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Background Cerebral venous sinus thrombosis (CVST) is not as well understood as an ischemic stroke of arterial origin. Although the prognosis of CVST is usually good, parenchymal lesions may occur in some patients, and the development of intracranial herniation may result in death. For this reason, recognizing the risk factors for intracranial herniation and accurately determining those patients who should undergo decompressive craniectomy is important. Objective This study aims to determine the risk factors for intracranial herniation in patients with CVST. Methods A total of 177 patients diagnosed with CVST between 2015 and 2021 in our tertiary center were retrospectively included in this study. Results Of the 177 patients, 124 were female and 53 were male with mean ages of 40.65 ± 13.23 and 44.13 ± 17.09, respectively. Among those, 18 patients had developed intracranial herniation. A significant statistical relationship was observed between superior sagittal sinus thrombosis, sinus rectus thrombosis, venous collateral score, nonhemorrhagic venous infarct, presence of malignancy, small juxtacortical hemorrhage, and cortical vein thrombosis. The binary logistic regression analysis results showed that the most significant variables were the venous collateral score of 0, malignancy, and small juxtacortical hemorrhages. Conclusion This study identified small juxtacortical hemorrhages, the presence of malignancy, and a venous collateral score of 0 to be independent risk factors for intracranial herniation in CVST patients. Drawing on these results, we recommend close clinical observation of CVST patients, as they may be candidates for decompressive craniectomy. Resumo Antecedentes A trombose do seio venoso cerebral (CVST) não é tão bem compreendida como um acidente vascular cerebral isquémico de origem arterial. Embora o prognóstico de CVST seja geralmente bom lesões parenquimatosas podem ocorrer em alguns pacientes e o desenvolvimento de herniação intracraniana pode resultar em morte. Por esse motivo é importante reconhecer os fatores de risco para hérnia intracraniana e determinar com precisão os pacientes que devem ser submetidos à craniectomia descompressiva. Objetivo Este estudo tem como objetivo determinar os fatores de risco para herniação intracraniana em pacientes com CVST. Métodos Um total de 177 pacientes diagnosticados com CVST entre 2015 e 2021 em nosso centro terciário foram retrospectivamente incluídos neste estudo. Resultados Dos 177 pacientes 124 eram do sexo feminino e 53 do masculino com média de idade de 40 65 ± 13 23 e 44 13 ± 17 09 respectivamente. Destes 18 pacientes desenvolveram hérnia intracraniana. Uma relação estatística significativa foi observada entre trombose do seio sagital superior trombose do seio reto escore de colateral venosa infarto venoso não hemorrágico presença de malignidade pequena hemorragia justacortical e trombose da veia cortical. Os resultados da análise de regressão logística binária mostraram que as variáveis mais significativas foram o escore colateral venoso de 0 malignidade e pequenas hemorragias justacorticais. Conclusão Este estudo identificou pequenas hemorragias justacorticais a presença de malignidade e um escore colateral venoso de 0 como fatores de risco independentes para herniação intracraniana em pacientes CVST. Com base nesses resultados recomendamos uma observação clínica rigorosa dos pacientes CVST pois eles podem ser candidatos à craniectomia descompressiva.

El trauma craneoencefálico, una emergencia médica, es un problema al cual el personal de emergencia y quirófano se enfrenta con bastante regularidad. La intervención precoz mejora notablemente el resultado y pronóstico del paciente a cualquier plazo, la evolución de la terminología de la cirugía de control de daño a la reanimación de control de daños permite esclarecer que las decisiones e intervenciones deben ser oportunas, coordinadas, dinámicas y simultáneas. Es importante conocer la mecánica del trauma porque puede determinar el comportamiento y evolución de la lesión cerebral, el prevenir que la lesión primaria progrese a través del tiempo es el objetivo primario. La mejor evidencia ha sido revisada para proporcionar conceptos actuales, intervenciones novedosas y directrices para un manejo integral de los pacientes que requieren de una reanimación apropiada para conservar su estado neurológico y vital.

