[Cerebrovascular diseases in patients aged 15 to 40 years: neuropathological findings in 47 cases]. / Doenças cerebrovasculares em pacientes entre 15 e 40 anos: achados neuropatológicos em 47 casos.

Cerebrovascular diseases in patients between 15 and 40 years old are not a frequent subject in Latin-American literature, especially when focusing on neuropathology. We analyzed 47 brains from necropsies performed from 1987 to 1997 and selected on a basis of age and the presence of vascular pathology. From the 47 analyzed brains, 26 belonged to females (55.3%). When distributed among age groups, 12.8% (n=6) affected patients from 15 to 20 yo, 51,1% (n=24) from 21 to 30 yo, 36,2% (n=17) from 31 to 40 yo. The underlying diseases were: cardiac and haemathologic (19.2%), pregnancy complications (12.76%), infections, diseases of blood vessels and neurological (10.1% each) amongst others. The neuropathological abnormalities included cerebral and/or cerebellar herniation (16%), cerebral edema (13.8%), subarachnoid hemorrhage (10%), recent cerebral infarction (9%), intraparenchymatous hemorrhage (8.14%), hypoxic-ischemic encephalopathy (3%) and other events such as Sneddon syndrome and Lupus vasculitis. These findings express that the cerebrovascular phenomena in this age group are unique and closely related with the underlying disease.

April 2001: a 70 year old woman with recurrent meningioma.

The April Case of the Month (COM). The contributors report a case of a 70 year-old woman with recurrent meningiomas, one of which showed rhabdoid and lipomatous differentiation. Histopathological study of the first and second previous resections showed only typical meningothelial meningioma. On the third craniotomy, a new tumor specimen showed an admixture of classic meningothelial meningioma with lipomatous and rhabdoid foci. Immunohistochemical studies showed diffuse reactivity for epithelial membrane antigen and vimentin, as well as focal positivity for desmin and smooth muscle actin in the areas with rhabdoid features and S100 protein in the lipomatous foci. The presence of these three different and concomitant histological patterns only in the third surgical resection might support a metaplastic origin and, also, corroborates the concept that rhabdoid features are suggestive of an aggressive behavior.

[Neurocysticercosis: a clinical and pathological study of 27 necropsied cases]. / Neurocisticercose: estudo clínico e patológico de 27 casos de necrópsia.

Neurocysticercosis is the most frequent and widespread neuroparasitosis of the human being. The development of brain and leptomeningeal lesions, with subsequent symptoms, are mainly related with the immune status of the host, and to the number and evolutional phase of the parasites. We present the pathological findings in 27 necropsies of patients with neurocysticercosis, which accounted for 3.1% of the necropsies. 77% of the patients were male and the age ranged from 18 to 85 years. In 26% there was previous history of alcoholism. Clinicopathological study showed that 50% of the cases were classified as asymptomatic form, 11% epileptic form, 11% intraventricular form and 11% combined form. 33% of the patients presented seizures as a factor of aggravation of the clinical picture. There was a single cysticercus in 60% of the cases, the cellulosae form present in 82% and the racemous form in 7% of the cases; the remaining 11% had both forms present. In 30% of the patients the cause of death was directly related with the presence of the cysticercus in the central nervous system. Our findings confirm the high morbidity of this disease.

[Krabbe s disease - case report] / Doença de Krabbe - relato de caso.

OBJECTIVE: Report a case of Krabbés disease with necropsy. METHODS: Review of medical and necropsy records. RESULTS: An 8 months-old male patient developed tremors, swallowing difficulty and excessive salivation for 4 months prior to admission, evolving with vomiting and fever. Physical examination showed microcephaly and diffuse pigmentation of the retinae. Neurological examination showed flexion of upper limbs with spastic hyperthony, symmetrical global hyperreflexia, nystagmus and spontaneous spasms. EEG showed multifocal irritative activity. There was increase in both CSF protein and gamaglobulin. The patient evolved with transitory hyperthermia, vomiting and pneumopathy, dying on the 23rd day after admission. Post mortem studies revealed microcephaly with widening of brain sulci. Histological examination revealed several globoid cells in the deep portion of the white matter, reactive gliosis and demyelination. CONCLUSIONS: These findings were similar to those in the world literature, indicating a poor prognosis due to substantial brain damage.

[Tuberous sclerosis: case report with histopathological and ultrastructural study]. / Eclerose tuberosa. Relato de caso com estudo histopatológico e ultraestrutural.

Tuberous sclerosis complex is a group of autosomal disorders characterized by hamartomas and benign neoplastic lesions that invariably affect the central nervous system. We report a case of tuberous sclerosis that is the first presenting ultrastructural findings of this phacomatosis in the Latin American literature. The patient was a 2 year old girl presenting West syndrome non responsive to the clinical treatment with vigabatrin, trileptal and clonazepan, and undergoing left frontal lobectomy. The histopathological and ultrastructural findings were compatible with tuberous sclerosis. These results may help to further understand this controversial phacomatosis, warning to the clinical presentation as West syndrome.

Prevalence of headache in children of a school from Curitiba, Brazil, comparing data obtained from children and parents.

This study analyzed prevalence, frequency and cause of headache among 460 children ranging from 10 to 14 years-old from a Brazilian school. A questionnaire was handed both to children and parents to know if there would be differences among children and parental reports. The lifetime prevalence of headache was 93.5% (children reports) and 93.3% (parental reports). The last year prevalence was 90% (children) and 89.8% (parents). Headache episodes were frequent in 17.6% (children) and 18.5% (parents). The most often reported cause was "flu" (39.1% by children, and 46.7% by parents). This study demonstrated that the prevalence of headache in children is high; moreover, there were noted few differences between data obtained from children and parents. So, we could say that when the objective of a epidemiologic study is to determine the prevalence of headache in children, both children and parental reports may be used.