Volumes de hematomas em hemorragias intracerebrais espontâneas: o método da elipse (ABC/2) produziu volumes inferiores do que aqueles determinados pelo método planimétrico Intracranial hypertension is considered the main reason for surgical indication in subjects with ICH, especially in cases in which there is a progressive neurological deterioration 5,6 . The ABSTRACT Objective:To compare two different methods for measuring intracerebral hemorrhage (ICH) volume: the ellipse volume (called ABC/2), and the software-aided planimetric. Methods: Four observers evaluated 20 brain computed tomography (CT) scans with spontaneous ICH. Each professional measured the volume using the ABC/2 and the planimetric methods. The average volumes were obtained, and the intra-and inter-rater variability was determined. Results: There is an absolute 2.24 cm 3 average difference between both methodologies. Volumes yielded by the ABC/2 method were as much as 14.9% smaller than by the planimetric one. An intra-observer variability rate of 0.46% was found for the planimetric method and 0.18% for the ABC/2. The inter-observer rates were 1.69 and 1.11% respectively. Conclusions: Both methods are reproducible. The ABC/2 yielded hemorrhage volumes as much as 14.9% smaller than those measured using the planimetric methodology.Key words: cerebral hemorrhage, tomography, evaluation studies. RESUMO Objetivo:Comparar dois métodos diferentes para determinar o volume da hemorragia intracerebral: volume da elipse (chamado ABC/2), e método planimétrico auxiliado por computador. Métodos: Quatro diferentes observadores avaliaram as imagens de 20 tomografias cerebrais com diagnóstico de hemorragia intracerebral espontânea. Cada profissional determinou o volume da hemorragia usando os dois métodos. Foram comparadas as médias dos volumes obtidos, bem como suas variabilidades intra e interobservadores. Resultados: Foi observada diferença estatisticamente significativa entre os volumes calculados por meio dos dois métodos, com uma variação média absoluta de 2,24 cm 3 e com volumes até 14,9% menores para o método ABC/2. A média da variabilidade intraobservador foi de 0,46% para o método planimétrico e 0,18% para o ABC/2. As taxas de variabilidade interobservador foram de 1,69 e de 1,11%, respectivamente. Conclusões: Ambos os métodos são reprodutíveis. O volume determinado pelo ABC/2 pode ser até 14,9% menor que aquele determinado pelo método planimétrico.Palavras-Chave: hemorragia cerebral, tomografia, estudos de avaliação.

The dural sinus malformation (DSM) are rare congenital vascular anomalies with variable anatomic features, clinical conditions, and outcomes. There are two forms of disease: a lateral subtype, affecting the jugular bulb with associated high flow arteriovenous fistula; and a midline subtype, called torcular DSM. The torcular subtype is more common and characterized by a giant dural sinus lake involving the confluens sinuum (torcular Herophili). We present a case of a 28-year-old woman with an ultrasound at 32 weeks’ gestation showing a fetal intracranial thrombosed lesion, measuring 6x4 cm. An elective c-section was performed at 38 weeks’ gestation, and a male neonate was born. He remained asymptomatic, and a brain MRI performed 9 days later showed a thrombosed midline mass due to a torcular DSM. The outcome with conservative treatment was favorable, and further development was unremarkable. The 2-year follow-up imaging demonstrated spontaneous involution of the clot. The torcular DSM is frequently diagnosed prenatally as an intraluminar lake thrombosis, and differential diagnosis include tumors, subdural collections, vein of Galen aneurysmal malformations, pial malformations, arachnoid and dermoid cysts. A literature review involving 126 patients with torcular DSM found an overall mortality of 22.1%. Torcular DSM seems to have better prognosis than those having dural arteriovenous shunts, and the worst outcomes were associated to brain damage and patent feeders. In addition, antenatal diagnosis and thrombosis of pouch have good prognosis, possibly because the clot may spontaneously obliterate the fistulas. Treatment options must be individualized, and include conservative, embolization, ventriculoperitoneal shunt and endoscopic third ventriculostomy. Although systemic anticoagulation is controverse in infants, it should be considered for patients with sinovenous thrombosis affecting outflow pathways, especially those aggravated by venous congestion. Intervention is recommended for grade III patients because they progress to grade IV, and endovascular treatment is the gold standard therapy due to the risk of fatal intraoperative exsanguination. Whenever possible, embolization should be prioritized over hydrocephalus treatment because it may avoid ventriculoperitoneal shunt. Close follow-up imaging is recommended to detect any changes, with lesion reduction indicating favorable outcome.

