Valor preditivo da punção liquórica (tap test) na hidrocefalia de pressão normal

Eighteen patients (mean age of 66.5 years) with normal pressure hydrocephalus (NPH) underwent a ventriculo-peritoneal shunt surgery. Prior to operation a cerebrospinal fluid tap-test (CSF-TT) was performed with measurements of gait pattern and psychometric functions (memory, visuo-motor speed and visuo-constructive skills) before and after the removal of 50 ml CSFby lumbar puncture (LP). Fifteen patients improved and 3 were unchanged after surgery. Short duration of disease, gait disturbance preceding mental deterioration, wide temporal horns and small sulci on CT-scan were associated with good outcome after shunting. There was a good correlation between the results of CSF-TT and shunt surgery (X² = 4,11 ,phi = 0.48, p < 0.05), with gait test showing highest correlation (r = 0.99, p = 0.01). In conclusion, this version of CSF-TT proved to be an effective test to predict improvement after shunting in patients with NPH.Este estudo visa melhorar o valor diagnóstico e preditivo da punção liquórica (tap test, TT) na hidrocefalia de pressão normal (HPN), particularmente nos casos em que os dados clinicos e de neuroimagem são inconclusivos e não permitem uma decisão cirúrgica segura. Dezoito pacientes (média de idade = 66.5 anos) com HPN foram submetidos a derivação (shunt) ventriculo-peritoneal. O TT era realizado antes da cirurgia, consistindo na análise quantitativa da marcha e funções cognitivas (memória, rapidez perceptivo-motora e habilidade vísuo-construtiva) antes e depois da retirada de 50 ml de liquor via punção lombar. Quinze pacientes melhoraram e 3 permaneceram inalterados após a cirurgia. Curta duração da doença, distúrbio da marcha precedendo a deterioração mental, dilatação dos cornos temporais e apagamento (ou redução) dos sulcos corticais na tomografia computadorizada cerebral estavam associados a bons resultados pós-operatórios. Houve boa correlação entre os resultados do TT e os do shunt (X² = 4.11, phi = 0.48, p < 0.05), principalmente no teste da marcha (r = 0.99, p = 0.01). Esta versão do TT liquórico mostrou-se efetiva na prediçâo da melhora pós-operatória em pacientes com HPN.17918

Epilepsia secundária a lesões destrutivas hemisféricas congênitas: achados clínicos e relevância de atrofia hipocampal associada

We studied the clinical, EEG and MRI findings in 19 patients with epilepsy secondary to congenital destructive hemispheric insults. Patients were divided in two groups: 10 with cystic lesions (group 1), and 9 with atrophic lesions (group 2). Seizure and EEG features, as well as developmental sequelae were similar between the two groups, except for the finding that patients of group 2 more commonly presented seizures with more than one semiological type. MRI showed hyperintense T2 signal extending beyond the lesion in almost all patients of both groups, and it was more diffuse in group 2. Associated hippocampal atrophy (HA) was observed in 70% of group 1 patients and 77.7% of group 2, and it was not correlated with duration of epilepsy or seizure frequency. There was a good concordance between HA and electroclinical localization. The high prevalence of associated HA in both groups suggests a common pathogenesis with the more obvious lesion. Our findings indicate that in some of these patients with extensive destructive lesions, there may be a more circumscribed epileptogenic area, particularly in those with cystic lesions and HA, leading to a potential rationale for effective surgical treatment.Analisamos os achados clínicos, de EEG e RM de 19 pacientes com epilepsia secundária a insultos destrutivos hemisféricos congênitos. Os pacientes foram divididos em dois grupos: 10 com lesões císticas (grupo 1), e 9 com lesões atróficas (grupo 2). As características das crises e achados de EEG foram similares entre os dois grupos exceto pelo fato dos pacientes do grupo 2 terem apresentado mais comumente crises com mais de um padrão semiológico. A RM mostrou sinal T2 hiperintenso estendendo-se ao redor da lesão e à distância em quase todos os pacientes de ambos os grupos, de modo mais extenso no grupo 2. Observou-se atrofia hipocampal (AH) associada em 70% dos pacientes do grupo 1 e 77,7% do grupo 2 e não houve correlação com a duração da epilepsia ou freqüência das crises. Houve boa correlação entre a AH e localização eletroclínica. A alta prevalência de AH associada em ambos os grupos sugere uma patogenia comum com a lesão mais óbvia. Estes achados indicam que alguns destes pacientes com extensas lesões destrutivas, particularmente aqueles com lesões císticas e AH, a zona epileptogênica pode ser mais circunscrita possibilitando a indicação de uma ressecção restrita para o controle das crises.990100

