-Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case of a 64 yearold woman who suffered a spontaneous cerebellar hemorrhage, treated conservatively, and presented 1 month later with a chronic subdural posterior fossa hematoma.KEY WORDS: intracranial hematoma, subdural hematoma, posterior fossa.Hematoma subdural crônico de fossa posterior associado a hemorragia cerebelar espontânea: relato de doença rara com achados de RNM RESUMO -Hematomas subdurais da fossa posterior são lesões raras, mais comumente relacionadas com traumas graves. A ocorrência de hematomas subdurais crônicos na fossa posterior é muito rara, sendo descritos 15 casos até o momento, boa parte relacionada ao uso de anticoagulantes. Em nossa revisão da literatura, não pudemos encontrar nenhum relato da associação entre hematoma subdural crônico da fossa posterior e hemorragia cerebelar espontânea. Relatamos o caso de paciente de 64 anos com hematoma intraparenquimatoso cerebelar tratado conservadoramente e hematoma subdural crônico, tratado cirurgicamente, cerca de 1 mês após o acidente vascular cerebelar. PALAVRAS-CHAVE: fossa posterior, hematoma subdural, hematoma intracraniano.Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case in a woman. CASEA 64-year-old hypertensive woman presented to another emergency service 15 days before admission to our hospital with a history of sudden headache and gait disturbance. Her hypertension was well controlled with regularly taken antihypertensive medications. She was submitted to a CT scan of the head and treated conservatively with diagnosis of spontaneous cerebellar hemorrhage, and discharged five days after without intercurrences. Fifteen days later, she presented to our outpatient clinic with complaints of continuous headache, somnolence and urinary incontinence. Another CT scan was performed and showed hydrocephalus, and a ventriculoperitoneal shunt was inserted (Fig 1). On the first postoperative day, the patient presented with somnolence, slurred speech, incoordination and ataxia. A MRI (Figs 2 and 3) showed a right posterior fossa extra-axial hematoma, hyperintense both on T1 and T2 sequences, compressing the right cerebellar hemisphere, and a small, contiguous, intraparenchymal right cerebellar hematoma in subacute fase, with some edema; MRI angiography was normal. The patient was taken to the operating room. A suboccipital right craniectomy ...

-Hemangioblastomas of the spinal cord are rare lesions, and those located at the cauda equina are even rarer. Most commonly these tumors are present in patients with von Hippel-Lindau (VHL) syndrome. We describe here the case of a 48 years old woman with a pure radicular hemangioblastoma, not associated with VHL, presenting with radicular pain, diagnosed with magnetic ressonance imaging (MRI) and submitted to total resection with a very good outcome. To our knownledge, this is the second report to describe the MRI aspect of histologically proved hemangioblastoma of the cauda equina in a patient without clinical criteria for VHL.KEY WORDS: cauda eqüina, hemangioblastoma, Von Hippel-Lindau syndrome.Hemangioblastoma da cauda equina: relato de caso Hemangioblastoma da cauda equina: relato de caso Hemangioblastoma da cauda equina: relato de caso Hemangioblastoma da cauda equina: relato de caso Hemangioblastoma da cauda equina: relato de caso RESUMO -Hemangioblastomas da medula espinhal são lesões raras, sendo sua localização na cauda equina ainda mais incomum. Estes tumores são diagnosticados com mais frequência em pacientes portadores da síndrome de Von Hippel-Lindau. Descrevemos o caso mulher de 48 anos hemangioblastoma radicular na cauda equina, diagnosticado com ressonância nuclear magnética, não associado à síndrome de Von HippelLindau, tratado cirurgicamente com ótimo resultado. Em nossa revisão, este é o segundo relato de diagnóstico com ressonância nuclear magnética de hemangioblastoma da cauda equina em paciente sem critérios clínicos da síndrome de Von Hipppel-Lindau. PALAVRAS-CHAVE: cauda equina, hemangioblastoma, síndrome Von Hippel-Lindau. Hemangioblastomas represents about 1.6 to 2.1% of all spinal cord tumors. Extramedullary-intradural hemangioblastomas are rarer, representing only one fifth of all spinal hemangioblastomas. One recent report suggested that the number of reported cases of hemangioblastoma of the cauda equina may be as low as 40. Most commonly, these lesions are associated with VHL disease, an heredo-familial autosomal dominant genetic disease with incomplete penetrance [1][2][3][4][5][6] . We relate here a case of an hemangioblastoma of the cauda equina, diagnosed in a patient without clinical criteria to VHL disease, and show the aspects of MRI imaging of this rare disease. CASEA 40-years-old woman presented with left leg paresthesia for twenty days prior to hospital admission. Her physical examination showed a discrete weakness for left leg extension, patelar arreflexia and hypoestesia in the medial side of the same leg. The CT scan and eletromyography were unremarkable, and MRI showed an intradural, hyperintense lesion, with brightly enhancing after gadolinium infusion, at the aproximated level of the L2-L3 disc space (Figs 1 and 2). The patient was submitted to a L2-L3 laminectomy and complete ressection of a reddish-brown, highly vascular lesion. The tumor was attached to some radiculae of the fourth left lumbar root, but a total removal was acomplished. In the immediate p...

