Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.959
Filtrar
1.
J Neurol Sci ; 417: 117085, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32871412

RESUMO

INTRODUCTION: Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Several studies have been performed, focusing on understanding the acute respiratory syndrome and treatment strategies. However, there is growing evidence indicating neurological manifestations occur in patients with COVID-19. Similarly, the other coronaviruses (CoV) epidemics; severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) have been associated with neurological complications. METHODS: This systematic review serves to summarize available information regarding the potential effects of different types of CoV on the nervous system and describes the range of clinical neurological complications that have been reported thus far in COVID-19. RESULTS: Two hundred and twenty-five studies on CoV infections associated neurological manifestations in human were reviewed. Of those, 208 articles were pertinent to COVID-19. The most common neurological complaints in COVID-19 were anosmia, ageusia, and headache, but more serious complications, such as stroke, impairment of consciousness, seizures, and encephalopathy, have also been reported. CONCLUSION: There are several similarities between neurological complications after SARS-CoV-1, MERS-CoV and COVID-19, however, the scope of the epidemics and number of patients are very different. Reports on the neurological complications after and during COVID-19 are growing on a daily basis. Accordingly, comprehensive knowledge of these complications will help health care providers to be attentive to these complications and diagnose and treat them timely.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/complicações , Transtornos da Consciência/etiologia , Doenças dos Nervos Cranianos/etiologia , Encefalite Viral/etiologia , Humanos , Imagem por Ressonância Magnética , Doenças Musculares/etiologia , Neuroimagem , Doenças do Sistema Nervoso Periférico/etiologia , Convulsões/etiologia , Síndrome Respiratória Aguda Grave/complicações , Acidente Vascular Cerebral/etiologia
2.
J Laryngol Otol ; 134(6): 487-492, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32498757

RESUMO

BACKGROUND: Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline. OBJECTIVE: This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management. METHODS: A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review. RESULTS: Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately. CONCLUSION: This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.


Assuntos
Meato Acústico Externo/microbiologia , Necrose/etiologia , Otite Externa/complicações , Administração dos Cuidados ao Paciente/métodos , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Doenças dos Nervos Cranianos/epidemiologia , Doenças dos Nervos Cranianos/etiologia , Doenças dos Nervos Cranianos/mortalidade , Progressão da Doença , Humanos , Necrose/diagnóstico por imagem , Otite Externa/epidemiologia , Otite Externa/patologia , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Prevalência , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Escócia/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Osso Temporal/microbiologia
3.
Rinsho Shinkeigaku ; 60(7): 504-507, 2020 Jul 31.
Artigo em Japonês | MEDLINE | ID: mdl-32536666

RESUMO

This is the rare case report that bilateral vagus nerve paralysis was emerged as the initial symptom of acute myelogenous leukemia (AML). An 83-year-old man admitted to our hospital because of dysphagia. His dysphagia progressed two months prior to admission. Although physical examination revealed no abnormality, videoendoscopy and videofluorography examination clearly revealed bilateral vagus nerve palsy. Brain MRI showed hypointense signals at the bilateral clivus on T1 weighted images, suggesting tumor infiltration to bilateral petroclivus. He was diagnosed as AML by blood samples and bone marrow biopsy. After initiation of the treatment including radiation therapy, dysphagia shows mild improvement. Although bilateral cranial nerve palsy due to malignant tumor involving at the clivus is very uncommon, we should pay attention to the symptom.


Assuntos
Doenças dos Nervos Cranianos/etiologia , Transtornos de Deglutição/etiologia , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/diagnóstico , Nervo Vago , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Humanos , Masculino
4.
Spine Deform ; 8(5): 1135-1137, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32350759

RESUMO

PURPOSE: The aim of the present work is to present a rare case of Tapia's syndrome (hypoglossal and recurrent laryngeal nerve apraxia) following cervical spine surgery with tracheostomy. METHODS: Clinical data were collected from patient's medical records. RESULTS: After uneventful cervical spine surgery with tracheostomy, the patient reported mild dysphagia and dysphonia. Clinical examination and electromyography confirmed unilateral hypoglossal and recurrent laryngeal disfunction, contralateral to surgical access. Neural damage was transitory and full functional recovery was achieved within 12 months. CONCLUSION: Tapia's syndrome can be a rare complication of cervical spine surgery with tracheostomy, due to multiple factors, including tracheostomy cuffed cannula and cervical spine position during surgery.


