Jose Marcus Rotta | IAMSPE (original) (raw)

Papers by Jose Marcus Rotta

Arquivos De Neuro-psiquiatria, Jun 1, 2014

Normal pressure hydrocephalus (NPH) is characterized by gait disturbance, dementia and/or urinary... more Normal pressure hydrocephalus (NPH) is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence confirms association between NPH and psychiatric symptoms. We selected 35 patients with idiopathic normal pressure hydrocephalus from January 2010 to January 2012 in a Brazilian tertiary hospital and performed a formal psychiatric evaluation to identify psychiatric disorders. Psychiatric disorders were present in 71% of these patients, especially anxiety, depression and psychotic syndromes. NPH patients may develop symptoms with frontal dominance, such as personality changes, anxiety, depression, psychotic syndromes, obsessive compulsive disorder, Othello syndrome; shoplifting and mania. Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment.

Arquivos Brasileiros de Neurocirurgia, Jun 1, 2011

Contexto: Estudos da percepção da qualidade de vida no trabalho (QVT) permitem estimar a percepçã... more Contexto: Estudos da percepção da qualidade de vida no trabalho (QVT) permitem estimar a percepção de uma classe profissional inteira, identificar desequilíbrios específicos e proporcionar políticas de desenvolvimento profissional. Objetivo: Avaliar a percepção da QVT dos neurocirurgiões que trabalham em Serviços de Emergência em São Paulo usando instrumentos de validação disponíveis na língua portuguesa. Método: A percepção da QVT dos neurocirurgiões da cidade de São Paulo (Capital) foi estudada com questionário validado para língua portuguesa. Resultados: Cinquenta e oito neurocirurgiões responderam ao questionário. A análise revelou fortes tendências negativas na maioria das áreas de QVT. As áreas com forte tendência negativa deveriam ser tratadas com políticas específicas. Conclusão: Há fortes tendências negativas em quase todos os domínios da QVT.

Arquivos Brasileiros de Neurocirurgia, May 31, 2019

Frontiers in Human Neuroscience, 2012

Hydrocephalus is an entity which embraces a variety of diseases whose final result is the enlarge... more Hydrocephalus is an entity which embraces a variety of diseases whose final result is the enlarged size of cerebral ventricular system, partially or completely. The physiopathology of hydrocephalus lies in the dynamics of circulation of cerebrospinal fluid (CSF). The consequent CSF stasis in hydrocephalus interferes with cerebral and ventricular system development. Children and adults who sustain congenital or acquired brain injury typically experience a diffuse insult that impacts many areas of the brain. Development and recovery after such injuries reflects both restoration and reorganization of cognitive functions. Classic examples were already reported in literature. This suggests the presence of biological mechanisms associated with resilient adaptation of brain networks. We will settle a link between the notable modifications to neurophysiology secondary to hydrocephalus and the ability of neuronal tissue to reassume and reorganize its functions.

Arquivos Brasileiros de Neurocirurgia, Jun 1, 2000

Os autores descrevem o caso de um paciente do sexo masculino, de 66 anos de idade, com lesão neop... more Os autores descrevem o caso de um paciente do sexo masculino, de 66 anos de idade, com lesão neoplásica gástrica Borrmann IV, desde 2 cm do cárdia até a região pré-pilórica, cujo exame anatomopatológico revelou adenocarcinoma tubulopapilífero pouco diferenciado. O mesmo paciente era portador de glioblastoma multiforme do lobo temporal esquerdo. Neoplasias malignas primárias múltiplas que incluam neoplasias cerebrais primárias são raras, havendo apenas 17 casos descritos na literatura. Os autores discutem a etiopatogenia dessa infreqüente patologia.

Arquivos Brasileiros de Neurocirurgia, Jun 1, 2013

Endoscopic third ventriculostomy (ETV) is an established treatment for hydrocephalus and is an al... more Endoscopic third ventriculostomy (ETV) is an established treatment for hydrocephalus and is an alternative method avoiding shunts and its complications. There is still controversy regarding the higher risk of failure in younger infants. NARF was a male preterm newborn of 33 weeks old, with Moebius syndrome and 1,800 grams at birth. Detailed neonatal evaluation revealed hydrocephalus with bilateral ventricular index of 0.6. It was then decided, in spite of prematurity and low birth weight to perform ETV with the age of 25 days, with 1,850 grams. After discharge, follow-up was lost due to family moving to another city. By chance, after seven years child returned to our medical facility and a follow-up magnetic resonance revealed pervious ETV with high flow, demonstrating functionality of ventriculostomy. Patient's age and etiology of hydrocephalus are the most important factors influencing the success rate of ETV. Recently, the age between 6 months and 1 year old became a cutoff below which failure rates are reported to be particularly high and there are dichotomized experience. The results in low birth weight and preterm infants is not widely known and can be poor. Our case illustrates a successful ETV in a both preterm and low birth weight newborn and a satisfactory long term result, reinforcing the security and efficacy of ETV even in newborns.

