans were interpreted by one experienced neuroradiologist and one nuclear radiologist, both blinded to the clinical data. In the diagnosis of dementia, CT and SPECT showed equal sensitivity (82.7%) and statistically similar specificity (63.8 and 81.8%, respectively). The specificity of SPECT in diagnosing Alzheimers disease (100%) was statistically superior to CT (69%). However, both methods showed similar sensitivity in detecting Alzheimers disease. In conclusion, SPECT and CT showed similar accuracy in the diagnosis of dementia. The quite high specificity of SPECT in Alzheimers disease may be useful for confirming that diagnosis, particularly for patients with presenile onset of the disease.

Craniostenose. Tratamento cirúrgico: considerações a respeito de 25 casos

Craniostenosis is know since Hippocrates but its pathology began to be correctly understood only a hundred years ago, with Virchows papers. Surgical attempts for its treatment started in 1888, and were well standardized since 1920. In order to avoid some confuse expressions used in the literature the authors employed the classification based on the affected suture and the associated malformations. From 1959 until 1964 40 patients were examined, and 25 of them were surgically treated. These cases were specially analysed and regarding its type they were divided as follows: premature fusion of the sagital suture (10 cases), premature fusion of the coronary suture (4), premature fusion of the sagital and coronary sutures (2), premature fusion of the metopic suture (2), unilateral premature fusion of the lambdoid suture (1), Aperts syndrome (2), Crouzons disease (1). Clinical, radiological and therapeutic aspects of each type were commented. Recently, some authors do not indicate surgery in cases with only one fused suture. We will continue to indicate early surgery with prophylactic aim, in such cases. We believe that the surgery in the earliest months not only prevents sequels, but is less traumatic and leads to better plastic results. There is not a good technique to be employed with the aim of preventing bone regeneration and re-establishment of craniostenosis. We obtained unsatisfactory results with the lining of the bone edges with polyethilene or silicone. In some cases the newly formed bone grew over the plastic material and re-established the craniostenosis. In two cases the plastic material had to be removed because of local infection. It is not yet an established fact that the use of special solution can avoid the periosteum osteoblastic activity of the periosteum. We have no personal experience with these solutions and intend to test them from now on.Craniostenosis is know since Hippocrates but its pathology began to be correctly understood only a hundred years ago, with Virchows papers. Surgical attempts for its treatment started in 1888, and were well standardized since 1920. In order to avoid some confuse expressions used in the literature the authors employed the classification based on the affected suture and the associated malformations. From 1959 until 1964 40 patients were examined, and 25 of them were surgically treated. These cases were specially analysed and regarding its type they were divided as follows: premature fusion of the sagital suture (10 cases), premature fusion of the coronary suture (4), premature fusion of the sagital and coronary sutures (2), premature fusion of the metopic suture (2), unilateral premature fusion of the lambdoid suture (1), Aperts syndrome (2), Crouzons disease (1). Clinical, radiological and therapeutic aspects of each type were commented. Recently, some authors do not indicate surgery in cases with only one fused suture. We will continue to indicate early surgery with prophylactic aim, in such cases. We believe that the surgery in the earliest months not only prevents sequels, but is less traumatic and leads to better plastic results. There is not a good technique to be employed with the aim of preventing bone regeneration and re-establishment of craniostenosis. We obtained unsatisfactory results with the lining of the bone edges with polyethilene or silicone. In some cases the newly formed bone grew over the plastic material and re-established the craniostenosis. In two cases the plastic material had to be removed because of local infection. It is not yet an established fact that the use of special solution can avoid the periosteum osteoblastic activity of the periosteum. We have no personal experience with these solutions and intend to test them from now on.

Desenvolvimento neuropsicomotor da criança desnutrida: II subnutrição

The cases of 5 children with severe malnutrition, marasmic type, aged four to fourteen months are reported. The patients were sturied at admission in the hospital and 45-60 days and 4-5 months later. Eeach study included: hemoglobinemia, cholesterolemia, glycemia, weight, height, Gesell test, neurological examination, pneumoencephalogram, electroencephalogram and cerebrospinal fluid examination. Biochemical and physical recuperation was very good. Gesell test show an important and homogeneous deficiency, even at the third study. All patients presented cortical atrophy at the pneumoencephalogram in the first study: 4 patients were re-studied 4-5 months later and only one become normal. No changes in electroencephalogram and cerebrospinal fluid were found. It was not possible to evaluate the significancy of the poor psychosocial environment from where the patients came in the aetiology of the mental deficiency.

Diagnóstico angiográfico dos tumores de plexo coróide do ventrículo lateral

The authors believe that cerebral angiography is the best neuroradio-logic procedure for the diagnosis of tumors of the choroid plexus of the lateral ventricles. Pneumographs needing a large quantity of contrast material are very traumatic and occasionally insufficient. In the 3 cases reported cerebral angiograms disclosed the presence of pathological circulation, enhancing a correct diagnosis. Another interesting point is the demonstration of the dilatation of the blocked temporal horn. In addition, angiography allows the study of the afferent and efferent vessels, thus facilitating surgical procedures. The angiographic picture in a case of carcinoma was different from those found in four papillomata cases.

Megalencefalia: Considerações a respeito de 7 casos diagnosticados em vida

Megalencephaly should be diagnosed during life, especially knowing that it could be confused with hydrocephalus. The diagnosis could be arrived at on the basis of clinical data in some cases, but mostly by way of the ventricular puncture. Pneumoencephalography or pneumoventriculography may confirm the diagnosis but it is not essential in a typical case. Other procedures like X rays of the skull, electroencephalograma or cerebral angiography are of little help. Seven cases diagnosed during life are presented. One patient had macroglossia; two brothers had a hemangioma at the glabella area. A familial tendency was noticed in two pairs of children, one of them with consanguineous parents. Judging by our series, which seems to be larger than others, megalencephaly is not such a rare condition as it is thought to be.

Anomalia megadolicobasilar: a propósito de 5 casos diagnosticados angiograficamente

After brief considerations on the symptomatology and ethiopathogeny of megadolichobasilar, five cases of this vascular anomaly are presented. Agreeing with the majority of the papers on the subject, the age of the patients was between the fourth and the sixth decades, all of them presenting arterial hypertension of long duration and advanced atherosclerosis; the neurological findings were varied, having in common the fact of an abrupt (ictal) beggining. The angiographic study of the vertebrobasilar system was basic in the diagnosis in every case.After brief considerations on the symptomatology and ethiopathogeny of megadolichobasilar, five cases of this vascular anomaly are presented. Agreeing with the majority of the papers on the subject, the age of the patients was between the fourth and the sixth decades, all of them presenting arterial hypertension of long duration and advanced atherosclerosis; the neurological findings were varied, having in common the fact of an abrupt (ictal) beggining. The angiographic study of the vertebrobasilar system was basic in the diagnosis in every case.

Agenesias e cavos do septo pelúcido

Four cases of agenesis and one of cavum of septum pellucidum are reported. Comments on the incidence, symptomatology and association with other anomalies, emphasizing the absence of a definite clinical picture or symptom are made.

Craniostenose em gêmeos: estudo genético

The occurrence of two clinical forms of craniostenosis in twins of different sex born to consanguineous parents is reported. The girl showed total fusion of the coronary suture; in the boy sagittal suture was the only one involved. The genetic study showed that the craniostenosis was not associated with chromosomal anomalies and was related to rare auto-somic recessive gens.