bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symptomatic spinal cord metastasis of glioblastoma multiforme
Authors: De Andrade Emerson Magno F. , De Freitas Sérgio , Montanaro Antônio Carlos 
Published: April 2019

Symptomatic spinal cord metastasis from glioblastoma multiforme (GBM) has rarely been reported in the literature. We report the case of a 27-year-old man that presented with back and bilateral leg pain nine months after the primarydiagnosis of intracranial GBM. A magnetic resonance imaging (MRI) of the lumbar spine showed a L1-L2 tumor that was removed successfully and histopathological examination was consistent with GBM metastasis. Spinal metastasis should be investigated and included in the differential diagnosis if a patient with a previous history of intracranial GBM presentswith spinal symptoms.
Cavernous carotid traumatic dissecting aneurysm and subarachnoid hemorrhage after orthognathic surgery treated with arterial embolization
Authors: De Andrade Guilherme Cabral , Alves Helvércio F. Polsaque , Júnior Roberto Parente , Salvarani Cármine P. , Clímaco Walter M. , Pereira Eduardo R. , Pavan Ângelo 
Published: April 2019

Aneurysmal dissection of the internal carotid artery in the cavernous segment is an uncommon lesion, as well as the association with subarachnoid hemorrhage. Its description is related to direct or indirect trauma of the neck region. We report on a 26 year-old male patient who presented in the imediate postoperative after an orthognathic surgery with paralysis the right ocular cranial nerves (IIIº °, IVº ° and VIº°) with ophthalmoplegia, without chemosis or proptosis and with subarachnoid hemorrhage in the cranial tomography. Angiography disclosed a dissecting aneurysm of the right internal carotid artery in the cavernous segment, presenting with rebleeding during his evolution. The therapeutic option was arterial embolization with platinum microcoils. After extensive literature review, endovascular treatment was suggested.
De novo Aneurysms
Authors: Gonzales-Portillo Gabriel A. 
Published: April 2019

Introduction: Patients who have undergone craniotomy and clipping of an aneurysm are believed to be cured. We report two cases with previous ruptured aneurysms who presented 10 and 14 years later with de novo aneurysms. Methods: The charts of 39 patients who underwent craniotomy and clipping of 52 intracranial aneurysms by a single surgeon at a single institution from July 1999 to June 2003 were reviewed. Medline search for published English literature on de novo aneurysms was conducted from 1964 to 2003. Results: Two female patients out of 39 (5%) were found to have de novo aneurysms in our series. Mean age was 47. One patient presented again with SAH. Both were found to have multiple aneurysms less than 6 mm in size. There are 77 cases of de novo aneurysms in the English literature. Sixty-two (81%) patients presented with ruptured de novo aneurysm. The mean age of initial aneurysm presentation was 42.2 years, with average time interval between this and diagnosis of de novo aneurysm formation was 9.2 years. The female to male ratio is 2:1. Multiple aneurysms were found in 17 (22%) and 16 (21%) patients in the initial presentation and the de novo presentation respectively. Conclusions: Patients who undergo craniotomy and aneurysm clipping at an early age may benefit from follow up imaging studies for up to 20 years. Helicoidal CT angiogram with 3D reconstruction will allow for non-invasive follow up.
Cerebral Arteriovenous Malformations
Authors: Aguiar Paulo Henrique , Stefani Marco Antonio , Isolan Gustavo Rassier , Zicarelli Carlos Alexandre , Antunes Apio Claudio Martins 
Published: April 2019

A significant improvement of central nervous system arteriovenous vascular malformations (AVM) outcome has been observed due to the advances in all modalities of diagnosis and treatment. The authors report the advances in diagnosis and integrated global treatment of AVM`s.
Unusual Penetrating Cranioencephalic Injury by a Harpoon in a Brazilian Man
Authors: Júnior Sérgio Robson Martucci , Cohen Moyses Isaac , Chaves Renato Andrade , Teixeira Marco Aurélio Fernandes , Ellakkis Richam Faissal El Hossain , Meguins Lucas Crociati , De Morais Dionei Freitas 
Published: April 2019

