Intraventricular rupture of brain abscess: case report

A ruptura intraventricular do abscesso cerebral é uma condição rara e freqüentemente fatal. Apesar dos avanços nas técnicas neurocirúrgicas, dos métodos de neuroimagem e da antibioticoterapia moderna, a mortalidade associada com ruptura intraventricular de abscesso cerebral é elevada. Os autores relatam um caso de ruptura intraventricular de abscesso cerebral supratentorial, com péssima evolução e chamam a atenção para a necessidade do diagnóstico e tratamento precoce desta entidade clínica._________________________________________________________________________________________ ABSTRACT: The intraventricular rupture of brain abscess is a rare condition and frequently ominous. Despite the advances in technical neurosurgery, in neuroradiology and the modern antibiotics, the mortality verifi ed in cases of intraventricular rupture of brain abscess is very high. The authors report a case of intraventricular rupture of supratentorial brain abscess, with very bad evolution and emphasize the importance of precocious diagnosis and treatment

Intraventricular rupture of brain abscess: case report

A ruptura intraventricular do abscesso cerebral é uma condição rara e freqüentemente fatal. Apesar dos avanços nas técnicas neurocirúrgicas, dos métodos de neuroimagem e da antibioticoterapia moderna, a mortalidade associada com ruptura intraventricular de abscesso cerebral é elevada. Os autores relatam um caso de ruptura intraventricular de abscesso cerebral supratentorial, com péssima evolução e chamam a atenção para a necessidade do diagnóstico e tratamento precoce desta entidade clínica._________________________________________________________________________________________ ABSTRACT: The intraventricular rupture of brain abscess is a rare condition and frequently ominous. Despite the advances in technical neurosurgery, in neuroradiology and the modern antibiotics, the mortality verifi ed in cases of intraventricular rupture of brain abscess is very high. The authors report a case of intraventricular rupture of supratentorial brain abscess, with very bad evolution and emphasize the importance of precocious diagnosis and treatment

