Avaliacao da hemorragia intracraniana em recem nascidos de baixo peso pela ultra-sonografia trans-fontanelar: prevalencia e definicao de um protocolo

BV UNIFESP: Teses e dissertaçõe

Endovascular treatment of intracavernous carotid aneurysm with hyperprolactinaemia

A 42-year-old woman presented with headache, galactorrhoea, marked hyperprolactinemia and normal neurologic examination.CT MR and MR-angiography showed an intracavernous carotid artery aneurysm with minimal displacement of the pituitary stalk. Treatment by embolisation using GDC coils allowed exclusion of the aneurysm.Galactorrhoea resolved and serum prolactin levels fell to normal after eight months. Followup MR showed absence of the aneurysm, although the discrete mass effect persisted, suggesting that hyperprolactinaemia was due to pulsatility.Univ Sao Paulo, Serv Intervent Radiol, Heart & Radiol Inst, Sao Paulo, BrazilUniv Fed Sao Paulo, CAPES, Neurosurg Serv, Sao Paulo, BrazilHosp NS Lourdes, Serv Intervent Neuroradiol, Sao Paulo, BrazilUniv Fed Sao Paulo, CAPES, Neurosurg Serv, Sao Paulo, BrazilWeb of Scienc

Doppler transcraniano convencional em voluntários assintomáticos: variabilidade e valores de referência para parâmetros de fluxo sanguíneo Reference values for measures of blood flow velocities and impedance indexes in healthy individuals through conventional transcranial Doppler

OBJETIVO: Estabelecer valores de referência para medidas de velocidade sanguínea e índices de impedância em indivíduos saudáveis por meio do Doppler transcraniano convencional (DTC) e observar suas variações em relação à idade e sexo. MÉTODO: Foram examinados 88 voluntários assintomáticos, sem antecedentes de doença cerebrovascular, cardíaca ou vascular periférica. Os exames de DTC foram realizados pelo mesmo examinador, sendo as artérias cerebrais médias, anteriores e posteriores estudadas por meio da janela temporal e as artérias vertebrais e basilar por meio da janela suboccipital. Foram arquivados os valores de velocidade média (VM), velocidade de pico sistólico (VPS), velocidade diastólica final (VDF) e índices de resistência (IR) e pulsatilidade (IP) de cada segmento arterial examinado. RESULTADOS: Os limites de referência encontrados por nós foram semelhantes aos descritos por outros autores para todos os parâmetros estudados. Houve tendência das velocidades de fluxo diminuírem e dos índices de impedância aumentarem com o avançar da idade. Os valores de velocidade nas mulheres foram superiores aos encontrados em homens. CONCLUSÃO: O DTC se mostrou útil na avaliação hemodinâmica cerebral de nossa população. Os nossos resultados são semelhantes aos de outros estudos, tanto nos valores de referência quanto na sua relação com a idade e o sexo.<br>OBJECTIVE: To establish reference values for measures of blood flow velocities and impedance indexes in healthy individuals through conventional transcranial Doppler (TCD) and to observe their variations in relation to the age and sex. METHOD: 88 asymptomatic volunteers were examined without antecedents of cardiac, peripheral or cerebrovascular diseases. The TCD were accomplished by the same examiner. The middle, anterior and posterior cerebral arteries were studied through the temporal acoustic window and the vertebral and basilar arteries through the suboccipital acoustic window. The values of mean velocity (MV), peak-systolic velocity (PSV), final diastolic velocity (FDV), resistance index (RI) and pulsatility index (PI) of each examined arterial segment were filed. RESULTS: The reference limits found by us were similar to the described by other authors for all of the studied parameters. There was tendency of the flow velocities decrease and of the impedance indexes increase with moving forward of the age. The values of velocities in the women were superior to the found in men. CONCLUSION: TCD was shown useful in the evaluation of hemodynamic cerebral for our population. Our results are similar to the other studies, so much in the reference values as in relationship with the age and the sex

