Abstract Background There is very few data regarding homocysteine's influence on the formation and rupture of intracranial aneurysms. Objective To compare homocysteine levels between patients with ruptured and unruptured intracranial aneurysms, and to evaluate possible influences of this molecule on vasospasm and functional outcomes. Methods This is a retrospective, case-control study. We evaluated homocysteinemia differences between patients with ruptured and unruptured aneurysms; and the association of homocysteine levels with vasospasm and functional outcomes. Logistic regressions were performed. Results A total of 348 participants were included: 114 (32.8%) with previous aneurysm rupture and 234 (67.2%) with unruptured aneurysms. Median homocysteine was 10.75μmol/L (IQR = 4.59) in patients with ruptured aneurysms and 11.5μmol/L (IQR = 5.84) in patients with unruptured aneurysms. No significant association was detected between homocysteine levels and rupture status (OR = 0.99, 95% CI = 0.96-1.04). Neither mild (>15μmol/L; OR = 1.25, 95% CI 0.32-4.12) nor moderate (>30μmol/L; OR = 1.0, 95% CI = 0.54-1.81) hyperhomocysteinemia demonstrated significant correlations with ruptured aneurysms. Neither univariate (OR = 0.86; 95% CI 0.71-1.0) nor multivariable age-adjusted (OR = 0.91; 95% CI = 0.75-1.05) models evidenced an association between homocysteine levels and vasospasm. Homocysteinemia did not influence excellent functional outcomes at 6 months (mRS≤1) (OR = 1.04; 95% CI = 0.94-1.16). Conclusion There were no differences regarding homocysteinemia between patients with ruptured and unruptured intracranial aneurysms. In patients with ruptured aneurysms, homocysteinemia was not associated with vasospasm or functional outcomes. homocysteines s retrospective casecontrol case control study performed 34 included 11 32.8% 328 32 8 (32.8% 23 67.2% 672 67 2 (67.2% 1075μmolL μmolL 10 75μmol L μmol IQR 4.59 459 4 59 115μmolL 5μmol 5.84 584 5 84 099 0 99 0.99 95 0.961.04. 096104 0.96 1.04 . 96 1 04 0.96-1.04) >15μmol/L 15μmolL 15μmol (>15μmol/L 125 25 1.25 0.324.12 032412 0.32 4.12 12 0.32-4.12 >30μmol/L 30μmolL 30μmol (>30μmol/L 1.0 0.541.81 054181 0.54 1.81 54 81 0.54-1.81 0.86 086 86 0.711.0 07110 0.71 71 0.71-1.0 ageadjusted age adjusted 0.91 091 91 0.751.05 075105 0.75 1.05 75 05 0.75-1.05 mRS≤1 mRS1 mRS (mRS≤1 104 0.941.16. 094116 0.94 1.16 94 16 0.94-1.16) 3 32.8 (32.8 67.2 (67.2 4.5 45 5.8 58 09 9 0.9 961 0.961.04 09610 096 0.96-1.04 1.2 324 0.324.1 03241 032 0.3 412 4.1 0.32-4.1 1. 541 0.541.8 05418 054 0.5 181 1.8 0.54-1.8 0.8 08 711 0.711. 0711 071 0.7 7 0.71-1. 751 0.751.0 07510 075 105 0.75-1.0 mRS≤ (mRS≤ 941 0.941.16 09411 094 116 1.1 0.94-1.16 32. (32. 67. (67. 4. 5. 0. 0.961.0 0961 0.96-1.0 0.324. 0324 03 41 0.32-4. 0.541. 0541 18 0.54-1. 0.711 07 0.71-1 0.751. 0751 0.75-1. (mRS 0.941.1 0941 0.94-1.1 (32 (67 0.961. 0.96-1. 0.324 0.32-4 0.541 0.54-1 0.71- 0.751 0.75-1 0.941. 0.94-1. (3 (6 0.961 0.96-1 0.32- 0.54- 0.75- 0.941 0.94-1 ( 0.96- 0.94-

