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Publicações | 2014

Chronic subdural hematoma treatment with adjustment of programmable valve in idiopathic normal pressure hydrocephalus patient: a case report.

 

Oliveira MF, Reis RC, Pinto FCG, Rotta JM. Arq Bras Neurocir 2014; 33(02): 139-141. 

Abstract:

Chronic subdural hematoma (CSDH) is a common entity in daily neurosurgical practice. It is considered a benign condition. Idiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, dementia and/or urinary incontinence added to dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure. We describe an experience of a conservative treatment of subdural hematoma based in the physiopathology and ability to control the pressure in programmable valves. The adjustment of programmable valves in the treatment of INPH allow us the therapeutic control of hydrocephalus and an important tool to manage complications, especially overshunting and undershunting.

Amyloidosis presenting as multiple vertebral fractures.

Botelho RV, Oliveira MF, Rotta JM. Arq Bras Neurocir 2014; 33(03): 240-243. 

Abstract:

 

Amyloidosis is a plasma cell disorder characterized by the overproduction and tissue deposition of a monoclonal IG light chain or fragments. Musculoskeletal and soft tissue manifestations are arthropathy, myopathy, bone lesions, and lymphadenopathy. It can also present with symptoms and signs that mimic a variety of rheumatic conditions, such as scleroderma, rheumatoid arthritis, Sjögren's syndrome polymyalgia rheumatica, a myeloma or a bone tumour. We describe the case of a 64-year-old white woman with an acute history of fall from own height in whose investigation revealed fractures in T8, T9, T11 and L1. In order to determine the nature of lesion, the patient was submitted to percutaneous biopsy guided by fluoroscopy of T11, without any surgical complications. Pathological findings were compatible with deposition of amyloid protein and amyloidosis. Amyloidosis must be considered in differential diagnosis of pathological fractures together with other osteopenic and lytic conditions, such as bone metastasis, metabolic and infectious.

Spinous process fractures after chiropractic massage in a previously healthy subject.

Botelho RV, Oliveira MF, Sousa UO; Rotta JM.Arq Bras Neurocir 2014; 33(03): 210-212

Abstract:

 

Increasing available alternative therapies to the treatment of back pain and sometimes difficult access to specialized medical evaluations allowed a widespread use of alternative therapies for the treatment of back pain. We describe a case with a consequence of massage therapy in a patient with initial symptoms of back pain resulting in spinous process fractures. She promptly searched medical attendance and cervical plain radiograph revealed avulsion of spinous processes of C6 and C7 in their outer third. Due to benign nature of lesion, without evidence of instability and spinal cord injury, the subject was managed conservatively, with application of a Philadelphia collar and analgesic medication. We reinforce the need of medical attention before beginning any therapeutic method in order to identify previous alterations and plan an adequate programming.

Psychiatric symptoms are present in most of the patients with idiopathic normal pressure hydrocephalus.

Oliveira MF, Oliveira JR, Rotta JM, Pinto FC.Arq Neuropsiquiatr. 2014 Jun;72(6):435-8

Abstract:

 

Normal pressure hydrocephalus (NPH) is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence confirms association between NPH and psychiatric symptoms. We selected 35 patients with idiopathic normal pressure hydrocephalus from January 2010 to January 2012 in a Brazilian tertiary hospital and performed a formal psychiatric evaluation to identify psychiatric disorders. Psychiatric disorders were present in 71% of these patients, especially anxiety, depression and psychotic syndromes. NPH patients may develop symptoms with frontal dominance, such as personality changes, anxiety, depression, psychotic syndromes, obsessive compulsive disorder, Othello syndrome; shoplifting and mania. Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment

Epidemiology of intracranial neoplasms in Hospital of Servidor Público Estadual of São Paulo: 2010-2012.

Rodrigues DB, LimaLO, Pereira ELR, Sousa UO, Oliveira MF, Lima AM, Rotta JM.Arq Bras Neurocir 2014; 33(01): 06-12

Abstract:

 

OBJECTIVE:

To perform an epidemiological analysis about primary and metastatic brain tumors among patients treated at the Hospital of Servidor Público of São Paulo during the years 2010 to 2012.

 

METHOD:

Epidemiological study descriptive, retrospective and observational of medical records of 369 patients who underwent treatment for intracranial tumors primary or metastatic brain tumors between the years 2010 and 2012 at Hospital of Servidor Público of São Paulo (HSPE-SP), according to the data obtained in the field of hospital records, the records of the institution and pathological records of patients treated surgically.

