Hernias cerebrais intracranianas e lesões secundarias do tronco cerebral

Guidugli Neto, João

doi:10.1590/S0004-282X1976000200002

Resumos

Estudando casos com deslocamento intracraniano de massa encefálica e hemorragia secundária do tronco cerebral o autor assinala lesões ao nível de artérias Os tipos de lesões encontradas sugerem uma etiologia mecânica. São discutidos os demais fatores e o achado de hemorragias venosas e capilares. O deslocamento caudal do tronco cerebral é interpretado como o fator lesivo mais importante.

Intracranial cerebral herniations with secondary lesions in the brain stem are reported. The secondary lesions founded on the upper brain stem of 23 encephala with cerebral herniations are described. Hemorrhages in arteries were seen in all the brains. The lesions points to a mechanical etiology, the caudal displacement of the brain stem being the most important factor. Areas of ischemic infarction were found in the brain stem in all the cases; it is sugested that they were produced by factors others than the causative of the hemorrhagic lesions

Hernias cerebrais intracranianas e lesões secundarias do tronco cerebral

Intracranial cerebral herniations and secondary lesions in the brain stem

João Guidugli Neto

Serviço de Anatomia Patológica (Diretor: Dr. L. C. Mattosinho França), do Hospital do Servidor Público Estadual de São Paulo, Francisco Morato de Oliveira (HSPE-FMO): Médico Assistente

RESUMO

Estudando casos com deslocamento intracraniano de massa encefálica e hemorragia secundária do tronco cerebral o autor assinala lesões ao nível de artérias Os tipos de lesões encontradas sugerem uma etiologia mecânica. São discutidos os demais fatores e o achado de hemorragias venosas e capilares. O deslocamento caudal do tronco cerebral é interpretado como o fator lesivo mais importante.

SUMMARY

Intracranial cerebral herniations with secondary lesions in the brain stem are reported. The secondary lesions founded on the upper brain stem of 23 encephala with cerebral herniations are described. Hemorrhages in arteries were seen in all the brains. The lesions points to a mechanical etiology, the caudal displacement of the brain stem being the most important factor. Areas of ischemic infarction were found in the brain stem in all the cases; it is sugested that they were produced by factors others than the causative of the hemorrhagic lesions

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Serviço de Anatomia Patológica Hospital do Servidor Público Estadual F.M.O. Caixa Postal 8570 01000 São Paulo, SP Brasil.

Agradecimentos O autor agradece aos Drs. Neil Ferreira Nova e Elias Rodrigues de Paiva, da Disciplina de Estatística Médica, do Departamento de Medicina preventiva da Escola Paulista de Medicina, o tratamento estatístico dos resultados; ao Prof. Antonio Spina França Neto, da Disciplina de Neurologia da Faculdade de Medicina da Universidade de São Paulo a orientação recebida na feitura desta investigação.