RESUMO Antecedentes Existem poucos dados sobre a influência da homocisteína na formação e rotura de aneurismas intracranianos (AI). Objetivo Comparar os níveis de homocisteína entre pacientes com AI rotos e não rotos e influências no vasoespasmo e resultados funcionais. Métodos Estudo caso-controle, que avaliou as diferenças de homocisteinemia entre pacientes com aneurismas rotos e não rotos, além da associação entre níveis de homocisteína, vasoespasmo e estado funcional. Regressões logísticas foram realizadas. Resultados Um total de 348 participantes foram incluídos: 114 (32,8%) com aneurismas rotos e 234 (67,2%) não rotos. A homocisteína mediana foi de 10,75μmol/L (IQR = 4,59) nos rotos e 11,5μmol/L (IQR = 5,84) nos não rotos. Não houve associação significativa entre os níveis de homocisteína e o status de ruptura (OR = 0,99, 95% CI = 0,96-1,04). Nem a hiperhomocisteinemia leve (>15μmol/L; OR = 1,25, 95% CI = 0,32-4,12) nem a moderada (>30μmol/L; OR = 1,0, 95% CI = 0,54-1,81) mostraram correlações significativas com aneurismas rotos. Modelos univariados (OR = 0,86; 95% CI = 0,71-1,0) e multivariados ajustados por idade (OR = 0,91; 95% CI = 0,75-1,05) não evidenciaram associação entre homocisteína e vasoespasmo. A homocisteinemia não influenciou resultados funcionais excelentes em seis meses (mRS ≤ 1) (OR = 1,04; 95% CI = 0,94-1,16). Conclusão Não houve diferenças em relação à homocisteinemia entre pacientes com aneurismas intracranianos rotos e não rotos. Em pacientes com aneurismas rotos, a homocisteinemia não foi associada ao vasoespasmo ou resultados funcionais. AI. . (AI) casocontrole, casocontrole caso controle, controle caso-controle funcional realizadas 34 incluídos 11 32,8% 328 32 8 (32,8% 23 67,2% 672 67 2 (67,2% 1075μmolL μmolL 10 75μmol L μmol IQR 4,59 459 4 59 115μmolL 5μmol 5,84 584 5 84 099 0 99 0,99 95 0,961,04. 096104 0,96 1,04 96 1 04 0,96-1,04) >15μmol/L 15μmolL 15μmol (>15μmol/L 125 25 1,25 0,324,12 032412 0,32 4,12 12 0,32-4,12 >30μmol/L 30μmolL 30μmol (>30μmol/L 1,0 0,541,81 054181 0,54 1,81 54 81 0,54-1,81 0,86 086 86 0,711,0 07110 0,71 71 0,71-1,0 0,91 091 91 0,751,05 075105 0,75 1,05 75 05 0,75-1,05 mRS 104 0,941,16. 094116 0,94 1,16 94 16 0,94-1,16) (AI 3 32,8 (32,8 67,2 6 (67,2 4,5 45 5,8 58 09 9 0,9 961 0,961,04 09610 096 0,96-1,04 1,2 324 0,324,1 03241 032 0,3 412 4,1 0,32-4,1 1, 541 0,541,8 05418 054 0,5 181 1,8 0,54-1,8 0,8 08 711 0,711, 0711 071 0,7 7 0,71-1, 751 0,751,0 07510 075 105 0,75-1,0 941 0,941,16 09411 094 116 1,1 0,94-1,16 32, (32, 67, (67, 4, 5, 0, 0,961,0 0961 0,96-1,0 0,324, 0324 03 41 0,32-4, 0,541, 0541 18 0,54-1, 0,711 07 0,71-1 0,751, 0751 0,75-1, 0,941,1 0941 0,94-1,1 (32 (67 0,961, 0,96-1, 0,324 0,32-4 0,541 0,54-1 0,71- 0,751 0,75-1 0,941, 0,94-1, (3 (6 0,961 0,96-1 0,32- 0,54- 0,75- 0,941 0,94-1 ( 0,96- 0,94-

Abstract Background Increased intracranial pressure (ICP) consists of a set of signs and symptoms related to changes in intracranial compliance (ICC) and ICP. Objective This study presents a retrospective analysis of patients who underwent non-invasive monitoring of ICC based on complaints of headache, correlating decreased brain compliance and increased intracranial pressure. Methods Noninvasive ICC monitoring was performed using a Brain4care device, which contains a strain gauge and a recorder connected to a mechanical device that touches the scalp surface in the frontoparietal area lateral to the sagittal suture. This tool monitors the ICP by identifying small changes in skull measurements that are caused by pressure variations, i.e., skull deformation is associated with the detection of changes in mean ICP. A clinical evaluation of 32 patients with complaints of headache occurred from the analysis of their medical records. Results Of the 32 patients initially chosen, it was possible to complete the analysis of 18 due to the availability of data in the medical records. From the non-invasive monitoring of the ICC, the following data were collected: time-to-peak, P2/P1 ratio, age, and gender. From the statistical analysis of age and P2/P1 ratio, it was noted that as age increases, ICC tends to decrease regardless of sex (p < 0.05). Conclusion This study concluded that there is a correlation between changes in intracranial compliance and headache complaints in outpatients. There was also a relationship between age and decreased intracranial compliance but without a specific pain pattern. (ICP (ICC noninvasive non invasive Braincare Brain care suture variations ie i e i.e. 3 records chosen 1 collected timetopeak, timetopeak time peak, peak time-to-peak P2P1 PP P2 P1 P P2/P ratio gender increases p 0.05. 005 0.05 . 0 05 0.05) outpatients pattern i.e P2P 00 0.0 0.

