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Calcified chronic subdural hematomas (CCSDHs) are rare entities, whose yearly incidence ranges from 1.72 to 20.6 per every 100 thousand persons. Several different approaches to their management are reported in the literature, ranging from conservative treatment to craniotomy with full removal of the neomembranes. Currently, there are no guidelines or consensus that establish the best technique. We herein report a case of symptomatic CCSDH initially drained through a burr-hole craniotomy, with no resolution of the symptoms. Later, our patient underwent a craniotomy and partial membranectomy, which resulted in full symptomatic recovery.

Background: Spinal cord compression is a common complication of spine metastasis and multiple myeloma. About 30% of patients with cancer develop symptomatic spinal metastases during their illness. Prompt diagnosis and surgical treatment of these lesions, although palliative, are likely to reduce the morbidity and improve quality of life by improving ambulatory function. Study Design: Retrospective review of medical records. Objective: To evaluate postoperative functional recovery and the epidemiological profile of neoplastic spinal cord compression in two neurosurgical centers in southern Brazil. Methods: We retrospectively analyzed the data of all patients who underwent palliative surgery for symptomatic neoplastic spine lesion from metastatic cancer, in two neurosurgical centers, between January 2003 and July 2021. The variables age, sex, neurological status, histological type, affected segment, complications and length of hospitalization were analyzed. Results: A total of 82 patients were included. The lesions occurred in the thoracic spine in 60 cases. At admission, 95% of the patients had neurological deficits, most of which were Frankel C (37%). At histopathological analysis, breast cancer was the most common primary site. After surgery, the neurological status of 46 patients (56%) was reclassified according to the Frankel scale. Of these, 22 (47%) regained ambulatory capacity. Conclusion: Surgical treatment of metastatic spinal cord compression improved neurological status and ambulatory ability in our sample. Level of evidence II; Retrospective study. Resumo: Introdução: A compressão medular é uma complicação comum de metástases da coluna vertebral e de mieloma múltiplo. Cerca de 30% dos pacientes com câncer desenvolvem metástases sintomáticas na coluna no decorrer da doença. O diagnóstico imediato e o tratamento cirúrgico dessas lesões, embora paliativos, em geral reduzema morbidade e melhoram a qualidade de vidaao ampliar a capacidade de deambular. Desenho do estudo: Revisão retrospectiva de prontuários médicos. Objetivo: Avaliar a recuperação funcional pós-operatória e o perfil epidemiológico da compressão medular neoplásica em dois centros de neurocirurgia do sul do Brasil. Métodos: Analisamos retrospectivamente os dados de todos os pacientes submetidos à cirurgia paliativa de lesão neoplásica sintomática da coluna decorrente decâncer metastático, em dois centros neurocirúrgicos entre janeiro de 2003 e julho de 2021. Foram analisadas as variáveis idade, sexo, estado neurológico, tipo histológico, segmento acometido, complicações e tempo de internação. Resultados: Foram incluídos 82 pacientes no estudo. As lesões ocorreram na coluna torácica em 60 casos. À internação, 95% dos pacientes apresentavam déficits neurológicos, sendoa maioria classificada como Frankel C (37%). Na análise histopatológica, o câncer de mama foi o sítio primário mais comum. Depois da cirurgia, 46 pacientes (56%) tiveram o estado neurológico reclassificado pela escala de Frankel. Entre eles, 22 (47%) recuperaram a capacidade de deambular. Conclusões: O tratamento cirúrgico da compressão medular metastática melhorou o estado neurológico e a capacidade de deambulação em nossa amostra. Nível de evidência II; Estudo retrospectivo. Resumen: Introducción: La compresión de la médula espinal es una complicación común de la metástasis de la columna vertebral y el mieloma múltiple. Aproximadamente el 30% de los pacientes con cáncer desarrollan metástasis espinales sintomáticas en el curso de la enfermedad. El diagnóstico precoz y el tratamiento quirúrgico de estas lesiones, aunque son paliativos, suelen reducir la morbilidad y mejor en lacalidad de vida al aumentar la de ambulación. Diseño del estudio: Revisión retrospectiva de registros médicos. Objetivo: Evaluarla recuperación funcional postoperatoria y el perfil epidemiológico de la compresión medular neoplásica en dos centros neuroquirúrgicos del sur de Brasil. Métodos: Analizamos retrospectivamente los datos de todos los pacientes sometidos a cirugía paliativa por lesión vertebral neoplásica sintomática por cáncer metastásico, en dos centros neuroquirúrgicos entre enero de 2003 y julio de 2021. Se analizaron las variables edad, sexo, estado neurológico, tipo histológico, segmento afectado, complicaciones y duración de la hospitalización. Resultados: Se incluyeron 82 pacientes en el estudio. Las lesiones se produjeron en la columna torácica en 60 casos. Al ingreso, el 95% de los pacientes presentaban déficits neurológicos y la mayoría de ellos eran clasificados como Frankel C (37%). En el análisis histopatológico, elcáncer de mama fue el sitio primario más común. Después de la cirugía, se reclasificó el estado neurológico de 46 pacientes (56%) por la escala de Frankel. Entre ellos, 22 (47%) recuperaron la capacidadde deambulación. Conclusiones: El tratamiento quirúrgico de la compresión medular metastásica mejoró el estado neurológico y la capacidad de deambulación en nuestra muestra. Nivel de evidencia II; Estudio retrospectivo.

