RESUMO
Introdução: O ependimoma anaplásico é um raro tumor neuroepitelial intracraniano composto por células neoplásicas ependimárias, sendo mais frequente em crianças. Os ependimomas se originam da camada ependimária que recobre os ventrículos cerebrais e o canal central da medula espinhal, manifestando-se em crianças e adultos jovens, com características morfológicas e comportamento biológico extremamente variável. Objetivo: relatar um caso de ependimoma anaplásico supratentorial em neonato. Relato de caso: lactente de 3 meses de idade que realizou pré-natal de forma regular e ultrassom morfológico sem alterações, foi internado com sintomas de hipertensão intracraniana (cefaleia, náusea, vômitos, rebaixamento de nível de consciência). Foram realizadas tomografia e ressonância magnética do encéfalo e foi evidenciada lesão expansiva comprometendo todo o hemisfério cerebral direito, com captação heterogênea do contraste e focos de necrose. Inicialmente, o paciente foi submetido a implante de um cateter por meio da derivação ventricular externa (DVE), em seguida foi realizada microcirurgia para a ressecção do tumor cerebral, com ressecção subtotal (cerca de 80%). As análises histopatológicas e imuno-histoquímicas revelaram o diagnóstico de ependimoma anaplásico (Grau 3, OMS). Porém, no pós-operatório a criança continuou com as mesmas manifestações clínicas, somada a convulsões e sepse, evoluindo para óbito após três meses. Conclusão: O ependimoma supratentorial extraventricular é um tumor raro e possui um largo espectro de manifestações clínicas e imaginológicos. Devido a isso, é muito importante o conhecimento, por parte dos neurocirurgiões, sobre a doença, tendo em vista que o diagnóstico precoce e a melhor escolha da terapia reduzem a mortalidade(AU)
Introduction: Anaplastic ependymoma is a rare intracranial neuroepithelial tumor composed of neoplastic ependymal cells, with most cases being reported in children. Ependymomas originate from the ependymal layer that covers the cerebral ventricles and the central canal of the spinal cord, manifesting itself in children and young adults, with extremely variable morphological characteristics and biological behavior. Objective: to report a case of supratentorial anaplastic ependymoma in a neonate. Case report: a 3-month-old infant who underwent regular prenatal and unchanged morphological ultrasound was hospitalized with symptoms of intracranial hypertension (headache, nausea, vomiting, lowering of consciousness level). Tomography and magnetic resonance imaging of the brain were performed and an expansive lesion was detected compromising the entire right cerebral hemisphere, with heterogeneous contrast uptake and foci of necrosis. Initially, the patient underwent implantation of a catheter through external ventricular shunt (PVD), then microsurgery was performed for resection of the brain tumor, with subtotal resection (about 80%). Histopathological and immunohistochemical analyzes revealed the diagnosis of anaplastic ependymoma (Grade 3, WHO). However, in the postoperative the child continued with the same clinical manifestations, associated with seizures and sepsis, evolving to death after three months. Conclusion: The extraventricular supratentorial ependymoma is a rare tumor and has a wide spectrum of clinical and imaging manifestations. Because of this, neurosurgeons' knowledge of the disease is very important, since early diagnosis and a better choice of therapy reduce mortality(AU)
Introducción: El ependimoma anaplásico es un raro tumor neuroepitelial intracraneal compuesto por células neoplásicas ependimias, siendo más frecuentes casos reportados en niños. Los ependimomas se originan de la capa ependimaria que recubre los ventrículos cerebrales y el canal central de la médula espinal, manifestándose en niños y adultos jóvenes, con características morfológicas y comportamiento biológico extremadamente variable. Objetivo: relatar un caso de ependimoma anaplásico supratentorial en neonato. En la mayoría de los casos, la mayoría de las personas que sufren de hipertensión intracraneal (cefalea, náuseas, vómitos, descenso de nivel de conciencia), han sido internados con síntomas de hipertensión intracraneal (cefalea, náuseas, vómitos, descenso de nivel de conciencia). Se realizaron tomografía y resonancia magnética del encéfalo y se evidenció una lesión expansiva comprometiendo todo el hemisferio cerebral derecho, con captación heterogénea del contraste y focos de necrosis. Inicialmente, el paciente fue sometido a implante de un catéter por medio de la derivación ventricular externa (DVE), luego se realizó una microcirugía