Intracranial haemorrhage possibly related to Tipranavir in an HIV-1 patient with cryptococcal meningitis.

A 55-year-old HIV-infected patient on antiretroviral treatment with Ritonavir-boosted Tipranavir as part of HAART developed intracranial haemorrhage during the acute phase of cryptococcal meningitis. CT scan and MRI confirmed the intracranial haemorrhage. Positive cryptococcal antigen and cultures of both blood and CSF confirmed the diagnosis of meningitis caused by Cryptococcus neoformans. There was no evidence of any bleeding disorder, use of aspirin or antiplatelet agents. The patient was treated with Liposomal Amphotericin B for cryptococcal meningitis. No special treatment was needed for the intracranial haemorrhage, but Tipranavir was discontinued and replaced by Kaletra and Saquinavir. Intracranial haemorrhage could be related to Tipranavir and cryptococcal meningitis was a predisposing factor. Headache stopped 3 days after starting antifungal treatment. To the best of our knowledge, this is the first reported case of intracranial haemorrhage related to Tipranavir treatment after the end of the "RESIST" studies and the only one related to meningitis.

Primary traumatic pulmonary pseudocysts: a rare entity.

OBJECTIVE: Pulmonary contusion is the usual manifestation of lung parenchymal injury after blunt chest trauma. With deceleration these parenchymal lacerations can result in cavities known as primary traumatic pulmonary pseudocysts (TPPC). We present our experience in treating this rare entity. MATERIAL: From 1989 trough 1999, 14 young patients, 11 male and three female ranging in age between 13 and 24 years were treated for primary TPPC in our department. Blunt chest injuries resulting from traffic accidents were the causes in all our cases. The main symptoms were pain, hemoptysis and dyspnea not associated with severe hypoxemia. The cavitary lesion was apparent in chest radiographs, but the imaging modality of choice was the computed tomography. RESULTS: Multisystem injury was present in 7 of them. Two of our patients required ICU facilities but none needed mechanical ventilation. Hemopneumothorax was present in two cases, whereas pneumothorax in four drained by tube thoracostomy. The hospital stay ranged between 9 and 23 days. Contraction and complete radiological resolution of the PPC needed a follow up of 6-11 weeks. CONCLUSIONS: (1) Primary traumatic pulmonary pseudocysts are benign lesions secondary to blunt chest trauma needing only conservative treatment unless complications arise, such as hemo- or pneumothorax or infection of the cavitary lesion. (2) Computed tomography is a really sensitive method for early detection of the lesion while plain roentgenograms are sufficient for the follow up.

Posttraumatic spinal cord lesions without skeletal or discal and ligamentous abnormalities: the role of MR imaging.

The thoracic spine is different from other mobile segments of the spine because of the presence of ribs and their articulations. The rib cage makes the thoracic spine much more stable and, during trauma, provides additional strength and energy-absorbing capacity. This leads to the conclusion that severe trauma is required to damage the thoracic spine, and the skeletal injury is usually evident on radiographs. A spontaneous reducible vertebral luxation (dislocation) is not easy to identify, even with magnetic resonance (MR) imaging. Subtle changes in thoracic spine osseous injuries are not seen on radiographs but may be demonstrated on computed tomography (CT) scans. MR imaging can also demonstrate the posterior ligamentous lesions. In this study, we present three cases of thoracic spinal cord changes without spinal fracture and one disk herniation (degenerative chronic disease). These patients had a permanent neurologic deficit (complete paraplegia); plain radiographs and CT scans showed nothing abnormal. MR imaging showed lesions in the thoracic spinal cord and, in one case, a posttraumatic disk herniation. In cases of post-traumatic cord lesions, MR imaging provides diagnostic information that appears to exceed other imaging modalities. The existence of a neurologic deficit indicates MR as the first examination in cases of traumatic spinal lesions.

Paraganglioma of the cauda equina: a case presenting features of increased intracranial pressure.

Paragangliomas are benign tumors arising from the heterotopic sympathetic ganglion. They occur more often in the carotid body, glomus jugulare, mediastinum, and paraaortic region; central nervous system locations include the petrous ridge, pineal region, and sella turcica. We report the clinical and imaging features of an unusual case of paraganglioma of the cauda equina. Magnetic resonance imaging (MRI) of the thoracolumbar region should be performed in cases of increased intracranial pressure whenever the head examination does not reveal the exact cause of the problem.