RESUMO
The fungus Cryptococcus neoformans can cause common opportunistic infection in acquired immune deficiency syndrome (AIDS) patients. But other conditions can be associated with sarcoidosis. Meningoencephalitis is the most common manifestation of this disease. One of the most important neurological complications is the development of intracranial hypertension (ICH), which may result in high morbidity and mortality. We report the case of a patient harboring a ventriculoperitoneal shunt, and having contracted a cryptococcal meningitis as a risk factor for pulmonary sarcoidosis. Brain MRI showed arachnoiditis, with a mass in contact with the right frontal horn. Indian ink staining of the cerebrospinal fluid (CSF) showed positivity that was confirmed by the identification of Cryptococcus neoformans after culture. The evolution was favorable under medical treatment with removal of material. The relationship between sarcoidosis and cryptococcosis, described in the literature is not coincidental but is a rare complication of sarcoidosis of potential severity (40% of mortality). Sarcoidosis is a common systemic disease that may increase host susceptibility to CNS cryptococcal infection without any other signs or symptoms of host immunosuppression. The diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.
Assuntos
Aracnoidite/etiologia , Meningite Criptocócica/etiologia , Infecções Relacionadas à Prótese/etiologia , Sarcoidose Pulmonar/complicações , Derivação Ventriculoperitoneal/efeitos adversos , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Aracnoidite/líquido cefalorraquidiano , Aracnoidite/diagnóstico , Aracnoidite/tratamento farmacológico , Aracnoidite/microbiologia , Carbono , Líquido Cefalorraquidiano/microbiologia , Corantes , Confusão/etiologia , Cryptococcus neoformans/isolamento & purificação , Suscetibilidade a Doenças , Quimioterapia Combinada , Flucitosina/administração & dosagem , Flucitosina/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite Criptocócica/líquido cefalorraquidiano , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/líquido cefalorraquidiano , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Agitação Psicomotora/etiologia , Coloração e RotulagemRESUMO
Tuberous sclerosis is a phacomatosis resulting from an autosomal dominant inheritance. It is characterized by the presence of multiple hamartomas in various organs, especially the brain, the skin, the kidneys and the heart. The diagnosis of tuberous sclerosis is based on imaging and clinical examination, where magnetic resonance imaging constitutes the key investigation showing characteristic brain lesions. Neuro-encephalic manifestations may be particularly severe, and may even be life threatening. The authors report personal cases series and review the literature highlighting epidemiology, clinical features and imaging of neuro-encephalic tuberous sclerosis.
Assuntos
Encéfalo/patologia , Neurônios/patologia , Esclerose Tuberosa/patologia , Esclerose Tuberosa/fisiopatologia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Diagnóstico Diferencial , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/etiologia , Transtornos Mentais/patologia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/patologia , Neuroimagem/métodos , Neurônios/diagnóstico por imagem , Neurônios/fisiologia , Radiografia , Esclerose Tuberosa/complicações , Esclerose Tuberosa/diagnósticoRESUMO
Thalamo-mesencephalic neuroepithelial cysts are rare lesions of the central nervous system. They are thought to arise from neuroectoderm and are also referred to as ependymal cysts due to their origin. It can remain asymptomatic throughout life or rarely can cause symptoms. We describe a 42-year-old woman who presented with thalamic syndrome due to a neuroepithelial cyst of the thalamo-midbrain. Differential diagnosis is made with other cystic lesions in the brain. However a good analysis of imaging feature led to diagnosis. When the lesion is symptomatic, mini-invasive procedure is indicated.
Assuntos
Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/patologia , Neoplasias Neuroepiteliomatosas/diagnóstico , Neoplasias Neuroepiteliomatosas/patologia , Doenças Talâmicas/diagnóstico , Adulto , Cistos do Sistema Nervoso Central/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Mesencéfalo/patologia , Neoplasias Neuroepiteliomatosas/cirurgia , Procedimentos NeurocirúrgicosAssuntos
Equinococose Hepática/complicações , Equinococose Pulmonar/complicações , Equinococose , Doenças da Medula Espinal/parasitologia , Adulto , Albendazol/administração & dosagem , Albendazol/uso terapêutico , Anticestoides/administração & dosagem , Anticestoides/uso terapêutico , Equinococose/tratamento farmacológico , Equinococose/cirurgia , Equinococose Hepática/tratamento farmacológico , Equinococose Pulmonar/diagnóstico por imagem , Equinococose Pulmonar/tratamento farmacológico , Seguimentos , Humanos , Laminectomia , Masculino , Radiografia Torácica , Recidiva , Doenças da Medula Espinal/tratamento farmacológico , Doenças da Medula Espinal/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
The authors report the case of a 35-years-women with a thoracic disc herniation, who presented with seven years history of episodic acute ureteric colic. An early diagnosis of a spinal disc herniation was made difficult by the absence of neurological findings. Imaging studies showed no lesion in the genito-urinary tract. Magnetic resonance imaging demonstrated a postero-lateral disc herniation at T10-T11 level. The pain disappeared immediately after surgery decompression. A literature search showed that acute ureteric colic associated with a lower thoracic disc herniation has not been previously reported.
