Acta neurologica latinoamericana最新文献

Despite advances in the surgical management of cerebral arteriovenous malformations (AVMs), giant (AVMs (greater than 5 cm] are still considered unsuitable for direct surgical resection by most neurosurgeons. Some of the lesions are being treated with embolization, or embolization followed by surgical excision. Embolization alone is not curative and carries potential risks of neurological deficit as well involves multiple procedures. Fourteen patients with giant AVMs underwent surgical resection without prior embolization. Four of the AVMs were located primarily in the frontal lobe, two in the temporal lobe, one each in the parietal and occipital lobes, while six AVMs were localized to two lobes (temporal-occipital or parietal-occipital). Four patients had associated aneurysms with the arteriovenous malformation. Eight patients presented primarily with seizures. One of these had multiple subarachnoid hemorrhages while another had symptoms suggestive of transient vertebrobasilar ischemia. Two patients had one or more subarachnoid hemorrhages. The primary complaint in the remaining four patients was headache with other associated symptoms. The patients with AVMs involving the optic radiation have had varying degrees of visual field deficit not interfering with their function. There were no deaths and only three patients had deterioration of neurological function. One of these three had an intra cerebral hemorrhage secondary to an associated aneurysm rupture. We feel that the majority of these giant AVMs are amenable to direct surgical excision. It is difficult to asses, from the literature, the benefit of embolization prior to surgical excision in cases of giant AVMs. At least in one report dealing with combined treatment of seven giant AVMs, some authors stressed that preoperative embolization did not significantly alter the blood flow and, hence, potential of bleeding at the time of operation. Blood loss has not been a significant problem in our experience. When there is an associated aneurysm, it should be treated prior to or at the time of excision of the malformation.

The authors present an exceptional case of chemodectoma jugulare with important invasion of the skull base involving all the cranial nerves on one side and conforming Garcin's syndrome. Practically all the possible ways of spreading were followed by the tumor, with involvement of the posterior, middle and anterior fossas of the skull base and also orbit, middle ear and neck. The clinical and histopathological difficulties in the diagnosis, especially when the chemodectoma has only neurological signs, are stressed. The association of otologic symptoms makes the diagnosis easier. The patient had an early onset of the symptoms and a rapid evolution considering this type of tumors. The appearance of goitre in this patient is a sign of endocrine disturbance, which is occasionally associated with these tumors. Apparently this chemodectoma was not a secreting tumor, since the blood pressure values were normal. No signs of multicentricity or metastatic growths were detected. The radiological studies, and especially computerized tomography scanning, gave precise information about the spreading of the tumor. The authors consider that the knowledge of this entity is important in order to arrive at a correct diagnosis.

Taking into account its complex pathogenesis, we stress the inadequacy of considering brain edema as a single clinical or pathological entity. Vasogenic, cytotoxic and hydrocephalic varieties are considered. Some clinical conditions underlied by the common morphologic feature of "status spongiosus" are discussed. The methods of investigation of brain edema are presented as well as problems concerning its diffusion and resolution.

In a retrospective study of 808 adult epileptic patients undertaken at the Neurological Institute of Montevideo, Uruguay, the rate of remission of seizures (three seizure-free years) was 32%, and that of relapse 39%. Remission occurred mostly during the first years after onset, and relapse during the first years after remission. Patients with generalized or partial seizures alone had a better prognosis than when both types coexisted. Patients with Petit Mal absences persisting after 14 years of age, had the lowest rate of remission. Mental status, abnormal neurological examination and age of onset showed no significant prognosis value. Remission and relapse was similar in cryptogenetic and symptomatic epilepsy. Genetic predisposition did not change the prognosis. Withdrawal of drugs after a minimal seizure-free period of three years produced a higher rate of relapse than when medication was continued. In the first EEG, only the existence of a slow background rhythm had an unfavorable prognosis. These results are compared with those of other series. It is concluded that the differing results can be attributed to a different selection of population and different methods of study. Anyway, several factors showed a similar influence on prognosis in the different series. As to indication for method of drug withdrawal after remission, and its influence on relapse, no definite conclusion can be drawn and a large, multicentric, methodical study on this topic is suggested.

Plantar ulcers of neurological origin are known to be associated with several disorders, some of which may be familial. We present the case report together with the clinical and post-mortem data of a patient with peroneal muscular atrophy of the Charcot-Marie-Tooth type and plantar ulcers as a prominent feature. At least three other members of her family had Charcot-Marie-Tooth disease. The family pedigree is included. The discussion stresses the difference between patients with Charcot-Marie-Tooth disease with associated manifestations, bony destruction of the feet and plantar ulcers and patients with hereditary motor and hereditary sensory radicular neuropathies.

This study was concerned with the assumed role that the frontal eye fields could play in the mechanisms of: the voluntary saccade optokinetic responses. Ten patients with frontal lobe tumors (8 unilateral, 2 bilateral) and two patients with a right hemispherectomy were studied. EOG and EEG were performed in the same session. Left and right voluntary saccadic potentials could be recorded in all cases, no matter where the frontal lesion was located. Minor differences in amplitude were observed between the fast eye movement to the lesion and to the normal side. Horizontal optokinetic responses to a moving drum were a constant finding in all cases. The frequency and amplitude of the fast component of the responses did not show substantial differences with the drum moving to the lesion or to the healthy side. Voluntary saccadic eye movements to the left and left horizontal optokinetic responses to a moving drum to the right, were recorded in the two cases with a right hemispherectomy. The hypothesis that considers frontal eye field as the pulse generator area for the voluntary or reflex saccadic eye movements is discussed.

The authors present a 47 years old female patient with cutaneomeningospinal angiomatosis or Cobb's syndrome of thoracic location. This entity, included in the primarily mesodermic phacomatose, is extremely rare, and only 17 cases have been sufficiently documented in the literature on the subject. The rare association with vertebral haemangioma of the same metameric level was present in this patient. The diagnostic criteria, possible associations, pathophysiology and nosological situation are discussed. The telangiectasic type of angioma and the principally extradural location are stressed. The authors concluded on the importance of clinical suspicion of this diagnosis based on a spinal cord syndrome in the presence of a cutaneous angioma of the same metameric level. The necessity of a complete paraclinical studies which includes selective spinal angiography and linear tomography of the spine are also stressed. With this methodology the real incidence of this syndrome will be revealed, permitting a planned surgical treatment which will diminish the high mortality and morbidity of the cases published up to the present.

Brief survey of the present knowledges concerning the melanocyte, its localization in the CNS and its transformation in melanoma. Through a catamnestic study of patients with intracranial melanoma the symptomatology and evolution of these patients is analyzed. It is stressed the importance of the early recognition of this mortal disease.

Current experimental models of brain edema are described and evaluated for their contribution to the knowledge of basic processes involved in its production as well their contribution to the understanding of different clinical forms. The participation of each main pathogenic mechanism in a given experimental model is analyzed and proves to vary with each particular model and site studied. The importance of various experimental models in the evaluation of different therapeutic procedures directed to control the genesis and evolution of brain edema is stressed.

Review of available literature reveals the lack of reports on memory impairment in relation to visuo-spatial and tridimensional dominance. Considering the absence of specific methods for assaying evaluations, the intention of our study was to devise a systematic testing procedure in order to explore the patterns referrable to this aspect.