Spontaneous subarachnoid hemorrhage as the primary manifestation of carotid cavernous fistulas: case report.

We report the case of a 19-year old male patient initially admitted to our service after a motor vehicle accident with a normal neurologic evaluation and a CT scan that revealed no abnormalities. Nineteen months later, he was readmitted after a subtle headache episode, followed by a brief loss of consciousness. He was submitted to a complete evaluation, which revealed no abnormalities (even in the neurologic and ophthalmologic exams). A CT was performed revealing a diffuse subarachnoid hemorrhage. Contrast enhancement displayed a right paraselar lesion, which was first interpreted as a giant aneurysm. The patient underwent a cerebral angiography which showed a right carotid-cavernous fistula with retrograde venous drainage through the superior and inferior petrosal sinuses. Filling of various cortical vessels was observed. The patient was treated with endovascular technique and a control angiographic study assured the complete closure of the fistula. He had an excellent clinical recovery, being discharged in good conditions.

Guidelines for neurosurgical trauma in Brazil.

This chapter emphasizes some aspects of the Brazilian Guidelines for the Assessment of Head Injury Patients, written based on the experience of the Emergency Service, Neurosurgical Division of the University of São Paulo Medical School Hospital, and sponsored by the Brazilian Society of Neurosurgery. These guidelines approach the management of head-injury patients from their initial assessment in the Emergency Room until the final suggested clinical or surgical management. The Brazilian Guidelines represents our efforts to provide the basis for a common unified data collection system, which may allow cooperative studies in the future.

Spontaneous epidural hematoma following a shunt in an infant with congenital factor X deficiency. Case report and literature review.

The authors describe a case of an infant with congenital factor X deficiency. The patient presented with a central nervous system hemorrhage followed by hydrocephalus. He underwent a ventriculoperitoneal shunt and, during the postoperative period, developed a spontaneous epidural hematoma, which was evacuated. The clinical and pathophysiological aspects of this case are discussed based on a literature review.

Transient mutism following a posterior fossa approach to cerebellar tumors in children: a critical review of the literature.

Transient mutism has been known as a rare complication following a posterior fossa approach to cerebellar tumors and its cause has not been clearly elucidated. The cerebellar mutism is not accompanied by cranial nerve deficits and disorders of consciousness. Since 1985 only 23 cases of mutism following removal of a cerebellar tumor in children have been reported in the literature. Two additional cases have been operated upon in our department. Extensive injury to the vermian and paravermian cerebellar area, involving the hemispheric cortex, cerebellar peduncles, fibers from the dentato-thalamocortical pathway, and dentate and interpositum nuclei may be the most important anatomical substrate of mutism. The mechanism of such transient mutism seems to be a complex of two or more factors (vascular disturbances due to manipulation or retraction of the cerebellar region around the IV ventricle and emotional factors). On the basis of these 25 cases the major features of the cerebellar mutism are discussed.

Primary malignant rhabdoid tumor of the spinal dura.

We report a case of an intradural extramedullary malignant rhabdoid tumor (MRT) occurring in a 2-year-old girl. Histologically, immunohistochemically and ultrastructurally, the tumor fulfilled the diagnostic criteria for MRT. Many tumor cells contained typical cytoplasmic eosinophilic hyaline inclusions which were filamentous by electron microscopy. Positive vimentin staining was observed immunohistochemically but epithelial markers were negative. Extrarenal MRT are rare. Ten instances in the central nervous system have been reported. This case is the first intradural MRT of the spinal canal. The differential diagnosis from other tumors of this region is important because the prognosis and therapeutic approaches are greatly different.

[Magnetic resonance imaging in spinal dysraphisms]. / Ressonância nuclear magnética nos disrafismos espinais.

We studied by magnetic resonance imaging the incidence of associated malformations in a group of 38 patients with diagnosis of spina bifida followed in our outpatient clinic. Twenty-two children were born with spina aperta and 16 with spina bifida occulta. Tethered cord was found in the majority of patients of both groups. Syringomyelia was found in 13 patients. The craniocervical region was studied in 11 patients with the diagnosis of spina bifida aperta; Chiari malformation was found in 8. The results point to the fact that asymptomatic malformations detected by MRI techniques are frequent in patients with spina bifida.