Prognostic factors in thalamic hemorrhage: initial considerations about 35 cases

Objetivo: Estudar, prospectivamente, os fatores prognósticos de pacientes com hemorragia talâmica (HT). Métodos: Foram estudados os aspectos clínicos e tomográficos de 35 pacientes, internados no Hospital João Alves Filho, Aracaju, SE, entre agosto de 2004 e julho de 2005. Na análise estatística dos dados obtidos, foi considerado significante o valor p < 0,05. Foi utilizado teste ANOVA com pós-teste de Tukey e regressão linear. Resultados: Houve predominância do sexo feminino (63%); as idades variaram entre 46 e 84 anos com média de 64,5. A principal etiologia foi hipertensão arterial (85%) e o mais importante fator de risco vascular foi o diabetes melito (57%). O quadro clínico predominante foi cefaléia acompanhada de alterações do nível de consciência e déficit motor e sensitivo. A projeção talâmica mais acometida foi a direita (60%) e o território vascular mais envolvido foi o póstero-lateral (46%). Hematomas grandes (volume ≥ 20 cm3) foram mais freqüentes (71%). Conclusões: Na curva de regressão linear verificou-se relação significante entre o volume do hematoma e a idade do paciente. A análise estatística permitiu concluir existência de significância ao se correlacionar volume do HT e sua localização (p < 0,0001), volume do HT e quadro clínico (p < 0,0001), idade e gravidade do quadro clínico (p < 0,0001), prognóstico e volume do HT (p < 0,0001) e prognóstico e idade do paciente (p = 0,0004)._________________________________________________________________________________________ ABSTRACT: Objective: Prospective study of prognostic factors of patients with thalamic hemorrhage (TH). Methods: The clinical aspects and computed tomography of 35 patients, admitted in the Hospital João Alves Filho, Aracajú, Sergipe, Brazil, between August, 2004 and July, 2005 were analyzed. The results were considered significant when p < 0.05. It was used ANOVA with Tukey’s post-tests and linear regression curve. Results: A female predominance was observed (63%); the the patient’s ages varied between 46 and 84 years with average of 64.5. The main etiology of TH was arterial hypertension (85%) and the most important factor of vascular risk was the diabetes mellitus (57%). The predominant clinical manifestation was the association of headache, alterations of the conscience level and motor and sensitive deficit. The HT predominated on the right (60%) and the more involved vascular territory was the posterolateral (46%). Bigger hematomas (volume ≥ 20 cm3) were more frequent (71%) than the smaller. Conclusions: The linear regression curve showed significant relation between the volume of the hematoma and the age of the patient. The statistical analysis allowed to conclude the existence of significance when correlating the volume of the HT and its localization (p < 0.0001), volume of the HT and clinical picture (p < 0.0001), age and gravity of the clinical picture (p < 0.0001), prognosis and volume of HT (P < 0.0001) and prognosis and age of the patient (p = 0.0004).Objective: Prospective study of prognostic factors of patients with thalamic hemorrhage (TH). Methods: The clinical aspects and computed tomography of 35 patients, admitted in the Hospital João Alves Filho, Aracajú, Sergipe, Brazil, between August, 2004 and July, 2005 were analyzed. The results were considered significant when p < 0.05. It was used ANOVA with Tukey’s post-tests and linear regression curve. Results: A female predominance was observed (63%); the the patient’s ages varied between 46 and 84 years with average of 64.5. The main etiology of TH was arterial hypertension (85%) and the most important factor of vascular risk was the diabetes mellitus (57%). The predominant clinical manifestation was the association of headache, alterations of the conscience level and motor and sensitive deficit. The HT predominated on the right (60%) and the more involved vascular territory was the posterolateral (46%). Bigger hematomas (volume ≥ 20 cm3) were more frequent (71%) than the smaller. Conclusions: The linear regression curve showed significant relation between the volume of the hematoma and the age of the patient. The statistical analysis allowed to conclude the existence of significance when correlating the volume of the HT and its localization (p < 0.0001), volume of the HT and clinical picture (p < 0.0001), age and gravity of the clinical picture (p < 0.0001), prognosis and volume of HT (P < 0.0001) and prognosis and age of the patient (p = 0.0004)

