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To compare fetuses with intrauterine growth restriction (IUGR) and those with normal growth, in terms of skull and brain measurements obtained by magnetic resonance imaging (MRI).This was a prospective cohort study including 26 single fetuses (13 with IUGR and 13 with normal growth), evaluated from 26 to 38 weeks of gestation. Using MRI, we measured skull and brain biparietal diameters (BPDs); skull and brain occipitofrontal diameters (OFDs); corpus callosum length and area; transverse cerebellar diameter; extracerebral cerebrospinal fluid (eCSF); and right and left interopercular distances (IODs).The following were significantly smaller in IUGR fetuses than in control fetuses: skull BPD (76.9 vs. 78.2 mm;IUGR fetuses had smaller OFD and BPD, both skull and brain, and less eCSF when compared to normal growth fetuses.Comparar medidas do crânio e encéfalo por meio da ressonância magnética (RM) de fetos com restrição do crescimento intrauterino (RCIU) e com crescimento adequado.Realizou-se um estudo de coorte prospectivo com 13 fetos com RCIU e 13 controles entre 26 e 38 semanas. Foram realizadas as seguintes medidas por RM: diâmetro biparietal (DBP) e diâmetro occipitofrontal (DOF) cerebral e ósseo, comprimento e área do corpo caloso (CPC), diâmetro transverso do cerebelo, líquido cerebroespinhal (LCE) extracerebral e distância interopercular (DIO) direita e esquerda.Observaram-se diferenças significativas nas medidas do DBP ósseo (76,9 vs. 78,2 mm;Fetos com RCIU tiveram menores DBP e DOF, ambos crânio e encéfalo, e menor LCE extracerebral que fetos com crescimento adequado.

Background: Individuals with migraine usually complain about lower memory performance. Diagnostic methods such as neuroimaging may help in the understanding of possible morphologic and functional changes related to the memory of those individuals. Therefore, the aim of this review is to analyze the available literature on neuroimaging changes related to memory processing in migraine. Methods: We searched the following databases: Pubmed/Medline, Psycinfo, Science Direct, Cochrane and Web of Science. We used articles without restriction of year of publication. The combination of descriptors used for this systematic review of literature were Neuroimaging OR Imaging OR Brain AND Migraine OR Chronic Migraine AND Memory. Results: Of the 306 articles found, nine were selected and all used magnetic resonance imaging (MRI). The studies used structural and functional MRI techniques with a predominance of 3 Tesla equipment and T1-weighted images. According to the results obtained reported by these studies, migraine would alter the activity of memory-related structures, such as the hippocampus, insula and frontal, parietal and temporal cortices, thereby suggesting a possible mechanism by which migraine would influence memory, especially in relation to the memory of pain. Conclusions: Migraine is associated to global dysfunction of multisensory integration and memory processing. This condition changes the activity of structures in various regions related to memory of pain, prospective memory, as well as in short- and long-term verbal and visuospatial memories. However, it is necessary to perform studies with larger samples in association with cognitive tests, and without the interference of medications to verify possible alterations and to draw more concrete conclusions. RESUMO Introdução: Indivíduos com enxaqueca geralmente se queixam de menor desempenho de memória. Métodos de diagnóstico como a neuroimagem podem auxiliar no entendimento de possíveis alterações morfológicas e funcionais relacionadas à memória desses indivíduos. Portanto, o objetivo desta revisão é analisar a literatura disponível sobre alterações de neuroimagem relacionadas a alterações de memória na enxaqueca. Métodos: Pesquisou-se nas seguintes bases de dados: PubMed/MEDLINE, Psycinfo, Science Direct, Cochrane e Web of Science. Foram utilizados artigos sem restrição de ano de publicação. A combinação dos descritores utilizados para esta revisão sistemática da literatura foram Neuroimaging OR Imaging OR Brain AND Migraine OR Chronic Migraine AND Memory. Resultados: Dos 306 artigos encontrados, nove foram selecionados e todos utilizaram ressonância magnética (RM). Os estudos utilizaram as técnicas de RM estrutural e funcional com predomínio de equipamentos de 3 Tesla e imagens ponderadas em T1. De acordo com os resultados obtidos nos estudos, a enxaqueca alteraria a atividade de estruturas relacionadas à memória, como o hipocampo, a ínsula e os córtices frontal, parietal e temporal, sugerindo um possível mecanismo pelo qual a enxaqueca influenciaria a memória, especialmente em relação à memória da dor. Conclusões: A enxaqueca está associada à disfunção global da integração multissensorial e processamento de memória. Essa condição altera a atividade de estruturas em várias regiões relacionadas à memória da dor, à memória prospectiva, bem como às memórias verbais e visuais-espaciais de curto e longo prazo. No entanto, é necessário realizar estudos com amostras maiores em associação com testes cognitivos, e sem a interferência de medicamentos para verificar possíveis alterações e tecer conclusões mais concretas.

Background and Objectives To determine the relative importance of global or regional MRI and blood markers of neurodegeneration and neuroaxonal injury in predicting cognitive performance for recently diagnosed patients with multiple sclerosis (MS). Methods Thirty-five newly diagnosed patients with relapsing-remitting MS (RRMS) and 23 healthy controls (HCs) simultaneously completed a full clinical and neuropsychological assessment, structural brain MRI, and serum neurofilament light chain (sNfL) level test. Linear regression analyses were performed to determine which global or regional measures of gray matter (GM) atrophy and cortical thickness (CT), in combination with sNfL levels and clinical scores, are most strongly related to neuropsychological impairment. Results Compared with HCs, patients with MS showed bilateral thalamic GM atrophy (left, p = 0.033; right, p = 0.047) and diminished CT, particularly in the right superior and transverse temporal gyri (p = 0.045; p = 0.037). Regional atrophy failed to add predictive variance, whereas anxiety symptoms, sNfL, and global CT were the best predictors (R-2 = 0.404; p < 0.001) of cognitive outcomes, with temporal thickness accounting for greater variance in cognitive deficits than global CT. Discussion Thalamic GM atrophy and thinning in temporal regions represent a distinctive MRI trait in the early stages of MS. Although sNfL levels alone do not clearly differentiate HCs and patients with RRMS, in combination with global and regional CT, sNfL levels can better explain the presence of underlying cognitive deficits. Hence, cortical thinning and sNfL increases can be considered 2 parallel neurodegenerative markers in the pathogenesis of progression in newly diagnosed patients with MS., This work was supported by the European Regional Development Fund and the Spanish Ministry of Science, Innovation and Universities (grant: RTI2018-096951-A-I00) and the Ministry of Economy and Competitiveness (grant: RYC-2015-18467).

