Challenges for learning neuroradiology in undergraduate medical school: analysis from the students' point of view / Desafios para o aprendizado de neurorradiologia na graduação médica: análise do ponto de vista discente

Abstract: Introduction: The teaching of neuroradiology in undergraduate medical school must be seen as an integration tool for the interdisciplinary study of radiology, anatomy and neurology. In practice, there is a limitation on the part of students in acquiring such knowledge, either due to "neurophobia", or due to the lack of previous anatomical-radiological knowledge and also due to the lack of integrated didactic materials aimed at undergraduate school. However, there are few studies reporting the difficulties encountered by students in learning neuroradiology. Objective: To assess the perception of medical students about learning difficulties in neuroradiology. Method: Quantitative study, carried out with medical students enrolled in the second and seventh semesters of a university in Fortaleza. Data were obtained through a structured questionnaire with 12 yes or no answer questions. The questions addressed the possible difficulties encountered in acquiring neuroradiological knowledge, among them: the lack of targeted didactic material, the lack of integration with neurology, the need for basic radiological and anatomical knowledge, the large volume of content to study, and the limitations of active and traditional methodologies. Results: 181 questionnaires were analyzed. Most students report as difficulties: the need for basic knowledge of radiology (80.1%); neuroanatomy (77.5%); and to correlate radiology and neuroanatomy (70.9%). When comparing the 2nd semester and 7th semester groups, there was a greater tendency to point out the lack of practical knowledge of neurology by 2nd-semester students as a factor of greater difficulty in learning neuroradiology (82.6% versus 67.4 %, with p <0.0018). When asked about the usefulness of creating an e-book aimed at undergraduate students for learning neuroradiology, 85.6% of the students answered affirmatively; in the case of a mobile application, 92.3% agreed. As for the correlation between neuroradiology and medical practice, 98.3% answered that it is useful and necessary knowledge. Conclusion: In the students' opinion, previous knowledge of neuroanatomy and clinical neurology is important for learning neuroradiology. The development of material such as an e-book or mobile application focused on integrating the teaching of these disciplines is considered a good alternative to facilitate the understanding of neuroradiology.

Resumo: Introdução: O ensino da neurorradiologia na graduação médica deve ser encarado como uma ferramenta de integração para o estudo interdisciplinar de radiologia, anatomia e neurologia. Na prática, percebe-se uma limitação dos alunos em adquirir tais conhecimentos, seja pela "neurofobia", seja pela falta de conhecimentos anatômico-radiológicos prévios e também pela carência de materiais didáticos integrados direcionados para a graduação. Contudo, há poucos trabalhos relatando as dificuldades encontradas pelos alunos no aprendizado de neurorradiologia . Objetivo: Avaliar a percepção dos estudantes de medicina sobre as dificuldades do aprendizado em neurorradiologia. Método: Estudo quantitativo, realizado com estudantes de medicina matriculados no segundo e no sétimo semestres de uma universidade de Fortaleza. Os dados foram obtidos por meio de questionário estruturado com 12 questões de respostas sim ou não. As questões versaram sobre as possíveis dificuldades encontradas para aquisição do conhecimento neurorradiológico, dentre elas: à carência de material didático direcionado, à falta de integração com a neurologia, à necessidade de conhecimentos básicos radiológicos e anatômicos, ao volume de assunto, e às limitações das metodologias ativas e tradicionais. Resultados: Foram analisados 181 questionários. Grande parte discente refere como dificuldade a necessidade de ter conhecimentos básicos prévios de radiologia (80,1%); de neuroanatomia (77,5%); e de correlacionar radiologia e neuroanatomia (70,9%). Quando comparados os grupos do 2o semestre e do 7o semestre, houve uma tendência maior a apontar a ausência de conhecimento prático de neurologia pelos alunos do 2o semestre como um fator de maior dificuldade para o aprendizado de neurorradiologia (82,6% versus 67,4%, com p<0,0018). Quando perguntados sobre a utilidade da criação de um e-Book direcionado para a graduação para o aprendizado de neurorradiologia, 85,6% dos alunos responderam afirmativamente; no caso de um aplicativo, 92,3% concordaram. Quanto à correlação entre a neurorradiologia e a prática médica, 98,3% responderam que é um conhecimento útil e necessário. Conclusão: Na opinião dos estudantes, os conhecimentos prévios de neuroanatomia e de neurologia clínica são importantes para o aprendizado de neurorradiologia. A elaboração de um material como e-book ou aplicativo com foco em integrar o ensino dessas disciplinas é considerada uma boa alternativa para facilitar a compreensão da neurorradiologia.

