Pott’s puffy tumor is a rare and severe complication of frontal sinusitis, characterized by the progressive swelling of the frontal soft tissues secondary to a subperiosteal abscess. Radiological imaging with ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are important diagnostic tools in establishing diagnosis and treatment planning. Early surgery along with intravenous antibiotics are required in order to achieve a good recovery. The authors report a case of Pott’s puffy tumor in an obese 14-year-old male, with a previous history of asthma and a chronic use of steroids, treated with neurosurgical debridement followed by a combined course of intravenous (IV) and oral antibiotics, who had a favorable outcome upon long-term follow-up. In addition, a brief review of the current medical literature was performed for a discussion on the diagnostic and therapeutic features of this pathology.
The supraorbital eyebrow approach is an alternative route to operate on craniopharyngiomas in properly selected cases of all pediatric age ranges, from infants to teenagers. There is sufficient working space for the endoscope and all instruments, allowing for endoscopic assistance and bimanual surgical technique. Cosmetic results are excellent, and complications related to the approach are minimal.
Thymoma is strongly associated with myasthenia gravis (MG), particularly at the onset of the disease 1 . Thymus investigation in MG patients is typically recommended at the onset of MG or when patients present with clinical deterioration or a progressive increase of anti-acetylcholine receptor (AChR) antibody 2,3 . However, it is unknown if repeated screenings for thymoma at fixed intervals, even in the absence of MG deterioration, are necessary when the initial screening is negative. In addition, therapeutic guidelines do not mention the importance of thymus follow-up if the initial screening is negative 1,4 .The main objective of this study was to determine the recurrence rate and incidence of new thymoma in a series of MG patients without clinical deterioration who underwent long-term follow-up.
METHODSWe included MG patients who fulfilled the following criteria: (1) diagnosis based on abnormal repetitive nerve
ABSTRACTThymoma screening is recommended at the onset of myasthenia gravis (MG) or when patients with MG present with clinical deterioration or a progressive increase of anti-acetylcholine receptor antibody. However, it is unknown if it is necessary to repeat the screening of thymoma at fixed intervals, even in the absence of MG deterioration, when the initial screening is negative. We analyzed the recurrence rate and incidence of new thymoma in a series of patients with well-controlled MG. The sample consisted of 53 patients, aged 17 to 72 years, and the follow-up varied between 75 and 472 months. The chest computerized tomography detected thymus abnormalities in eight patients at the initial screening and no abnormalities in all patients at a second screening after five years. The findings of this study support the classical opinion that screening for thymoma should be recommended only if there is clinical deterioration due to the disease.Keywords: myasthenia gravis, thymus gland, thymoma, tomography.
RESUMOA investigação de timoma é recomendada em pacientes com miastenia gravis (MG) no início da doença, em caso de haver piora clínica ou aumento dos níveis do anticorpo antirreceptor de acetilcolina. Contudo, não foi estabelecido se é necessário repetir a investigação de timoma em intervalos fixos, na ausência de piora clínica, quando a investigação inicial foi negativa. A taxa de recorrência e a incidência de novo timoma foram analisadas em uma série de pacientes com MG bem controlada. A amostra consiste de 53 pacientes, idade entre 17 e 72 anos, com tempo de acompanhamento variando entre 75 e 472 meses. A primeira tomografia computadorizada de tórax detectou anormalidades no timo em oito pacientes durante a investigação inicial da doença e nenhuma anormalidade no segundo exame, após cinco anos de doença, em todos os pacientes. Os achados desse estudo corroboram a clássica opinião de que a investigação de timoma deveria ser recomendada somente se houver piora clínica da doença.
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.
Exploding head syndrome is a rare entity associated with migraine that occurs during sleep onset. A male migraine with aura patient presented with episodes of abrupt awakening following perceptions of sounds resembling a speeding up motorcycle engine interspersed with bursts of exhaust explosions like noises, accompanied by an exploding sensation in the head. The patient presented in the evolution of self-limited period of headache chronicity. This syndrome has been associated with an atypical form of acoustic aura that often leads to migraine chronification.
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