RESUMO
Nocardia is a Gram-positive, partially acid-fast, catalase-positive, and urease-positive bacterium that grows aerobically. We present an extremely rare case of cauda equina syndrome due to isolated intramedullary Nocardia farcinica infection. A 44-year-old male presented with low backache and gradually progressive weakness in bilateral lower limbs followed by paraplegia. He was found to have a well-defined, sharply demarcated ring-enhancing lesion located from T11-T12 to L3 vertebral body. He underwent laminectomy and decompression. The histopathological examination revealed a Gram-positive filamentous organism that looks like Nocardia. The culture report was suggestive of Nocardia farcinica. He was then treated with antibiotics and had a remarkable clinical and radiological improvement.
Assuntos
Antibacterianos/uso terapêutico , Síndrome da Cauda Equina/microbiologia , Cauda Equina/efeitos dos fármacos , Dor Lombar/microbiologia , Nocardiose/microbiologia , Paraplegia/microbiologia , Adulto , Cauda Equina/diagnóstico por imagem , Cauda Equina/microbiologia , Cauda Equina/cirurgia , Síndrome da Cauda Equina/diagnóstico por imagem , Síndrome da Cauda Equina/tratamento farmacológico , Síndrome da Cauda Equina/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Laminectomia/métodos , Dor Lombar/diagnóstico por imagem , Dor Lombar/tratamento farmacológico , Dor Lombar/cirurgia , Imageamento por Ressonância Magnética , Masculino , Meropeném/uso terapêutico , Nocardia/efeitos dos fármacos , Nocardia/crescimento & desenvolvimento , Nocardia/patogenicidade , Nocardiose/diagnóstico por imagem , Nocardiose/tratamento farmacológico , Nocardiose/cirurgia , Paraplegia/diagnóstico por imagem , Paraplegia/tratamento farmacológico , Paraplegia/cirurgia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
Background: Microvascular decompression (MVD) of the trigeminal nerve is a well-accepted nondestructive procedure for trigeminal neuralgia. Usually, Teflon (PTFE) puff or felt graft techniques, which are most commonly used, are associated with arachnoiditis and recurrence among other complications. We use the "sleeve graft" technique using PTFE to separate the neurovascular conflict and here we describe our experience with the same in 376 cases. Objectives: To study the outcomes in 376 patients treated with sleeve graft technique for trigeminal neuralgia. Materials and Methods: For a period of 18 years, from 2002 to 2020, all cases of medically refractory trigeminal neuralgia were subjected to the "sleeve graft" technique for MVD. Pre- and post-operatively, pain score was given according to Barrow Neurological Institute pain intensity score. Cases were observed for any complications and pain relief in short and long-term follow-up. Results: In total, 376 cases of refractory primary trigeminal neuralgia cases, among which 198 patients underwent MVD with no prior intervention, 158 underwent MVD following percutaneous ablative procedure, 13 were "Revision MVD" previously done at other centers, and four were post gamma knife failure. There was no incidence of arachnoiditis or recurrence of symptoms. Further, 368 (97.8%) patients had complete recovery from symptoms while eight (2.2%) had partial recovery after 5 years of follow-up. Complications included hearing loss (n = 1), temporary hypoesthesia (n = 45), and permanent hypoesthesia (n = 7). Conclusion: "PTFE Sleeve Graft" technique to remove the neurovascular conflict in micro vascular decompression (MVD) for trigeminal neuralgia is a safe and effective technique that yields better results.
Assuntos
Aracnoidite , Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Aracnoidite/complicações , Descompressão , Humanos , Hipestesia , Cirurgia de Descompressão Microvascular/métodos , Dor/etiologia , Politetrafluoretileno , Estudos Retrospectivos , Resultado do Tratamento , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgiaRESUMO
Spontaneous (nontraumatic, nonsurgical) cerebrospinal fluid (CSF) rhinorrhea constitute only 3-4% of all cases. Here, we present a case of a 66-year-old male who presented with spontaneous CSF rhinorrhea, where intraoperative findings revealed an anterior clival defect as the cause. Such cases are extremely rare, and to the best of our knowledge only five of such cases are described in the literature. In this report, we discuss the possible etiology and management of this rare condition.