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1.
Neurología (Barc., Ed. impr.) ; 32(6): 363-370, jul.-ago. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-165048

RESUMO

Introducción: El síndrome de Sturge-Weber es un trastorno vascular congénito caracterizado por una malformación facial capilar (mancha en vino de Oporto) asociada a malformaciones venosas y capilares en el cerebro y en el ojo. También pueden observarse alteraciones en otras localizaciones y síntomas neurológicos. Objetivos: Describir las características clínicas y epidemiológicas, así como los diferentes tratamientos realizados en una cohorte de pacientes diagnosticados de síndrome de Sturge-Weber en un hospital terciario. Material y métodos: Estudio comparativo, retrospectivo y transversal, mediante la revisión de historias clínicas de pacientes diagnosticados de síndrome de Sturge-Weber entre los años 1998 y 2013. Resultados: Se incluyeron 13 pacientes (54% varones, 46% mujeres) diagnosticados de síndrome de Sturge-Weber. La edad media al diagnóstico fue de 15 meses. Presencia de angiomatosis leptomeníngea en el 100% de los casos: hemisferio derecho (46%), hemisferio izquierdo (38%), afectación bilateral (15%). Presencia de angioma facial (61%): derecho (23%), izquierdo (38%) y bilateral (7%). Otras alteraciones cutáneas: 23% de los casos (2 de ellos la afectación en el hemicuerpo del lado en el que se encontraba también la angiomatosis facial y leptomeníngea y en el otro caso la afectación cutánea fue en forma de cutis marmorata generalizada). Encontramos afectación ocular en el 77% de los pacientes, siendo las más frecuentes: glaucoma (46%), estrabismo (23%) y angiomatosis coroidea (23%). Presencia de epilepsia 100% de los casos, siendo las crisis parciales (simples o complejas) las más frecuentes (62%). El control de las crisis epilépticas fue muy variable, ya que el 31% han necesitado probar más de 3 fármacos, 15% 3 fármacos, 31% 2 fármacos y 23% tuvieron buen control con monoterapia. Uno de los pacientes requirió cirugía de la epilepsia (hemisferectomía izquierda), quedando libre de crisis hasta la fecha. En electroencefalogramas lo más frecuente fue: puntas, puntas ondas o polipuntas-ondas en los lóbulos afectados por angiomatosis leptomeníngea (46%). Otros síntomas neurológicos: hemiparesia (39%), cefaleas recurrentes (39%), episodios stroke-like (23%), retraso psicomotor (46%), retraso mental (46%). Presencia calcificaciones leptomeníngeas en la resonancia magnética (85%). Aumento de las calcificaciones en el 70%. Pacientes tratados con ácido acetilsalicílico: 54%. Conclusiones: Son múltiples las manifestaciones clínicas del síndrome de Sturge-Weber, siendo de vital importancia conocerlas todas para poder realizar un correcto diagnóstico, seguimiento y tratamiento de las mismas, mejorando así la calidad de vida de estos pacientes (AU)


Introduction: Sturge-Weber syndrome is a congenital vascular disorder characterised by facial capillary malformation (port-wine stain) associated with venous and capillary malformations in the brain and eye. Neurological symptoms and alterations in other locations may also be observed. Objectives: This study describes the clinical and epidemiological characteristics and different treatments in a cohort of patients diagnosed with Sturge-Weber syndrome in a tertiary hospital. Material and methods: This comparative, retrospective and cross-sectional study was conducted by reviewing the medical records of patients diagnosed with Sturge-Weber syndrome between 1998 and 2013. Results: The study included 13 patients (54% male, 46% female) diagnosed with Sturge-Weber syndrome. The mean age at diagnosis was 15 months. Leptomeningeal angiomatosis was present in 100% of cases: right hemisphere (46%), left hemisphere (38%), and bilateral (15%). Facial angioma was present in 61% of the cases: right (23%), left (38%) and bilateral (7%). Other skin disorders were found in 23% of the cases, including 2 with hemilateral involvement on the side where facial and leptomeningeal angiomatosis was present and one case of generalised cutis marmorata. Ocular disease was found in 77% of patients; the most common conditions were glaucoma (46%), strabismus (23%) and choroidal angioma (23%). Epilepsy was present in 100% of the cases, with partial seizures (simple or complex) being the most frequent (62%). Seizure control was highly variable; 31% of the patients had needed to try more than 3 drugs, 15% 3 drugs, and 31% 2 drugs, while 23% experienced good seizure control with monotherapy. One patient required surgery for epilepsy (left hemispherectomy) and has been seizure-free since then. The most frequent observations in electroencephalograms were spikes, polyspikes, and wave spikes in the lobes affected by leptomeningeal angiomatosis (46%). Other neurological symptoms were hemiparesis (39%), recurrent headaches (39%), stroke-like episodes (23%), psychomotor retardation (46%), and mental retardation (46%). Leptomeningeal calcifications could be seen in 85% of patient MRIs, as well as increased calcification in 70%; 54% of the patients had been treated with aspirin. Conclusions: There are multiple clinical manifestations of Sturge-Weber syndrome. Being familiar with all of them is vitally important for diagnosing and for monitoring and treating the condition correctly, which will improve the quality of life of these patients (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Síndrome de Sturge-Weber/epidemiologia , Mancha Vinho do Porto/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Estudos Retrospectivos , Epilepsia/epidemiologia , Cistos Aracnóideos/epidemiologia , Síndromes Neurocutâneas/epidemiologia , Hemangioma/epidemiologia , Angiomatose/epidemiologia
2.
BMC Vet Res ; 13(1): 212, 2017 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-28676057

