Revisão de 840 casos de pacientes submetidos a intervenções neurocirúrgicas na Unidade de Neurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo durante 5 anos (1962-1967) para verificar a incidência de reações inflamatórias leptomeníngeas (RIL) no pós-operatório. Em 106 casos (12,6%) foi demonstrada a ocorrência de RIL. O diagnóstico de RIL foi comprovado pelo quadro liquórico; em apenas um caso êle resultou dos achados do exame necroscópico exclusivamente. Analisando os 105 casos em que o LCR foi estudado verificou-se ser a hipertermia, a cefaléia, os sinais meníngeos e as alterações da consciência os sintomas que com mais freqüência sugeriam o diagnóstico; este foi comprovado em média 10 dias após o ato cirúrgico, mediante o exame do LCR. Baseando -se nas alterações do LCR os casos foram divididos em três grupos: RIL provavelmente asséptica (72 casos), RIL provavelmente séptica (26 casos), RIL sépticas (7 casos). Em 59 casos associava-se à RIL hemorragia sub-aracnóidea, dado considerado indicativo de gravidade, pois dos 24 pacientes que vieram a falecer, 20 apresentavam hemorragia sub-aracnóidea e RIL.

Data concerning to 840 patients submitted to neurosurgical operations during 5 years (1962-1967) were reviewed in order to verify the occurrence of acute inflammatory leptomeningeal reactions (RIL) in the immediate post -operative period. It was verified that RIL occurred in 106 cases (12,6%). In one case the demonstration was made at the necroscopic examination; in 105 cases the demonstration was based in the cerebrospinal fluid (CSF) examination. Clinical and CSF data concerning to the last 105 cases were studied. It was shown that fever, headache, meningism and changes in consciousness were the symptoms that most commonly suggested the diagnosis. Symptoms were more conspicuous about the tenth day (mean) of the post-operative period. Considering the CSF changes found, the cases were divided in three groups: probably aseptic RIL (72 cases), probably septic RIL (26 cases) and septic RIL (7 cases). Only in the last group the bacteriological examination of the CSF sample was positive. In 59 cases there occurred the association of RIL and sub-arachnoid haemorrhage. The severity of this association was pointed out based upon the incidence of deaths among the patients studied. Twenty four patients have died; in 20 the RIL and subarachnoid haemorrhage association has occurred.

Foi estudado o LCR de 45 cadáveres, sendo os resultados considerados em função do tempo decorrido entre o momento da morte e a colheita do LCR (TOC). Obedecendo a esse critério os casos foram assim grupados: 1) aqueles com TOC até 4 horas; 2) aqueles com TOC de 4 a 8 horas; 3) aqueles com TOC de 8 horas ou mais. Com o aumento do TOC a presença de hemácias no LCR de cadáveres se torna mais freqüente e mais intensa. A mistura de sangue ao LCR prejudica a avaliação das modificações cadavéricas de outros componentes do LCR, conforme foi demonstrado para as concentrações de cloretos glicose e proteínas totais, para o perfil protêico e para a atividade de transaminases. Assim sendo, para avaliar as modificações da composição do LCR próprias ao post-mortem devem ser considerados apenas os casos com menos de 1000 hemácias/mm³. O número normal de leucócitos foi proporcionalmente mais comum nas amostras provenientes de cadáveres cujo TOC era igual ou superior a 8 horas. A pleocitose foi observada com mais freqüência que o número normal de leucócitos, sendo mais comumente ligeira ou discreta. Quantidades superiores a 50 leucócitos/mm³ foram observadas geralmente em casos relativos a pacientes que faleceram na vigência de processos infecciosos agudos. As concentrações de cloretos e de glicose no LCR tendem a cair no postmortem e as diminuições mostraram-se, em média, tanto mais intensas quanto maior o TOC. A hipoglicorraquia foi, em média mais acentuada nos casos com pleoeitose mais intensa. A concentração de uréia tende a elevar-se de modo precoce, não tendo sido encontradas médias significativamente diversas em função do TOC. A atividade de TGO tende a elevar-se no post-mortem sendo esta elevação, em média, mais nítida a partir do grupo de casos com TOC de 4 até 8 horas. Ocorre também tendência a aumento da atividade de TGP; esta se mostrou menos intensa que a de TGO e, em média, foi mais nítida a partir do grupo de casos com TOC de 8 horas ou mais. A hiperproteinorraquia foi comum e mostrou, em média, tendência a acentuar-se com o aumento do TOC. O perfil protêico foi, geralmente, de tipo "misto", com aumento das globulinas alfa e/ou gama, compensado por queda do teor albumínico. O aumento dessas globulinas foi mais freqüente nos casos em que o óbito ocorreu na vigência de processos infecciosos. Nos casos com menos de 1000 hemácias/mm³ as modificações do perfil protêico, embora do mesmo tipo, eram menos acentuadas; em conjunto, houve predomínio das globulinas, especialmente das dos grupos alfa e gama. Em função do TOC foram verificadas discretas modificações do perfil protêico: com o aumento do TOC tendia a ser maior a participação da globulina gama e menor a da globulina beta. Os aspectos da composição do LCR aqui analisados permitem concluir que, 4 horas após a morte, já se delineiam modificações que caracterizam o LCR no post-mortem, sendo mais nítidas as relacionadas com o número de leucócitos e às concentrações de uréia, cloretos e glicose.

