RESUMO
High dose intravenous immunoglobulin (IVG) is increasingly used in a broad range of immune mediated diseases. Thrombosis was exceptionally reported as a complication of this therapy. We describe three cases of thrombotic complications during or soon after IVIG treatment: myocardial infarction in a man and cerebral infarctions in an elderly man, associated with peripheral ischemia in a woman. In addition we review the published cases in the literature and discuss the possible etiologic factors.
Assuntos
Imunoglobulinas Intravenosas/efeitos adversos , Trombose/etiologia , Idoso , Idoso de 80 Anos ou mais , Infarto Cerebral/etiologia , Relação Dose-Resposta Imunológica , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Tomografia Computadorizada por Raios X/métodosRESUMO
A review of 30 cases with cerebellopontine angle tumors was carried out to identify patients with trigeminal neuralgia (TN) at presentation and to compare them with patients without TN. The study shows that dermoid tumors and the presence of tumor at the apex of petrous bone on CT are associated with a significantly higher incidence of TN, while the incidence did not appear to be influenced by age, sex, or size of tumor. In all patients but one (with medulloblastoma) that had surgery, there the TN disappeared following total or subtotal excision of the tumor, providing the trigeminal nerve was well decompressed. Patients with TN should be investigated carefully by CT or MRI irrespective of their age or the absence of neurological signs.
Assuntos
Neoplasias Cerebelares/complicações , Ângulo Cerebelopontino , Neuralgia do Trigêmeo/etiologia , Adulto , Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Intracranial mycotic infections requiring neurosurgical intervention are being diagnosed more frequently. This study is a review of 17 cases of intracranial mycotic infections that were treated in a neurosurgical unit in Saudi Arabia over an 8-year period. A primary focus of infection was identified in 41% of patients while 18% of patients had a predisposing factor. Forty-seven percent of patients presented with a brain abscess (solitary 29%, multiple 18%) while 35% had a granuloma. 18% meningitis and ventriculitis and 12% hydrocephalus. The Aspergillus species and Ramichloridium machenziei were the commonest pathogens. Following the appropriate surgical and antimicrobial treatment, the mortality rate was 41% and there was evidence of residual disease at follow-up in 18%. The reason for a fatal outcome was failure to consider a fungal aetiology and to obtain a tissue diagnosis early-because of late referral (2 cases), as well as failure to respond to antimycotic therapy (4 cases) and rupture of the internal carotid artery due to Aspergillus arteritis (one case). It is concluded that an early tissue diagnosis is crucial in the management of intracranial mycotic infection so that the appropriate surgical and antimycotic treatment can be started early.