ilustraciones, gráficas, tablas Introducción: el síndrome de encefalopatía posterior reversible (PRES) es un desorden clínico-radiológico de instauración aguda, que se caracteriza por presentar síntomas neurológicos asociados a edema vasogénico que compromete principalmente los territorios irrigados por la circulación posterior. Objetivo: describir las características clínicas y radiológicas de PRES en la población de la Fundación Hospital Pediátrico La Misericordia. Metodología: se realizó un estudio retrospectivo tipo serie de casos, en el que se incluyeron 19 pacientes pediátricos con diagnóstico de PRES. Un médico especialista en radiología revisó las imágenes de tomografía computarizada y resonancia magnética adquiridas en el episodio agudo y durante el seguimiento radiológico de cada paciente. Resultados: la media de la edad fue de 11,16 años (± 4,5) al momento del diagnóstico y el 52,6% eran mujeres (n=10). El diagnóstico primario más frecuente fueron las neoplasias linfoproliferativas en el 47,4% (n=9). La alteración del estado de conciencia se presentó en 78,9% (n=15) y las convulsiones en 73,7% (n=14). El factor de riesgo más importante fue la hipertensión arterial, en el 85,2% de la población (n=16). El patrón radiológico más frecuente fue el dominante parieto-occipital en 63,2% (n=12). Se contaron con imágenes de seguimiento de 14 pacientes, de los cuales el 64,3% presentaron resolución completa o casi completa de las lesiones. Conclusión: el PRES es una enfermedad multifactorial, que puede estar asociada a hipertensión arterial, quimioterapia, corticoides e infecciones. Las lesiones atípicas tienden a persistir en las imágenes de seguimiento. (Texto tomado de la fuente). Introduction: posterior reversible encephalopathy syndrome (PRES) is a clinicallyradiological disorder of acute onset, characterized by presenting neurological symptoms associated with vasogenic edema that mainly affects the territories irrigated by the posterior circulation. Objective: to describe the clinical and radiological features of PRES in the population of Fundación Hospital Pediátrico La Misericordia. Methods: a retrospective case series study, which included 19 pediatric patients with PRES. A radiologist reviewed computed tomography and magnetic resonance images acquired in the acute episode and during the radiological follow-up of each patient. Results: the mean age was 11.16 years (± 4,5) at the time of diagnosis, and 52.6% were women (n=10). The most frequent primary diagnosis was lymphoproliferative neoplasms in 47.4% (n=9). Alteration of consciousness occurred in 78.9% (n=15) and seizures in 73.7% (n=14). The most important risk factor was arterial hypertension in 85.2% (n = 16). The most frequent radiological pattern was the parieto-occipital dominant in 63.2% (n=12). Follow-up images of 14 patients were available, of which 64.3% had complete or almost complete resolution of the lesions. XIV Síndrome de encefalopatía posterior reversible en población pediátrica: características clínicas y radiológicas. Conclusion: PRES is a multifactorial disease, which can be associated with high blood pressure, chemotherapy, corticosteroids, and infections. Atypical lesions tend to persist on follow-up images. Incluye anexos Especialidades Médicas Especialista en Radiología e Imágenes Diagnósticas Estudio retrospectivo tipo series de casos. Población Se revisaron las bases de datos de los servicios de neurorradiología y neuropediatría, con el objetivo de extraer los pacientes con diagnóstico de síndrome de encefalopatía posterior reversible valorados en la Fundación Hospital Pediátrico La Misericordia durante los años 2016 a 2021. El tamaño de muestra se definió a conveniencia de los investigadores. Posteriormente, se recopilaron datos sociodemográficos y clínicos a partir de la historia clínica institucional de cada paciente. Las imágenes diagnósticas (TC y RM) en formato DICOM fueron analizadas de forma conjunta por un médico radiólogo especialista en neuroimágenes pediátricas y un residente de radiología e imágenes diagnósticas en cuarto año de formación. La definición de caso compatible con PRES, se estableció por consenso entre un médico neuropediatra y un médico radiólogo especialista en neuroimágenes pediátricas. Los casos que generaron controversia fueron excluidos del estudio. Criterios de Inclusión * Edad inferior a 18 años. Presencia de síntomas neurológicos como convulsiones, variación del estado de conciencia, cefalea o alteraciones visuales (visión borrosa, alucinaciones visuales, hemianopsia, ceguera cortical). * Pacientes con factores de riesgo para PRES como hipertensión, falla renal, quimioterapia, enfermedades autoinmunes u otros previamente reportados en la literatura * Resonancia magnética de cerebro con o sin medio de contraste realizada en la Fundación Hospital de la Misericordia (Bogotá, Colombia), en el periodo comprendido entre 2016 y 2021. Criterios de Exclusión * Resonancia magnética de cerebro de mala calidad (“no diagnostica”). * Pacientes con otras causas de encefalopatía Aspectos Éticos El presente estudio se encuentra en la categoría de “investigación sin riesgo” según el artículo 11 de la resolución número 8430 de 1993 del ministerio de salud, dado que todos los datos y variables se recolectarán de forma retrospectiva y no se realizará ninguna intervención o modificación intencionada de las variables biológicas, fisiológicas, psicológicas o sociales de los individuos que participen en el mismo. La información de cada paciente será confidencial y el tratamiento de los datos se realizará únicamente por parte del grupo de investigadores, quienes declaran no tener ningún conflicto de interés. Análisis estadístico Se realizó un estudio descriptivo, en el cual las variables cualitativas y semi-cualitativas se presentaron como porcentajes. Mientras que las variables cuantitativas se expresaron como media y desviación estándar. Neuroradiología pediátrica

