Relato de Caso: Síndrome de Sneddon por Anticorposantifosfolipides / Sneddon's Syndrome by Antiphospholipid Antibodies: Case Report

Introdução: A Síndrome de Sneddon, descrita em 1965, caracteriza-se pela associação de eventos isquêmicos cerebrovasculares com livedo reticular. É rara e tem predomínio em mulheres jovens. Seus sintomas variam de ataques isquêmicos transitórios a acidentes vasculares cerebrais isquêmicos, causado pela obliteração de artérias de pequeno a médio porte, levando a alterações patológicas como a inflamação endotelial, posterior proliferação subintimal e então fibrose. A evolução é lenta e progressiva, podendo levar ao óbito ou incapacidade. Objetivos: descrever o caso de uma paciente com Síndrome de Sneddon que acompanha no Hospital Universitário Evangélico Mackenzie e revisar a literatura atual. Descrição do Caso: mulher, 37 anos conta história de quatro episódios de AVE isquêmico e um de AVE hemorrágico, tendo o primeiro sido aos 22 anos e resultando em afasia, convulsões e hemiparesia a D. Na investigação detectou-se hipertensão arterial, livedo reticularis, nódulos subcutâneos e anticardiolipinas positivas em altos títulos (acima de 100 U/mL), além de plaquetopenia (n=70.000/mm3). Uma ecocardiografia mostrou insuficiência mitral com vegetações em válvulas. A paciente tinha, também, alteração da função renal e uma biópsia mostrou lesão intersticial não imune. Com diagnóstico de síndrome de Sneddon secundária à sindrome do anticorpo antifosfolipide, (SAF) a paciente foi anticoagulada com cumarinicos e sua hipertensão foi controlada com losartana. A investigação para lúpus eritematoso sistêmico subjacente foi negativa Conclusão: SAF é uma das causas da Síndrome de Sneddon e deve ser lembrada toda vez que uma paciente jovem se apresentar com AVEs isquêmicos.

Background: Sneddon's syndrome, described in 1965, is characterized by the association of cerebrovascular ischemic events with livedo reticularis. It is rare and predominates in young women. Its symptoms range from transient ischemic attacks to ischemic strokes, caused by the obliteration of small to medium-sized arteries, leading to pathological changes such as endothelial inflammation, subsequent subintimal proliferation and then fibrosis. The evolution is slow and progressive, leading to death or disability. Aim: Describe the case of a patient with Sneddon Syndrome who is being followed up at Hospital Universitário Evangélico Mackenzie and review the current literature. Case description: A 37-year-old woman tells the story of four episodes of ischemic stroke and one of hemorrhagic stroke, the first being at 22 years of age and resulting in aphasia, seizures and hemiparesis to D. In the investigation, arterial hypertension, livedo reticularis, subcutaneous nodules and positive anticardiolipins in high titers (above 100 U / mL), in addition to thrombocytopenia (n = 70,000 / mm3). An echocardiography showed mitral insufficiency with valve vegetations. The patient also had impaired renal function and a biopsy showed a non-immune interstitial lesion. With a diagnosis of Sneddon's syndrome secondary to the antiphospholipid antibody syndrome (APS), the patient was anticoagulated with cumadinicos and her hypertension was controlled with losartan. The investigation for underlying systemic lupus erythematosus was negative. Conclusion: APS is one of the causes of Sneddon Syndrome and must be remembered whenever a young patient presents with ischemic strokes.

Caracterización demográfica y epidemiológica de aneurismas intracraneales en un hospital de Quito, Ecuado / Demographic and epidemiological characterization of intracranial aneurysms in a hospital in Quito, Ecuador

INTRODUCCIÓN. La ruptura aneurismática ha sido responsable de hasta el 85 % de hemorragia subaracnoidea de origen no traumático, lo que ha producido altas tasas de morbimortalidad y altos costos hospitalarios, el diagnóstico oportuno y detallado de la localización y el tamaño del aneurisma ha determinado el manejo adecuado del paciente, ya sea invasivo o expectante. OBJETIVO. Analizar el comportamiento de una serie de casos de aneurismas intracraneales rotos y no rotos en cuanto a tamaño, localización sexo y edad. MATERIALES Y MÉTODOS. Estudio retrospectivo de la historia clínica única del informe radiológico de 155 pacientes diagnosticados de aneurisma intracraneal por panangiografía cerebral con sustracción digital como gold estánda que mejoró la calidad de imagen, en el Hospital de Especialidades Carlos Andrade Marín, periodo enero del 2015 a agosto de 2018. RESULTADOS. De los 155 pacientes con un total de 204 aneurismas intracraneales de los cuales (122; 204), accidentados y (82; 204), no accidentados, el 72,0% se presentó en mujeres. Los mayores porcentajes de ruptura de acuerdo con su localización, fueron: arteria comunicante posterior 34,0 %, arteria cerebral media 26,0 % y arteria comunicante anterior 15,0%. En cuanto a los aneurismas no accidentados, las localizaciones más frecuente fueron: arteria cerebral media 33,0%, arteria comunicante posterior 23,0% y segmento termino carotideo 12,0%. El 65% de aneurismas presentó roturas con diámetros iguales o mayores a 5 mm. La edad promedio de diagnóstico fue 56 años rango; 17 ­ 90. CONCLUSIÓN. Analizando los porcentajes de comportamiento de ruptura en cuanto a tamaño y localización de nuestra cohorte y comparándola con las referidas en la bibliografía revisada se pudo concluir que el comportamiento de ruptura aneurismática fue distinto dependiendo de la región poblacional estudiada.

