BARBARA ALBUQUERQUE MORAIS
Índice h a partir de 2011
7
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
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- Brain abnormalities in myelomeningocele patients(2020) MORAIS, Barbara Albuquerque; SOLLA, Davi Jorge Fontoura; YAMAKI, Vitor Nagai; FERRACIOLLI, Suely Fazio; ALVES, Cesar Augusto P. F.; CARDEAL, Daniel Dante; MATUSHITA, Hamilton; TEIXEIRA, Manoel JacobsenBackground Myelomeningocele (MMC) is often related to hydrocephalus and Chiari malformation (CM) type 2; however, other brain abnormalities have been reported in this population. In order to better understand and quantify other forebrain abnormalities, we analyzed magnetic resonance imaging (MRI) of MMC patients treated in utero or postnatal. Methods Between January 2014 and March 2017, 59 MMC were treated in our hospital. Thirty-seven patients (32 postnatal and 5 intrautero repair) had brain MRI and were enrolled at the study. MRI was analyzed by two experienced neuroradiologists to identify the supra and infratentorial brain abnormalities. Results A wide range of brain abnormalities was consistently identified in MMC patients. As expected, the most common were hydrocephalus (94.5%) and CM type II (89.1%). Of note, we found high incidence of corpus callosum abnormalities (86.4%), mostly represented by dysplasia (46%). Conclusions The data are consistent with the concept that brain abnormalities related to MMC can be both infratentorial and supratentorial, cortical, and subcortical. More studies are needed to correlate these forebrain abnormalities to long-term functional outcome and their prognostic value for these patients.
- High Intra-Abdominal Pressure Secondary to Obesity as a Determining Factor for Ventriculoperitoneal Shunt Malfunction(2018) MORAIS, Barbara Albuquerque; YAMAKI, Vitor Nagai; CARDEAL, Daniel Dante; ANDRADE, Fernanda Goncalves; PAIVA, Wellingson Silva; MATUSHITA, Hamilton; TEIXEIRA, Manoel JacobsenThe ventriculoperitoneal shunt (VPS) is an established treatment for hydrocephalus. The functioning of the system requires a pressure difference between the cranial and abdominal cavities. The VPS can be particularly problematic in patients with increased intra-abdominal pressure (IAP). We report the case of a 16-year-old girl with VPS since she was 2 months old due to hydrocephalus secondary to myelomeningocele. The patient had been asymptomatic ever since, but she sought the emergency service with intermittent headache and vomiting. A non-enhanced brain tomography, a shunt trajectory X-ray and an abdominal ultrasound revealed no cause of system malfunction. In view of the persistent clinical picture, a revision of the shunt was performed, which revealed adequate intraoperative functioning. She returned with the same symptoms two weeks after surgery. The patient was obese (body mass index [BMI]: 48). We hypothesized intermittent valve malfunction due to increased intra-abdominal pressure. She underwent a ventriculoatrial shunt, without intercurrences. In the postoperative period, the patient presented transient tachycardia and was asymptomatic at the 6-month follow-up. Obesity should be considered an important variable for the inadequate functioning of the VPS due to increased IAP and catheter dystocia to the extraperitoneal cavity. Studies have already correlated the IAP with the BMI, which reaches between 8mm Hg and 12mm Hg in obese individuals. Therefore, the BMI can be considered during the selection of valve pressure in systems with non-adjustable valves to prevent insufficient drainage. The recognition of obesity as a cause of VPS malfunction is fundamental to avoid unnecessary surgeries and intermittent malfunction of the system. Resumo A derivacAo ventriculoperitoneal (DVP) e um tratamento estabelecido para a hidrocefalia; contudo, algumas variaveis podem influenciar na eficacia desta modalidade. O funcionamento do sistema requer uma diferenca de pressAo entre as cavidades craniana e abdominal. A DVP pode ser particularmente problematica em pacientes com aumento da pressAo intra-abdominal (PIA). Neste artigo, relatamos o caso de uma paciente do sexo feminino, de 16 anos, portadora de DVP desde os 2 meses de idade por hidrocefalia secundaria