Giant cerebral abscess in pediatric patient

Introduction: Brain abscess is a focal infection consisting of purulent collection, encapsulated in the brain parenchyma. The term “giant” has a subjective character because there is no specific definition concerning the measure of the lesion. The most common etiology includes Streptococcus, Staphylococcus, gram-negative and the first two decades of life are the most affected age group. Its pathogenesis occurs by contiguity, hematogenous or metastasis. The clinical presentation is variable and requires treatment with antibiotic therapy and possible surgical approaches. Giant abscesses are rare and rarely occur without apparent clinical manifestations. Objective: Report a patient with a giant brain abscess who was diagnosed on a routine examination.Case report: Observation of rare or atypical manifestations in cases of a known disease. Case: A male patient with significant idiopathic hydrocephalus at birth who was treated with ventricular-peritoneal shunt (VPS). It evolves with four episodes of ventriculites. After antibiotic therapy and VPS changes, he remained stable for a long period, with significant cognitive-motor delay and epilepsy that was controlled. Control computed tomography (CT) were periodically performed and, at the age of 4, a suggestive image of large-volume abscess was observed, involving 2/3 of the intracranial space. Conservative treatment was chosen because of clinical stability and the impossibility of completing drainage of the lesion. Discussion: The patient was stable and the reason for executing the CT scan was due to the control of epileptic seizures. Finding the injury was casual. Conservative treatment was the option due to the size of the abscess and the impossibility of completing drainage. The patient has been followed since 2002. Conclusion: Conservative treatment has kept the child stable, as anticonvulsants are still being used. The follow-up of the patient from birth allowed the choice of the therapeutic option since the surgical approach may be more harmful due to the clinical picture

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

Spontaneous acute subdural hematoma contralateral to an arachnoid cyst Hematoma subdural agudo espontâneo contralateral a cisto aracnóideo

Arachnoid cysts (AC) are extra-cerebral cerebrospinal fluid collections of unknown origin. They correspond to 1% of all intracranial nontraumatic space-occupying lesions and appear more frequently in the middle fossa (50%). More than 25% of these cysts are incidental findings and the majority of patients are asymptomatic. Seizures, intracranial hypertension signs, neurological deficits, macrocrania, developmental delay and bulging of the skull are the main signs and symptoms of the lesion. AC rupture and bleeding are rare, usually occurring in young adults and associated with trauma. The risk of hemorrhage does not exceed 0.04% / year. We describe the case of a ten-year-old boy who presented with acute signs of intracranial hypertension secondary to a spontaneous acute subdural hematoma, contralateral to an AC of the middle fossa. Three factors were significant in this case: signs and symptoms occurred spontaneously; the presence of an acute subdural hematoma exclusively contralateral to the AC; successful outcome of the conservative treatment.Os cistos aracnóideos (CA) são coleções liquóricas extra-cerebrais e intra-aracnóideas de origem desconhecida. Correspondem a 1% de todas as lesões expansivas intracranianas não traumáticas e têm nítido predomínio na fossa média (50%). Até 25% destes cistos são achados incidentais sendo que a maioria dos pacientes é assintomática. Crises epilépticas, sinais de hipertensão intracraniana, déficits neurológicos focais, macrocrania, atraso no desenvolvimento e abaulamento da calota craniana são os principais sinais e sintomas da lesão. A ruptura dos CA, assim como seu sangramento, são situações raras, geralmente associadas a traumas e acometem adultos jovens. O risco de hemorragia em pacientes com CA não excede 0,04% ao ano. É descrito caso de paciente de dez anos de idade que subitamente apresentou sinais de hipertensão intracraniana secundários a hematoma subdural agudo espontâneo, contralateral a volumoso CA de fossa média. Três fatores foram de relevância neste paciente: a ocorrência de sinais e sintomas espontaneamente, especialmente em um menino; presença de hematoma subdural agudo exclusivamente contralateral ao CA; e a boa evolução com o tratamento conservador

Extensa falha cutânea e craniana em paciente com aplasia cutis congenita Large scalp and skull defect in patient with aplasia cutis congenita

Aplasia cutis congenita (ACC) é doença rara, caracterizada pela ausência de formação completa da pele. Geralmente ocorre no couro cabeludo, na linha mediana, e apresenta-se ao nascimento como uma ferida ulcerada que pode atingir diferentes profundidades e envolver o periósteo, crânio e dura-máter. Descrevemos o caso de menina recem-nascida que apresentava fácies dismórfica com defeito no couro cabeludo que abrangia a quase totalidade da abóbada craniana e apresentava falha óssea desde a base dos ossos frontais até os occipitais e mastóides. A dura-máter estava em sua maior parte exposta, sem sinais de fissuras. Devido à raridade da ACC e ao pequeno número de pacientes nas séries publicadas na literatura a padronização do tratamento ainda é incipiente. O que existem são recomendações. Ainda são necessários estudos que abordem desde a etiologia da doença até a avaliação dos métodos de tratamento e evolução de grupos maiores de pacientes.<br>Aplasia cutis congenita is a rare condition characterized by the absence of skin layers. It is most common on the scalp, middle line, and it can be seen as a congenital ulcer involving periosteum, skull and dura. We present the case of a female newborn infant with a dysmorphic facies, a large scalp and skull defect exposing the dura. There was no cerebrospinal fluid leakage. The rarity of cases with large defects and small series reported make difficult to determinate the ideal treatment for aplasia cutis congenita. More studies are necessary to define the etiology and best management of this patients

Uso da ultra-sonografia na triagem de disrafismos espinhais ocultos Screening of occult spinal dysraphism by ultrasonography

O uso da ultra-sonografia para diagnóstico de lesões da coluna vertebral é difundido desde a década de oitenta. Suas aplicações envolvem: diagnóstico de lesões medulares traumáticas; uso intra-operatório em cirurgias do trauma e tumores medulares; uso pré-operatório e evolutivo em pacientes com disrafismos espinhais; diagnóstico pré-natal dos disrafismos; diagnóstico dos disrafismos espinhais ocultos ao nascimento. Pacientes com suspeita de disrafismo espinhal oculto (estigmas cutâneos em linha média ou história familiar de disrafismos) representaram a principal indicação do exame que foi realizado em 292 pacientes do Hospital das Clínicas da Universidade Federal de Minas Gerais. Alterações como lipomas do cone medular, medula baixa, filo terminal espesso, cistos da ponta do cone medular e seios dérmicos foram identificados com fidelidade à ultra-sonografia. A interpretação do exame não apresentou dificuldades técnicas. Sua realização é rápida, não é necessária sedação, apresenta baixo custo e idealmente deve ser realizado pelo próprio neurocirurgião devido ao grande número de informações possíveis durante o exame. O exame entretanto não substitui a ressonância magnética mas pode ser um bom método de triagem para os pacientes.<br>Ultrasonography for diagnosis of spinal cord diseases has been used since the eighties. There are different fields for its use: traumatic spine lesions, intra-operative use in trauma and spine tumors surgery, pre-operative and follow up study for spinal dysraphism, occult spinal dysraphism of the newborn. Patients with suspected occult spinal dysraphism are the most important indication for the method. Utrasonography was performed in 292 patients of Hospital das Clínicas, Universidade Federal de Minas Gerais. Lesions such as conus medullaris lipomas, low level of conus medullaris, filum terminale tethering, cauda equina cysts and dermal sinuses can be well demonstrated. There is no difficulty in interpreting the image. The exam does not need sedation; it is safe, fast and cheap. Ideally it should be performed by the neurosurgeon as it may provide many information during the examination. The ultrasonography does not replace magnetic resonance imaging but it is an excellent method for screening