[Introduction] Stroke is a serious public health problem, given it is a major cause of disability worldwide despite the spread of recanalisation therapies. Enhancement of brain plasticity with stem cell administration is a promising innovative therapy to reduce sequelae in these patients., [Methods and analysis] We have developed a phase IIb, multicentre, randomised, double-blind, placebo-controlled clinical trial protocol to evaluate the safety and efficacy of intravenous administration of allogeneic adipose tissue-derived mesenchymal stem cells (AD-MSCs) in patients with acute ischaemic stroke, concurrently with conventional stroke treatment. Thirty patients will be randomised on a 1:1 basis to receive either intravenous placebo or allogeneic AD-MSCs as soon as possible within the first 4 days from stroke symptom onset. Patients will be followed up to 24 months after randomisation. The primary objective is the safety assessment of early intravenous administration of allogeneic AD-MSCs by reporting all adverse events and neurological or systemic complications in both treatment groups. Secondary objectives assess efficacy of early intravenous AD-MSC treatment in acute ischaemic stroke by evaluating changes in the modified Rankin Scale and the National Institutes of Health Stroke Scale throughout the follow-up period. In addition, brain repair biomarkers will be measured at various visits., [Ethics and dissemination] This clinical trial has been approved by the Clinical Research Ethics Committee of La Paz University Hospital (Madrid, Spain) and by the Spanish Agency of Medication and Health Products and has been registered in Eudra CT (2019-001724-35) and ClinicalTrials.gov (NCT04280003). Study results will be disseminated through peer-reviewed publications in Open Access format and at conference presentations., This clinical trial has been promoted by the La Paz University Hospital Institute for Health Research—IdiPAZ (La Paz University Hospital—Universidad Autónoma de Madrid) and sponsored from a competitive grant from the Carlos III Health Institute Healthcare Research Fund, and cofunded by the European Regional Development Fund (ERDF) 'A way to make Europe'/'Investing in your future' (PIC18/00016). This clinical trial has been supported by Plataforma Española de Investigación Clínica y Ensayos Clínicos, SCReN (Spanish Clinical Research Network), funded by Carlos III Health Institute-General Subdirection for Evaluation and Promotion of Research, research PT17/0017/0013; State Plan for Scientific Investigation, Technology and Innovation (2017–2020) and cofunded by European Regional Development Fund/European Social fund 'A way to make Europe'/'Investing in your future' (grant ID PT17/0017/0013).

Introducción. La arteria laberíntica transcurre a través del meato acústico interno hasta llegar al oído interno, aportando allí su irrigación. Se han descrito dos posibles variantes anatómicas de su origen: como rama directa de la arteria basilar o como rama de la arteria cerebelosa anteroinferior.Objetivo. Identificar la prevalencia del origen de la arteria laberíntica.Materiales y métodos. Se realizó un estudio analítico descriptivo con métodos cuantitativos sobre el origen de la arteria laberíntica en una muestra de 29 encéfalos obtenidos por muestreo a conveniencia.Resultados. Se determinó que la arteria laberíntica se originó de la arteria basilar en 22 (75.9%) encéfalos; en los 7 (24.1%) restantes esta surgía como rama de la arteria cerebelosa anteroinferior.Conclusión. El origen de la arteria laberíntica en la muestra seleccionada tiene una mayor prevalencia en la arteria basilar respecto a la arteria cerebelosa anteroinferior, hallazgo que se asemeja a algunas investigaciones contrastadas con este estudio.

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RESUMEN Objetivo: describir las características sociodemográficas, aspectos clínicos y complicaciones de los niños de 0 a 10 años de edad que sufrieron traumatismo craneoencefálico, atendidos en el Hospital General de Medellín y en la Clínica Somer de Rionegro entre los años 2010 y 2017. Métodos: estudio descriptivo retrospectivo, toma como fuente de información las historias clínicas de los niños con diagnósticos relacionados con el traumatismo craneoencefálico entre 2010-2017. Se calcularon las proporciones de las variables sociodemográficas, circunstanciales, espacio-temporales y clínicas. Resultados: se encontraron 224 pacientes con traumatismo craneoencefálico, el 64,7 % de los casos fueron de sexo masculino, la edad promedio fue de 4,5 años. El trauma ocurrió con mayor frecuencia en el domicilio del paciente entre los días de la semana en las horas de la tarde. La causa principal del trauma fue caída (75 %), seguido por accidentes de tránsito (13,3 %). La gravedad del traumatismo se midió con la escala de coma de Glasgow, el 78 % fue leve, hubo un caso fatal y 7 (3 %) tuvieron complicaciones motoras durante la hospitalización. Conclusión: los hallazgos de este estudio coinciden con las principales características del traumatismo craneoencefálico de la población pediátrica en el mundo, amplía la información regional y local para el desarrollo de estrategias de prevención, diagnóstico y seguimiento a largo plazo de los pacientes. SUMMARY Objective: To describe the demography, clinical presentation and complications associated with traumatic brain injury (TBI) in a cohort of children, ages 0-10, treated at Hospital General de Medellín and Clínica Somer between 2010-2017. Methods: Cross sectional retrospective study chart review of all children with a diagnosis of TBI between 2010 and 2017. There were systematic review and recording of demographic information, mechanism of injury, clinical presentation, and associated complications. Results: A total of 224 patients with TBI were identified. Among them, 64.7% were males and mean age was 4.5 years. Injuries most frequently occurred at the patient’s home, during the afternoon hours and between Monday and Friday. The most common mechanisms of injury were falls (75%), followed by motor vehicle accidents (13.3%). Severity of injury, measured by Glasgow coma scale, found that 78% of cases were mild. Seven (3%) of cases had neuromuscular complications during hospitalization and one TBI related death was identified. Conclusion: Findings of this study are consistent with the known characteristics of pediatric TBI worldwide. This information may be used to improve prevention, diagnosis, and long term follow-up.

Recent studies investigated the association of cardiorespiratory ftness with white matter microstructure in children, yet little work has explored to what extent other components of physical ftness (i.e., muscular or motor ftness) are associated with white matter microstructure. Indeed, this association has not been previously explored in children with overweight/obesity who present a diferent white matter development. Therefore, we aimed to examine associations between physical ftness components and white matter microstructure in children with overweight/obesity. In total, 104 (10.04 ± 1.15 years old; 43 girls) children were included in this cross-sectional study. Physical ftness was assessed using the ALPHA-ftness test battery. Fractional anisotropy (FA) and mean difusivity were derived from difusion tensor imaging (DTI). No association was found between physical ftness and global DTI metrics (all P> 0.082). Within individual tracts, all associations became non-signifcant when analyses were adjusted for multiple comparisons. Using the voxel-wise approach, we identifed a small cluster in the left lateral frontal lobe where children with greater upper-body muscular ftness showed higher FA (PFWE-corrected = 0.042). Although our results cannot conclude physical ftness is related to white matter microstructure in children with overweight/obesity; those fndings indicate that the association of muscular ftness with white matter microstructure might be more focal on frontal areas of the brain, as opposed to global diferences., Spanish Ministry of Economy and Competitiveness DEP2013-47540 DEP2016-79512-R DEP2017-91544-EXP RTI2018-095284-J-100, European Union (EU), European Commission Joint Research Centre 667302, Alicia Koplowitz Foundation, University of Granada, Research and Knowledge Transfer Fund (PPIT) 2016, Excellence Actions Programme: Units of Excellence, Scientific Unit of Excellence on Exercise and Health (UCEES), Andalusian Regional Government, Regional Ministry of Economy, Knowledge, Entreprises and University, European Union (EU) SOMM17/6107/UGR, SAMID III network, RETICS - PN I+D+I 2017-2021 (Spain), Spanish Ministry of Education, Culture and Sport FPU14/06837 FPU 16/02760, Government of Andalusian, Integrated Territorial Initiative 2014-2020 for the province of Cadiz PI-0002-2017, Spanish Ministry of Science, Innovation and Universities FJCI-2017-33396