Background: Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. Objective: To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. Methods: Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. Results: A favorable outcome (mRS≤3) was observed in 37.5% of the DC patients and 29.4% of CT patients (p=0.42). Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); however, with no statistical significance. Nonetheless, the proportion of patients with moderate to severe disability (mRS 4‒5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). Conclusion: In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability. RESUMO Introdução: O infarto maligno da artéria cerebral média (ACM) ocorre em um subgrupo de pacientes com acidente vascular cerebral (AVC) isquêmico e a craniectomia descompressiva (CD) precoce é um de seus tratamentos. Objetivo: Investigar o desfecho funcional de pacientes com acidente vascular cerebral isquêmico maligno submetidos à craniectomia descompressiva em um centro de emergência neurológica do nordeste do Brasil. Métodos: Nesta coorte prospectiva, os pacientes foram divididos em dois grupos: aqueles submetidos a tratamento cirúrgico com craniectomia descompressiva (CD) e aqueles que mantiveram tratamento conservador (TC) padrão. A funcionalidade foi avaliada por meio da Escala de Rankin modificada (ERm) ao final de seis meses de seguimento. Resultados: Evidenciou-se desfecho favorável (ERm≤3) em 37,5% dos pacientes craniectomizados e em 29,4% dos pacientes não craniectomizados (p=0,42). A mortalidade foi menor no grupo de pacientes que se submeteram a tratamento cirúrgico (25%) do que entre aqueles tratados conservadoramente (52,8%), porém sem significância estatística. Por outro lado, a proporção de pacientes com incapacidade moderada a grave (ERm 4‒5) foi maior no grupo cirúrgico (37,5%) do que no grupo não cirúrgico (17,7%). Conclusão: Em valores absolutos, percebeu-se superioridade na eficácia do tratamento cirúrgico sobre o conservador, mostrando que a redução de mortalidade se dá à custa de aumento da incapacidade funcional.

Objective: The suspicion of an underlying medical cause must guide to the clinical and paraclinical approach when faced with a new case of catatonia. For that purpose, a case is presented in which the aetiology has never been reported in the literature. Clinical case: A 58 year-old man, with no significant medical history, presenting with a catatonic syndrome of one week onset. Neuroimages showed a left parietal tumour with intense surrounding oedema, suspicious of tuberculous granuloma. The oedema was resolved with corticosteroid use, which led to the disappearance of the catatonia. Result: Contrary to other reports where the excision of the tumour mass was followed by the resolution of the catatonia, in this case the treatment of the cerebral oedema resolved the catatonia completely. Conclusion: The case presented highlights the need for the early detection of catatonia in order to be managed appropriately, either symptomatic or causal. As far as we know, there are no previous reports in the literature of catatonia secondary to cerebral oedema. Objetivo. La sospecha de causa médica subyacente debe dirigir el abordaje clínico y paraclínico ante un caso nuevo de catatonía, con ese fin presentamos un caso de etiología antes no reportada en la literatura. Caso clínico. Varón de 58 años, sin antecedentes médicos de importancia, con síndrome catatónico de una semana de evolución; las neuroimágenes mostraron imagen tumoral parietal izquierda con intenso edema circundante, sospechosa de granuloma tuberculoso. La resolución del edema, con uso de corticoides, llevó a la desaparición de la catatonía. Resultado. A diferencia de otros reportes, donde solamente la exéresis de la masa tumoral conllevaba la resolución de la catatonía, en el presente reporte el tratamiento del edema cerebral resolvió el cuadro catatónico. Conclusiones. Nuestro caso subraya la necesidad de detección temprana de la catatonía para su adecuado manejo, sintomático o causal. Hasta donde conocemos, no hay reportes previos de catatonía secundaria a edema cerebral.

