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Introduction One of the major complications of intracranial aneurysm surgery is vasospasm. Papaverine is an effective vasodilator that can be instilled directly onto the vessels in the operative field with the aim of preventing intraoperative and postoperative vasospasm. Several case reports of hemodynamic instability in general and of hypotension, in particular, were reported after the use of topical papaverine during aneurysm clipping surgery. Case description Herein, we report three cases of transient profound hypotension and relative bradycardia after intracisternal papaverine usage during ruptured anterior communicating artery aneurysm clipping surgery. Conclusion Caution should be taken while using papaverine intracisternally during anterior circulation aneurysm clipping, since it may cause several serious complications, including profound hemodynamic instability, particularly when instilling on a fenestrated lamina terminalis.
Introdução Uma das principais complicações da cirurgia de aneurisma intracraniano é o vasoespasmo. A papaverina é um vasodilatador eficaz que pode ser instilado diretamente nos vasos do campo operatório com o objetivo de prevenir o vasoespasmo intra e pós-operatório. Vários relatos de casos de instabilidade hemodinâmica em geral e de hipotensão, em particular, foram relatados após o uso de papaverina tópica durante cirurgia de clipagem de aneurisma. Descrição de caso Aqui, relatamos três casos de hipotensão profunda transitória e bradicardia relativa após o uso de papaverina intracisternal durante a cirurgia de clipagem de aneurisma da artéria comunicante anterior rompida. Conclusão Deve-se ter cuidado ao usar papaverina intracisternamente durante a clipagem do aneurisma da circulação anterior, uma vez que pode causar várias complicações graves, incluindo profunda instabilidade hemodinâmica, particularmente ao instilar em uma lâmina terminal fenestrada.
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BACKGROUND: Cerebellar mutism (CM) is defined as the lack of speech production, despite an intact state of consciousness and cognitive function, that happens secondary to a cerebellar insult. To the best of our knowledge, only five cases have thus far been described in the English literature. In this paper, we report the sixth incidence overall, which is also the first case of a CM associated with penetrating head injury. The relevant literature is reviewed and analyzed, our current knowledge of the neuroanatomical and functional relations is summarized, and potential future research endeavors are indicated. CASE DESCRIPTION: An 8-year-old girl was transferred to our hospital having had fallen on a rod that penetrated her neck behind the ear. An urgent computed tomography scan of the head revealed a right cerebellar contusion with surrounding edema. Three days later, she became mute but was still obeying commands. Repeat imaging showed a resolving cerebellar contusion with increased edema and mass effect. By day 9, she had uttered a few words. At 1-month follow-up, the child had regained normal speech. CONCLUSION: Posttraumatic CM is a rare and probably underreported condition with only six documented cases to date. Although it may well be on the same spectrum as postoperative CM, further understanding of the exact mechanism, clinical course, and prognosis of this entity is bound to significantly improve the recovery and quality of life of head trauma patients.
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Moyamoya disease is a chronic and unusual cerebrovascular disorder characterized by progressive stenosis and occlusion of the distal portions of internal carotid arteries and its main branches within the circle of Willis. Posterior circulation (vertebral and basilar arteries) may also be affected; however, this presentation is uncommon. As well as stenosis of the terminal portion of intracranial arteries, it is seen the development of a network of collateral vessels abnormally dilated at the base of the brain with an aspect of a "puff of smoke," whose term in Japanese is described as "moyamoya." The present study aims to report two consecutive cases of patients who presented to our service with different clinical manifestations. Further investigation with digital subtraction angiography showed a moyamoya pattern.