HB - Neurocirurgia
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- Hematoma subdural raquidianoPublication . Ribeiro, M; Cerqueira, J; Fernandes, J; Alegria, C; Rocha, JSpinal subdural haematoma is a rare pathology and may cause severe neurological deficit. In this paper a case of acute spinal subdural haematoma of multifactorial etiology--traumatic versus iatrogenic--is presented, in which the clinical evaluation, Computerized Tomography and Magnetic Resonance were of utmost importance as far as the early diagnosis is concerned, allowing therefore decompressive surgery to avoid neurological deficit development.
- Abcesso isolado do clivus achados em ressonância magnética convencional: estudo de difusãoPublication . Fernandes, JS; Valle, JM; Morais, N; Ribeiro, M; Magalhães, Z; Moreira da Costa, JA; Rocha, J
- Casos clínicosPublication . Morais, N; Moreira da Costa, JA; Valle, JM; Amorim, J; Serviço de Neurocirurgia, Hospital de Braga; Serviço de Neurocirurgia, Hospital de Braga
- Primary angiitis of the central nervous system: an infrequent form of presentationPublication . Jordão, MJ; Almeida, F; Moreira da Costa, JA; Rocha, JINTRODUCTION: Primary angiitis of the central nervous system (CNS) is a rare disease. Clinical signs and symptoms include headache and cognitive disorders associated to multifocal neurological deficits. A definitive diagnosis can only be achieved by means of a cerebromeningeal biopsy. CASE REPORT: We describe the case of a 15-year-old male who first reported lower back pain and progressive paresis of the right lower limb, later followed by laterocollis on the right side. Magnetic resonance (MR) scanning of the brain and spinal cord revealed a pseudotumoral lesion in the right cerebellum and two lesions in the spinal cord. Dexamethasone was administered and surgical resection of the cerebellar lesion was performed. Following surgery, the patient received corticoid treatment with progressive withdrawal. Full clinical recovery of the patient was achieved. A year later, the same patient was admitted to hospital again because of headaches and diplopia. A new MR brain scan showed a right frontotemporal lesion. Dexamethasone was administered and the patient recovered. Thirteen months later, he reported dysarthria and right-side hemiparesis. An MR brain scan revealed the presence of a number of bilateral lesions in the white matter. Results of a lumbar puncture showed lymphocytic pleocytosis and raised protein levels in cerebrospinal fluid. The laminae from the cerebromeningeal biopsy were reviewed and the results confirmed the hypothetical diagnosis of angiitis of the CNS. Treatment was established with intravenous cyclophosphamide in association with oral prednisone. CONCLUSIONS: Primary angiitis of the CNS is an infrequent disease and its pathogenesis remains unknown. The definitive diagnosis of these patients is histological. It courses spontaneously and generally has a fatal outcome. Treatment, which consists in an association of cyclophosphamide and prednisone, must be started as early as possible.
- Casos clínicos IIPublication . Morais, N; Moreira da Costa, JA; Valle, JM; Amorim, J
- Diffusion-weighted MR imaging findings in an isolated abscess of the clivusPublication . Soares-Fernandes, JP; Valle-Folgueral, JM; Morais, N; Ribeiro, M; Moreira da Costa, JAWe report the finding of restricted diffusion in an isolated abscess of the clivus and discuss the imaging differential diagnosis, with an emphasis on the usefulness of diffusion-weighted imaging.
- Lesões TalâmicasPublication . Morais, N; Oliveira, J; Afonso, M; Abreu-Lima, J; Moreira da Costa, JA; Serviço de Neurocirurgia, Hospital de Braga
- Envolvimento meníngeo em caso de esclerodermia localizadaPublication . Carvalho, R; Fernandes, J; Ribeiro, M; Morais, N; Moreira da Costa, JA; Magalhães, Z; Rocha, J
- Fibromuscular dysplasia with dissecting basilar aneurysm: Endovascular treatmentPublication . Ribeiro, M; Soares-Fernandes, J; Rocha, J; Machado, A; Cerqueira, J; Moreira da Costa, JA; Reis, J
- Difficulties diagnosing spinal subdural hemorrhage in a hypo-coagulated patient due to simultaneous symptomatic subdural cranial hemorrhagePublication . Mascarenhas, LA hypo-coagulated 58-year-old female complained of headaches right after being exposed to the first pressure waves generated during an exhibition of fireworks. The day after she presented with seizures and the CT scan showed subdural hemorrhage over the left frontoparietal sulci. Eight hours after admission she disclosed left lower limb hypo-esthesia, i.e. a finding not attributable to the cranial hemorrhage. Four hours later sphincter dysfunction and paraparesis were also present with a left predominance. This was due to a T12-L1 subdural extramedullary hemorrhage. The patient was operated and showed a favorable outcome. Hypo-coagulated patients with cranial hemorrhage require prolonged surveillance and may harbor spinal hemorrhage as well. This rare combination can be unsuspected in view of the evident cranial event, and may cause severe neurological deficits if not detected.