Focal status epilepticus as a manifestation of idiopathic hypertrophic cranial pachymeningitis.

BACKGROUND: Idiopathic hypertrophic cranial pachymeningitis (IHCP) is an uncommon disease of unknown etiology characterized by thickening of the cerebral dura mater with possible associated inflammation. The most frequently described clinical symptoms include headache, cranial nerve palsy, and cerebellar dysfunction. Epilepsy and/or status epilepticus as main presentation is very uncommon. CASE PRESENTATION: Two consecutive cases are presented of patients manifesting focal status epilepticus secondary to IHCP, with clinical, laboratory [blood test and cerebrospinal fluid (CSF) analysis], neuroradiologic [magnetic resonance imaging (MRI) at 3 Tesla and digital subtraction angiography (DSA)], and therapeutic data. One patient underwent meningeal biopsy; pathology findings are also included. Corticosteroid therapy resulted in clinical improvement in both cases, and neuroimaging showed decreased abnormal morphology, compared to initial findings. CONCLUSION: In the diagnostic approach to focal status epilepticus or epilepsy, IHCP must be considered a potential, although extremely infrequent, cause. Anti-inflammatory treatment is an effective addition to antiepileptic drug therapy in patients with IHCP.

[3 rare cases of textiloma after renal surgery. Review of the literature]. / Tres raros casos de textilomas tras cirugía renal. Revisión de la literatura.

OBJECTIVE: To review the literature on textiloma or surgical sponges left during renal surgery because of the important medical-legal implications of this complication. METHOD: Three cases of textiloma in patients undergoing renal surgery are presented. Two of them had undergone surgery at other hospitals 26 and 4 years earlier. The third patient had undergone transplantation at our hospital and was reoperated 4 months later for a purulent cutaneous fistula caused by the textiloma. RESULTS/CONCLUSIONS: A review of the literature since 1950 showed few reports of textiloma. The risk factors according to the type of surgery performed and current controls in the operating room to avoid this complication that can occasionally be severe, are presented in detail. The forms of presentation, diagnostic methods and difficulties encountered due to the long period of time the foreign body has been left indwelling, are analyzed. To our knowledge, 8 cases of textilomas have been reported in patients undergoing renal surgery.