[Moyamoya disease among children. An analysis of a series in the Western world and literature review]. / Moyamoya en la poblacion infantil. Analisis de una serie occidental y revision de la bibliografia.

PATIENTS AND METHODS: A total of 12 patients with moyamoya disease or syndrome with a mean age of 6 years were analyzed in a retrospective fashion. RESULTS: Infarction was the most frequent presentation feature (8 out of 12 patients), 2 had epilepsy and 2 were incidental findings. Seven cases were classified as idiopathic while the other five were related to systemic illnesses. Diagnosis was initially made by magnetic resonance angiography in 9 cases, and conventional angiography in 3 cases. Mean follow-up is 5 years; six patients experienced clinical worsening of symptoms, while 6 cases remained clinically stable. However, all of them showed angiographic progression. Four patients underwent revascularization surgery. Two children died due to complications associated with moyamoya disease, and six have moderate handicaps. CONCLUSION: Due to the fact moyamoya disease is not an indolent disorder and readily progress to cause complications, surgical revascularization should always be considered in the management of these patients.

[Locked-in syndrome due to a vertebral dissection and therapeutic options with intraarterial fibrinolysis in acute phase]. / Disección vertebral como causa del síndrome de enclaustramiento y opciones terapéuticas con fibrinólisis intraarterial durante la fase aguda.

INTRODUCTION: Dissection of vertebral artery is an unusual pathology but sometimes is the cause of stroke in young patients. Since last years, and with the rise of some chiropractic technics, some authors have related these ones with the dissection of vertebral artery. CASE REPORT: We show a case of a 37 years old woman that after a chiropractic session began symptoms of posterior circulation dysfunction as decrease level of sense, tetraparesis and alteration of cranial nerves. The arteriography confirmed the existence of a vertebral dissection of V2 portion and thrombosis of basilar and contralateral vertebral arteries. Intraarterial fibrinolysis was performed with complete recanalization of the artery. Although this, the patient had parenchimal lesions in pons, cerebellum and territory of posterior cerebral artery that produced a locked-in syndrome. All the complementary exams were normal. DISCUSSION: We discuss the relationship between cervical manipulation as an aetiology of vertebral dissection, locked-in syndrome and therapeutic options in these patients

Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement.

PURPOSE: To determine the efficacy of percutaneous vertebroplasty in treating spinal metastases that result in pain or instability. MATERIALS AND METHODS: Thirty-seven patients (20 men, 17 women; aged 33-86 years) underwent 52 percutaneous injections of surgical cement into a vertebra (vertebroplasty) with fluoroscopic guidance in 40 procedures. Vertebroplasty was performed for analgesia in 29 procedures, stabilization of the vertebral column in five procedures, and both in six procedures. RESULTS: Twenty-four of the 33 procedures performed for analgesia that were evaluated resulted in clear improvement; seven, moderate improvement; and two, no improvement. Improvement was stable in 73% of patients at 6 months. In the procedure performed for stabilization, no displacement of treated vertebrae was observed (mean follow-up, 13 months). Three patients had transient radiculopathy due to cement extrusion, and two patients had transient difficulty in swallowing. CONCLUSION: Vertebroplasty of metastases is a minimally invasive procedure that provides immediate and long-term pain relief and contributes to spinal stabilization.