PHACE(S) syndrome is a neurocutaneous syndrome with a wide array of presentations. The most known and present trait is facial hemangioma > 5 cm. The name is an acronym for Posterior fossa malformations, infantile Hemangiomas, Arterial anomalies, aortic Coarctation, Eye abnormalities, and middle-line malformations of the Sternum. The exact etiopathogenic mechanism of this syndrome is not fully understood, and its treatment depends on detailed and individualized assessment. The aim of this paper is to describe a child with a throat hemangioma, vascular malformations, cognitive delay, and other anomalies to illustrate the neuroimaging found in this syndrome.

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entitled "Spinal Neurovascular Malformations in Klippel-Trenaunay syndrome: A Single Center Study." 1 This study provided important insights into the prevalence and spectrum of spinal neurovascular anomalies in Klippel-Trenaunay syndrome (KTS).In a recently published paper, we reported a child with Parkes Weber syndrome (PWS) and a spinal arteriovenous fistula (AVF), initially misdiagnosed as KTS. 2 Diagnostic inaccuracy is common in overgrowth disorders, and considering the rare and overlapping features, establishing a diagnosis can be challenging. 3 Sometimes, even the triple eponym Klippel-Trenaunay-Weber is used but should be abandoned. 3 Although both KTS and PWS have overgrowth affecting predominantly the lower extremities, they should be considered separate disorders. 3 A distinction between these entities is relevant because the clinical manifestations, prognosis, and therapeutic strategies are quite different. [3][4][5] The International Society for the Study of Vascular Anomalies (ISSVA) defines KTS as the association of capillary malformation, limb overgrowth, and venous malformation, with or without a lymphatic malformation. 6 Likewise, PWS consists of capillary malformations plus limb overgrowth but differs from KTS by having AVFs. 6 Therefore, although KTS is a pure low-flow condition, PWS has a significant AVF and worse prognosis. 4 In the genetic aspect, those syndromes also have different causal genes: KTS was attributed to a mutation in the PIK3CA gene, which dysregulates cell proliferation and angiogenesis, 1,6 and PWS was related to RASA1 mutation, and GNA11 was associated with capillary malformation with congenital nonprogressive limb overgrowth. 6 The imaging studies with digital subtraction angiography and, more recently, with thick-slice dynamic magnetic resonance projection angiography are helpful for correct distinction: early appearing draining veins characterize arteriovenous shunting, typical of PWS. 4 However, survey results indicate a lack of familiarity of the musculoskeletal radiologists with the ISSVA classification, which also makes the correct diagnosis difficult. 7 In a paper entitled "Klippel-Trenaunay syndrome and spinal arteriovenous malformations: an erroneous association," Alomari et al 3 reviewed 24 reports involving 31 patients and found no solid evidence of the diagnosis of KTS in any patient. They further suggested alternative possible diagnoses, such as congenital lipomatous overgrowth, vascular malformations, epidermal nevi, skeletal/scoliosis and spinal abnormalities syndrome and capillary malformation-arteriovenous malformation, in 9 patients. Other authors also emphasize the importance of distinguishing the different features. 5,8 In this series of Larson et al, 1 epidural AVFs were found in 3 patients, and conus medullaris AVF was diagnosed in 1. In the process of learning, we raise our questions to know about the correct diagnosis in these controversial cases, especially those with AVF. How did the authors perform the differential diagnosis particularly betw...

Professor Sérgio Mascarenhas was a Brazilian researcher with a vast legacy. His work paved the way for new research possibilities by consolidating the use of innovation and transdisciplinary science. In Medicine, he proposed changes to what had previously been well-accepted concepts, and his contributions have influenced medical practices. Although many authors consider intracranial pressure (ICP) as an unrivaled variable for monitoring and diagnosis of many diseases, its clinical applicability is still the subject of debate in the literature because of the difficulty in standardizing protocols. Mascarenhas's research and the creation of a device for noninvasive monitoring of intracranial compliance are discussed and are shown to have led to the creation of Brain4care, a start-up, and a new perspective on the debate on ICP monitoring.

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