a mielomeningocele. Desde entAo assintomatica, procurou o pronto-socorro com queixa de cefaleia e vomitos intermitentes. Uma tomografia de cranio sem contraste, um raio X (RX) do trajeto do cateter distal, e uma ultrassonografia (USG) abdominal nAo evidenciaram a causa do mau funcionamento do sistema. Diante do quadro persistente, realizou-se uma revisAo da derivacAo, que mostrou funcionamento adequado no periodo intraoperatorio. A paciente retornou com os mesmos sintomas duas semanas apos a cirurgia. A paciente era obesa (indice de massa corporal [IMC]: 48). Aventou-se possivel funcionamento intermitente da valvula pelo aumento da PIA. A paciente foi submetida a uma derivacAo ventriculo-atrial, que foi realizada sem intercorrencias. No pos-operatorio, ela apresentou quadro transitorio de taquicardia, e nAo apresentou sintomas no acompanhamento feito depois de 6 meses. A obesidade deve ser considerada uma variavel importante para o funcionamento inadequado da DVP, pelo aumento da PIA e pela associacAo com distocia do cateter para a cavidade extraperitoneal. Estudos ja correlacionaram a PIA com o IMC, que pode atingir entre8mm Hg e 12mm Hg em obesos. Logo, o IMC pode ser considerado na selecAo da pressAo da valvula em sistemas com valvulas nAo ajustaveis, para prevenir a drenagem insuficiente. O reconhecimento da obesidade de risco para o mau funcionamento da DVP e fundamental para evitar cirurgias desnecessarias e o mau funcionamento intermitente do sistema.
- Traumatic Lumbosacral Spondyloptosis in a Pediatric Patient: Case Report and Literature Review(2018) YAMAKI, Vitor Nagai; MORAIS, Barbara Albuquerque; BROCK, Roger Schmidt; PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira de; TEIXEIRA, Manoel JacobsenA 4-year-old girl was admitted to the emergency department after having been buried beneath a wall. A computed tomography scan revealed anterior grade V L5-S1 spondylolisthesis, and magnetic resonance imaging showed a traumatic rupture of the fibrous annulus of the L5-S1 intervertebral disc and lesion of the anterior longitudinal and yellow ligaments. The patient underwent anterior and posterior fixation. Four months later she was able to walk independently, despite a persistent left foot drop. Additionally, we conducted a literature review on lumbosacral spondyloptosis in the pediatric population published between 1990 and 2017. We found 16 cases, 86.6% of which were male, with a mean patient age of 16 +/- 5.05 years. Most patients underwent spine instrumentation. Based on the data reviewed, the neurological status at admission might be a valid predictor of outcome. Pedicle screws are a safe and reliable procedure for stable fixation of the spine in these cases. The removal of screws is discouraged. (c) 2018 S. Karger AG, Basel.
- Post-traumatic carotid-cavernous fistula in a pediatric patient: a case-based literature review(2018) MORAIS, Barbara Albuquerque; YAMAKI, Vitor Nagai; CALDAS, Jose Guilherme Mendes Pereira; PAIVA, Wellingson Silva; MATUSHITA, Hamilton; TEIXEIRA, Manoel JacobsenCarotid-cavernous fistula (CCF) is a shunt between the carotid artery and the cavernous sinus. Traumatic CCFs are diagnosed in 0.2% of head traumas being only 4.6% of the pediatric population. Classified by Barrow in 1985, type A CCF is the most frequent, occurring in 75% of cases. Type A is characterized by direct and high-flow CCF that generally can occur as a result of traumatic injury or rupture of an intracavernous aneurysm. The subject was an 8-year-old boy with penetrating trauma to his left eye. During the initial evaluation, a computed tomography (CT) scan was unremarkable, and after relief of symptoms, the patient was discharged. Seven days later, he developed grade I proptosis, conjunctival chemosis, ophthalmoplegia (III, IV, and VI cranial nerve palsies), and left-sided ptosis and mydriasis. Arteriography confirmed a post-traumatic CCF, and the patient was treated with an endovascular detachable balloon. CCF should be suspected in craniofacial traumas with ocular symptoms. The presence of a skull base fracture on CT is a poor predictor of CCF associated with head trauma. Early diagnosis and treatment can prevent permanent neurological deficits and unfavorable outcomes.