Sarcoidosis en cicatriz periocular como primer hallazgo de sarcoidosis sistémica: características clínico-radiológicas / Sarcoidosis in the periocular scar as the first finding of systemic sarcoidosis: Clinical-radiological characteristics

Se presenta un caso raro de una mujer caucásica de 29 años con un granuloma en una cicatriz antigua, en la región periocular derecha, como primer signo clínico de una sarcoidosis sistémica. Se procedió a una biopsia escisional de la lesión con diagnóstico anatomopatológico de inflamación crónica granulomatosa no necrosante, con características histológicas sugestivas de sarcoidosis de cicatriz. Al año, la lesión recidivó, por lo que se trató con esteroides depot intralesionales. Esta patología se produce con más frecuencia cuando existen cuerpos extraños y puede ser la primera señal de sarcoidosis sistémica

An unusual case is presented of a 29 year-old Caucasian woman with a granuloma in an old scar in the right periocular region as a first clinical sign of a systemic sarcoidosis. An excisional biopsy was performed, for which the histological diagnosis was a chronic non-necrotising granulomatous inflammation, suggestive of scar sarcoidosis. The lesion re-appeared one year after initial treatment, and was treated with intralesional depot steroids, showing adequate progression. This disease occurs more frequently in wound areas where there are foreign bodies and could be the first sign of systemic sarcoidosis

Sarcoidosis in the periocular scar as the first finding of systemic sarcoidosis: Clinical-radiological characteristics. / Sarcoidosis en cicatriz periocular como primer hallazgo de sarcoidosis sistémica: características clínico-radiológicas.

An unusual case is presented of a 29 year-old Caucasian woman with a granuloma in an old scar in the right periocular region as a first clinical sign of a systemic sarcoidosis. An excisional biopsy was performed, for which the histological diagnosis was a chronic non-necrotising granulomatous inflammation, suggestive of scar sarcoidosis. The lesion re-appeared one year after initial treatment, and was treated with intralesional depot steroids, showing adequate progression. This disease occurs more frequently in wound areas where there are foreign bodies and could be the first sign of systemic sarcoidosis.

Tubérculo coroideo asintomático en un paciente con enfermedad de Crohn en tratamiento con adalimumab / Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment

Introducción: Adalimumab, un antifactor de necrosis tumoral que se utiliza en la enfermedad de Crohn activa (EC), se asocia con un mayor riesgo de tuberculosis. Caso clínico: Se describe el caso de un varón de 48 años con EC activa en tratamiento con adalimumab. Después de 3 meses desarrolló una tuberculosis pulmonar miliar, y en un estudio oftalmológico se encontró un tubérculo coroideo no reactivo solitario temporal superior al disco óptico. La angiofluoresceingrafía mostró hiperfluorescencia tardía. Con la tomografía de coherencia óptica se observó una masa plana sin desprendimiento seroso de retina. El tubérculo coroideo regresó lentamente con la terapia antituberculosa. Discusión: En pacientes con EC y en tratamiento con adalimumab, un tubérculo coroideo puede presentarse sin sintomatología vítreo-retiniana (AU)

Introduction: Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection. Case report: The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy. Discussion: Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab (AU)

Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment. / Tubérculo coroideo asintomático en un paciente con enfermedad de Crohn en tratamiento con adalimumab.

INTRODUCTION: Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection. CASE REPORT: The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy. DISCUSSION: Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab.

Presunta proliferación circunscrita solitaria de los astrocitos retinianos / Presumed solitary circumscribed retinal astrocytic proliferation

INTRODUCCIÓN: La presunta proliferación circunscrita solitaria de los astrocitos retinianos (PPCSAR) es una pequeña lesión solitaria y definida. Caso clínico. Varón de 58 años con una lesión opaca amarillenta inferonasal al disco óptico. La angiofluoresceingrafía mostró hiperfluorescencia leve en fase precoz y tardía. La ecografía no mostró calcificación. La autofluorescencia presentó autofluorescencia moderada. La tomografía de coherencia óptica mostró la masa con una configuración de bola de nieve con superficie lisa. Más de un año después, la lesión se mantuvo sin cambios. DISCUSIÓN: PSCRAP es una lesión benigna estable. Es importante diferenciarla de otras lesiones retinianas blanco-amarillentas

