RESUMO
Los quistes óseos aneurismáticos son lesiones óseas benignas infrecuentes, de localización inusual en el sacro. Sintomatológicamente son inespecíficas. Tras un traumatismo aparece dolor, pudiendo acompañarse de complicaciones de estructuras adyacentes por edema asociado. Los hallazgos de las imágenes suelen ser característicos, aunque el diagnóstico debe confirmarse por biopsia y realizar diagnóstico diferencial con otros tumores. El tratamiento a aplicar en huesos largos consiste en legrado y relleno con material de reemplazo óseo. En el sacro pueden conllevar complicaciones neurológicas, siendo la embolización arterial selectiva una alternativa en su manejo. Describimos un caso de quistes óseos aneurismáticos en el sacro en un varón de 71 años con antecedente de leucemia linfoide crónica e hiperplasia benigna de próstata. El informe incluye la presentación clínica, los hallazgos de imagen y la evolución tras el tratamiento mediante embolización arterial selectiva. Este caso destaca las opciones terapéuticas y las dificultades encontradas en el manejo de estas lesiones en el sacro que complican su tratamiento habitual. La embolización arterial selectiva es una opción terapéutica en pacientes con quistes óseos aneurismáticos en el sacro, permitiendo tratamientos menos agresivos y prósperos resultados (AU)
Aneurysmal bone cysts are rare benign bone lesions. Location in the sacrum is unusual. Symptoms are nonspecific. After an injury, pain develops and complications of adjacent structures can be triggered by the associated oedema. Radiological presentation is usually characteristic but must be confirmed by biopsy and a differential diagnosis must be made with other tumours. Treatment in long bones is based in curettage and refill with bone replacement material. In the sacrum, neurological complications can develop with selective arterial embolisation being an alternative in their management. We describe the case of a 71-year-old male patient with sacral aneurysmal bone cysts and a history of chronic lymphoid leukaemia and benign prostatic hyperplasia. The report includes the clinical presentation, imaging findings and outcome after treatment with selective arterial embolisation. This case highlights the therapeutic options and difficulties encountered in the management of these lesions when located in the sacrum, which complicates their usual treatment. Selective arterial embolisation is a therapeutic option in patients with sacral aneurysmal bone cysts, allowing less aggressive treatments and favourable results (AU)
Assuntos
Humanos , Masculino , Idoso , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Cistos Ósseos Aneurismáticos/terapia , Região Sacrococcígea , Sacro/diagnóstico por imagemRESUMO
Aneurysmal bone cysts are rare benign bone lesions. Location in the sacrum is unusual. Symptoms are nonspecific. After an injury, pain develops and complications of adjacent structures can be triggered by the associated oedema. Radiological presentation is usually characteristic but must be confirmed by biopsy and a differential diagnosis must be made with other tumours. Treatment in long bones is based in curettage and refill with bone replacement material. In the sacrum, neurological complications can develop with selective arterial embolisation being an alternative in their management. We describe the case of a 71-year-old male patient with sacral aneurysmal bone cysts and a history of chronic lymphoid leukaemia and benign prostatic hyperplasia. The report includes the clinical presentation, imaging findings and outcome after treatment with selective arterial embolisation. This case highlights the therapeutic options and difficulties encountered in the management of these lesions when located in the sacrum, which complicates their usual treatment. Selective arterial embolisation is a therapeutic option in patients with sacral aneurysmal bone cysts, allowing less aggressive treatments and favourable results.
Assuntos
Cistos Ósseos Aneurismáticos , Idoso , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Cistos Ósseos Aneurismáticos/terapia , Curetagem , Humanos , Masculino , Radiografia , Região Sacrococcígea , Sacro/diagnóstico por imagemRESUMO
La espasticidad es un trastorno motor, caracterizado por un aumento del tono muscular, y que aparece como consecuencia de un trastorno del sistema nervioso central, dando lugar a déficit y discapacidad, con deterioro de la calidad de vida. En el daño cerebral adquirido del adulto, la espasticidad constituye un problema grave y frecuente, apareciendo en un 20-30% de pacientes con ictus y en un 13-20% de pacientes con traumatismo craneoencefálico moderado-grave. El objetivo principal de este trabajo es realizar una revisión sistemática de los tratamientos utilizados en la espasticidad del paciente adulto con daño cerebral adquirido secundario a ictus y traumatismo craneoencefálico. Como objetivo secundario se pretende averiguar las principales escalas de valoración utilizadas para la medida de la espasticidad en estos pacientes. Se ha realizado una búsqueda sistemática de ensayos controlados aleatorizados, publicados entre el 1 de enero de 2013 y 30 de junio de 2017 en inglés y castellano, en las bases de datos PubMed, Biblioteca Cochrane plus y Ovid. Se han seleccionado finalmente 17 estudios, con una calidad metodológica al menos aceptable, según la escala de Jadad. Los tratamientos más frecuentemente investigados son la toxina botulínica, especialmente el serotipo A, junto a medidas rehabilitadoras. Las escalas clínicas son las más frecuentemente utilizadas para la evaluación de la espasticidad
Spasticity is a motor disorder characterised by an increase in muscle tone that appears as a consequence of a central nervous system disorder, leading to deficit and disability and impairing quality of life. In acquired adult brain damage, spasticity is a severe and frequent problem, appearing in 20-30% of patients with stroke and in 13-20% of patients with moderate-severe traumatic brain injury. The main objective of this study was to perform a systematic review of the treatments used in spasticity in adult patients with acquired brain damage secondary to stroke and head trauma. A systematic search of randomised controlled trials, published between January 1, 2013 and June 30, 2017 in English and Spanish, was carried out in the PubMed, Cochrane plus Library and Ovid databases. We finally selected 17 studies, with methodological quality that was at least acceptable according to the Jadad scale. The most frequently investigated treatments are botulinum toxin, especially serotype A, together with rehabilitative measures. Clinical scales are the most frequently used to assess spasticity
Assuntos
Humanos , Encefalopatia Traumática Crônica/reabilitação , Espasticidade Muscular/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Modalidades de Fisioterapia , Baclofeno/uso terapêutico , Bloqueio Nervoso/métodos , Nervo TibialRESUMO
Spasticity is a motor disorder characterised by an increase in muscle tone that appears as a consequence of a central nervous system disorder, leading to deficit and disability and impairing quality of life. In acquired adult brain damage, spasticity is a severe and frequent problem, appearing in 20-30% of patients with stroke and in 13-20% of patients with moderate-severe traumatic brain injury. The main objective of this study was to perform a systematic review of the treatments used in spasticity in adult patients with acquired brain damage secondary to stroke and head trauma. A systematic search of randomised controlled trials, published between January 1, 2013 and June 30, 2017 in English and Spanish, was carried out in the PubMed, Cochrane plus Library and Ovid databases. We finally selected 17 studies, with methodological quality that was at least acceptable according to the Jadad scale. The most frequently investigated treatments are botulinum toxin, especially serotype A, together with rehabilitative measures. Clinical scales are the most frequently used to assess spasticity.