Prognostic factors in thalamic hemorrhage: initial considerations about 35 cases

Objetivo: Estudar, prospectivamente, os fatores prognósticos de pacientes com hemorragia talâmica (HT). Métodos: Foram estudados os aspectos clínicos e tomográficos de 35 pacientes, internados no Hospital João Alves Filho, Aracaju, SE, entre agosto de 2004 e julho de 2005. Na análise estatística dos dados obtidos, foi considerado significante o valor p < 0,05. Foi utilizado teste ANOVA com pós-teste de Tukey e regressão linear. Resultados: Houve predominância do sexo feminino (63%); as idades variaram entre 46 e 84 anos com média de 64,5. A principal etiologia foi hipertensão arterial (85%) e o mais importante fator de risco vascular foi o diabetes melito (57%). O quadro clínico predominante foi cefaléia acompanhada de alterações do nível de consciência e déficit motor e sensitivo. A projeção talâmica mais acometida foi a direita (60%) e o território vascular mais envolvido foi o póstero-lateral (46%). Hematomas grandes (volume ≥ 20 cm3) foram mais freqüentes (71%). Conclusões: Na curva de regressão linear verificou-se relação significante entre o volume do hematoma e a idade do paciente. A análise estatística permitiu concluir existência de significância ao se correlacionar volume do HT e sua localização (p < 0,0001), volume do HT e quadro clínico (p < 0,0001), idade e gravidade do quadro clínico (p < 0,0001), prognóstico e volume do HT (p < 0,0001) e prognóstico e idade do paciente (p = 0,0004)._________________________________________________________________________________________ ABSTRACT: Objective: Prospective study of prognostic factors of patients with thalamic hemorrhage (TH). Methods: The clinical aspects and computed tomography of 35 patients, admitted in the Hospital João Alves Filho, Aracajú, Sergipe, Brazil, between August, 2004 and July, 2005 were analyzed. The results were considered significant when p < 0.05. It was used ANOVA with Tukey’s post-tests and linear regression curve. Results: A female predominance was observed (63%); the the patient’s ages varied between 46 and 84 years with average of 64.5. The main etiology of TH was arterial hypertension (85%) and the most important factor of vascular risk was the diabetes mellitus (57%). The predominant clinical manifestation was the association of headache, alterations of the conscience level and motor and sensitive deficit. The HT predominated on the right (60%) and the more involved vascular territory was the posterolateral (46%). Bigger hematomas (volume ≥ 20 cm3) were more frequent (71%) than the smaller. Conclusions: The linear regression curve showed significant relation between the volume of the hematoma and the age of the patient. The statistical analysis allowed to conclude the existence of significance when correlating the volume of the HT and its localization (p < 0.0001), volume of the HT and clinical picture (p < 0.0001), age and gravity of the clinical picture (p < 0.0001), prognosis and volume of HT (P < 0.0001) and prognosis and age of the patient (p = 0.0004).Objective: Prospective study of prognostic factors of patients with thalamic hemorrhage (TH). Methods: The clinical aspects and computed tomography of 35 patients, admitted in the Hospital João Alves Filho, Aracajú, Sergipe, Brazil, between August, 2004 and July, 2005 were analyzed. The results were considered significant when p < 0.05. It was used ANOVA with Tukey’s post-tests and linear regression curve. Results: A female predominance was observed (63%); the the patient’s ages varied between 46 and 84 years with average of 64.5. The main etiology of TH was arterial hypertension (85%) and the most important factor of vascular risk was the diabetes mellitus (57%). The predominant clinical manifestation was the association of headache, alterations of the conscience level and motor and sensitive deficit. The HT predominated on the right (60%) and the more involved vascular territory was the posterolateral (46%). Bigger hematomas (volume ≥ 20 cm3) were more frequent (71%) than the smaller. Conclusions: The linear regression curve showed significant relation between the volume of the hematoma and the age of the patient. The statistical analysis allowed to conclude the existence of significance when correlating the volume of the HT and its localization (p < 0.0001), volume of the HT and clinical picture (p < 0.0001), age and gravity of the clinical picture (p < 0.0001), prognosis and volume of HT (P < 0.0001) and prognosis and age of the patient (p = 0.0004)

Cerebrospinal fluid fistula through parietal bone stab wound: case report

Os autores apresentam um caso de fístula liquórica traumática provocada por arma branca, comunicando o ventrículo lateral à região parietal esquerda. O paciente foi submetido a tratamento cirúrgico para fechamento da laceração dural, evoluindo de maneira satisfatória._________________________________________________________________________________________ ABSTRACT: The authors report a case of cerebrospinal fluid fistula due to stab wound which penetrated the left parietal bone and reached the lateral ventricle. The asymptomatic patient was submitted to surgical closure of the dural laceration, with excellent result

Cerebrospinal fluid fistula through parietal bone stab wound: case report

Os autores apresentam um caso de fístula liquórica traumática provocada por arma branca, comunicando o ventrículo lateral à região parietal esquerda. O paciente foi submetido a tratamento cirúrgico para fechamento da laceração dural, evoluindo de maneira satisfatória._________________________________________________________________________________________ ABSTRACT: The authors report a case of cerebrospinal fluid fistula due to stab wound which penetrated the left parietal bone and reached the lateral ventricle. The asymptomatic patient was submitted to surgical closure of the dural laceration, with excellent result

Epidemiologic findings of the cranial injury in rural areas of the State of Sergipe, Brazil

