Nubor O. Facure

Ventriculo-auriculostomia nos bloqueios ao trânsito do líquido cefalorraqueano na cisticercose encefálica

Sixteen cases of brain cysticercosis with obstruction of cerebrospinal fluid circulation were operated from 1960 to 1965, through ventriculo-auri- culostomy with Holter valve. Five patients died, ten are alive and free of signs of intracranial hypertension and one could not be followed up. Considering the usual bad prognosis of the disease, mainly when increased intracranial pressure is present, the results obtained can be considered good. Therefore, the ventriculovenous shunts are a valuable resource in the treatment of the neurocysticercosis with ventricular dilatation caused by cerebrospinal fluid obstruction either in the intraventricular pathway or in the subarachnoid space. Sometimes the evolution is not satisfatory owing to the progressive course of the disease itself and not as a consequence of a bad control of the increased intracranial pressure.

Verificação do funcionamento de derivações ventrículo-peritoneais com válvula mediante emprego de radioisótopos: contribuição técnica pessoal

A simplified method to evaluate the patency of ventriculo-peritoneal shunts with valve by simultaneous captation of radiation at ventricles and peritoneal cavity of intraventricular injected RIHSA is reported. The study is completed by simultaneous brain and peritoneal scanning after an 18-24 hours interval.

Ventrículo-auriculostomia nos bloqueios inflamatorios e tumorais à circulação do líquido cefalorraqueano

The results obtained in 32 patients with obstruction of the cerebrospinal fluid circulation caused by cerebral tumors and inflammatory reactions of the leptomeninges or ventricular ependima, are presented. The results were satisfactory in 20 cases; 3 patients did not come back for follow-up and 9 died. All deaths occurred in the group of neoplasms, and only in one case this bad evolution was related to infectious complication of the ventriculo-venous shunt.

Complicações infecciosas da ventrículo-auriculostomia

Most of the ventriculovenous shunt complications are caused by infections. From a series of 184 patients submitted to ventriculo-auriculostomy, 39 cases have had infectious complications. In 18 of them ventriculitis or meningitis was present and in 21 patients infections in the valve or catheters was found. Despite these complications the ventriculo-auriculostomy remains the most employed shunt in the treatment of hydrocephalus. If better selection of patients could be made the results, probably, would improve. Up to the present the cause and prophylaxy of the infection are very controversial. In cases with ventriculitis an intensive antibiotic treatment must be made, including by intraventricular route, and the shunt will be removed as soon as the conditions of the patient improve. In cases with bacteremia the remotion of the shunt may be postponed, according to the severity of the infection and the response to drug therapy.

Doença de Alzheimer: relação entre o tempo de doença e seu estadiamento

Sao analisados 49 pacientes com diagnostico clinico de doenca de Alzheimer, submetidos a avaliacao neuropsicologica para estadiamento dia doenca segundo a escala de Reisberg. Foi comparado o tempo de aparecimento dos sintomas ao estadiamento da doenca. Em 28,5% dos pacientes nos estagios 3 e 4 a evolucao foi prolongada, insidiosa, oligossintomatica, apenas com deteriorizacao da memoria. Para outro grupo de pacientes (12,2%), a evolucao foi desde o inicio acrescida de manifestacoes mais graves com comprometimento praxico-gnostico. Alem da perda de memoria, 34 pacientes vieram a apresentar disturbios praxico-gnosticos, teindo 50% deles iniciado estas manifestacoes nos dois primeiros anos da doenca. A analise dos dados sugere a ocorrencia de dois subgrupos, um com evolucao rapida e outro com evolucao protraida. Sugere tambem que a evolucao nos dois primeiros anos e critica para caracterizar a severidade da progressao das manifestacoes clinicas da doenca de Alzheimer.Forty-nine patients with clinical diagnosis of Alzheimers disease were submitted to neuropsychological evaluation for staging the disease. The time of the initial symptoms was correlated to the stage of the disease. The evolution was protracted in 28.5% of the patients with only insidious memory deterioration. For another group of patients (12.2%) the evolution was serious since the beginning of the disease, with apraxo-agnosic signs. For the 34 patients with apraxo-agnosic impairment, in 50% this manifestation began in the first two years of the disease. Data suggest the occurrence of two subgroups. In the first the evolution of the disease, is rapid, and in the second it is protracted. Also, they suggest that the evolution in the first two years is critical for characterizing the severity of progression in the clinical manifestations of Alzheimers disease.

Malformações arteriovenosas intracranianas. Diagnóstico e tratamento

Twenty-seven cases of arteriovenous malformation of the brain were studied. In 77% of these cases the site of the anomaly was the motor and adjacent areas. Meningeal hemorrhage was observed in 62% of the cases. The angiographic study, and particulary the cerebral pan-angiography, is emphasized. Total remotion is the method of choice including for the anomalies located in the motor area.