ResumoOs cistos epidermoides constituem lesões congênitas, benignas e raras, que correspondem a cerca de 0,2% a 1,8% de todos os tumores intracranianos, sendo que em apenas 5% dos casos localizam-se no quarto ventrículo. Apesar de sua gênese na vida intrauterina, são geralmente diagnosticados entre a terceira e quinta década de vida em decorrência de seu padrão de crescimento muito lento. A imagem ponderada pela difusão da ressonância magnética é fundamental para a formulação do diagnóstico. O tratamento ideal consiste no esvaziamento do conteúdo cístico com ressecção completa da cápsula. Neste trabalho, é descrito um caso de uma paciente de 31 anos de idade com síndrome cerebelar, evoluindo com síndrome de hipertensão intracraniana. A sintomatologia era decorrente de hidrocefalia obstrutiva por cisto epidermoide localizado no interior do quarto ventrículo, confirmado pela anatomia patológica. Keywords► epidermoid cyst ► fourth ventricle ► hydrocephalus AbstractEpidermoid cysts constitute congenital, benign and rare lesions, corresponding to approximately 0.2 to 1.8% of all intracranial tumors. Only 5% of cases located in the fourth ventricle. Despite its genesis in intrauterine life, are usually diagnosed between the third and fifth decade of life due to its very slow growth pattern. The imagem weighted by the diffusion of the magnetic resonance is essential to formulation of the diagnosis. The ideal treatment of choice is the empyting of the cystic contente with complete capsule ressection. In this work the case of a 31-year-old female with cerebelar syndrome evolving with intracranial hypertension. The symptomatology was due to obstructive hydrocephaly by an epidermoid cyst located inside the fourth ventricle, confirmed by the pathological anatomy.
Pneumoventricle and liquoric fistula are possible complications of traumatic brain injury (TBI), the main cause of morbimortality related to trauma in Brazil. Liquoric fistulae are more common after direct trauma with skull base fractures. However, pneumoventricle is rare and occurs due to excessive cerebrospinal fluid (CSF) drainage in the presence of a poorly compliant ventricle system, resulting in the influx of air to its interior. The pathophysiology of tension pneumoventricle remains uncertain. However, the traumatic cause is certain and multiple bone fractures of the face and liquoric fistula may contribute to the process. If symptomatic, the tension pneumoventricle can cause rapid clinical deterioration. The authors aim to report a rare case of post-TBI tension pneumoventricle with complete resolution and without signs of recurrence of the liquoric fistula after surgical treatment. Palavras-Chave ResumoO pneumoventrículo e a fístula liquórica são possíveis complicações decorrentes do traumatismo cranioencefálico (TCE), principal causa de morbimortalidade relacionada ao trauma no Brasil. As fístulas liquóricas são mais comuns após traumas diretos, com fraturas da base do crânio. Já o pneumoventrículo é raro e ocorre após a drenagem liquórica excessiva, na presença de sistema ventricular pouco complacente, resultando em um influxo de ar para o seu interior. A fisiopatologia do pneumoventrículo hipertensivo permanece incerta. Entretanto, a causa traumática é certa, e múltiplas fraturas de ossos da face e a fístula liquórica podem ter contribuição no processo. Se for sintomático, o pneumoventrículo hipertensivo pode provocar rápida deterioração clínica. Os autores têm por objetivo relatar um caso raro de pneumoventrículo hipertensivo após TCE com completa resolução e sem sinais de recorrência da fístula liquórica após tratamento cirúrgico.
Introduction: COVID-19 affects several vital organs, including the brain, and can cause neurological manifestations. Objective: To characterize the neurological manifestations of hospitalized patients with laboratory confirmation of COVID-19, between May and August, 2020. Design and setting: Observational study at Veredas Hospital and University Hospital Professor Alberto Antunes in Alagoas, Brazil. Methods: Socio-demographic data, infectious and neurological symptoms, risk factors for neurological and infectious diseases, clinical history, treatment instituted and outcome of patients were collected. Results: We included 30 patients with a mean age of 61.05 ± 18.65 years, 70% were female. The average between the onset of COVID-19 symptoms and hospital admission was 10 ± 9.7 days. Systemic arterial hypertension (66.7%) and diabetes mellitus (63.3%) were the main comorbidities. Cough, fever (60%) and dyspnea (56.7%) stood out in general symptoms. The most frequent neurological symptoms were changes in the level of consciousness (56.7%), epileptic seizures (33.3%) and motor deficits (23.3%). Ischemic stroke (40%) was the main neurological diagnosis, followed by epileptic seizures (33.3%), delirium (13.3%), encephalitis (10%), SAH (6.6%), vasculitis (6, 6%), hemorrhagic stroke, TIA, cranial neuropathy, meningitis and peripheral neuropathy (3.3% each). Regarding treatment, 100% used antibiotic therapy, 96.7% prophylactic heparin, 50% mechanical ventilation, 46.7% antiparasitic, 20% vasoactive drugs and 6.7% hydroxychloroquine. The death rate was 40%. Conclusions: Neurological manifestations by patients with COVID-19 are not uncommon, presenting in different ways, and can be potentially fatal. The main neurological symptom was changes in the level of consciousness and diagnosis, ischemic stroke.
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