Made available in DSpace on 2018-12-11T17:22:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-06-01. Added 1 bitstream(s) on 2019-10-09T18:31:58Z : No. of bitstreams: 1 S0100-736X2018000601196.pdf: 972631 bytes, checksum: 136b09fbf4352b4105a9385f46ca3445 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) This study aimed to identify changes related to brain parenchyma as advancing age in healthy domestic cats. Our hypothesis is that cats suffer cerebral and cerebellar atrophy and show focal changes in signal intensity of the brain parenchyma in accordance with the progression of age. Twelve adult (1 to 6 years), eleven mature (7 to11 years) and ten geriatric non-brachycephalic cats (12 years or more of age) underwent brain magnetic resonance imaging (MRI). There were no changes in signal intensity and contrast uptake in brain parenchyma of the cats. Geriatric animals showed significantly lower average thickness of the interthalamic adhesion and percentage of the cerebral parenchyma volume in relation to intracranial volume than those found in the adult group. No significant differences were found between groups for cerebral volume, cerebellar volume and percentage of cerebellar volume in relation to intracranial volume. The results of this study indicate that atrophy of the cerebral parenchyma, including the interthalamic adhesion, occurs with age in domestic cats, confirming the hypothesis of the study. However, the results did not corroborate the hypothesis that cats show cerebellar atrophy and focal changes in signal intensity of the brain parenchyma with advancing age. Este estudo objetivou a identificação de alterações no parênquima cerebral relacionadas ao avanço da idade em gatos domésticos saudáveis. Nossa hipótese é de que os gatos sofrem atrofia cerebral e cerebelar, além de alterações focais na intensidade do sinal do parênquima cerebral, de acordo com a progressão da idade. Doze gatos não braquicéfalos adultos (1 a 6 anos), onze maduros (7 a 11 anos) e dez geriátricos (12 anos ou mais) foram submetidos à ressonância magnética encefálica. Não foram observadas alterações na intensidade do sinal e na captação de contraste do parênquima encefálico nos gatos. Os animais geriátricos apresentaram médias da espessura da adesão intertalâmica e porcentagem do volume do parênquima cerebral, em relação ao volume intracraniano, significativamente menores a aquelas encontradas no grupo dos adultos. Não foram encontradas diferenças significativas entre os grupos para volume cerebral, volume cerebelar e porcentagem de volume cerebelar em relação ao volume intracraniano. Os resultados deste estudo indicam que a atrofia do parênquima cerebral, incluindo a adesão intertalâmica, ocorre com o avanço da idade em gatos domésticos, confirmando a hipótese do estudo. No entanto, os resultados não corroboraram a hipótese de que os gatos apresentam atrofia cerebelar e alterações focais na intensidade do sinal do parênquima encefálico com a progressão da idade. Departamento de Reprodução Animal e Radiologia Veterinária Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade Estadual Paulista (Unesp) Campus de Botucatu, Rua Prof. Dr. Walter Mauricio Correa s/n Departamento de Bioestatística Instituto de Biociências Universidade Estadual Paulista (Unesp) Campus de Botucatu, Rua Prof. Dr. Walter Mauricio Correa s/n Departamento de Reprodução Animal e Radiologia Veterinária Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade Estadual Paulista (Unesp) Campus de Botucatu, Rua Prof. Dr. Walter Mauricio Correa s/n Departamento de Bioestatística Instituto de Biociências Universidade Estadual Paulista (Unesp) Campus de Botucatu, Rua Prof. Dr. Walter Mauricio Correa s/n FAPESP: 2013/06148-0

Vitamin D deficiency during critical periods of development could lead to persistent brain alterations. We aimed to assess the association between maternal vitamin D-3, the major circulatory form of vitamin D, at pregnancy and neurodevelopmental outcomes during childhood, namely: behavioural problems, Attention Deficit and Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) symptoms, and social competence. This study included 2,107 mother-child pairs of a Spanish population-based birth cohort. Maternal plasma vitamin D-3 was measured in pregnancy. The outcomes were measured through questionnaires at 5, 8, 14, and 18 years old. We ran multivariate regression models adjusted for potential confounding variables. We found that per each 10 ng/mL increment of maternal vitamin D-3, children obtained higher social competence scores (coefficient =0.77; 95% CI=0.19, 1.35) at 5 years old. However, we observed null associations between maternal vitamin D-3 and total behavioural problems and ADHD and ASD symptoms in children from 5 to 18 years old. Further studies carried out in countries where the population is exposed to lower vitamin D levels are needed., The authors are grateful to all the teachers, parents and children who have participated in the INMA project for their generous collaborative efforts. We thank all the investigators who have collected information and samples from the participants. Menorca: This study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176; CB06/02/0041; 97/0588; 00/0021-2; PI061756; PS0901958; PI14/00677 incl. FEDER funds), CIBERESP, Beca de la IV convocatoria de Ayudas a la Investigacion en Enfermedades Neurodegenerativas de La Caixa, and EC Contract No. QLK4-CT-2000-00263. Sabadell: This study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176; CB06/02/0041; PI041436; PI081151 incl. FEDER funds; CPII/00018), CIBERESP, Generalitat de Catalunya-CIRIT 1999SGR 00241, Generalitat de Catalunya-AGAUR 2009 SGR 501, Fundacio La marato de TV3 (090430), EU Commission (261357). ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya. Valencia: This study was funded by Grants from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), Spain: ISCIII (G03/176; FIS-FEDER: PI11/01007, PI11/02591, PI11/02038, PI12/00610, PI13/1944, PI13/2032, PI14/00891, PI14/01687, PI16/1288, and PI17/00663; Miguel Servet-FEDER CP11/00178, CP15/00025, and MSII16/00051), Generalitat Valenciana: FISABIO (UGP 15-230, UGP15-244, and UGP-15-249), and Alicia Koplowitz Foundation 2017. Asturias: This study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176 and CB06/02/0041), FIS-PI042018, FIS-PI09/02311, FIS-PI13/02429, FIS-PI18/00909, CIBERESP, Obra Social Cajastur/Fundacion Liberbank and UNIVERSIDAD DE OVIEDO. Gipuzkoa: This study was funded by grants from Instituto de Salud Carlos III (FIS-PI06/0867, FIS-PI09/00090 and FIS-PI13/02187), CIBERESP, Department of Health of the Basque Government (2005111093, 2009111069, 2013111089 and 2015111065), and the Provincial Government of Gipuzkoa (DFG06/002, DFG08/001 and DFG15/221) and annual agreements with the municipalities of the study area (Zumarraga, Urretxu, Legazpi, Azkoitia y Azpeitia y Beasain).

Objective To assess the relationship of the grade of unruptured and untreated Brain Arteriovenous Malformations (AVMs), with the risk of subsequent stroke and death during follow‐up. Methods This prospective study was drawn from a cohort of adult patients with unruptured AVMs, who participated in the conservative treatment arm (medical management only for headache or seizures) of the randomized clinical trial of unruptured brain AVMs (ARUBA study). The grade of AVMs (Spetzler–Martin scale) was dichotomized into categories: AVMs of grades I and II were considered low grade; AVMs of grades III and IV were considered high grade. There were no grade V AVM patients in ARUBA. The primary outcome was symptomatic stroke (hemorrhagic or ischemic – documented by imaging) or death. Results The conservative treatment group had 123 patients (“as treated” analysis). 71 (57.7%) had lesions characterized for this analysis as low‐grade lesions and 52 (42.2%) as high grade. From the total of 10 (8.13%) primary outcomes, three occurred (4.22%) in low‐grade AVMs and seven (13.46%) in high‐grade AVMs (P = 0.0942). Interpretation Statistical analysis of the cohort of patients with unruptured and untreated AVMs from ARUBA study showed that the graduation categories (Spetzler–Martin grades) were not associated with the outcome of subsequent stroke or death.