Objetivo: A maior incidência de traumatismo craniencefálico encontra-se nas zonas rurais. Dessa forma, tornam-se imprescindíveis estudos epidemiológicos que definam as características e a etiologia do traumatismo craniencefálico na zona rural, possibilitando estabelecer condutas, estratégias de prevenção, prioridades em pesquisas e planejamento de recursos, além da disponibilidade de profissionais capacitados e serviços de emergência, juntamente com infra-estrutura e aparelhagem adequadas para o tratamento desta patologia. Este estudo visa avaliar, epidemiologicamente, os casos de traumatismo craniencefálico ocorridos na zona rural do Estado de Sergipe analisando-os quanto à idade, sexo, localização, causas do acidente, exame neurológico, exames complementares, conduta, morbidade e mortalidade. Método: Foram estudados, de forma prospectiva e longitudinal, os pacientes admitidos no Serviço de Neurocirurgia do Hospital Governador João Alves Filho, acometidos por TCE e residentes da zona rural do Estado de Sergipe, entre o período de 1º de setembro de 2003 e 31 de dezembro de 2004. Ao todo, 470 casos foram estudados. Conclusão: Apesar de esta pesquisa demonstrar que 89% dos pacientes apresentaram TCE-leve e que 78% dos pacientes foram liberados após atendimento inicial, o TCE na zona rural não deve ser negligenciado, pois representa um grande problema de saúde pública devido aos altos custos hospitalares com atendimentos, exames complementares, tratamento e reabilitação dos pacientes. Nossos resultados fornecem um ponto de partida para a análise das causas e prevenção do TCE na zona rural._________________________________________________________________________________________ ABSTRACT: Objective: The highest rates of brain injury are located in the rural areas. So, it is necessary an epidemiological study that can define characteristics and the causes of brain injury in rural area, improving knowledge, prevention strategies, priority in research and planning, besides the professionals and emergency services within local and adequate devices to treat this disease. An epidemiological study of brain injury in the rural areas of the State of Sergipe, Brazil, was made analyzing age, sex, location, causes, neurological status, neuroimaging finding, morbidity and mortality. Method: A prospective and longitudinal study of the patients with craniocerebal trauma admitted to the Serviço de Neurocirurgia do Hospital Governador João Alves Filho, coming form the rural zone of the State of Sergipe, Brazil. During the period between September 1, to December 31, 2004, 470 patients were studied. Conclusion: Despite the results of this study demonstrating that 89% of the patients presented minor trauma, and that 78% of the patients were set to hospital discharge after initial attendance, craniocerebral trauma in rural zones is not to be neglected because it represents a high cost public health. Our results may supply a starting point to the analysis of the causes and prevention of the craniocerebral trauma in the Brazilian rural zone

Treatment of clinical complications due to neurosurgical interventions. Part I: infections, complications of specific procedures, systemic complications, cognitive and others complications

Objetivo: Apresentar as complicações neurocirúrgicas que ocorrem com grande freqüência; apesar dos esforços para preveni-las, algumas são inevitáveis. Método: Analisaram-se as principais complicações decorrentes de procedimentos neurocirúrgicos e os tratamentos específicos, baseados em revisão literária e em experiência própria. Conclusão: O tratamento médico dessas complicações pode ser transitório ou definitivo da causa subjacente, conforme a evolução clínica do paciente._________________________________________________________________________________________ ABSTRACT: Objective: Review the more frequent neurosurgical complications, some of which are inevitable although the efforts to avoid them. Method: The principal complications of neurosurgical proceeds and their treatment are presented based on literature review end personal experience. Conclusion: The medical treatment of these complications can be transitory or definitive of the underlying cause, as the clinical evolution of the patient

Epidemiologic findings of the cranial injury in rural areas of the State of Sergipe, Brazil