Quadrigeminal cisterna lipoma: report of two cases and literature review / Lipoma da cisterna quadrigeminal: relato de dois casos e revisão da literatura

Intracranial lipomas are congenital, benign and slow-growing tumors. The incidence were 0.1 to 0.5 percent of all primary brain tumors and are often diagnosed in incidental findings of neuroradiological investigation. Lipoma in quadrigeminal region occurs in 25 percent of intracranial lipomas and has been reported as lipomas in quadrigeminal cistern (perimesencephalic cistern), quadrigeminal plate, ambiens cistern or superior medullary velum. MRI is the most major exam. The treatment is conservative in most cases, surgical removal is hampered by their deep location and contiguous with adjacent neurovascular structures. The authors report two cases of lipoma in the quadrigeminal region, incidental findings and discuss the clinical findings, neuroimaging and treatment.

Lipomas intracranianos são tumores congênito, benigno e de crescimento lento. Sua incidência é de 0.1 a 0.5 por cento de todos os tumores cerebrais primários e são frequentemente diagnosticados em achados incidental de investigação neuroradiológica. Lipoma na região quadrigeminal ocorre em 25 por cento dos lipomas intracranianos e tem sido relatados como lipomas na cisterna quadrigeminal (cisterna perimesencefálica), placa quadrigeminal, cisterna ambiens ou véu medular superior. O exame de eleição é ressonância magnética. O tratamento é conservador na maioria dos casos, a remoção cirúrgica é dificultada pela sua localização profunda e da contiguidade com estruturas neurovasculares adjacentes. Os autores relatam dois casos de lipoma na região quadrigeminal achados incidentalmente e discutem os achados clínicos, imagem e tratamento.

Reduction of contractility and reactivity in isolated lymphatics from hemorrhagic shock rats with resuscitation

PURPOSE: To evaluate the changes of contractility and reactivity in isolated lymphatics from hemorrhagic shock rats with resuscitation. METHODS: Six rats in the shock group suffered hypotension for 90 min by hemorrhage, and resuscitation with shed blood and equal ringer's solution. Then, the contractility of lymphatics, obtained from thoracic ducts in rats of the shock and sham groups, were evaluated with an isolated lymphatic perfusion system using the indices of contractile frequency (CF), tonic index (TI), contractile amplitude (CA) and fractional pump flow (FPF). The lymphatic reactivity to substance P (SP) was evaluated with the different volume of CF, CA, TI and FPF between pre- and post-treatment of SP at different concentrations. RESULTS: The CF, FPF, and TI of lymphatics obtained from the shocked rats were significantly decreased than that of the sham group. After SP stimulation, the ∆CF (1×10-8, 3×10-8, 1×10-7, 3×10-7 mol/L), ∆FPF (1×10-8, 3×10-8, 1×10-7 mol/L), and ∆TI (1×10-8 mol/L) of lymphatics in the shock group were also obviously lower compared with the sham group. In addition, there were no statistical differences in CA and ∆CA between two groups. CONCLUSION: Lymphatic contractility and reactivity to substance P appears reduction following hemorrhagic shock with resuscitation. .

Habilidade auditiva em criança desnutrida / Auditory ability in malnourished child

Objetivo Caracterizar e comparar o desempenho de crianças com desnutrição e crianças eutróficas nas habilidades do processamento auditivo. Métodos A amostra foi composta por 30 crianças na faixa etária de 5 a 10 anos, de ambos os gêneros, sendo 15 crianças com desnutrição, que compuseram o grupo amostral (G1) e 15 crianças com estado nutricional adequado, como grupo controle (G2). Os grupos foram pareados segundo gênero, faixa etária e escolaridade. Ambos os grupos foram submetidos à avaliação auditiva periférica e central. Resultados As crianças desnutridas apresentaram maior índice de alterações na habilidade de sequencialização sonora para sons verbais e não verbais, quando comparadas com as crianças eutróficas. O mesmo ocorreu nas habilidades de fechamento e figura fundo. Quanto ao grau do distúrbio do processamento auditivo, houve maior severidade nas crianças desnutridas. Conclusão Crianças com desnutrição apresentaram maior frequência de alterações nas habilidades auditivas, quando comparadas a crianças eutróficas, sendo as habilidades de ordenação temporal, memória auditiva, atenção seletiva, figura fundo e fechamento, as habilidades mais afetadas. .

Purpose To characterize and compare the performance of malnourished children and normal children in auditory processing. Methods The sample comprised 30 children from five to ten years old, both genders, being 15 malnourished children (G1) and 15 children with adequate nutritional status, as a control group (G2). The groups were paired according to gender, age and grade level. Both groups underwent peripheral and central auditory assessment, noting that malnourished children had higher changes in the skill of sequencing score for verbal and nonverbal when compared to normal children, and the same occurred in closing skills and background figure. Results Regarding the degree of auditory processing disorder, it was more severe in malnourished children. Conclusion Children with malnutrition have higher frequency alterations in auditory abilities when compared to normal children, being the temporal ordering skills, auditory memory, selective attention, figure-ground and closing the most affected skills. .

