Cervical and intracranial arterial evaluation is an important issue for acute ischemic stroke (IS). Objective: Compare the use of the neurovascular ultrasound examination (NVUE) to digital subtraction angiography (DSA) in acute IS patients for diagnosing significant extracranial and intracranial arteriopathy. Method: Nonconsecutive patients with IS or transient ischemic attack admitted within 12 hours of the onset of symptoms were evaluated retrospectively. Standardized NVUE and DSA were done in all patients within the first 120 hours of hospital admission. Results: Twenty-four patients were included in the study. Compared to DSA, the NVUE demonstrated 94.7% sensitivity and 100% specificity for identifying symptomatic extracranial and/or intracranial arteriopathy. Conclusion: The standardized NVUE technique demonstrated high sensitivity and specificity compared to DSA for diagnosing arterial abnormalities in acute IS patients.Keywords: transcranial Doppler, ultrasonography, digital substraction angiography, ischemic stroke. RESUMOA avaliação cervical e intracraniana é uma etapa importante no AVC isquêmico (AVCi) agudo. Objetivo: Comparar o uso do ultrassom neurovascular (USNV) com técnica padronizada e a angiografia digital (AD) em paciente com AVCi agudo no diagnóstico de doença arterial significativa extra e/ou intracraniana. Método: Pacientes com AVCi e AIT admitidos em até 12 horas do início dos sintomas foram retrospectivamente avaliados. Todos os pacientes foram submetidos a USNV e AD padronizado em até 120 horas da admissão. Resultados: Vinte e quatro pacientes foram incluídos no estudo. Em comparação com a AD, o USNV apresentou sensibilidade de 94,7% e especificidade de 100% para o diagnóstico de doença arterial significativa extra e/ou intracraniana. Conclusão: O uso de técnica padronizada de USNV demonstrou elevada sensibilidade e especificidade para o diagnóstico de doença arterial significativa extra e intracraniana quando comparado a AD.Palavras-chave: ultrassom diagnóstico, ultrassom, angiografia, acidente vascular cerebral isquêmico.
Cavernomas são hamartomas que podem acometer qualquer ponto do neuro-eixo. São malformações vasculares com maior ou menor potencial de sangramento ao longo da vida, em função de determinadas variáveis. Podem ter como origem fatores genéticos, tema de diversas pesquisas recentes, embora a maioria seja esporádica. Com o avanço da tecnologia de neuroimagem atual, a incidência de diagnósticos casuais vem aumentando. Quando há repercussão clínica, geralmente se dá por hemorragia, crise convulsiva, ou por crescimento e efeito expansivo.
Revisão J Bras Neurocirurg 23 (3): 217-221, 2012 Maranha LA, Augusto LP, Zanine SC, Araújo JC -Acrania e outras falhas na formação dos ossos do crânio: uma revisão da literatura Acrania e outras falhas na formação dos ossos do crânio: uma revisão da literatura Acrania and other failures in the formation of the skull bones: a literature reviewA acrania é uma malformação congênita rara que cursa com ausência parcial ou total do crânio de fetos humanos. Está associada frequentemente com anencefalia e é, via de regra, fatal em curtíssimo prazo. Existem alguns marcadores pré-natais, sendo a ultrassonografia o exame diagnóstico padrão-ouro. Os autores revisam aspectos relacionados a epidemiologia, fisiopatologia, diagnóstico ultrassonográfico, diagnóstico diferencial entre malformações cefálicas e manejo obstétrico da doença. Palavras Chave: Acrania; malformação de sistema nervoso central; anencefalia.ABSTRACT Acrania is a rare congenital malformation with partial or total absence of skull of human fetuses. It is often associated with anencephaly and is usually fatal in very short time. There are some prenatal markers and the ultrasound is the gold-standard diagnostic method. The authors review aspects of the epidemiology, pathophysiology, ultrasound diagnosis, differential diagnosis of cephalic malformations and obstetric management of the disease.
Objectives External ventricular drainage (EVD) is extensively used in the neurosurgical practice with the purpose of monitoring the intracranial pressure and draining the cerebrospinal fluid (CSF). Despite its remarkable benefits, the technique is not devoid of risks, notably infections, which have been reported in up to 45% of the cases. Methods A retrospective analysis of the main risk factors for CSF infection in neurosurgical patients submitted to EVD at a single institution. We recorded and submitted to statistical comparison every risk factor for CSF infection present or absent in each of the 110 EVD patients enrolled, 53 males and 57 females, with an average age of 52.9 years, with different underlying neurosurgical conditions. Results Infection of the CSF occurred in 32 patients (29%). The rate of mortality related to CSF infection was of 18.7% (6 of 32). The risk factors that showed statistical significance for CSF infection in this series were: emergency surgery; length of stay at the intensive care unit (UCI); duration of the EVD; parenchymal and/or intraventricular hemorrhage; simultaneous infections; time of bladder catheterization; and the use of non-disposable adhesive drapes as part of the preparation of the wound area. Conclusions Infection of the CSF in patients submitted to EVD is multifactorial and a challenge in terms of prevention. Further studies proposing scores with blended risk factors may be useful to prevent and reduce the morbidity and mortality associated with CSF infection.
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