INTRODUCTION: Presumed solitary circumscribed retinal astrocytic proliferation (PSCRAP) is a small defined solitary lesion. Case report. A 58-year-old man had an opaque yellow retinal lesion inferonasal to the optic disc. Fluorescein angiography showed mild early hyperfluorescence and late fluorescence. Ultrasound showed no calcification. Autofluorescence disclosed moderate hyperautofluorescence. Optical coherence tomography showed the mass with a snowball configuration and a smooth surface. More than one year later, the lesion was unchanged. DISCUSSION: PSCRAP is a benign stable lesion. The main importance lies in its differentiation from well-circumscribed yellow-white lesions of the retina

Presumed solitary circumscribed retinal astrocytic proliferation. / Presunta proliferación circunscrita solitaria de los astrocitos retinianos.

INTRODUCTION: Presumed solitary circumscribed retinal astrocytic proliferation (PSCRAP) is a small defined solitary lesion. CASE REPORT: A 58-year-old man had an opaque yellow retinal lesion inferonasal to the optic disc. Fluorescein angiography showed mild early hyperfluorescence and late fluorescence. Ultrasound showed no calcification. Autofluorescence disclosed moderate hyperautofluorescence. Optical coherence tomography showed the mass with a snowball configuration and a smooth surface. More than one year later, the lesion was unchanged. DISCUSSION: PSCRAP is a benign stable lesion. The main importance lies in its differentiation from well-circumscribed yellow-white lesions of the retina.

Migraña oftalmopléjica: una urgencia oftalmológica real / Ophthalmoplegic migraine: A real eye emergency

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[Intracranial injury caused by captive bolt gun]. / Lesiones intracraneales originadas con pistola de bala cautiva.

Guns bullet or captive bolt is used as a weapon for stunning animals as a prelude to sacrifice. Placed in front of it induce an immediate loss of consciousness, thus achieving a "humanization" of process. It's use for suicide is rare, almost exclusively of people who have access to them because of their occupation, causing severe injuries to the brain. We analyse three cases presented in our service. One of them dies as a result of injuries.

Lesiones intracraneales originadas con pistola de bala cautiva / Intracranial injury caused by captive bolt gun

Las pistolas de bala cautiva o clavija perforadora son empleadas para aturdir al animal como paso previo al sacrificio. Colocadas en la frente del mismo inducen una inmediata perdida de consciencia, logrando así una “humanización” del proceso. Su uso con fines suicidas es raro, casi exclusivo de personas que tienen acceso a las mismas dada su ocupación laboral, causando graves lesiones a nivel cerebral. Analizamos tres casos que se presentaron en nuestro servicio. Uno de ellos fallece como consecuencia de las lesiones ocasionadas (AU)

Guns bullet or captive bolt is used as a weapon for stunning animals as a prelude to sacrifice. Placed in front of it induce an immediate loss of consciousness, thus achieving a "humanization" of process. It´s use for suicide is rare, almost exclusively of people who have access to them because of their occupation, causing severe injuries to the brain. We analyse three cases presented in our service. One of them dies as a result of injuries (AU)

[Isolated hypoglossal nerve palsy secondary to an atlantoccipital joint synovial cyst. Case report and literature review]. / Parálisis aislada del nervio hipogloso secundaria a quiste articular atlanto-occipital. Presentación de un caso y revisión de la literatura.

Hypoglossal nerve palsy is commonly associated with the involvement of other cranial nerves. His injury is rarely isolated. We present a patient in which paralysis is due to the presence of a "juxtafacet cyst" of the atlanto-occipital joint. We review the anatomy of the hypoglossal nerve, different therapeutic options, the differential diagnosis and papers published to date.

