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1.
Edumecentro ; 13(2): 6-18, abr.-jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1286238

ABSTRACT

RESUMEN Fundamento: el trabajo independiente se fortalece con el uso de medios de enseñanza, entre ellos, los mapas mentales. Objetivo: confeccionar mapas mentales sobre las configuraciones externa e interna del tronco encefálico para contribuir a la dirección del trabajo independiente desde la disciplina Morfofisiología, utilizando la tecnología móvil. Métodos: se realizó una investigación de desarrollo tecnológico en la Facultad de Estomatología de la Universidad Médica de Pinar del Río, durante el curso 2019-2020. Se utilizaron métodos teóricos: análisis-síntesis y abstracción-concreción; y empíricos: cuestionario y análisis documental para la fundamentación y recogida de información. Los mapas mentales fueron diseñados utilizando la aplicación para Android, Mindomo versión 3.0.15. Resultados: se confeccionaron los mapas mentales que permitieron representar gráficamente los contenidos relacionados con la configuración externa e interna del tronco encefálico, constituido por modelos tridimensionales y apoyados en la tecnología móvil. Conclusiones: fueron valorados por criterio de especialistas quienes consideraron como adecuadas su pertinencia, la factibilidad de aplicación del producto, y su utilidad para perfeccionar el trabajo independiente en la disciplina Morfofisiología.


ABSTRACT Background: independent work is strengthened with the use of teaching aids, including mind maps. Objective: to make mental maps on the external and internal configurations of the brain stem to contribute to the direction of independent work from the Morphology-physiology discipline, using mobile technology. Methods: a technological development investigation was carried out at Pinar del Río Faculty of Dentistry of the Medical University, during the 2019-2020 academic year. Theoretical methods were used: analysis-synthesis and abstraction-concretion; and empirical ones: questionnaire and documentary analysis for the foundation and collection of information. The mind maps were designed using the Mindomo version 3.0.15 application for Android. Results: mental maps were made that allowed to graphically represent the contents related to the external and internal configuration of the brainstem, made up of three-dimensional models and supported by mobile technology. Conclusions: their relevance, the feasibility of applying the product, and its usefulness to improve independent work in the Morphology-physiology discipline were evaluated by the criteria of specialists who considered them adequate.


Subject(s)
Students, Medical , Computer Communication Networks , Medical Informatics Applications , Brain Stem
2.
Acta cir. bras ; 36(12): e361206, 2021. graf
Article in English | LILACS, VETINDEX | ID: biblio-1355568

ABSTRACT

ABSTRACT Purpose: To evaluate whether the pigeon (Columba livia) is a good model for evaluating the vestibular system involved with postural maintenance during movement. Methods: This study maps the brainstem targets of the horizontal ampullary inputs from the vestibular periphery of the pigeon. We used biotin dextran amine (BDA) injection in horizontal semicircular canal (HSCC), immunohistochemistry for GluR2/3 and GluR4 AMPA and computerized histomorphology reconstruction. Results: Our results show the same distribution pattern with ipsilateral projections to vestibular nuclear complex (VNC) from the HSCC, with the majority of labeled fibers being, long, thin, with few varicosities and many ramifications. Horizontal semicircular canal projections achieve neurons belonging to all nuclei of the VNC with exception of dorsal portion of lateral vestibular nucleus and this area express GluR2/3 and GluR4 AMPA receptors reinforcing the idea of glutamate participation in these connections. Conclusions: Pigeon is an appropriated experimental model to study of projections of HSCC and reinforcing the information that the vestibular system has strong relation with the fast responses necessary for postural control. Moreover, its phylogenetic organization apparently conservation, also seems to be a fundamental characteristic for vertebrates.