RESUMO

BACKGROUND: French Bulldog (FB) has significantly gained in popularity over the last few years, and seems to be frequently affected by various neurological conditions. The purpose of this retrospective study was to report the prevalences of neurological diseases in a large population of FB, presented with neurological signs between 2002 and 2016, and for which a definitive diagnosis was established. A secondary objective was to identify epidemiological characteristics regarding specific diseases in this singular breed. RESULTS: During the study period, 533 FBs were presented for neurological signs, representing 18.7% of all admitted FBs (N = 2846). In total, 343 FBs with definitive diagnosis were included in this descriptive epidemiological study. Hansen type I intervertebral disk herniation (IVDH) was by far the most common neurological disorder (45.5% of all cases). The IVDH location was cervical in 39.8%, and thoracolumbar in 60.2% of cases. The median ages for cervical and thoracolumbar IVDH were 4.2 and 4 years, respectively. C3-C4 was the most commonly affected disk (57.8% of cervical IDVH) all locations combined. Spinal arachnoid diverticulum (SAD) was detected in 25 FBs, representing the second most common myelopathy (11.3%). A concurrent spinal abnormality was identified in 64.0% of SAD cases. Brain tumours represented 36.8% of encephalopathies, with glioma (confirmed or suspected) being the most common. Meningoencephalitis of unknown origin (MUO) represented 25.0% of brain disorders, females less than 5.5 years being more likely to be affected. Aside from central nervous system conditions, otitis interna associated with peripheral vestibular signs and bilateral congenital deafness (associated with white coat) were also common. CONCLUSIONS: The findings of this study suggest that FB seems to be prone to several neurological diseases. IVDH is clearly predominant in FB and cervical location seems more represented than in other breeds. FBs affected by IVDH tend to be younger than previously described, either for both cervical and thoracolumbar locations. Thoracic SAD was the second most common myelopathy, with a concurrent spinal anomaly identified in two thirds of the cases. MUO was more likely to affect young to middle-aged females. These findings could be of interest for owners, breeders, practicing veterinarians and insurance companies.


Assuntos
Doenças do Cão/epidemiologia , Doenças do Sistema Nervoso/veterinária , Animais , Cistos Aracnóideos/epidemiologia , Cistos Aracnóideos/veterinária , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/veterinária , Cães , Feminino , França/epidemiologia , Deslocamento do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/veterinária , Masculino , Meningoencefalite/epidemiologia , Meningoencefalite/veterinária , Doenças do Sistema Nervoso/epidemiologia , Prevalência , Estudos Retrospectivos , Especificidade da Espécie
3.
World Neurosurg ; 103: 19-27, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28344182

RESUMO

BACKGROUND: Frontoethmoidal encephalocele is a congenital abnormality of the anterior skull base involving herniation of cranial contents through a midline skull defect. Patency of the foramen cecum, along with other multifactorial variables, contributes to the development of frontoethmoidal encephaloceles. Because of limited resources, financial constraints, and lack of surgical expertise, repair of frontoethmoidal encephaloceles is limited in developing countries. METHODS: Between 2008 and 2013 an interdisciplinary team composed of neurosurgeons, craniofacial surgeons, otolaryngologists, plastic surgeons, and nursing personnel, conducted surgical mission trips to Davao City in Mindanao, Philippines. All patients underwent a combined extracranial/intracranial surgical approach, performed in tandem by a neurosurgeon and a craniofacial surgeon, to detach and remove the encephalocele. This procedure was followed by reconstruction of the craniofacial defects. RESULTS: A total of 30 cases of frontoethmoidal encephalocele were repaired between 2008 and 2013 (20 male; 10 female). The average age at operation was 8.7 years, with 7 patients older than 17 years. Of the 3 subtypes, the following breakdown was observed in patients: 18 nasoethmoidal; 9 nasofrontal; and 3 naso-orbital. Several patients showed concurrent including enlarged ventricles, arachnoid cysts (both unilateral and bilateral), and gliotic changes, as well as orbit and bulbus oculi (globe) deformities. There were no operative-associated mortalities or neurologic deficits, infections, or hydrocephalus on follow-up during subsequent trips. CONCLUSIONS: Despite the limitations of performing advanced surgery in a developing country, the combined interdisciplinary surgical approach has offered effective treatment to improve physical appearance and psychological well-being in afflicted patients.


