Nelson Pires Ferreira

Optic nerve apoplexy caused by a cavernous angioma: case report.

A case of a cavernous angioma of the optic nerve is presented. The abrupt onset of monocular visual symptoms was accompanied by an intense bitemporal headache, indicating apoplexy of the optic nerve. The surgical and histological findings demonstrated a cystic cavernous angioma. The lesion was removed completely without any noticeable bleeding. The preoperative visual deficit persisted.

Criteria of Cure and Remission in Cushing's Disease: An Update

We review the clinical and biochemical criteria used for evaluation of the transsphenoidal pituitary surgery results in the treatment of Cushings disease (CD). Firstly, we discuss the pathophysiology of the hypothalamic-pituitary-adrenal axis in normal subjects and patients with CD. Considering the series published in the last 25 years, we observed a significant variation in the remission or cure criteria, including the choice of biochemical tests, timing, threshold values to define remission, and the interference of glucocorticoid replacement or previous treatment. In this context we emphasize serum cortisol levels obtained early (from hours to 12 days) in the postoperative period without any glucocorticoid replacement or treatment. Our experience demonstrates that: (i) early cortisol < 5 to 7 microg/dl, (ii) a period of glucocorticoid dependence > 6 mo, (iii) absence of response of cortisol/ACTH to CRH or DDAVP, (iv) return of dexamethasone suppression, and circadian rhythm of cortisol are appropriate indices of remission of CD. In patients with undetectable cortisol levels early after surgery, recurrence seems to be low. Finally, although certain biochemical patterns are more suggestive of remission or surgical failure, none has been proven to be completely accurate, with recurrence observed in approximately 10 to 15% of the patients in long-term follow-up. We recommended that patients with CD should have long-term monitoring of the CRH-ACTH-cortisol axis and associated co-morbidities, especially hypopituitarism, diabetes mellitus, hypertension, cardiovascular disturbances, and osteoporosis.

Hematomas intraparenquimatosos espontâneos supratentoriais: a proposito de 28 casos

Os autores analisam 28 pacientes com hematomas intraparenquimatosos espontâneos supratentoriais. Comentam as diversas topografias baseadas no estudo angiografico, a mortalidade e a morbilidade da patologia. Os resultados sao analisados em relacao a presenca de hipertensao arterial sistemica, ao comprometimento da consciencia e a topografia do processo expansivo. Chamam a atencao para a indefinicao da escolha e da oportunidade do tratamento cirurgico identificada na literatura.Twenty eight patients with supratentorial spontaneous intracerebral hemorrhage have been reviewed as concerns the location disclosed by angiography, the morbidity and the mortality. The results are analysed with consideration to the presence of arterial hypertension, consciousness disfunction and topography of the lesion. The conflicting opinions in the literature concerning the surgical treatment of spontaneous intercerebral hemorrhage are pointed out.

Primary meningeal Burkitt-type lymphoma presenting as the first clinical manifestation of acquired immunodeficiency syndrome

The purpose of this study is to report a rare case of primary meningeal high grade Burkitt-type lymphoma presenting as the first clinical manifestation of acquired immunodeficiency syndrome. A 38-year-old Caucasian man, with a negative past medical history, sought treatment after experiencing global headache for five days. CT-Scan revealed a right front-temporo-parietal hyperdense subdural expansive mass. A craniotomy was performed and a hard white subdural was microsurgically dissected. Some hours after the surgery, the patient developed hemispheric cerebral edema and intracranial hypertension syndrome. Decompressive craniotomy was performed and the patient had an excellent recovery. Screening blood tests diagnosed human immunodeficiency virus infection. Further investigation ruled out systemic diseases. Eleven days after the initial surgery, the patient developed an acute respiratory failure and sepsis, dying on that day. Pathological studies diagnosed Burkitt-type lymphoma.

Abscesso hipofisário simulando apoplexia

A pituitary abscess is a rare pathology, but it must be considered when evaluating sellar masses, since its prognosis depends on surgical drainage and on the use of specific antibiotics. The main clinical manifestation is chronic headache, and it is not always associated with the identification of a site of infection, which diminishes the probability of including it in diagnostic hypotheses. The case is presented of a patient with a pituitary abscess and a previous history of adenoma that had been operated on, recent onset headache and acquired hypopituitarism whose initial diagnosis was pituitary apoplexy.