Subject(s)
Animals , Columbidae , Vestibule, Labyrinth , Phylogeny , Brain Stem , Semicircular Canals , alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid , Vestibular System
3.
Braz. j. med. biol. res ; 54(8): e11335, 2021. tab, graf
Article in English | LILACS | ID: biblio-1285674

ABSTRACT

Stereotactic biopsies for lesions in the brainstem and deep brain are rare. This study aimed to summarize our 6-year experience in the accurate diagnosis of lesions in the brain stem and deep brain and to discuss the technical note and strategies. From December 2011 to January 2018, 72 cases of intracranial lesions in the brainstem or deep in the lobes undergoing stereotactic biopsy were retrospectively reviewed. An individualized puncture path was designed based on the lesion's location and the image characteristics. The most common biopsy targets were deep in the lobes (43 cases, 59.7%), including frontal lobe (33 cases, 45.8%), temporal lobe (4 cases, 5.6%), parietal lobe (3 cases, 4.2%), and occipital lobe (3 cases, 4.2 %). There were 12 cases (16.7%) of the brainstem, including 8 cases (11.1%) of midbrain, and 4 cases (5.6%) of pons or brachium pontis. Other targets included internal capsule (2 cases, 2.8%), thalamus (3 cases, 4.2%), and basal ganglion (12 cases, 16.7%). As for complications, one patient developed acute intracerebral hemorrhage in the biopsy area at 2 h post-operation, and one patient had delayed intracerebral hemorrhage at 7 days post-operation. The remaining patients recovered well after surgery. There was no surgery-related death. The CT-MRI-guided stereotactic biopsy of lesions in the brainstem or deep in the brain has the advantages of high safety, accurate diagnosis, and low incidence of complications. It plays a crucial role in the diagnosis of atypical, microscopic, diffuse, multiple, and refractory lesions.


Subject(s)
Humans , Brain/diagnostic imaging , Stereotaxic Techniques , Biopsy , Brain Stem/diagnostic imaging , Retrospective Studies , Image-Guided Biopsy
5.
Rev. chil. neuro-psiquiatr ; 58(2): 161-170, jun. 2020.
Article in Spanish | LILACS | ID: biblio-1115481

ABSTRACT

Resumen El espectro de Neuromielitis óptica (NMOSD por su sigla en inglés) corresponde a un conjunto de manifestaciones clínicas derivadas de un proceso inflamatorio y desmielinizante del sistema nervioso central, que causa lesiones primariamente en la médula espinal y nervios ópticos, pero también en otras regiones como tronco encefálico, diencéfalo o áreas cerebrales específicas. La mayoría de los pacientes con NMOSD son seropositivos para autoanticuerpos contra AQP4, el principal canal de agua de los astrocitos, sin embargo, existe un porcentaje no despreciable de pacientes, cercano al 25%, quienes son seronegativos para estos anticuerpos y en quienes la presencia de anticuerpos dirigidos contra mielina (anti-MOG) podrían tener un rol patogénico, el cual a la fecha no ha sido bien dilucidado. La evidencia científica actual, ha permitido reconocer que AQP4-IgG es patogénico en NMOSD, probablemente por un mecanismo que involucra citotoxicidad celular dependiente de la activación del complemento, generando infiltración leucocitaria, liberación de citokinas y disrupción de la barrera hemato-encefálica, lo cual lleva a muerte de oligodendrocitos, pérdida de mielina y muerte neuronal. Este artículo presenta una revisión basada en la evidencia, la cual enfatiza los principales aspectos de la patogénesis de NMOSD.


Neuromyelitis Optica Spectrum Disorders (NMOSD) is a set of clinical manifestations derived from an inflammatory and demyelinating process of the central nervous system that causes lesions primarily in spinal cord and optic nerves but also in other regions such as brainstem, diencephalon or specific brain areas. Most patients with NMOSD are seropositive for autoantibodies against AQP4, the major water channel of astrocytes, however there is a non-negligible percentage of patients, close to 25%, who are seronegative for these antibodies and in whom the presence of antibodies directed against myelin (anti-MOG) could have a pathogenic role that to date has not been well elucidated. Current scientific evidence has allowed recognize that AQP4-IgG is pathogenic in NMOSD, probably by a mechanism involving complement dependent cellular cytotoxicity, causing leucocyte infiltration, cytokine release and blood-brain barrier disruption, which leads to oligodendrocyte death, myelin loss and neuron death. This article presents an evidence-based review, which emphasizes the main aspects in NMOSD pathogenesis.


