RESUMO
We report a clinical case of spontaneous bilateral carotid-cavernous fistulas. Bilateral pulsatile exophthalmos and symmetric cavernous sinuses detected by CT scan helped to suspect the diagnosis. Arteriography confirmed the diagnosis. The patient underwent embolization with favorable neurologic and ophthalmic evolution. Carotid-cavernous fistula is a rare but severe complication associated with a poor functional (blindness) and vital (meningeal and intracerebral hemorrhage) prognosis. The concomitant use of arteriography and embolization has considerably improved the prognosis.
Assuntos
Fístula Carótido-Cavernosa/terapia , Embolização Terapêutica/métodos , Exoftalmia/etiologia , Angiografia/métodos , Fístula Carótido-Cavernosa/diagnóstico por imagem , Seio Cavernoso/diagnóstico por imagem , Feminino , Humanos , Prognóstico , Tomografia Computadorizada por Raios X/métodos , Adulto JovemAssuntos
Neoplasias Encefálicas/patologia , Encéfalo/patologia , Cisto Dermoide/patologia , Transtornos da Cefaleia/etiologia , Transtornos Parkinsonianos/etiologia , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/fisiopatologia , Craniotomia , Cisto Dermoide/diagnóstico por imagem , Cisto Dermoide/cirurgia , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/patologia , Lobo Frontal/cirurgia , Lateralidade Funcional/fisiologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Paresia/etiologia , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/patologia , Lobo Temporal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tremor/etiologiaRESUMO
Os odontoideum is an uncommon abnormality of the cranio-vertebral junction (CVJ) that exists as a separate ossicle apart from a hypoplastic dens. Its genesis and natural history have been debated, and its proper treatment remains uncertain. A 48-year-old woman complained of persistent upper neck pain and paraesthesia of her left side. Magnetic resonance imaging of the CVJ demonstrated an os odontoideum. Dynamic computed tomography scan of the CVJ showed a reduction of the space available for the spinal cord to 50% from extended to flexed position. The patient underwent posterior spinal fusion of C1-C2 using a sublaminar titanium hook and rods fixed in moderate extension. We discuss the usefulness of the dynamic computed tomography (CT) scan in the evaluation of atlantoaxial motion and the management of this pathology.
Assuntos
Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Fusão Vertebral/métodos , Articulação Atlantoaxial/patologia , Feminino , Humanos , Hipestesia/etiologia , Pessoa de Meia-Idade , Cervicalgia/etiologia , Processo Odontoide/patologia , Tomografia Computadorizada por Raios XAssuntos
Vértebras Cervicais/patologia , Cistos/patologia , Doenças da Coluna Vertebral/patologia , Vértebras Torácicas/patologia , Articulação Zigapofisária/patologia , Cistos/complicações , Cistos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/fisiopatologia , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Posterior epidural migration of an extruded disk fragment is rare, and posterior migration of the free fragments causing cauda equina syndrome is exceptionally rare. The disk fragment must transgress through numerous anatomical restraints including the nerve roots in such cases. METHODS: Two cases of migration of the sequestrated disk into the posterior epidural space are presented. The first patient complained, over the course of 1 month, of paresthesias and weakness of the lower limbs, with urinary retention. However, in the other case, there was steppage gait and strength score of 3/5 on dorsiflexion of left foot, without bladder or bowel disturbance. RESULTS: Lumbar CT scan with sagittal reconstruction showed a posterior epidural mass, which was isodense to the disk. The preoperative differential diagnosis included epidural abscess, hematoma, and neoplasm. An urgent decompressive lumbar laminectomy was performed. At surgery, the lesion proved to be a massive extruded disk fragment. CONCLUSION: Diagnosis of posterior epidural migration of the sequestrated disks may be difficult. It may present with subtle clinical features. Magnetic resonance images may mimic those of other more common posterior epidural lesions. Early surgery should be the first choice to prevent severe neurologic deficits.
Assuntos
Espaço Epidural , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/patologia , Vértebras Lombares , Polirradiculopatia/etiologia , Adulto , Humanos , Deslocamento do Disco Intervertebral/cirurgia , MasculinoRESUMO
BACKGROUND: Intraosseous cavernous hemangiomas of the bone are uncommon tumors, accounting for 0.7% to 1% of all bone neoplasms. The vertebral column is most often affected, followed by the skull. Calvarial cavernous hemangioma is rare, comprising about 0.2% of all benign neoplasms of the skull. CASES REPORTS: We describe 3 patients with calvarial hemangiomas that were localized frontally (2 cases) and parietally. The diameter ranged from 2 to 3 cm. They presented with slowly growing mass, hard to pressure, with freely mobile skin above the cavernoma sites. Cranial CT scan showed osteolytic lesion with erosion of the tabula externa. Magnetic resonance imaging performed in one patient showed hypointense lesion on T1-weighted image and hyperintense on T2-weighted image. Resection and postoperative course were uneventful. Pathological examination revealed a cavernous hemangioma of the diploe. CONCLUSION: Skull cavernous hemangiomas are rare benign tumors. The preferred treatment is complete tumor removal with normal bony margins. Sometimes, the classic radiographic appearances are not evident. Consequently, the diagnosis is most often made during surgical resection.