Penetrating brain injury due to low energy objects is an unusual cause of head trauma, unlike gunshot wounds. Most cases reported are noteworthy due to its large dimension and, sometimes, good functional outcome. The present report describes the case of a Brazilian man presenting with a deep penetrating brain injury by a harpoon and no neurologic deficits. We discuss the main mechanisms of trauma and make a brief review of the literature upon epidemiological aspects and possible therapeutic approach. The early and appropriate neurosurgical management, on experience hands, may improve considerably patient outcome.
Intraoperative MRI Features of Absorbable Oxidized Regenerated Cellulose During Cerebral Glioma Surgery
Authors: Ramina Ricardo , Neto Maurício Coelho , Nascimento Alessandra B. , Vosgerau Ronaldo 
Published: April 2019

Objectives: Foreign body reaction to absorbable hemostatic agents may mimick recurrent brain tumor or abscess on postoperative MRI. Their appearance on intraoperative MRI and their use as resection borders marker have been not previously described. This study evaluates the intraoperative MRI appearance of absorbable oxidized regenerated cellulose in surgery of cerebralgliomas. Methods: 72 patients with cerebral gliomas were intraoperatively examined with high field MRI (1.5 T). 32 patients presented low-grade and 40 high-grade gliomas. After tumor resection the tumor bed was covered with absorbable oxidized regenerated cellulose. Results: The absorbable hemostat presented a hyperintense signal on MRI-T1 sequences in all patients. Tumor remnants under the hemostatic agent could be identified. Conclusions: Oxidized Regenerated Cellulose can be easily observed as a hyperintense signal lining covering the borders of the surgical cavity on intraoperative MRI-T1 sequences. It may be a useful marker of tumor resection borders of cerebral gliomas.
Espondilodiscite espontânea
Authors: Zanatelli Marcelo Motta , Zanatelli Filipe Mota , Galassi Alexandro Roberto 
Published: April 2019

A espondilodiscite é uma enfermidade incomum no adulto 1-6, associada ao risco aumentado de morbidade e mortalidade devido à dificuldade diagnóstica, com aumento de incidência na infância e na fase adulta, representando de 2 a 4% dos casos de osteomielite2-4 e até 15% de todos os casos de infecção da coluna vertebral. Insuficiência renal crônica em paciente realizando hemodiálise, diabetes melitus, obesidade (principalmente IMC >30), etilismo crônico, uso de drogas injetáveis, neoplasias ou qualquer outro fator imunossupressor aumentam os riscos de desenvolver a doença. Entre os principais patógenos piogênicos, o Staphilococos aureus é o mais frequente. Nas formas de apresentação granulomatosa, o Mycobacterium tuberculosis é omais frequente, seguido de Brucella millitensis (em regiões endêmicas), espiroquetas e fungos2,4. Os exames de imagem ajudam na formulação do diagnóstico etiológico2,3,4, sendo a ressonância nuclear magnética o exame mais sensível. Antibioticoterapia direcionada ao patógeno encontrado é o tratamento de escolha. Relatamos o caso de um paciente internado com quadro deparaparesia crural (FMG II) secundária a discite D7/D8 que foi submetido à descompressão cirúrgica da medula e artrodese antero-lateral. Houve controle da doença com uso de esquema antibiótico clindamicina/ciprofloxacino por 12 semanas.
Encefalocele fronto-etmoidal
Authors: Ferri Ricardo Gimenes , Ribeiro Paulo Ronaldo Jube , Panarello Alan Fernando , De Menezes Rodrigo Toledo 
Published: April 2019

