[Unusual cause for bilateral trigeminal neuralgia: unilateral racemous cysticercus of cerebellopontine angle. Case report]. / Neuralgia do trigêmeo bilateral por cisticerco racemoso unilateral no ângulo-ponto cerebelar: relato de caso.

We report the case of a 42-year-old woman with a racemous cystecercus in the right cerebellopontine angle (CPA), who presented with bilateral trigeminal neuralgia. The parasite was completly removed via a right suboccipital craniotomy. On the first postoperative day, the patient indicated that the pain disappeared. The neuralgia was caused by two probable mechanisms: a distortion of the brain stem and compression of the nerve against an arterial loop at the entry zone or arachnoiditis caused by the parasite in the both CPA cisternae. This case demonstrates the advisability of obtaining imaging studies in all patients with trigeminal neuralgia before starting any management. We must always remind that the cysticercus may be a differential diagnosis of CPA lesions.

Causes and treatment of intracranial haemorrhage complicating shunting for paediatric hydrocephalus.

Intracranial haematomas are a well-known complication of shunting procedures for hydrocephalic patients. Most are subdural haematomas, and epidural haematomas are much less common in this setting. Their aetiology is thought to be due to an overdrainage of cerebrospinal fluid and a rapid lowering of intracranial pressure, leading to the development of these haematomas. Since the advent of modern neuroimaging techniques, prompt diagnosis of postshunting intracranial haematoma has been possible even in asymptomatic patients. The choice between surgical and nonsurgical management of postshunting intracranial haematoma is a difficult and controversial issue, especially in asymptomatic patients. Several therapeutic options have been proposed for the treatment of postshunting intracranial haematoma. Evacuation of the haematoma by conventional neurosurgical methods with the implantation of a higher pressure valve system is the most common option adopted. Intraventricular haemorrhage is occasionally reported, chiefly in children with hydrocephalus associated with vein of Galen malformation.

Malignant ectomesenchymoma. Case report and review of the literature.

Malignant ectomesenchymoma is an uncommon neoplasm composed of neuroectodermal elements and one or more mesenchymal neoplastic elements. It is believed to arise from remnants of migratory neural crest cells (ectomesenchyme). The authors report the clinical and pathological findings of a 3-year-old girl with malignant ectomesenchymoma of the CNS. Embryogenesis of this tumor is discussed, and a review of the literature with 39 other cases is done.

Prognostic factors to predict outcome following the administration of hypertonic/hyperoncotic solution in hypovolemic patients.

Hypertonic solutions effectively improve hemodynamic parameters in patients admitted to the emergency room. However, no significant differences in outcome were observed compared with standard isotonic treatment in most previously published studies. This study evaluates pretreatment prognostic factors that predict a beneficial effect of hypertonic solution in patients admitted to the emergency room with hemorrhagic hypovolemia in a prospective double-blind fashion. The patients (n = 212) were randomized upon admission to receive 250 mL intravenous (i.v.) bolus of hypertonic 7.5% NaCl + 6% dextran (HSD, n = 101), or isotonic 0.9% NaCl solutions (IS, n = 111) as the first treatment, followed by standard resuscitation. Pretreatment factors assessed were sex, age, cause of hypovolemia, revised trauma score (RTS), Glasgow index, and mean arterial pressure (MAP) on admission. Both groups were compared for survival at 24 h and 30 days postadmission. Infused volumes were registered. HSD administration significantly increased MAP and reduced i.v. crystalloid infusions to maintain hemodynamic parameters, compared with IS. There was no difference between groups in the number of blood transfusions administered. Overall complication rates in both groups were similar (24%). There was a significant difference (p < .03) in overall (30 days) survival rate between HSD (73%) and IS (64%) groups. The 24 h survival rate was significantly lower in IS (72%) compared with HSD (87%); p < .01. Multivariate analyses showed that RTS and MAP were identified as independent predictors for 24 h survival in the group that received HSD. When evaluated for overall survival rate, hypertonic infusion benefited significantly only patients with MAP < 70 mmHg (p < .01).

[Falx osteochondroma: case report and review of the literature]. / Osteocondroma da foice. Relato de caso e revisão da literatura.

One case of an intracranial osteochondroma originating from the falx is described. The tumor was partially removed. Surgical aspects and etiopathogenesis of falx chondromas are discussed. The values of computerized tomography and magnetic resonance are emphasized.

[Depressed skull fractures in children under 2 years of age. Retrospective study of 43 cases]. / Fratura com afundamento craniano em crianças com menos de dois anos de idade. Estudo retrospectivo de 43 casos.

Depressed skull fractures (DSF) in infancy and childhood are frequent but only a few articles make an analysis in children with age between 0 and 2 years. This is a retrospective study of 43 patients with DSF and age ranged from 0 to 2 years. Falls and traffic accidents were the most common causes. Most patients were admitted in alert state. 69.8% of the patients were submitted to surgical treatment. The parietal bone was more frequently injured (55.8%). Most of the patients had type 1 DSF (the depressed bone remains connected to the cranial vault). The incidence of associated lesions of nervous system was lower than reported in the literature.