Assuntos
Encefalocele/cirurgia , Missões Médicas , Equipe de Assistência ao Paciente , Adolescente , Adulto , Cistos Aracnóideos/epidemiologia , Malformação de Arnold-Chiari/epidemiologia , Criança , Pré-Escolar , Comorbidade , Encefalocele/diagnóstico por imagem , Encefalocele/epidemiologia , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/cirurgia , Feminino , Osso Frontal/diagnóstico por imagem , Osso Frontal/cirurgia , Humanos , Hidrocefalia/epidemiologia , Lactente , Masculino , Osso Nasal/diagnóstico por imagem , Osso Nasal/cirurgia , Neurocirurgiões , Duração da Cirurgia , Cirurgiões Bucomaxilofaciais , Otorrinolaringologistas , Filipinas , Complicações Pós-Operatórias/epidemiologia , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
4.
Acta Obstet Gynecol Scand ; 96(7): 837-843, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28295149

RESUMO

INTRODUCTION: The primary aim of this study was to ascertain the prevalence of the individual conditions and of associated anomalies in fetuses with the prenatal diagnosis of enlarged posterior fossa (PF) and to explore the diagnostic accuracy of ultrasound in these anomalies. The secondary aim was to evaluate the postnatal outcome of children affected by PF anomalies. MATERIAL AND METHODS: All fetuses with enlarged PF detected by prenatal sonography at a referral center from 2001 to 2015 were analyzed retrospectively. Some were also studied by fetal magnetic resonance imaging (MRI) or volume ultrasound examinations. Fetal sonographic and MRI were compared using following classification: Dandy-Walker malformation (DWM); megacisterna magna (MCM); Blake's pouch cyst; isolated vermian hypoplasia; vermian agenesis; PF arachnoid cyst (AC); and cerebellar hypoplasia (CH). RESULTS: The ultrasound diagnoses of the 69 fetuses were as follows: MCM (n = 29; of these isolated n = 15), DWM (n = 28, isolated n = 4), vermian hypoplasia (n = 5, isolated n = 4), Blake's pouch cyst (n = 4, isolated n = 1), CH (n = 2; none isolated) and AC in the PF (n = 1, isolated). Thirteen of the 41 karyotyped fetuses were aneuploid, including seven with DWM. Associated malformations were found in 37/69 cases. There were 39 live births, including 11 with confirmed DWM, six of whom show a normal development. Twelve infants with isolated MCM show normal development. There were eight false-positive prenatal diagnoses (or resolution until birth) of "enlarged PF": three with Blake's pouch cyst, two with MCM and one with vermian hypoplasia. CONCLUSIONS: An enlarged PF requires specific diagnoses for the best possible counseling. The term "Dandy-Walker variant" should not be used anymore. Isolated MCM and Blake's pouch cyst can either resolve or be normal variants, but may also indicate the presence of a more severe anomaly or associated malformations.


Assuntos
Cistos Aracnóideos/epidemiologia , Fossa Craniana Posterior/diagnóstico por imagem , Síndrome de Dandy-Walker/epidemiologia , Diagnóstico Pré-Natal , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/embriologia , Fossa Craniana Posterior/anormalidades , Fossa Craniana Posterior/embriologia , Síndrome de Dandy-Walker/diagnóstico por imagem , Síndrome de Dandy-Walker/embriologia , Diagnóstico Diferencial , Feminino , Idade Gestacional , Humanos , Imagem por Ressonância Magnética , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Suíça/epidemiologia
5.
Rev. chil. neurocir ; 42(2): 141-143, nov. 2016. ilus
Artigo em Inglês | LILACS | ID: biblio-869766

RESUMO

Se presenta el caso de una mujer de 31 años de edad con cefalea y cervicalgia que se agravaba con la maniobra de Valsalva, presentando además mareos, encontrándose una malformación de Chiari secundario a un quiste aracnoideo cuadrigeminal. Después de efectuada la resonancia magnética diagnóstica, la paciente fue sometida a descompresión del agujero magno y extirpación del quiste cuadrigeminal, seguido por la resolución tanto de la malformación de Chiari y el quiste. Los síntomas desaparecieron después de la cirugía y han permanecido completamente resuelto hasta la actualidad. En pacientes adultos que presentan signos y síntomas de una malformación de Chiari debido a la compresión de la médula por las las amígdalas cerebelosas, la presencia de un quiste aracnoideo de cisterna cuadrigéminal es una rara patología asociada que puede ser tratada quirúrgicamente.