Introdução: A encefalocele consiste em uma má formação congênita do SNC, caracterizada pela herniação do tecido nervoso decorrente de alterações do tubo neural. Em sua forma intranasal, a encefalocele pode ser confundida com inúmeras afecções que mimetizam vários outros sinais e sintomas, contribuindo para diagnósticos errôneos por longos anos. Alguns pacientes cursam com quadro clínico agravado, podendo evoluir com quadros de meningites de repetição e abscessos cerebrais, que podem culminar com prognóstico reservado. Relato de Caso: Paciente de 44 anos de idade, com história de quatro anos de presença de secreção de líquido claro e inodoro unilateral à direita, usualmente diagnosticado como quadros de rinite unilaterale/ou polipose nasal. A TC de seios da face e a RM demostraram encefalocele fronto-etmoidal, sendo submetido a tratamento cirúrgico vídeo-assistido. Discussão: O diagnóstico precoce é a melhor opção a estes pacientes, sendo o tratamento cirúrgico sempre indicado. A escolha do método de tratamento deve buscar aquele que obtenha resultados com menor morbidade possível.Acredita-se que a cirurgia endoscópica é uma excelente opção pelas altas taxas de sucesso e relativa menor morbidade quando comparada a cirurgia tradicional. Conclusão: A cirurgia endoscópica nasal, com acesso a base do crânio, mostrou-se uma excelente opção terapêutica ao caso reportado.
Asymmetric optic nerve sheath diameter as an outcome fator following cranioplasty in ‘syndrome of the trephined’ patients
Authors: De Araújo Junior Antônio Santos , Arlani Pedro Alberto , Salvestrini Jr. Arnaldo , Altieri Carlos Eduardo , Santos Jasper Guimarães , Pinto Lauro Figueira , Fazzito Mirella Martins , Lee Hae Won , Godoy Luis Felipe De Souza 
Published: April 2019

Background: Decompressive craniectomy (DC) is gaining an increasing role in the neurosurgical treatment of intractable intracranial hypertension, but not without complications. A rare complication is the “syndrome of the trephined” (ST). It occurs when the forces of gravity overwhelm intracranial pressures, leading the brain to become sunken. Methods: We followed-up 5 patients submitted to DC and diagnosed with ST. All were submitted to brain MRI to calculate the optic nerve sheath diameter (ONSD). Our goal was to determine the usefulness of asymmetric ONSD as an outcome factor after cranioplasty. Results: Only two patients presented an asymmetric ONSD, being ONSD larger at the site of craniectomy. Surprisingly these patients had a marked neurological improvement after cranioplasty. They became independent a week after and statistically earlier than others. Conclusion: It is presumed that the presence of an asymmetric ONSD in trephined patients is an independent factor of good outcome after cranioplasty.
Bell’s Cruciate paralysis in a patient victim of a gunshot wound in the cervical region
Authors: De Souza Rodrigo Becco , De Aguiar Guilherme Brasileiro , Daniel Jefferson Walter , Veiga José Carlos Esteves 
Published: April 2019

Bell’s cruciate paralysis is characterized by paralysis of the upper limbs associated with little or no deficit in lower limbs. Its diagnosis is often overlooked, given that its symptoms similarities to that occasioned by the centromedullary syndrome, whose incidence is considerably higher. The present case report describes the case of a 16-year-old male patient victim of a gunshot wound in the anterior cervical region that developed Bell’s cruciate paralysis. The Magnetic Resonance Imaging (MRI) of the cervical spine showed medullary signal change in the cervicomedullary junction, with anteromedial location. A somatotopy of the corticospinal tract was suggested by Bell (1970) at cervicomedullary transition, with the anatomical hypothesis that fibers responsible for the movement of the upper limbs would cross higher and more superficially that the fibers of the lower limbs. This case combines the MRI assessment with the clinical outcome and corroborates with the Bell’s anatomical theory.
Lesão granulomatosa intracraniana mimetizando meningioma
Authors: Mathias Roger Neves , Aguiar Paulo Henrique Pires , Lehmann Marcio Francisco , Maldaun Marcos Vinicius Calfat 
Published: April 2019

