Péricles Maranhão-Filho

Intracranial Meningiomas in Children : Ten-Year Experience

Meningiomas are central nervous system neoplasms derived from arachnoid cap cells. They are the second most common brain tumors after gliomas, but are rare in children. Furthermore, meningiomas exhibit different behavior in this age group. From 1997-2007, 7 children with brain meningiomas were treated at the Department of Neurosurgery, Brazilian National Cancer Institute, Rio de Janeiro, Brazil. They represented 2.7% of all brain meningiomas, and 2.1% of all brain tumors, in children followed during this period at our institution. There were 4 boys, and the mean age at diagnosis was 7.3 years. Headaches, seizures, and motor deficits were the most frequent signs at presentation. All patients underwent surgery, and total resection was achieved in 6 of 7 patients. Most lesions were World Health Organization class I meningiomas. There were no deaths, and patients were asymptomatic or demonstrated mild motor or sensory signs at follow-up. In conclusion, meningiomas are rare in the pediatric population. Most of the lesions are low-grade, and the prognosis in this setting is good.

Neuropareidolia: diagnostic clues apropos of visual illusions

Diagnosis in neuroimaging involves the recognition of specific patterns indicative of particular diseases. Pareidolia, the misperception of vague or obscure stimuli being perceived as something clear and distinct, is somewhat beneficial for the physician in the pursuit of diagnostic strategies. Animals may be pareidolically recognized in neuroimages according to the presence of specific diseases. By associating a given radiological aspect with an animal, doctors improve their diagnostic skills and reinforce mnemonic strategies in radiology practice. The most important pareidolical perceptions of animals in neuroimaging are the hummingbird sign in progressive supranuclear palsy, the panda sign in Wilsons disease, the panda sign in sarcoidosis, the butterfly sign in glioblastomas, the butterfly sign in progressive scoliosis and horizontal gaze palsy, the elephant sign in Alzheimers disease and the eye-of-the-tiger sign in pantothenate kinase-associated neurodegenerative disease.

Vestibulo-ocular reflex and the head impulse test

The authors highlights the importance of the vestibulo-ocular reflex examination through the head impulse test as a diagnostic method for vestibular dysfunction as well as, and primarily, a bedside semiotic resource capable of differentiating between acute peripheral vestibulopathy and a cerebellar or brainstem infarction in emergency rooms.

Professor Aristides Leão. Much More Than Spreading Depression

Professor Leão described cortical spreading depression (CSD) in 1944 and changed the way migraine pathophysiology is scientifically conceived. This Brazilian professor and researcher developed his career in Rio de Janeiro. Because of him, the city once became the CSD world capital, attracting scientists from many laboratories around the globe. Aristides Leão was first and foremost a naturalist, a man genuinely interested in birds, fishes, plants, shells, and neuroscience. He could easily fascinate whoever would come for a chat, leaving no question without answers. He was born in 1914 and died in 1993. This report focuses on his life, family, habits, and hobbies, describing a little of Leão apart from CSD and the year of 1944.

Can Clinical Tests Detect Early Signs of Monohemispheric Brain Tumors

Background and Purpose: Prior to modern neuroimaging, neurological treatment decisions were based on findings obtained from patient history and clinical examination. Despite the availability of sophisticated neuroimaging methods, to identify intracranial tumors the clinical recognition of associated subtle motor deficits is important for practice. Precise clinical tests are particularly advantageous, as some tumors may remain unnoticed for many. The purpose of this study was to determine the sensitivity and specificity of 13 clinical tests for detection of subtle motor deficits in patients with unilateral brain tumors. Methods: Sixty patients with unilateral brain tumors without obvious focal signs and 30 controls with normal magnetic resonance imaging were examined. Thirteen clinical maneuvers described to detect motor deficits were performed and their sensitivity, specificity, and positive and negative predictive values were estimated. Results: The test with greatest sensitivity and specificity (with 95% confidence interval) was the Digit Quinti Sign: 0.51 (0.41-0.61) and 0.70 (0.61-0.79), respectively. The agreement measurement among the 3 most sensitive signs (Digit Quinti Sign, Pronator Drifting Test, and Finger Rolling Test) was 21%. The Kappa index for these 3 tests indicated no significant concordance. Conclusions: The Digit Quinti Sign, the Pronator Drifting Test, and the Finger Rolling Test are simple yet very useful maneuvers that clinicians can perform at bedside. Even without apparent motor deficits, when present, these signs suggest that comprehensive investigation for intracranial neoplams should be undertaken.

Isolated pathetick nerve paresis by compression from a dolichoectatic basilar artery: case report

The article describes a woman with 53 year-old that has presented diplopia when looking down and adopted a tilted head position in order to read for the last six months. The neuro-ophthalmic examination shows isolated right superior oblique muscle paresis. The magnetic resonance and the angioresonance show the dolicoectatic basilar artery compressing the right ventral lateral brainstem.

The mystery of two red ears: A bilateral simultaneous case

A 55-year-old migrainous woman presents since the age of 11 with spontaneous outbursts of red burning ears lasting for about 30min. Since last year, the episodes have occurred almost daily, despite the use of nortriptyline for migraine prophylaxis. No trigger factors are present. The neurological examination is normal, except for the ear redness (Figure 1). Brain and cervical MRI are unremarkable. Red-ear syndrome is an under-diagnosed disorder of unknown aetiology and treatment (1) that may occur in association with migraine (2). It may be primary or secondary to various conditions including temporomandibular joint dysfunctions, upper cervical disorders, glossopharyngeal and trigeminal neuralgia (3). In our patient, the attacks happen independently from the migraine episodes (4). The rare simultaneous bilateral involvement challenges the hypothesis of an antidromic release of vasodilator peptides secondary to third cervical root discharges (5). It is possible that a brainstem dysfunction activates the trigeminovascular system bilaterally, leading to sensory antidromic and parasympathetic reflex firing.

Neurological examination: pioneering authors and their books

The objective of this article is to highlight some of the most important pioneering books specifically focused on the neurological examination and their authors. During the XIX Century, Alexander Hammond, William Gowers and Charles Mills pioneered the neurological literature, followed in the XX Century by Aloysio de Castro, Monrad-Krohn, Derek Denny-Brown, Robert Wartenberg, Gordon Holmes, and Russel DeJong. With determination and a marked sense of observation and research, they competently developed and spread the technique and art of the neurological exam.

Paradoxical Worsening of Brain Tuberculomas During Treatment

Marco A. Lima. Fundacao Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado a Fiocruz, mas nao consta a informacao no documento.

What is the essential neurological examination

In order to determine which aspects would be essential to the neurological examination (NE) in a given specific situation (a patient referred with a potential neurological complaint, but the history suggests that a neurological problem is unlikely), we presented the same questionnaire used by Moore and Chalk in Canada to 19 neurologists in Rio de Janeiro, Brazil. We considered significant aspects of NE, whose average responses were greater than or equal to 3.5: visual fields, fundoscopy, pursuit eye movements, facial muscle power testing, gait, pronator drift or rapid arm movement in upper limbs, finger-nose, tone in arms and legs, five tendon reflexes, and plantar responses. We concluded that, despite geographical and economical differences between Brazil and Canada, neurologists from both countries agree about the essential NE in the proposed scenario.