Raupp: 50 years of neuroradiology / Raupp: 50 anos de neurorradiologia

OBJECTIVE: Evaluate the laboral and intellectual contributions of a founder of Brazilian Neuroradiology to the development of specialty. METHOD: Interviews were conducted with Dr. Raupp and contemporary doctors. Then we made a literature review with the Raupp search term aiming to identify those papers which included major changes in the diagnostic and therapeutic neurosurgical. RESULTS: The colleagues consulted were unanimous in recognizing the work of avant-garde and the importance of Dr. Raupp to the development of neuroradiological methods, especially in the pre-computed tomography fase. CONCLUSION: The work of Dr. Raupp was fundamental for the consolidation of Brazilian Neuroradiological School over the past five decades. He developed diagnostic and therapeutic techniques in congruence with the practices of the specialty on the global stage and he promoted education through medical residency programs.

OBJETIVO: Avaliar a contribuição laboral e intelectual de um dos fundadores da Neurorradiologia Brasileira para o desenvolvimento da especialidade. MÉTODO: Foram realizadas entrevistas com o Dr. Raupp e com médicos contemporâneos. Em seguida, foi feita uma revisão de literatura com o termo Raupp com o objetivo de identificar os trabalhos que definiram mudanças importantes na avaliação diagnóstica e terapêutica neurocirúrgica. RESULTADOS: Os colegas consultados foram unânimes no reconhecimento do trabalho de vanguarda e da importância do Dr. Raupp no desenvolvimento das técnicas neurorradiológicas, especialmente na fase pré-tomografia computadorizada. CONCLUSÃO: O trabalho do Dr. Raupp foi fundamental para a consolidação da Escola Neurorradiológica Brasileira ao longo das últimas cinco décadas. Ele desenvolveu técnicas diagnóstica e terapêutica em congruência com as práticas da especialidade no cenário mundial e promoveu o ensino através dos programas de residência médica.

The database and its data sharing of neuropathic images / 中国医疗器械杂志

This paper introduces the basic principle and method of establishing a database for neuropathic images, and discusses its significance and data sharing. The database is composed of three data volumes about basic knowledge for images, cranial sectional anatomy and neuropathic images. The data sharing is achieved by using a method of linking the dynamic network of neuropathic images with database of neuropathic images. There are three searching approaches: catalog searching, key words searching and code searching.

Advances in neuroimaging of stroke

This article reviews the recent advances in the neuroradiological diagnosis of acute stroke, highlighting the perspectives for the next 10 years. Key words: Brain infarction; cerebral hemorrhage; early diagnosis; neuroimaging.

O artigo sumaria os avanços recentes no diagnóstico neuroradiológico do acidente vascular cerebral isquêmico e hemorrágico, discutindo as perspectivas para a próxima década.

X-Linked adrenoleukodystrophy the Saudi Experience

To evaluate the clinical, biochemical, neuroradiological, and neurophysiological findings of patients with X-linked adrenoleukodystrophy. Retrospective study evaluating the data of 10 X-linked adrenoleukodystrophy patients diagnosed at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. The common presenting symptoms were deterioration in school performance, vision and hearing, behavioral changes, and seizures. Eight patients survived 1-4 years and one patient 12 years after the initial presentation, while one patient expired. Six patients had the childhood form, 3 had the adolescent form and one had the adrenomyeloneuropathy form. Six are in an advanced stage of the disease and 3 have mild to moderate spasticity. All except 2 manifested moderate to severe dementia with variable degrees of visual loss. Decreased hearing and features of adrenal insufficiency were seen in 7 patients. Very long chain fatty acids were significantly increased in seven and mildly elevated in 2 patients, however the C26 to C22 ratio was increased in all. The characteristic high-signal intensity of parieto-occipital white matter on brain magnetic resonance imaging T2-weighted images was observed in all patients. Two patients had functional study of the brain, which showed hypometabolic activity in gray and white matter of the occipital lobes. Various neurophysiological abnormalities were detected. The response to different treatment modalities was not promising. The disease is more common than had been previously recognized due to phenotypic variability and a wide spectrum of presentations. This report describes various aspects of this disorder and emphasizes the importance of early identification and treatment of asymptomatic but biochemically affected individuals, since all current therapeutic approaches are disappointing if overt neurological abnormalities have been already developed

