Roberto Colichio Gabarra

Sinking skin flap syndrome with delayed dysautonomic syndrome—An atypical presentation

INTRODUCTION Sinking skin flap syndrome or “syndrome of the trephined” is a rare complication after a large craniectomy, with a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. PRESENTATION OF CASE We report a case of 21 years old man with trefinated syndrome showing delayed dysautonomic changes. DISCUSSION Our patient had a large bone flap defect and a VP shunt that constitute risk factors to develop this syndrome. Also, there is reabsorption of bone tissue while it is placed in subcutaneous tissue. The principal symptoms of sinking skin flap syndrome are severe headache, mental changes, focal deficits, or seizures. Our patient presented with a delayed dysautonomic syndrome, with signs and symptoms very characteristics. Only few cases of this syndrome were related in literature and none were presented with dysautonomic syndrome. CONCLUSION We reported here a very uncommon case of sinking skill flap syndrome that causes a severe dysautonomic syndrome and worsening the patient condition.

Aneurisma cerebral e cisto de aracnóide: a propósito de caso com hemorragia intracística

We report a case of a carotid artery bifurcation aneurysm which ruptured into a silvian fissure arachnoid cyst. In the review of the literature, only three cases were before reported. We discuss about uncommom clinical findings, the surgical aspects and the associations among the lesions.

Familial cancer: depressed NK-cell cytotoxicity in healthy and cancer affected members

Depressed natural killer (NK) cell activity has been showed in family members of patients with different types of cancer. The present work aimed to evaluate T cell subsets and NK cell cytotoxic activity in 15 members of a family with high incidence of tumors, such as glioblastoma, gastric, pancreas and colon rectal carcinoma, chronic myelocitic leukemia, melanoma and osteoblastoma. As controls, 19 healthy subjects with the age range equivalent were studied. The enumeration of CD3+ lymphocytes and their CD4+ and CD8+ subsets were defined by monoclonal antibodies and NK cell cytotoxicity towards K562 target cells were evaluated by single cell-assay. The results showed in family members low percentage of total T cells (CD3+), and their CD4+ subset and impairment of CD4/CD8 ratio in relation to control group. All family members presented percentage of NK-target cell conjugate formation below the minimum value observed in control group. Thirteen people were examined and followed up during five years, in order to assure that there was no undiagnosed or unsuspected disease at the moment of evaluation. One of them developed osteoblastoma and other malignant melanoma. Two cancer patients, with glioblastoma and chronic myelocytic leukemia were studied during illness. All the corresponding values were comparable. The persistence of low percentage of conjugate formation may be related to a defect on adhesion molecules expression in the surface of NK cells that was probably responsible for the low activity of these cells presented by the family group. Thus, the inheritance mechanism of low adherence of NK cells should have a prognostic value in determining the risk of developing tumors.

Isolated Richter's syndrome in central nervous system: case report

Diffuse large cell non Hodgkins lymphoma associated with chronic lymphoid leukemia (CLL), or Richters syndrome, is a rare and serious complication. Isolated Richters syndrome in the central nervous system is very rare; only 12 cases have been reported. We describe a 74-year-old patient with diffuse large cell non Hodgkins lymphoma in the right frontal region with the appearance of multiform glioblastoma.

Trigone ventricular meningiomas: surgical approaches.

OBJECTIVE Report our experience with trigone ventricular meningiomas and review the surgical approaches to the trigone. METHOD From 1989 to 2006, six patients with meningiomas of the trigone of the lateral ventricles underwent microsurgical resection. Their clinical features, image, follow up, and surgical approaches were retrospectively analyzed. RESULTS Five patients presented with large and one with small volume meningioma. Unspecific symptoms occurred in three patients; intracranial hypertension detected in three patients; homonymous hemianopsy in three; and motor deficit present in one patient. Three patients were operated by transparietal transcortical approach, two by middle temporal gyrus approach, and one by parieto-occipital interhemispheric precuneus approach. Total resection was achieved in all patients without additional deficits. CONCLUSION Judicious preoperative plan, adequate knowledge of anatomy, and use of correct microsurgical techniques are fundamental in achieving complete resection of trigone meningioma with low morbidity.

L4-L5-S1 human dermatomes: a clinical, electromyographical, imaging and surgical findings

There is substantial controversy in literature about human dermatomes. We studied L4, L5, and S1 inferior limb dermatomes by comparing clinical signs and symptoms with conduction studies, electromyographical data, neurosurgical findings, and imaging data from computerized tomography (CT) or magnetic resonance imaging (MRI). After analyzing 60 patients, we concluded that L4 is probably located in the medial aspect of the leg, L5 in the lateral aspect of the leg and foot dorsus, and S1 in the posterior aspect of the backside, tight, leg and plantar foot skin. This is the first time that these human dermatomes have been evaluated by combined analysis of clinical, electromyographical, neurosurgical, and imaging data.

Pilomyxoid Astrocytoma of the Brainstem

Abstract A pilomyxoid astrocytoma is a recently described tumor that occurs predominantly in the hypothalamic-chiasmatic region and is rarely found elsewhere. It has similar features as pilocytic astrocytomas, but has distinct histological characteristics and a poorer prognosis. A pilomyxoid astrocytoma is an aggressive tumor, and increased awareness is necessary with a suspect case. We present the first case of a pilomyxoid astrocytoma of the brainstem described after the newest World Health Organization classification of central nervous system tumors.

Dermátomos humanos C5 e C6: estudo clínico, eletromiográfico, de imagem e cirúrgico

Ha controversias na literatura sobre os dermatomos humanos. Neste estudo os dermatomos do membro superior C5 e C6 foram analisados. O metodo consistiu em comparar os sinais e sintomas com achados eletromiograficos, de imagem e achados cirurgicos. Analise dos dados do membro superior de 18 pacientes sugere que o dermatomo C5 esteja localizado na regiao lateral do ombro e braco, e o dermatomo C6 na regiao lateral do antebraco e 1o, 2o e 3o dedos da mao. Este e o primeiro estudo em que os dermatomos C5 e C6 foram avaliados pelos dados clinicos, eletromiograficos, de imagem e achados cirurgicos.

Doença de Forestier: uma causa de disfagia a ser lembrada

Universidade Estadual Paulista “Julio de Mesquita Filho”, Botucatu, SP, Brazil.Corresponding author: Francisco Otavio Camargo Pereira − Distrito de Rubiao Junior, s/n − Zip code: 18618-970 − Botucatu, SP, Brazil − Phone: (55 14) 3880-1220 − E-mail: franotavio@hotmail.comReceived on: Oct 20, 2012 – Accepted on: Dec 2, 2013DOI: 10.1590/S1679-45082014AI2659

Isolated cortical vein thrombosis in a patient with sickle cell disease: Treatment with decompressive craniotomy and anticoagulation and literature review

Department of Neurology, Psychology and Psychiatry Botucatu Medical School Sao Paulo State University