Assuntos
Apraxias/etiologia , Vértebras Cervicais/cirurgia , Doenças dos Nervos Cranianos/etiologia , Discotomia/efeitos adversos , Doenças do Nervo Hipoglosso/etiologia , Complicações Pós-Operatórias/etiologia , Nervo Laríngeo Recorrente , Traqueostomia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome
5.
World Neurosurg ; 140: 122-127, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32434021

RESUMO

BACKGROUND: The mainstay treatment for petrous apicitis (Gradenigo's syndrome) is medical management with antibiotics, steroids, and placement of pressure equalization tubes. The role for surgery is limited as second-line treatment if conservative methods have failed. CASE DESCRIPTION: We report 2 cases of medically refractory petrous apicitis presenting with progressive cranial neuropathies who underwent petrous apex resection and debridement via an anterior petrosal (Kawase) approach. Both patients had improvement of their preoperative cranial nerve deficits within 24-48 hours of surgery, that previously did not improve after 2 weeks of medical management. CONCLUSIONS: To our knowledge, the use of the Kawase approach for petrous apicitis has not been previously reported. In addition, we postulate that surgical intervention can potentially result in quicker recovery of preexisting cranial nerve deficits in medically refractory petrous apicitis. This raises the potential role of earlier surgical intervention.


Assuntos
Doenças dos Nervos Cranianos/etiologia , Petrosite/cirurgia , Osso Petroso/cirurgia , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Petrosite/complicações , Resultado do Tratamento
6.
Neurology ; 95(5): e601-e605, 2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32303650

RESUMO

OBJECTIVE: To report 2 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented acutely with Miller Fisher syndrome and polyneuritis cranialis, respectively. METHODS: Patient data were obtained from medical records from the University Hospital "Príncipe de Asturias," Alcalá de Henares, and the University Hospital "12 de Octubre," Madrid, Spain. RESULTS: A 50-year-old man presented with anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia, areflexia, albuminocytologic dissociation, and positive testing for anti-GD1b-immunoglobulin G antibody. Five days previously, he had developed a cough, malaise, headache, low back pain, and fever. A 39-year-old man presented with ageusia, bilateral abducens palsy, areflexia, and albuminocytologic dissociation. Three days previously, he had developed diarrhea, a low-grade fever, and poor general condition. Oropharyngeal swab test for SARS-CoV-2 by qualitative real-time reverse transcriptase PCR assay was positive in both patients and negative in the CSF. The first patient was treated with IV immunoglobulin and the second with acetaminophen. Two weeks later, both patients made a complete neurologic recovery, except for residual anosmia and ageusia in the first case. CONCLUSIONS: Our 2 cases highlight the rare occurrence of Miller Fisher syndrome and polyneuritis cranialis during the coronavirus disease 2019 (COVID-19) pandemic. These neurologic manifestations may occur because of an aberrant immune response to COVID-19. The full clinical spectrum of neurologic symptoms in patients with COVID-19 remains to be characterized.


Assuntos
Infecções por Coronavirus/fisiopatologia , Doenças dos Nervos Cranianos/fisiopatologia , Síndrome de Miller Fisher/fisiopatologia , Neurite (Inflamação)/fisiopatologia , Pneumonia Viral/fisiopatologia , Adulto , Ageusia/etiologia , Ageusia/fisiopatologia , Betacoronavirus , Infecções por Coronavirus/complicações , Doenças dos Nervos Cranianos/etiologia , Doenças dos Nervos Cranianos/imunologia , Gangliosídeos/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Miller Fisher/etiologia , Síndrome de Miller Fisher/imunologia , Neurite (Inflamação)/etiologia , Neurite (Inflamação)/imunologia , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Pandemias , Pneumonia Viral/complicações , Índice de Gravidade de Doença , Espanha
8.
Acta Neurochir (Wien) ; 162(4): 821-829, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31919599

