Ribeiro, M; Soares-Fernandes, J; Rocha, J; Machado, A; Cerqueira, J; Moreira da Costa, JA; Reis, J
A hypo-coagulated 58-year-old female complained of headaches right after being exposed to the first pressure waves generated during an exhibition of fireworks. The day after she presented with seizures and the CT scan showed subdural hemorrhage over the left frontoparietal sulci. Eight hours after admission she disclosed left lower limb hypo-esthesia, i.e. a finding not attributable to the cranial hemorrhage. Four hours later sphincter dysfunction and paraparesis were also present with a left predominance. This was due to a T12-L1 subdural extramedullary hemorrhage. The patient was operated and showed a favorable outcome. Hypo-coagulated patients with cranial hemorrhage require prolonged surveillance...
Lemos, L; Alegria, C; Oliveira, J; Machado, A; Oliveira, P; Almeida, A
In idiopathic trigeminal neuralgia (TN) the neuroimaging evaluation is usually normal, but in some cases a vascular compression of trigeminal nerve root is present. Although the latter condition may be referred to surgery, drug therapy is usually the first approach to control pain. This study compared the clinical outcome and direct costs of (1) a traditional treatment (carbamazepine [CBZ] in monotherapy [CBZ protocol]), (2) the association of gabapentin (GBP) and analgesic block of trigger-points with ropivacaine (ROP) (GBP+ROP protocol), and (3) a common TN surgery, microvascular decompression of the trigeminal nerve (MVD protocol). Sixty-two TN patients were randomly treated during...
Mascarenhas, L; Ribeiro, M; Guimarães, S; Rocha, J; Alegria, C
A 56-year-old woman underwent surgery for a ruptured carotid-ophthalmic artery aneurysm. Intraoperative visual inspection confirmed that the ophthalmic artery was left intact. She had no light perception on the operated side right after surgery. Angiography one week after surgery confirmed exclusion of the aneurysm, no filling of the proximal portion of the ophthalmic artery, and a very faint filling of its distal orbital part. She gradually recovered from this deficit and 9 months after surgery she is capable of counting fingers. At this time angiography displayed filling of all the portions of the ophthalmic artery, absence of recruitment of collateral...