Assuntos
Dor nas Costas/etiologia , Cólica/diagnóstico , Erros de Diagnóstico , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Nefropatias/diagnóstico , Vértebras Torácicas/patologia , Adulto , Descompressão Cirúrgica , Diagnóstico Diferencial , Feminino , Humanos , Deslocamento do Disco Intervertebral/patologia , Região Lombossacral , Imageamento por Ressonância Magnética , Fatores de TempoRESUMO
We report the case of a 50-year-old woman presenting a primitive adenoid cystic carcinoma of the middle part of skull base diagnosed by transphenoidal biopsy. She was treated by exclusive radiation therapy with cobalt 60 1.25 MeV and the dose received was 66 Gy in 33 fractions. Our patient remains alive 50 months after the completion of treatment. Adenoid cystic carcinoma is a slow growing malignant tumor with perineural invasion which arises more frequently from salivary glands. The occurrence of primary intracranial adenoid cystic carcinoma is exceptional. The best treatment is radical surgery followed by radiotherapy. Chemotherapy is rarely used. Prognosis is worse than for salivary glands.
Assuntos
Carcinoma Adenoide Cístico/cirurgia , Neoplasias da Base do Crânio/cirurgia , Biópsia , Carcinoma Adenoide Cístico/patologia , Carcinoma Adenoide Cístico/radioterapia , Terapia Combinada , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Prognóstico , Neoplasias da Base do Crânio/patologia , Neoplasias da Base do Crânio/radioterapia , Tomografia Computadorizada por Raios XRESUMO
Intradiploic epidermoid cyst of the skull is a rare clinical entity that can exceptionally grow to a large size with intracranial extension. The authors report the case of a 38-year-old man with a giant epidermoid cyst of the parietal bone with extra and intracranial extension, presenting with focal neurological symptoms. The diagnosis was suggested at imaging (skull radiographs, CT and MRI), and confirmed at histology. Complete removal of the cyst and its capsule was performed followed by cranioplasty. Postoperatively, the patient was discharged free of symptoms. CT scan provides good evaluation of the bony lesion and may suggest intracranial extension. MRI is superior for evaluation of cerebral compression. The pathogenesis, clinical presentation, diagnostic evaluation and therapeutic management of these rare lesions are reviewed.
Assuntos
Doenças Ósseas/diagnóstico , Cisto Epidérmico/diagnóstico , Crânio , Adulto , Biópsia , Doenças Ósseas/complicações , Doenças Ósseas/epidemiologia , Doenças Ósseas/cirurgia , Diagnóstico Diferencial , Cisto Epidérmico/complicações , Cisto Epidérmico/epidemiologia , Cisto Epidérmico/cirurgia , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Metilmetacrilato/uso terapêutico , Prognóstico , Tomografia Computadorizada por Raios XAssuntos
Abscesso Encefálico/microbiologia , Doenças Cerebelares/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Lactococcus lactis/patogenicidade , Antibacterianos , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/cirurgia , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/cirurgia , Terapia Combinada , Quimioterapia Combinada/uso terapêutico , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Boca/microbiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/cirurgia , Sucção , Cirurgia Bucal , Tomografia Computadorizada por Raios X , VirulênciaRESUMO
Central nervous system metastases from prostate cancer are exceptional secondary sites, reported in less than 4% of postmortem cases. The authors describe an unusual case of cerebral metastasis from prostate cancer in a 44-year-old man that temporarily regressed during endocrine therapy.
Assuntos
Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/secundário , Antagonistas de Androgênios/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/secundário , Acetato de Ciproterona/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Adulto , Evolução Fatal , Humanos , Masculino , Neoplasias da Próstata/patologia , Indução de RemissãoRESUMO
We report two cases of brainstem tuberculomas with favorable outcome after medical treatment alone. Tuberculomas should be suspected in all cases presenting space-occupying lesions of the brainstem.
Assuntos
Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/patologia , Tuberculose do Sistema Nervoso Central/diagnóstico , Adulto , Anti-Inflamatórios/uso terapêutico , Antibióticos Antituberculose/uso terapêutico , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Esteroides , Tomografia Computadorizada por Raios X , Tuberculose do Sistema Nervoso Central/tratamento farmacológicoRESUMO
Behçet disease is a rare condition in central Europe but more common in Morocco. A case of multiple intracranial arterial aneurysms occurring in a 44 year-old Moroccan patient with 2-years history of Behçet's disease is reported. CT-scan showed an infarction in the right middle cerebral artery territory. Panangiography showed sacciform aneurysms of the bifurcation of the right and left middle cerebral arteries. The draining veins and sinuses were normal. The two aneurysms were successfully clipped by two microsurgical frontotemporal approach in one surgical time. There have been only eight reports of intracranial arterial aneurysms associated to Behçet disease in the literature.
Assuntos
Síndrome de Behçet/complicações , Aneurisma Intracraniano/complicações , Adulto , Humanos , Aneurisma Intracraniano/cirurgia , Masculino , MarrocosRESUMO
A case of intradural extramedullary neurenteric cyst is reported. The embryogenesis and surgical treatment of this lesion are discussed.
Assuntos
Cisto Mediastínico/complicações , Cisto Mediastínico/diagnóstico , Paraplegia/etiologia , Espinha Bífida Oculta/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Cisto Mediastínico/cirurgia , Pessoa de Meia-Idade , Mielografia , Paraplegia/diagnóstico , Paraplegia/cirurgia , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/etiologiaRESUMO
A case of intrasacral meningocele with low back pain and sciatica as the presenting manifestations in a 47-year-old male is reported. Magnetic resonance imaging established the diagnosis. Surgical treatment was successful.