RESUMO

BACKGROUND: Skull base paragangliomas are highly vascular tumors that are often embolized before surgical resection; however, the safety and efficacy of preoperative embolization using an ethylene vinyl alcohol copolymer (Onyx; Medtronic, Dublin, Republic of Ireland) in these tumors is unknown. This retrospective cohort study evaluated patient outcomes after preoperative embolization of skull base paragangliomas using Onyx. METHODS: We retrospectively analyzed data from all patients with skull base paragangliomas who underwent preoperative Onyx embolization at our institution (January 01, 2005-December 31, 2017). Patient, tumor, embolization, and outcomes data were extracted by reviewing inpatient and outpatient clinical and imaging records. RESULTS: Seven patients were studied (5/7 [71%] female), 6 with glomus jugulares and 1 with a glomus vagale. The median age was 52 years, and the most common presenting symptom was cranial neuropathy (6/7 [86%]). The tumor vascular supply was from the ascending pharyngeal artery in all 7 cases (100%) with additional feeders including the occipital artery in 5 (71%); internal carotid artery in 3 (43%); middle meningeal, vertebral, and internal maxillary artery each in 2 (29%); and posterior auricular artery in 1 (14%). The median postembolization tumor devascularization was 80% (range, 64-95%). The only postembolization complication was a facial palsy in 1 patient. CONCLUSION: Preoperative embolization with Onyx affords excellent devascularization for the majority of skull base paragangliomas, and it may facilitate resection of these hypervascular lesions. The advantages provided by Onyx with respect to penetration of intratumoral vessels must be weighed against the risk of cranial neuropathy.


Assuntos
Doenças dos Nervos Cranianos/terapia , Embolização Terapêutica/métodos , Paraganglioma/terapia , Polivinil , Neoplasias da Base do Crânio/terapia , Criança , Doenças dos Nervos Cranianos/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraganglioma/complicações , Estudos Retrospectivos , Neoplasias da Base do Crânio/complicações , Resultado do Tratamento , Adulto Jovem
10.
Arthritis Rheumatol ; 72(1): 67-77, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31390162

RESUMO

OBJECTIVE: To determine the frequency, clinical characteristics, associations, and outcomes of different types of peripheral nervous system (PNS) disease in a multiethnic/multiracial, prospective inception cohort of systemic lupus erythematosus (SLE) patients. METHODS: Patients were evaluated annually for 19 neuropsychiatric (NP) events including 7 types of PNS disease. SLE disease activity, organ damage, autoantibodies, and patient and physician assessment of outcome were measured. Time to event and linear regressions were used as appropriate. RESULTS: Of 1,827 SLE patients, 88.8% were female, and 48.8% were white. The mean ± SD age was 35.1 ± 13.3 years, disease duration at enrollment was 5.6 ± 4.2 months, and follow-up was 7.6 ± 4.6 years. There were 161 PNS events in 139 (7.6%) of 1,827 patients. The predominant events were peripheral neuropathy (66 of 161 [41.0%]), mononeuropathy (44 of 161 [27.3%]), and cranial neuropathy (39 of 161 [24.2%]), and the majority were attributed to SLE. Multivariate Cox regressions suggested longer time to resolution in patients with a history of neuropathy, older age at SLE diagnosis, higher SLE Disease Activity Index 2000 scores, and for peripheral neuropathy versus other neuropathies. Neuropathy was associated with significantly lower Short Form 36 (SF-36) physical and mental component summary scores versus no NP events. According to physician assessment, the majority of neuropathies resolved or improved over time, which was associated with improvements in SF-36 summary scores for peripheral neuropathy and mononeuropathy. CONCLUSION: PNS disease is an important component of total NPSLE and has a significant negative impact on health-related quality of life. The outcome is favorable for most patients, but our findings indicate that several factors are associated with longer time to resolution.


