Browsing by Author "Machado, E"
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- Blue rubber-bleb nevus syndrome: report of a familial case with a dural arteriovenous fistulaPublication . Carvalho, S; Barbosa, V; Santos, N; Machado, EWe report a case of a 45-year-old woman known to have a familial form of blue rubber-bleb nevus syndrome (BRBNS). The patient developed severe occipital headaches and bilateral retroauricular bruits. Cerebral angiography showed a large dural arteriovenous fistula in the torcular region. Central nervous system involvement in BRBNS is not often reported, and most cases of BRBNS are sporadic.
- Collateral pial circulation relates to the degree of brain edema on CT 24 hours after ischemic strokePublication . Galego, O; Jesus-Ribeiro, J; Baptista, M; Sargento-Freitas, J; Martins, AI; Silva, F; Santos, GC; Cunha, L; Nunes, C; Machado, EBackground Cerebral edema is frequent in patients with acute ischemic stroke (AIS) who undergo reperfusion therapy and is associated with high mortality. The impact of collateral pial circulation (CPC) status on the development of edema has not yet been determined. Methods We studied consecutive patients with AIS and documented M1-middle cerebral artery (MCA) and/or distal internal carotid artery (ICA) occlusion who underwent reperfusion treatment. Edema was graded on the 24-hour non-contrast computed tomography (NCCT) scan. CPC was evaluated at the acute phase (≤6 hours) by transcranial color-coded Doppler, angiography and/or CT angiography. We performed an ordinal regression model for the effect of CPC on cerebral edema, adjusting for age, baseline National Institutes of Health Stroke Scale, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on admission, NCCT, parenchymal hemorrhagic transformation at 24 hours and complete recanalization at six hours. Results Among the 108 patients included, 49.1% were male and mean age was 74.2 ± 11.6 years. Multivariable analysis showed a significant association between cerebral edema and CPC status (OR 0.22, 95% CI 0.08-0.59, p = 0.003), initial ASPECTS (OR 0.72, 95% CI 0.57-0.92, p = 0.007) and parenchymal hemorrhagic transformation (OR 23.67, 95% CI 4.56-122.8, p < 0.001). Conclusions Poor CPC is independently associated with greater cerebral edema 24 hours after AIS in patients who undergo reperfusion treatment.
- Estudo de aneurismas cerebrais: por angio-tomografia computorizada cerebralPublication . Pereira, S; Santos, G; Marques, C; Machado, E; Brito, O
- Fístulas da tenda do cerebelo: diagnóstico e tratamentoPublication . Machado, E; Santos, N; Carvalho, S; Freitas, P; Filho, T; Machado, C; Martins, FAmong the 17 intracranial dural fistulae treated in the Department of Neuroradiology of the University Hospital of Coimbra (17 patients, 28 embolizations) between 19/10/98 and 20/11/2000, 4 cases (23%) were located on the tentorium cerebelli. Three patients were men aged 45, 53 and 56 years old. The remaining patient was an 85-year-old woman. All 4 patients were treated by embolization. One underwent post embolization surgical interruption of the draining vein. The authors analyse clinical presentation, complementary tests, therapy and outcome.
- Hemorragia Subaracnoideia e Angiografia Cerebral por Tomografia ComputorizadaPublication . Santos, N; Machado, E; Carvalho, S; Barbosa, MD; Martins, FWe present a review of 57 cases of nontraumatic subarachnoid hemorrhagesubmitted to CT angiography of the cerebral vessels. The purpose of our study was to estimate the value of CT angiography in the detection of intracranial aneurysms. These findings were compared with those from selective angiography. The results showed that CT angiography is a rapid, low-risk technique with a low level of invasiveness and high specificity and sensitivity in the detection of cerebral aneurysms, allowing the planning of endovascular intervention and surgical approach.
