JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA

Volume 28 - nº 1 - Janeiro / Fevereiro / Março 2017

  • Volume: 28
  • Número: 1
  • Período: Janeiro / Fevereiro / Março 2017
  • ISSN (versão impressa): 0103-5118
  • e-ISSN (versão online): 2446-6786
  • Editor: Ricardo Ramina - Curitiba/PR
TEXTO COMPLETO DO FASCÍCULO

Artigo completo

Victor de Oliveira Sousa Guimarães, Carlos Umberto Pereira

Objective: The hemorrhagic stroke (HS) is a burden for young people due to its high mortality and disability. Although uncommon, there is a tendency to increase in incidence, especially by the high prevalence of risk factors. This study seeks to identify the epidemiological characteristics of young adults affected by HS. Methods: We analyzed 49 patients aged between 20 and 45 years and with hemorrhagic stroke diagnosis between July 2012 and April 2015. Results: By sex, there were 37 (75.5%) males and 12 (24.5%) female. Mean age was 39.5 years. Systemic arterial hypertension (SAH) was the most prevalent risk factor (55.1%). There were no cases associated with smoking. Hemorrhagic stroke secondary to arteriovenous malformations (AVM) and the use of sympathomimetic drugs were 10.2% and 8.1%, respectively. The lobar (46.9%) was the most affected region. The mortality rate was 49%, with 24.5% surviving without presenting sequels. Conclusions: The under-diagnosis and under control of hypertension in Brazil should distinguish them among the risk factors of HS. The increase in consumption of sympathomimetic drugs also rises its importance. Public health measures are necessary for the prevention of hemorrhagic stroke among young people.

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Nícollas Nunes Rabelo, Vitor Hugo Honorato Pereira, Artur Bastos Rocha, Isadora Cerruti Guarnieri, Neiffer Nunes Rabelo, Luiz Antônio Araujo Dias, Carlos Umberto Pereira

Abstract
Hans van Chiari (1851-1916) was an illustrious physician who gave many contributions to the scientific knowledge of Medicine and medical history. This paper describes a brief historical note and his contribution along the history of Medicine.

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Giuliano Schmidt Bertazzo Silveira, Beatriz Manzan Dalla Vecchia, Leonardo Schmidt Bertazzo Silveira, Marcos Rodrigo Pereira Eismann, Marcelo Neves Linhares, Antônio Cesar de Melo Mussi

ABSTRACT
Major head trauma can cause oculomotor nerve palsy by direct or indirect injuries. Isolated third cranial nerve (CNIII) palsy subsequent to a head injury is uncommon. The following study presents a case of isolated and direct injury of the oculomotor nerve due to transnasal penetrating trauma. Elsewhere was described that in 65% of the cases of traumatic paralysis of the oculomotor nerve occurs an aberrant regeneration. In persistent cases of paralysis an extraocular musculature surgery may be necessary.

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Artigo completo

Augusto Cesar Santos Esmeraldo, Carlos Umberto Pereira

ABSTRACT
Introduction: Intracranial meningiomas correspond to 20% of primary CNS tumors. Frontobasal location occurs in 8% and 15% of cases. Foster Kennedy’s syndrome (anosmia, homolateral optic atrophy and contralateral papilledema), behavioral disorder due to frontal lobe involvement (apathy, abulia, depression), urinary incontinence and seizures. Case report: Female 49-year-old patient in outpatient depression treatment for four years. Result: Magnetic resonance imaging revealed bilateral frontobasal expansive lesion. The lesion was completely excised, which revealed meningoendothelial meningioma. Conclusion: Frontal lobe lesions cause personality changes and emotional disturbances, which can lead to misdiagnosis and inadequate treatment before knowing the true cause.

