RESUMO
In the present study, we have evaluated the use of intraventricular pressure catheters in thalamic and ganglionic hemorrhages. Ten patients admitted in our Emergency Department in Glasgow Coma Scale (GCS) equal or below 13 enrolled the study (at least one point should have been lost in the eye opening score to exclude purely aphasic patients that were fully alert). After a complete clinical and neurological evaluation, computed tomography scans were obtained and the volume of the hematomas, as well as presence or absence of hydrocephalus, were considered. Intraventricular pressure catheters connected in parallel to external derivation systems were implanted and patients were thereafter sent to the ICU. Patients that presented mass effect lesions with sustained increased ICP levels or clinical and neurological deterioration were submitted in addition, to the surgical evacuation of the hematomas. Clinical evolution, complications and the rehabilitation of the patients were recorded. Clinical outcome was assessed with the Glasgow Outcome Score. In all but three patients the initial intracranial pressure levels were bellow 20 mmHg (mean for all patients was 14.1 +/- 6.5 mmHg). Notwithstanding, these three patients were extremely difficult to treat. For this group of patients mortality was 100%. Among the patients that presented ICP levels bellow 20 mmHg, 04 developed hydrocephalus and 03 did not display ventricular dilation. As expected, the major benefits concerning the intraventricular pressure catheters connected in parallel with external derivation systems were observed in the group of patients that presented ICP levels bellow 20 mmHg and had hydrocephalus. Mild non-statistically significant correlations for all the three groups were achieved either when the initial GCS and ICP levels (r=-0.28, p=0.43) or when ICP levels and the volumes of the hematomas were compared (r=0.38, p=0.28). In addition, no significant correlations were observed concerning the final outcome of the patients and the variables previously evaluated.
Assuntos
Hemorragia Cerebral/terapia , Pressão Intracraniana , Monitorização Fisiológica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia dos Gânglios da Base/diagnóstico por imagem , Hemorragia dos Gânglios da Base/mortalidade , Hemorragia dos Gânglios da Base/terapia , Cateteres de Demora , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Drenagem/instrumentação , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Tálamo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Foi avaliada por ressonância nuclear magnética a incidência de malformaçöes da medula espinal em 38 crianças com espinha bífida. Destas, 22 apresentavam espinha bífida aberta e 16 espinha bífida oculta. Medula presa foi detectada na maioria dos pacientes. Siringomielia foi encontrada em 13 casos. A transiçäo occipitocervical foi estudada em 11 pacientes com meningomielocele e malformaçäo de Chiari foi encontrada em 8. A análise da cauística permitiu comprovar que existe número significativo de malformaçöes assintomáticas detectadas pela RNM
Assuntos
Lactente , Pré-Escolar , Criança , Adolescente , Humanos , Masculino , Feminino , Imageamento por Ressonância Magnética , Disrafismo Espinal/diagnósticoRESUMO
Relata-se um caso de tumor cerebral como intercorrencia do terceiro trimestre de uma gestacao. O diagnostico e a conduta em lesoes intracranianas devem ser sempre lembradas no diagnostico diferencial de cefaleia cronica e persistente, assim como em casos de episodios convulsivos durante a gravidez. Indica-se o parto prematuro terapeutico seguido de craniotomia na viabilidade fetal e na piora progressiva da funcao neurologica.
