Cavernous malformations: surgical management in Belo Horizonte Santa Casa Hospital

The better understanding of the natural history of the cavernous malformations and the improvement of diagnostic methods and of microsurgical techniques have made the management of cavernous malformations possible through the conservative treatment, radiosurgery, and microsurgical resection. We present 33 cases operated at our service at Santa Casa Hospital, Belo Horizonte, from 1992 to 2001. Cortical and subcortical cavernomas manifested by epilepsy (57.5%) or mainly by hemorrhage (15.1%) were surgically approached, the deep lesions (basal ganglia, talamo and brain steam) represented 27.7% of our cases. They should only be operated when located near the pial or ependimary surface. the resection of spinal cord lesions (5.5%) and of deep brain lesions is also recommended when they present progressive focal deficit (13.8%) or recurrent episodes of hemorrhage (13.8%). Small and deep seated cavernomas that do not present bleeding must be conservatively treated. There has been no evident favourable result related to radiosurgery so far.Fac Ciencias Med Minas Gerais, Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilEscola Paulista Med, Belo Horizonte, MG, BrazilEscola Paulista Med, Belo Horizonte, MG, BrazilWeb of Scienc

Paracoccidioidomicose do sistema nervoso central: análise de 13 casos

Paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by Paracoccidioides brasiliensis, prevalent in Latin America, particularly in Brazil. Central nervous system (CNS) involvement occur in about 10% of cases. Thirteen patients with PCM involving CNS were studied considering clinical manifestation, neuroradiology and treatment modalities. Age ranged from 30 to 71 years-old (M=47.1 +/- 11.6 Me=46). There were eleven men and two women. the most frequent symptoms were motor deficits (53.8%), cognitive disturbance (53.8%), weight loss (46.1%), headaches (46.1%) and seizures (46.1%). the diagnosis was confirmed by the demonstration of P. brasiliensis. Granulomatous forms were present in all patients. Four (30.8%) of them had also meningeal involvement (mixed form). Computerized tomography (CT) scans were obtained in all cases and magnetic resonance imaging (MRI) was used in one case. Serology for HIV was done in ten patients (76.9%), and all the tests were negatives. Amphotericin B was used in twelve patients (92.3%), one of them by intraventricular infusion. in eight patients (61.5%), trimethopim and sulfamethoxazole were used, and, in two (15.4%), sulfadiazine and pirimetamine. Fluconazole, ketoconazole and itraconazole were each one used in a different patient as well. Six patients died (46.1%) and seven (53.9%) had satisfatory outcome. the follow-up period ranged from 2 to 74 (M=30.9) months. in conclusion, the CNS involvement in paracoccidioidomycosis is more frequent and more serious than thought before. the clinical manifestations, CT scans and MRI findings are not specific of paracoccidioidomycosis.Clin Neurol & Neurocirurgia Santa Casa Belo Horiz, Belo Horizonte, MG, BrazilMestre Med Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUNIFESP, Escola Paulista Med, São Paulo, BrazilServ Neurocirurg Santa Casa, Belo Horizonte, MG, BrazilUniv Fed Minas Gerais, Dept Bioquim & Imunol, Inst Ciencias Biol, Belo Horizonte, MG, BrazilPrograma Pos Grad Santa Casa, Belo Horizonte, MG, BrazilUNIFESP, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Pituitary deficiency after aneurysmal subarachnoid hemorrhage

OBJECTIVE: Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome. METHODS: Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor. RESULTS: The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ≤13 (t test, p = 0.008), Hunt-Hess grade ≥4 (t test, p;0.05) with increased hospitalization or clinical outcome. CONCLUSION: Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome