NAWM was found to have a normal Naa/Cr in patients with NMO, reinforcing the concept that the white matter is not primarily affected in this disease.

No abstract

Central nervous system actinomycosis is a rare but treatable chronic suppurative bacterial infection. The case of a young immunocompetent male with actinomycosis of the CNS is presented. The abscess originated from a primary cervico-facial infection and was located in the left parasellar region. After excision of the mass, that showed Actinomyces colonies, the patient was treated with intravenous Penicillin for 42 days followed by oral administration of the drug for 30 days. After surgery the patient was left with mild sequelae that had improved by the last follow-up, 7 months later. A new CT scan at that time revealed no residual disease or recurrence. The early diagnosis of cerebral actinomycosis relies essentially on a clinical suspicion. Hence it is imperative to be aware of the natural history of this infection and its various modes of presentation.

Central precocious puberty (CPP) is due to premature activation of the hypothalamic-pituitary-gonadal axis. It may be idiopathic or result from congenital or acquired CNS lesions. We describe a 7.4 year-old Brazilian girl with CPP who also presented hypertelorism, limitation of lateral neck rotation and synkinesis of the hands. Sellar and cervical column MRIs revealed pituitary duplication and rudimentary intervertebral disks. We present the clinical and imaging observations of this case, and a thorough literature review of this rare developmental abnormality. KEY WORDSpituitary, pituitary duplication, central precocious puberty, hypothalamic hamartoma PATIENT REPORTA 7.4 year-old Brazilian girl developed breast and pubic hair at 6.8 years and menarche at 7 years of age, according to the history obtained from her parents. On past medical history her birth weight was 2.9 kg and length 49 cm. She had normal development and reached milestones at appropriate age. The only neurological problem noticed was bimanual synkinesis (involuntary mirror move-

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.

-We present the magnetic resonance (MR) findings of five patients with amyotrophic lateral sclerosis (ALS) using a spin-echo sequence with an additional magnetization transfer (MT) pulse on T1-weighted images (T1 SE/MT). These findings were absent in the control group and consisted of hyperintensity of the corticospinal tract. Moreover we discuss the principles and the use of this fast but simple MR technique in the diagnosis of ALS.KEY WORDS: amyotrophic lateral sclerosis, pyramidal / corticospinal tract, magnetic resonance, magnetization transfer.Alterações encontradas por ressonância magnética na esclerose lateral amiotrófica utilizando sequência spin-echo com transferência de magnetização: relato preliminar RESUMO -Apresentamos as alterações do sinal de ressonância magnética (RM) encontradas em cinco pacientes com esclerose lateral amiotrofica (ELA) utilizando sequência spin-echo ponderada em T1 com pulso adicional de transferência de magnetização (T1 SE/MT). Essas anormalidades estão ausentes no grupo controle e consistem de hipersinal dos tratos piramidais. Discutimos os princípios e o emprego dessa técnica simples e rápida de imagens por RM no diagnóstico de ELA. PALAVRAS-CHAVE: esclerose lateral amiotrófica, trato piramidal / cortico-espinhal, ressonânica magnética, transferência de magnetização.Amyotrophic lateral sclerosis is a rare degenerative disease of unknown etiology that affects the motor neurons of the corticospinal tract and the spinal cord. Although the clinical and pathological abnormalities of ALS have been well described, its radiological findings are scarce and nonspecific.The gross pathological changes include spinal cord atrophy secondary to neuron loss, which includes the motor nuclei of the inferior brainstem and the precentral cortex. Magnetic resonance (MR) imaging may depict these changes, mainly those of the brainstem and spinal cord. However,

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.

-The basal encephaloceles refer to rare entities and they correspond to herniation of brain tissue through defects of skull along the cribiform plate or the sphenoid bone. A rare morning glory syndrome, with characteristic retinal defect has been reported in association with basal encephaloceles. Hypophysis hormonal deficiencies may occur. We accounted for a pituitary dwarfism with delayed diagnosed transsphenoidal encephalocele associated with morning glory syndrome, showing the alterations found in retinography, computed tomography and magnetic resonance imaging.KEY WORDS: basal encephalocele, morning glory syndrome, computed tomography, magnetic resonance imaging, pituitary dwarfism.Encefalocele basal associada a síndrome "morning glory": relato de caso RESUMO -As encefaloceles basais são entidades raras e correspondem a herniações do tecido cerebral através de um defeito do crânio, ao longo da lâmina crivosa etmoidal ou do osso esfenoidal. A rara síndrome morning glory, com alterações de fundo de olho características pode apresentar-se associada à encefalocele basal. Deficiências hormonais hipofisárias podem ocorrer. Relatamos caso de nanismo hipofisário com encefalocele transesfenoidal de diagnóstico tardio associada à síndrome de morning glory, mostrando as alterações na retinografia, tomografia computadorizada e ressonância magnética. PALAVRAS-CHAVE: encefalocele basal, síndrome de "morning glory", tomografia computadorizada, ressonância magnética, nanismo hipofisário.