RESUMO
Mortality rates associated with acute type B aortic dissection (ABAD) complicated by malperfusion remains significant. Optimal management of patients with ABAD is still debatable. We present a case report of a 50-year-old man who was admitted due to ABAD. He was treated medically with his pain resolved and he was discharged on oral antihypertensive medications. One month after initial diagnosis, he was readmitted with abdominal pain, nausea, vomiting, and diarrhea. On imaging, an extension of the aortic dissection into the visceral arteries with occlusion of the celiac and superior mesenteric arteries (SMA) was noted. He underwent thoracic endovascular aortic repair (TEVAR) and bypass grafting to the SMA. Despite the intervention, the patient developed large bowel, liver, and gastric ischemia and underwent bowel resection. He died from multi-organ failure. In selected cases of uncomplicated ABAD, TEVAR should be considered and when TEVAR fails and visceral malperfusion develops, an aggressive revascularization of multiple visceral arteries should be attempted.
Assuntos
Aneurisma da Aorta Torácica/complicações , Dissecção Aórtica/complicações , Artéria Celíaca/fisiopatologia , Artéria Mesentérica Inferior/fisiopatologia , Isquemia Mesentérica/etiologia , Grau de Desobstrução Vascular , Doença Aguda , Administração Oral , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/fisiopatologia , Dissecção Aórtica/terapia , Anti-Hipertensivos/administração & dosagem , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/terapia , Aortografia/métodos , Implante de Prótese Vascular , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/cirurgia , Procedimentos Endovasculares , Evolução Fatal , Humanos , Masculino , Artéria Mesentérica Inferior/diagnóstico por imagem , Artéria Mesentérica Inferior/cirurgia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/fisiopatologia , Isquemia Mesentérica/cirurgia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Circulação Esplâncnica , Tomografia Computadorizada por Raios X , Falha de TratamentoRESUMO
An encephalocele is a protrusion of the cranial contents beyond the normal confines of the skull. It is a rare cause of seizure in adults. A 38-year-old woman presented with a first-onset seizure. Brain CT was interpreted as right frontal sinus opacification suggestive of sinusitis. The patient was discharged home with an amoxicillin prescription. A few days later, she was re-admitted with another seizure. Careful evaluation of the brain CT and MRI revealed a right frontal sinus posterior wall defect and possible brain encephalocele. The patient had complained of chronic nasal discharge for years and had also noticed a watery discharge from her right nostril. We suspected cerebrospinal fluid rhinorrhea. A bifrontal craniotomy was performed, the encephalocele was resected and cranialisation of the frontal sinus was completed. The patient remained free of seizures at the last follow-up.