BackgroundParadoxical embolism due to pulmonary arteriovenous malformations is the main mechanism of brain infarction in patients with hereditary hemorrhagic telangiectasia. International Guidelines have recently been published to clarify the performance of screening tests and the effectiveness of treatment for pulmonary arteriovenous malformations.Case PresentationWe present two cases of hereditary hemorrhagic telangiectasia patients of our hospital who experienced an acute stroke secondary to paradoxical embolism.ConclusionsThese two cases show that the guidelines must be followed to prevent the occurrence of ischemic stroke in patients with hereditary hemorrhagic telangiectasia, and that although they may be adequate in most cases, there are some patients who need a more personalized approach.

The diagnosis of parkinsonism is established by the presence of tremor, stiffness and bradykinesia alongside with neurological examination, requiring the exclusion of secondary causes such as stroke, hydrocephalus and infectious diseases. Included in this last category, neurocysticercosis is a disease caused by Taenia solium, with a variable clinical presentation that can include epileptic seizures, hydrocephalus and rarely parkinsonism. In the reported case, the syndrome is a consequence of lesions in the nigrostriatal dopaminergic pathway caused by the implant and mass effect of the cysticercus. The authors report a case of parkinsonism in a 59-year-old woman with a previous history of neurocysticercosis who presented with hydrocephalus on magnetic resonance imaging exam. The patient was treated with pharmacological therapy and ventriculoperitoneal shunt, progressing with amelioration of the symptoms presented.

BackgroundCerebral venous thrombosis (CVT) is a rare disease that frequently occurs in young women of childbearing age, with variable clinical presentation in regions with limited access to diagnostic imaging or specialized neurological care. In the last decade, there has been an increase in the number of studies on CVT in Latin America, which may contribute to a better epidemiological description of the disease in this region and, consequently, its early diagnosis.ObjectivesOur study aims to review the risk factors, clinical and radiological characteristics of CVT in Latin America, being critically compared with data from world literature.MethodsPubMed, ScienceDirect, BVS, and Scopus were searched to identify studies reporting CVT in Latin American countries published up to July 2022. We excluded case reports and case series reporting <5 patients later in the final analysis.ResultsWe identified a total of 3714 studies and 26 qualified for the quantitative analysis, which described 1486 cases of CVT. Headache was the most frequent symptom (82.1%) and the use of oral contraceptives in women was the main risk factor (46.7%). The transverse sinus was the most frequent location of the thrombus (52%). The treatment used most in the acute phase was heparin (88.5%) and oral anticoagulation was widely used at hospital discharge (67.8%). The mortality was low (6.5%), and most patients achieved complete recovery (75.3%).ConclusionDespite considerable dissimilarities in studies between countries, particularities were identified in the risk factors of CVT in Latin America compared to other regions of the world.

No abstract

RESUMO -Apresenta-se o caso de mulher de 60 anos com doença renal policística autossômica dominante (DRPAD) que desenvolveu quadro de cefaléia e oftalmoplegia completa à direita. A TC levantou a hipótese de um aneurisma gigante do segmento intracavernoso da carótida interna direita, o que foi confirmado pela arteriografia. Realizou-se, então, tratamento endovascular por oclusão do vaso parental com molas destacáveis no segmento supraclinóideo. A paciente evoluiu com a interrupção da cefaléia e com redução parcial da ptose e da oftalmoplegia. Neste artigo, enfatiza-se a relação entre DRPAD e aneurismas intracranianos. Comenta-se a história natural dos aneurismas originados no segmento intracavernoso da artéria carótida interna e comparam-se as opções terapêuticas no manejo destas lesões.PALAVRAS-CHAVE: aneurisma intracraniano, doença renal policística autossômica dominante, artéria caró-tida interna intracavernosa, aneurisma gigante, tratamento endovascular. Giant aneurysm of the intracavernous internal carotid artery associated with autosomal dominant polycystic kidney disease: case reportABSTRACT -We report the case of a 60 years-old woman with autosomal dominant polycystic kidney disease (ADPKD) that presented with headache and right complete ophthalmoplegia. The CT scan raised the possibility of a giant aneurysm of the right intracavernous internal carotid artery, confirmed by angiography. The patient underwent endovascular occlusion of parent vessel with detachable coils, then she presented interruption of headache and partial recovery of ptosis and ophthalmoplegia. We emphasize the relationship between ADPKD and intracranial aneurysms. We also discuss the natural history and compare the therapeutic options for the management of giant aneurysms of the cavernous portion of the carotid artery.KEY WORDS: intracranial aneurysm, autosomal dominant polycystic kidney disease, intracavernous internal carotid artery, giant aneurysm, endovascular treatment.A prevalência de aneurismas intracranianos na população em geral é de aproximadamente 2% 1 . Entre eles, 3-5% ocorrem na porção intracavernosa da artéria carótida interna 2 . Aproximadamente um terço dos pacientes com aneurismas intracavernosos são assintomáticos ao diagnóstico, um terço tem cefaléia e metade tem alguma anormalidade de nervo craniano (III, IV, V 1 , V 2 e VI) 3 . Esses aneurismas podem, com menor freqüência, promover sintomas também por meio de ruptura, o que pode conduzir a uma fís-tula carótido-cavernosa, a uma hemorragia subaracnóidea (HSA) ou, ainda, a uma grave epistaxe 4,5 . Das numerosas doenças hereditárias do tecido conjuntivo que têm sido associadas com aneurismas intracranianos, as mais importantes são a doença renal policística autossômica dominante (DRPAD), a síndrome de Eh-