 

RESULTS:

Primary brain tumors accounted for 69% of the sample was predominantly female, the average age was 62 years, with peak incidence in the age group 41-64 years. Meningiomas were found most primary brain tumors (23%), followed by gliomas (21%). Lung cancer, breast and gastrointestinal tract were, in descending order, the most frequent primary locations of metastases, these were multiple in only 26% of cases and had a predilection for frontal lobe and the cerebellum.

 

CONCLUSION:

Primary intracranial tumors were predominant in the sample, meningiomas and gliomas corresponded to the main histological types. Cancers of the lung, breast and gastrointestinal tract were, in descending order, the most frequent primary locations of intracranial metastases; these had predilection for frontal lobe and cerebellum and were, most frequently, single.

Abstract:

Primary familial brain calcification (PFBC) is identified by mineralization of the basal ganglia and other brain regions in the absence of known causes. The condition is often inherited in an autosomal dominant pattern and can manifest itself clinically with neuropsychiatric symptoms such as Parkinsonism, headaches, psychosis, and mood swings. Mutations in the SLC20A2 gene account for ~40% of inherited cases, and this gene encodes an inorganic phosphate transporter (PiT-2), a transmembrane protein associated with Pi homeostasis. The p.Y386X mutation in SLC20A2 was identified in a patient who presented migraines, brain calcification, and mild but chronic hypovitaminosis D. SLC20A2 c.1158C > G single-nucleotide heterozygous mutation results in a premature stop codon and a putative truncated protein of 385 amino acids. Proband parents do not present the mutation, which is also not present in major public SNP databases, suggesting a de novo sporadic trait. This study describes for the first time a de novo SLC20A2 mutation in a PFBC patient with migraine and mild hypovitaminosis D. This data further reinforces the pathogenic role of SLC20A2 mutations as causal factors in PFBC physiopathology.

Updating technology of shunt valves. 

Oliveira MF, Pereira RM, Pinto FCG.Medica Express 2014 August;1(4):166-169

Abstract:

 

Cerebrospinal fluid shunts are one of the greatest advances of modern neurosurgery and represent a shift in the treatment of hydrocephalus. The underlying physical principle is quite simple and consists of diverting the flow of cerebrospinal fluid to either intracranial structures, jugular system, right heart atrium, pleura, peritoneum or to other natural cavities, such as the omental bursa and even the bladder. All systems operate by means of a differential pressure between the proximal catheter and distal catheter and are composed of ventricular and distal catheters, and a valve, which is the device that allows unidirectional cerebrospinal fluid flow. Current valve technology allows control of the shunt through regulation of drainage pressure, flow regulation or anti-siphon devices. There are valves with low, medium and high pressure designed to open and allow the flow out of CSF when the intraventricular pressure rises above the opening pressure. In contrast to fixed pressure and programmable pressure, valves with flow regulation attempt to maintain constant flow despite changes in the fluid pressure and patient position. Anti-siphon devices are used to avoid the siphon effect and prevent under- or over-drainage of fluid. We discuss briefly the current aspects of hydrodynamics and update valve technology.

Laparoscopy for ventriculoperitoneal shunt implantation and revision surgery. 

Pinto FC, de Oliveira MF.

World J Gastrointest Endosc. 2014 Sep 16;6(9):415-8.

Abstract:

 

Ventriculoperitoneal shunting (VPS) is a widely accepted technique for the treatment of hydrocephalus. The probability of shunt dysfunction is pretty high throughout life. Laparoscopy has become a valuable tool to perform VPS and treat abdominal complications. An electronic literature search was performed to reveal the published data relating laparoscopy and ventriculoperitoneal shunt in Medline, Embase, Scielo and Lilacs databases. The keywords employed were" laparoscopy" OR "laparoscopic surgery" AND "ventriculoperitoneal shunt" OR "shunt" AND "surgery" OR "implantation" OR "revision" OR "complication". No high  quality trials were developed comparing conventional laparotomic incision vs laparoscopic approach. Both approaches have evolved and currently there are less invasive options for laparotomy, like periumbilical small incisions; and for laparoscopy, like smaller and less incisions. Operating room time, blood loss and hospital stay may be potentially smaller in laparoscopic surgery and complications are probably the same as laparotomy. In revision surgery for abdominal complications after VPS, visualization of whole abdominal cavity is fundamental to address properly the problem and laparoscopic approach is valuable once it is safe, fast and much less invasive than laparotomy. Ventriculoperitoneal shunting is a widely accepted technique for the treatment of hydrocephalus. Laparoscopy assisted shunt surgery in selected cases might be a less invasive and more effective option for intrabdominal manipulation. The laparoscopic approach allows a better catheter positioning, lysis of fibrotic bundles and peritoneal inspection as well, without any additional complication. 

Remote spinal cord injury in mucopolysaccharidosis type IVA after cervical decompression. 