Subject(s)
Humans , Optic Nerve , Brain , Brain Stem , Central Nervous System , Neuromyelitis Optica
6.
Arq. neuropsiquiatr ; 78(2): 63-69, Feb. 2020. tab
Article in English | LILACS | ID: biblio-1089001

ABSTRACT

Abstract Objective: Investigate the auditory pathway in the brainstem of children with acute lymphoblastic leukemia submitted to chemotherapy (by intravenous or intrathecal infusion). Methods: Fourteen children aged between 2 and 12 years with diagnosis of acute lymphoid leukemia were evaluated. The following procedures were used: meatoscopy, acoustic immitance measurements, tonal audiometry, vocal audiometry, transient otoacoustic emissions, and auditory brainstem response. Results: From the 14 children with normal auditory thresholds, 35.71% showed an alteration in auditory brainstem response, with a predominance of hearing impairment in the lower brainstem. It was found that 80% of the children with alteration had used intrathecal methotrexate less than 30 days and that 40% had the highest cumulative intravenous methotrexate doses. Conclusion: Children with acute lymphoblastic leukemia submitted to chemotherapy, present auditory pathway impairment in the brainstem, with a predominance of a low brainstem.


Resumo Objetivo: Investigar a via auditiva em tronco encefálico de crianças com leucemia linfoide aguda submetidas à quimioterapia (por infusão intravenosa ou por via intratecal). Métodos: Foram avaliadas 14 crianças com idade entre 2 e 12 anos, com diagnóstico de leucemia linfoide aguda. Foram utilizados os seguintes procedimentos: meatoscopia, medidas de imitância acústica, audiometria tonal, audiometria vocal, emissões otoacústicas transientes e potencial evocado auditivo de tronco encefálico. Resultados: Das 14 crianças com limiares auditivos normais, 35,71% demonstraram alteração no Potencial Evocado Auditivo de Tronco Encefálico, com predomínio de comprometimento de via auditiva em tronco encefálico baixo. Verificou-se que 80% das crianças com alteração haviam feito uso do metotrexato via intratecal a menos de 30 dias e que 40% tinham as maiores doses acumulativas de metotrexato por via endovenosa. Conclusão: Crianças com leucemia linfoide aguda submetidas à quimioterapia apresentam comprometimento na via auditiva em tronco encefálico, com predomínio em tronco encefálico baixo.


Subject(s)
Humans , Child, Preschool , Child , Otoacoustic Emissions, Spontaneous , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Auditory Pathways , Auditory Threshold , Brain Stem , Methotrexate , Evoked Potentials, Auditory, Brain Stem
7.
Braz. j. med. biol. res ; 53(5): e9162, 2020. tab, graf
Article in English | LILACS | ID: biblio-1098111

ABSTRACT

In this study, we aimed to explore the relationship among miR-22, deep cerebral microbleeds (CMBs), and post-stroke depression (PSD) 1 month after ischemic stroke. We consecutively recruited 257 patients with first-ever and recurrent acute cerebral infarction and performed PSD diagnosis in accordance with the Diagnostic and Statistical Manual IV criteria for depression. Clinical information, assessments of stroke severity, and imaging data were recorded on admission. We further detected plasma miR-22 using quantitative PCR and analyzed the relationship among miR-22, clinical data, and PSD using SPSS 23.0 software. Logistic regression showed that deep (OR=1.845, 95%CI: 1.006-3.386, P=0.047) and brain stem CMBs (OR=2.652, 95%CI: 1.110-6.921, P=0.040), as well as plasma miR-22 levels (OR=2.094, 95%CI: 1.066-4.115, P=0.032) were independent risk factors for PSD. In addition, there were significant differences in baseline National Institutes of Health Stroke Scale scores (OR=1.881, 95%CI: 1.180-3.011, P=0.007) and Widowhood scores (OR=1.903, 95%CI: 1.182-3.063, P=0.012). Analysis of the receiver operating curve (AUC=0.723, 95%CI: 0.562-0.883, P=0.016) revealed that miR-22 could predict PSD one month after ischemic stroke. Furthermore, plasma miR-22 levels in brainstem and deep CMBs patients showed an upward trend (P=0.028) relative to the others. Patients with acute ischemic stroke, having brainstem and deep cerebral microbleeds, or a higher plasma miR-22 were more likely to develop PSD. These findings indicate that miR-22 might be involved in cerebral microvascular impairment and post-stroke depression.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cerebral Hemorrhage/psychology , Brain Infarction/psychology , MicroRNAs/metabolism , Depression/psychology , Brief Psychiatric Rating Scale , Recurrence , Socioeconomic Factors , Severity of Illness Index , Brain Stem/blood supply , Magnetic Resonance Imaging , Biomarkers/metabolism , Cerebral Hemorrhage/metabolism , Acute Disease , Risk Factors , Depression/metabolism
8.
Rev. argent. neurocir ; 33(4): 195-201, dic. 2019. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1152275