We investigated the associations of different sedentary behaviors (SB) with gray matter volume and we tested whether SB related to gray matter volume is associated with intelligence. Methods: 99 children with overweight or obesity aged 8&ndash, 11 years participated in this cross-sectional study. SB was measured using the Youth Activity Profile-Spain questionnaire. T1-weighted images were acquired with a 3.0 T Magnetom Tim Trio system. Intelligence was assessed with the Kaufman Brief Test. Whole-brain voxel-wise multiple regression models were used to test the associations of each SB with gray matter volume. Results: Watching TV was associated with lower gray matter volume in six brain regions (&beta, ranging &minus, 0.314 to &minus, 0.489 and cluster size 106 to 323 voxels, p &lt, 0.001), playing video games in three brain regions (&beta, 0.391 to &minus, 0.359, and cluster size 96 to 461 voxels, 0.001) and total sedentary time in two brain regions (&beta, 0.341 to &minus, 0.352, and cluster size 897 to 2455 voxels, 0.001). No brain regions showed a significant positive association (all p &gt, 0.05). Two brain regions were related, or borderline related, to intelligence. Conclusions: SB could have the potential to negatively influence brain structure and, in turn, intelligence in children with overweight/obesity.

Objective:It was supposed that troponins in cardiac myxoma patients might be in a same fashion as in the conditions without myocardial injury. In order to verify this hypothesis, troponins in cardiac myxoma patients were discussed by presenting a comprehensive retrieval of the literature with incorporating the information of a recent patient.Methods:Postoperative detections of troponin I, creatine kinase isoenzyme MB (CK-MB) and N-terminal pro-B-type natriuretic peptide revealed elevated troponin I and CK-MB and normal N-terminal pro-B-type natriuretic peptide. Postoperative troponin I and CK-MB shared a same trend, reaching a peak value at postoperative hour 2, gradually decreased on postoperative day 1, and reached a plateau on postoperative days 7 and 13. A significant correlation could be noted between the postoperative values of the two indicators (Y=0.0714X + 0.6425, r2=0.9111, r=0.9545, P=0.0116). No significant linear correlation between troponin I and N-terminal pro-B-type natriuretic peptide were found. Literature review of troponins in cardiac myxoma patients revealed the uncomplicated patients had a normal or only slightly elevated troponin before open heart surgery. However, the complicated patients (with cerebral or cardiac events) showed a normal preoperative troponin in 3 (23.1%) and an elevated troponin in 10 (76.9%) patients (χ2=7.54, P=0.0169, Fisher's exact test). The overall quantitative result of troponin I was 2.45±2.53 µg/L, and that of troponin T was 3.10±4.29 mg/L, respectively.Conclusion:Troponins are not necessarily elevated in patients with a cardiac myxoma without coronary syndrome. By contrast, patients with a cardiac myxoma with an elevated troponin may herald the presence of an associated coronary event. An old cerebral infarct does not necessarily cause an elevation of troponin or B-type natriuretic peptide, or new neurological events, but might lead to a delayed awakening. ResumoObjetivo:Supunha-se que troponinas em pacientes com mixoma cardíaco poderiam estar em uma mesma forma que naqueles sem lesão miocárdica. Para verificar essa hipótese, as troponinas em pacientes com mixoma cardíaco foram discutidas, em uma revisão abrangente da literatura com a incorporação das informações de um paciente recente.Métodos:Detecções pós-operatórias de troponina I, creatina quinase isoenzima MB (CK-MB) e peptídeo natriurético tipo B N-terminal revelaram troponina I e CK-MB elevadas e pró-peptídeo natriurético tipo B N-terminal normais. Troponina I e CK-MB no pós-operatório tiveram a mesma tendência, chegando a um valor de pico na 2ª hora de pós-operatório, diminuindo gradualmente no primeiro dia pós-operatório, chegando a um patamar nos dias 7 e 13 do pós-operatório. Correlação significativa pode ser observada entre os valores pós-operatórios de dois indicadores (Y=0,6425 + 0.0714X, r2=0,9111, r=0,9545, P=0,0116). Nenhuma correlação linear significativa entre troponina I e pró-peptídeo natriurético tipo B N-terminal foi encontrada. A revisão da literatura de troponina em pacientes com mixoma cardíaco revelou que os pacientes sem complicações tiveram troponina normal ou apenas ligeiramente elevada antes da cirurgia de coração aberto. No entanto, nos pacientes com complicações (com eventos cerebrais ou cardíacos) três (23,1%) estavam com troponina normal e 10 (76,9%) com troponina elevada no pré-operatório (χ2=7,54, P=0,0169, teste exato de Fisher). O resultado quantitativo global de troponina I foi 2,45±2,53 µg/L, e o de troponina T foi 3,10±4,29 mg/L, respectivamente.Conclusão:As troponinas não são necessariamente elevadas em pacientes com mixoma cardíaco sem síndrome coronariana. Por outro lado, em pacientes com mixoma cardíaco a troponina elevada pode ser preditora de um evento coronariano associado. Um infarto cerebral antigo não necessariamente causa elevação de troponina, do peptídeo natriurético tipo B, ou novos eventos neurológicos, mas pode levar a um atraso no despertar.

Superficial siderosis (SS) of the central nervous system (CNS) is a rare and possibly underdiagnosed disorder resulting from chronic or intermittent bleeding into the subarachnoid space, leading to deposition of blood products in the subpial layers of the meninges. Magnetic resonance imaging (MRI) shows a characteristic curvilinear pattern of hypointensity on its blood-sensitive sequences. Methods Series of cases collected from Brazilian centers. Results We studied 13 cases of patients presenting with progressive histories of neurological dysfunction caused by SS-CNS. The most frequent clinical findings in these patients were progressive gait ataxia, hearing loss, hyperreflexia and cognitive dysfunction. The diagnoses of SS-CNS were made seven months to 30 years after the disease onset. Conclusion SS-CNS is a rare disease that may remain undiagnosed for long periods. Awareness of this condition is essential for the clinician. RESUMO Siderose superficial (SS) do sistema nervoso central (SNC) é uma doença rara e provavelmente subdiagnosticada, resultante de sangramento crônico no espaço subaracnóide, levando ao depósito de produtos sanguíneos nas camadas meníngeas subpiais. Ressonância magnética (RM) mostra um padrão curvilíneo característico com hipointensidade nas suas sequências sensíveis a sangue. Métodos Série de casos coletados de centros brasileiros. Resultados Apresentamos 13 casos de pacientes com história progressiva de disfunção neurológica causada por SS-SNC. Os achados clínicos mais frequentes destes pacientes foram ataxia progressiva da marcha, perda auditiva, hiperreflexia e disfunção cognitiva. O diagnóstico de SS-SNC foi firmado de sete meses a 30 anos após o início da doença. Conclusão SS-SNC é uma condição rara que pode permanecer sem diagnóstico por longos períodos. O conhecimento desta entidade é essencial ao clínico.

Depression is one of the most common mental health problems which affects more than 10% of the global population. The prevalence of this disorder is higher in fibromyalgia patients. However, the influence of the combination of depression and fibromyalgia in the brain processing is poorly understood. To explore the modifications of EEG power spectrum in women with fibromyalgia when depressive feelings are elicited. Twenty eight women with fibromyalgia participated in this cross-sectional study. They were classified as women with depression or women without depression according to the score in the Geriatric Depression Scale. This questionnaire was used to elicit depression symptoms during the EEG recording. Analyses were performed with the standardized LOw Resolution Electric Tomography (sLORETA) software. Power spectrum were compared in the following frequency bands: delta, theta, alpha-1, alpha-2, beta-1, beta-2, and beta-3. Fibromyalgia patients with untreated depression showed a hypoactivation of the left hemisphere when compared with fibromyalgia patients without depression. In addition, when compared fibromyalgia patients without depression and women with both fibromyalgia and depression who were taking antidepressant medications, differences in EEG power spectrum in the studied frequency bands were not found. The current study contributes to the understanding on the influence of the combination of fibromyalgia and depression in the brain activity patterns. Patients with untreated depression showed a hypoactivation of the left hemisphere while eliciting depression symptoms. However, further research is needed, antidepressant medication might reduce the differences between patients with depression and those who do not suffer from depression symptoms., This study was co-funded by the Spanish Ministry of Economy and Competitiveness (reference no DEP2015-70356) in the framework of the Spanish National R+ D+ i Plan. This study was also supported by the Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES) and by FEDER funds from the European Union (CB16/10/00477) a way of doing Europe. This study was also funded by the Research Grant for Groups (GR18155) funded by Junta de Extremadura (Regional Government of Extremadura) and European Regional Development Fund (ERDF/FEDER) 'a way of doing Europe'. The author SV was supported by a grant from the regional department of economy and infrastructure of the Government of Extremadura and the European Social Fund (PD16008). The funders played no role in the study design, the data collection and analysis, the decision to publish, or the preparation of the manuscript.