Resumo Antecedentes O aumento da pressão intracraniana (PIC) consiste em um conjunto de sinais e sintomas relacionados a mudanças na complacência intracraniana (CIC) e na PIC. Objetivo Este estudo apresenta uma análise retrospectiva de pacientes que foram submetidos ao monitoramento não invasivo da CIC com base em queixas de cefaleia, correlacionando a diminuição da complacência cerebral e o aumento da pressão intracraniana. Métodos O monitoramento não invasivo da CIC foi realizado utilizando um dispositivo Brain4Care, que contém um medidor de tensão e um gravador conectado a um dispositivo mecânico que toca a superfície do couro cabeludo na área frontoparietal lateral à sutura sagital. Esta ferramenta monitora a PIC identificando pequenas alterações nas medidas do crânio que são causadas por variações de pressão, ou seja, a deformação do crânio está associada à detecção de alterações na PIC média. Uma avaliação clínica de 32 pacientes com queixas de cefaleia ocorreu a partir da análise de seus prontuários médicos. Resultados Dos 32 pacientes inicialmente escolhidos, foi possível concluir a análise de 18 devido à disponibilidade de dados nos prontuários médicos. A partir do monitoramento não invasivo da CIC, foram coletados os seguintes dados: time-to-peak, relação P2/P1, idade e sexo. Da análise estatística de idade e relação P2/P1, observou-se que à medida em que a idade aumenta, a CIC tende a diminuir independentemente do sexo (p < 0,05). Conclusão Este estudo concluiu que existe uma correlação entre as mudanças na CIC e a queixa de cefaleia em pacientes ambulatoriais. Houve também uma relação entre idade e diminuição da CIC, mas sem um padrão de dor específico. (PIC (CIC Brain4Care BrainCare Brain Care sagital seja média 3 médicos escolhidos 1 timetopeak, timetopeak time to peak, peak time-to-peak P2P1 PP P2 P1 P P2/P1 observouse observou se aumenta p 0,05. 005 0,05 . 0 05 0,05) ambulatoriais específico P2P P2/P 00 0,0 0,

Abstract Background Subarachnoid hemorrhage (SAH) prognosis remains poor. Vasospasm mechanism might be associated with inflammation. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied as inflammation markers and prognostic predictors. Objective We aimed to investigate NLR and PLR in admission as predictors of angiographic vasospasm and functional outcome at 6 months. Methods This cohort study included consecutive aneurysmal SAH patients admitted to a tertiary center. Complete blood count was recorded at admission before treatment. White blood cell count, neutrophil count, lymphocyte count, platelet count, NLR, and PLR were collected as independent variables. Vasospasm occurrence-modified Rankin scale (mRS), Glasgow outcome scale (GOS), and Hunt-Hess score at admission and at 6 months were recorded as dependent variables. Multivariable logistic regression models were used to adjust for potential confounding and to assess the independent prognostic value of NLR and PLR at admission. Results A total of 74.1% of the patients were female, with mean age of 55.6 ± 12.4 years. At admission, the median Hunt-Hess score was 2 (interquartile range [IQR] 1), and the median mFisher was 3 (IQR 1). Microsurgical clipping was the treatment for 66.2% of the patients. Angiographic vasospasm incidence was 16.5%. At 6 months, the median GOS was 4 (IQR 0.75), and the median mRS was 3 (IQR 1.5). Twenty-one patients (15.1%) died. Neutrophil-to-lymphocyte ratio and PLR levels did not differ between favorable and unfavorable (mRS > 2 or GOS < 4) functional outcomes. No variables were significantly associated with angiographic vasospasm. Conclusion Admission NLR and PLR presented no value for prediction of functional outcome or angiographic vasospasm risk. Further research is needed in this field. (SAH poor Neutrophiltolymphocyte Neutrophil (NLR platelettolymphocyte (PLR center occurrencemodified occurrence modified mRS, , (mRS) GOS, (GOS) HuntHess Hunt Hess 741 74 1 74.1 female 556 55 55. 124 12 12. years interquartile IQR [IQR 1, 1) 1. . 662 66 66.2 165 16 5 16.5% 0.75, 075 0.75 0 75 0.75) 1.5. 15 1.5 1.5) Twentyone Twenty one 15.1% 151 (15.1% died outcomes risk field (GOS 7 74. 66. 16.5 07 0.7 15.1 (15.1 16. 0. 15. (15. (15 (1 (