We report a rare case of a 31-year-old woman with headache and pain manifested by cervicalgia that worsened with the Valsalva maneuver and dizziness, who was found to have a Chiari malformation secondary to a posterior fossa arachnoid cyst. After magnetic resonance imagining (MRI), the patient was submitted to foramen magnum decompression and arachnoid cyst removal that were followed by resolution of both the Chiari malformation and the cyst. The symptoms disappeared after surgery and have remained completely resolved to the present day. In adult patients who present with signs and symptoms of Chiari malformation due to direct medulla compression by the tonsils, a quadrigeminal cistern arachnoid cyst is a rare associated pathology that can be treated surgically.


Assuntos
Humanos , Adulto , Feminino , Malformação de Arnold-Chiari , Cisterna Magna , Craniectomia Descompressiva/métodos , Forame Magno , Cistos Aracnóideos/cirurgia , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/epidemiologia , Teto do Mesencéfalo , Manobra de Valsalva , Diagnóstico por Imagem , Fossa Craniana Posterior/patologia , Imagem por Ressonância Magnética/métodos
6.
World Neurosurg ; 92: 480-490.e2, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27319312

RESUMO

OBJECTIVE: To review the literature and analyze the efficacy and safety of 3 surgical methods (neuroendoscopic fenestration, microsurgical fenestration, and cystoperitoneal shunting) for middle cranial fossa arachnoid cysts (MCFACs). METHODS: We searched MEDLINE, PubMed, and Cochrane Central electronic databases and collected studies of patients with MCFACs treated with 1 of 3 surgical methods. Eligible studies reported the rate of clinical symptoms improvement (RCSI), rate of cyst reduction (RCR), rate of total complications (RTC), rate of short-term complications (RSTC), rate of long-term complications (RLTC), and other parameters. RESULTS: Eighteen studies met the criteria. MCFACs were divided into 3 groups on the basis of surgical method: RCSI in group I (237 patients, neuroendoscopic fenestration) was 90% (95% confidence interval [CI]: 83%-95%); RCR: 76% (95% CI: 67%-84%); RTC: 28% (95% CI: 22%-34%); RSTC: 23% (95% CI: 17%-30%); and RLTC: 6% (95% CI: 3%-11%). RCSI in group II (144 patients, microsurgical fenestration) was 87% (95% CI: 75%-96%); RCR: 87% (95% CI: 70%-97%); RTC: 49% (95% CI: 30%-68%); RSTC: 44% (95% CI: 21%-68%); RLTC: 3% (95% CI: 0%-12%). RCSI in group III (93 patients, cystoperitoneal shunting) was 93% (95% CI: 66%-99%); RCR: 93% (95% CI: 66%-99%); RTC: 20% (95% CI: 5%-42%); RSTC: 10% (95% CI: 0%-31%); RLTC: 15% (95% CI: 9%-23%). RLTC differed significantly between the 3 groups (P = 0.005); RTC and RSTC between group I and group II (P = 0.002). CONCLUSIONS: All 3 surgical methods are effective for MCFACs, but considering safety, neuroendoscopic fenestration may be the best initial procedure.


Assuntos
Cistos Aracnóideos/epidemiologia , Cistos Aracnóideos/cirurgia , Microcirurgia/estatística & dados numéricos , Neuroendoscopia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Derivação Ventriculoperitoneal/estatística & dados numéricos , Adolescente , Cistos Aracnóideos/diagnóstico , Criança , Pré-Escolar , Fossa Craniana Média/cirurgia , Feminino , Humanos , Internacionalidade , Masculino , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Fatores de Risco , Resultado do Tratamento
7.
Neurocir.-Soc. Luso-Esp. Neurocir ; 27(3): 121-128, mayo-jun. 2016. ilus
Artigo em Espanhol | IBECS | ID: ibc-152954

RESUMO

El manejo terapéutico de los quistes aracnoideos depende, en gran medida, de su localización. Casi el 50% de los quistes aracnoideos se localizan en la fosa temporal-cisura de Silvio. En cambio, la otra mitad se reparte en localizaciones diversas, a veces excepcionales. En este trabajo describimos, bajo la denominación de «quistes aracnoideos de localización infrecuente», aquellos compuestos por las 2 hojas de membrana aracnoidea que no se encuentran localizados en la fosa temporal y que son primarios o de origen congénito (AU)


The therapeutic management of arachnoid cysts depends largely on its location. Almost 50% of arachnoid cysts are located in the temporal fossa-Sylvian fissure, whereas the other half is distributed in different locations, sometimes exceptional. Under the name of infrequent location arachnoid cysts, a description is presented of those composed of 2 sheets of arachnoid membrane, which are not located in the temporal fossa, and are primary or congenital (AU)


Assuntos
Humanos , Cistos Aracnóideos/terapia , Cistos do Sistema Nervoso Central/terapia , Cistos Aracnóideos/epidemiologia , Teto do Mesencéfalo/patologia , Fossa Craniana Posterior/patologia , Neoplasias do Ventrículo Cerebral/diagnóstico
8.
Neurosurg Focus ; 40(4): E9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27032926