-Spontaneous subarachnoid hemorrhage accounts for 5 to 10 % of all strokes, with a worldwide incidence of 10.5 / 100000 person/year, varying in individual reports from 1.1 to 96 /100000 person/year. Angiographic and autopsy studies suggest that between 0.5% and 5% of the population have intracranial aneurysms. Approximately 30000 people suffer aneurysmal subarachnoid hemorrhage in the United States each year, and 60% die or are left permanently disabled. We report our experience in the surgical treatment of intracranial aneurysms in a six year period, in Belo Horizonte, Minas Gerais, Brazil. We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 1997 to January 2003. Four hundred and seventy-seven patients were submitted to 525 craniotomies for treatment of 630 intracranial aneurysms. The majority of patients were female (72.1%) in the fourth or fifth decade of life. Anterior circulation aneurysms were more common (94.4%). The most common location for the aneurysm was the middle cerebral artery bifurcation. The patients were followed by a period from 1 month to 5 years. The outcome was measured by the Glasgow Outcome Scale (GOS). At discharge, 62.1% of the patients were classified as GOS 5, 13.9% as GOS 4, 8.7% as GOS 3, 1.7% as GOS 2 and 14.8% as GOS 1.KEY WORDS: aneurysm, subarachnoid hemorrhage, stroke. Tratamento cirúrgico dos aneurismas intracranianos: experiência de seis anos em Belo Horizonte, MG, BrasilRESUMO -A hemorragia subaracnóidea espontânea é responsável por cerca de 5 a 10% de todos os acidentes vasculares cerebrais, com uma incidência mundial de 10,5 / 100000 pessoas/ano, variando em estudos individuais de 1,1 a 96 / 100000 pessoas / ano, de acordo com diferenças étnicas e geográficas. Estudos angiográficos e de necropsia sugerem que a presença de aneurismas intracranianos ocorre em 0,5-5% da população mundial. De acordo com estatísticas norte-americanas, ocorrem cerca de 30000 rupturas de aneurisma cerebral por ano naquele país, com conseqüências desastrosas para grande parte dos pacientes: cerca de 60% morrem ou permanecem com seqüelas neurológicas graves. Relatamos a experiência do nosso serviço num período de seis anos no tratamento dos aneurismas intracranianos em Belo Horizonte, Minas Gerais. Foram revistos os prontuários e descrições de cirurgia de todos os pacientes operados para tratamento de aneurismas intracranianos no período de janeiro de 1997 a janeiro de 2003. Quatrocentos e setenta e sete pacientes foram submetidos a 525 procedimentos cirúrgicos para tratamento de 630 aneurismas. A maior parte dos pacientes era do sexo feminino, na quarta e quinta décadas de vida. Aneurismas de circulação anterior foram mais freqüentes, e a localização mais comum foi a artéria cerebral média. O período de seguimento dos pacientes variou de um mês a 5 anos. A avaliação do resultado foi feita de acordo com a "Glasgow Outcome Scale" (GOS) por ocasião da alta hospitalar, com 296 pacientes em GOS 5 (6...

-Extradural hematoma (EDH) is a frequent lesion, with an incidence varying from 0.2 to 6% in patients admitted to hospital due to traumatic head injury. The higher incidence is found in patients with more severe injuries. The association of EDH with subperiosteal intraorbital hematomas is rarely reported, and we were not able to find in the literature any report of traumatic bilateral intraorbital hematomas and EDH. We report this case of a 32 year-old man with bilateral intraorbital (subperiosteal) hematoma associated with unilateral EDH. The lesions were treated surgically, but unfortunately with an unfavorable outcome.KEY WORDS: extradural hematoma, head trauma, orbital hematoma. Hematoma intraorbitário bilateral traumático associado a hematoma epidural: relato de casoRESUMO -Hematomas epidurais (HE) são lesões frequentes, com incidência entre 0,2 a 6% em pacientes internados após traumatismo cranioencefálico, sendo a maior incidência associada a pacientes portadores de traumas mais graves. A associação entre o HE e o hematoma intraorbitário é rara, sendo que não conseguimos encontrar na literatura nenhum relato de HE e hematoma intraorbitário bilateral. Relatamos o caso de um paciente de 32 anos com HE associado a hematoma intraorbitário bilateral, tratados cirurgicamente. PALAVRAS-CHAVE: hematoma epidural, hematoma intraorbitário, traumatismo cranioencefálico.