Funder: National Institute for Health Research; doi: http://dx.doi.org/10.13039/501100000272, Funder: Great Ormond Street Hospital for Children; doi: http://dx.doi.org/10.13039/501100003784, Hinge craniotomy (HC) is a technique that allows for a degree of decompression whilst retaining the bone flap in situ, in a ‘floating’ or ‘hinged’ fashion. This provides expansion potential for ensuing cerebral oedema whilst obviating the need for cranioplasty in the future. The exact indications, technique and outcomes of this procedure have yet to be determined, but it is likely that HC provides an alternative technique to decompressive craniectomy (DC) in certain contexts. The primary objective was to collate and describe the current evidence base for HC, including perioperative parameters, functional outcomes and complications. The secondary objective was to identify current nomenclature, operative technique and operative decision-making. A scoping review was performed in accordance with the PRISMA-ScR Checklist. Fifteen studies totalling 283 patients (mean age 45.1 and M:F 199:46) were included. There were 12 different terms for HC. The survival rate of the cohort was 74.6% (n = 211). Nine patients (3.2%) required subsequent formal DC. Six studies compared HC to DC following traumatic brain injury (TBI) and stroke, finding at least equivalent control of intracranial pressure (ICP). These studies also reported reduced rates of complications, including infection, in HC compared to DC. We have described the current evidence base of HC. There is no evidence of substantially worse outcomes compared to DC, although no randomised trials were identified. Eventually, a randomised trial will be useful to determine if HC should be offered as first-line treatment when indicated.

El deporte de aventura ha ganado popularidad en los últimos años. Viajar a grandes altitudes o deportes como el alpinismo, cada vez son más frecuentes entre la población y las últimas estadísticas epidemiológicas revelan un aumento considerable de los accidentes en la montaña. Esta creciente morbi-mortalidad, junto con el elevado coste económico de la atención sanitaria, genera un problema de Salud Pública. De todos los viajeros que ascienden por encima de los 2.500 m de altitud, el 40%-90% se verán afectados por el mal agudo de montaña o alguna de sus entidades. El desarrollo de esta enfermedad, potencialmente peligrosa, depende de la susceptibilidad individual, de la altitud alcanzada y de la velocidad de ascenso. La atención sanitaria en un entorno aislado y hostil no siempre es posible por lo que realizar un ascenso seguro y correcto resulta imprescindible para prevenir esta enfermedad. La educación y la prevención son la base de la seguridad en la montaña y es el profesional sanitario quien debe formar a los viajeros, tanto de manera práctica como teórica, proporcionar asesoramiento a clubs o federaciones de montaña, informar a través de charlas previas a la expedición… para lograr un viaje seguro. Adventure sports have gained popularity in recent years. Traveling to high-altitude or practicing sports such as hiking or trekking are becoming more prevalent among the population and the latest epidemiological statistics are revealing a considerable increase in mountain accidents. This growing morbidity and mortality, together with the high economic cost of health care generates a Public Health problem. Between 40%-90% of those traveling to altitudes above 2.500m are affected by some form of acute mountain sickness. While most cases of altitude illness are mild, some cases can become life threatening. The faster you climb to a high altitude, the more likely you will get acute mountain sickness. Health care in an isolated and hostile environment may not be possible, so ascending slowly is the best way to avoid altitude sickness. Knowledge and learning how to recognize early symptoms is the best prevention and it is the healthcare proffessional responsability to train travellers on general health precautions that will reduce their chances of experiencing this illness through talks and workshops at mountain clubs so that the travellers can have a safe trip. Grado en Enfermería