RESUMO

OBJECTIVE Arachnoid cysts (ACs) are congenital lesions bordered by an arachnoid membrane. Researchers have postulated that individuals with an AC demonstrate a higher rate of structural brain injury after trauma. Given the potential neurological consequences of a structural brain injury requiring neurosurgical intervention, the authors sought to perform a systematic review of sport-related structural-brain injury associated with ACs with a corresponding quantitative analysis. METHODS Titles and abstracts were searched systematically across the following databases: PubMed, Embase, CINAHL, and PsycINFO. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed case reports, case series, or observational studies that reported a structural brain injury due to a sport or recreational activity (hereafter referred to as sport-related) with an associated AC were included. Patients were excluded if they did not have an AC, suffered a concussion without structural brain injury, or sustained the injury during a non-sport-related activity (e.g., fall, motor vehicle collision). Descriptive statistical analysis and time to presentation data were summarized. Univariate logistic regression models to assess predictors of neurological deficit, open craniotomy, and cystoperitoneal shunt were completed. RESULTS After an initial search of 994 original articles, 52 studies were found that reported 65 cases of sport-related structural brain injury associated with an AC. The median age at presentation was 16 years (range 4-75 years). Headache was the most common presenting symptom (98%), followed by nausea and vomiting in 49%. Thirteen patients (21%) presented with a neurological deficit, most commonly hemiparesis. Open craniotomy was the most common form of treatment (49%). Bur holes and cyst fenestration were performed in 29 (45%) and 31 (48%) patients, respectively. Seven patients (11%) received a cystoperitoneal shunt. Four cases reported medical management only without any surgical intervention. No significant predictors were found for neurological deficit or open craniotomy. In the univariate model predicting the need for a cystoperitoneal shunt, the odds of receiving a shunt decreased as age increased (p = 0.004, OR 0.62 [95% CI 0.45-0.86]) and with male sex (p = 0.036, OR 0.15 [95% CI 0.03-0.88]). CONCLUSIONS This systematic review yielded 65 cases of sport-related structural brain injury associated with ACs. The majority of patients presented with chronic symptoms, and recovery was reported generally to be good. Although the review is subject to publication bias, the authors do not find at present that there is contraindication for patients with an AC to participate in sports, although parents and children should be counseled appropriately. Further studies are necessary to better evaluate AC characteristics that could pose a higher risk of adverse events after trauma.


Assuntos
Cistos Aracnóideos/epidemiologia , Cistos Aracnóideos/cirurgia , Concussão Encefálica/epidemiologia , Concussão Encefálica/cirurgia , Lesões Encefálicas/epidemiologia , Esportes , Adolescente , Adulto , Idoso , Cistos Aracnóideos/complicações , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Lesões Encefálicas/cirurgia , Criança , Pré-Escolar , Feminino , Cefaleia/complicações , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Adulto Jovem
9.
J Neurol ; 263(4): 689-94, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26860092

RESUMO

To investigate the prevalence of intracranial arachnoid cysts in a large population-based sample. We also aimed to assess the association between arachnoid cysts and cognitive impairment, depression, epilepsy, headache, dizziness, previous head trauma, hip fractures, and mortality. A population-based cohort and nested case-control study. The sample comprised representative populations (n = 1235) aged ≥ 70 years. All participants underwent baseline neuropsychiatric examinations, including computed tomography (CT) of the brain, between 1986 and 2000. All CT scans were examined for arachnoid cysts. Headache, dizziness, history of head trauma, dementia, depression, epilepsy, and hip fracture were assessed using data from clinical examinations, interviews and the Swedish hospital discharge register. Cognition was assessed using the Mini-Mental Status Examination, and depressive symptoms using the Montgomery-Åsberg Depression Rating Scale. Date of death was obtained from the National Swedish Death Registry. The prevalence of arachnoid cysts was 2.3 % (n = 29), with no significant difference between men and women. Probands with and without cysts had the same frequency of headache, dizziness, previous head trauma, cognitive impairment, and depressive symptoms. Furthermore, there were no differences regarding the prevalence of dementia, depression, epilepsy, or previous hip fracture. Arachnoid cysts were not associated with increased mortality. Arachnoid cysts are common incidental finding, with the same rate in men and women, and are probably asymptomatic. The lack of relation with symptoms like headache, dizziness and cognitive impairment suggest caution in ascribing symptoms to incidentally discovered arachnoid cysts and a restrictive attitude to treatment.