Assuntos
Doenças dos Nervos Cranianos/fisiopatologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/fisiopatologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Adulto , Fatores Etários , Estudos de Coortes , Doenças dos Nervos Cranianos/etiologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Mononeuropatias/etiologia , Mononeuropatias/fisiopatologia , Análise Multivariada , Doenças do Sistema Nervoso Periférico/etiologia , Modelos de Riscos Proporcionais , Índice de Gravidade de Doença , Adulto Jovem
12.
Aust Crit Care ; 33(1): 30-38, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31079994

RESUMO

BACKGROUND: To reduce the neurovascular complications caused by physical restraint in intensive care patients, there is a need to examine the occurrence of neurovascular complications and their rate. OBJECTIVES: The objective of this research was to investigate the effect of physical restraint on the occurrence of neurovascular complications and their rate. METHODS: A prospective observational cohort study was carried out. A total of 90 patients from anaesthesia and internal intensive care units participated in this study. Patients were assessed at intervals of 24 h for 4 days using the following instruments: Individual Characteristics Form, Richmond Agitation-Sedation Scale (RASS), Behavioral Pain Scale, and Complication Diagnostic Diary. RESULTS: Redness (p < 0.001), limb movement (p < 0.001), oedema (p < 0.001), and colour complication (p < 0.001) increased, whereas pulse strength (p < 0.001) decreased in physically restrained sites on the arm from day 1 to day 4. Redness was increased in patients physically restrained with all types of materials (p < 0.001; p < 0.001; p = 0.020). Although there was a statistically significant difference in terms of movement (p = 0.006; p = 0.003) and oedema (p < 0.001; p < 0.001), both with a roll of gauze and tough cuff, these complications were not significantly different in patients restrained with green foam tie (p > 0.05). According to logistic regression analysis, material type, position of the limb, space between the physical restraint and limb, age, RASS, and pain were independent risk factors for neurovascular complications. RASS and pain were independent protective factors against movement complications. CONCLUSIONS: The duration of physical restraint increases neurovascular complications. This study revealed that nurses did not regularly check the restrained wrist and did not focus on the peripheral circulation. It is necessary to develop training programs, standards, and appropriate follow-up strategies in intensive care units in Turkey.


Assuntos
Doenças dos Nervos Cranianos/etiologia , Unidades de Terapia Intensiva , Restrição Física/efeitos adversos , Lesões do Sistema Vascular/etiologia , Idoso , Feminino , Humanos , Masculino , Avaliação em Enfermagem , Medição da Dor , Estudos Prospectivos , Turquia
13.
Laryngoscope ; 130(6): 1520-1524, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31498451

RESUMO

OBJECTIVE: Spontaneous vocal recovery from idiopathic vocal fold paralysis (VFP) appears to differ in time course from recovery in iatrogenic VFP. This study aimed to determine if this difference could be explained by differing mechanisms causing recurrent laryngeal nerve (RLN) dysfunction, specifically whether idiopathic VFP is consistent with a focal RLN axonal lesion. STUDY DESIGN: Case series with mathematical modeling. METHODS: A review of 1267 cases of unilateral VFP over a 10-year period yielded 114 subjects (35 idiopathic, 79 iatrogenic) with a discrete onset of spontaneous vocal recovery. The time-to-recovery data were fit to a previously described two-phase model that incorporates the Seddon classification of neuropraxia and higher grades of axonal injury. Alternatively, the data were fit to a single phase model that does not assume a focal axonal lesion. RESULTS: Time to vocal recovery in iatrogenic VFP can be reliably modeled by the assumption of a focal axonal lesion, with an early recovery group corresponding to neuropraxia and a late recovery group with more severe nerve damage. Time to recovery in idiopathic VFP can be more simply modeled in a single phase, with a time course that mirrors those in diverse biological processes such as transcription and microtubule growth. CONCLUSION: Idiopathic VFP may not be caused by a focal axonal lesion. Neuritis may be a compatible mechanism. The iatrogenic VFP data lend further support to the concept that the severity of RLN injury, not the length of axon to regenerate, is the chief determinant of recovery time after iatrogenic injury. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1520-1524, 2020.


Assuntos
Nervo Laríngeo Recorrente , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças dos Nervos Cranianos/etiologia , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Paralisia das Pregas Vocais/complicações , Adulto Jovem
14.
J Vasc Interv Radiol ; 31(4): 544-550, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31235409