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Artigo completo

Moysés Isaac Cohen, Wander da Silva Ferreira, Renildo Sérgio Batista dos Anjos, Marcos Robert da Silva Souza, Cleóstenes Farias do Vale

ABSTRACT
Double neural tube defect is a rare congenital problem. We report a case and discuss about current theories of neural tube closure. A 39 weeks term baby with occipital encephalocele and lumbosacral myelomeningocele is reported and her management is described. A single-staged surgery was performed. The present case is the first described in South America and seems to support a multi-site closure theory.

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Artigo completo

Anderson Rodrigo Souza, Eberval Gadelha Figueiredo, Alessandra dos Santos Silva

ABSTRACT
Pterional approach is one of the best known approaches in neurosurgery. It is used both in the treatment of vascular diseases and in pathologies of the skull base, given its versatility. The pre-capillary incision with an enlargement of the mini-pterional craniotomy provides a very similar operative field, thus allowing a performance of neurological surgery through pterional approach. After the replacement of the bone flap, the approach has the additional advantage of smaller incision, and little or no deficit, either functional, anatomic or cosmetic. However, further studies are needed to compare with other approaches.

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Artigo completo

Marcos Paulo dos Santos Teixeira, Carlos Umberto Pereira

ABSTRACT
Pneumocephalus is usually due to craniofacial traumatic injury. When resulting from penetrating injury to the orbital region, it has been considered as rare. Tension pneumocephalus is considered a neurosurgical emergency. The authors report a case of tension pneumocephalus in a patient victim of domestic accident by screwdriver on the right orbital region. Its pathophysiology, treatment and prognosis were discussed.

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Jorge Dornellys da Silva Lapa, Cícero Santos de Lima, Luan Messias Magalhães, Marcos Paulo dos Santos Teixeira, Geraldo Ávila Reis, Ronald Alves Barcellos, Carlos Umberto Pereira

ABSTRACT
Isolated basilar artery dissection is a rare event with difficult diagnosis. Its prognosis is worse than the most common cases of internal carotid artery dissection in the extracranial portion. The aim of this paper is to describe a case of isolated basilar artery dissection with pontine stroke and locked-in syndrome. The patient was submitted to endovascular treatment with angioplasty and pseudoaneurysm embolization with satisfactory neurological evolution.

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Carlos Umberto Pereira, Marcos Paulo dos Santos Teixeira

ABSTRACT
Traumatic intracerebellar hematoma is considered as a rare lesion. It is associated to a direct injury to the occipital area or by contrecoup mechanism. Computer tomography (CT) is the exam of choice for diagnosis and management. This pathology in general results in poor prognosis. The authors reported a case of traumatic intracerebellar hematoma with a literature review.

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Carlos Umberto Pereira, Breno José Alencar Pires Barbosa, Roberto Alexandre Dezena, João Manoel da Silva Santos, Yves Glauber Silva dos Santos, Jamerson Ademir Cantarelli de Carvalho, Laíse Oliveira Resende

ABSTRACT
Introduction: Spinal cord injury (SCI) due to stab wounds have been reported seldom in the medical literature and its treatment is still controversial. In the present article, the authors present a case series and discuss both treatment and prognosis. Methods: During the period from January 2009 to December 2013, 12 victims of SCI due to stabbing were admitted to the Neurosurgical unit of the HUSE (Aracaju-Sergipe, Brazil). All cases were analyzed according to gender, age, anatomical location of injury, neurological symptoms, imaging, treatment and sequelae. Results: Ten cases were male and two female. Ages ranged between 16 and 54 years, with mean age of 28 years. Cervical spine lesions were the most frequent (5 cases), followed by thoracic (4 cases) and lumbar (3 cases). Computed tomography was the imaging method of choice. Eight patients had motor deficits at admission. Five patients underwent surgical intervention, three for removal of foreign body and two for dura mater correction. There were no deaths. Conclusion: SCI due to stab wounds have been less frequently reported than SCI due to gunshots, with a better prognosis according to the literature. Our findings corroborate the literature rates. Prophylactic systemic antibiotics and motor physical therapy are recommended as routine for all cases with encouraging results.

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