ABSTRACT

Introducción: Las "zonas de entrada seguras" (ZES) al tronco cerebral describen accesos destinados a preservar estructuras críticas. La mayoría de las publicaciones son descripciones anatómicas; existiendo pocas sobre su aplicación. En este escenario, nuestro trabajo puede sumar información para el manejo quirúrgico en casos seleccionados. Material y Métodos: De una serie de 13 pacientes, se presentan 9 que no eran candidatos para biopsia estereotáctica y recibieron microcirugía. Las localizaciones fueron: mesencéfalo (3), tectum (1), protuberancia (2) y bulbo (3). Cinco pacientes tuvieron KPS => 70; y 4, KPS <70. Diferentes ZES fueron utilizadas según la topografía lesional. El grado de resección se basó en la biopsia intraoperatoria y el monitoreo neurofisiológico. Resultados: Los hallazgos patológicos fueron: astrocitoma pilocítico (1), glioma de bajo grado (1), hemangioblastoma (1), subependimoma (1), disgerminoma (1), y lesiones pseudotumorales (3 cavernomas y 1 pseudotumor inflamatorio). El grado de resección fue completo (4), subtotal (3), y biopsia fue considerada suficiente en (2). Un paciente falleció en el postoperatorio. Discusión: Las lesiones del tronco cerebral son infrecuentes en adultos. Las controversias surgen cuando se balancean los beneficios de obtener diagnóstico histopatológico y los riesgos potenciales de procedimientos invasivos. La amplia variedad de hallazgos en esta localización exige una precisa definición histopatológica, que no solamente determinará la terapéutica adecuada, sino que advierte sobre las consecuencias potencialmente catastróficas de los tratamientos empíricos. Las ZES ofrecen un acceso posible y seguro, aunque es más realista considerarlas como áreas para abordar lesiones intrínsecas con baja morbilidad más que como zonas completamente seguras


Introduction: The "safe entry zones" (SEZ) to the brainstem are special entrances described to preserve critical structures. Most publications correspond to anatomic research; few papers report their application in surgery. In this scenario, our report could add information to the surgical management in selected cases. Material and Methods: Out of a series of 13 patients, 9 were non-candidates for stereotactic biopsy and received microsurgery. Localizations of the lesions were: mesencephalus (3), tectal plate (1), pons (2) and medulla oblongata (3). Five patients had KPS => 70; 4, KPS <70. Different SEZ were used according to lesional topography. The extent of resection were based on the frozen pathology findings and neurophysiological monitoring. Results: A variety of pathological findings were found: low-grade glioma (1); pilocytic astrocytoma (1); hemangioblastoma (1); subependimoma (1); disgerminoma (1); pseudotumoral lesions (cavernomas 3 and inflammatory pseudotumor 1). The extent of resection was complete (4), subtotal (3), and biopsy was considered sufficient in 2 cases. One patient died 96-hours-postoperative due to brainstem edema. Discussion: Brainstem structural lesions are uncommon in adults. Controversies arise regarding the need of histologic diagnosis, weighing benefits of a reliable diagnosis and the potential disadvantages of the invasive procedures. The accurate histopathological definition could not only determine an adequate therapy, but also can prevent the disastrous consequences of empiric treatments. The SEZ provides a feasible and safe access, although it is more realistic to consider them as areas to approach intrinsec lesions with less morbidity than to consider them as completely safe entrances


Subject(s)
Brain Stem , Pathology , Therapeutics , Mesencephalon , Microsurgery
9.
Psychol. av. discip ; 13(2): 67-78, jul.-dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1250598