Cerebrospinal fluid examination was carried out in 45 corpes, the results being related to the time elapsed from death till the sample's collection (TOC). The cases were distributed in three groups: 1 — cases with TOC till four hours; 2 — cases with TOC from four till eight hours; 3 — cases with TOC of eight hours or more. The CSF samples were submitted to investigations concerning to the cytology, the concentrations of chlorides, glycosis, urea and total proteins, the protein profile and the activities of glutamic-oxalacetic (GOT) and glutamic-pyruvic (GPT) transaminases. It was found that the presence of red blood cells became more frequent and that the number of hematiae tended to be higher with the increase of the TOC. The number of red blood cells in the sample indicates the degree of CSF and blood mixture, the evaluation of data proper to CSF composition being impaired by mixture. So, the evaluation of the changes that may be considered proper to the CSF in the post-mortem was carried out only in the samples presenting no more then 1,000 hematiae per mml. Normal white cells number was proportionally more common in the third group of cases. Pleocytosis was more frequently found than normal cell count. It was slight or discrete in most of the cases. More than 50 white cells per mml were found in the samples collected from cases in which the patients had died in the course of acute infections. Low concentrations of chloride and glycosis were found in most of the cases and they tended to be lower with the increase of TOC. Hipoglycorrhachia was found to be more intense in the cases with pleocytosis. The concentration of urea was high in most of the cases; the increase of urea contents was at the same range in the three groups of cases considered. High GOT and GPT activities were found in several cases and the TOC appeared to influence the increase of these activities. This influence was more conspicuous in the last group only for GPT. Total protein concentrations above normal were frequent. They tended to be more conspicuously elevated with the increasing of TOC. The protein profiles were marked by the inversion of albumin/globulins ratio. They tended to be of the mixed type, with increase in the alpha and/or gamma globulins participation. The gamma globulin increase was more frequently observed. The increase of these globulin fractions was more conspicuous in the cases refering to patients who died during infectious diseases. An increase of the beta globulin fraction was observed in four cases: in two the death occurred in the course of hepatic cyrrhosis and, in two, of neoplasies. The influence of TOC on the protein profile changes was discrete: with the increase of the TOC the participation of gamma globulin increased and that of beta globulin decreased. The aspects of CSF composition here considered allow the conclusion that many of the changes are delineated during the first 4 hours after death, being more conspicuous those related to cell contents and chloride, glycosis and urea concentrations.

Estudo do proteinograma do LCR de 15 pacientes com MMR. Os resultados foram analisados em função das alterações verificadas no proteinograma do LCR de 10 pacientes com PRN. Os aumentos da concentração protêica total do LCR verificados entre os pacientes com MMR não se mostraram tão intensos como os verificados entre os pacientes com PRN. As alterações do perfil protêico nos casos de MMR foram do mesmo tipo que as verificadas para os de PRN. Um moderado aumento do teor de globulina gama caracterizava as alterações mais nítidas do perfil protêico do LCR na maioria dos casos de MMR.

The findings concerning the protein pattern of cerebrospinal fluid (CSF) samples from 15 patients with meningo-radiculo-myelitis probably related to virus infection (MMR) are reported. Protein fractions were separated by paper electrophoresis. The results obtained were discussed comparatively with those obtained for CSF samples from 10 cases of polyradiculoneuritis (PRN). Total protein concentration was slightly increased in most of MMR cases. The changes found in the protein pattern were similar in both groups of patients but they were more conspicuous among those of MMR group. Moderate increase of gamma globulin relative concentration was the main change observed in most of MMR cases. The meaning of changes observed were discussed.

Foram analisados os perfis eletroforéticos das proteínas dos líquidos contidos em cistos de astrocitoma (13 casos) e de glioblastoma multiforme (10 casos), sendo os resultados comparados àqueles obtidos nos líquidos de cistos de craniofariogeoma (7 casos) e de coleções subdurais de origem inflamatória (12 casos). Considerando a participação da albumina no perfil protêico eqüivalente à unidade, foi calculada a participação de cada globulina segundo os grupos de casos. Em relação aos dados obtidos para as coleções subdurais, foi verificado que nos LCT de glioblastomas multiformes era maior a participação da globulina gama, comparável à encontrada no LCT de craniofaringeomas e que, nos LCT de astrocitomas, era menor a participação das globulinas alfa-1 e alfa-2. Esta última verificação se mostrou altamente significativa quando comparada à participação dessas globulinas no LCT de astrocitomas e de glioblastomas. Os dados obtidos foram discutidos, permitindo atribuir as diferenças encontradas especialmente a fatôres locais, relacionados à diferente constituição das paredes dos cistos nos astrocitomas e nos glioblastomas multiformes.

The differences in the protein composition of cyst fluids from tumors of the central nervous system have been explained by the conditions in which the exchanges between the blood and the cyst fluid occur as well by metabolic aspects related to the malignancy of the tumor cells. In order to explore the influence of these factors the protein fractions from cyst fluids of astrocytoma (13 cases) and from glioblastoma multiforme (10 cases) were studied and the results were compared to those obtained for the protein fractions of two other series of cases: the first was represented by the results obtained for protein fractions of cyst fluids from craneopharyngeoma (7 cases) and, the second, by those concerning to the fluids from inflammatory subdural collections (12 cases). The protein fractions were studied by paper electrophoresis and the results are presented in table 1. The participation of each globulin fraction was calculated and the unit for comparison was the percent value of the albumin fraction for each given case and the mean values and their standard deviations are presented in table 2. The data were discussed and it was possible to show that the differences found are more able to be explained on the basis of the conditions in which the protein exchanges between blood and cyst fluid occur possibly related to the structural characteristics of the wall of the cysts.