- Malformações do desenvolvimento cortical em doentes com epilepsia: estudo neurorradiológico de 17 casosPublication . Carvalho, S; Brito, O; Machado, E; Santos, N; Melo Freitas, P; Bento, C; Santana, I; Sales, F; Martins, FThis article reviews Malformations of Cortical Development (MCD) diagnosed by Magnetic Resonance Imaging (MRI) in a series of patients with epilepsy. This study spans a five year period. The frequency of these malformations was 7.1%. Most of these were focal or multifocal and the most common ones were polymicrogyria (35.3% of the patients), heterotopia (29.4%), and focal cortical dysplasia (29.4%). The frontal lobes were the most frequently affected regions. The various MCD encountered reflect the wide spectrum of MCD leading to epilepsy.
- Multiple Dural Arteriovenous Fistulas Presenting as Rapidly Progressive DementiaPublication . Mendonça, N; Santos, G; Duro, D; Machado, E; Goulão, A; Santana, IINTRODUCTION:Dural arteriovenous fistulas (DAVFs) are important causes of neurological dysfunction and are many times misdiagnosed. Particularly in older populations, DAVFs may present with a selective cognitive dysfunction. CASE REPORT: The authors describe a 70-year-old woman presenting with a rapidly progressive dementia, very similar in presentation to prion disease. Neuroimaging showed multifocal DAVFs associated with venous thrombosis and white matter changes, suggesting that impaired cerebral circulation due to venous hypertensive encephalopathy caused the patient's dementia. Prompt treatment of some of the abnormal shunts with endovascular embolization resulted in a clinically relevant improvement. Subsequent clinical improvement was achieved with anticoagulation, although no cause or predisposing factor was documented that could have led to the development of the venous thrombosis. CONCLUSIONS:Neurologists should maintain a high degree of suspicion to avoid missing the diagnosis of DAVFs that are potentially treatable lesions.
- Trombose Venosa Cerebral: Análise Retrospectiva de 49 CasosPublication . Santos, GR; André, R; Pereira, SL; Parreira, T; Machado, EIntroduction: Cerebral Venous Thrombosis (CVT) is a rare and potentially life-threatening disease, accounting for about 0.5% of stroke cases. However, it is believed to be an underdiagnosed condition. Early diagnosis requires a high degree of suspicion and appropriate use of imaging modalities. Objectives: Imagiological and clinical characterization of CVT cases diagnosed at our hospital from 2004 to 2007. Methods: This study was a retrospective, cross-sectional analysis from 2004 to 2007, using our institution database. We reviewed hospital discharge data to assess the incidence of CVT. The study population consisted of 49 patients. Retrospective review of the clinical data and imaging studies of these patients was then performed. Results: Of the 49 patients with confirmed CVT, 38 were female. Patient age varied between 16 and 75 years, with an average of 42.6 years. Thrombotic risk factors were found in 43 patients; the most frequent was dyslipidemia (n = 22) followed by oral contraceptive use (n = 18). Initial head Computerized Tomography (CT) was normal in six cases. Diagnosis was made by Magnetic Resonance (MR) in 38 cases, Cerebral CT-Venography in 10 cases and Digital Subtraction Angiography in one case. Average time from onset of symptoms to diagnosis was nine days; this was not significantly different when comparing the group diagnosed by MR with the group diagnosed by CT-Venography. Right transverse sinus was the most frequent location of thrombosis (n = 36). Only in four cases thrombosis did not involve the lateral sinuses. Conclusions: Lateral sinus thrombosis is a frequent variety of CVT, accounting for 91.8% of our cases. A negative Head CT scan does not exclude the presence of cerebral venous thrombosis; therefore appropriate imaging study should be performed whenever there's a high degree of clinical suspicion. Cerebral CT-Venography seems to be a good alternative to MR for the diagnosis of CVT.
- Vasospasmo precoce na HSA AneurismáticaPublication . Barbosa, MD; Machado, E; Gonçalves, J; Fernandes, R