Resumo em Inglês:

The authors outline the development of the spine and skull, particularly of axis, atlas and occipital bone. As neuro-skeletal dysmorphisms, the occipito-cervical malformations belong to the neurodysplastic group. They are classified as skeletal anomalies, associated nervous malformations and meningeal reactions. Vertebralization of the occipital bone and occipitalization of atlas, subluxation of odontoid process, dysplasia of the occipital bone, dystrophia brevicollis and other anomalies are discussed. Special care is given to the study of basilar impression; its concept, history, incidence, clinical and neurological symptoms, radiological characterization (craniographic, perimyelographic and iodoventriculographic aspects) and surgical treatment are reviewed. The authors report five cases of occipito-cervical malformations, which are the first references in Brazilian literature. In case 1 the anomalies (manifestation of occipital vertebra and Arnold-Chiari deformity) were disclosed at an operation for cisticercosis of the posterior fossa. In the following four cases invagination of the basilar portion of the occipital bone (basilar impression) could be radiologically demonstrated; in case 2 a suboccipital craniectomy and a laminectomy of atlas and axis were performed but the patient died a week later and the necroscopic examination confirmed the neuro-skeletal anomalies. In all cases there were several associated malformations. In case 2 there were occipitalization of the atlas, fusion of the first and second cervical vertebrae, supernumerary rib of the seventh cervical vertebra, supernumerary lumbar vertebra, and Arnold-Chiari deformity; at necropsy it was found a syringomyelic cyst on the cervical cord and a fibrous dural ring over the foramen magnum. Case 3 showed the syndrome of Klippel-Feil, besides supernumerary ribs of the seventh cervical and first dorsal vertebrae, Arnold-Chiari malfotmation and probable aplasia of cell groups in the nuclei of oculomotor and facial nerves. In case 4 there were occipitalization of atlas and Chiari deformity. In case 5 vertebral reduction in the cervical region was evidenced but bony coalescence could not be proved. In the last four cases the constitutional morphologic type was determined. Electroencephalograms of cases 3, 4 and 5 showed no abnormalities; in case 1 slow bilateral occipital waves were recorded. The authors call attention to the importance of the diagnosis of these anomalies susceptible of successful surgical correction, which can simulate many nervous diseases of untoward course, like lateral amyotrophic sclerosis, syringomyelia (which can be actually associated to the bony anomaly, as in case 2), sclerosis of dorsal funiculi of the spinal cord, tabes, multiple sclerosis, heredocerebellar ataxia, etc. The authors also stress the clinico-radiological differences between basilar impression and platybasia, frequently taken as synonyms. Although both anomalies may coexist (as in cases 4 and 5) their association is not an absolute rule; on the contrary, in case 2 the basal angle was in the inferior limit of normality and in case 3 it was much lower. Emphasis is put on the value of the Chamberlain's line and chiefly in the McGregor basal line for the correct diagnosis of basilar invagination of the occipital bone.

Resumo em Português:

Mil casos de tuberculose foram revistos neste trabalho. Quanto ao comprometimento de todos os órgãos, foram encontrados 21 casos de tuberculoma do cérebro, 4 do cerebelo e 40 casos de meningite. E' interessante observar que, enquanto em 607 casos de infecção tuberculosa foram encontrados três órgãos envolvidos por caso, quando havia tuberculose do sistema nervoso a relação era de 4:1; como conseqüência, pode-se afirmar que, quando ocorre uma disseminação da tuberculose, há maior probabilidade de infecção do sistema nervoso. Examinando os diferentes órgãos nos casos em que havia lesões do sistema nervoso foi encontrada infecção dos gânglios linfáticos em 18,45%, dos pulmões em 15,13% e das pleuras em 9,25%; em segundo plano vêm o fígado (8,86%), o baço (8,86%) e os rins (6,67%); num terceiro grupo, as suprarrenais (2,58%), a próstata (2,58%), o peritôneo (2,21%) e o pericárdio (2,21%). A afecção dos outros órgãos foi menor. Por essa estatística pode-se dizer que a infecção de gânglios, especialmente dos localizados nos hilos pulmonares, predispõe à infecção do sistema nervoso. Em relação à idade, o máximo de infecção se acha entre 10 e 19 anos. Havia meningite tuberculosa em 40 casos de tuberculose miliar.

Resumo em Espanhol:

Para efectuar este trabajo, se han revisado 1.000 exámenes post-morten, se habiendo encontrado lesiones tuberculosas en 607 casos (60,7%). La infección del sistema nervioso en estos mismos casos estaba representada por 40 casos de meningitis, 21 tuberculomas del cerebro y 4 del cerebelo. En los 607 casos de tuberculosis se ha visto que la enfermedad ha afectado en una proporción de tres órganos por paciente. Cuando se hace esta misma comparación en los que han presentado lesiones en el sistema nervioso, se ve que la proporción es de cuatro, hecho que permite afirmar que, cuando la infección tuberculosa es más diseminada y mayor el número de órganos afectados, mayores son las probabilidades de extensión del proceso al sistema nervioso. Examinando los diferentes órganos en los 65 casos con lesiones en sistema nervioso, se nota un gran predominio de la infección en los gânglios (18,45%), principalmente en los ganglios del hilio pulmonar, hecho que facilita la infección del cerebro y de las meninges, por Ias relaciones anatómicas de dichos órganos con los grandes vasos por los que se realiza la diseminación hematógena. Además, las adenitis hiliares van a la caseosis en una alta proporción de casos (40% en 40 de meningitis tuberculosa presentados en este relato). En relación a la edad, el mayor número de casos se hallaron entre los 10 a los 19 años.

Resumo em Inglês:

In this work, 1,000 cases of tuberculosis are reviewed. In relation to the infection of all organs, 21 cases of tuberculomata of the brain, 4 of the cerebellum and 40 cases of meningitis were found. It was interesting to find out that, while in 607 cases of tuberculous infection there were 3 organs per case involved, when there was tuberculosis of the nervous system the relation was 4 to 1; as a consequence, we can affirm that, when there is a dissemination of tuberculosis, there are more chances of infection of the nervous system. On examining the different organs that were affected on the nervous system cases, we found infection of the lymphatic glands on 18.45%, lungs 15.13% and pleuras 9.25%; in the second place comes the liver with 8.86%, spleen 8.86%, kidneys 6.64%; in a third group the adrenals with 2.58%, prostate 2.58%, peritoneum 2.21% and pericardium 2.21%. In the rest of organs the rate of infection was lesser. From this statistics, we can state that the infection of the ganglia, especially the ones that are located on the hila of the lungs, predisposes to the infection of the nervous system. In relation to age, the maximum of infection was between 10 and 19 years. In 40 cases of tuberculous meningitis, we found miliary tuberculosis in 14 (35%).