Jornal Brasileiro De Pneumologia, Dec 1, 2013

$Research paper thumbnail of Amyloidosis presenting as multiple vertebral fractures$

Arquivos Brasileiros de Neurocirurgia, Sep 1, 2014

Amyloidosis is a plasma cell disorder characterized by the overproduction and tissue deposition o... more Amyloidosis is a plasma cell disorder characterized by the overproduction and tissue deposition of a monoclonal IG light chain or fragments. Musculoskeletal and soft tissue manifestations are arthropathy, myopathy, bone lesions, and lymphadenopathy. It can also present with symptoms and signs that mimic a variety of rheumatic conditions, such as scleroderma, rheumatoid arthritis, Sjögren's syndrome polymyalgia rheumatica, a myeloma or a bone tumour. We describe the case of a 64-year-old white woman with an acute history of fall from own height in whose investigation revealed fractures in T8, T9, T11 and L1. In order to determine the nature of lesion, the patient was submitted to percutaneous biopsy guided by fluoroscopy of T11, without any surgical complications. Pathological findings were compatible with deposition of amyloid protein and amyloidosis. Amyloidosis must be considered in differential diagnosis of pathological fractures together with other osteopenic and lytic conditions, such as bone metastasis, metabolic and infectious diseases.

Arquivos De Neuro-psiquiatria, Nov 1, 2014

Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracrania... more Aging is a major risk factor for poor outcome in patients with ruptured or unruptured intracranial aneurysms (IA) submitted to treatment. It impairs several physiologic patterns related to cerebrovascular hemodynamics and homeostasis. Objective: Evaluate clinical, radiological patterns and prognostic factors of subarachnoid hemorrhage (SAH) patients according to age. Method: Three hundred and eighty nine patients with aneurismal SAH from a Brazilian tertiary institution (Hospital do Servidor Público Estadual de São Paulo) were consecutively evaluated from 2002 to 2012 according to Fisher and Hunt Hess classifications and Glasgow Outcome Scale. Results: There was statistically significant association of age with impaired clinical, radiological presentation and outcomes in cases of SAH. Conclusion: Natural course of SAH is worse in elderly patients and thus, proper recognition of the profile of such patients and their outcome is necessary to propose standard treatment.

Acta Neurologica Belgica, 2020

Idiopathic normal pressure hydrocephalus (iNPH) is a condition characterized by gait disturbance,... more Idiopathic normal pressure hydrocephalus (iNPH) is a condition characterized by gait disturbance, dementia and/or urinary incontinence and enlarged ventricular system due to disturbance of cerebrospinal fluid (CSF). This study aims to describe the long-term experience with patients with iNPH submitted to ventriculoperitoneal shunt (VPS) with the programmable valve STRATA® (Medtronic). We prospectively selected a cohort of patients with a diagnosis of iNPH from January 2010 to April 2013 in a Brazilian tertiary hospital. All patients underwent clinical evaluation, which consists of the Mini-Mental State Examination and Time Up and Go tests and the application of Japanese Scale for Idiopathic Normal Pressure Hydrocephalus in three stages: prior to the TT, 3 h after the TT and 72 h after the TT. Fifty patients were submitted to VPS and followed. There were 32 men and 18 women. Mean age was 77.1 with standard deviation of 10.9. Follow-up time ranged from 96 to 120 months, with mean of 106 months. After 1 year of follow-up, 42 (83%) patients presented with clinical improvement, decreasing to 62% of patients at mid-term follow-up and 38% of patients at late follow-up. Complications occurred in 18% of subjects, needing reoperation in 16%. Our results show relevant clinical impact of shunting in iNPH patients, decreasing over time. Complications should not be underestimated, reaching up to 18% and demanding reoperation in 16% of cases. Thus, although much has been improved with current shunt technology, it is still important to consider the drawbacks of treatment.

Neurosurgical Review, 2020

Idiopathic intracranial hypertension (IIH) is a rare disease with an incidence rate of 0.5-2.0/10... more Idiopathic intracranial hypertension (IIH) is a rare disease with an incidence rate of 0.5-2.0/100,000/year. Characteristic symptoms are headache and several degrees of visual impairment. Psychiatric symptoms in association with IIH are usually poorly described and underestimated. In this study, we evaluated IIH subjects to determine the association with psychiatric symptoms. We evaluated thirty consecutive patients with IIH submitted to neurosurgery from January 2017 to January 2020 in two Brazilian tertiary hospitals. They underwent clinical evaluation, obtaining medical history, comorbidities, body mass index (BMI-kg/m 2), and applying Neuropsychiatric Inventory Questionnaire (NPI-Q). There were 28 females and 2 males. Ages ranged from 18 to 66 years old, with mean age of 37.97 ± 12.78. Twenty-five (83%) presented comorbidities, being obese and having arterial hypertension the most frequent. Body mass index ranged from 25 to 35 kg/m 2 and mean value was 31 ± 3.42. After application of Neuropsychiatric Interview, 26 of 30 presented psychiatric symptoms (86%). Depression-anxiety syndromes were reported in 25 patients (83%). Nighttime disturbances were reported by 14 subjects (46%). Appetite and eating disorders were described by 23 (76%). Psychiatric symptoms in association with IIH are usually poorly described and underestimated. In our sample, twentysix out of 30 (86%) reported psychiatric symptoms. We highlight the high prevalence of psychiatric symptoms among IIH patients and the need of managing these patients with a multidisciplinary team, including psychiatrists.