A doença de Erdheim-Chester (DEC) é uma rara histiocitose de células não-Langerhans com acometimento multi-sistêmico e apresentação variada. O diagnóstico clínico é desafiador e na maioria das vezes feito em diferentes tempos. Não há padrão radiológico ou histológico patognomônico, por isso a somatória de achados clínicos, radiológicos e histológicos é fundamental para a suspeita diagnóstica e a imunohistoquímica diferencia de outras variantes de histiocitoses. O envolvimento do sistema nervoso é ainda mais raro e pode variar desde lesões nodulares, infiltrações de fibras brancas até lesões com efeito de massa expressivas que necessitam tratamento cirúrgico. Apresentamos nesse artigo um relato de caso da DEC e considerações diagnósticas e terapêuticas da doença.
Tratamiento Quirúrgico de Aneurismas Gigantes Intracraneanos
Authors: Jaume Alejandra , Salle Frederico , Fernandez Martín , Cabrera Viviana , Aramburu Ignacio , Spagnuolo Edgardo 
Published: April 2019

Introducción: Los aneurismas gigantes intracraneanos son lesiones vasculares de baja incidencia, constituyendo aprox. entre el 2 y el 5% de todos los aneurismas intracraneanos. La historia natural de esta patología tiene resultados poco alentadores, con elevada morbi-mortalidad. Métodos: Se realizó un trabajo retrospectivo, en base a 145 pacientes operados de aneurismas gigantes en los últimos 10 años, los cuales fueron tratados con cirugía, mediante reconstrucción con clips. Se completó con una revisión bibliográfica enfocada en el tratamiento de aneurismas gigantes, en los últimos 13 años, en Pubmed. Resultados: De los 145 aneurismas incluidos en el trabajo, 140 fueron del sector anterior del polígono de Willis, y 5 fueron del sector posterior. La localización más frecuente fue en la arteria cerebral media. Del total, solo el 26% se presentaron con hemorragia subaracnoidea (HSA), mientras que los restantes presentaron una evolución seudotumoral. La mortalidad de los pacientes que debutaron con HSA fue de 15%, y la morbilidad de 10%. Los aneurismas no rotos, tuvieron una mortalidad del 6,5%, y una morbilidad del 15%. Conclusiones: los resultados obtenidos en nuestro trabajo, al igual que en el resto de las series, tienen una baja morbimortalidad, en comparación con la evolución natural de la enfermedad.
Sinus Pericranii
Authors: Negrotto Matías , Crosa Roberto , Jaume Alejandra 
Published: April 2019

Sinus pericranii es una anomalía vascular poco frecuente que consiste en conexiones anómalas congénitas o adquiridas entre sistemas venosos extracraneales e intracraneales. Los lagos venosos extracraneales se conectan a los senos durales intracraneales a través de venas dilatadas diploicas y emisarias. Este trastorno es hallado generalmente en la población pediátrica y la mayoría de las veces involucra el seno sagital superior y ocasionalmente el seno transverso. Son procesos generalmente estables habiéndose publicado inclusive casos de regresiónespontánea.
Trombose venosa cerebral em paciente jovem do sexo masculino com história de uso de Tamoxifeno
Authors: Mello Luís Renato G. de Oliveira , Haas Leandro J. , Lang Michael R. , Bonadio Lucas Eduardo , Cabral Filipe L , Peres Gabriel Hoher , Marcolini Thomas R. , Barbosa Julys S. 
Published: April 2019

A Trombose Venosa Cerebral (TVC) é uma afecção rara, que resulta em obstrução parcial ou total dos seios venosos cerebrais. Possui diversas causas desencadeantes como infecção, trauma e distúrbios de coagulação, assim como diversas apresentações clínicas. O trabalho relata o caso de TVC de um paciente jovem, do sexo masculino, que havia feito uso de Tamoxifeno, receitadona academia de musculação, para evitar crescimento das mamas pelo uso de suplementos de fórmula não conhecida. Foram discutidos também seu diagnóstico e abordagem escolhida.
Hemorragia Intracraniana por Malformação Arteriovenosa na Gravidez
Authors: Pereira Carlos Umberto , Barcelos Ronald , Reis Geraldo Ávila , Santos Ana Cristina Lima , Júnior José Anísio Santos , Passos Rodrigo Oliveira 
Published: April 2019