INTRODUCTION: Amyloidosis in elderly individuals can be an independent alteration and a characteristic of aging. However, the clinical, pathophysiologic, and biochemical characteristics of amyloidosis related to age remain uncertain. OBJECTIVE: The purpose of this study was to determine the extent to which the heart and/or the brain of individuals aged 60 years or over exhibits amyloid deposits. MATERIALS AND METHODS: The autopsy findings of individuals who were at least 60 years old were studied. The autopsies took place between the years of 1976 and 2000. A total of 10 cases were selected that had hearts without cardiopathies, had negative serology for Chagas' disease, and had brains without morphological changes related to encephalopathies. Slides with fragments of heart and brain were processed and analyzed using polarized and common light microscopy. RESULTS: Of the 10 cases, 4 were positive for amyloidosis. All had positive findings in the brain, and 1 case also had positive findings in the heart. Among the positive cases, 50% were of people aged 60 to 69 years. There appeared to be a relationship between the presence of amyloid deposits and the ratio of brain and body weight, with the ratio in the positive cases being smaller than in the negative cases. CONCLUSIONS: The analysis of amyloid deposits in the brains and hearts of elderly individuals shows that such deposits may lead to a systemic attack of senility, common to natural aging. It is not certain that beta-amyloid deposits would alone bring such drastic repercussions to the individual. Some additional disorders of the organism could cause the breakdown of the natural balance related to the accumulation of these proteins, leading the way to the pathological contexts of amyloidosis. RESUMO INTRODUÇÃO: A amiloidose em idosos pode ser uma alteração independente e própria do envelhecimento. Entretanto, as características clínicas, fisiopatológicas e bioquímicas da Amiloidose relacionada à idade ainda permanecem incertas. OBJETIVO: Verificar se o coração e o encéfalo de indivíduos acima de 60 anos apresentavam depósito amilóide. MATERIAL E MÉTODOS: Foram estudados laudos consecutivos de autópsias de indivíduos acima de 60 anos realizadas entre 1976 e 2000, que apresentavam corações sem cardiopatias, com sorologia negativa para Doença de Chagas e encéfalos sem alterações morfológicas de encefalopatias, chegando a um n de 10 casos. Lâminas de fragmentos do coração e de encéfalo foram processadas e analisadas em microscopia de luz comum e polarizada. RESULTADOS: Dos 10 casos, 3 apresentaram depósito amilóide no encéfalo e 1 no encéfalo e no coração. Em 50% dos casos, os indivíduos tinham entre 60 e 69 anos. A relação entre o peso encefálico e o peso corporal mostrou ter uma associação significativa com os casos positivos, sendo esta menor em relação aos negativos. CONCLUSÃO: A análise conjunta de depósitos amilóides em encéfalo e coração de indivíduos idosos talvez direcione para um acometimento sistêmico comum ao envelhecimento natural. Alguma alteração adicional do organismo poderia determinar a quebra de um equilíbrio natural sobre o acúmulo dessas proteínas, levando dessa forma aos contextos patológicos da amiloidose.

The aim of this study was to simultaneously measure in vivo volumes of gray matter (GM), normal white matter (WM), abnormal white matter (aWM), and cerebro-spinal fluid (CSF), and to assess their relationship in 50 patients with relapsing-remitting multiple sclerosis (RR-MS) (age range, 21-59; mean EDSS, 2.5; mean disease duration, 9.9 years), using an unsupervised multiparametric segmentation procedure applied to brain MR studies. Tissue volumes were normalized to total intracranial volume providing corresponding fractional volumes (fGM, faWM, fWM, and fCSF), subsequently corrected for aWM-related segmentation inaccuracies and adjusted to mean patients' age according to age-related changes measured in 54 normal volunteers (NV) (age range 16-70). In MS patients aWM was 23.8 +/- 29.8 ml (range 0.4-138.8). A significant decrease in fGM was present in MS patients as compared to NV (49.5 +/- 3.2% vs 53.3 +/- 2.1%; P < 0.0001), with a corresponding increase in fCSF (13.0 +/- 3.8% vs 9.1 +/- 2.4%; P < 0.0001). No difference could be detected between the two groups for fWM (37.5 +/- 2.6% vs 37.6 +/- 2.2%). faWM correlated inversely with fGM (R = -0.434, P < 0.001 at regression analysis), and directly with fCSF (R = 0.473, P < 0.001), but not with fWM. There was a significant correlation between disease duration and EDSS, while no relationship was found between EDSS or disease duration and fractional volumes. Brain atrophy in RR-MS is mainly related to GM loss, which correlates with faWM. Both measures do not appear to significantly affect EDSS, which correlates to disease duration.

CONTEXT: Proton spectroscopy has been recognized as a safe and noninvasive diagnostic method that, coupled with magnetic resonance imaging techniques, allows for the correlation of anatomical and physiological changes in the metabolic and biochemical processes occurring within previously-determined volumes in the brain. There are two methods of proton magnetic resonance spectroscopy: single voxel and chemical shift imaging OBJECTIVE: The present work focused on the clinical applications of proton magnetic resonance spectroscopy in patients with brain lesions. CONCLUSIONS: In vivo proton spectroscopy allows the detection of certain metabolites in brain tissue, such as N-acetyl aspartate, creatine, choline, myoinositol, amino acids and lipids, among others. N-acetyl aspartate is a neuronal marker and, as such, its concentration will decrease in the presence of aggression to the brain. Choline increase is the main indicator of neoplastic diseases. Myoinositol is raised in patients with Alzheimer's disease. Amino acids are encountered in brain abscesses. The presence of lipids is related to necrotic processes. CONTEXTO: A espectroscopia de prótons é reconhecidamente um método não invasivo que, quando associada à imagem por ressonância magnética, possibilita a correlação de alterações metabólicas e bioquímicas com mudanças fisiológicas e anatômicas dentro de um volume previamente determinado no encéfalo. Existem dois métodos de espectroscopia de prótons por ressonância magnética: volume único de interesse (single voxel) e imagem espectroscópica (chemical shift imaging). OBJETIVO: Este trabalho discute as aplicações clínicas da espectroscopia de prótons por ressonância magnética em pacientes com lesões encefálicas. CONCLUSÕES: A espectroscopia de próton por ressonância magnética in vivo permite detectar alguns metabólitos existentes no tecido encefálico, como N-acetil aspartato, creatina, colina, mio-inositol, aminoácidos, lipídios, entre outros. O N-acetil aspartato é um marcador neuronal cuja concentração diminui quando há lesão encefálica. O aumento na concentração de colina é o principal indicador de doenças neoplásicas. A quantidade de mio-inositol apresenta-se aumentada em casos de doença de Alzheimer. Aminoácidos estão presentes em abscessos encefálicos. A presença de lipídios está relacionada à necrose tecidual.