Background Stroke is a clinical syndrome characterized by a sudden-onset neurological deficit of vascular cause. Stroke-like clinical symptoms that are later found to have nonvascular disorders have been termed stroke mimics (MIM), and their incidence ranges from 1.3 to 25% in patients not treated with thrombolytic therapy. Eventually, intravenous thrombolysis of MIM may occur. Case Description We describe a 74-year-old woman with abrupt global aphasia who received thrombolytic therapy after the presumed diagnosis of acute ischemic stroke. She gradually improved despite the finding of an asymptomatic left temporal hematoma on the computed tomography (CT) scan. Two months later, she presented with a new focal neurological deficit and was diagnosed with a glioblastoma in the topography of the previous bleeding. Conclusion This case highlights the rare occurrence of hemorrhage after thrombolysis in patients with MIM.

Background: Lumbar plexus schwannomas are a rare occurrence in neurosurgery, with few reported cases and no standard surgical approach. This study describes a successful surgical resection with no complications using the Wiltse approach. Methods: Patient presented with an intra-psoas tumor suggesting schwannoma. We described the surgical technique involved step by step. Results: The patient recovered from the surgery with no complications. The anatomopathological examination confirmed the schwannoma diagnosis. The post operatory magnetic resonance imaging showed complete resection. Conclusion: This study shows that the use of Wiltse approach, mainly used for classical herniated disc extraforaminal, can be used successfully on Lumbar plexus schwannomas.

Bruns syndrome is one of the clinical presentations of intraventricular neurocysticercosis, and it is characterized by episodes of headache, vertigo and vomiting. The intraventricular form of neurocysticercosis occurs in 7% to 20% of the cases, and it is more serious than the intraparenchymal form. The management is primarily surgical, associated with pharmacological therapy with anthelmintic drugs and corticosteroids. We report the case of a patient who presented Bruns syndrome due to neurocysticercosis.

Spinal anesthesia is a technique commonly used for local anesthesia and in obstetric surgeries. Rarely, the formation of an intracranial subdural hematoma (SDH) may result from spinal anesthesia, constituting a serious condition that often leads to severe neurological deficits. The presentation and course of this pathology may occur in a completely different way, which makes its diagnosis and management difficult. In the present article, the authors report two cases of patients with intracranial SDH after spinal anesthesia with completely different presentations and outcomes, demonstrating the variability of the manifestations of this condition. A quick review of key points of its pathophysiology, symptomatology, diagnosis, and treatment was also performed.