Tumores não hipofisários da região selar

The pituitary gland, sella turcica and the parasellar region can be involved by a wide variety of lesions, including benign and malignant neoplasms as well as a wide variety of non neoplastic tumor-like lesions. Clinical and radiological aspects could help in the differential diagnosis of these lesions. Nevertheless, in many cases only the histopathological analysis could establish the definitive diagnosis. In this paper, we review the nonpituitary tumors of the sellar region emphasizing the associated hormonal disturbances.

Hematomas intraparenquimatosos espontâneos: experiência com 134 casos

One hundred thirty four cases of spontaneous intraparenchymatous hematomas have been studied. They were separated into six groups according to criteria related to topography, level of consciousness, and hematoma volume. Treatment protocols - conservative, conservative with I.C.P. monitoring, and surgical - were different in each group. Results have shown an increased mortality (p<0.05) among patients whose level of consciousness were more severely compromised, in those older than 50 years old, and in those harbouring quadrilateral, intraventricular or brainstem hematomas. Overall mortality was 26.1%.One hundred thirty four cases of spontaneous intraparenchymatous hematomas have been studied. They were separated into six groups according to criteria related to topography, level of consciousness, and hematoma volume. Treatment protocols - conservative, conservative with I.C.P. monitoring, and surgical - were different in each group. Results have shown an increased mortality (p<0.05) among patients whose level of consciousness were more severely compromised, in those older than 50 years old, and in those harbouring quadrilateral, intraventricular or brainstem hematomas. Overall mortality was 26.1%.

Tumores raqueanos: a proposito de 100 casos

One hundred cases of spinal tumors are studied concerning to the histological type, age, topography and evolution of the clinical manifestation. In the given material was identified a predominance of the tumors of the neural tissue and associated structures: neurinomas (16%), meningiomas (15%), ependymomas (4%) and astrocytomas (2%); following metastatic tumors (32%), tumors of mesenchymal tissue (16%): fibroma (2%), lipomas (2%), haemangioblastoma (4%), angiosarcoma (2%), angioma (1%), angioblastoma (1%), chordomas (2%), osteoblastoma (1%) and adamantinoid tumor (1%); tumors of lymphatic and haematopoietic tissue: plasmacytoma (6%), histiocytic lymphoma (3%), lymphocytic lymphoma (2%), Hodgkin (1%) and unclassified lymphomas (1%); teratomas: differentiated teratoma (1%).One hundred cases of spinal tumors are studied concerning to the histological type, age, topography and evolution of the clinical manifestation. In the given material was identified a predominance of the tumors of the neural tissue and associated structures: neurinomas (16%), meningeomas (15%), ependymomas (4%) and astrocytomas (2%); following metastatic tumors (32%), tumors of mesenchymal tissue (16%): fibroma (2%), lipomas (2%), haemangioblastoma (4%), angiosarcoma (2%), angioma (1%), angioblastoma (1%), chordomas (2%), osteoblastoma (1%) and adamantinoid tumor (1%); tumors of lymphatic and haematopoietic tissue: plasmscytoma (6%), histocytic lymphoma (3%), limphocytic limphoma (2%), Hodgkin (1%) and unclassified limphomas (1%); teratomas: diferencied teratoma (1%).

Aneurisma micotico de origem extra-vascular

The case of a female patient presenting a complete unilateral ophthalmoplegia secundary to a septic aneurysm of the internal carotid artery is reported. The possible existence of an extravascular infectious etiology in view of the presence of trombophlebitis of the cavernous sinus is discussed. Pertinent reports from the literature are reviewed and the rarity of the phenomenon is commented. The indication for internal carotid artery ligation as a form of treatment deserves further observations.: The case of a female patient presenting a complete unilateral ophthalmoplegia secundaru to a septic aneurysm of the internal carotid artery is reported. The possible existence of an extravascular infectious etiology in vies of the presence of trombophelebitis of the cavernous sinus is discussed. Pertinent reports from the literature are reviewed and the rarity of the phenomenn is commented. The indication for internal carotid artery ligation as a form of treatment deserves further observations.

Cisto aracnóideo extradural do canal espinal

The case of a pacient with thoracic arachnoideal cyst is reported. There was a neurological picture of a spinal cord compression in thoracic level with analgesia and anesthesia in T12 and L1 at left. Radiographs showed compression of the pedicles with widening of interpedicular spaces of the eight to twelfth thoracic vertebrae. The myelogram and the laminectomy confirmed the hypothesis of aracnoideal cyst. This case of extradural cyst of the spinal canal is added to the 76 previously described in the literature. The incidence, etiology, phisiopathology, clinical-picture, diagnosis, surgical treatment and prognosis are discussed.