RESUMO

PURPOSE: To evaluate the efficacy and safety of ultrasound (US)-guided radiofrequency (RF) ablation in the treatment of facial microcystic lymphatic malformations (mLMs) or mixed venolymphatic malformations (VLMs) and to introduce the "induced-paralysis" technique with the use of an injectable electrode to minimize neural complications. MATERIALS AND METHODS: Data from patients with symptomatic facial mLMs or mixed VLMs who underwent US-guided RF ablation in 2014-2017 were retrospectively reviewed. Computed tomography (CT) and/or magnetic resonance (MR) imaging was used to localize any functional structures close to the target lesion. Treatment outcome was assessed by 4-point cosmetic grading score (CGS). Treatment outcome was compared between patients with vs without a functional structure close to the lesion and those treated with a noninjectable vs an injectable electrode. Immediate and late complications were assessed during follow-up. RESULTS: Data from 15 patients were evaluated. Initial CGS and median volume were significantly decreased at the last follow-up in all patients (from 4 to 1 and from 7 mL to 0.7 mL, respectively; P < .05). Treatment outcome differed significantly between those with and without a functional structure on CT or MR imaging (P < .05) but showed no difference between noninjectable (n = 9) and injectable electrodes (n = 6). Two cases of transient cranial nerve palsy were seen in the noninjectable electrode group. CONCLUSIONS: US-guided RF ablation is effective in patients with facial mLMs or mixed VLMs. The induced-paralysis technique with an injectable electrode has the potential to ensure technical safety without compromising efficacy.


Assuntos
Ablação por Cateter/instrumentação , Eletrodos , Anormalidades Linfáticas/cirurgia , Vasos Linfáticos/cirurgia , Malformações Vasculares/cirurgia , Veias/cirurgia , Adolescente , Adulto , Ablação por Cateter/efeitos adversos , Doenças dos Nervos Cranianos/etiologia , Feminino , Humanos , Anormalidades Linfáticas/diagnóstico por imagem , Vasos Linfáticos/anormalidades , Vasos Linfáticos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção , Malformações Vasculares/diagnóstico por imagem , Veias/anormalidades , Veias/diagnóstico por imagem , Adulto Jovem
15.
Pan Afr Med J ; 34: 51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762917

RESUMO

Rhabdomyosarcoma (RMS), a tumor of skeletal muscle origin, is the most common soft tissue sarcoma encountered in childhood and adolescence; it is primarily found in the head and neck region, it is relatively uncommon tumors of the oral cavity. Clinical signs depend on the exact location of the lesion in the oral cavity and its development. Authors reported the case of a 14-year-old patient who presented an oropharyngeal mass causing voice dysfunction, after two surgical operation the patient experimented two 2 recurrences of the lesion. The histopathological examination objectifies an oropharyngeal rhabdomyosarcoma. Immediate postoperative outcome was uneventful with improvement in the voice dysfunction and dysphagia one month after surgery. Complementary treatment (chemotherapy and radiotherapy) was not available and accessible to the patient. Twenty months (20) after surgery, the examination found a recurrence of the tumor with pulmonary metastases and neurological complications. Oropharyngeal rhabdomyosarcomas are rare. Their interest lies in the fact that they often affect children and adolescents. The prognosis remains unfavorable in our context, even for cases accessible to surgery since complementary treatment with chemotherapy and / or radiotherapy does not exist. The prognosis depends on tumor size, location, staging, age of patients and especially the quality of the management.


Assuntos
Doenças dos Nervos Cranianos/etiologia , Neoplasias Orofaríngeas/diagnóstico , Rabdomiossarcoma/diagnóstico , Adolescente , Transtornos de Deglutição/etiologia , Seguimentos , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias Orofaríngeas/patologia , Neoplasias Orofaríngeas/cirurgia , Prognóstico , Rabdomiossarcoma/patologia , Rabdomiossarcoma/cirurgia , Distúrbios da Voz/etiologia
16.
BMJ Case Rep ; 12(11)2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31748369

RESUMO

Neurosarcoidosis when encountered by neurologists most commonly presents as cranial neuropathy, peripheral mononeuropathy,polyneuropathy, myopathy, meningitis or myelopathy. There are limited reports in the current literature on the cases of neurosarcoidosis patients presenting with ischaemic stroke. We discuss a 52-year-old patient with a known previous history of cutaneous sarcoidosis presenting with an acute third nerve palsy, facial weakness and ataxia. His magnetic resonance imaging (MRI) brain demonstrated focal signal changes in the midbrain consistent with an acute ischaemic event in the region of his third nucleus, suggesting a partial Claude syndrome presentation. Cerebrospinal fluid (CSF) examination demonstrated an elevated angiotensin-converting enzyme (ACE) level. We discuss the difficulties associated with confirming a diagnosis for his presentation and consider distinctions in stroke in neurosarcoid and its management in comparison to more common causes.