Among all pediatric tumors in CNS, the intramedullary spinal cord tumors are less than one-third of 1% and only about 1-3% of them are high-grade gliomas. Intramedullary glioblastoma (GBM) is considered highly threatening because of its aggressiveness and, even with intense management, lesion progress and patients develop severe deficits. Authors report a very rare case of a 10-year-old patient with extensive cervical GBM with an unusual outcome.

Paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by a fungus known as Paracoccidioides brasiliensis. Central nervous system (CNS) is affected in 12% of the cases, but posterior fossa involvement is rarer. We report a case of a patient who presented an expansive lesion at the posterior fossa causing a right hemispheric cerebellar syndrome. After lesion excision and analysis, the diagnosis of Neuroparacoccidiomicosis was confirmed. Our case highlights this rare presentation of this pathology and its capacity to simulate neoplastic lesions.

O hematoma subdural é uma complicação incomum e grave do uso da técnica de raquianestesia. A primeira manifestação clínica usualmente é cefaleia. Apresentamos o caso de uma puérpera de 29 anos submetida a raquianestesia para parto cesariano que desenvolveu hematoma subdural. A paciente foi submetida a tratamento conservador, sem necessidade de intervenção neurocirúrgica com boa evolução. O hematoma subdural pós-raquianestesia é uma patologia grave que sempre deve ser suspeitada em pacientes com cefaleia, principalmente quando associada a outras manifestações neurológicas, para diferenciar de outras patologias associadas, como a hipotensão liquórica por punção dural.

A paralisia de C5 é uma conhecida complicação de cirurgia de descompressão medular cervical devido à mielopatia espondilótica crônica, que pode ser definida como déficit motor do deltóide e/ou do bíceps braquial, déficit sensitivo no território de C5, ou aumento da dor no território de C5 comparado ao status pré-operatório. Apresentamos um relato de caso de um paciente com mielopatia espondilótica cervical que foi submetido à laminectomia dos níveis C4 a C6 e evoluiu com paralisia de C5, obtendo melhora muito significativa em aproximadamente um ano. A incidência de paralisia de C5 pós-operatória pode variar de 0 a 30%, conforme a literatura. A fisiopatologia da paralisia pós-operatória de C5 ainda não é bem compreendida. Os pacientes geralmente têm bom prognóstico. A recuperação é espontânea, o que justifica o emprego de tratamento conservador. Há estudos comparando diferentes técnicas empregadas para descompressão medular cervical quanto à recuperação neurológica e a ocorrência de paralisia pós-operatória de C5, bem como avaliando o valor preditivo de monitoração neurofisiológica.

The Kernohan syndrome results from the compression of the cerebral peduncle against the tentorium cerebelli. This phenomenon represents a relevant clinical sign of transtentorial herniation due to an ipsilateral expansive lesion. We reported a case of a 50-year-old woman with a right temporal meningioma who developed a false localizing hemiparesis, which improved after microsurgical resection. This case emphasizes the mechanism and rarity of this pathology.

Neurodegeneration with Brain Iron Accumulation (NBIA) belongs to a group of disorders characterized by the predominant involvement of the basal ganglia. Patients may present psychiatric symptoms, extrapyramidal signs and cognitive decline. Few cases of this disease have been reported in Brazil. We present a typical NBIA case. This case has the classical signs and symptoms of NBIA in a woman with advanced/end-stage disease, in addition to the presence of cerebral atrophy, which is not a common finding.

The cavernous angioma is a vascular malformation that can affect various organs, and its location in the spinal cord is unusual. We report a case of a pregnant patient who presented with pain in the lower limbs and urinary retention, diagnosed with cavernous angioma of the spinal cord and treated with surgical excision. Our case highlights this rare pathology and its initial presentation during pregnancy.

