RESUMEN
Crouzon's syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon's syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon's syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon's syndrome due to a ruptured jugular venous diverticulum is described.
Asunto(s)
Disostosis Craneofacial/complicaciones , Divertículo/terapia , Embolización Terapéutica , Hemorragia/terapia , Venas Yugulares/diagnóstico por imagen , Enfermedades Vasculares/terapia , Adulto , Divertículo/complicaciones , Oído/diagnóstico por imagen , Femenino , Hemorragia/etiología , Humanos , Tomografía Computarizada por Rayos X , Enfermedades Vasculares/complicaciones , Adulto JovenRESUMEN
We describe the occurrence of cerebral hyperperfusion syndrome (CHS) in a case of long-standing carotid-jugular fistula (CJF) treated by endovascular reconstruction of the carotid artery. A 43-year-old male with a high-flow CJF between the internal carotid artery (ICA) and internal jugular vein underwent endovascular reconstruction of the carotid artery using a stent graft. After treatment, the patient developed CHS. The patient succumbed to a large intracranial bleed in the left external capsule and parietal lobe on the fifth postoperative day. CHS following endovascular reconstruction of carotid artery is rare. We present the first reported case of CHS following endovascular reconstruction of ICA. A review of literature for patients treated by endovascular rerouting of blood flow to the cerebral parenchyma associated with hyperperfusion syndrome has been performed.
Asunto(s)
Fístula Arteriovenosa/cirugía , Arteria Carótida Interna/cirugía , Circulación Cerebrovascular/efectos de los fármacos , Hipertensión/complicaciones , Complicaciones Posoperatorias/diagnóstico , Adulto , Angiografía de Substracción Digital/métodos , Antihipertensivos/uso terapéutico , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Resultado Fatal , Hematoma/complicaciones , Hematoma/diagnóstico , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hemorragias Intracraneales/complicaciones , Hemorragias Intracraneales/diagnóstico , Venas Yugulares/diagnóstico por imagen , Labetalol/uso terapéutico , Imagen por Resonancia Magnética/métodos , Masculino , Complicaciones Posoperatorias/tratamiento farmacológico , Stents , Síndrome , Tomografía Computarizada por Rayos X/métodosRESUMEN
Cerebral hyperperfusion syndrome (CHS) describes a syndrome of sudden onset focal neurological features, unilateral headache, and systemic hypertension. Recurrent CHS in the same patient has not been described to date. We describe a 55-year-old woman who first developed CHS post intracranial stenting with sudden-onset right focal seizures and associated acute focal edema on imaging. After one and half years, the patient developed symptomatic in-stent restenosis and underwent repeat angioplasty with stenting. Postprocedure, the patient had another episode of CHS in the form of acute bleed in the basal ganglia and died. A review of literature of patients for CHS postintracranial angioplasty and stenting also was performed. The present case describes a rare clinical scenario where the patient had recurrent CHS with different clinical and imaging features.