Assuntos
Cistos Aracnóideos/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Cistos Aracnóideos/complicações , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Prevalência
10.
Acad Emerg Med ; 23(3): 358-61, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26728086

RESUMO

OBJECTIVES: Arachnoid cysts are abnormal intracranial fluid collections, and there is concern that these cysts may bleed or rupture following blunt head trauma. Our objective was to determine the risk of cyst-related complications in a cohort of children with arachnoid cysts who were evaluated for head trauma. METHODS: We analyzed the Pediatric Emergency Care Applied Research Network (PECARN) head trauma public use data set, which was the product of a study that enrolled children with blunt head trauma from June 2004 to September 2006. We identified children with arachnoid cysts on cranial computed tomography (CT) and described the patient demographics, mechanisms of injury, clinical presentations, CT evidence of traumatic brain injury (TBI), and clinical outcomes. Clinically important TBI was defined as TBI leading to: 1) death from TBI, 2) neurosurgical intervention, 3) intubation for > 24 hours for the TBI, or 4) hospitalization for 2 or more nights for the head injury in association with TBI on CT. RESULTS: Data were available for 43,399 children who sustained blunt head trauma, of whom 15,899 had cranial CT scans obtained and 68 (0.4%) had arachnoid cysts. Falls were the most common mechanisms of injury (47%) and 87% of children had either moderate or severe injury mechanisms. Glasgow Coma Scale (GCS) scores ranged from 6 to 15, with 61 (90%) having GCS scores of 15. Two of the children with arachnoid cysts had TBIs on CT, one of which was clinically important. There were no identified cases of arachnoid cyst-related bleeding or complications. CONCLUSIONS: In this cohort of 68 children with arachnoid cysts who sustained head trauma, none demonstrated cyst-related bleeding or complications. This suggests the risk of arachnoid cyst-related complications in children following blunt head trauma is low and evaluation should align with existing clinical decision rules.


Assuntos
Cistos Aracnóideos/complicações , Cistos Aracnóideos/epidemiologia , Traumatismos Cranianos Fechados/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Masculino , Pediatria , Estudos Prospectivos , Tomografia Computadorizada por Raios X
11.
J Neurosurg Pediatr ; 17(4): 410-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26636254

RESUMO

OBJECT There is currently no consensus on the safety of sports participation for patients with an intracranial arachnoid cyst (AC). The authors' goal was to define the risk of sports participation for children with this imaging finding. METHODS A survey was prospectively administered to 185 patients with ACs during a 46-month period at a single institution. Cyst size and location, treatment, sports participation, and any injuries were recorded. Eighty patients completed at least 1 subsequent survey following their initial entry into the registry, and these patients were included in a prospective registry with a mean prospective follow-up interval of 15.9 ± 8.8 months. RESULTS A total 112 patients with ACs participated in 261 sports for a cumulative duration of 4410 months or 1470 seasons. Of these, 94 patients participated in 190 contact sports for a cumulative duration of 2818 months or 939 seasons. There were no serious or catastrophic neurological injuries. Two patients presented with symptomatic subdural hygromas following minor sports injuries. In the prospective cohort, there were no neurological injuries CONCLUSIONS Permanent or catastrophic neurological injuries are very unusual in AC patients who participate in athletic activities. In most cases, sports participation by these patients is safe.


Assuntos
Cistos Aracnóideos/epidemiologia , Traumatismos em Atletas/epidemiologia , Sistema de Registros/estatística & dados numéricos , Esportes/estatística & dados numéricos , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino
12.
J Coll Physicians Surg Pak ; 25(8): 588-91, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26305305

RESUMO

OBJECTIVE: To report clinicopathologic features of symptomatic surgically removed non-neoplastic cysts of the central nervous system (CNS). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from 2003 to 2012. METHODOLOGY: All non-neoplastic CNS cysts reported during the study period were retrieved and reviewed. Age, gender, location, histologic type and clinical features were noted. RESULTS: A total of 124 cysts were diagnosed in the study period. These included 44 epidermoid cysts (mean age 30.5 ± 13.8 years), 35 colloid cysts (mean age 31 ±13.2 years), 32 arachnoid cysts (mean age 24.8 ±20.2 years), 6 dermoid cysts, 3 enterogenous cysts and Rathke's cleft cysts each and 1 ependymal cyst. All cyst types mainly presented in young adults in both genders with signs and symptoms of a mass lesion. CONCLUSION: Non-neoplastic cyst mainly presented like a CNS mass lesion in young adults. Epidermoids were the most common type of these cysts in the present series followed by the colloid and the arachnoid cysts.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Cisto Epidérmico/cirurgia , Adolescente , Adulto , Distribuição por Idade , Idoso , Cistos Aracnóideos/epidemiologia , Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/classificação , Cistos do Sistema Nervoso Central/epidemiologia , Cistos Coloides/epidemiologia , Cistos Coloides/cirurgia , Cisto Epidérmico/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento , Adulto Jovem
13.
Neurocirugia (Astur) ; 26(5): 234-40, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25843209

RESUMO

The prevalence of arachnoid cysts in children is 1-3%. They are more frequent in boys. They can be located intracranially or in the spine. Intracranial cysts are classified as supratentorial, infratentorial, and supra-infratentorial (tentorial notch). Supratentorial are divided into middle cranial fossa, convexity, inter-hemisferic, sellar region, and intraventricular. Infratentorial are classified into supracerebellar, infracerebellar, hemispheric, clivus, and cerebellopontine angle. Finally spinal arachnoid cysts are classified taking into account whether they are extra- or intradural, and nerve root involvement.