ABSTRACT

Resumen El accidente cerebrovascular es una afección clínica que tiene entre uno de sus factores de riesgo la presión arterial alta. En la gestación, la complejidad de esta afección puede desembocar en un cuadro hipertensivo severo, comúnmente conocido como síndrome de HELLP, el cual es una de las variaciones más complejas de la hipertensión gestacional, que conlleva a múltiples alteraciones en la salud de aquellas que lo padecen. La mayoría de los estudios en el área se han enfocado en conocer su etiología, epidemiología y las consecuencias físicas que acarrean este síndrome; sin embargo, poca es la información que se tiene sobre las secuelas cognitivas a largo plazo que produce en la madre un embarazo complicado posterior a un cuadro hipertensivo severo. El presente estudio tuvo como objetivo analizar el caso de una mujer, quien presentó síndrome de HELLP con una complicación de encefalopatía en tallo cerebral y su posterior perfil cognitivo. Se realizó un análisis descriptivo de exploración neuropsicológica y se compararon sus resultados con datos normativos. Entre los resultados se encontraron dificultades en todas las áreas del funcionamiento, además de un déficit cognitivo secundario al cuadro clínico de base. Se concluyó que la hipertensión gestacional es más severa cuando se acompaña de una afectación vascular. Esto afecta la cognición, teniendo un impacto negativo en la vida de la mujer en sus diferentes áreas de ajuste.


Abstract Stroke is a clinical condition that has between one of its risk factors high blood pressure. In gestation, the complexity of this condition can lead to a severe hypertensive picture, commonly known as HELLP syndrome, which is one of the most complex variations of gestational hypertension, which leads to multiple alterations in the Health of those who suffer from it. Most studies in the area have focused on knowing its etiology epidemiology, and physical consequences of this syndrome; however little information exists on long-term cognitive sequel when the mother experiences a complicated pregnancy following a severe hypertensive condition. The present study aimed to analyze the case of a woman with HELLP syndrome with a complication of brain stem encephalopathy and her subsequent cognitive profile. It was performed a descriptive analysis of neuropsychological exploration and compared the results with normative data. Among the results were difficulties in all areas of functioning and cognitive impairment secondary to clinical basis. In conclusion, gestational hypertension is most severe when it´s combined with vascular involvement. This affects cognition, which has a negative impact on the life of the woman in different areas of adjustment.


Subject(s)
Brain Diseases , HELLP Syndrome , Stroke , Syndrome , Brain Stem , Adaptation, Psychological , Cognition , Affect , Hypertension, Pregnancy-Induced , Cognitive Dysfunction , Arterial Pressure
10.
Arq. bras. neurocir ; 38(4): 263-271, 15/12/2019.
Article in English | LILACS | ID: biblio-1362489

ABSTRACT

Lowering of the level of consciousness is a very common presentation at the emergency room, often without any history that helps finding an etiology. This emergency requires quick empirical measures to reduce neuronal mortality, with additional protection against sequelae. According to the Advanced Cardiac Life Support (ACLS) guidelines, there are current emergency neurological support protocols, such as the Emergency Neurological Life Support (ENLS) created by the Neurocritical Care Society. The present paper shows how to approach unconscious patients, highlighting possible etiologies and proposed treatments.


Subject(s)
Brain Stem/physiopathology , Coma/physiopathology , Coma/therapy , Advanced Trauma Life Support Care , Hypothalamus, Posterior/physiopathology , Coma/diagnosis , Coma/ethnology , Trauma, Nervous System , Emergency Medical Services/organization & administration , Clinical Governance
12.
Rev. bras. ortop ; 54(5): 605-608, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1057931

ABSTRACT

Resumo The posterior inferior cerebellar artery usually arises from the intracranial segment (V4) of the vertebral artery. Despite its mean diameter of 2 mm, it usually irrigates important areas of the brain. When occluded, whether due to trauma or surgery, it may cause infarction in the brain stem and cerebellum. The present report describes a case of incidental finding of a posterior inferior cerebellar artery arising from the cervical segment (V3) of the vertebral artery, demonstrated by angiography. The findings were recorded and compared to those of earlier publications. Brief explanations regarding anatomy, vascular anomalies and embryology were provided. A literature review showed that anomalous branches of the cervical segment of the vertebral artery are infrequent andmust be known. A better understanding of anatomy and its variations enables an accurate topographic diagnosis, as well as the planning of the optimal surgical approach and therapy. Knowledge of this anatomical variation is essential because, if it is mistaken for a muscle branch and coagulated, this can cause ischemia and disabling sequelae.