1. ATTWATER, H. L. Pontine haemorrhages. Guy's Hospital Rep. 65:339, 1911.
2. BLACKWOOD, W. Vascular diseases of the central nervous system. In BLACKWOOD, W.; McMENEMEY, W. H.; MEYER, R. M. & RUSSEL, R.S. Greenfield's Neuropathology. 2^nd ed. Edward Arnold Ltd., London, 1963. p. 71-137
3. CABIESES MOLINA, F. & JERI, R. Transtentorial temporal lobe herniation. Acta neurol. latinoamer. 1:167, 1955.
4. EVANS, J. P. & SCHEINKER, I. M. Histologic studies of the brain following head trauma: post-traumatic infarction of cerebral arteries, with special consideration of the associated clinical picture. Arc. Neurol. Psychiat. (Chicago) 50:258, 1943.
5. FREYTAG, E. Autopsy findings in head injuries blunt forces. Arch. Path. 75:402, 1963.
6. FRIEDE, R. L. & ROESSMANN, U. The pathogenesis of secondary midbrain hemorrhages. Neurology (Minneapolis) 16:1210, 1966.
7. GUIDUGLI NETO, J. Hérnias cerebrais intracranianas. Arq. Neuro-Psiquiatria (São Paulo) 33:305, 1975.
8. HASSLER, O. Arterial pattern of the human brainstem: normal appearence and deformations in expanding supratentorial conditions. Neurology (Minneapolis) 17:368, 1967.
9. HASSLER, O. Brainstem haemorrhages secondary to expanding supratentorial conditions. Acta path. microbiol. scand. 72:448, 1968.
10. HOWELL, D. A. Upper brain-stem compression and foraminal impaction with intracranial space-occupying lesions and brain swelling. Brain 82:525, 1969.
11. JEFFERSON, G. The tentorial pressure cone. Arch Neurol. Psychiat (Chicago) 40:857, 1938.
12. JOHNSON, R. T. & YATES, O. Brain stem hemorrhages in expanding supratentorial conditions. Acta radiol. (Stockholm) 46:250, 1956.
13. KLINTWORTH, G. K. Paratentorial grooving of human brains with particular reference to transtentorial herniation and the pathogenesis of secondary brainstem hemorrhages. Amer. J. Path. 53:391, 1968.
14. LINDENBERG, R. Compression of brain arteries as pathogenetic factor for tissue necroses and their areas of predilection. J. Neuropath. exp. Neurol. 14: 223, 1955.
15. MATSUOKA, K. SAKAKI, S. & OKAMOTO, E. A clinico-pathological study on the cause of hemorrhagic lesion in the brain stem with head injury. Med. J. Osaka Univ. 17:257, 1967.
16. MATSUOKA, K. SAKAKI, S. & OKAMOTO, E. Experimental study on hemorrhage in te brain stem induced by an intracranial space occupying lesion. Folia psychiat. neurol. jap. 22:245, 1968.
17. McNEALY, D. E. & PLUM, F. Brainstem dysfuction with supratentorial mass lesions. Arch. Neurol. (Chicago) 7:10, 1962.
18. MOORE, M. T. & STERN, K. Vascular lesions in the brain-stem and occipital lobe in association with brain tumours. Brain 61:70, 1938.
19. NELSON, J. Involvement of the brain stem in the presence of sub-dural hematoma. J.A.M.A. 119:864, 1942.
20. NORRIS, F. H. & FAWCETT A sign of intracranial mass with impending uncal herniation. Arch. Neurol. (Chicago) 12:381, 1965.
21. RUSSEL, D. S. & RUBINSTEIN, L. J. Deformations and others structural changes produced by intracranial tumours. In Pathology of Tumours of the Nervous System, 2nd ed. Edward Arnold Ltd., London, 1963, p. 232-241.
22. SATO, K. Transtentorial herniation and brainstem hemorrhage in connection with acute head injuries. Arch. jap. Chir. 37:94, 1968.
23. SCHWARZ, G. A. & ROESNER, A. A. Displacement and herniation of the hippocampal gyrus through the incisura tentorii. A clinico-pathological study. Arch. Neurol. Psychiat. (Chicago) 46:297, 1941.
24. SHIMOURA, N. On the pontine hemorrhages in the fatal cases of head injury. Jap. J. leg. Med. 21:397, 1967.
25. SIEGEL, S. The Kendall coefficient of concordance: In Nonparametric Statistics. McGraw-Hill Book Co. Inc., Tokio, 1956, p. 229-328.
26. TANDON, P. N. Brain stem hemorrhage in cranio-cerebral trauma. Acta neurol. scand. 40:375, 1964.
27. VINCENT, C.; DAVID, M. & THIÉBAUT, F. Le cône de pression temporal dans les tumeurs des hémisphères cérébraux. Rev. neurol. (Paris) 65:536, 1936.
28. WOLMAN, L. Ischaemic lesions in the brain stem associated with raised supratentorial pressure. Brain 76:364, 1953.

Datas de Publicação

Publicação nesta coleção
08 Mar 2013
Data do Fascículo
Jun 1976

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ATTWATER, H. L. Pontine haemorrhages. Guy's Hospital Rep. 65:339, 1911.

[2] 2. BLACKWOOD, W. Vascular diseases of the central nervous system. In BLACKWOOD, W.; McMENEMEY, W. H.; MEYER, R. M. & RUSSEL, R.S. Greenfield's Neuropathology. 2^nd ed. Edward Arnold Ltd., London, 1963. p. 71-137

[3] 3. CABIESES MOLINA, F. & JERI, R. Transtentorial temporal lobe herniation. Acta neurol. latinoamer. 1:167, 1955.

[4] 4. EVANS, J. P. & SCHEINKER, I. M. Histologic studies of the brain following head trauma: post-traumatic infarction of cerebral arteries, with special consideration of the associated clinical picture. Arc. Neurol. Psychiat. (Chicago) 50:258, 1943.

