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RESUMO - Reference values for measures of blood flow velocities and impedance indexes in healthy individuals through conventional transcranial DopplerABSTRACT -Objective: To establish reference values for measures of blood flow velocities and impedance indexes in healthy individuals through conventional transcranial Doppler (TCD) and to observe their variations in relation to the age and sex. Method: 88 asymptomatic volunteers were examined without antecedents of cardiac, peripheral or cerebrovascular diseases. The TCD were accomplished by the same examiner. The middle, anterior and posterior cerebral arteries were studied through the temporal acoustic window and the vertebral and basilar arteries through the suboccipital acoustic window. The values of mean velocity (MV), peak-systolic velocity (PSV), final diastolic velocity (FDV), resistance index (RI) and pulsatility index (PI) of each examined arterial segment were filed. Results: The reference limits found by us were similar to the described by other authors for all of the studied parameters. There was tendency of the flow velocities decrease and of the impedance indexes increase with moving forward of the age. The values of velocities in the women were superior to the found in men. Conclusion: TCD was shown useful in the evaluation of hemodynamic cerebral for our population. Our results are similar to the other studies, so much in the reference values as in relationship with the age and the sex.

Endovascular treatment of direct CCF with detachable balloons has been shown to be a long-term effective and stable therapeutic method. The authors found asymptomatic pseudoaneurysms in 91% of cases where the ICA patency was preserved. MRI and MRA demonstrated an accuracy similar to that of DSA in the diagnosis of pseudoaneurysms of cavernous ICA.

RESUMO -Aneurismas dissecantes da artéria vertebral em seu segmento intracraniano são lesões pouco comuns, principalmente quando associadas a hemorragia subaracnóidea, sendo também raras as fenestrações da artéria vertebral. Apresentam elevada morbidade e mortalidade, com elevado índice de ressangramento e dificuldade de abordagem cirúrgica. Apresentamos o caso de um homem de 19 anos, o qual foi vitima de agressão física em região occipto-cervical, apresentando hemorragia subaracnóidea e aneurisma dissecante na artéria vertebral direita, a qual era fenestrada, sendo submetido ao tratamento endovascular. Realizamos revisão da literatura sobre o assunto, sendo colocado o tratamento endovascular como uma opção terapêutica para estes casos.PALAVRAS-CHAVE: aneurisma dissecante, hemorragia subaracnóidea, artéria vertebral. Dissecting: aneurysm of the intracranial fenestrated vertebral artery submited to endovascular treatment case reportABSTRACT -Dissecting aneurysms of the vertebral artery at its intracranial segment are uncommon lesions, mainly when associated to subarachnoid hemorrhage, being also rare fenestrations of the vertebral artery. They present high morbidity and mortality, with high rebleeding rate and difficulty of surgical approach. We present a 19 years old man who was victim of physical aggression in the occipto-cervical region, presenting subarachnoid hemorrhage and a dissecting aneurysm of the right vertebral artery, which had a fenestration, being submitted to endovascular treatment. We accomplished a literature review about this subject, proposing endovascular treatment as a therapeutic option for these cases.

Background: This study aimed to estimate occupational doses and patient peak skin doses (PSDs) during interventional radiology procedures. Materials and Methods: We examined data from brain embolization (n = 30), hepatic chemoembolization (n = 50), and uterine embolization (n = 12). The PSDs were measured using radiochromic film around the patient' s head (group 1) or abdominal/pelvic region (group 2). Acquisition technical data and kerma-area products (KAP) were also recorded. Occupational doses were measured using Instadose TM dosimeters near the left eye region (LER), chest, and left ankle. Results and Discussion: The third quartile (median) KAP values were 408.1 (235.3) Gy• cm 2 for group 1 and 584.4 (449.4) Gy• cm 2 for group 2. The average PSDs were greatest during vascular procedures, reaching 1,004.4 (786.4) mGy, and the highest PSD was 2,352.6 mGy (during hepatic chemoembolization). The third quartile (median) occupational doses were 0.35 (0.21) mSv at the LER, 0.25 (0.15) mSv at the chest, and 1.47 (0.64) mSv at the left ankle. Occupational doses at the LER were higher than at the chest, which highlights the importance of protective glasses and suspended shields. The occupational doses at the ankle region were also high, which highlights the importance of using a lead-lined curtain attached to the table. Conclusion: The results indicate that physicians can reach, for eye region, the weekly occupational dose limit after around 15 procedures, even when using proper protection. The average PSD values were below the threshold for tissue reactions, although the complexity of these procedures emphasises the importance of considering related risks.

