São registrados dois casos de tumores situados no assoalho da fossa craniana média (carcinoma sólido da hipófise e craniofaringeoma) acompanhados de leptomeningite de etiologia não determinada. Especialmente no segundo caso esta se caracterizava pela ocorrência de repetidos surtos de exacerbação. Em ambos o diagnóstico inicial foi de leptomeningite, tendo sido o insucesso das medidas terapêuticas adotadas que levou a estudos radiológicos, na tentativa de evidenciar focos que pudessem estar mantendo a infecção. Em ambos os casos o exame radiológico forneceu dados que permitiram orientar o diagnóstico de tumor do assoalho da fossa craniana média. As condições clínicas, no entanto, impediram que fossem adotadas em tempo útil medidas terapêuticas que visassem diretamente o tumor, vindo os pacientes a falecer. A possibilidade da ocorrência de meningites em tumores dessa região é discutida, bem como a natureza séptica ou asséptica da reação inflamatória. Os casos apresentados permitem concluir que, em processos meningíticos de evolução longa, acompanhados de surtos de agudização, nos quais nem mesmo durante os surtos agudos é encontrado o agente etiológico no LCR, a possibilidade da ocorrência de tumores do assoalho da fossa média do crânio deve ser estudada. O estudo deve ser feito precocemente, para permitir a adoção de medidas terapêuticas adequadas, visando diretamente o tumor, em tempo hábil, na tentativa de evitar que os surtos meningíticos venham a comprometer a vida do paciente.

A study was made of a patient with carcinoma of the hypophisis which invaded the sphenoid bone and made protrusion under the nasopharyngeal mucosa, and that of a patient with craniopharyngeoma. The patients had no symptoms proper to the tumors but presented several episodes of meningitis. The presence of the tumor, in both cases, was evidenced lately, when the failure of the antibiotic therapy became patent leading to the search of intracranial focuses of infection through radiologic examinations. The nature of the leptomeningitic episodes is discussed. Their relation to possible communications between the oropharyngeal cavity and the subarachnoid space, secundary to the changes in the anatomic structures of the region provoked by the tumors, is emphasized since these communications make possible the invasion of the subarachnoid space by bacteria. Although this opinion is acceptable in respect to the cases related, it is not possible to exclude the aseptic nature of meningitic episodes observed as no pathogenic micro-organism was isolated from the CSF samples studied and the necroscopic examination showed no septation in the leptomeningeal structures that surrounded the tumor or no obvious focus of infection related to them. Considering the cases reported the authors point out that radiologic and neuro-radiologic examinations must be indicated, as soon as possible, in order to exclude such tumors in patients suffering from meningitis of obscure origin, specially when its course is delayed and/or marked by acute episodes or re-exacerbation.

Foram estudadas comparativamente as respostas motoras reflexas desencadeadas por estímulo sensitivo táctil e por estímulo frio, aplicados à face plantar dos pés, de 31 pessoas sadias e de 49 pacientes com afecções do sistema nervoso. Êstes foram grupados segundo apresentassem quadros clínicos sugestivos de comprometimento do sistema nervoso periférico (7 pacientes) ou do SNC. Dêstes últimos, um grupo de pacientes não apresentava sintomas próprios à lesão do neurônio motor central (12 pacientes). Nos demais havia sintomas sugestivos de lesão do neurônio motor central e foram considerados segundo apresentassem, ou não, sinal de Babinski à pesquisa mediante o estímulo táctil: em 9 o sinal de Babinski não era evidenciado e nos restantes estava presente. Êste último grupo de pacientes compreende 13 casos nos quais o sinal de Babinski ocorria unilateralmente e 8, nos quais ocorria bilateralmente. Os resultados permitiram verificar que o estímulo frio apenas ocasionalmente desencadeia a resposta que caracteriza o reflexo cutâneo plantar normal. Por outro lado, o estímulo frio possibilita com freqüência aproximadamente semelhante àquela observada para o estímulo táctil, a verificação do sinal de Babinski. Com freqüência a resposta que caracteriza o sinal de Babinski é mais nítida e duradoura quando se emprega o estímulo frio. Êsses dados mostram que o emprêgo do estímulo frio representa modalidade de semiotécnica útil para a elucidação de casos nos quais haja dúvidas quanto à presença de sinal de Babinski quando a pesquisa é feita segundo a técnica clássica. De fato, com o estímulo frio, observa-se tendência a refôrço do sinal de Babinski quando êle está presente; na sua ausência o mesmo tipo de estímulo não costuma determinar qualquer tipo de resposta.

Thirty one healthy people and 49 patients suffering from diseases of the nervous system were studied in order to evaluate the technique of eliciting Babinski's signal by means of cold stimulation as it was proposed by Dalsgaard-Nielsen. The patients were distributed in 4 groups. Patients of group 1 (7 cases) had clinical signs of peripheric nervous system impairment. Patients of groups 2, 3 and 4 had clinical signs of CNS impairment. In those of group 2 (12 cases) there were no evidences of central motor lesions. In the remaining patients these evidences were found and they were grouped considering the absence (group 3: 9 cases) or the presence (group 4: 21 cases) of Babinski's sign, when tactile stimulation was used. The results obtained were compared to those found in the same people by means of tactile plantar stimulation. For both methods, results were considered to be: absent, when any motor reflex activity was elicited; in-characteristic, when it was observed a rapid dorsiflexion of toes; normal, when the ventral flexion of toes proper to cutaneo-plantar reflex occurred and Babinski's sign, when it occurred the hallux dorsiflexion proper to this signal. The results obtained show that the plantar cold stimulation is not useful for eliciting the normal cutaneo-plantar reflex. It was elicited by this method only in 2 healthy people and in 3 patients of groups 1 and 2. Babinski's toe phenomenon was elicited by cold stimulation in 18 patients of group 4. It was observed that the response was more characteristic and remained by a longer period when cold stimulation was used. These aspects were observed specially in those patients that had bilateral Babinski's sign. The results show that cold stimulation of the plantar region is an useful method of eliciting Babinski's toe phenomenon. The qualitative aspects of the motor response which were refered show that cold stimulation is an useful method of investigation to be employed specially when doubtful responses are obtained by tactile stimulation techniques.