[5] 5. FREYTAG, E. Autopsy findings in head injuries blunt forces. Arch. Path. 75:402, 1963.

[6] 6. FRIEDE, R. L. & ROESSMANN, U. The pathogenesis of secondary midbrain hemorrhages. Neurology (Minneapolis) 16:1210, 1966.

[7] 7. GUIDUGLI NETO, J. Hérnias cerebrais intracranianas. Arq. Neuro-Psiquiatria (São Paulo) 33:305, 1975.

[8] 8. HASSLER, O. Arterial pattern of the human brainstem: normal appearence and deformations in expanding supratentorial conditions. Neurology (Minneapolis) 17:368, 1967.

[9] 9. HASSLER, O. Brainstem haemorrhages secondary to expanding supratentorial conditions. Acta path. microbiol. scand. 72:448, 1968.

[10] 10. HOWELL, D. A. Upper brain-stem compression and foraminal impaction with intracranial space-occupying lesions and brain swelling. Brain 82:525, 1969.

[11] 11. JEFFERSON, G. The tentorial pressure cone. Arch Neurol. Psychiat (Chicago) 40:857, 1938.

[12] 12. JOHNSON, R. T. & YATES, O. Brain stem hemorrhages in expanding supratentorial conditions. Acta radiol. (Stockholm) 46:250, 1956.

[13] 13. KLINTWORTH, G. K. Paratentorial grooving of human brains with particular reference to transtentorial herniation and the pathogenesis of secondary brainstem hemorrhages. Amer. J. Path. 53:391, 1968.

[14] 14. LINDENBERG, R. Compression of brain arteries as pathogenetic factor for tissue necroses and their areas of predilection. J. Neuropath. exp. Neurol. 14: 223, 1955.

[15] 15. MATSUOKA, K. SAKAKI, S. & OKAMOTO, E. A clinico-pathological study on the cause of hemorrhagic lesion in the brain stem with head injury. Med. J. Osaka Univ. 17:257, 1967.

[16] 16. MATSUOKA, K. SAKAKI, S. & OKAMOTO, E. Experimental study on hemorrhage in te brain stem induced by an intracranial space occupying lesion. Folia psychiat. neurol. jap. 22:245, 1968.

[17] 17. McNEALY, D. E. & PLUM, F. Brainstem dysfuction with supratentorial mass lesions. Arch. Neurol. (Chicago) 7:10, 1962.

[18] 18. MOORE, M. T. & STERN, K. Vascular lesions in the brain-stem and occipital lobe in association with brain tumours. Brain 61:70, 1938.

[19] 19. NELSON, J. Involvement of the brain stem in the presence of sub-dural hematoma. J.A.M.A. 119:864, 1942.

[20] 20. NORRIS, F. H. & FAWCETT A sign of intracranial mass with impending uncal herniation. Arch. Neurol. (Chicago) 12:381, 1965.

[21] 21. RUSSEL, D. S. & RUBINSTEIN, L. J. Deformations and others structural changes produced by intracranial tumours. In Pathology of Tumours of the Nervous System, 2nd ed. Edward Arnold Ltd., London, 1963, p. 232-241.

[22] 22. SATO, K. Transtentorial herniation and brainstem hemorrhage in connection with acute head injuries. Arch. jap. Chir. 37:94, 1968.

[23] 23. SCHWARZ, G. A. & ROESNER, A. A. Displacement and herniation of the hippocampal gyrus through the incisura tentorii. A clinico-pathological study. Arch. Neurol. Psychiat. (Chicago) 46:297, 1941.

[24] 24. SHIMOURA, N. On the pontine hemorrhages in the fatal cases of head injury. Jap. J. leg. Med. 21:397, 1967.

[25] 25. SIEGEL, S. The Kendall coefficient of concordance: In Nonparametric Statistics. McGraw-Hill Book Co. Inc., Tokio, 1956, p. 229-328.

[26] 26. TANDON, P. N. Brain stem hemorrhage in cranio-cerebral trauma. Acta neurol. scand. 40:375, 1964.

[27] 27. VINCENT, C.; DAVID, M. & THIÉBAUT, F. Le cône de pression temporal dans les tumeurs des hémisphères cérébraux. Rev. neurol. (Paris) 65:536, 1936.

[28] 28. WOLMAN, L. Ischaemic lesions in the brain stem associated with raised supratentorial pressure. Brain 76:364, 1953.