ABSTRACT
Fazemos breve revisäo das bases anatômicas e fisiopatológicas da síndrome do túnel do carpo, seu tratamento cirúrgico e suas complicaçöes. Relatamos os casos de duas pacientes que desenvolveram alteraçöes simpáticas como edema da mäo e problemas vasculares (fenômeno de Raynaud) para as quais ensaiamos uma explicaçäo, por nós denominada "denervaçäo, coincidindo com a retirada da imobilizaçäo do punho no 22§ dia pós-operatório
Subject(s)
Humans , Female , Middle Aged , Carpal Tunnel Syndrome/physiopathology , Retrospective Studies , Carpal Tunnel Syndrome/surgery , Carpal Tunnel Syndrome/complicationsABSTRACT
A ocorrência de meningiomas císticos é incomum. As imagens destas lesöes obtidas pela tomografia computadorizada de crânio (TC) podem lembrar lesäo cística de origem glial ou metastática, sendo necessário realizarmos, além da TC, angiografia cerebral e ressonância magnética do crânio para firmarmos diagnóstico correto pré-operatório. O diagnóstico incorreto de glioma pode resultar em tratamento paliativo, ao invés da remoçäo radical desta neoplasia potencialmente curável. Três casos säo relatados, ilustrando o problema
Subject(s)
Humans , Male , Female , Child , Middle Aged , Meningioma , Meningeal Neoplasms , Aged, 80 and over , Diagnosis, Differential , Tomography, X-Ray ComputedABSTRACT
Trata-se do relato do caso de paciente do sexo feminino, com 39 anos, politraumatizada, que desenvolveu quadro de diabetes insipidus. A paciente faleceu onze dias após sua internaçäo, período em que foram realizadas tomografia computadorizada e ressonância magnética, evidenciando lesöes hipotalâmicas características. Estes fatos nos estimularam revisar a literatura e chamar a atençäo para prevençäo de síndromes endócrinas que podem acometer secundária e tardiamente pacientes vítimas de traumatismo crânio-encefálico e que, se diagnosticadas e tratadas de maneira precoce, podem ter sua morbidade diminuída
Subject(s)
Humans , Female , Adult , Brain Injuries/complications , Diabetes Insipidus/etiology , Brain Injuries/diagnosis , Magnetic Resonance Spectroscopy , Tomography, X-Ray ComputedABSTRACT
Os autores relatam dois casos de presença de ar livre em hematoma extradural agudo. Trata-se de achado radiológico näo incomúm, mas que tem sido relatado infrequentemente na literatura
Subject(s)
Humans , Male , Child , Adult , Air , Brain Diseases , Hematoma , Brain Diseases/etiology , Hematoma/etiology , Skull Fractures/complications , Temporal Bone/injuries , Tomography, X-Ray ComputedABSTRACT
The clinical aspects of the meningiomas are well described. However, there is an important number of reports on a variety of other lesions simulating meningioma, including the prostate cancer. The authors describe one additional patient with prostate cancer who at presentation had clinical and radiographic signs suggesting meningioma. The literature on the subject is reviewed and summarized.
Subject(s)
Humans , Male , Aged , Adenocarcinoma , Brain Neoplasms , Prostatic Neoplasms/pathology , Adenocarcinoma , Brain Neoplasms , Cerebral Angiography , Craniotomy , Diagnosis, Differential , Meningioma , Tomography, X-Ray ComputedABSTRACT
Multiple intracranial meningiomas (MIM) may be a specific pathological entity. In general these lesions are associated with neurofibromatosis. The classical clinical picture of neurofibromatosis, as described by von Recklinghausen, may not necessarily be associated with MIM. This possibility is a direct result of the variable penetrability of chromosomic aberrations connected with the chromosome 22. Molecular studies of these tumors confirmed this finding. In our series of 108 patients with intracranial meningiomas only three cases were multiple. In only one of them external stigmata of von Recklinghausen's disease were detected. In the absence of skin manifestations of neurofibromatosis in patients with MIM it is very difficult to diagnosis von Recklinghausen's disease, and the so called "true multiple meningiomas". The authors believe that there are no justificative findings to consider MIM as an independent pathological entity.