Dementia presenting with prominent higher order visual symptoms may be observed in a range of neurodegenerative conditions and is often challenging to diagnose. We describe a case of progressive dementia presenting with prominent visual cortical symptoms. A 55-year-old, right-handed, woman with early onset of visual impairment not associated with anterior visual pathology, presenting with dyslexia, visual agnosia, Balint's syndrome, and spatial disorientation. Ophthalmologists should consider this condition especially in presenile patients with slowly progressive higher-order visual symptoms. Although described in association with different conditions, it may also occur in Alzheimer disease.

Introduction Functional imaging studies of addiction following protracted abstinence have not been systematically conducted to look at the associations between severity of use of different drugs and brain dysfunction. Findings from such studies may be relevant to implement specific interventions for treatment. The aim of this study was to examine the association between resting-state regional brain metabolism (measured with 18F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and the severity of use of cocaine, heroin, alcohol, MDMA and cannabis in a sample of polysubstance users with prolonged abstinence from all drugs used., Methods Our sample consisted of 49 polysubstance users enrolled in residential treatment. We conducted correlation analyses between estimates of use of cocaine, heroin, alcohol, MDMA and cannabis and brain metabolism (BM) (using Statistical Parametric Mapping voxel-based (VB) whole-brain analyses). In all correlation analyses conducted for each of the drugs we controlled for the co-abuse of the other drugs used., Results The analysis showed significant negative correlations between severity of heroin, alcohol, MDMA and cannabis use and BM in the dorsolateral prefrontal cortex (DLPFC) and temporal cortex. Alcohol use was further associated with lower metabolism in frontal premotor cortex and putamen, and stimulants use with parietal cortex., Conclusions Duration of use of different drugs negatively correlated with overlapping regions in the DLPFC, whereas severity of cocaine, heroin and alcohol use selectively impact parietal, temporal, and frontal-premotor/basal ganglia regions respectively. The knowledge of these associations could be useful in the clinical practice since different brain alterations have been associated with different patterns of execution that may affect the rehabilitation of these patients., This study has been supported with funds from the SEJ2006-08278 project from the Spanish Ministry of Education and Science, the P07-HUM-03089 project from the Council of Science and Innovation. Laura Moreno-López is supported by the FPU grant (AP2007-03583) from the Spanish Ministry of Science and Innovation.

O objetivo deste estudo retrospectivo foi identi [1]icar cães com neoplasmas envolvendo o sistema nervoso central (SNC), atendidos entre janeiro de 2003 a junho de 2011, no HVU-UFSM, e obter informações a respeito da raça, do sexo, da idade, dos sinais neurológicos, da localização, da evolução clínica, do tipo e da origem do tumor e dos achados de exames complementares. Os 26 neoplasmas envolvendo o SNC incluídos nesse estudo ocorreram principalmente em Boxers (35%), com predomínio de idade de cinco anos ou mais (92,3%). A evolução dos sinais clínicos nos neoplasmas encefálicos variou entre sete e 115 dias e nos medulares entre sete a 420 dias. Os sinais neurológicos principais em cães com neoplasmas encefálicos e medulares foram alteração do nível de consciência (58%), caracterizada principalmente por sonolência, e hiperestesia espinhal (57%), respectivamente. As regiões tálamo-cortical e T3-L3 foram as mais acometidas (58% e 43%, respectivamente). Dos 12 neoplasmas que afetaram o encéfalo, 10 eram primários (83,3%). Dos 14 neoplasmas que afetaram a medula espinhal, apenas quatro eram primários (28,6%). Dos neoplasmas encefálicos e medulares primários, o mais comum foi o meningioma, perfazendo 40% e 75% dos casos, respectivamente. This retrospective study was aimed to identify dogs with neoplasms affecting the central nervous system (CNS) and compile information on the affected breeds, sex, age group, anatomical site of the tumor, type of clinical signs and clinical course, and laboratory results. The study included the cases submitted to the Veterinary Teaching Hospital (HVU) of the Federal University of Santa Maria (UFSM), Brazil, from January 2003 to June 2011. The 26 neoplasms affecting the CNS included in this study occurred mainly in Boxers (35%) and the predominantly affected age-group was 5-year-old or older (92.3%). The course of clinical signs in dogs with brain neoplasms was 7-115 days and that of spinal cord tumors was 7-420 days. The most frequently observed neurological signs in dogs with brain and spinal cord neoplasms were respectively changes in the conscience levels (58%), which were characterized by somnolence, and spinal hyperesthesia (57%). The cortico-thalamic region and the T3-L3 spinal cord segment were the most frequently anatomical sites involved (58% and 43%, respectively). Ten out 12 neoplasms affecting the brain were primary (83.3%) whereas only four of those 14 neoplasms affecting the spinal cord were primary (28.6%). Meningioma was the most frequent m primary neoplasms affecting the brain and spinal cord of dogs, consisting respectively of 40% e 75% of the cases.

A hemorragia subaracnóide é um exemplo de agravo capaz de elevar a pressão intracraniana a patamares de expressiva morbidade. A dilatação gástrica aguda e o retardo do esvaziamento gástrico são alterações de relevância fisiopatológica em pacientes com hipertensão intracraniana, sendo a normalização desses parâmetros útil para otimizar a recuperação dos pacientes vítimas de lesões do sistema nervoso central. Conduziu-se uma revisão bibliográfica em revistas de pesquisa médico-acadêmica e bibliotecas eletrônicas na área das ciências da saúde nacionais e internacionais nos últimos vinte e oito anos a respeito do eixo funcional cérebro-trato gastrintestinal e seu comportamento em animais experimentais ou pacientes com lesão cerebral aguda. A diminuição do tônus parassimpático é uma potencial causa da intolerância alimentar associado a hipertensão intracraniana. O comportamento do esvaziamento gástrico e do trânsito do trato gastrintestinal seguem padrão bifásico: uma fase inicial de esvaziamento gástrico acelerado e uma fase tardia de letargia intestinal. Observações experimentais são importantes para compreender o difícil manejo nutricional e volêmico de pacientes em terapia intensiva que evoluem com HIC secundária a um trauma crânio encefálico ou após hemorragia subaracnóide pós-rotura aneurismática cerebral. A elevação da pressão intracraniana causa incremento na atividade simpática, que é responsável por muitos dos sintomas periféricos sistêmicos e gastrintestinais. Conclui-se que as lesões cerebrais agudas que cursam com elevação importante da pressão intracraniana retardam o esvaziamento gastrintestinal tendo como via fisiopatológica as alterações no sistema nervoso autônomo. Subarachnoid hemorrhage can increase intracranial pressure, causing significant morbidity. Acute gastric dilation and delayed gastric emptying are commonly seen in patients with intracranial hypertension, and correction of these gastric abnormalities can facilitate the recovery of patients with brain injuries. We conducted a literature review of both national and international health sciences medical journals and electronic libraries spanning the last twenty-eight years and focused on the brain, gut motility and gastric emptying functional axis either in experimental animal models of brain injury or patients with acute cerebral injuries. Decreased parasympathetic tonus is a potential cause of intracranial hypertension-related food intolerance. Changes in gastrointestinal transit after a brain injury follow a biphasic pattern: an initial phase of accelerated gastric emptying and a late stage of intestinal lethargy. Changes in the physiology underlying gut motility may be essential for homeostatic stabilization in hemodynamically unstable patients. Research studies are necessary to understand the difficult management of intensive care patients with intracranial hypertension secondary to subarachnoid hemorrhages resulting from traumatic brain injuries or rupture of a cerebral aneurysm. Increased intracranial pressure induces massive increases in sympathetic activity, which is responsible for many of the peripheral systemic and gastrointestinal symptoms. Brain injuries leading to significant increases in intracranial pressure result in delayed gastrointestinal emptying due to autonomic nervous system changes.