Intradural tumors

History of Spinal Disorders.- Basic Science: Biomechanics of the Spine.- Spinal Instrumentation.- Age-Related Changes of the Spine.- Pathways of Spinal Pain.- Epidemiology and Risk Factors of Spinal Disorders.- Predictors of Surgical Outcome.- Patient Assessment: History and Physical Examination.- Imaging Studies.- Spinal Injections.- Neurological Assessment in Spinal Disorders.- Neurophysiological Investigations.- Surgical Approaches.- Peri- and Postoperative Management: Preoperative Assessment.- Intraoperative Anaestesia Management.- Postoperative Care and Pain Management.- Degenerative Disorders: Degenerative Disorders of the Cervical Spine.- Disc Herniation and Radiculopathy.- Lumbar Spinal Stenosis.- Degenerative Lumbar Spondylosis.- Non-specific Low Back Pain.- Postoperative Rehabilitation.- Spinal Deformities and Malformations: Idiopathic Scoliosis.- Neuromuscular Scoliosis.- Congenital Scoliosis.- Degenerative Scoliosis.- Spondylolisthesis.- Juvenile Kyphosis (Scheuermann's Disease).- Malformations of the Spinal Cord.- Fractures: Cervical Spine Injuries.- Thoracolumbar Spinal Injuries.- Osteoporotic Spine Fractures.- Tumor and Inflammation: Primary Tumors of the Spine.- Spinal Metastasis.- Intradural Tumors.- Infections of the Spine.- Rheumatoid Arthritis.- Ankylosing Spondylitis.- Treatment of Postoperative Complications.- Outcome Questionnaires and Tools in Spinal Surgery

Early Development Destructive Brain Lesions And Their Relationship To Epilepsy And Hippocampal Damage.

Fifty-one consecutive adult patients with epilepsy and early development destructive brain lesions were divided into three main groups according to the topographic distribution of the lesion on magnetic resonance imaging: hemispheric (H) (n=9); main arterial territory (AT) (n=25) and arterial borderzone (Bdz) (n=17). Eight (89%) patients from group H presented status epilepticus in the first 5 years of life, five of them associated with fever. Seventeen of the 25 patients from group AT (76%) had an obvious hemiparesis observed early in life. In addition, major prenatal events were significantly more common in the group AT compared with the other two groups. Among patients from group Bdz, prenatal or postnatal events were not identified, except for one patient. Conversely, nine patients from group Bdz (60%) showed a history of perinatal complications. Hippocampal atrophy (HA) was determined by visual analysis in 74.5% of all patients and by volumetry in 92%. The frequency of HA was comparable among groups, but patients from group H presented the most severe atrophy and more frequent hyperintense T2 hippocampal signal. In conclusion, these three groups of patients with early destructive lesions and epilepsy (H, AT and Bdz), appear to have distinct pathogenic mechanisms. Our data show that there is a striking association of HA with different patterns of neocortical destructive lesions of early development. This association seems to be related to a common and synchronic pathogenic mechanism. The recognition of the pattern and degree of HA among these patients with intractable seizures may influence the surgical rationale.25560-7