Report on a rare case of infestation by cysticercosis involving the cerebral subarachnoid space and the epidural space in the cervical and thoracic regions of a 59-year old female patient who presented nausea, signs of cerebelar ataxia and gradual loss of the sensibility in both legs. The diagnosis was based on magnetic resonance imaging of brain and cervical-thoracic spine demonstrating the presence of cysts in the subarachnoid spaces. An enzyme-linked immunosorbent assay (ELISA) performed on cerebrospinal fluid resulted positive and demonstrated a protein level of 420 mg/dl indicating the disease activity. Parasites were surgically removed for the necessity of thoracic spinal cord decompression. Based on findings of literature review, brief comments were made on the pathogenesis of the intradural-extramedullary spinal cysticercosis cystic form, magnetic resonance imaging findings and treatment.

Keywords: Cysticercosis, Brain, Spine, Magnetic resonance imaging

BACKGROUND: Pleural effusion is frequently seen on imaging examinations following elective abdominal surgery and has no clinical significance in most patients. This condition should be distinguished from pulmonary complications that require treatment. OBJECTIVE: To prospectively determine the incidence of pleural effusion in patients submitted to elective abdominal surgery using ultrasound (US), and to assess the possible association with risk factors related to the patients and anesthetic-surgical procedures. MATERIALS AND METHODS: Thirty-seven patients, 21 (56.8%) female, and 16 (43.2%) male aged 29 to 76 years submitted to elective abdominal surgery were evaluated. US was performed preoperatively and 48 hours after surgery in all patients. Associated risk factors were also assessed - age > 60 years, sex, obesity, smoking history, alcoholism and associated diseases -, and anesthetic-surgical procedure - cancer resection, class ASA > 2, duration of surgery, longitudinal incision and incision > 15 cm. Biliar lithiasis (43.2%) and gastrointestinal cancer (43.2%) were the main causes leading to surgery. RESULTS: The incidence of postoperative pleural effusion (PPE) detected by US was 70.3% (26/37). Two of these patients (5.4%) developed pulmonary complications, and one died. The risk factors age > 60 years, smoking history, alcoholism, obesity and associated diseases had no influence on the development of the PPE whereas cancer resection, class ASA > 2, longitudinal incision and incision > 15 cm were significantly statistically associated with the presence of PPE. PPE developed even during antibiotic therapy. The duration of hospitalization was more than 2.4 longer in the patients with PPE. CONCLUSION: PPE is a very frequent condition observed in patients submitted to elective abdominal surgery. Most of the cases of PPE are self-limited, resolving without symptoms. The use of the US for the detection of PPE proved to be effective and should therefore be recommended.

Keywords: Abdomen, Surgery, Postoperative complications, Lung complications, Risk factors, Ultrasound

Objective: To describe the correlation between the Glasgow Coma Scale, risk factors, age, sex and tracheal intubation with the cranial computed tomographic findings in patients with traumatic brain injury. Materials and Methods: A prospective, cross sectional study was developed with 102 patients who were given a Glasgow coma score and submitted to computed tomography at the first 12 hours following admission. Results: The mean age of the entire series was 37.77 ± 18.69 years, with prevalence of male patients (80.4%). The most common causes of head injury were: automobile accidents (52.9%), falls (20.6%), pedestrian injuries (10.8%), falls to the ground (7.8%) and aggression (6.9%). In the present study, 82.4% of patients had traumatic brain injury rated as mild, 2.0% as moderate and 15.6% as severe. Tomographic findings such as subgaleal hematoma, skull fractures, subarachnoid hemorrhage, cerebral contusion, extra-axial blood collection and diffuse cerebral edema were observed in 79.42% of the patients. Most of the findings of severe traumatic brain injury were observed in the patients above 50 years (93.7%) and in this group, all the patients required tracheal intubation. Conclusion: Statistical significance was observed in the correlation between the Glasgow Coma Scale, age > 50 years (p < 0.0001), need for tracheal intubation (p < 0.0001) and CT findings.

Keywords: Head injury; Glasgow Coma Scale; Epidemiology; Computed tomography.