Resumo Antecedentes O prognóstico da hemorragia subaracnoidea (HSA) permanece ruim. Vasoespasmo pode estar associado à inflamação. Razões neutrófilo-linfócito (NLR) e plaqueta-linfócito (PLR) têm sido estudadas como marcadores de inflamação e prognóstico. Objetivo Investigar NLR e PLR na admissão como preditores de vasoespasmo angiográfico e desfecho aos 6 meses. Métodos Este estudo de coorte incluiu pacientes consecutivos com HSA aneurismática de um centro terciário. Contagem de leucócitos, neutrófilos, linfócitos e plaquetas, proporção de neutrófilos para linfócitos e de plaquetas para linfócitos foram coletados como variáveis independentes. Ocorrência de vasoespasmo, escala de Rankin modificada, escala de desfecho de Glasgow e o escore de Hunt-Hess na admissão e 6 meses após a mesma foram registradas como variáveis dependentes. Modelos de regressão logística multivariável foram usados para ajustar potenciais fatores de confusão e avaliar valor prognóstico independente de NLR e PLR. Resultados Um total de 74,1% pacientes eram do sexo feminino, com idade média de 55,6 ± 12,4 anos. Na admissão, a pontuação média de Hunt-Hess foi de 2 (IQR 1) e a mediana de mFisher foi de 3 (IQR 1). Clipagem microcirúrgica foi o tratamento escolhido para 66,2% dos pacientes. A incidência de vasoespasmo angiográfico foi de 16,5%. Aos 6 meses, a escala de desfecho de Glasgow mediana era 4 (IQR 0,75) e a escala de Rankin modificada mediana era 3 (IQR 1,5). Vinte e um pacientes (15,1%) morreram. Os níveis de NLR e PLR não diferiram entre resultados funcionais favoráveis e desfavoráveis (mRS > 2 ou GOS < 4). Nenhuma variável foi significativamente associada ao vasoespasmo angiográfico. Conclusão Razão neutrófilo-linfócito e a PLR não apresentaram valor preditivo de desfecho funcional ou risco de vasoespasmo angiográfico. Mais pesquisas são necessárias neste campo. (HSA ruim neutrófilolinfócito neutrófilo linfócito (NLR plaquetalinfócito plaqueta (PLR terciário leucócitos independentes HuntHess Hunt Hess dependentes 741 74 1 74,1 feminino 556 55 55, 124 12 12, anos IQR 1. . 662 66 66,2 165 16 5 16,5% 0,75 075 0 75 1,5. 15 1,5 1,5) 15,1% 151 (15,1% morreram mRS 4. 4) campo 7 74, 66, 16,5 0,7 07 1, 15,1 (15,1 16, 0, 15, (15, (15 (1 (

