Sérgio Mazer

Clinical, radiological and cerebrospinal fluid presentation of neurocysticercosis: a prospective study.

The wide clinical spectrum of neurocysticercosis has led to many attempts at clinical, radiological, CSF and other classifications. Based on an objective review of the relevant literature and on a prospective study of 42 patients with active neurocysticercosis, a new classification is proposed, based on clinical, tomographic, magnetic resonance and CSF evidence of viability of cysts. The first step is to define whether the disease is active or not. Inactive disease may be parenchymal calcifications or hydrocephalus. Active disease may be intraparenchymal, extraparenchymal or mixed. Statistical analysis of 42 cases with active disease shows intraparenchymal disease to occur in younger patients, perhaps more frequently in females, and to have a better prognosis than extraparenchymal of mixed disease. The latter appears to have the worst prognosis. Therapeutic implications are that only active disease warrants etiological therapy. There remain doubts about the best therapy for some infrequent subtypes of extraparenchymal and mixed disease.

The computed tomographic spectrum of cerebral cysticercosis

The main findings observed in computed tomography (CT) of the brain of 116 patients with cerebral cysticercosis are reviewed. Calcifications, cysts, nodules, hydrocephalus and inflammatory reactions are better detected by CT than through the use of any of the conventional neuroradiologic procedures, and surgical cases are more properly selected.

Neurofibromatose e doença arterial oclusiva intracraniana extensa (doença de Moya-Moya): registro de um caso

A 33-year-old female with neurofibromatosis and intracranial vascular lesions of the Moya-Moya type is reported. Clinical and angiographic aspects of both syndromes are discussed with respect to earlier reports of this rare association, with the conclusion that it produces slow intellectual and motor deterioration in adolescents or young adults. There are no specific guidelines to therapy, and the prognosis is mixed, some patients ceasing to progress at least for a few years.A 33-year-old female with neurofibromatosis and intracranial vascular lesions of the Moya-Moya type is reported. Clinical and angiographic aspects of both syndromes are discussed with respect to earlier reports of this rare association, with the conclusion that it produces slow intelectual and motor deterioration in adolescents or young adults. There are no specific guidelines to therapy, and the prognosis is mixed, some patients ceasing to progress at least for a few years.A 33-year-old female with neurofibromatosis and intracranial vascular lesions of the Moya-Moya type is reported. Clinical and angiographic aspects of both syndromes are discussed with respect to earlier reports of this rare association, with the conclusion that it produces slow intelectual and motor deterioration in adolescents or young adults. There are no specific guidelines to therapy, and the prognosis is mixed, some patients ceasing to progress at least for a few years.

Pseudo-aneurismas: relato de dois casos e revisão da literatura

Pseudo-aneurismas sao uma afeccao arterial rara. Os autores destacam a raridade da ocorrencia de pseudo-aneurisma da arteria carotida comum pos-traumatico e a associacao de pseudo-aneurisma com osteocondroma femoral. Enfatizam a importância dos metodos por imagem, em especial a angiotomografia, no diagnostico de afeccoes vasculares, como na ocorrencia de pseudo-aneurismas. Realizam, ainda, revisao bibliografica pertinente ao assunto.

Análises visual e volumétrica por ressonância magnética das formações hipocampais em um grupo de pacientes com diagnóstico clínico de epilepsia do lobo temporal

The purpose of this study is to test the sensitivity of the volumetric analysis compared to the visual analysis of the hippocampal formations of a group of 153 patients with clinical diagnosis of temporal lobe epilepsy and candidates to temporal lobectomy, evaluated by magnetic resonance (MR), using a 0.5 Tesla machine and inversion-recovery T1-weighted images and 5 mm coronal slices. There was agreement between the prospective visual analysis and another retrospective visual analysis carried out by two independent observers (C=0.748 and C=0.720). There was also agreement between the retrospective analysis of the two investigators (C=0.733). There was genuine agreement (C=0.788) between the results of the qualitative and quantitative analyses carried out prospectively. Volume measurements showed a nonsignificant tendency to lateralize more cases of clinically presumed hippocampal atrophy. Our results confirm the reliability of a qualitative visual analysis and indicate the utility of hippocampal volumetry as a supplementar, objective and quantitative measure of hippocampal sclerosis.The purpose of this study is to test the sensitivity of the volumetric analysis compared to the visual analysis of the hippocampal formations of a group of 153 patients with clinical diagnosis of temporal lobe epilepsy and candidates to temporal lobectomy, evaluated by magnetic resonance (MR), using a 0.5 Tesla machine and inversion-recovery T1-weighted images and 5 mm coronal slices. There was agreement between the prospective visual analysis and another retrospective visual analysis carried out by two independent observers (C=0.748 and C=0.720). There was also agreement between the retrospective analysis of the two investigators (C=0.733). There was genuine agreement (C=0.788) between the results of the qualitative and quantitative analyses carried out prospectively. Volume measurements showed a nonsignificant tendency to lateralize more cases of clinically presumed hippocampal atrophy. Our results confirm the reliability of a qualitative visual analysis and indicate the utility of hippocampal volumetry as a supplementar, objective and quantitative measure of hippocampal sclerosis.

Alça da artéria pulmonar: relato de dois casos e revisão da literatura

The authors report two cases of pulmonary artery sling diagnosed by three-dimensional reconstruction of images of the tracheobronchial tree and the esophagus acquired using magnetic resonance imaging or helical computer tomography. The typical clinical findings of this congenital abnormality, which may not be as rare as previously believed, include those related to severe tracheobronchial obstruction, although asymptomatic or mild symptomatic cases have been reported. Early diagnosis of this anomaly is extremely important, since in most cases immediate surgical correction is indicated due to its high lethality. The use of three-dimensional reconstruction allows simultaneous identification of the associated tracheobronchial and cardiovascular malformations, in addition to a clear visualization of the anomaly. Thus, the diagnosis can usually be established non-invasively, avoiding the use of the selective angiocardiography, considered the gold-standard.

Gemelidade imperfeita: avaliação pelos métodos de imagem

Conjoined twins are rare malformations and a challenge for both radiologists and pediatric surgeons. Antenatal evaluation is essential for the identification of anatomic fusions and other associated abnormalities, which will enable an adequate surgical planning and the assessment of fetal prognosis. The authors present the clinical and imaging findings of thoracopagus twins, joined by the anterior portion of the thorax, sharing the heart and the liver. Diagnosis was made by ultrasonography and confirmed with fetal magnetic resonance imaging.

Simple and safe heparin regimen for acute ischaemia

The risk/benefit ratio of acute anticoagulation in ischaemic cerebro-vascular disease is not clearly established. A simple and safe intermittent intravenous heparin regimen (20000 IU daily) was used prospectively in 50 patients of 57 +/- 14 (m +/- sd) years of age whose blood pressures ranged from normal to severe hypertension. Twenty-two patients had cardiogenic embolism and the remaining had recurrent severe transient ischaemic attacks of recent onset or progressive cerebral infarcts. Time of exposure to heparin was 6.4 +/- 4 (m +/- sd) days. Two patients had recurrences of cerebral thromboembolism and none had bleeding complications. This is a safe and efficient method of anticoagulation for patients with cerebral ischaemia when continuous infusion of heparin or close monitoring of clotting times are not used routinely.