Assuntos
Cistos Aracnóideos/classificação , Cistos Aracnóideos/epidemiologia , Encéfalo/patologia , Ângulo Cerebelopontino/patologia , Criança , Fossa Craniana Posterior/patologia , Humanos , Doenças da Medula Espinal/classificação , Doenças da Medula Espinal/epidemiologia
15.
Brain Dev ; 36(9): 801-6, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24325802

RESUMO

OBJECTIVE: Some clinical findings in tuberous sclerosis complex (TSC), such as hypomelanotic macules or angiofibromas are related to problems in development of the neural crest, which is also the origin of cranial leptomeninges. Arachnoid cysts have been reported in two TSC patients to date. The purpose of this study was to assess the prevalence and characteristics of arachnoid cysts in a large cohort of TSC. MATERIALS AND METHOD: We performed a review of brain MRIs of 220 TSC patients searching for arachnoid cysts. RESULTS: Arachnoid cysts were found in 12 (5.5%) (general population: 0.5%), including ten males (83.3%). Four patients (33.3%) had also autosomal dominant polycystic kidney disease (ADPKD) due to a contiguous deletion of the TSC2-PKD1 genes. Three patients (25%) had two or more arachnoid cysts, of whom two also had ADPKD. One patient with an arachnoid cyst did not have tubers, subependymal nodules or white matter migration lines. CONCLUSION: Our study suggests that arachnoid cysts are part of the clinical spectrum of TSC and may be also present in TSC patients without other typical TSC brain lesions.


Assuntos
Cistos Aracnóideos/epidemiologia , Cistos Aracnóideos/patologia , Encéfalo/patologia , Esclerose Tuberosa/epidemiologia , Esclerose Tuberosa/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos Aracnóideos/genética , Criança , Pré-Escolar , Feminino , Deleção de Genes , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Renais Policísticas/epidemiologia , Doenças Renais Policísticas/genética , Prevalência , Estudos Retrospectivos , Canais de Cátion TRPP/genética , Esclerose Tuberosa/genética , Proteína 2 do Complexo Esclerose Tuberosa , Proteínas Supressoras de Tumor/genética , Adulto Jovem
17.
J Neurosurg Pediatr ; 12(6): 555-64, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24093592

RESUMO

OBJECT: Intracranial arachnoid cysts are a relatively common benign intracranial pathology, accounting for as many as 0.75%-1% of nontraumatic CNS lesions. Although it has already been demonstrated that rupture of arachnoid cysts may lead to subdural hematomas/hygromas, no study to date has investigated benign extracerebral collection in infancy as a possible predisposing factor for further development of arachnoid cysts. METHODS: The authors performed a retrospective imaging and chart review of macrocephalic infants 12 months old or younger who were referred to neurosurgical care at OSF St. Francis Medical Center from 2003 to 2010, and who were diagnosed with benign extracerebral fluid collection in infancy on thin-slice (1-mm) head CT scans. Special attention was given to the investigation of risk factors for further development of de novo arachnoid cysts. Several epidemiological factors in the infants and mothers were analyzed, including gestational age at delivery, mode of delivery, mother's age at delivery, delivery complications, birth weight, age of macrocephaly development, degree of macrocephaly, family history of macrocephaly, prenatal and postnatal history of infection, fontanel status, presence of papilledema, previous history of head trauma, and smoking status. Imaging characteristics of the initial scans, such as location of subdural collection (frontal vs frontoparietal and frontotemporal) and presence of ventriculomegaly, were also evaluated. For those patients in whom arachnoid cysts were identified on subsequent CT scans, the size and location of the cysts were also analyzed. RESULTS: The authors identified 44 children with benign extracerebral fluid collection in infancy. From this group, over a mean follow-up of 13 months (range 6-13 months), 18 children developed intracranial arachnoid cysts (a 40.9% incidence of de novo development of arachnoid cysts), with 27.8% presenting with bilateral cysts. In the multiple logistic regression analysis, infants who presented with an extracerebral collection restricted to the bilateral frontal region were more likely to develop intracranial arachnoid cysts (p = 0.035) than those with collections involving the frontotemporal and frontoparietal regions (odds ratio [OR] = 5.73). Additionally, children with benign extracerebral fluid collections and plagiocephaly were more likely to develop intracranial arachnoid cysts (p = 0.043) than those without plagiocephaly (OR = 4.96). CONCLUSIONS: This is the first report in the neurosurgical literature demonstrating that benign extracerebral fluid collections in infancy may constitute a significant risk factor for development of de novo arachnoid cysts. These findings support a 2-hit hypothesis for the development of arachnoid cysts, in which the combination of an embryological defect in arachnoid development followed by a second event leading to impairment of CSF fluid absorption in early childhood could lead to abnormal CSF dynamics and the consequent expansion of fluid collections in the intraarachnoid spaces.