ABSTRACT Purpose: Temporary arterial occlusion (TAO) is a widespread practice in the surgical treatment of intracranial aneurysms. This study aimed to investigate TAO’s role during ruptured aneurysm clipping as an independent prognostic factor on short- and long-term outcomes. Methods: This prospective cohort included 180 patients with ruptured intracranial aneurysms and an indication of microsurgical treatment. Patients who died in the first 12 hours after admission were excluded. Results: TAO was associated with intraoperative rupture (IOR) (odds ratio – OR = 10.54; 95% confidence interval – 95%CI 4.72–23.55; p < 0.001) and surgical complications (OR = 2.14; 95%CI 1.11–4.07; p = 0.01). The group with TAO and IOR had no significant difference in clinical (p = 0.06) and surgical (p = 0.94) complications compared to the group that had TAO, but no IOR. Among the 111 patients followed six months after treatment, IOR, number of occlusions, and total time of occlusion were not associated with Glasgow Outcome Scale (GOS) in the follow-up (respectively, p = 0.18, p = 0.30, and p = 0.73). Among patients who underwent TAO, IOR was also not associated with GOS in the follow-up (p = 0.29). Conclusions: TAO was associated with IOR and surgical complications, being the latter independent of IOR occurrence. In long-term analysis, neither TAO nor IOR were associated with poor clinical outcomes. Purpose (TAO TAOs s short longterm long term outcomes Methods 18 1 excluded Results (IOR odds 10.54 1054 10 54 95 95CI CI 4.72–23.55 4722355 4 72 23 55 0.001 0001 0 001 2.14 214 2 14 1.11–4.07 111407 11 07 0.01. 0.01 . 01 0.01) 0.06 006 06 0.94 094 94 occlusions (GOS followup follow up respectively, respectively (respectively 018 0.18 030 30 0.30 0.73. 073 0.73 73 0.73) 0.29. 029 0.29 29 0.29) Conclusions occurrence analysis 10.5 105 5 9 4.72–23.5 472235 7 0.00 000 00 2.1 21 1.11–4.0 11140 0.0 0.9 09 0.1 03 3 0.3 0.7 02 0.2 10. 4.72–23. 47223 2. 1.11–4. 1114 0. 4.72–23 4722 1.11–4 4.72–2 472 1.11– 4.72– 47 1.11 4.72 1.1 4.7 1. 4.

ABSTRACT Purpose: To evaluate the risk factors for poor outcomes after surgical and endovascular treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods: Patients with ≥ 18-years of age and aSAH were included, while patients who died within 12 h of admission or lost follow-up were excluded. All participants underwent standardized clinical and radiological assessment on admission and were reassessed at discharge and at 6-months follow-up using the Glasgow Outcome Scale (GOS). Results: Death at discharge was associated with female gender, anterior communication artery (ACoA) aneurysm location and presence of atherosclerotic plaque in the surgical group, and with age in the endovascular group. Both groups had clinical condition on follow-up associated with mFisher score on admission and hypertension. GOS on follow-up was also associated with presence of atherosclerotic plaque and multiple aneurysms in surgical group, and with age in endovascular group. Conclusions: Subjects treated surgically are prone to unfavorable outcomes if atherosclerotic plaques and multiple aneurysms are present. In patients with endovascular treatment, age was the main predictor of clinical outcome.

ABSTRACT Purpose: To analyze the role of serum creatinine levels as a biomarker of intracranial aneurysm outcomes. Methods: This is a prospective analysis of outcomes of patients with intracranial aneurysm. One hundred forty-seven patients with serum creatinine at admission and 6 months follow up were included. Linear and logistic regressions were used to analyze the data. Modified Rankin scale (mRS) was used to assess outcome. Results: Creatinine level was not directly related to aneurysm outcome nor aneurysm rupture (p > 0.05). However, patients with a glomerular filtration rate (GFR) lower than 72.50 mL·min–1 had an odds ratio (OR) of 3.049 (p = 0.006) for worse outcome. Similarly, aneurysm rupture had an OR of 2.957 (p = 0.014) for worse outcomes. Stepwise selection model selected 4 variables for outcomes prediction: serum creatinine, sex, hypertension and treatment. Hypertensive patients had, on average, an increase in 0.588 in mRS (p = 0.022), while treatment with microsurgery had a decrease in 0.555 (p = 0.038). Conclusions: Patients with higher GFR had better outcomes after 6 months. Patients with higher GFR had better outcomes after 6 months. Creatinine presented an indirect role in GFR values and should be included in models for outcome prediction.

RESUMO Objetivo: Identificar evidências atuais sobre topiramato para o estado de mal epiléptico refratário. Métodos: Foi revisada a literatura para investigar a eficácia do topiramato no tratamento de estado de mal epiléptico refratário. Os termos de busca utilizados foram: “status epilepticus”, “refractory”, “treatment” e “topiramate”. Não se empregaram restrições. Resultados: A busca identificou 487 artigos que descreviam o uso de topiramato para tratamento de estado de mal epiléptico refratário e seus resultados. Relatos de caso, revisões e experimentos em animais foram excluídos. Após exclusão de duplicatas e aplicação dos critérios de inclusão e exclusão, restaram nove estudos. Realizaram-se análises descritivas e qualitativas, com os seguintes resultados: as taxas de resposta, definidas como término de crises até 72 horas após administração de topiramato, variaram entre 27% e 100%. A mortalidade variou de 5,9% a 68%. Desfechos funcionais positivos, definidos como alta hospitalar, volta à funcionalidade basal ou reabilitação, foram documentados por sete estudos, e as taxas variaram entre 4% e 55%. A maioria dos estudos reportou apenas efeitos colaterais leves ou ausentes. Conclusão: Topiramato foi efetivo em abortar estado de mal epiléptico refratário, apresentando baixa mortalidade e boa tolerabilidade. Portanto, topiramato poderia ser uma boa opção como terceira linha para estado de mal epiléptico refratário, porém mais estudos são necessários.