A hemorragia intracraniana espontânea (HIE) que ocorre durante a gravidez ou puerpério é rara. A malformação arteriovenosa (MAV) intracraniana é responsável por cerca de 20% a 48% das HIE durante a gestação e puerpério. Convulsão, cefaleia, déficits neurológicos e alterações do nível de consciência podem ser as manifestações inicias em gestantes com HIE devido à MAV. Os autores relatam um caso de MAV em uma paciente de 21 anos de idade, no 4º mês de gravidez e discutem conduta e prognóstico.
Epidemiologia do Traumatismo Raquimedular em Idosos
Authors: Passos Rodrigo Oliveira , Pereira Carlos Umberto , Santos Ana Cristina Lima , Dos Santos José Anísio , Sousa Allisson Hora 
Published: April 2019

Objetivo: O traumatismo raquimedular (TRM) é uma das lesões traumáticas mais comuns e que mais causam sequelas ou óbitos. O presente trabalho relata a epidemiologia de TRM em idosos. Métodos: Foram analisados 44 pacientes vítimas de TRM, com idade acima de 60 anos, durante o ano de 2013. Resultados: Participaram do estudo 30 (68,2%) pacientes do sexo masculino e 14 (31,8%) do feminino. A idade dos pacientes variou entre 60 e 95 anos. O segmento mais acometido foi coluna cervical com 22 (50%) casos, seguido de 12 (27,3%) lombar, seis (13,6%) torácicos e quatro (9%) em múltiplos segmentos. Queda foi a principal causa, com 26 (59,1%) dos casos, seguida de acidente automobilístico com 12 (27,3%) casos. A lesão associada mais comum foi otraumatismo crânio encefálico (TCE). O tratamento foi cirúrgico em 14 (31,8%) casos e conservador em 30 (68,2%). Houve cinco óbitos (11,4%). Conclusões: Nos idosos, o TRM predomina no sexo masculino, acomete principalmente o segmento cervical da coluna vertebral e tem como causa principal a queda. É de fundamental importância o aperfeiçoamento do atendimento ao paciente idoso vítima de TRM, assim como a criação de programas de conscientização e prevenção.
Paraplegia Following Massage Therapy Intervention in a Patient With Undiagnosed Multiple Myeloma
Authors: Botelho Ricardo Vieira , De Oliveira Matheus Fernandes , Reis Rodolfo Casimiro , Ferreira Jânio Alves , Gameleira Filho Sílvio Tenório , Rotta José Marcus 
Published: April 2019

Introduction: Due to increased number of available alternative therapies to the treatment of back pain and sometimes a difficult access to specialized medical evaluations, there is a widespread use of alternative therapies for the treatment of back pain. Case Description: We describe a case with a catastrophic consequence of massage therapy in a patient with initial symptoms of back pain resulting in definitive paraplegia and discuss the needs for medical diagnosis for any treatment. Discussion and Conclusion: We discuss the potencial harms to the patient when initiating a questionable treatment method, which are late diagnosis, direct physical harm, interference with tradiotional treatments, financial harm and time loss. Alternative treatments are valuable tools to control refractory symptoms, especially pain. But we reinforce the need of adequate medical screening before performing therapies which may bring unwilling outcomes.
C1-C2 Luxation in Patient with Down Syndrome
Authors: Holanda Maurus Marques de Almeida , Santos Rayan Haquim Pinheiro , Peixoto Gustavo De Moura , Pereira Neto Normando Guedes , Melo Luiz Ricardo Santiago 
Published: April 2019

