Arquivos de neuro-psiquiatria
-
Giant pituitary adenomas are uncommonly large tumors, greater than 4 cm in size that can produces endocrine symptoms, visual loss and cranial nerve palsies. We report the rare occurrence of seesaw nystagmus as the presenting sign of giant pituitary adenoma. ⋯ After surgery, nystagmus disappeared. Our case is relevant in understanding its pathogenesis since it documents seesaw nystagmus in a patient bitemporal hemianopia due to a large tumor but without mesencephalic compression.
-
This study aims to provide information about epidemiological factors related to traumatic brachial plexus injuries in adults. ⋯ Traction is the most frequent mechanism related to brachial plexus injuries, and root avulsions are common in this cases. Pain and concomitant lesions are frequently observed in these group. In this series, the rate of incidence to the local population was 1.75/100000/year.
-
This paper reports the use of dexmedetomidine in three epileptic patients with cavernous angiomas that underwent awake surgery in order to map their speech areas. ⋯ Dexmedetomidine was useful for awake craniotomy as it decreased patients level of consciousness but did not produce agitation. Laryngeal mask was not necessary to keep air ventilation.
-
Case Reports
Ventral extradural spinal meningeal cyst causing cord compression: neurosurgical treatment.
Spinal extradural meningeal cysts are typically formed by a thin fibrotic membranous capsule, macroscopically similar that of an arachnoid membrane, filled by cerebro spinal fluid and related to a nerve root or to the posterior midline. Ventral location is extremely rare and when it occurs they usually cause spinal cord herniation through the ventral dural gap. A 61 year-old man who began with a two years long history of insidious tetraparesis, spasticity and hyperreflexia in lower extremities, and flaccid atrophy of upper limbs, without sensory manifestations, is presented. ⋯ The cyst reduced in size significantly and the patient is asymptomatic over a 48 months follow-up. This is the first reported case of a spontaneous ventral extradural spinal meningeal cyst causing cord compression. Cyst-peritoneal shunt was effective in the treatment of the case and it should be considered in cases in which complete resection of the cyst is made more difficult or risky by the need of more aggressive surgical maneuvers.
-
Cerebral ischemic processes associated with infective endocarditis caused by Streptococcus bovis are rare; only 2 cases having been reported. Here we report a case of a 50-year-old man with S. bovis endocarditis who presented signs of frontal, parietal and occipital lobe cerebral ischemia. This is the first case reported in which the presence of hemianopsia preceded the endocarditis diagnosis. ⋯ Later, vegetating lesions were identified in the aortic valve and S. bovis grew in blood cultures. Antibiotic use and aortic valve replacement eliminated the infection and ceased thromboembolic events. A video colonoscopy examination revealed no mucosal lesions as a portal of entry in this case, although such lesions have been encountered in up to 70% of reported cases of S. bovis endocarditis.