Resumo A artéria cerebelar inferoposterior geralmente nasce do segmento intracraniano (V4) da artéria vertebral. Apesar de ter diâmetro médio de 2 mm, usualmente irriga áreas eloquentes do encéfalo. Quando ocluída, seja por trauma ou cirurgia, pode causar infarto no tronco encefálico e no cerebelo. Apresentamos um caso de artéria cerebelar inferoposterior com origem anômala no segmento cervical (V3) da artéria vertebral, demonstrado por angiografia. Os resultados foram registrados e comparados com os de publicações anteriores. Foram fornecidas breves explicações sobre a anatomia, anomalias vasculares e embriologia. A revisão da literatura mostrou que os ramos anômalos do segmento cervical da artéria vertebral são infrequentes e devem ser conhecidos. Uma melhor compreensão da anatomia e suas variações permite fazer um diagnóstico topográfico preciso, bem como planejar a abordagem e a terapia cirúrgicas ideais. O conhecimento dessa variação anatômica é essencial, pois, se confundida com um ramo muscular e coagulada, pode causar isquemia com sequelas incapacitantes.


Subject(s)
Humans , Male , Middle Aged , Vertebral Artery , Lateral Medullary Syndrome , Brain Stem , Cerebral Angiography , Angiography , Anatomic Variation , Intraoperative Complications
15.
Rev. argent. neurocir ; 33(2): 107-112, jun. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1177742

ABSTRACT

A partir de la introducción de las técnicas modernas en diagnóstico por Resonancia Magnética por Imágenes (RMI), revolucionó la comprensión de las malformaciones cavernosas, permitiendo su diagnóstico preciso. En paralelo, el avance de las técnicas microquirúrgicas y el conocimiento de las zonas seguras de acceso al tronco cerebral han definido los accesos para su resección segura. Se presenta un caso de paciente varón de 25 años de edad, sin antecedentes patológicos, consulta por cefalea de un año de evolución. En RM donde se observa lesión nodular en relación con el receso lateral derecho. Se realiza abordaje suboccipital medial, con acceso telovelar hacia el receso lateral con la exéresis completa de la lesión. Un adecuado conocimiento sobre la anatomía del IV ventrículo, seleccionando el abordaje microquirúrgico más apropiado, con técnica quirúrgica meticulosa es prioritario en la resección de cavernomas en esta localización. El devastador resultado neurológico que puede ocurrir en un paciente con una malformación cavernosa del tronco encefálico cuando estos sangran, plantean a la resección microquirúrgica como la mejor opción en aquellas lesiones accesibles a través de zonas seguras.


From the introduction of modern imaging techniques with Magnetic Resonance Imaging, it revolutionized the understanding of cavernous malformations, allowing for accurate diagnosis. In parallel, the advancement of microsurgical techniques and the knowledge of safe areas of access to the brain stem have defined access for safe resection. We present a case of male patient of 25 years of age, without pathological history, consultation for headache of one year of evolution. In MRI where nodular lesion is observed in relation to the right lateral recess. A medial suboccipital approach was performed, with telovelar access to the lateral recess with complete excision of the lesion. An adequate knowledge about the anatomy of the IV ventricle, selecting the most appropriate microsurgical approach, with meticulous surgical technique is a priority in the resection of cavernous in this location. The devastating neurological outcome that can occur in a patient with a cavernous malformation of the brainstem when they bleed, posed to microsurgical resection as the best option in those lesions accessible through safe areas.


Subject(s)
Humans , Male , Congenital Abnormalities , Brain Stem , Magnetic Resonance Imaging , Headache
16.
Arq. bras. neurocir ; 38(1): 64-67, 15/03/2019.
Article in English | LILACS | ID: biblio-1362674

ABSTRACT

Meningitis or meningoencephalitis are the most common presentations of Koch bacilli infection on the central nervous system (CNS), especially in immunosuppressed patients, in whom the bacilli normally reaches the meninges and the cerebral parenchyma.. A least common pathological presentation is the tumoral growth pattern disease known as tuberculoma. This pathological entity is more common in the cerebral hemispheres and is rarely located in the brainstem. The present case report describes a case of a 55-year-old patient under regular antiretroviral therapy who was hospitalized with signs of brainstem and cerebellar disturbances. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain showed an exophytic lesion in the dorsal region of the pons. The patient underwent total resection of the lesion and the histopathologic analysis was consistent with a tuberculoma.