Objetivo: A maior incidência de traumatismo craniencefálico encontra-se nas zonas rurais. Dessa forma, tornam-se imprescindíveis estudos epidemiológicos que definam as características e a etiologia do traumatismo craniencefálico na zona rural, possibilitando estabelecer condutas, estratégias de prevenção, prioridades em pesquisas e planejamento de recursos, além da disponibilidade de profissionais capacitados e serviços de emergência, juntamente com infra-estrutura e aparelhagem adequadas para o tratamento desta patologia. Este estudo visa avaliar, epidemiologicamente, os casos de traumatismo craniencefálico ocorridos na zona rural do Estado de Sergipe analisando-os quanto à idade, sexo, localização, causas do acidente, exame neurológico, exames complementares, conduta, morbidade e mortalidade. Método: Foram estudados, de forma prospectiva e longitudinal, os pacientes admitidos no Serviço de Neurocirurgia do Hospital Governador João Alves Filho, acometidos por TCE e residentes da zona rural do Estado de Sergipe, entre o período de 1º de setembro de 2003 e 31 de dezembro de 2004. Ao todo, 470 casos foram estudados. Conclusão: Apesar de esta pesquisa demonstrar que 89% dos pacientes apresentaram TCE-leve e que 78% dos pacientes foram liberados após atendimento inicial, o TCE na zona rural não deve ser negligenciado, pois representa um grande problema de saúde pública devido aos altos custos hospitalares com atendimentos, exames complementares, tratamento e reabilitação dos pacientes. Nossos resultados fornecem um ponto de partida para a análise das causas e prevenção do TCE na zona rural._________________________________________________________________________________________ ABSTRACT: Objective: The highest rates of brain injury are located in the rural areas. So, it is necessary an epidemiological study that can define characteristics and the causes of brain injury in rural area, improving knowledge, prevention strategies, priority in research and planning, besides the professionals and emergency services within local and adequate devices to treat this disease. An epidemiological study of brain injury in the rural areas of the State of Sergipe, Brazil, was made analyzing age, sex, location, causes, neurological status, neuroimaging finding, morbidity and mortality. Method: A prospective and longitudinal study of the patients with craniocerebal trauma admitted to the Serviço de Neurocirurgia do Hospital Governador João Alves Filho, coming form the rural zone of the State of Sergipe, Brazil. During the period between September 1, to December 31, 2004, 470 patients were studied. Conclusion: Despite the results of this study demonstrating that 89% of the patients presented minor trauma, and that 78% of the patients were set to hospital discharge after initial attendance, craniocerebral trauma in rural zones is not to be neglected because it represents a high cost public health. Our results may supply a starting point to the analysis of the causes and prevention of the craniocerebral trauma in the Brazilian rural zone

Rehabilitation in myelomeningocele

A mielomeningocele é o tipo mais freqüente de espinha bífida. Nesta patologia há uma protrusão de elementos neurológicos encontrados sem o saco tecal, o que ocasiona uma série de déficits apresentados através de alterações ortopédicas, neurológicas e geniturinárias. As manifestações ortopédicas se apresentam sob a forma de contraturas musculares generalizadas, deformidades da coluna vertebral, as quais, posteriormente, geram dores articulares. As alterações neurológicas estão intimamente relacionadas à localização e magnitude da falha, sendo a sede mais freqüente, na mielomeningocele, a região lombossacra. Os acometimentos do trato geniturinário são norteados pela incontinência urinária e fecal, bem como alterações na sexualidade dos portadores desta patologia. Tendo em vista todos estes aspectos, nota-se quão necessário se faz uma abordagem fisioterapêutica precoce nestes pacientes, buscando eliminar ou minimizar as alterações proporcionadas por esta patologia. No presente trabalho, os autores discutem a reabilitação de pacientes acometidos pela mielomeningocele._________________________________________________________________________________________ ABSTRACT: Myelomeningocele is the most frequent form of spina bifida. This pathology causes a protrusion of neurological elements found on tecal sack and this generates a lot of deficits presented by orthopedic, neurological and genitourinary alterations. Orthopedic manifestations are presented by general muscular contractures, spine deformities, which generate articular pain. Neurological alterations are intimately related with location and lesion magnitude, which are most frequent located, in myelomeningocele, at lomb sacral region. Genitourinary problems are exposed by sexuality alterations, urinary and fecal incontinence. This aspects show the importance of precocious physical therapy approach to this patients, with intuit to minimize or eliminate alterations proportioned for this pathology. In present research the authors discuss rehabilitation in patients elapsed from myelomeningocele