RESUMEN
Reversible cerebral vasoconstriction syndrome (RCVS) typically presents with recurrent thunderclap headaches and neurological deficits that are usually self-limiting. The intra-arterial (IA) use of vasodilators for RCVS has been reported for severe cases. Patients with RCVS have the potential for serious and permanent neurological deficits. It is a rare disorder, with a recent surge in the number of reports, and probably continues to be under-diagnosed. We report two patients with RCVS with severe neurological sequelae, treated in a large tertiary hospital. Both patients received high-dose cortico steroids due to the possibility of angiitis of the central nervous system, but they deteriorated neurologically, which suggests that steroids may have a deleterious effect in RCVS. Treatment with IA verapamil resulted in reversal of vasoconstriction, but multiple treatments were necessary. Therefore, IA administration of verapamil is a possible treatment for severe RCVS, but there is only limited sustained improvement in vasodilation that may require repetitive treatments with a currently undetermined optimal treatment interval.
Asunto(s)
Arterias Cerebrales/efectos de los fármacos , Trastornos Cerebrovasculares/tratamiento farmacológico , Vasodilatadores/administración & dosificación , Vasoespasmo Intracraneal/tratamiento farmacológico , Verapamilo/administración & dosificación , Adulto , Anciano de 80 o más Años , Arterias Cerebrales/diagnóstico por imagen , Arterias Cerebrales/patología , Trastornos Cerebrovasculares/etiología , Trastornos Cerebrovasculares/fisiopatología , Femenino , Humanos , Radiografía , Resultado del Tratamiento , Vasoespasmo Intracraneal/etiología , Vasoespasmo Intracraneal/fisiopatologíaRESUMEN
The authors present a case of "surfer's myelopathy," a rarely described syndrome characterized by nontraumatic paraparesis/paraplegia in novice surfers and theorized to result from spinal cord ischemia secondary to surfing-related positional hyperextension. Imaging and clinical course of the youngest known affected individual are discussed, including evidence of acute spinal cord infarction on diffusion-weighted magnetic resonance imaging, a finding not previously described in the literature.
Asunto(s)
Imagen de Difusión por Resonancia Magnética/métodos , Isquemia de la Médula Espinal/diagnóstico , Deportes , Adolescente , Diagnóstico Diferencial , Femenino , Humanos , Isquemia de la Médula Espinal/etiología , Isquemia de la Médula Espinal/rehabilitación , SíndromeRESUMEN
The authors describe the off-label use of Onyx for embolization of fusiform mycotic and dissecting intracranial aneurysms based on their experience with 3 patients treated at the University of Utah Hospital from 2006 through 2007. Technical success in occluding the parent artery/aneurysm was achieved in all patients. There were no complications. The authors conclude that Onyx can be used to achieve occlusion of fusiform mycotic and dissecting intracranial aneurysms in conjunction with parent artery occlusion.
Asunto(s)
Disección Aórtica/terapia , Dimetilsulfóxido , Embolización Terapéutica/métodos , Aneurisma Intracraneal/terapia , Polivinilos , Adulto , Anciano , Disección Aórtica/diagnóstico por imagen , Angiografía Cerebral , Cuerpo Calloso/irrigación sanguínea , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: We present the largest case series in the English-language imaging literature, emphasizing the variety of presentations of Rosai-Dorfman disease in the head and neck. CONCLUSION: Rosai-Dorfman disease is a rare disorder with multiple sites of involvement in the head and neck.