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Tuberculomas are rare and a life-threatening condition. Diagnosis followed by appropriate treatment can lead to complete resolution of the disease. A suggestive imaging study in an appropriate clinical setting can lead to the diagnosis. We describe a case of a postpartum woman with a headache and seizure in which eclampsia was the initial suspicion. Imaging exams demonstrated a solitary expansile lesion in the left parietal lobe suspicious of neoplasia. A biopsy, instead, confirmed a tuberculoma. In addition to eclampsia, many other differential diagnoses are possible in the context of seizures in pregnant and peripartum patients, including central nervous system tuberculosis. Brain imaging studies can be crucial in the diagnostic process.
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Abstract Introduction Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD). However, there is little evidence regarding the effect of DBS on dysphagia. Objective To assess the swallowing and quality of life of individuals with PD before and after DBS surgery. Methods Our sample consisted of people who had undergone DBS surgery in a referral hospital in the state of Rio Grande do Sul, Brazil. The inclusion criteria were a diagnosis of PD and having undergone DBS surgery. A cognitive screening, through a questionnaire about depression and quality of life, was conducted. Evaluations of each patient's swallowing were performed before and after surgery. The assessment consisted of anamnesis, clinical assessment, the Functional Oral Intake Scale, clinical evaluation of swallowing, and the Hoehn and Yahr scale. Results The sample included 10 individuals, all male, with a mean age of 57.3 years (±4.7), a mean disease duration of 13.0 years (±2.4), and mean level education of 8.1 years (±4.0). In the clinical evaluation of the swallowing, a significant improvement after DBS was not observed. However, little changes in the signs and symptoms of dysphagia that had a positive impact on the quality of life were observed. Furthermore, there was no relation between the patients' motor subtype and swallowing pre- and post-DBS. Conclusion There was an improvement in the quality of life of the patients after DBS. However, the improvement in the clinical signs and symptoms of dysphagia did not cause an overall improvement in the swallowing function.
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Introduction Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD). However, there is little evidence regarding the effect of DBS on dysphagia. Objective To assess the swallowing and quality of life of individuals with PD before and after DBS surgery. Methods Our sample consisted of people who had undergone DBS surgery in a referral hospital in the state of Rio Grande do Sul, Brazil. The inclusion criteria were a diagnosis of PD and having undergone DBS surgery. A cognitive screening, through a questionnaire about depression and quality of life, was conducted. Evaluations of each patient's swallowing were performed before and after surgery. The assessment consisted of anamnesis, clinical assessment, the Functional Oral Intake Scale, clinical evaluation of swallowing, and the Hoehn and Yahr scale. Results The sample included 10 individuals, all male, with a mean age of 57.3 years (±4.7), a mean disease duration of 13.0 years (±2.4), and mean level education of 8.1 years (±4.0). In the clinical evaluation of the swallowing, a significant improvement after DBS was not observed. However, little changes in the signs and symptoms of dysphagia that had a positive impact on the quality of life were observed. Furthermore, there was no relation between the patients' motor subtype and swallowing pre- and post-DBS. Conclusion There was an improvement in the quality of life of the patients after DBS. However, the improvement in the clinical signs and symptoms of dysphagia did not cause an overall improvement in the swallowing function.