INTRODUCTION. Aneurysmal rupture has been responsible for up to 85% of subarachnoid hemorrhage of non-traumatic origin, which has produced high morbidity and mortality and high hospital costs, the timely diagnosis, the detail of the location and size of the aneurysm has been adequate, either invasive or expectant. OBJECTIVE. Analyze the behavior of a series of cases of broken and unruptured intracranial aneurysms in terms of size, location, sex and age. MATERIALS AND METHODS. Retrospective study of the unique clinical history of the radiological report of 155 patients diagnosed with intracranial aneurysm by brain panangiography with digital subtraction as a gold standard that improved image quality, at the Carlos Andrade Marín Specialties Hospital, January 2015 to August 2018. RESULTS. Of the 155 patients with a total of 204 intracranial aneurysms of which (122; 204), injured and (82; 204), not injured, 72,0% occurred in women. The highest rupture percentages according to their location were: posterior communicating artery 34,0%, middle cerebral artery 26,0% and anterior communicating artery 15,0%. As for non-accident aneurysms, the most frequent locations were: 33,0% mean brain artery, 23,0% posterior communicating artery and 12,0% carotid segment. 65,0% of aneurysms presented ruptures with diameters equal to or greater than 5 mm. The average age of diagnosis was 56 years range; 17 - 90. CONCLUSION. Analyzing the percentages of rupture behavior in terms of size and location of our cohort and comparing it with those referred in the reviewed bibliography, it was concluded that the behavior of aneurysmal rupture was different depending on the population region studied.

Orbitozygomatic craniotomy in three pieces: tips and tricks / Craniotomia orbitozigomática em três peças: dicas e truques

ABSTRACT Objective Didactically describe the orbitozygomatic craniotomy made in three pieces. Method This approach was performed, from 2002 to 2011, in 49 patients admitted at Beneficência Portuguesa of São Paulo Hospital. Results Twenty-seven patients had vascular lesions and twenty-two suffered for intracranial skull base tumors. The vascular lesions varied from cavernous angiomas inside the mesencephalum, high bifurcation basilar tip aneurysms, superior cerebellar arteries aneurysms and arteriovenous malformations in the interpeduncular cistern. Skull base tumors as meningiomas, interpeduncular hamartomas and third ventricle floor gliomas were among the neoplastic lesions approached. We had no permanent injuries and minimal transient complications had occurred. Conclusion It is a descriptive text, organized in the sequence of the main stages in which such a craniotomy is performed, describing in details the technique in which this group of evolutionarily authors came to accomplish the task.

RESUMO Objetivo Descrever didaticamente a craniotomia orbitozigomática realizada em três peças. Método Esse acesso foi realizado em 49 pacientes, de 2002 a 2011 em pacientes admitidos no Hospital Beneficência Portuguesa de São Paulo. Resultados Vinte e sete pacientes apresentavam lesões vasculares e vinte e dois sofriam de tumores da base do crânio. As lesões vasculares variaram entre angiomas cavernosos do mesencéfalo, aneurismas topo da artéria basilar com bifurcações altas, aneurismas da artéria cerebelas superior a malformações arteriovenosas na cisterna interpeduncular. Tumores da base do crânio como meningeomas, hamartomas interpedunculares e gliomas no assoalho do terceiro ventrículo estão entre as lesões neoplásicas abordadas. Nós não tivemos sequelas definitivas e tivemos mínimas complicações temporárias. Conclusão Trata-se de um texto descritivo, dividido conforme as principais etapas da realização desta craniotomia, o qual descreve com detalhes a técnica com que o presente grupo de autores evolutivamente veio a realizá-la.

Pretemporal craniotomy / Craniotomia pre temporal

This paper aims to describe the performance of the pretemporal craniotomy performed didactically from 2002 to 2012 in eighty patients. It is therefore a fundamentally descriptive text, organized in the sequence of the main stages in which such a craniotomy is performed, and describing in detail the technique with which this group of evolutionarily authors came to accomplish the task.