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA, 2018

Introduction: Due to increased number of available alternative therapies to the treatment of back... more Introduction: Due to increased number of available alternative therapies to the treatment of back pain and sometimes a difficult access to specialized medical evaluations, there is a widespread use of alternative therapies for the treatment of back pain. Case Description: We describe a case with a catastrophic consequence of massage therapy in a patient with initial symptoms of back pain resulting in definitive paraplegia and discuss the needs for medical diagnosis for any treatment. Discussion and Conclusion: We discuss the potencial harms to the patient when initiating a questionable treatment method, which are late diagnosis, direct physical harm, interference with tradiotional treatments, financial harm and time loss. Alternative treatments are valuable tools to control refractory symptoms, especially pain. But we reinforce the need of adequate medical screening before performing therapies which may bring unwilling outcomes.

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA, 2017

Apresenta-se o relato de caso de um paciente portador de neurocitoma intraventricular, operado no... more Apresenta-se o relato de caso de um paciente portador de neurocitoma intraventricular, operado no Serviço de Neurociruigia da Faculdade de Medicina da Universidade de São Paulo. Os neurocitomas constituem cerca de 50% dos tumores intra-ventriculares supratentoriais em adultos, porém menos que l% de todos os tumores do sistema nervoso central e seus envoltórios. A cirurgia radical é o melhor tratamento, sendo a radioterapia indicada nos casos de ressecção incompleta ou de contra-indicação clínica para cirurgia. Nosso paciente foi submetido a abordagem transcalosa com ressecção microcirúrgica subtotal, com boa evolução, sem alteração cognitiva relacionada à memória e ainda livre de recidiva. Histopalologia com técnica imunoistoquímica revelou neurocitoma. Os aspectos relativos ao quadro clínico, diagnóstico, patologia, cirurgia e prognóstico foram criteriosamente revistos na literatura e são discutidos.

XXXII Congresso Brasileiro de Neurocirurgia, 2018

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2014

Resumo Objetivo: Analisar aspectos clínicos e epidemiológicos dos tumores cerebrais primários e m... more Resumo Objetivo: Analisar aspectos clínicos e epidemiológicos dos tumores cerebrais primários e metastáticos entre os pacientes atendidos no Hospital do Servidor Público Estadual de São Paulo, durante os anos de 2010 a 2012. Método: Estudo transversal, retrospectivo, do tipo observacional, com análise de 369 casos de neoplasias intracranianas de acordo com os dados obtidos no setor de registro hospitalar, nos prontuários da instituição e registros anatomopatológicos dos pacientes tratados cirurgicamente. Resultados: Tumores cerebrais primários corresponderam a 69% da amostra; houve predomínio do sexo feminino; a média de idade foi de 62 anos, com pico na incidência na faixa etária de 41 a 64 anos. Meningiomas foram os tumores cerebrais primários mais encontrados (23%), seguidos pelos gliomas (21%). Cânceres de pulmão, de mama e do trato gastrointestinal foram, em ordem decrescente, as localizações primárias mais frequentes das metástases; estas foram múltiplas em somente 26% dos cas...

Arquivos de Neuro-Psiquiatria, 2016

Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the ... more Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. Method From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. Results Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). Conclusion Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2015

Background Treatment of target lesions when parent vessels are injured or diseased may be quite d... more Background Treatment of target lesions when parent vessels are injured or diseased may be quite difficult. Moret et al have proposed an endovascular technique based on retrograde transcirculation approach through communicating vessels. Methods We report on the first Brazilian experience with retrograde endovascular approach, to the best of our knowledge. Results The two cases illustrate difficult anterograde approach techniques to treat basilar apex aneurysms. In the first case, tortuosity and angulation of both vertebral arteries associated to stenosis did not allow an anterograde approach. In the second case, after a SAH of a basilar apex aneurysm treated more than a decade ago with bilateral vertebral artery trapping, the patient underwent a retrograde approach. Conclusion For this approach, follow-up data are still lacking and complications are usually more common than in anterograde approach. Nevertheless, in select cases, it may be applied by experienced hands with acceptable ...

Jornal Brasileiro de Neurocirurgia, Mar 20, 2018

Relatamos um caso de sinus dérmico em uma paciente de 1 ano e 8 meses, apresentando desde o nasci... more Relatamos um caso de sinus dérmico em uma paciente de 1 ano e 8 meses, apresentando desde o nascimento nódulo endurecido em região occipital, com presença de falha óssea adjacente e exames de imagem mostrando extensão da lesão para fossa posterior. Trata-se de um tumor de inclusão resultante de uma falha no desenvolvimento ectodérmico, curável pela ressecção completa e com excelente prognóstico 1,2,3,6 .