Background: The association between remote cerebellar hematoma (RCH) and spinal surgery is poorly understood and rarely reported. We present seven cases of RCH after spinal surgery. Methods: Seven patients were diagnosed with RCH utilizing computed tomography and/or magnetic resonance, between 2012 and 2016. Their clinical presentations, imaging data, treatment modalities, and outcome were analyzed. There were five females and two males with an average age of 55.8 ± 8.4 years. The age of onset ranged from 43 to 67 years and the time to clinical presentation ranged from 3 h to 5 days. Patients presented with: diplopia/strabismus (one patient), dysphagia/urinary incontinence (one patient), respiratory arrest (one patient), meningismus (one patient), and dysarthria (two patients), along with other symptoms/signs. Results: Three patients were successfully managed without surgery, two required external ventricular drainage, and two were treated with posterior fossa decompression plus ventriculostomy. Four patients recovered completely, two showed mild residual deficits at discharge, while one expired 7 days postoperatively. Conclusion: RCH is an uncommon and underdiagnosed complication of spine surgery. It should be suspected when intracranial symptoms occur after spinal procedures.

Background Hemangiomas are benign vascular malformations that can involve the spine. Pure epidural hemangiomas are rare and represent only 4% of all epidural lesions. Most hemangiomas are of the cavernous type; the capillary variant is atypical, and only ten cases have been reported in the literature. Case description A 69-year-old female presented with nonspecific dorsal pain. Magnetic resonance imaging (MRI) showed a spinal epidural tumor at the T9-T10 level. Following a T9-T11 laminectomy, the lesion was completely resected en bloc. Histopathologic analysis showed a pure epidural capillary hemangioma with adipose tissue mesenchyma. Conclusions Although epidural capillary hemangiomas are extremely rare, they should be considered among the differential diagnoses of extradural, extramedullary spinal lesions. Further, they must be differentiated from other more common lesions such as meningiomas and schwannomas. The recommended surgical management is en bloc gross total excision.

Gorham’s syndrome is a rare osteolytic disease in which progressive and spontaneous resorption of bone occurs. We present a case of a boy who presented with Chiari I malformation and recurrent meningitis without fistula. The patient was submitted to occipital bone biopsy and due to lymphocytic infiltration and intraosseous vascular ectasia the diagnosis of Gorham-Stout Syndrome was made. The patient underwent conservative treatment but, unfortunately he died by cardiorespiratory arrest secondary to atlantooccipital dislocation. This case emphasizes the rarity of this pathology and the previously unreported association with recurrent meningitis without fistula.

Background: Hemangiomas are benign vascular malformations that can involve the spine. Pure epidural hemangiomas are rare and represent only 4% of all epidural lesions. Most hemangiomas are of the cavernous type; the capillary variant is atypical, and only ten cases have been reported in the literature. Case Description: A 69‑year‑old female presented with nonspecific dorsal pain. Magnetic resonance imaging (MRI) showed a spinal epidural tumor at the T9‑T10 level. Following a T9‑T11 laminectomy, the lesion was completely resected en bloc. Histopathologic analysis showed a pure epidural capillary hemangioma with adipose tissue mesenchyma. Conclusions: Although epidural capillary hemangiomas are extremely rare, they should be considered among the differential diagnoses of extradural, extramedullary spinal lesions. Further, they must be differentiated from other more common lesions such as meningiomas and schwannomas. The recommended surgical management is en bloc gross total excision.

The hemangiomas are benign vascular malformations. There are two types of hemangiomas that may affect the central nervous system, the cavernous type and the capillary type. The last is most uncommon and its presentation at spinal epidural space is extremely rare. These lesions usually present with signs and symptoms of myelopathy, radiculopathy or cauda equine syndrome. Magnetic resonance imaging (MRI) is the examination of choice and the treatment must be surgical regardless of the presentation of the patient due to the risk of spinal cord compression.