O presente artigo visa descrever de forma didática e prática a realização da craniotomia pré-temporal aplicada em oitenta pacientes de 2002 a 2012. Trata-se, portanto, de um texto fundamentalmente descritivo, dividido conforme as principais etapas da realização desta craniotomia, e que descreve com detalhes a técnica com que o presente grupo de autores evolutivamente veio a realizá-la.

Factores predictivos de la evolución en pacientes con lesiones intracraneales tratados por método estereotáctico en Camagüey / Predictive factors for the evolution in patients treated with stereotactic technique in Camagüey

El tratamiento de lesiones intracraneales mediante técnicas estereotácticas se ha incrementado en la actualidad como parte de las técnicas de mínima invasión. Objetivo: caracterizar el comportamiento de los pacientes tratados por este método. Método: se realizó un estudio analítico longitudinal y prospectivo en la sala de neurocirugía del Hospital Universitario Manuel Ascunce Domenech. El universo estuvo constituido por 110 pacientes sometidos a proceder estereotáctico desde febrero de 2007 hasta septiembre de 2010. La muestra de tipo no probabilístico, coincidió con el universo. Para la recolección de datos se confeccionó una encuesta y se utilizaron técnicas univariadas y multivariadas de procesamiento de datos. Resultados: predominaron pacientes masculinos entre 31 y 60 años con lesiones profundas de origen glial. Los factores que influyeron en la evolución fueron alteración de consciencia, hipertensión endocraneana y lesiones que desviaban la línea media. Conclusiones: se identificaron los factores que influyeron en la evolución de los pacientes.

The treatment of intracranial lesions by stereotactic techniques has increased today as part of minimal invasive surgical techniques. Objective: to characterize the behavior of patients treated by this method. Method: a longitudinal and prospective analytical study was conducted in the neurosurgical ward at the University Hospital Manuel Ascunce Domenech. The universe was made up of 110 patients subject to stereotactic procedure from February 2007 to September 2010. Non probabilistic-type sample was used and it coincided with the universe. A survey was made for data collecting, multivariate and univariate techniques of data processing were used. Results: male patients between 31 and 60 years old with deep lesions of glial origin prevailed. Factors that influenced in the evolution of patients were consciousness disturbances, endocranial hypertension and midline shift lesions. Conclusions: factors that influenced in the evolution of patients were identified.

Arterial ischemic stroke in children--recent advances.

Childhood stroke syndromes are an important cause of mortality and morbidity. This paper focuses on the recent advances in arterial ischaemic stroke beyond the neonatal period. Vascular risk factors are identified in the majority of children and guide both acute and longer term treatments, as well as determining prognosis. Contrary to popular belief many children have residual impairments encompassing a wide range of domains. National and international collaborations are facilitating an increase in the understanding of childhood stroke and have the eventual aim of conducting trials of potential therapeutic interventions.

Prevalence and risk factors of asymptomatic intracranial vascular stenosis in patients with essential hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>The aim of the study was to determine the prevalence and the distribution pattern of lesion site of intracranial vascular stenosis and to identify risk factors for the stenosis in patients with essential hypertension.</p><p><b>METHODS</b>A total of 231 consecutive inpatients with essential hypertension were included in this study. Patients with the history of cerebrovascular diseases and relevant neurological symptoms were excluded. Intracranial vascular stenosis (>50% diameter reduction) was detected using CT angiography (CTA).</p><p><b>RESULTS</b>Of 231 patients, 69 (29.87%) had intracranial artery stenosis. The most common stenosis site is middle cerebral artery (43.69%), followed by carotid siphon (20.39%). The stenosis in internal carotid arterial system (78.64%) was more common than in vertebrobasilar arterial system (21.56%, P < 0.05). The patients with intracranial vascular stenosis were older, had longer history of hypertension, higher levels of systolic blood pressure, higher plasma cholesterol, higher LDL-C. Lp (a), higher urinary microalbumin excretion, thicker ventricular septum, and lower levels of HDL-C than the patients without stenosis. Logistic analysis showed that systolic blood pressure (OR 1.650, 95% CI 1.134 - 2.400, P = 0.023), course of hypertension (OR 1.238, 95% CI 1.072 - 1.429, P = 0.006), LDL-C (OR 2.103, 95% CI 1.157 - 3.823, P = 0.014) and type 2 diabetes (OR 2.325, 95% CI 1.161 - 4.341, P = 0.011) were the independent risk factors of asymptomatic intracranial arterial stenosis.</p><p><b>CONCLUSIONS</b>Nearly 30% inpatients with essential hypertension had asymptomatic intracranial artery stenosis. The most common site of stenosis was middle cerebral artery. Hypertension, dyslipidemia and diabetes were risk factors for the development of intracranial arterial stenosis.</p>