ABSTRACT Objective: To identify current evidence on the use of topiramate for refractory status epilepticus. Methods: We reviewed the literature to investigate the efficacy of topiramate in the treatment of refractory status epilepticus. The search terms used were “status epilepticus”, “refractory”, “treatment” and “topiramate”. No restrictions were used. Results: The search yielded 487 articles that reported using topiramate as a treatment for refractory status epilepticus and its outcomes. Case reports, review articles, and animal experiments were excluded. After excluding duplicates and applying inclusion and exclusion criteria, nine studies were included for analyses. Descriptive and qualitative analyses were performed, and the results were as follows: response rates (defined as termination in-hospital until 72 hours after the administration of topiramate) varied from 27% to 100%. The mortality rate varied from 5.9% to 68%. Positive functional long-term outcomes, defined as discharge, back to baseline or rehabilitation, were documented by seven studies, and the rates ranged between 4% and 55%. Most studies reported no or mild adverse effects. Conclusion: Topiramate was effective in terminating refractory status epilepticus, presented relatively low mortality and was well tolerated. Therefore, topiramate could be a good option as a third-line therapy for refractory status epilepticus, but further studies are necessary.

RESUMO O período neonatal é um período vulnerável para o recém nascido. As altas taxas de morbidade e mortalidade neonatal atestam a fragilidade da vida durante esta fase. Trauma durante o nascimento é de 0,8%, variando de 0,2 a 2 por 1000 nascimentos. O objetivo deste estudo é descrever o tocotraumatismo, seu mecanismo, considerações anatômicas e fisiopatologia da lesão em recém nascido. Métodos Revisão da literatura utilizando base de dados PubMed, MEDLINE, EMBASE, Science Direct, The Cochrane Detabase, Google Scolar, ensaios clínicos. Os trabalhos selecionados foram de 1922 a 2016. Foram selecionados 109 trabalhos, através de palavras-chave, inclusão e critérios de exclusão. Discussão Este artigo discute os fatores de risco para o trauma do nascimento, a anatomia da apresentação do vértex occipto-anterior e as lesões traumáticas cerebrais. Conclusão Lesão cerebral traumática no nascimento pode causar complicações graves nos recém-nascidos. O tratamento desta condição deve ser especializado, envolvendo trabalho, equipe e abordagem individualizado

ABSTRACT The neonatal period is a highly vulnerable time for an infant. The high neonatal morbidity and mortality rates attest to the fragility of life during this period. The incidence of birth trauma is 0.8%, varying from 0.2-2 per 1,000 births. The aim of this study is to describe brain traumas, and their mechanism, anatomy considerations, and physiopathology of the newborn traumatic brain injury. Methods A literature review using the PubMed data base, MEDLINE, EMBASE, Science Direct, The Cochrane Database, Google Scholar, and clinical trials. Selected papers from 1922 to 2016 were studied. We selected 109 papers, through key-words, with inclusion and exclusion criteria. Discussion This paper discusses the risk factors for birth trauma, the anatomy of the occipito-anterior and vertex presentation, and traumatic brain lesions. Conclusion Birth-related traumatic brain injury may cause serious complications in newborn infants. Its successful management includes special training, teamwork, and an individual approach.

Neste trabalho é relatado um caso de lesão do menisco medial do tipo em alça de balde (AB), que se resolveu espontaneamente, em associação com lesão de ligamento cruzado anterior (LCA). O paciente torceu o joelho esquerdo durante uma luta em artes maciais, evoluindo com dor e bloqueio articular e sensação de falseamento. Na RMN havia rotura em alça de balde do menisco medial com deslocamento do fragmento para a região intercondilar, rotura do menisco lateral e rotura do LCA. Após tratamento clínico e fisioterápico, em um intervalo de um ano, o exame de controle demonstrou que havia ocorrido resolução espontânea da AB.

We report a case of injury of the medial bucket handle meniscal tears (BH), which resolved spontaneously, in association with anterior cruciate ligament (ACL) injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treatment and physiotherapy, in an interval of one year, later examinations showed that there was spontaneous healing of AB