X-linked adrenoleukodystrophy the Saudi experience

To evaluate the clinical, biochemical, neuroradiological, and neurophysiological findings of patients with X-linked adrenoleukodystrophy. Retrospective study evaluating the data of 10 X-linked adrenoleukodystrophy patients diagnosed at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. The common presenting symptoms were deterioration in school performance, vision and hearing, behavioral changes, and seizures. Eight patients survived 1-4 years and one patient 12 years after the initial presentation, while one patient expired. Six patients had the childhood form, 3 had the adolescent form and one had the adrenomyeloneuropathy form. Six are in an advanced stage of the disease and 3 have mild to moderate spasticity. All except 2 manifested moderate to severe dementia with variable degrees of visual loss. Decreased hearing and features of adrenal insufficiency were seen in 7 patients. Very long chain fatty acids were significantly increased in seven and mildly elevated in 2 patients, however the C26 to C22 ratio was increased in all. The characteristic high-signal intensity of parieto-occipital white matter on brain magnetic resonance imaging T2-weighted images was observed in all patients. Two patients had functional study of the brain, which showed hypometabolic activity in gray and white matter of the occipital lobes. Various neurophysiological abnormalities were detected. The response to different treatment modalities was not promising. The disease is more common than had been previously recognized due to phenotypic variability and a wide spectrum of presentations. This report describes various aspects of this disorder and emphasizes the importance of early identification and treatment of asymptomatic but biochemically affected individuals, since all current therapeutic approaches are disappointing if overt neurological abnormalities have been already developed

Leucoaraiosis: imágenes diagnósticas / Leukoaraiosis: diagnostic images

La enfermedad vascular cerebral ha adquirido una gran importancia en las últimas décadas, en parte debido al incremento en su frecuencia y al desarrollo de técnicas diagnósticas precisas, especialmente de imagenología. La leucoaraiosis es un término neurorradiológico que expresa rarefacción de la sustancia blanca profunda de los lóbulos cerebrales, cuerpo calloso y comisura blanca anterior. Esta afección es causada por fenómenos isquémicos que conducen a desmielinización y gliosis. Con frecuencia se asocia a enfermedades que son factores de riesgo para enfermedad vascular cerebral, como la hipertensión arterial. El objetivo de esta investigación es informar sobre cinco casos en los cuales fue difícil diagnosticar esta patología debido a los hallazgos neurorradiológicos; se describen las características clínicas y de imagen, y se hace referencia al diagnóstico diferencial

Hallazgos neurorradiológicos en dos casos de enfermedad de Wilson de presentación neurológica / Neuroradiological findings in Wilson disease presenting with neurological involvement: report of 2 cases

Wilson disease is an inborn error of copper metabolism that bas neurological and hepatic manifestations. We report a 13 years old girl and a 12 years old boy with Wilson disease. In both patient, brain computed tomography and magnetic resonance imaging showed marked involvement of basal ganglia and other deep gray nuclei. Considering that this is a treatable disease, it should be included in the differential diagnosis of the so called "striatal necrosis of childhood"

Apuntes de neurorradiología: anatomía radiológica mediante multimedios / Neurorradiology notes: radiologic anatomy using mutimedia

La radiología es una de las especialidades que más avanza y se transforma con el paso del tiempo. De esta forma muchos radiólogos se enfrentan al hecho de que la disciplina en la que se formaron es ahora completamente diferente. Frente a esto, aparece la necesidad de actualización y de estudio constante, sólo para mantenerse al día. Un área que se está transformando en una necesidad casi cotidiana es la Neurorradiología, en la medida en que más radiólogos generales cuentan con Tomografía Computada, hecho que está ocurriendo especialmente en provincias. Esta área es particularmente compleja, tanto por sus contenidos propiamente tales, como por la forma en que éstos son abordados en los textos clásicos. Así, el interesado debe estudiar la anatomía clásica para luego abstraer los conceptos de anatomía radiológica realmente últiles para llegar finalmente a un diagnóstico. Es por esto que concebimos la creación de un software que fuera capaz de integrar estos conceptos, sectorizando la anatomía en varios pequeños capítulos que, en conjunto, hemos llamado "Apuntes de Neurorradiología". Hemos comenzado por el estudio anatómico del cráneo. Para esto se elaboró un software-multimedios, utilizando la tecnología PC compatible en lo concerniente a computadores, softwares y scanner. Se preparó material fotográfico y cortes tomográficos de una preparación anatómica existente en el Servicio de Radiología del Hospital Clínico Dr. J.J. Aguirre y de pacientes normales. Se utilizaron además esquemas diseñados especialmente para este motivo. El programa abarca la anatomía normal y radiológica del cráneo, con los reparos anatómicos de interés diagnóstico, relacionando esquemas, fotos y cortes de tomografía axial computada, apoyados por textos explicativos. El material de apoyo que hemos creado, permitirá al radiólogo general aproximarse al estudio de la Neurorradiología, con una visión diagnóstica del estudio anatómico. La elección de la tecnología multimedios obedece a la posibilidad casi natural de integrar contenidos en forma fácil y motivante, obteniendo un producto de sencillo acceso tanto para el principiante como para el experto en computación