Safety and short-term results of stent-assisted angioplasty for the treatment of intracranial arterial stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and short-term outcome of endovascular stent-assisted angioplasty for the treatment of intracranial arterial stenosis.</p><p><b>METHODS</b>Angioplasty and stent placement were administered to treat 46 patients with lesions of atherosclerotic intracranial stenosis, including 16 lesions of basilar artery, 12 of vertebral artery, 13 of internal carotid artery and 9 of middle cerebral artery.</p><p><b>RESULTS</b>Technical success was achieved in 49 of 50 vessels (98%), with no procedure-related death or cerebral ischemic attack. Extracranial internal carotid artery dissection occurred in 1 patient and was successfully treated with a self-expand stent. One patient had subarachnoid hemorrhage because of perforation by microwire with no permanent neurologic deficit, and another 2 patients had groin hematoma. Angiographic examination immediately after stenting revealed that the stenosis rate was significantly reduced (72.4% +/- 12.3% vs 10.6% +/- 7.8%). There was no cerebral ischemic attack in the 37 patients who were clinically followed up (6 - 18 months, mean of 8.5 months).</p><p><b>CONCLUSION</b>Angioplasty and stenting for the treatment of intracranial stenosis is safe and feasible, and it may be favorable for decreasing the incidence of ischemic attack.</p>

A systematic study of the brain base arteries in the pampas fox (dusicyon gymnocercus)

Thirty epecimens of the pampas fox (Dusicyon gymnocercus) were injected with Neoprene latex to study the distribution of the internal carotid and vertebral arteries, and their derived vessels, on the ventral surface of the brain. The internal carotid artery and ist rostral and caudal branches were single on both sides in all cases, as was the right middlle cerebal artery; the corresponding left artery was single in 96.7 por cento of the cases and double in 3.3 por cento. The right rostral cerebral artery was single in all cases, and single (96.7 por cento)or absent (3.3 por cento) on the left. The rostral communicating artery was present in 96.7 por cento and absent in 3.3 por cento while the right caudal cerebal artery was sigle in 86.7 por cento and doublein 13.3 por cento but only single on the left. The basilar arterywas single in all cases. The cerebal arterial circle was closed rostrally in 96.7 por cento of the cases and pen in 3.3 por cento but was closed caudally in all animals. The encephalon blood supply was derived principally from the carotid system, but also from the complementary vertebral-basilar system.

The causes and some recommendations to reduce the occurences of residues following intracranial aneurysm clipping

3 cases of intracranial aneurismal residue following clipping at Viet Duc Hospital were studied. The causes of this condition were anatomical and technical. It is necessary to identified prior surgery the cause of hemorrhage, to limit the disruption of aneurism, to expose entirely the neck of aneurism before the setting of clip and to explore throughly the place of clip- Anterigraphy or systematic Xray control should be made for checking the results

Investigación del Diagnóstico de las Enfermedades Encefalicas de los Niños a Traves de Ultrasonidos

El ultrasonido es una técnica de diagnóstico excelente para detectar lesiones del parénquima cerebral... (UD)

Síndrome de Sneddon: relato de um caso e revisão da literatura / Sneddon's syndrome: a case report and revision onf literature

A síndrome de Sneddon caracteriza-se pela associação de livedo racemoso e lesões vasculares cerebrais, podendo acometer outros órgãos internos. Afeta artérias de pequeno e médio calibre da derme profunda e o tecido celular subcutâneo superior, iniciando o processo por uma inflamação do endotélio, que evolui com oclusão, fibrose e atrofia dos vasos. Em alguns casos foi relatada a ocorrência de anticorpos antifostolipídeos. sua evolução é lenta e progressiva, e não há tratamento reconhecidamente efetivo, Relatamos um caso dessa síndrome em uma paciente de 48 anos, em que não foram detectados anticorpos antifosfolipídeos

Biopsia estereotáctica guiada por computadora para lesiones intracraneales: evaluación de su seguridad y eficacia / Computer-guided stereotactic biopsy for intracranial lesions: evaluation of its safety and efficacy

La neurocirugía estereotáctica guiada por imágenes ha venido a mejorar las estrategias de manejo de las lesiones intracraneales. En el presente trabajo hacemos una evaluación de los resultados en una muestra de 64 pacientes operados con esta técnica en el Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez en México D.F.(INNN-MUS). Setenta y cuatro pacientes que fueron sometidos a neurocirugía esteretáctica guiada por imágenes entre 1994 y 1997 fueron revisados...