Subject(s)
Humans , Male , Middle Aged , Tuberculoma/pathology , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/therapy , Brain Stem/pathology , Immunocompromised Host
17.
Rev. argent. neurocir ; 33(1): 1-13, mar. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1177834

ABSTRACT

Objetivos: A través del estudio cadavérico dividir al central core cerebral (CCC) en diferentes áreas y proponer para cada sector el abordaje neuroquirurgico correspondiente. Como objetivo secundario analizaremos la anatomía neuroquirúrgico cortical y subcortical del CCC. Introducción : El CCC es descripto como un bloque que descansa sobre el tronco del encéfalo. Incluye la ínsula, capsula extrema, claustro, capsula externa, núcleo lenticular, capsula interna, núcleo caudado y el tálamo. Material y Métodos: Se estudiaron 12 hemisferios cerebrales humanos adultos y una cabeza en el ­LaNeMic- de la Universidad de Buenos Aires, analizamos 9 casos de patologías neuroquirúrgicas del CCC y dibujos digitales de los abordajes propuestos para cada sector del CCC. Se tomaron fotografías de cada disección y las mediciones obtenidas con calibre digital. Resultados: Dividimos al CCC en un sector medial, intermedio y lateral; con subdivisiones específicas para el lateral y medial. La proyección lateral del foramen de Monro se encontró en el tercer giro corto de la ínsula con las distancias: MILA: 23,95 mm; MILP: 22,92 mm; SLS: 14,99 mm y SLI: 13,76 mm. Proponemos los siguientes abordajes: abordaje transcalloso homolateral, abordaje transcalloso contralateral, abordaje trans-fisura coroidea, abordaje trans-esplenial, acceso trans-parietal ingresando al surco intraparietal y abordaje trans-silviano. Discusión: Se deben analizar los estudios preoperatorios del paciente, comprendiendo las lesiones según la ubicación y de ese modo seleccionar el abordaje más preciso y seguro. Conclusiones: Se provee a través de este trabajo una descripción de los límites y anatomía del CCC, empleando disecciones cerebrales, análisis de casos operados y de medidas útiles para el neurocirujano.


Objectives: Through the cadaveric study, we divide the cerebral central core (CCC) in different areas and propose the corresponding neurosurgical approach for each sector. As a secondary objective, we will analyze the cortical and subcortical microsurgical anatomy of the CCC. Introduction: The CCC is described as a block that rests on the trunk of the brain. It includes the insula, extreme capsule, claustro, external capsule, lenticular nucleus, internal capsule, caudate nucleusand thalamus. Material and Methods: We studied 12 adult human brain hemispheres and one head in the -LaNeMic- of the University of Buenos Aires, analyzed 9 cases of CCC neurosurgical pathologies and digital drawings of the approaches proposed for each sector of the CCC. Photographs of each dissection and measurements obtained with digital caliber were taken. Results: We divide the CCC into a medial, intermediate and lateral sector; with specific subdivisions for the lateral and medial. The lateral projection of the foramen of Monro was found in the third short gyri of the insula with the distances: MILA: 23.95mm; MILP: 22.92mm; SLS: 14.99mm and SLI: 13.76mm. We propose the following approaches: ipsilateral transcallosal approach, contralateral transcallosal approach, choroidal trans-fissure approach, trans-splennial approach, trans-parietal access entering the intraparietal sulcus, and trans-silvian approach. Discussion: The preoperative studies of the patient should be analyzed, understanding the lesions according to the location and in this way selecting the most accurate and safe approach. Conclusions: A description of the limits and anatomy of the CCC is provided through this work, using brain dissections, analysis of operated cases and useful measurements for the neurosurgeon.


Subject(s)
Brain Stem , Thalamus , Brain , Cerebral Ventricles , Anatomy , Neurosurgery
18.
Rev. argent. neurocir ; 33(1): 16-16, mar. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1177844

