Volumes de hematomas em hemorragias intracerebrais espontâneas: o método da elipse (ABC/2) produziu volumes inferiores do que aqueles determinados pelo método planimétrico Intracranial hypertension is considered the main reason for surgical indication in subjects with ICH, especially in cases in which there is a progressive neurological deterioration 5,6 . The ABSTRACT Objective:To compare two different methods for measuring intracerebral hemorrhage (ICH) volume: the ellipse volume (called ABC/2), and the software-aided planimetric. Methods: Four observers evaluated 20 brain computed tomography (CT) scans with spontaneous ICH. Each professional measured the volume using the ABC/2 and the planimetric methods. The average volumes were obtained, and the intra-and inter-rater variability was determined. Results: There is an absolute 2.24 cm 3 average difference between both methodologies. Volumes yielded by the ABC/2 method were as much as 14.9% smaller than by the planimetric one. An intra-observer variability rate of 0.46% was found for the planimetric method and 0.18% for the ABC/2. The inter-observer rates were 1.69 and 1.11% respectively. Conclusions: Both methods are reproducible. The ABC/2 yielded hemorrhage volumes as much as 14.9% smaller than those measured using the planimetric methodology.Key words: cerebral hemorrhage, tomography, evaluation studies. RESUMO Objetivo:Comparar dois métodos diferentes para determinar o volume da hemorragia intracerebral: volume da elipse (chamado ABC/2), e método planimétrico auxiliado por computador. Métodos: Quatro diferentes observadores avaliaram as imagens de 20 tomografias cerebrais com diagnóstico de hemorragia intracerebral espontânea. Cada profissional determinou o volume da hemorragia usando os dois métodos. Foram comparadas as médias dos volumes obtidos, bem como suas variabilidades intra e interobservadores. Resultados: Foi observada diferença estatisticamente significativa entre os volumes calculados por meio dos dois métodos, com uma variação média absoluta de 2,24 cm 3 e com volumes até 14,9% menores para o método ABC/2. A média da variabilidade intraobservador foi de 0,46% para o método planimétrico e 0,18% para o ABC/2. As taxas de variabilidade interobservador foram de 1,69 e de 1,11%, respectivamente. Conclusões: Ambos os métodos são reprodutíveis. O volume determinado pelo ABC/2 pode ser até 14,9% menor que aquele determinado pelo método planimétrico.Palavras-Chave: hemorragia cerebral, tomografia, estudos de avaliação.

PHACE(S) syndrome is a neurocutaneous syndrome with a wide array of presentations. The most known and present trait is facial hemangioma > 5 cm. The name is an acronym for Posterior fossa malformations, infantile Hemangiomas, Arterial anomalies, aortic Coarctation, Eye abnormalities, and middle-line malformations of the Sternum. The exact etiopathogenic mechanism of this syndrome is not fully understood, and its treatment depends on detailed and individualized assessment. The aim of this paper is to describe a child with a throat hemangioma, vascular malformations, cognitive delay, and other anomalies to illustrate the neuroimaging found in this syndrome.

The dural sinus malformation (DSM) are rare congenital vascular anomalies with variable anatomic features, clinical conditions, and outcomes. There are two forms of disease: a lateral subtype, affecting the jugular bulb with associated high flow arteriovenous fistula; and a midline subtype, called torcular DSM. The torcular subtype is more common and characterized by a giant dural sinus lake involving the confluens sinuum (torcular Herophili). We present a case of a 28-year-old woman with an ultrasound at 32 weeks’ gestation showing a fetal intracranial thrombosed lesion, measuring 6x4 cm. An elective c-section was performed at 38 weeks’ gestation, and a male neonate was born. He remained asymptomatic, and a brain MRI performed 9 days later showed a thrombosed midline mass due to a torcular DSM. The outcome with conservative treatment was favorable, and further development was unremarkable. The 2-year follow-up imaging demonstrated spontaneous involution of the clot. The torcular DSM is frequently diagnosed prenatally as an intraluminar lake thrombosis, and differential diagnosis include tumors, subdural collections, vein of Galen aneurysmal malformations, pial malformations, arachnoid and dermoid cysts. A literature review involving 126 patients with torcular DSM found an overall mortality of 22.1%. Torcular DSM seems to have better prognosis than those having dural arteriovenous shunts, and the worst outcomes were associated to brain damage and patent feeders. In addition, antenatal diagnosis and thrombosis of pouch have good prognosis, possibly because the clot may spontaneously obliterate the fistulas. Treatment options must be individualized, and include conservative, embolization, ventriculoperitoneal shunt and endoscopic third ventriculostomy. Although systemic anticoagulation is controverse in infants, it should be considered for patients with sinovenous thrombosis affecting outflow pathways, especially those aggravated by venous congestion. Intervention is recommended for grade III patients because they progress to grade IV, and endovascular treatment is the gold standard therapy due to the risk of fatal intraoperative exsanguination. Whenever possible, embolization should be prioritized over hydrocephalus treatment because it may avoid ventriculoperitoneal shunt. Close follow-up imaging is recommended to detect any changes, with lesion reduction indicating favorable outcome.

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