Síndrome del uno y medio de Fisher a causa de un cavernoma bulbo-protuberancial / Fisher one-and-a-half syndrome due to a bulb protuberance cavernoma

El síndrome del uno y medio de Fisher está producido por una lesión unilateral en la parte dorsal e inferior de la protuberancia localizada específicamente en el tegmento pontino, área que contiene el fascículo longitudinal medial (FLM), la formación reticular paramediana pontina (FRPP) y el núcleo del VI par craneal, responsables de los movimientos horizontales de la mirada. Clínicamente se manifiesta con una parálisis conjugada de la mirada con oftalmoplejía internuclear ipsilateral. Se presenta el caso de una paciente de 60 años de edad que, tras presentar diplopía binocular, oftalmoplejía y parálisis de la mirada conjugada a la izquierda se realizaron estudios de imagen observándose un hematoma hemiprotuberancial secundario a un cavernoma. Tras conducta expectante presentó varios episodios de resangrados con empeoramiento clínico: cefalea, diplopía, tetraparesia e hipoestesia en hemicara derecha, por lo que ante tal evolución se planteó exéresis microquirúrgica del cavernoma protuberancial

The one and a half Fisher syndrome is produced by an unilateral lesion in the dorsal and inferior part of the pons located specifically in the pontine tegmentum. This is an area that contains the medial longitudinal fasciculus (LMF), the paramedian pontine reticular formation (PPRF) and the nucleus of the sixth cranial nerve, responsible for the horizontal movements of the gaze. Clinically it manifests with conjugate gaze palsy with internuclear ophthalmoplegia. The case is reported on a 60 year-old patient, who presented with binocular diplopia, ophthalmoplegia and paralysis of the gaze conjugated to the left. Imaging studies were performed that showed a hemi-protuberant haematoma secondary to a cavernoma. As expected, he presented with several episodes of re-bleeding with clinical worsening: headache, diplopia, tetraparesis, and hypoaesthesia in the right side of the face, as such that the microsurgical exeresis of the protuberant cavernoma was considered

Fisher one-and-a-half syndrome due to a bulb protuberance cavernoma. / Síndrome del uno y medio de Fisher a causa de un cavernoma bulbo-protuberancial.

The one and a half Fisher syndrome is produced by an unilateral lesion in the dorsal and inferior part of the pons located specifically in the pontine tegmentum. This is an area that contains the medial longitudinal fasciculus (LMF), the paramedian pontine reticular formation (PPRF) and the nucleus of the sixth cranial nerve, responsible for the horizontal movements of the gaze. Clinically it manifests with conjugate gaze palsy with internuclear ophthalmoplegia. The case is reported on a 60 year-old patient, who presented with binocular diplopia, ophthalmoplegia and paralysis of the gaze conjugated to the left. Imaging studies were performed that showed a hemi-protuberant haematoma secondary to a cavernoma. As expected, he presented with several episodes of re-bleeding with clinical worsening: headache, diplopia, tetraparesis, and hypoaesthesia in the right side of the face, as such that the microsurgical exeresis of the protuberant cavernoma was considered.

[Thalamic abscess. A stereotaxically treatable lesion]. / Absceso talámico. Una lesión tratable estereotácticamente.

Solitary abscesses of the thalamus are an infrequent entity which carry serious problems with regard to treatment. We present a patient with an unknown septic focci who developed a right thalamic abscess due to Streptococcus constellatus and was treated by stereotaxic drainage for the suppuration and antibiotics. The patient was clinically and radiologically (CAT) controlled up until total cure of the lesion. Complications included dissemination of the infection to the meningeal space and a residual coreic picture controlled with tetrabenzine. The authors believe that evacuation by stereotaxic punction should be included among the therapeutic options available for deeply localized cerebral abscesses.

[Neurofibromatosis and stenosis of the aqueduct of Sylvius. A magnetic resonance assessment]. / Neurofibromatosis y estenosis del acueducto de Silvio. Evaluación mediante resonancia magnética.

Von Recklinghausen's neurofibromatosis is an autosomal dominant disease involving peripheral nerves and central nervous system. Obstructive hydrocephalus in this disease represents a common finding when it is due to the development of infratentorial neoplasm. Nevertheless, the occurrence of isolated nonneoplastic aqueductal stenosis in patients affected by neurofibromatosis has been described rarely. The authors report two cases of primary nontumoral aqueductal stenosis associated with Von Recklinghausen's disease who were diagnosed by CT scan and MRI. The pathogenesis of aqueductal narrowing in neurofibromatosis is discussed.

[Meningioma of the third ventricle. Presentation of a case]. / Meningioma del tercer ventrículo. Presentación de un caso.

Meningiomas of the third ventricle are extremely rare; the authors report a case of meningothelial meningioma located in the anterior part of the third ventricle. The tumor was successfully removed through a trans-ventricular approach. The clinical presentation, radiological findings and surgical management of these tumors are reviewed.

Spontaneous spinal epidural hematoma diagnosed by MRI. Case report.

The case of a patient with a spinal epidural hematoma diagnosed by MRI is presented. There was no history of major trauma, anticoagulant use or coagulopathy. During the intervention didn't evidence an underlying tumor or vascular malformation.

Intramedullary spinal neurofibroma diagnosed with computed tomography: report of a case.

A case of intramedullary neurofibroma of the cervical spine in a patient with no signs of von Recklinghausen's disease is presented. Intramedullary neurofibroma is extremely rare, accounting for less than 1% of spinal cord neurofibromas. This case is the first diagnosed with computed tomography.

Intradural extramedullar tuberculoma of spinal cord. Case report.

A case of intradural tuberculoma in an infant and the patient was diagnosed operated on successfully. The author's advice is to perform surgery followed by antituberculosis treatment during the recovery period.