ABSTRACT

Objetivo: Describir el acceso quirúrgico a la fosa interpeduncular para la resección de cavernomas ubicados en situación ventromedial del mesencéfalo. Introducción: El abordaje ¨Pretemporal¨ contralateral con resección orbitocigomatica utilizando la via transilviana, permite abordar la cara ventral de la fosa interpeduncular para lesiones comprendidas entre la union diencefalo-mesencefálica y el surco ponto-mesencefálico. Materiales y Métodos: Datos de historia clínica, fotografías y videos obtenidos de un caso quirúrgico operado en nuestro servicio. Disecciones cadavéricas en 14 piezas anatómicas de tronco cerebral (9 siguiendo la técnica de Klingler y 5 piezas sin congelar, de modo comparativo), 23 especímenes inyectados describiendose los corredores quirúrgicos a la región, mas estudios complementarios. Discusión: La bibliografía internacional consultada propone el abordaje orbitocigomatico homolateral para lesiones situadas en la fosa interpeduncular. En nuestro caso elegimos el abordaje ¨Pretemporal¨ con resección orbito-cigomática contralateral dada la localización alta de la lesión y la disposición de su eje mayor (antero-posterior) en sentido opuesto, ofreciendo de este modo un mejor ángulo de ataque por esta vía propuesta. Conclusión: En nuestra experiencia el abordaje ¨Pretemporal¨ contralateral con orbitotomia y en ¨particular¨ la resección cigomática mejoró el ángulo de trabajo, desde inferior a superior y de lateral a medial, para alcanzar de este modo lesiones mesencefálicas ventro-mediales ¨altas¨ en el plano sagital, versus un acceso ¨Orbitocigomatico¨ clásico homolateral.


Subject(s)
Cisterns , Brain Stem , Stroke , Neuroanatomy , Neurosurgery
19.
Article in English | WPRIM | ID: wpr-764123

ABSTRACT

PURPOSE: The brainstem plays an important role in the control of micturition, and brainstem strokes are known to present with micturition dysfunction. Micturition dysfunction in cases of lateral medullary infarction (LMI) is uncommon, but often manifests as urinary retention. In this study, we investigated the neuro-anatomical correlates of urinary retention in patients with LMI. METHODS: This was a hospital-based retrospective study conducted in the neurology unit of a quaternary-level teaching hospital. Inpatient records from January 2008 to May 2018 were searched using a computerized database. Cases of isolated LMI were identified and those with micturition dysfunction were reviewed. MRI brain images of all patients were viewed, and individual lesions were mapped onto the Montreal Neurological Institute (MNI) space manually using MRIcron. Nonparametric mapping toolbox software was used for voxel-based lesion-symptom analysis. The Liebermeister test was used for statistical analysis, and the resultant statistical map was displayed on the MNI template using MRIcron. RESULTS: During the study period, 31 patients with isolated LMI were identified. Their mean age was 48 years and 28 (90%) were male. Six of these patients (19%) developed micturition dysfunction. All 6 patients had urinary retention and 1 patient each had urge incontinence and overflow incontinence. In patients with LMI, the lateral tegmentum of the medulla showed a significant association with urinary retention. CONCLUSIONS: In patients with isolated LMI, we postulate that disruption of the descending pathway from the pontine micturition centre to the sacral spinal cord at the level of the lateral tegmentum results in urinary retention.


Subject(s)
Brain , Brain Stem , Hospitals, Teaching , Humans , Infarction , Inpatients , Magnetic Resonance Imaging , Male , Neurology , Retrospective Studies , Spinal Cord , Stroke , Urinary Incontinence, Urge , Urinary Retention , Urination
20.
Article in English | WPRIM | ID: wpr-740159

ABSTRACT

Ramsay Hunt syndrome with the complication of encephalitis or meningoencephalitis is rarely reported and uncommon in immunocompetent patients. The radiological manifestations of such cases usually involve the cerebellum and brainstem or exhibit the absence of any abnormality. We report a case of a 78-year-old immunocompetent man hospitalized with Ramsay Hunt syndrome, who later developed meningoencephalitis. The cerebrospinal fluid-study excluded other causes of meningoencephalitis, and the clinical diagnosis indicated varicella zoster virus meningoencephalitis. Magnetic resonance imaging revealed increased signal intensities in the bilateral temporal lobe, midbrain, and pons on T2-weighted imaging, and T2 fluid attenuated inversion recovery and contralateral asymmetric pachymeningeal enhancement. Contrast-enhanced T1-weighted imaging revealed ipsilateral facial nerve enhancement.


Subject(s)
Aged , Brain Stem , Cerebellum , Diagnosis , Encephalitis , Facial Nerve , Herpes Zoster Oticus , Herpesvirus 3, Human , Humans , Magnetic Resonance Imaging , Meningoencephalitis , Mesencephalon , Pons , Temporal Lobe
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