Hydrocephaly or hydranencephaly: importance of cranial transillumination for differential diagnosis

anp Arquivos de Neuro-Psiquiatria Arq. Neuro-Psiquiatr. 0004-282X 1678-4227 Academia Brasileira de Neurologia - ABNEURO São Paulo, SP, Brazil Report of two anatomical-clinical cases, one being an hydranencephalic and the other of congenital hydrocephaly. The neurological examination showed in both cases a similar picture which characteristics recalling those found in a normal newborn. In both cases a transillumination of the skull and a carotidangiography were performed in order to study the cerebral circulation. The conclusions are as follows: 1) Transillumination has not been safe method for differential diagnosis between hydrocephaly and hydranencephaly, since in case 2 (hydrocephaly) was obtained a clear transillumination whereas in case 1 (hydranencephaly) it was absolutely negative; it must be emphasized that the cranial fluid of the hydranencephalic case was cloudy thus explaining possibly the insuccess of transillumination. 2) No analogy was found between the arterial distribution demonstrated by angiography and the anatomical-pathological findings of the hydranencephalic case, i.e., the anterior and medial cerebral arteries were well visualized, but necropsy showed absence of the portions of the hemispheres that are supplied by those arteries (fronto-parieto-temporal portions); on the contrary the territory supplied by the posterior cerebral artery was quite well developed, but the this artery was reduced to a short, tortuous and slender tuft of vasa. 3) Owing to the impossibility to take EEG tracings in the hydranen-cephalic case it was not possible to evaluate the importance of EEG in the differential diagnosis between hydrocephaly and hydranencephaly. Hidrocefalia ou hidranencefalia. Valor da transiluminação do crânio no diagnóstico diferencial. Estudo anátomo-clínico de dois casos Hydrocephaly or hydranencephaly. Importance of cranial transillumination for differential diagnosis Antonio B . LefèvreI; José ZaclisII; Maria I. ValenteII ILivre-Docente IIAssistentes RESUMO São apresentados dois casos anátomo-clínicos, um de hidranencefalia e outro de hidrocefalia congênita por estenose do aqueduto de Sylvius. O exame neurológico revelou, nos dois casos, um quadro semelhante, cujas caracte- rísticas lembram as encontradas em um recém-nascido normal. Nos dois casos foi feita a transiluminação do crânio e o estudo da circulação cerebral por meio de carótido-angiografia. Dos fatos observados podem ser destacados os seguintes aspectos: 1) A transiluminação não parece ser elemento seguro para o diagnóstico diferencial entre a hidrocefalia e a hidranencefalia, pois, no caso de hidrocefalia (caso 2) foi obtida nítida transparência, enquanto que no caso de hidranencefalia (caso 1) esta prova foi completamente negativa; deve notar-se que o liqüido contido no interior do crânio do paciente de hidranencefalia era fortemente turvo, o que talvez explique não ter sido obtida a transiluminação. 2) Não houve correspondência entre a distribuição arterial observada pela carótido-angiografia e os achados anátomo-patológicos verificados no caso de hidranencefalia; as artérias cerebral anterior e cerebral média foram nitidamente visualizadas e não obstante havia falta das porções dos hemisférios que seriam supridas por estas artérias; ao contrário, o território irrigado pela cerebral posterior estava relativamente bastante desenvolvido, embora esta artéria estivesse representada apenas por penachos de vasos tortuosos, curtos e muito delgados. 3) As presentes observações não permitem avaliar a importância da eletrencefalografia no diagnóstico diferencial entre hidrocefalia e hidranencefalia, pois não foi possível realizar o traçado no caso 2 (hidranencefalia). SUMMARY Report of two anatomical-clinical cases, one being an hydranencephalic and the other of congenital hydrocephaly. The neurological examination showed in both cases a similar picture which characteristics recalling those found in a normal newborn. In both cases a transillumination of the skull and a carotidangiography were performed in order to study the cerebral circulation. The conclusions are as follows: 1) Transillumination has not been safe method for differential diagnosis between hydrocephaly and hydranencephaly, since in case 2 (hydrocephaly) was obtained a clear transillumination whereas in case 1 (hydranencephaly) it was absolutely negative; it must be emphasized that the cranial fluid of the hydranencephalic case was cloudy thus explaining possibly the insuccess of transillumination. 2) No analogy was found between the arterial distribution demonstrated by angiography and the anatomical-pathological findings of the hydranencephalic case, i.e., the anterior and medial cerebral arteries were well visualized, but necropsy showed absence of the portions of the hemispheres that are supplied by those arteries (fronto-parieto-temporal portions); on the contrary the territory supplied by the posterior cerebral artery was quite well developed, but the this artery was reduced to a short, tortuous and slender tuft of vasa. 3) Owing to the impossibility to take EEG tracings in the hydranen-cephalic case it was not possible to evaluate the importance of EEG in the differential diagnosis between hydrocephaly and hydranencephaly. Texto completo disponível apenas em PDF. Full text available only in PDF format. BIBLIOGRAFIA Trabalho do Serviço de Neurologia da Fac. Med. da Univ. de São Paulo (Prof. A. Tolosa), apresentado ao Departamento de Neuro-Psiquiatria da Associação Paulista de Medicina em 7 fevereiro 1955. Entregue para publicação em 15 maio 1955. Nota dos autores - O presente trabalho já estava pronto para publicação quando tivemos conhecimento do trabalho de Ch. M. Poser, F. C. Walsh e L. C. Scheinberg (Hydranencephaly. Neurology, 5:284-289, abril, 1955) versando sobre o mesmo assunto e chegando a conclusões muito semelhantes às nossas no que diz respeito à importância do fator vascular na gênese da hidranencefalia. Clínica Neurológica. Hospital das Clínicas da Fac. Med. da Univ. de São Paulo - Caixa Postal 3461 - São Paulo, Brasil. 1. OLIVE, J. T.; DU SHANE, J. W. - Hydranencephaly. Am. J. Dis. Children, 85:43-46 (janeiro) 1953. Hydranencephaly Am. J. Dis. Children 01 1953 43 46 85 OLIVE J. T. 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