This study aims at evaluating the application of magnetic resonance spectroscopy (MRS) in the differential diagnosis of brain tumors and inflammatory brain lesions. The examinations of 81 individuals, who performed brain MRS and were retrospectively analyzed. The patients with ages between 10 and 80 years old, were divided into two groups. Group A consisted of 42 individuals with diagnoses of cerebral toxoplasmosis and Group B was formed of 39 individuals with diagnosis of glial neoplasms. On analyzing the ROC curve, the discriminatory boundary for the Cho/Cr ratio between inflammatory lesions and tumors was 1.97 and for the NAA/Cr ratio it was 1.12. RMS is an important method useful in the distinction of inflammatory brain lesions and high-degree tumors when the Cho/Cr ratio is greater than 1.97 and the NAA/Cr ratio is less than 1.12. And so this method is important in the planning of treatment and monitoring of the therapeutic efficiency. O presente estudo tem como objetivo avaliar a aplicação da espectroscopia por ressonância magnética (ERM) no diagnóstico diferencial entre lesões expansivas encefálicas inflamatórias e neoplásicas. Foram analisados retrospectivamente 81 indivíduos que realizaram exames de ERM com idade entre 10 a 18 anos, divididos em dois grupos. O grupo A foi formado por 42 indivíduos com diagnóstico de neurotoxoplasmose e o grupo B foi formado por 39 indivíduos com diagnóstico de neoplasias gliais. Após análise da curva ROC observou-se que o valor discriminatório da relação Co/Cr entre lesões inflamatórias e neoplásicas foi de 1,97 e da relação Naa/Cr foi de 1,12. A espectroscopia por RM é um método útil na distinção de lesões expansivas inflamatórias e neoplasias de alto grau quando a relação Co/Cr é maior que 1,97 e a relação Naa/Cr é menor que 1,12, o que torna este método importante no planejamento do tratamento e monitorização da eficácia terapêutica.

OBJECTIVES: to compare the acute and chronic effects of ethanol on the neural development, by analysis of the ontogenetic neural structure of mammals. METHODS: searches were performed in the following electronic databases: MEDLINE, SciElo, PubMed, LILACS, CAPES periodical, and the Open Journal System. The descriptors used were: "chronic ethanol toxicity", "chronic alcohol toxicity", "acute ethanol toxicity", "acute alcohol", "neural ontogenic development", "neuronal migration disturbances", "neural structure". The following inclusion criteria were used: articles published between 2003 and 2007, some classic articles in the field and an important neuropsychology textbook. RESULTS: the analysis of papers revealed that, although several studies of the chronic effects of ethanol exposure on the mammalian nervous system have been conducted, only a few have investigated the acute effects of ethanol on specific days of gestation, and these studies have revealed important disorders relating to the cerebral tissue. CONCLUSIONS: it should be recommended that women refrain from the consumption of ethanol during gestational phase to protect the fetus' health. Furthermore, the acute consumption of ethanol by women nearing the eighth or ninth week of gestation has been shown to be potentially harmful to the nervous tissue of the fetus. OBJETIVOS: comparar os efeitos agudo e crônico do etanol sobre o desenvolvimento do sistema nervoso através da análise da estrutura ontogênica neural dos mamíferos. MÉTODOS: pesquisas foram feitas nas bases eletrônicas: MEDLINE, SciElo, PubMed, LILACS, CAPES periodical, Open Journal System. Os descritores usados foram: "toxidade crônica ao etanol", "toxidade crônica ao álcool", "toxicidade aguda ao etanol", "toxicidade aguda ao álcool", "desenvolvimento ontogênico neural", "distúrbios da migração neuronal", "estrutura neural".Foram considerados critérios de inclusão: artigos publicados no periódo de 2003 e 2007, alguns artigos clássicos da área, e um livro básico em neuropsicologia. RESULTADOS constatou-se que muitos estudos sobre os efeitos crônicos do etanol sobre o sistema neural de mamíferos foram feitos, mas poucos estudos foram realizados sobre os efeitos agudos do etanol em dias específicos da gestação, e esses revelaram importantes desordens sobre o tecido neural. CONCLUSÕES: o consumo de etanol não é recomendado para mulheres na fase gestacional para preservar a saúde do feto, e o consumo agudo de etanol entre mulheres próxima à oitava e nona semanas de gestação têm demonstrado ser potencialmente perigoso para o tecido neural do feto.

O método de perfusão encefálica para a adequada proteção cerebral evoluiu desde o início da circulação extracorpórea. As limitações de tempo de atuação na parada circulatória total em hipotermia profunda, a ineficiente manutenção do metabolismo encefálico na retroperfusão cerebral e os cuidados relacionados à prevenção de eventos embólicos na perfusão cerebral seletiva resultaram em diferentes métodos de proteção cerebral durante sua evolução, principalmente nas operações que envolvem o arco aórtico. O fluxo arterial anterógrado, em oposição ao fluxo arterial retrógrado, e os sítios de canulação que permitem esse fluxo anterógrado são hoje, em associação à hipotermia moderada sistêmica, considerados o método mais efetivo de proteção cerebral. Brain perfusion for adequate cerebral protection has changed over the years. The limitations of the time during total circulatory arrest with deep hypotermia, the inefficient cerebral metabolism during retrograde perfusion and special care to prevent cerebral embolism during antegrade perfusion have resulted in the development of different methods of cerebral protection during the evolution of aortic arch operations. Antegrade cerebral perfusion associated with moderate hypothermia is today, considered the best option for cerebral protection.

Os ossos são tidos como uma barreira intransponível para obtenção de imagens sonográficas, pois a grande diferença entre as impedâncias acústicas das superfícies de tecidos moles e ósseos gera importantes artefatos de reflexão, contudo, a transmissão do feixe ultrassônico depende da espessura e da estrutura óssea e neste caso o osso temporal tem sido usado como uma janela acústica para o acesso, por ultrassonografia, do encéfalo de pacientes adultos. O presente trabalho examinou o encéfalo de cães adultos com o emprego da ultrassonografia com e sem a interposição do crânio, comparou as imagens obtidas e as correlacionou com a anatomia encefálica. Foram examinados dez cães adultos, mesaticefálicos. O exame ultrassonográfico foi realizado através do orifício magno e dos ossos temporal, parietal (porção lateral) e frontal. No exame sem a interposição óssea foi realizada uma pequena craniotomia no osso frontal. As imagens do encéfalo com a interposição óssea apresentaram resolução inferior às obtidas por craniotomia. Importantes estruturas anatômicas foram identificadas. Devido à correlação e a sua ampla disponibilidade, concluiu-se que o aparelho de ultrassom pode ser usado para o acompanhamento de lesões intracranianas expansivas, bem como em procedimentos intraoperatórios.

Os autores apresentam o estudo de oito pacientes com neurocisticercose encefálica no Estado do Rio Grande do Norte. Fazem comentários sobre a incidência da parasitose e referem as convulsões como o achado clínico mais freqüente, seguido pela cefaléia. O exame neurológico foi anormal em cinco dos oito pacientes. O diagnóstico foi baseado em achados da tomografia computadorizada em sete pacientes e do líquido cefalorraquidiano em três. The authors present the study of eight patients with cysticercosis of the central nervous system observed in the State of Rio Grande do Norte, Brazil. They comment about the frequency of the diasease. Seizures were present in six patients and headache in four. The neurologic examination was abnormal in Five patients. The'diagnosis was based on computed tomography findings in seven patients, and on cerebrospinal fluid findings in three.

