RESUMO
The Monro-Kellie doctrine states that the interior of the cranium is formed of three main components: blood, fluid and cerebral parenchyma. An increase in the volume of one or more components may increase the intracranial pressure (ICP). This doctrine also affirms that the skull cannot be expanded after the closure of the fontanels. Monro and Kellie's theory has been perfected during the last two centuries. This study leads to a new contribution that proves that even adults' consolidated skulls present volumetric changes as a consequence of ICP variations.
Assuntos
Circulação Cerebrovascular/fisiologia , Hipotensão Intracraniana/fisiopatologia , Pressão Intracraniana , Modelos Biológicos , Humanos , Técnicas In Vitro , Postura , Transdutores de PressãoRESUMO
Hemorrhage in regions remote from the site of initial intracranial operations is rare, but may be fatal. Postoperative cerebellar hemorrhage as a complication of supratentorial surgery, with a radiological appearance known as zebra sign, is an increasingly recognized clinical entity and is associated mainly with vascular neurosurgery or temporal lobe resection. The pathophysiology remains unclear. Three cases of remote cerebellar hematoma occurred after neck clipping of anterior communicating artery aneurysms. All patients had similar clinical findings and underwent pterional craniotomy with the head in accentuated extension. One patient died and the two were discharged without symptoms. Cerebellar hemorrhage probably has a multifactorial origin involving positioning associated with abundant cerebrospinal fluid drainage causing cerebellar sag with resultant vein stretching and bleeding, and use of aspirin or other antiplatelet agents.
Assuntos
Cerebelo/fisiopatologia , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Procedimentos Neurocirúrgicos/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/fisiopatologia , Idoso , Doenças Cerebelares/etiologia , Doenças Cerebelares/fisiopatologia , Cerebelo/irrigação sanguínea , Cerebelo/patologia , Angiografia Cerebral , Veias Cerebrais/diagnóstico por imagem , Veias Cerebrais/patologia , Veias Cerebrais/fisiopatologia , Craniotomia/efeitos adversos , Evolução Fatal , Feminino , Humanos , Hipotensão Ortostática/complicações , Hipotensão Ortostática/fisiopatologia , Doença Iatrogênica , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/cirurgia , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Hemorragia Intracraniana Hipertensiva/etiologia , Hemorragia Intracraniana Hipertensiva/fisiopatologia , Hemorragias Intracranianas/diagnóstico por imagem , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/fisiopatologia , Cuidados Intraoperatórios/efeitos adversos , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/efeitos adversos , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Ventriculostomia/efeitos adversosRESUMO
Multiple simultaneous intracerebral hemorrhages (ICH) are uncommon. We report the case of an 80-year-old woman with previous diagnosis of normal pressure hydrocephalus and who was brought to our hospital with altered mental status and urinary incontinence. Medical history of hypertension, hematological disorders or severe head trauma was absent. Platelet count and coagulation profile were unremarkable. An initial head computed tomography (CT) showed sulcal enlargement and ventricular dilatation, but no evidence of ICH. A tap test indicated as a guide to case selection for shunt surgery accidentally resulted in cerebrospinal fluid (CSF) overdrainage. The patient presented sudden neurological deterioration, with sluggishly responsive pupils and generalized tonic-clonic seizures. A new head CT demonstrated multiple supra and infratentorial ICH. The patient became comatose and had a fatal course. Hence, CSF overdrainage may either cause or precipitate multiple simultaneous ICHs, affecting both the infratentorial and supratentorial regions.
Assuntos
Hemorragia Cerebral/líquido cefalorraquidiano , Hemorragia Cerebral/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Humanos , Hidrocefalia de Pressão Normal/complicações , Hidrocefalia de Pressão Normal/cirurgia , Hipotensão Intracraniana/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
Spontaneous intracranial hypotension is a rare syndrome, characterized by pressure in the cerebrospinal fluid ranging between 50 and 70 mmH2O and postural headache. Its diagnosis is made through the clinical presentation, measurement of the cerebrospinal fluid pressure and neurorimage features. The clinical recognition of this pathology has been increasing and the differential diagnosis must be made with inflammatory meningeal processes and tumor. We report a case of spontaneous nerve root cerebrospinal fluid leaks in a 34 year-old man and intracranial hypotension. A literature review was performed evaluating the clinical, diagnostic and therapeutic aspects of this unusual pathology.