Neurocryptococcosis is a common mycotic central nervous system infection caused by the neurotropic fungus Cryptococcus neoformans 1 . It is most frequently found as the pathological presentation of cryptococcal meningoencephalitis 1 . Other rare forms of central nervous system cryptococcal infections are their solid-granulomatous appearance and abscesses, both being commonly named neurocryptococcomas, because of the mass effect they cause in surrounding tissue and their "tumoral aspect", many times simulating a brain tumor. Alternatively, Nucci et al. 2 described the unique report of a pseudocystic form of neurocryptococcosis. These medical conditions were classically described in immunocompromised hosts, mainly in HIV/AIDS infected patients.However, more recently, such disease has also been found in HIV-negative, immunocompetent individuals 1,3,4 . HIV-negative patients who were diagnosed with neurocryptococcoma had frequently other predisposing conditions to immunologic dysfunction such as sarcoidosis, diabetes, recent use of glucocorticoid or other immunossupresive therapy, as pointed by Gologorsky et al. 4 . CASEA 46 year-old male patient was admitted to the emergency room complaining of about two months of occipital headache, associated with nausea and vomiting in the last two days. Altered mental status had already been detected by his family within the last twelve hours before admittance. On neurological examination there was mild confusion and Glasgow coma scale score was 13. The patient was submitted to a contrast enhanced head computed tomography (CT) scan, which revealed a left cerebellar hemispheric tumor-like lesion with ring-like contrast enhancement, measuring about 2.8 cm on its major diameter. The lesion presented with surrounding edema, which caused fourth [A, B and C]. Complete resection of the lesion by a suboccipital craniectomy is shown in Fig 1D.
-We report the case of a severe head injured 43-year old male patient with a large extradural hematoma, Glasgow Coma Scale 3 and dilated fixed pupils. Patient was promptly submitted to surgical evacuation of the lesion, but remained in persistent vegetative state in the post-operative time. Head computed tomography scans performed before surgery, and at early and late post-operative periods comparatively revealed extreme bilateral cortical atrophy. Late consequences of severe head trauma drastically affect the prognosis of patients, being its prevention, and neuroprotection against secondary injury still a therapeutical challenge for neurosurgeons.KEY WORDS: brain atrophy, extradural hematoma, epidural hematoma, severe head injury, secondary injury. Atrofia cortical bilateral após traumatismo cranioencefálico grave e hematoma extraduralRESUMO -Relatamos o caso de um paciente de 43 anos, com traumatismo cranioencefálico grave, com grande hematoma extradural, Escala de Coma de Glasgow 3 e pupilas fixas e dilatadas. O paciente foi prontamente submetido à evacuação cirúrgica da lesão mas permaneceu em estado vegetativo persistente no período pós-operatório. As TC de crânio realizadas antes da cirurgia e nos períodos pós-operatórios precoce e tardio revelaram comparativamente extrema atrofia cerebral bilateral. As conseqüências tardias do traumatismo craniano grave afetam drasticamente o prognóstico dos pacientes, sendo sua prevenção, e a neuroproteção contra a injúria secundária ainda um desafio terapêutico para os neurocirurgiões. PALAVRAS-CHAVE: atrofia cerebral, hematoma extradural, hematoma epidural, traumatismo craniano grave, injúria secundária.
RESUMO PALAVRAS-CHAVE KEY WORDSPseudoaneurysm. Superficial temporal artery. Craniocerebral trauma.
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