Subject(s)
Humans , Male , Female , Middle Aged , Meningioma , Meningeal Neoplasms/pathology , Neurofibromatoses , Meningioma , Meningeal Neoplasms/surgeryABSTRACT
Hematomas of the posterior fossa are an uncommon complication of head injury. Almost invariably they occur after trauma of the occiput, and are associated with skull fracture. Their diagnosis and management have been greatly improved by CT scanning. In the present series, the majority of patients had acute evolution indicating the potential hazard of conservative treatment. Our results (29% mortality) are similar to those previously reported in other series.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adult , Brain Injuries , Hematoma, Epidural, Cranial , Brain Injuries , Cranial Fossa, Posterior , Craniotomy , Glasgow Coma Scale , Hematoma, Epidural, Cranial , Tomography, X-Ray ComputedABSTRACT
A selective review of the current methods of pain measurement and validation (psychophysical methods, verbal and analogical scales, psychological tests) is presented with emphasis on patient selection for surgical pain relief, and analysis of outcome. The identification of hemogeneous groups of patients with clinical and research objectives is prevented by the lack of a reliable pain scale, based on the assessment of objective and comprehensive parameters. This obstacle seems to be inherent to the complex nature of human pain experience. Psychiatric examination has proved important to alucidate to operative indications, particularly in cases of non-malignant obscure neuralgias. The importance of separate validation of the pain compliant and the psychiatric assessment is stressed. A critical comment is made on Hitchcock's pain scale and Lindqvist's psychiatric classification of candidates for surgery
Subject(s)
Humans , Pain , Pain Measurement/methods , Neurosurgery , Pain Measurement/classification , Pain Measurement/psychology , Pain/etiology , Pain/psychology , Pain/surgeryABSTRACT
Relato de caso de neuroblastoma periférico em paciente adulto, com 39 anos de idade, do sexo masculino. O tumor de localizaçäo retroperitoneal, acometeu o plexo lombossacral esquerdo. Os primeiros sintomas foram de lombociatalgia, progredindo com monoparesia crural pronunciada e dor incapacitante. Säo descritas as características histológicas dessa neoplasia rara na idade adulta, incluindo estudo imuno-histoquímico e microscopia eletrônica, bem como a técnica cirúrgica empregada para sua ressecçäo (via posterior) transglutea, sendo a cavidade pélvica alcancada atravéz do forame isquiático maior). Os neuroblastomas devem ser considerados no diagnóstico diferencial do chamdo grupo histológico dos tumores malignos de células pequenas, mesmo em se tratando de pacientes adultos
Subject(s)
Adult , Humans , Male , Neuroblastoma/diagnosis , Peripheral Nervous System Neoplasms/diagnosis , Neuroblastoma/pathology , Peripheral Nervous System Neoplasms/pathology , Tomography, X-Ray ComputedABSTRACT
Cistos aracnóideos representam displasia mesodérmica focal (do neurotélio subdural), sendo sua apresentaçäo clínica decorrente de seu tamanho e localizaçäo. No presente caso, um fibrossarcoma originou-se de cisto aracnóideo supratentorial verificado em cirurgia cinco anos antes. A malignizaçäo de cistos aracnóideos deve ser muito rara, e esse é provavelmente o primeiro caso relatado na literatura
Subject(s)
Infant , Humans , Male , Arachnoid , Brain Injuries/complications , Cysts/etiology , Fibrosarcoma/pathology , Meningeal Neoplasms/pathology , Cell Transformation, NeoplasticABSTRACT
A hipótese de que embriöes cisticereóticos possam alcançar os espaços subaracnóideos espinhais por migraçäo descendente a partir de espaços intraxcranianos previamente infestados näo é compatível ao acometimento leptomeningeo espinhal primário, que observamos em duas pacientes. É sugerido que nesses casos os embriöes invadem o sistema nervoso central através do fluxo sangüíneo retrógrado pelo plexo venoso vertebral interno e veias intervertebrais, e que o compartimento intracraniano do líqüido cefalorraqueano possa ser secundariamente invadido pelos cisticercos