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Introdução: As lesões expansivas do sistema nervoso central constituem um grupo diversificado de condições neoplásicas e não neoplásicas que podem ocorrer em virtualmente qualquer região anatômica e em pacientes de qualquer idade. A biópsia estereotáxica cerebral (BEC) é um procedimento seguro que pode ser usado na determinação do diagnóstico histopatológico desses processos. O objetivo deste estudo foi avaliar a acurácia da técnica de BEC na determinação do diagnóstico de processos expansivos intraparenquimatosos cerebrais. Métodos: Foram avaliadas 114 amostras distintas de BEC, através da técnica de hematoxilina-eosina, com o intuito de estabelecer o diagnóstico histológico de cada caso. As neoplasias secundárias foram avaliadas pela técnica de imunoistoquímica para estabelecer o sítio primário destas lesões. Resultados: Foi encontrada um média de idade igual a 52.92 anos (±8,125), com uma idade mediana de 51,0 anos. O grupo de pacientes incluiu 64 homens (56%). O número de fragmentos analisados em cada caso era igual a 12. Os fragmentos mediam em média 8,0 milímetros de largura e 1,0 mm de comprimento. O diagnóstico histológico de neoplasia foi estabelecido em 95 casos (83,3%), sendo o astrocitoma difuso (24,5%) e o glioblastoma (22,8%) os tipos histológicos mais frequentes. Foram encontrados 10 casos de envolvimento cerebral por neoplasias secundárias, sendo o linfoma não-hodgkiniano difuso de células B e o adenocarcinoma (80% em conjunto) os tipos predominantes. As lesões não neoplásicas corresponderam a 19 casos (16,7%) da amostra. Conclusão: A acurácia da BEC corresponde cerca de 92%, favorecendo seu emprego principalmente na investigação clínica de processos neoplásicos
Introduction: Expansive brain lesions of the central nervous system are a diverse group of neoplastic and non-neoplastic conditions that may occur in virtually any anatomical region and in patients of all ages. Stereotactic brain biopsy (SBB) is a safe procedure that can be used to determine the histopathologic diagnosis of these processes. The aim of this study was to evaluate the accuracy of SBB in determining the diagnosis of expansive intraparenchymal brain processes. Methods: We evaluated 114 different samples of SBB through the hematoxylin-eosin technique in order to establish the histologic diagnosis of each case. Secondary neoplasms were evaluated by immunohistochemistry to determine the primary site of these lesions. Results: Patient mean age was 52.92 years (± 8.125), with a median of 51.0 years. The group of patients included 64 men (56%). Twelve fragments were analyzed in each case. On average, fragments were 8.0 mm wide and 1.0 mm long. The histological diagnosis of cancer was established in 95 cases (83.3%). Diffuse astrocytoma (24.5%) and glioblastoma (22.8%) were the most frequent histological types. There were 10 cases of cerebral involvement by secondary neoplasms, and diffuse non-Hodgkin B-cell lymphoma and adenocarcinoma (80% combined) were the predominant types. There were 19 cases of non-neoplastic lesions (16.7%) in this sample. Conclusion: The accuracy of SBB was 92%, which favors its use in clinical research of neoplastic processes
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Humans , Biopsy , Brain Neoplasms , Immunohistochemistry , Central Nervous System NeoplasmsABSTRACT
BACKGROUND: The availability of markers able to provide an early insight related to prognostic and functional outcome of patients with traumatic brain injury (TBI) are limited. OBJECTIVE: The relationship of clinical outcome with CSF neuron-specific enolase (NSE), S100B and glial fibrillary acidic protein (GFAP) levels in patients with severe TBI was investigated. METHODS: Twenty patients with severe TBI (7 days at unit care) and controls were studied. Patients were grouped according to the outcome: (1) nonsurvival (n=5): patients who died; (2) survival A (n=15): CSF sampled between 1st and 3rd day from patients who survived after hospital admission; and (3) survival B (n=7): CSF sampled between 4th and 7th day from patients who survived after hospital admission and were maintained with intraventricular catheter up to 7 days. RESULTS: Up to 3 days, S100B and NSE levels (ng/mL) were significantly elevated in the nonsurvival compared with survival A group (S100: 12.45 ± 5.46 vs 5.64 ± 3.36; NSE: 313.20 ± 45.51 vs 107.80 ± 112.10). GFAP levels did not differ between groups. In the survival B group S100B, GFAP, and NSE levels were still elevated compared with control (4.59 ± 2.19, 2.48 ± 2.55, and 89.80 ± 131.10, respectively). To compare S100B and NSE for the prediction of nonsurvival and survival patients we performed receiver operating characteristic curves. At admission, CSF NSE level predicts brain death more accurately than S100B. CONCLUSION: Early elevations (up to 3 days) of S100B and NSE secondary to severe TBI predict deterioration to brain death. However, this feature was more prominently associated with NSE than S100B.
Subject(s)
Biomarkers/cerebrospinal fluid , Brain Injuries/cerebrospinal fluid , Glial Fibrillary Acidic Protein/cerebrospinal fluid , Nerve Growth Factors/cerebrospinal fluid , Phosphopyruvate Hydratase/cerebrospinal fluid , S100 Proteins/cerebrospinal fluid , Adult , Brain Injuries/mortality , Enzyme-Linked Immunosorbent Assay , Female , Glasgow Coma Scale , Humans , Male , Prognosis , ROC Curve , S100 Calcium Binding Protein beta Subunit , Treatment OutcomeABSTRACT
Solitary fibrous tumor (SFT) is rarely located in the central nervous system, and sella turcica involvement was reported in only two patients. We report the case of a 28-year-old man with a SFT of the sella turcica mimicking a pituitary nonfunctioning macroadenoma. He presented with optic nerve compression caused by a heterogeneous tumor located in the sellar and suprasellar area. At surgery, the tumor was hard and infiltrated the sellar diaphragm, so that resection resulted in a cerebrospinal fluid fistula. His postoperative course was also complicated by complete central diabetes insipidus, hypopituitarism, and two episodes of meningitis. After surgical resection, the diagnosis of SFT was reached on the basis of histological and immunohistochemical studies. He was discharged after 49 days. Ten months after surgery, he was clinically well, and magnetic resonance images showed no evidence of residual or recurrent tumor. SFT should be considered in the differential diagnosis of sellar and parasellar tumors.