Follow-up of endovascular treatment of direct carotid-cavernous fistulas

Direct carotid-cavernous fistula (CCF) is a direct communication between the internal carotid artery (ICA) and the cavernous sinus. Some patients treated with detachable balloons develop pseudoaneurysms or present with a true aneurysm recanalization in the cavernous ICA with poorly known long-term radiological and clinical progression. The objective of the present study was to evaluate the long-term clinical and radiological progression of patients treated with detachable balloons. The present study evaluated 13 patients previously treated for direct CCF by an endovascular approach. The follow-up period ranged between 19 and 128 months. Ophthalmological evaluation demonstrated alterations in eight patients (61.5%). All of these alterations were already present from the moment of the treatment and displayed no signs of progression. Cranial magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) were performed in all patients, and 11 pseudoaneurysms were demonstrated in ten of the 11 patients in whom ICA patency had been preserved. Five patients were submitted for cerebral digital subtraction angiography (DSA) to characterize the pseudoaneurysms previously observed on MRA studies, with no significant differences in morphology, size, aneurismal neck, and number of lesions. Endovascular treatment of direct CCF with detachable balloons has been shown to be a long-term effective and stable therapeutic method. The authors found asymptomatic pseudoaneurysms in 91% of cases where the ICA patency was preserved. MRI and MRA demonstrated an accuracy similar to that of DSA in the diagnosis of pseudoaneurysms of cavernous ICA

Transcranial endovascular obliteration of intracranial arteriovenous dural fistulae

We present a female patient with left eye hiperemia at 8 months. There was no prior history of trauma neither other complaints or symptons associated. The neurologic examination was normal except for marked hiperemia at left eye. There was no bruit. The CT scan revealed tortuous and dilated vascular structures at cortical surface of left temporal lobe. The digital subtraction angiography (DSA) revealed dural fistulae (DF) of the cavernous sinus type IV, with reflux through the superficial middle cerebral vein (SMCV) and venous ectasia, without drainage through superior oftalmic vein (SOV). Since there was no conventional endovascular access to the fistula, catetherization of SMCV by direct puncture and endovascular treatment was proposed. The procedure was performed under general anesthesia and the cranial drainage was completely excluded. The drainage became through the SOV and a small fistular component remained. One week later the treatment was completed, with obliteration of arterial afferents and functional exclusion of the DF.Escola Paulista Med, UNIFESP, Neurovasc Sector, BR-04023 Sao Paulo, BrazilEscola Paulista Med, UNIFESP, Neurovasc Sector, BR-04023 Sao Paulo, BrazilWeb of Scienc

Aneurisma dissecante de artéria vertebral intracraniana fenestrada submetido ao tratamento endovascular: relato de caso Dissecting: aneurysm of the intracranial fenestrated vertebral artery submited to endovascular treatment case report

Aneurismas dissecantes da artéria vertebral em seu segmento intracraniano são lesões pouco comuns, principalmente quando associadas a hemorragia subaracnóidea, sendo também raras as fenestrações da artéria vertebral. Apresentam elevada morbidade e mortalidade, com elevado índice de ressangramento e dificuldade de abordagem cirúrgica. Apresentamos o caso de um homem de 19 anos, o qual foi vitima de agressão física em região occipto-cervical, apresentando hemorragia subaracnóidea e aneurisma dissecante na artéria vertebral direita, a qual era fenestrada, sendo submetido ao tratamento endovascular. Realizamos revisão da literatura sobre o assunto, sendo colocado o tratamento endovascular como uma opção terapêutica para estes casos.<br>Dissecting aneurysms of the vertebral artery at its intracranial segment are uncommon lesions, mainly when associated to subarachnoid hemorrhage, being also rare fenestrations of the vertebral artery. They present high morbidity and mortality, with high rebleeding rate and difficulty of surgical approach. We present a 19 years old man who was victim of physical aggression in the occipto-cervical region, presenting subarachnoid hemorrhage and a dissecting aneurysm of the right vertebral artery, which had a fenestration, being submitted to endovascular treatment. We accomplished a literature review about this subject, proposing endovascular treatment as a therapeutic option for these cases