Glutamate excitotoxicity, metabolic rate and inflammatory response have been associated to the deleterious effects of temperature during the acute phase of stroke. So far, the association of temperature with these mechanisms has been studied individually. However, the simultaneous study of the influence of temperature on these mechanisms is necessary to clarify their contributions to temperature-mediated ischemic damage. We used non-invasive Magnetic Resonance Spectroscopy to simultaneously measure temperature, glutamate excitotoxicity and metabolic rate in the brain in animal models of ischemia. The immune response to ischemia was measured through molecular serum markers in peripheral blood. We submitted groups of animals to different experimental conditions (hypothermia at 33°C, normothermia at 37°C and hyperthermia at 39°C), and combined these conditions with pharmacological modulation of glutamate levels in the brain through systemic injections of glutamate and oxaloacetate. We show that pharmacological modulation of glutamate levels can neutralize the deleterious effects of hyperthermia and the beneficial effects of hypothermia, however the analysis of the inflammatory response and metabolic rate, demonstrated that their effects on ischemic damage are less critical than glutamate excitotoxity. We conclude that glutamate excitotoxicity is the key molecular mechanism which is influenced by body temperature during the acute phase of brain stroke. This project has been partially supported by grants from the Spanish Ministry of Science and Innovation SAF2011-30517 and Fondo de Investigaciones Sanitarias, Instituto Salud Carlos III, RETICS-RD06/0026; Xunta de Galicia (Consellería de Innovación, Industria e Comercio: 09CSA057918PR; Consellería de Sanidade: PS09/32 and; Fundación Mútua Madrileña and by Red de Investigación Cooperativa Neurovascular SI

A neuropathologic study in 190 consecutives autopsies of patients with congenital cardiopathy was performed: 116 cases underwent a surgical procedure (S group) and the remaining 74 were non-surgical (NS group). Neuropathologic alterations were observed in 71 cases (41 in the S group and 30 in the NS group). However, most of the 129 cases with a normal examination had died in the first 72 hours either after surgery or the clinical events responsible for the death. Almost all the neuropathologic alterations were hypoxic--ischemic. Infarctions, single or multiple, were found in 41 cases (23 in the S and 18 in the NS group). An embolic mechanism could be detected in 12 cases. Diffuse hypoxic changes were present in 17 cases (10 in the S and 7 in the NS group). Hemorrhages were found in 11 (6 in the S and 5 in NS group), 4 of which were related to a disseminated intravascular coagulation. In 17 cases (5 in the NS and 12 in the S group), the picture was of a periventricular leukomalacia. All these cases concerned children under 6 months of age. In 7 cases inflammatory alterations were present (diffuse micro-abscesses in 6 and a frontal lobe abscess in 1). Almost all cases in both groups presented clinical complications, isolated or associated, potentially harmful to the brain, as cardiac arrest, cardiac low output, hypoxemia, and respiratory distress. If was impossible to determine in each case the magnitude of the factor or factors responsible for the correspondent pattern of neuropathology damage. There was no difference as to the neuropathology pattern between congenital cardiopathies leading to increased or decreased pulmonary blood flow.

Desde que a doença vascular que acomete o sistema nervoso central de localização intracraniana pode comprometer estruturas supra ou/e infratentoriais, propomos a mudança de "Acidente vascular cerebral" para "Doença encéfalo vascular". Since the vascular disease that attempts the central nervous system localized intracranially may involve supra or/and infira tentorial structures, it is proposed the change of "Cerebrovascular disease" by "Brainvascular disease".

Deep hypothermia and total circulatory arrest technique for facilitating clipping complex posterior circulation cerebral aneurysms is not a new technique; however, this case report deals with the first case treated at the Hospital Santa Sofía in Manizales (Caldas) and in the Colombian coffee-growing area.Our team reports a 53-year-old female patient who underwent surgery to clip a giant basilar artery aneurysm; closed-chest extrathoracic cannulation for femorofemoral cardiopulmonary bypass was used, involving total circulatory arrest, deep hypothermia and heparin anticoagulation. Cardiac arrest lasted 15 minutes. The patient did not require conversion to sternotomy. Blood outflow via femoral vein was sufficient to maintain cardiopulmonary bypass and induce deep hypothermia (18°C, retention of spontaneous circulation, and propofol infusion (3–5mgkg-1h-1) under general anaesthesia, thereby facilitating easy clipping. No intraoperatorive complications were presented, such as ventricular fibrillation, ventricular dilatation or haemorrhage. Haemodynamics were controlled with neosinefrin. The patient was transferred (intubated) to the ICU.

ResumenEntre los sistemas dopaminérgicos que se modifican durante la evolución humana y que, en ciertas condiciones de conectividad y neurotransmisión anormal, desencadenan cambios patológicos en la adolescencia y adultez, se encuentra el mesolímbico basal. En adultos el ultrasonido transcraneal se realiza por la escama del hueso temporal con un equipamiento con transductor sectorial y focal de 1,8 a 2,8MHz. Los puntos de evaluación ecográficos fundamentales son el mesencéfalo, el área de la sustancia negra, el rafe, el cuerpo estriado y los tálamos, el tercer ventrículo y los sectores orbitofrontales. A pesar del acceso anatómico limitado, es uno de los métodos de Neuroimágenes que cuantifica la ecogenicidad (de 0 a 3) y el área de sección de la sustancia negra (normal hasta 0,2 cm2), lo cual se correlaciona con el empeoramiento de los síntomas motores parkinsonianos. Además, se evalúa y mensura el rafe (normal: 1mm), que se correlaciona con el humor o la apatía según corresponda.Los otros hallazgos evaluables son los cambios en el espesor del tegmentum mesenfálico (ángulo interpeduncular menor o mayor de 60°), el aumento de la ecogenicidad de los tálamos y los cuerpos estriados, y la dilatación del tercer ventrículo (mayor de 5mm). Su presencia colabora en el diagnóstico, clasificación, tratamiento y seguimiento de distintas patologías, como enfermedad de Parkinson, parálisis supranuclear progresiva, distonías, degeneración córtico-basal, esquizofrenia, depresiones, trastorno bipolar y autismo.AbstractThe basal mesolimbic system is among the dopaminergic systems that undergo changes during human evolution and that, under certain conditions, connectivity and abnormal neurotransmission trigger pathological changes during adolescence and adulthood. Transcranial ultrasound in adults is performed through the temporal squama with equipment that has a focal sectorial transducer from 1.8 to 2.8MHz. The key points of the ultrasound evaluation are mesencephalon, substantia nigra area, raphe, striatum and thalamus, third ventricle, and orbitofrontal sectors. Despite its limited anatomical access, it is one of the neuroimaging methods that quantifies the echogenicity (0-3) and the sectional area of the substantia nigra (normal up to 0.2 cm2), which correlates with the worsening of Parkinsonian motor symptoms. It also evaluates and measures the raphe (normal 1mm) which correlates with humour or apathy.Thickness changes of the mesencephalic tegmentum (interpeduncularangle, smaller or greater than 60°), thalamus and striatum increased echogenicity, and the third ventricle dilation (greater than 5mm), are other possible findings. These are used to corroborate the diagnosis, classification, treatment and monitoring of different pathologies, like Parkinson's disease, supranuclear progressive palsy, dystonias, cortico-basal degeneration, schizophrenia, depression, bipolar disorder, and autism.