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Mori E.,Tohoku University | Yamada S.,Neurosurgery Service
Clinical Neurology | Year: 2014

The morphological features of disproportionately enlarged subarachnoid-space hydrocephalus (DESH), the core type of idiopathic normal pressure hydrocephalus, can not be explained by the classical theory of CSF absorption at the arachnoid villi and the hypothesis of CSF flow blocking at the convexity subarachnoid spaces. By using MRI Time-SLIP CSF flow imaging, we demonstrated that CSF freely move in the subarachnoid spaces below and in the Sylvian fissures. CSF does not move in the convexity subarachnoid spaces in healthy individuals and patients with DESH, indicating the presence of flow obstacles in the convexity subarachnoid spaces by nature. If so, CSF absorption must take place below the Sylvian fissures. CSF would retain in the ventral subarachnoid spaces and ventricles, once the absorption below the Sylvian fissures is impaired. This hypothesis enables to explain the morphological features of DESH. We proposed an alternative hypothesis of CSF circulation and absorption including absorption from the cranial and spinal nerve roots to the lymphatic system.

Vale T.C.,Federal University of Minas Gerais | Moraes T.E.C.,Neurosurgery Service | Lara A.,Neurology Service | Cota G.F.,Neurology Service | Christo P.P.,Federal University of Minas Gerais
Neurological Sciences | Year: 2012

Neurosyphilis is recognized as a potential cause of hypertrophic pachymeningitis, but modern reports are few. A middle-aged man presented to hospital with a 1 month history of lower limb pain and weakness. Cerebrospinal fluid analysis showed pleocytosis with high protein levels and a positive venereal disease research laboratory result. Cervical spinal cord resonance imaging disclosed a dural contrast enhancement suggestive of pachymeningitis. Biopsy of the dura mater revealed a thick inflammatory process. Despite being treated accordingly, the patient rapidly deteriorated and died. The patient was diagnosed as having subacute hypertrophic cervical pachymeningitis which caused spinal cord compression. Serological evidence of neurosyphilis was present. Physicians should still be aware of this cause of hypertrophic pachymeningitis. © Springer-Verlag 2011.

Romero F.R.,Neurosurgery Service | Romero F.R.,University of Sao Paulo | de Freitas Bertolini E.,Hospital Ipiranga SUS | Veloso V.N.,Resident in Internal Medicine | And 2 more authors.
Arquivos de Neuro-Psiquiatria | Year: 2011

Objective: 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, have been associated with improved clinical outcomes after ischemic stroke and subarachnoid hemorrhage, but with an increased risk of incidental spontaneous intracerebral hemorrhage (ICH). We investigated whether the statin use before ICH, was associated with functional independence, 90 days after treatment. Method: We analyzed 124 consecutive ICH patients with 90-day outcome data who were enrolled in a prospective cohort study between 2006 and 2009. Eighty-three patients were included in this study. Among ICH survivors, univariate Cox regression models and Kaplan-Meier plots were used to determine subject characteristics that were associated with an increased risk of recurrence. Statin usage was determined through interviewing the patient at the time of ICH and confirmed by reviewing their medical records. Independent status was defined as Glasgow Outcome Scale grades 4 or 5. Results: Statins were used by 20 out of 83 patients (24%) before ICH onset. There was no effect from pre-ICH statin use on functional independence rates (28% versus 29%, P=0.84) or mortality (46% versus 45%, P=0.93). Conclusion: Pre-ICH statin use is not associated with changes to ICH functional outcome or mortality.

Santiago-Ramajo S.,University of Granada | Katati M.J.,University of Granada | Perez-Garcia M.,University of Granada | Arjona-Moron V.,Neurosurgery Service | Arjona-Moron V.,University of Granada
Neurosurgery | Year: 2010

BACKGROUND: It is not completely clear whether there are differences in the evolution of the neuropsychological outcomes between the 2 intervention procedures (surgery and endovascular coiling) used in subarachnoid aneurysmatic hemorrhage. Some studies have investigated this topic but without completely controlling the effect of learning the tests. OBJECTIVE: To analyze our data using 2 different statistical procedures that attempt to solve this problem. METHODS: The sample consists of 70 patients who have suffered a subarachnoid hemorrhage: 40 treated by means of surgery and 30 by means of endovascular coiling. Two cognitive evaluations were performed at 4 and 12 months after the invention. Twenty-seven healthy subjects were also evaluated twice with a delay of 8 months. The data were analyzed using 2 different statistical procedures: one by Samra et al (2007) using z scores and the other by Crawford and Garthwaite (2007) using the regbuild.exe program. RESULTS: The results indicate there are no important differences between the 2 treatment groups in the evolution of the cognitive alterations. Despite an improvement in cognitive scores on repeat testing at 12 months, neither of the 2 treatment groups showed the same level of test-retest learning as healthy control subjects. CONCLUSION: The recovery of neuropsychological functions after a subarachnoid hemorrhage is similar with the 2 interventions. It is important to control the learning effect produced by the repeated administration of tests. © 2010 by the Congress of Neurological Surgeons.

Furtado A.,Anatomic Pathology Service | Arantes M.,Neuroradiology Service | Silva R.,Neurology Service | Romao H.,Neurosurgery Service | And 2 more authors.
Clinical Neuropathology | Year: 2010

Two new cases of extraventricular neurocytoma are reported. The first concerns an 18-year-old female with a left frontal lobe lesion and the second occurred in a 54-year-old female in the thoracic spinal cord. The first patient is free of disease after 18 months of follow up. The second patient is stable after 16 months of follow up. Both were operated - total excision in Case 1 and partial resection in Case 2. The latter underwent adjuvant radiotherapy due to atypical histological features. Cases of extraventricular neurocytoma are reviewed. Differences and similarities between extraventricular and central neurocytoma are outlined. ©2010 Dustri-Verlag Dr. K. Feistle.

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