Superficial Siderosis of Central Nervous System as Primary Clinical Manifestation Secondary to Intradural Thoracic Disk Herniation.

BACKGROUND: Superficial siderosis of the central nervous system is a rare neurologic disorder characterized by the superficial deposition of hemosiderin in the subpial layer resulting in iron-related progressive neurodegeneration. CASE DESCRIPTION: In this report, we present a case of superficial siderosis of the central nervous system secondary to an intradural thoracic disk herniation causing a cerebrospinal fluid (CSF) leak. CONCLUSIONS: The patient was successfully treated with T6-T8 transpedicular partial corpectomy, as well as diskectomy with decompression followed by watertight closure of the CSF leak. Intraoperative watertight closure of the CSF leak was achieved.

Dolor lumbar en niños / Low back pain in children

El dolor lumbar en niños ha ido en aumento en su prevalencia en los últimos años. Si bien la causa del dolor lumbar generalmente se relaciona con alguna condición que resuelve espontáneamente, o a períodos de desarrollo y crecimiento acelerado, se deben descartar una serie de patologías presentes en este rango etario que conllevan severas implicancias para la adultez. Se ha constatado que la incidencia del dolor lumbar aumenta a lo largo de los años de vida del niño, y se espera que al llegar a la adolescencia, un 10-30% de la población pediátrica total haya experimentado dolor lumbar en algún momento de su vida. A pesar de la creciente incidencia, un estudio prospectivo en niños con dolor lumbar reveló, que menos de un 30% de los pacientes tuvo un diagnóstico definitivo, o con una etiología clara. Dentro del estudio del dolor lumbar son esenciales una historia clínica detallada, con caracterización del dolor, y presencia de banderas rojas. El examen físico debe ser completo, y en caso de hallazgos positivos, debe complementarse con estudio imagenológico. Hay que considerar que un gran porcentaje de los pacientes presentarán un dolor lumbar de carácter inespecífico atribuible a tensión muscular y factores psicosociales. Sin embargo, debe realizarse un seguimiento adecuado hasta la resolución sintomática. El estudio debe ir dirigido a descartar aquellas patologías de mayor complejidad, teniendo en consideración los factores de riesgo asociados: edad, actividad física, peso, factores psicosociales, entre otros. La radiografía nos orientará y ayudará a descartar la mayoría de las patologías prevalentes en este grupo etario, profundizando en el estudio, dependiendo de los hallazgos clínicos y de la anamnesis.

Lumbar pain in children has increased in frequency during the last years. Even though the primary cause for this pain is related to benign conditions, or accelerated bursts of growth, there are certain pathologies to be discarded since they can have an impact during adulthood. The incidence of lumbar pain increases with age, and it has been reported that by the time of adolescence up to 10 to 30% of the pediatric population will have experimented lumbar pain at some point in their lives. In spite of this increasing incidence, a report revealed that less than 30% of patients had a definitive diagnosis, o a clear etiology. It is of importance, during the study of lumbar pain, to have a good clinical history, characterization of pain, and thorough physical examination, and in the case of positive findings, an imagenology study must be completed. We have to consider that a large percentage of patients will experience unspecific lumbar pain, probably caused by muscle contraction and psychosocial factors. Nevertheless, close follow up must be made until the symptoms are resolved. The study must be directed at diseases that are more complex, considering the risk factors associated: age, physical activity, weight, psychosocial factors, among others. Radiography will help to guide the study and rule out the most prevalent pathology, according to the history and clinical findings.