Tivemos a oportunidade de acompanhar com exames de TC caso de intoxicação por metanol. O paciente foi submetido ao exame no momento da internação e após seis dias, pela persistência de quadro neurológico grave. Observou-se nesta última a presença de lesões putaminais simétricas e da substância branca subcortical, apesar do tratamento adequado. A comprovação tomográfica de lesões cerebrais evidenciou efeito tóxico do metanol e pode orientar o prognóstico neurológico.

A 42-year-old woman presented with headache, galactorrhoea, marked hyperprolactinemia and normal neurologic examination. CT, MR and MR-angiography showed an intracavernous carotid artery aneurysm with minimal displacement of the pituitary stalk. Treatment by embolisation using GDC coils allowed exclusion of the aneurysm. Galactorrhoea resolved and serum prolactin levels fell to normal after eight months. Follow-up MR showed absence of the aneurysm, although the discrete mass effect persisted, suggesting that hyperprolactinaemia was due to pulsatility.

Endovascular treatment of intracranial aneurysms with coil embolization became the most i m p o rtant therapeutic option with better morbidity and mortality rates and quality of life. Following immo-b i l i t y, patients are treated with general anaesthesia. Objective: To test viability of endovascular tre a t-ment on wake patients. Method: Considering clinical symptoms, psychological characteristics and aneury s-mal morphology, four patients with five intracranial aneurysms were selected. Results: Four among five cases were completed with this technique. Patient 1 was partially treated after 75 minutes presenting vesi-cal stress. Patient 2 presented subarachnoid hemorrhage after aneurysmal re-rupture, and the procedure was completed under general anaesthesia. The other three patients presented no interc u rrences during the tre a t m e n t. Conclusion: Endovascular treatment on wake patients with intracranial aneurysm can be an alternative to a selected group of patients. KEY WORDS: intracranial aneurysm, embolization, endovascular treatment, anaesthesia, wakefulness patients. Avaliação preliminar do tratamento endovascular de aneurismas intracranianos com espirais destacáveis em pacientes no estado de vigília RESUMO-O tratamento endovascular de aneurismas intracranianos com espirais destacáveis estabeleceu-se como principal opção terapêutica na maioria dos pacientes, por menores taxas de morbidade e mort a l i-dade. De forma geral, os pacientes são tratados sob anestesia geral, pela necessidade de imobilidade. Objetivo: Avaliar a viabilidade do tratamento endovascular de aneurismas intracranianos em pacientes no estado de vigília. Método: Cinco aneurismas foram tratados em quatro pacientes selecionados, con-siderando-se quadro clínico, a intenção de colaboração do paciente e características morfológicas do aneuris-m a. Resultados: A abordagem proposta foi possível em quatro dos cinco casos. O paciente 1 obteve com-pactação parcial do aneurisma, pois o tratamento foi interrompido por desconforto vesical. O paciente 2 a p resentou hemorragia subaracnóidea por re-ruptura do aneurisma, e o tratamento foi completado no mesmo tempo sob anestesia geral. Nos demais casos, não houve interc o rr ê n c i a s. Conclusão: O tratamen-to endovascular de aneurismas intracranianos em pacientes no estado de vigília é viável em grupo sele-cionado de pacientes. PA L AV R A S-C H AVE: aneurisma intracraniano, embolização, tratamento endovascular, anestesia, pacientes em alerta.