Meningiomas in children account for less than 2% of all meningiomas, and their location in the spinal region is even less common. The authors present a case of a 20-month-old female who presented with lumbar back pain, neurogenic bladder and progressive paraparesis 6 months after she started to walk. Magnetic resonance imaging demonstrated an intradural extramedullary neoplasm extending from the tenth thoracic vertebra to the third lumbar vertebra. Complete excision of the tumor was performed by means of laminoplasty and the patient had a satisfactory postoperative recovery. Pathology and immunohistochemical studies diagnosed psammomatous meningioma.
Arq Bras Endocrinol Metab vol 45 nº 6 Dezembro 2001 570 RESUMO RESUMOApesar de na literatura o hipotireoidismo estar classicamente associado a distúrbios do humor, na prática clínica nem sempre esse fato recebe a devida atenção. Com o intuito de confirmar esta assertiva, foram revisados prontuários de 117 pacientes adultos, consultando em ambulatório de Endocrinologia, com diagnóstico de hipotireoidismo primário. A amostra é constituída por 9 homens (idade média 53,4 anos) e 108 mulheres (44,9 anos), com hipotireoidismo: pós-cirúrgico (n= 37), espontâneo clássico (n= 45) ou subclínico (n= 35). Os sintomas psiquiátricos pesquisados foram os utilizados no diagnóstico de transtornos depressivos pelo DSM-IV. Foram caracterizados 3 grupos de pacientes: com diagnóstico de depressão em acompanhamento psiquiátrico com ou sem antidepressivos (n= 15); sem sintomas psiquiátricos (n= 34) e com sintomas sugestivos de depressão (n= 68). Desses 68 pacientes, 15, 23, 21, 7 e 2 apresentaram, respectivamente, 1, 2, 3, 4 e 5 sintomas psiquiátricos. Dois indivíduos apresentavam 5 sintomas psiquiátricos e 28 apresentavam 3 ou 4 sintomas, números esses respectivamente associados com depressão maior e distimia. Os dados atuais chamam a atenção para a possibilidade de muitos casos não diagnosticados de transtornos depressivos na população de hipotireóideos, os quais poderiam ser beneficiados com avaliação e atendimento psiquiátrico adequados. ABSTRACT ABSTRACTEven though hypothyroidism has been classically related to mood disorders in medical literature, this fact does not always receive proper attention in clinical practice. To confirm this, we reviewed 117 medical records of adult patients with diagnosis of primary hypothyroidism from an outpatient Endocrinology service. The sample is composed by 9 men (mean age 53.4 years) and 108 women (44.9 years), whose hypothyroid status were diagnosed as: post-surgical (n= 37), classical (n= 45) or subclinical (n= 35). The psychiatric symptoms investigated were the ones utilized for the diagnosis of mood disorders by the DSM-IV. Three groups of patients were characterized: those with diagnosis of depression in psychiatric care with or without antidepressive drugs (n= 15); those without any psychiatric symptoms (n= 34) and those with symptoms suggestive of depressive disorder (n= 68). From these 68 patients, 15, 23, 21, 7 and 2 presented, respectively, 1, 2, 3, 4 and 5 symptoms. In two cases there were 5 psychiatric symptoms and in 28, 3 or 4 symptoms; these numbers are respectively associated with depression and dysthymia. These data call attention for the possibility of a significant number of undiagnosed cases of depressive disorders among hypothyroid patients, who would benefit from adequate psychiatric evaluation and treatment.
Objective: The purpose of this report is to review intracranial arteriovenous malformations, present strategies for the evaluation and selection of optimal treatment modalities, and to discuss factors important to formulating a successful treatment plan. Methods: The authors performed a critical literature review in order to highlight recent and classic studies about intracranial arteriovenous malformations. Results: Recent advances in diagnostic techniques, microsurgery, endovascular therapy, and stereotactic radiosurgery have significantly improved the treatment outcome of vascularmalformations of the central nervous system. In patients who are minimally symptomatic, in normal neurologic condition, or whose treatment risk is high, not recommending any treatment can be an excellent viable option. For the others, microsurgery, endovascular embolization, and stereotacticradiosurgery offer complementary advantages and improve the chances of a lifetime cure. Conclusion: A thorough knowledge of the natural history ofintracranial arteriovenous malformations is fundamental to the treatment decision making process. A multidisciplinary team approach with the neurosurgeon taking a leading role is as well essential for a successful intracranial arteriovenous malformation management.
There is a consensus that most unruptured intracranial aneurysms can be treated with acceptably low morbidity and mortality. However, some studies recently reported postoperative cognitive impairment, suggesting that it could be attributableto neurosurgical clipping. The goal of this report is to review and discuss aspects referring to cognitive function and neurosurgical repair in patients with unruptured intracranial aneurysms.
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