ABSTRACT
BACKGROUND: The intrathoracic complications from ventriculoperitoneal shunt placement are very rare. However, they are potentially serious if not treated. CLINICAL CASE: We report the case of thoracic migration of a peritoneal catheter after ventriculoperitoneal shunt and we also review the literature references with discussion of the different mechanisms of shunt-tip migration described. No case of previous sternotomy as in our patient has been found published. CONCLUSION: All reports recommend early catheter repositioning into the peritoneal cavity after diagnosing the migration described, to prevent worse complications. Moreover, it is important to keep in mind that intrathoracic migration can happen and it is necessary to palpate the catheter continuously during passage through subcutaneous tunnelling to prevent it.
Subject(s)
Foreign-Body Migration/diagnosis , Prosthesis Failure , Ventriculoperitoneal Shunt/adverse effects , Humans , Patient PositioningABSTRACT
Venous angiomas are a developmental anomaly in which embryonic venous drainage is still present into adulthood. They are usually asymptomatic and benign course but they can cause seizures and less commonly bleeding, usually associated to cavernous malformation. Normally, treatment is not necessary although bleeding, severe clinical and lesions in which it is possible a favourable approach, we can consider treatment. We show a case of a 11 years old boy with acute decrease level of consciousness. We observed hematoma in the right cerebellar hemisphere with radial tubular structures consistent with developmental venous anomaly. The hematoma was evacuated without a demonstrable other reason justifying the bleeding.
Subject(s)
Central Nervous System Venous Angioma/complications , Cerebellar Neoplasms/complications , Central Nervous System Venous Angioma/diagnostic imaging , Central Nervous System Venous Angioma/embryology , Cerebellar Neoplasms/diagnostic imaging , Cerebellar Neoplasms/embryology , Cerebellum/blood supply , Cerebrospinal Fluid Shunts , Child , Consciousness Disorders/etiology , Craniotomy , Diagnosis, Differential , Drainage , Headache/etiology , Hematoma/etiology , Hematoma/surgery , Humans , Intracranial Arteriovenous Malformations/diagnosis , Intracranial Hemorrhages/etiology , Male , Radiography , Ventriculostomy , Vomiting/etiologyABSTRACT
Chronic hypertrophic pachymeningitis is an inflammatory process of unknown aetiology characterised by a thickening of the dura mater causing pseudotumoural growth. Clinical manifestations are usually secondary to compression of adjacent neurological structures but may be also secondary to inflammatory processes. Diagnosis is mainly obtained by excluding infectious, neoplastic and autoimmune causes. Nowadays, steroid treatment is the most commonly used therapy. Two clinical cases of hypertrophic pachymeningitis are presented which were treated by surgery without any additional treatment and with good clinical and radiological development.
Subject(s)
Meningitis/pathology , Adult , Brain Edema/etiology , Chronic Disease , Craniotomy , Dura Mater/pathology , Dura Mater/surgery , Epilepsies, Partial/etiology , Female , Headache/etiology , Humans , Hypertrophy , Magnetic Resonance Imaging , Male , Meningitis/complications , Meningitis/diagnostic imaging , Meningitis/surgery , Middle Aged , Remission Induction , Tomography, X-Ray ComputedABSTRACT
Introducción: Las complicaciones intratorácicas secundarias a la colocación de una derivación ventriculoperitoneal son infrecuentes, aunque se asocian a graves consecuencias si no son tratadas de forma adecuada. Caso clínico: Describimos un caso de migración intratorácica de un catéter peritoneal tras derivación ventriculoperitoneal y se revisan las escasas referencias en la literatura, con discusión de los posibles mecanismos de penetración en la cavidad torácica. En ninguno de los artículos publicados se describe la presencia de un paciente con estereotomía previa como en nuestro caso. Conclusión: Es recomendable que tras el diagnóstico de la migración descrita, se proceda a un tratamiento precoz de reposicionamiento del catéter que evite complicaciones posteriores de mayor relevancia. Asimismo, durante la colocación de una derivación ventriculoperitoneal destacamos la importancia de la palpación permanente del catéter durante la tunelización subcutánea para evitar la migración intratorácica del mismo
Background: The intrathoracic complications from ventriculoperitoneal shunt placement are very rare. However, they are potentially serious if not treated. Clinical case: We report the case of thoracic migration of a peritoneal catheter after ventriculoperitoneal shunt and we also review the literature references with discussion of the different mechanisms of shunt-tip migration described. No case of previous sternotomy as in our patient has been found published. Conclusion: All reports recommend early catheter repositioning into the peritoneal cavity after diagnosing the migration described, to prevent worse complications. Moreover, it is important to keep in mind that intrathoracic migration can happen and it is necessary to palpate the catheter continuously during passage through subcutaneous tunnelling to prevent it
Subject(s)
Aged , Humans , Male , Foreign-Body Migration/complications , Catheters, Indwelling/adverse effects , Ventriculoperitoneal Shunt/adverse effects , Thorax , Hydrocephalus/surgery , Risk FactorsABSTRACT
Los angiomas venosos se consideran una anomalía del desarrollo caracterizada por persistencia en la edad adulta de un drenaje venoso embrionario. Suelen ser asintomáticos y de curso benigno, aunque pueden ocasionar convulsiones y menos frecuentemente hemorragias, normalmente por malformación cavernosa asociada. En la mayoría de los casos no es preciso tratamiento alguno, salvo circunstancias como sangrado, clínica intensa atribuible a la lesión y localización de buen acceso quirúrgico. Se presenta el caso de un varón de 11 años con un cuadro brusco de disminución del nivel de consciencia, objetivándose en estudios de imagen hematoma en hemisferio cerebeloso derecho, así como estructuras tubulares radiales compatibles con anomalía venosa del desarrollo. Se practicó una intervención quirúrgica con evacuación de hematoma, sin objetivarse otras causas que justifiquen el sangrado (AU)
Subject(s)
Humans , Male , Child , Central Nervous System Venous Angioma/complications , Cerebral Hemorrhage/etiology , Intracranial Arteriovenous Malformations/surgery , Hemangioma, Cavernous/surgery , Risk FactorsABSTRACT
La paquimeningitis hipertrófica crónica (PHC) es un proceso inflamatorio de etiología desconocida que se caracteriza por afectar a la duramadre, provocando un crecimiento pseudotumoral de la misma. La clínica de presentación es consecuencia del efecto compresivo sobre estructuras neurológicas aunque en ocasiones se manifiesta por síntomas irritativos. El diagnóstico se realiza por exclusión de causas infecciosas, neoplásicas y autoinmunes fundamentalmente. El tratamiento esteroideo se considera la terapia más utilizada hoy en día. Se presentan 2 casos clínicos de PHC en los que se practicó resección quirúrgica de la lesión sin precisar posteriormente tratamiento coadyuvante dada la favorable evolución clínica y radiológica (AU)