Assuntos
Cistos Aracnóideos/epidemiologia , Cistos Aracnóideos/etiologia , Líquido Cefalorraquidiano , Tomografia Computadorizada por Raios X , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/patologia , Peso ao Nascer , Fontanelas Cranianas/patologia , Traumatismos Craniocerebrais/complicações , Parto Obstétrico , Feminino , Idade Gestacional , Humanos , Illinois/epidemiologia , Lactente , Modelos Logísticos , Masculino , Idade Materna , Registros Médicos , Megalencefalia/complicações , Análise Multivariada , Papiledema/complicações , Estudos Retrospectivos , Fatores de Risco , Derrame Subdural/etiologia , Tomografia Computadorizada por Raios X/métodos
18.
Neurosurgery ; 72(5): 716-22; discussion 722, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23313978

RESUMO

BACKGROUND: As the availability of imaging modalities has increased, the finding of arachnoid cysts has become common. Accurate patient counseling regarding physical activity or risk factors for cyst rupture or hemorrhage has been hampered by the lack of definitive association studies. OBJECTIVE: This case-control study evaluated factors that are associated with arachnoid cyst rupture (intracystic hemorrhage, adjacent subdural hematoma, or adjacent subdural hygroma) in pediatric patients with previously asymptomatic arachnoid cysts. METHODS: Patients with arachnoid cysts and intracystic hemorrhage, adjacent subdural hygroma, or adjacent subdural hematoma treated at a single institution from 2005 to 2010 were retrospectively identified. Two unruptured/nonhemorrhagic controls were matched to each case based on patient age, sex, anatomical cyst location, and side. Risk factors evaluated included arachnoid cyst size, recent history of head trauma, and altitude at residence. RESULTS: The proportion of imaged arachnoid cysts that presented either originally or subsequently with a rupture or hemorrhage was 6.0%. Larger cyst size, as defined by maximal cyst diameter, was significantly associated with cyst rupture/hemorrhage (P < .001). When dichotomized with a 5-cm cutoff, 9/13 larger cysts ruptured and/or hemorrhaged, whereas only 5/29 smaller cysts ruptured/hemorrhaged (odds ratio = 16.5 (confidence interval [2.5, ∞]). A recent history of head trauma was also significantly associated with the outcome (P < .001; odds ratio = 25.1 (confidence interval [4.0, ∞]). Altitude was not associated with arachnoid cyst rupture or hemorrhage. CONCLUSION: This case-control study suggests that larger arachnoid cyst size and recent head trauma are risk factors for symptomatic arachnoid cyst rupture/hemorrhage.


Assuntos
Altitude , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/epidemiologia , Angiografia Cerebral/estatística & dados numéricos , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Adulto , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Ruptura/diagnóstico por imagem , Ruptura/epidemiologia , Resultado do Tratamento , Utah/epidemiologia
20.
J Neurosurg ; 118(2): 222-31, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23140149

RESUMO

OBJECT: Arachnoid cysts are a frequent finding on intracranial imaging. The prevalence and natural history of these cysts in adults are not well defined. METHODS: We retrospectively reviewed the electronic medical records of a consecutive series of adults who underwent brain MRI over a 12-year interval to identify those with arachnoid cysts. The MRI studies were reviewed to confirm the diagnosis. For those patients with arachnoid cysts, we evaluated presenting symptoms, cyst size, and cyst location. Patients with more than 6 months' clinical and imaging follow-up were included in a natural history analysis. RESULTS: A total of 48,417 patients underwent brain MRI over the study period. Arachnoid cysts were identified in 661 patients (1.4%). Men had a higher prevalence than women (p < 0.0001). Multiple arachnoid cysts occurred in 30 patients. The most common locations were middle fossa (34%), retrocerebellar (33%), and convexity (14%). Middle fossa cysts were predominantly left-sided (70%, p < 0.001). Thirty-five patients were considered symptomatic and 24 underwent surgical treatment. Sellar and suprasellar cysts were more likely to be considered symptomatic (p < 0.0001). Middle fossa cysts were less likely to be considered symptomatic (p = 0.01. The criteria for natural history analysis were met in 203 patients with a total of 213 cysts. After a mean follow-up of 3.8 ± 2.8 years (for this subgroup), 5 cysts (2.3%) increased in size and 2 cysts decreased in size (0.9%). Only 2 patients developed new or worsening symptoms over the follow-up period. CONCLUSIONS: Arachnoid cysts are a common incidental finding on intracranial imaging in all age groups. Although arachnoid cysts are symptomatic in a small number of patients, they are associated with a benign natural history for those presenting without symptoms.


Assuntos
Cistos Aracnóideos/epidemiologia , Cistos Aracnóideos/patologia , Imagem por Ressonância Magnética , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Cistos Aracnóideos/cirurgia , Progressão da Doença , Feminino , Seguimentos , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
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