Introduction: Down syndrome is caused by trisomy of chromosome 21, and it is the most common chromosomal abnormality in humans. This genetic condition is characterized by multiple skeletal abnormalities, including atlantoaxial instability that occurs in 9-31% of patients presenting clinical consequences in 1-3% of them. This study aims to report a case of atlantoaxial instability with clinical repercussions of quadriparesia. Case Report: A case of a 10-year-old boy, with Down syndrome, who could notget up for three months is reported. Clinical examination revealed quadriparesis. The lateral radiograph of the cervical spine showed a atlanto-odontoid distance of 6mm, confirming atlantoaxial instability.
5-Aminolevulinic Acid–Protoporphyrin IX Fluorescence-Guided Surgery for CNS Tumors
Authors: Ramina Ricardo , Da Silva Júnior Erasmo Barros , Coelho Neto Maurício , Ruschel Leonardo Gilmone , Navarrette Felipe Andrés Constanzo 
Published: April 2019

Introduction: In the last two decades the 5-aminolevulinic acid (5-ALA) has been utilized in primary brain lesions and metastases surgery to aid the identification of tumor limits and infiltration. Objectives: In this retrospective study, we demonstrate our experience with the first 41 cases Latin America of surgical resection of central nervous system (CNS) lesions with 5-ALA. Methods: In 41 consecutive patients, we recorded age, sex, histopathological diagnosis, intraoperative 5-ALA fluorescence tumor response, 5-ALA post-resection resection grade through magnetic resonance image (MRI) and other concomitantintra-operative techniques utilized (transoperative imaging, awake surgery, electrophysiological stimulation and monitoring). Results: Twenty seven high-grade gliomas and 4 non-glial lesions were 5-ALA fluorescence positive; 6 low-grade gliomas, 1 high-grade glioma and a hippocampal gliosis were 5-ALA fluorescence negative. In one case of a low-grade glioma, the patient developed a cardiac arrhythmia, probably not related to 5-ALA administration, but the surgery was suspended. Conclusions: 5-ALA fluorescence-guided surgery is a safe and easy technique to be used, increasing tumor total gross resection in glioma cases, proving to be an invaluable neurosurgical tool for intracranial tumor surgery. There was no serious side effect in this series. This dye should be utilized in all cases of high-grade gliomas.
Tratamiento Quirúrgico de los Meningiomas Espinales
Authors: Villanueva Pablo , Santamaria  José Ignacio , Villalonga Juan Francisco , Cervio Andrés 
Published: April 2019

Objetivo: Presentar nuestra experiencia en el tratamiento quirúrgico de los meningiomas espinales. Material y métodos: Estudio descriptivo retrospectivo que incluye a 24 pacientes operados de meningiomas espinales durante el período Julio de 2009 a Diciembre de 2016. Se analizaron datos epidemiológicos, antecedentes personales, sintomatología preoperatoria, características radiológicas, hallazgos intraoperatorios, grado de resección, descripción histológica y evolución post operatoria. Resultados: Se operaron 24 pacientes siendo 83% de sexo femenino. En cuanto a la localización, 79% fueron dorsales, 17% cervicales y 4% lumbares. La anatomía patológica reveló meningiomas grado I (OMS) en todos los casos. En el 63% se abordó la lesión por hemilaminectomía, logrando en éstas un grado de resección satisfactorio (Simpson 2). El 66% de los pacientes presentaron mejoría clínica post operatoria, 30% sin cambios significativos y solo un caso (4%) de empeoramiento. El periodo de seguimiento promedio fue de 14,9 meses. Conclusión: La cirugía continúa siendo el tratamiento de elección en los meningiomas espinales. El abordaje por hemilaminectomía es una opción útil en lesiones con base de implantación lateral. Lesiones predominantemente ventrales, con componente cálcico y alteraciones motoras preoperatorias suelen presentar mayor complejidad quirúrgica y peor evolución.