Subject(s)
Pituitary Neoplasms/pathology , Sella Turcica/pathology , Solitary Fibrous Tumors/pathology , Adult , Diabetes Insipidus, Neurogenic/etiology , Diagnosis, Differential , Fistula/etiology , Humans , Hypopituitarism/etiology , Magnetic Resonance Imaging , Male , Meningitis/etiology , Neurosurgical Procedures/adverse effects , Pituitary Neoplasms/surgery , Postoperative Complications , Sella Turcica/surgery , Solitary Fibrous Tumors/surgery , Tomography, X-Ray ComputedABSTRACT
It is known that the caudal dislocation of the cerebellar tonsils may occur associated with clinical conditions such as an intracranial mass lesion or Chiari I and II malformation. It may also be acquired after repeated lumbar punctures or lumboperitoneostomy. The occurrence of cerebellar herniation after derivation of intracranial arachnoid cyst is extremely rare, and there are only three cases reported in the medical literature. We present the case of a 9-year-old boy with precocious puberty and suprasellar arachnoid cyst who developed a symptomatic herniation of the cerebellar tonsils three years after a cystoperitoneostomy. The patient underwent a suboccipital craniectomy with duraplasty and partial tonsillectomy, showing afterwards, remission of the symptoms. We discussed the pathogenesis suggested in the literature.
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Arachnoid Cysts/surgery , Cerebellar Diseases/etiology , Hernia/etiology , Cerebellar Cortex , Cerebellar Diseases/diagnosis , Cerebellar Diseases/surgery , Child , Craniotomy , Hernia/diagnosis , Herniorrhaphy , Humans , Magnetic Resonance Imaging , Male , Treatment Outcome , Ventriculoperitoneal ShuntABSTRACT
Sabe-se que o deslocamento caudal das tonsilas cerebelares pode ocorrer em associação com condições clínicas tais como: lesão expansiva intracraniana ou malformação de Chiari I e II. Pode ainda ser adquirido após repetidas punções lombares ou lomboperitoniostomia. A ocorrência de herniação cerebelar após derivação de cisto aracnóide intracraniano é evento extremamente raro, existindo apenas três casos relatados na literatura médica. O caso de menino de 9 anos de idade, com puberdade precoce e cisto aracnóide supra-selar, que desenvolveu herniação sintomática das tonsilas cerebelares três anos após cistoperitoniostomia. O paciente foi submetido a craniectomia suboccipital com plástica dural e tonsilectomia parcial, apresentando remissão dos sintomas. Discutimos a patogênese sugerida na literatura.
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Child , Humans , Male , Arachnoid Cysts/surgery , Cerebellar Diseases/etiology , Hernia/etiology , Cerebellar Cortex , Craniotomy , Cerebellar Diseases/diagnosis , Cerebellar Diseases/surgery , Hernia/diagnosis , Hernia/surgery , Magnetic Resonance Imaging , Treatment Outcome , Ventriculoperitoneal ShuntABSTRACT
Nos últimos 3 anos (1986-1988) foram operados 110 aneurismas intracranianos em 107 pacientes no Hospital Cristo Redentor. Foram analisados os resultados obtidos (77,14% curados, 8m57% maus, 14,28% óbitos), que dependem de vários fatores, como a idade, condiçöes gerais do paciente, a localizaçäo e o "timing" da intervençäo cirúrgica
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Intracranial Aneurysm/complications , Subarachnoid Hemorrhage/etiology , Retrospective Studies , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/surgeryABSTRACT
Os autores descrevem três casos de síndrome de Landry-Guillain-Barré-Sthohl tratados com sucesso pela plasmaferese - os únicos do Rio Grande do Sul - precedidos por breve revisäo e detendo-se no procedimento, fixando critérios para sua indicaçäo