Parálisis aislada del nervio hipogloso secundaria a quiste articular atlanto-occipital. Presentación de un caso y revisión de la literatura / Isolated hypoglossal nerve palsy secondary to an atlantoccipital joint synovial cyst. Case report and literature review

La parálisis del nervio hipogloso se asocia comúnmente con la afectación de otros pares craneales. Su lesión aislada es infrecuente.Presentamos el caso de un paciente en el cual la parálisis es debida a la presencia de un quiste yuxtafacetario a nivel de la articulación atlanto-occipital derecha. Revisamos la anatomía del nervio hipogloso, las diferentes opciones terapéuticas así como el diagnóstico diferencial y los trabajos publicados hasta la fecha (AU)

Hypoglossal nerve palsy is commonly associated with the involvement of other cranial nerves. Hisinjury is rarely isolated. We present a patient in which paralysis is due to the presence of a “juxtafacet cyst”of the atlanto-occipital joint. We review the anatomy of the hypoglossal nerve, different therapeutic options,the differential diagnosis and papers published to date (AU)

[Chronic subdural hematoma associated with arachnoid cyst. Report of 12 cases]. / Hematoma subdural crónico asociado a quiste aracnoideo. Presentación de 12 casos.

INTRODUCTION: We designed this study to investigate the clinical, neurological, and radiological outcome of patients with chronic subdural hematoma related to an intracranial arachnoid cysts. PATIENTS AND METHODS: Medical records of 12 cases of patients with arachnoids cyst complicated with chronic subdural hematoma were retrospectively reviewed. RESULTS: Between January 1984 and April 2008, 12 patients (0.9%) of 1.253 cases of chronic subdural hematoma surgically treated in our hospital had associated arachnoid cyst. Arachnoid cysts were located in the middle fossa (10 cases) and convexity (2 cases). The most frequent symptom was headache (6 cases), followed by seizures (3 cases). Eleven patients underwent burr hole and drainage; the oldest patient was treated conservatively. CONCLUSIONS: Patients with AC, especially when these are located in temporal fossa, appear to harbour a life-long risk of contracting subdural hematoma. Hematoma evacuation is adequate at first operation and if arachnoid cyst is symptomatic or preoperative symptoms persist, additional arachnoid cyst surgery should be considered.

Hematoma subdural crónico asociado a quiste aracnoideo. Presentación de 12 casos / Chronic subdural hematoma associated with arachnoid cyst. Report of 12 cases

Objetivos. Analizar las características clínicas,neurológicas y resultado neurorradiológico de una seriede pacientes con quiste aracnoideo asociado a un hematomasubdural crónico.Pacientes y método. Revisamos retrospectivamente12 casos de pacientes con quiste aracnoideo que presentaroncomo complicación un hematoma subduralcrónico.Resultados. Entre enero de 1984 y abril de 2008, 12pacientes (0.9%) de 1.253 casos con hematoma subduralcrónico presentaban un quiste aracnoideo intracraneal.La localización de los quistes fue en 10 casos en la fosatemporal y los otros dos en la convexidad. Los síntomasde presentación fueron cefalea en 6 pacientes (50%),seguidos por convulsiones (3 casos). En once pacientesse realizó agujero de trépano y drenaje del HSC, lapaciente de más edad fue tratada de forma conservadora.Únicamente se trataron 3 quistes aracnoideosmediante craneotomía y fenestración, con resolucióncompleta del quiste.Conclusiones. Los pacientes con quiste aracnoideo,sobre todo si esta localizado en la fosa temporal, tienenun mayor riesgo de sufrir un hematoma subduralcrónico. La primera opción terapéutica es el drenajedel hematoma subdural y si persiste la sintomatologíadeberá tratarse el quiste aracnoideo (AU)

Introduction. We designed this study to investigatethe clinical, neurological, and radiological outcome ofpatients with chronic subdural hematoma related to anintracranial arachnoid cysts.Patients and methods. Medical records of 12 cases ofpatients with arachnoids cyst complicated with chronicsubdural hematoma were retrospectively reviewed.Results. Between January 1984 and April 2008,12 patients (0.9%) of 1.253 cases of chronic subduralhematoma surgically treated in our hospital had associatedarachnoid cyst. Arachnoid cysts were located inthe middle fossa (10 cases) and convexity (2 cases). Themost frequent symptom was headache (6 cases), followedby seizures (3 cases). Eleven patients underwentburr hole and drainage; the oldest patient was treatedconservatively.Conclusions. Patients with AC, especially whenthese are located in temporal fossa, appear to harboura life-long risk of contracting subdural hematoma.Hematoma evacuation is adequate at first operationand if arachnoid cyst is symptomatic or preoperativesymptoms persist, additional arachnoid cyst surgeryshould be considered (AU)