Resumen El síndrome de encefalopatía posterior reversible es una condición que responde a múltiples causas y presenta características clínicas o radiológicas distintivas; los intensivistas y los médicos de urgencias deben conocerlo con el fin de hacer el diagnóstico y ordenar el tratamiento oportuno. Se presenta un caso fatal de síndrome de encefalopatía posterior reversible, en el cual se determinaron los factores de riesgo relacionados con el resultado final. Un hombre de 60 años sin antecedentes médicos ingresó por urgencias con depresión de la conciencia, convulsiones y tensión arterial elevada. Las imágenes de la tomografía revelaron un hematoma cerebeloso posterior, y las de resonancia magnética mostraron zonas isquémicas, edema vasogénico que se extendía desde los tálamos hacia el tallo cerebral, los pedúnculos cerebelosos medios y la sustancia blanca profunda de los hemisferios cerebelosos, así como zonas de transformación hemorrágica. A pesar del tratamiento médico y quirúrgico recibido, el paciente falleció. Se determinaron los factores de riesgo que se han descrito como causa de muerte en este síndrome. Este caso demuestra que dicho síndrome puede ocurrir sin que se hayan detectado factores de riesgo desencadenantes y pone en evidencia la necesidad de su reconocimiento temprano para establecer una intervención adecuada y evitar daños o un desenlace fatal. Además, abre el camino a nuevos estudios sobre la propensión a desarrollarlo y las medidas preventivas que pueden adoptarse. Abstract Posterior reversible encephalopathy syndrome is an illness with multiple causes and distinctive clinicalradiological characteristics that should be known by intensivists and emergency room physicians for a timely diagnosis and treatment. A fatal case of posterior reversible encephalopathy syndrome is presented, and the risk factors related to the outcome are identified. A 60-year-old man without a relevant medical history arrived at the emergency room presenting with depressed consciousness, seizures, and high blood pressure. Tomographic images revealed a posterior cerebellar hematoma. Resonance images showed ischemic zones, vasogenic edema from the thalamus to the brain stem, middle cerebellar peduncles, deep white matter of the cerebral hemispheres, and zones of hemorrhagic transformation. Despite medical-surgical management, the patient died. The risk factors described as the cause of the fatal outcome were identified. This case demonstrates that posterior reversible encephalopathy syndrome can occur without triggering risk factors and highlights the need for early recognition to establish an appropriate intervention to avoid injury or a fatal outcome. Cases of posterior reversible encephalopathy syndrome provide opportunities to investigate the susceptibility for the development of this condition and to establish appropriate preventive measures.

Background/Aims: Hypernatremic dehydration in term neonates is associated with inadequate fluid intake, usually related to insufficient lactation. The use of hypotonic fluids is appropriate to dilute serum sodium (SNa), but cerebral edema may develop when it happens abruptly. Our objective was to clarify how to correct hypernatremic dehydration properly. Methods: The following databases were searched, limited to studies published until January 31st, 2016: Clinical Trials, MEDLINE/PubMed, EMBASE, LILACS, and the Cochrane Library. We included open-label trials, nonrandomized controlled trials, or prospective and retrospective case series evaluating relevant outcomes. Information regarding the way of administering the treatment, type of fluid used, rates of complications and outcomes, as well as the rate of SNa reduction were collected. Results: Searches yielded 771 articles: 64 had the full text reviewed and 9 were included. No randomized clinical trials or systematic reviews focusing on treatment of hypernatremic dehydration and its outcomes were found. We found a scarcity of high quality studies and great methodology heterogeneity. Conclusions: More severe hypernatremia is at greater risk of causing severe adverse effects of treatment. There is no consensus about the optimal rate of SNa drop in this population, but a slower correction appears to be safer. Questions as when parenteral fluids are indicated remain unanswered.

Resumo Objetivos: Descrever um caso de Síndrome da Encefalopatia Reversível Posterior em gestante diagnosticada com eclâmpsia tardia, bem como seu manejo clínico. Descrição do caso: Paciente feminina, 34 anos, em sua terceira gestação, iniciou com aumento dos níveis tensionais durante o trabalho de parto e, após onze dias de puerpério, apresentou quadro de diminuição da acuidade visual à direita, seguida de crise convulsiva e subsequente perda parcial da visão do olho direito. Após a realização de exames de imagem e descartada a possibilidade de acidente vascular encefálico, a paciente foi diagnosticada com Síndrome da Encefalopatia Reversível Posterior (PRES). Instituído o manejo clínico das crises convulsivas e hipertensivas, houve remissão completa dos sintomas e reversão do quadro clínico inicial. Conclusões: Uma vez adequadamente diagnosticada e tratada, a Síndrome da Encefalopatia Reversível Posterior pode apresentar evolução satisfatória, especialmente quando associada a um fator desencadeado agudamente, como a eclâmpsia. Abstract Objectives: To describe a case of Posterior Reversible Encephalopathy Syndrome diagnosed in pregnant women with late-eclampsia, as well as its clinical management. Case description: A 34 years old patient in her third pregnancy had started with high blood pressure levels during labor; after eleven days postpartum, she presented a decreased right visual acuity; subsequently one episode of seizure followed by partial loss of vision in the right eye. After conducting tests and ruled out stroke, the patient was diagnosed as Posterior Reversible Encephalopathy Syndrome (PRES). Established the clinical management of seizures and hypertensive crisis, there was complete remission of symptoms and reversal of the initial clinical picture. Conclusion: Once properly diagnosed and treated, the Posterior Reversible Encephalopathy Syndrome can present satisfactory progress, especially when associated with an acutely triggered factor, as eclampsia.