para la resección del tumor cerebral, con resección subtotal (alrededor del 80%). Los análisis histopatológicos e inmuno-histoquímicos revelaron el diagnóstico de ependimoma anaplásico (Grado 3, OMS). Sin embargo, en el postoperatorio el niño continuó con las mismas manifestaciones clínicas, sumada a convulsiones y sepsis, evolucionando a la muerte después de tres meses. Conclusión: El ependimoma supratentorial extraventricular es un tumor raro y posee un amplio espectro de manifestaciones clínicas e imaginológicas. Debido a esto, es muy importante el conocimiento, por parte de los neurocirujanos, sobre la enfermedad, teniendo en cuenta que el diagnóstico precoz y la mejor elección de la terapia reducen la mortalidad(AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Neoplasias Encefálicas , Ependimoma , Sistema Nervoso Central , Ependimoma/diagnósticoRESUMO
BACKGROUND: Intracranial aneurysms are arterial anomalies affecting 2% to 3% of the general population in the world and these ruptures are associated with a high mortality. Some risk factors, such as age, gender, smoking, alcohol, hypertension and familial history are associated with the number of aneurysms and their size. In addition, inflammatory processes within the blood vessels of the brain can activate matrix metalloproteinase-9 (MMP-9), which degrades various components of the extracellular matrix, such as elastin. Thereby, this work has aimed at evaluating the relationship between plasma MMP-9 levels and the risk factors that are associated with intracranial aneurysm, as well as investigating the aneurysm statuses (ruptured and unruptured) and comparing them with the control volunteers. METHODS: Between August 2014 to June 2016, blood samples were collected from 282 patients (204 ruptured and 78 unruptured saccular intracranial aneurysms) and 286 control volunteers. The MMP-9 plasma levels were measured by ELISA. Statistical analyzes were performed with SPSS software when using parametric or nonparametric tests, after the normality tests. RESULTS: Higher levels of MMP-9 were found in the aneurysm groups as a whole and when they were stratified by rupture status, then compared with the control group (pâ¯<â¯0.0001). When stratifying them by diameter, those smaller than 7â¯mm presented high levels of MMP-9 (pâ¯<â¯0.0001), especially in the ruptured ones. As for risk factors, hypertension and smoking were the most important. However, hypertension was mostly associated with the ruptured aneurysms (pâ¯<â¯0.0001). CONCLUSIONS: High levels of MMP-9 were found in smaller ruptured and unruptured intracranial aneurysms (<7â¯mm) with strongest statistical associations than other sizes, especially when associated with smoking and hypertension.
Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Metaloproteinase 9 da Matriz/sangue , Adulto , Idoso , Aneurisma Roto/sangue , Aneurisma Roto/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/sangue , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: Traumatic brain injury (TBI) stands out as a grave social and economic problem. Emerging countries possess few epidemiologic studies on the range and impact of TBI. OBJECTIVE: Our study aimed to characterize the demographic, social, and economic profile of people suffering from TBI in Brazil. METHODS: Data on TBI cases in Brazil between 2008 and 2012 were collected through the website of the Information Technology Department of the Unified Health System (DATASUS) maintained by the Brazilian Ministry of Health. This database is fed by public hospital admission authorization forms provided nationwide. RESULTS: There were around 125,000 hospital admissions due to TBI a year, an incidence of 65.7 admissions per 100,000 inhabitants per year. Hospital mortality was 5.1/100,000/year, and the case fatality rate was 7.7%. The average annual cost of hospital expenses was US$ 70,960,000, with an average cost per admission of US$ 568. The age group 20-29, frequently admitted to the hospital due to TBI, presented the largest number of hospital deaths; however, the population >80 years of age showed the highest admission rate per age group, around 138/100,000/year, followed by the age group 70-79. CONCLUSIONS: TBI should be recognized as an important public health problem in Brazil because it is responsible for considerable social and economic costs. Besides the young adult age group (20-29 years old), the geriatric age group is especially vulnerable to the frequent and devastating consequences of TBI. The implementation of a system of effective epidemiologic vigilance for neurotrauma is urgent in Brazil and other countries worldwide.