Assuntos
Ataxia/etiologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Doenças do Sistema Nervoso Central/tratamento farmacológico , Debilidade Muscular/etiologia , Doenças do Nervo Oculomotor/etiologia , Sarcoidose/tratamento farmacológico , Administração Intravenosa , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/patologia , Infartos do Tronco Encefálico/líquido cefalorraquidiano , Doenças do Sistema Nervoso Central/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Diagnóstico Diferencial , Músculos Faciais/patologia , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Mesencéfalo/irrigação sanguínea , Mesencéfalo/diagnóstico por imagem , Mesencéfalo/patologia , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Fármacos Neuroprotetores/administração & dosagem , Fármacos Neuroprotetores/uso terapêutico , Peptidil Dipeptidase A/líquido cefalorraquidiano , Sarcoidose/complicações , Resultado do Tratamento
17.
Sci Rep ; 9(1): 14648, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601939

RESUMO

Tentorial meningiomas (TMs) may challenge the surgeon with their close association to neurovascular structures. We analyzed a consecutive series with regard to surgical and functional outcome following microsurgical resection. We retrospectively reviewed patient charts and imaging data of every patient with a TM resected at a single institution and compared surgical and functional outcomes between groups stratified by choice of approach. 57 consecutive patients from October 2006 to September 2017 were included, of which 75.4% were female; mean age was 60 years (range 31-90), follow-up data was available for 85.4% and reached a mean of 18.3 (range 2-119) months with a median of 14.5 months. 54.4% of TMs were located at the medial compartments of the tentorium, 45.6% at the lateral edges. Complete resection defined as Simpson grades I and II was achieved in 72% of all cases, without statistically significant differences for both subgroups (p = 0.532). 9 patients (15.8%) developed a new cranial nerve palsy postoperatively with the vestibulocochlear nerve affected exclusively in the lateral subgroup (8.8% of total), followed by disturbances of oculomotion (5.4%). After 12 months, 93.0% of patients with available follow-up after 12 months retained fully independent functional status without deficit. Despite providing a surgical challenge due to potentially complicated anatomical relations, the choice of an appropriate surgical strategy overall results in favourable oncological and functional outcome after resection of TMs.


Assuntos
Doenças dos Nervos Cranianos/epidemiologia , Dura-Máter/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Microcirurgia/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças dos Nervos Cranianos/etiologia , Dura-Máter/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/patologia , Meningioma/complicações , Meningioma/patologia , Microcirurgia/métodos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
18.
Pediatr Neurosurg ; 54(6): 405-410, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31597144

RESUMO

BACKGROUND/AIMS: Multiple lower cranial nerve paresis occurring after placement of a fourth ventricle shunt for an isolated fourth ventricle is an uncommon complication in the postoperative period. Of the various etiologies, direct brain stem injury by the catheter and rapid decompression of the fourth ventricle by the shunt causing traction on the cranial nerves have been reported in the literature. METHODS: We report the case of a 9-year-old girl with an isolated fourth ventricle who developed bilateral facial and multiple lower cranial nerve paresis with bilateral internuclear ophthalmoplegia a month after placement of a ventriculoperitoneal shunt. The postprocedure MRI showed a well-decompressed fourth ventricle with catheter tip located along the long axis of the fourth ventricle. RESULTS: She was managed non-operatively. She improved gradually in her cranial nerve paresis over the next 3 months and completely recovered at 9 months. CONCLUSION: We believe the reversible multiple cranial nerve neuropathies resulted from acute decompression of the fourth ventricle following the shunt insertion. A gradual decompression of the dilated fourth ventricle by an aqueductal stent or a high-pressure shunting system could prevent this potential complication.


Assuntos
Doenças dos Nervos Cranianos/etiologia , Quarto Ventrículo/cirurgia , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Malformação de Arnold-Chiari , Cateteres de Demora/efeitos adversos , Criança , Tratamento Conservador , Feminino , Quarto Ventrículo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Transtornos da Motilidade Ocular/etiologia , Espinha Bífida Oculta
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...