Penetrating spinal injuries by wooden foreign body (WFB) is rare 1 . We present a 52 year-old man with a cervical spine injury by a WFB, identified 172 days after the accident, with an intramedullary abscess. Surgical intervention and antibiotic treatment led to neurological improvement. CASEA 52 year-old man had fallen from a horse on May 29, in 2008, with a penetrating injury from a piece of wood below the angle of the left mandible causing prompt change in sensibility and strength in his left side. He underwent a superficial exploration and suture in the local hospital. Neurological deficits evolved over time to loss of independent gait and severe functional limitations of the upper limbs, particularly the left.He was admitted on October 13, in 2008, without signs of inflammation, dehiscence, or cerebrospinal fluid (CSF) fistula in the neck. Neurological examination showed tetraparesis, predominantly on the left side, and hyperreflexia in lower limbs with preserved vibration and position sensation in all four limbs. He was only able to walk with great difficulty if supported by two helpers. Bladder and bowel functions were normal.The magnetic resonance image (MRI) revealed spinal cord edema and a heterogeneous intramedullary lesion at C4-C5 level, with ring like post-contrast enhancement, consistent with an abscess (Fig A and B). There was a hypointense linear image within the left C4-C5 intervertebral foramen with intramedullary extension and hyperdense on computed tomography, measuring 3.0 cm, consistent with a WFB. It transfixed the ipsilateral vertebral artery, which was obliterated (Fig C and D).The WFB was surgically removed (Fig E). Purulent matter was drained from location, where the WFB had been lodged. Lab work showed the presence of Staphilococcus epidermiditis, and the patient was treated with oxacillin. At the latest outpatient follow-up visit on January 18 th , 2011, he was independent for activities of daily living, walking without any aid, with intact sphincter control. DISCUSSIONNon-missile penetrating spinal injuries are more commonly caused by stabs 2 . WFB is rarely reported as the cause of this type of injury 1 . Since the wood is an optimal source of infection due its porous, soft, organic, and vegetable nature, spinal infectious complications are prone to occur 1,3 . Foreign body reaction, another inflammatory complication, may lead to long-term neurological worsening 1 .CT and MRI are essential to evaluate spinal cord and the presence of a foreign body in penetrating spinal injuries. The density of wood on CT is highly variable and depends on its type and hydration status, as well as on the length of stay in the body 4 . This latter factor may explain the increased density of the wooden fragment in this patient. MRI is mandatory in non-missile penetrating spinal injuries for the diagnosis of associated lesions 5 , whenever a metallic foreign body has been excluded or removed 2 . Even when CT is negative, MRI should be performed to exclude retained foreign bodies 1 .Treatment of penetra...

Intramedullary tumors are rare. The authors reviewed 24 cases operated between 1996 and 2006. The study assessed the clinical characteristics and surgical results based upon the neurological function. Method: Medical records of patients with intramedullary astrocytoma and ependymoma were reviewed. The minimal follow up time was 6 months and, at the end of this period, a comparative analysis of the neurological function was performed based using the McCormick scale score. results: Most patients had astrocytoma (75%). Male gender was more prevalent (58.3%). The most common type of tumor was graded as I or II, and in three cases these were malignant. The total resection of the tumor was achieved in 20.8% of the cases. The statistical analysis did not show a statistically significant difference between preoperative and postoperative grades at McCormick scale. conclusion: The authors concluded that microsurgery to intramedullary tumors did not significantly alter the neurological function after six months. Key words: astrocytoma, ependymoma, microsurgery, spinal cord.tumores intramedulares em crianças: análise de 24 casos operados resuMo Os tumores intramedulares são doenças raras. Os autores analisaram 24 casos operados entre 1996 e 2006. O estudo analisou as características clínicas e o resultado da cirurgia quanto à função neurológica. Método: Foram analisados pacientes com astrocitomas e ependimomas intramedulares. O tempo mínimo de acompanhamento foi de 6 meses e ao final deste período foi realizada a avaliação comparativa da variação do estado neurológico baseado na escala de McCormick. resultados: A maioria dos pacientes era de astrocitoma (75%). O gênero masculino foi mais prevalente (58,3%). A maioria dos tumores era de grau I ou II, 3 casos eram malignos. A ressecção total do tumor ocorreu em 20,8% dos casos. A avaliação estatística demonstrou que não houve diferença significativa entre o estado neurológico na escala de McCormick pré-operatória e pós-operatória. conclusões: Os autores concluem que a microcirurgia para ressecção dos tumores intramedulares não ocasionou variação funcional significativa nos pacientes após seis meses da cirurgia. Palavras-chave: astrocitoma, ependimoma, microcirurgia, medula espinhal.