Borlot F, Arantes PR, Capel Cardoso AC, Kim CA. Neurology. 2014 Apr 15;82(15):1382-3.

Abstract:

 

Morquio A syndrome (Online Mendelian Inheritance in Man #253000) is a lysosomal storage disease caused by deficiency of N-acetylgalactosamine-6-sulfatase encoded by the GALNS gene. Key clinical features are skeletal dysplasia and short stature

Abstract:

 

Tuberculosis continues to be a serious health problem worldwide. The disease continues to be underdiagnosed and not properly treated. In conditions that affect the immune system, such as multiple sclerosis (MS), latent tuberculosis may thrive and reactivate during the use of immunomodulatory and immunosuppressive drugs. Among the best treatment options for patients with latent or active tuberculosis who have MS are IFN-β, glatiramer acetate and mitoxantrone. Drugs leading to a reduced number and/or function of lymphocytes should be avoided or used with caution. Tuberculosis must always be investigated  in patients with MS and treated with rigor.

Recommendations on diagnosis and treatment of depression in patients with multiple sclerosis. 

Fragoso YD, Adoni T, Anacleto A, da Gama PD, Goncalves MV, Matta AP, Parolin MF.Pract Neurol. 2014 Aug;14(4):206-9

Abstract:

 

Multiple sclerosis (MS) is frequently associated with depression. Yet there are few clinical trials on treating depression in MS and no agreed recommendations for its assessment and follow-up. We present evidence-based recommendations for several aspects of depression in MS, including screening for depression,recognition of other concomitant psychiatric conditions, suicide risk, disability, fatigue, cognition, adherence to treatment, the effect of drugs used to treat MS on depression and possible pharmacological treatments for depression in MS.

Abstract:

 

Subarachnoid hemorrhage following intracranial aneurysmal rupture is a major cause of morbidity and mortality. Several factors may affect the probability of rupture, such as tobacco and alcohol use; size, shape, and location of the aneurysm; presence of intraluminal thrombus; and even the sex of the patient.However, few data correlate such findings with the timing of aneurysmal rupture. The authors report 2 cases of middle-age women with headache and MRI findings of incidental aneurysms. Magnetic resonance imaging showed evidence of surrounding parenchymal edema, and in one case there was a clear increase in edema during follow-up, suggesting a progressive inflammatory process that culminated with rupture. These findings raise the possibility that bleb formation and na enlargement of a cerebral aneurysm might be associated with an inflammatory reaction of the aneurysm wall resulting in perianeurysmal edema and subsequente aneurysmal rupture. There may be a temporal link between higher degree of edema and higher risk for rupture, including risk for immediate rupture.

Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage.

Pahl FH, de Oliveira MF, Rotta MA, Dias GM, Rezende AL, Rotta JM.Surg Neurol Int. 2014 Sep 25;5:139. 

Abstract:

 

BACKGROUND:

Isolated cervical anterior spinal artery aneurysms are extremely rare. Subarachnoid hemorrhage (SAH) secondary to such lesions have been described only in six cases to the best of our knowledge.

 

CASE DESCRIPTION: We describe an unusual clinical picture of SAH due to rupture of anterior spinal artery aneurysm in a patient with previous normal angiogram.Due to the location of the aneurysm and clinical status of the patient,conservative management was proposed, and she was discharged to further follow-up. Monthly routine angiograms revealed resolution of the aneurysm 90 days after bleeding, which was highly suggestive of vascular dissection.

 

CONCLUSION: We highlight the need to consider these aneurysms in the differential diagnosis of SAH, especially when occurring in the posterior fossa and when angiography findings are inconclusive.

Abstract:

 

Gunshot wounds (GSW) to the cervical spine leading to instability are rare. Also, the presence of vital vascular and neurological structures in the surround area lead to death or severe disability in the vast majority of cases. In this brief report, we present a rare case of C1 fracture due to GSW leading to instability of the atlanto-occipital joint in a neurologically intact patient.

Abstract:

 

Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA) submitted to treatment. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis.

 

OBJECTIVE:

Evaluate clinical, radiological patterns and prognostic factors of subarachnoid hemorrhage (SAH) patients according to age.

 

METHOD:

Three hundred and eighty nine patients with aneurismal SAH from a Brazilian tertiary institution (Hospital do Servidor Público Estadual de São Paulo) were consecutively evaluated from 2002 to 2012 according to Fisher and Hunt Hess classifications and Glasgow Outcome Scale.

 

RESULTS:

There was statistically significant association of age with impaired clinical, radiological presentation and outcomes in cases of SAH.

 

CONCLUSION:

Natural course of SAH is worse in elderly patients and thus, proper recognition of the profile of such patients and their outcome is necessary to propose standard treatment.

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