El organismo experimenta cambios fisiológicos cuando asciende por encima de los 2.500 metros sobre el nivel del mar. Dichos cambios comprometen varios sistemas, entre ellos, el tracto gastrointestinal, con manifestaciones clínicas diversas, la mayoría de leve intensidad, y, por ende, poco reportadas y sub-diagnosticadas. Se presentan dos pacientes pediátricos, quienes consultaron a la Unidad de Gastroenterología, He patología y Nutrición Pediátrica (Gastronutriped) en Bogotá, documentándose los síntomas gastrointestinales asociados con la altura. A propósito de los casos, se revisó la literatura disponible, enfatizando en la fisiología, manifestaciones clínicas y tratamiento factible. La intención final de este manuscrito es sensibilizar al personal de la salud que trabaja en ciudades ubicadas a gran altura para que consideren esta entidad como diagnóstico diferencial en niños procedentes de lugares con menor altitud. Upon ascending above 2500 meters sea level, the human body undergoes a series of physiological changes that have been studied during years. These changes undertake various systems including gastrointestinal tract, with diverse clinical manifestations, most mild and therefore little reported and are underdiagnosed.Two pediatric patients who atended to the Pediatric Unit of Gastroenterology, Hepatology and Nutrition (Gastronutriped) in Bogota, in whose we documented symptoms affecting gastrointestinal tract associated with high altitude.Regarding to these cases, a review of the available literature focusing on physiology, clinical manifestations and feasible treatment was made. The final aim of this article is to sensitize to health care professionals working in cities located at high altitudes, to consider this entity as a differential diagnosis in children from places with lower altitude.

Occurrence of peritumoral brain edema (PBE) in meningiomas has been associated with several factors in recent years, although its pathophysiological mechanism has not yet been fully elucidated. The aim of this study was to analyze the correlation between the presence / degree of PBE and factors such as gender, age, size and histological subtype of tumor. We analyzed the MRI images of 74 patients operated on Hospital Beneficência Portuguesa de Porto Alegre for the presence / degree of PBE and data was statistically correlated with the parameters of the patient. PBE was present in 70.1% of patients. Tumors with higher volume had more PBE. Tumors of the olfactory groove showed more PBE than sphenoid wing and parassagittal tumors. Transitional subtype showed more PBE than fibroblastic and meningothelial subtypes. A presença de edema cerebral peritumoral (ECP) em meningiomas tem sido associada a diversos fatores nos últimos anos, embora o seu mecanismo fisiopatológico ainda não tenha sido inteiramente elucidado. O objetivo desse estudo foi analisar a correlação entre a presença/grau de ECP e fatores como sexo, idade, volume e subtipo histológico do tumor. Foram analisadas imagens de RM de 74 pacientes operados no Hospital Beneficência Portuguesa de Porto Alegre quanto à presença/grau de ECP e os dados correlacionados estatisticamente com os parâmetros do paciente. ECP estava presente em 70,1% dos pacientes. Tumores com maior volume apresentaram mais ECP. Tumores da goteira olfatória apresentaram mais ECP que os da asa do esfenóide e que os parassagitais. Meningiomas transicionais apresentaram mais ECP que os fibroblásticos e que os meningoteliais.

O edema cerebral e a hipertensão intracraniana (HIC) são as principais causas de morbidade e mortalidade de pacientes com insuficiência hepática fulminante (IHF). A patogênese dessas complicações tem sido investigada no homem, em modelos experimentais e em sistemas celulares isolados. Atualmente, o mecanismo subjacente ao edema cerebral e HIC na presença de IHF é multifatorial em etiologia e pouco compreendido na literatura. O objetivo deste trabalho é revisar a fisiopatologia das alterações hemodinâmicas e metabólicas cerebrais na IHF, visando melhorar a compreensão da complicação da hemodinâmica encefálica na IHF. Intracranial hypertension and brain swelling are a major cause of morbidity and mortality of patients suffering from fulminant hepatic failure (FHF). The pathogenesis of these complications has been investigated in man, in experimental models and in isolated cell systems. Currently, the mechanism underlying cerebral edema and intracranial hypertension in the presence of FHF is multi-factorial in etiology and only partially understood. The aim of this paper is to review the pathophysiology of cerebral hemodynamic and metabolism changes in FHF in order to improve understanding of intracranial dynamics complication in FHF. PASCHOAL, E. H. A. Universidade Federal do Pará