RESUMO -Através de estudo prospective) foram acompanhados 21 casos de acidente vascular de tronco encefálico, durante 12 meses, entre 1991 e 1992. O objetivo foi observar a relação entre o tipo de lesão, a apresentação clínica e a evolução. Com o exame neurológico, a tomografia computadorizada (CT) e, em alguns casos, angiografia e ressonância magnética (MRI) demonstrou-se a topografia da lesão. A hemorragia pontomesencefálica foi o achado mais freqüente. A hipertensão arterial sistêmica estava presente em 67% dos casos e a sexta década de vida foi a mais atingida. Todos os pacientes receberam tratamento clínico visando as doenças associadas. Utilizou-se o Glasgow Outcome Scale (GOS) para avaliar a evolução: 28% tiveram GOS 5, 24% GOS 4, 5% GOS 3, 28% GOS 2 e 14% GOS 1. Notou-se, por esta experiência, tratar-se de uma patologia grave e com várias formas de apresentação. Quando o paciente foi admitido em coma e com lesão mista, a evolução foi desfavorável (p < 0,01). Muitas vezes foi difícil correlacionar os casos com as descrições clássicas da literatura, por isto chamamos a atenção para o fato de que se deva observar individualmente as características de cada caso. PALAVRAS-CHAVE: acidente vascular de tronco encefálico, síndromes de tronco encefálico.Ischemic strokes and hemorrhages of the brain stem: study of 21 cases SUMMARY -A prospective study was designed to follow patients with syndromes of brain stem during 12 months (in 1991-1992). The aim was to correlate clinical and radiologic findings and comparing them with the classical descriptions of brain stem syndromes. Twenty one consecutive patients were admitted at the Hospital de Base do Distrito Federal. The diagnosis and the follow up were carried out by neurological examination and neuroradialogic images: CT (100%), angiography (24%, S) and MRI (5%, 1). Hypertension and old age were the most important risk factors and hemorrhage at pons with extension to midbrain was the most frequent finding. Coma at admission was associated to a poor outcome. The outcome was defined by the Glasgow Outcome Scale: 28% rated S, 24% rated 4, 5% rated 3; 28% rated 2 and 14% rated 1. Our results show that the clinical presentation of ischemic strokes and hemorrhages of the brain stem very frequently follow a mixed pattern, which do not conciliate with the classical descriptions of these syndromes.KEY WORDS: ischemic stroke, hemorrhage, brain stem.As lesões do tronco encefálico são usualmente caracterizadas pelas síndromes alternas, comprometendo nervos cranianos e longas vias. A manifestação clínica corresponde à região do tronco acometida, tendo como causa, muitas vezes, eventos isquêmicos, auto-imunes, inflamatórios e infecciosos 17 . Os acidentes hemorrágicos são importantes, porque afetam uma região ampla do tronco determinando um prognóstico reservado.

Resumo Objetivo: Os autores realizaram uma avaliação comparativa entre a abordagem anterior e posterior do nervo acessório para transferência nervosa para o nervo supraescapular. Método: Foram estudados pacientes submetidos à neurotização do nervo supraescapular utilizando como doador o nervo acessório, no período de janeiro de 2007 a janeiro de 2010. Os registros cirúrgicos foram avaliados para analisar as vantagens e desvantagens das duas formas de abordagem desses nervos na cirurgia. Foram avaliados os marcos anatômicos utilizados para a localização dos nervos durante a cirurgia e as dificuldades ocorridas nas duas formas de abordagem. Resultados: Foram estudados ao todo 29 pacientes, sendo que 22 deles foram abordados pela via anterior e sete por via posterior. A localização do nervo supraclavicular foi considerada mais fácil pela via posterior, enquanto a localização do nervo acessório foi feita mais rapidamente pela via anterior. Em nenhuma das cirurgias foi necessária a interposição de enxerto nervoso. Não ocorreram complicações cirúrgicas nas duas técnicas. Conclusão: A análise comparativa das duas abordagens cirúrgicas demonstra que a anatomia desses dois nervos é importante fator na dificuldade técnica apresentada na cirurgia. Novos estudos devem analisar se há uma melhora dos resultados funcionais com a abordagem pela via posterior.

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