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1.
J Stroke Cerebrovasc Dis ; 28(9): e132-e134, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239223

RESUMO

Intravascular lymphomatosis (IVL) is a rare subtype of large B-cell lymphoma that follows an aggressive course with rapidly progressive neurological involvement and potentially fatal outcome.1 We report on a 64-year-old man with progressive myelopathy at T6-T7 and recurrent cerebral infarctions. This case is illustrative of the clinical course that is seen in IVL. It aims to present a timeline of imaging findings that demonstrate the progression of disease and characteristic pathology findings. We emphasize the importance of IVL on the differential diagnosis of spinal cord infarction.


Assuntos
Isquemia Encefálica/etiologia , Infarto/etiologia , Linfoma de Células B/complicações , Medula Espinal/irrigação sanguínea , Acidente Vascular Cerebral/etiologia , Neoplasias Vasculares/complicações , Biópsia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/patologia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Progressão da Doença , Evolução Fatal , Humanos , Infarto/diagnóstico por imagem , Infarto/patologia , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologia
2.
J Stroke Cerebrovasc Dis ; 28(6): e66-e67, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30930242

RESUMO

Fibrocartilaginous embolism (FCE) is an uncommon cause of spinal cord infarction often misdiagnosed as transverse myelitis. The mechanism of ischemia is suspected to be due to retrograde embolization of nucleus pulposus material originating from Schmorl's nodes to the spinal vessels following acute disk herniation. We describe the clinical and imaging findings of FCE in 3 healthy young women with history of trivial spinal cord trauma, and recommend that FCE should be considered in the differential diagnosis of acute myelopathy.


Assuntos
Doenças das Cartilagens/complicações , Embolia/complicações , Infarto/etiologia , Extremidade Inferior/inervação , Isquemia do Cordão Espinal/etiologia , Medula Espinal/irrigação sanguínea , Extremidade Superior/inervação , Adolescente , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/terapia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Embolia/diagnóstico por imagem , Embolia/terapia , Feminino , Humanos , Infarto/diagnóstico por imagem , Infarto/fisiopatologia , Infarto/terapia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/fisiopatologia , Isquemia do Cordão Espinal/terapia , Resultado do Tratamento , Adulto Jovem
3.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015244

RESUMO

Diabetic muscle infarction is an unusual condition with distinctive clinical characteristics seen in patients with prolonged and uncontrolled diabetes. Clinical findings and imaging study are unique and challenging. Patients usually present with acute unilateral severe muscular pain and swelling, particularly in the lower extremities. The presentation is difficult to distinguish from other common conditions such as deep venous thrombosis and infectious myositis. However, early recognition of the clinical presentation and appropriate imaging selection can lead to the diagnosis and avoid unnecessary muscle biopsy. Here, we report a case of diabetic muscle infarction in a patient with poorly controlled type 1 diabetes who had a good clinical response after an early detection and appropriate treatment.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Infarto/patologia , Músculo Esquelético/patologia , Analgésicos Opioides/uso terapêutico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Infarto/diagnóstico por imagem , Infarto/etiologia , Insulina/administração & dosagem , Insulina/uso terapêutico , Imagem por Ressonância Magnética/métodos , Músculo Esquelético/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Tramadol/administração & dosagem , Tramadol/uso terapêutico , Resultado do Tratamento , Ultrassonografia/métodos , Adulto Jovem
4.
J Emerg Med ; 56(4): 413-416, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30824267

RESUMO

BACKGROUND: Acute infarctions of the spinal cord are rare events characterized by sudden paralysis or sensory deficits below the level of injury. Etiologies include spinal cord trauma, vascular injury, arterial dissection, thromboembolic disease, chronic inflammatory conditions, or mass effect on the spinal cord. CASE REPORT: A 63-year-old male presented to the emergency department with sudden-onset bilateral leg numbness and weakness. His physical examination was notable for decreased light touch and temperature sensation and bilateral lower-extremity paresis. Initial magnetic resonance imaging (MRI) of his spine did not show cord injuries. Computed tomography angiography of his chest, abdomen, and pelvis demonstrated a 7.5-cm non-ruptured infrarenal abdominal aortic aneurysm (AAA) extending into bilateral iliac arteries. The patient was diagnosed with clinical spinal cord infarction secondary to a thromboembolic event from his AAA. A repeat MRI 15 h later showed spinal cord infarction from T8 down to the conus. He received an endovascular aortic repair and was ultimately discharged to rehabilitation with slightly improved lower-extremity strength. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Atraumatic cord syndrome is exceedingly rare and is associated with dissection or complication of aortic aneurysm repair. There are very few reported cases of thrombotic events leading to ischemic cord syndrome. When presented with a patient with symptoms consistent with cord syndrome in the absence of trauma or mass effect on the spinal cord, providers should work up for vascular etiology.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Infarto/etiologia , Paralisia/etiologia , Isquemia do Cordão Espinal/etiologia , Serviço Hospitalar de Emergência/organização & administração , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Medula Espinal/irrigação sanguínea , Tomografia Computadorizada por Raios X/métodos
5.
Rinsho Ketsueki ; 60(2): 106-111, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30842376

RESUMO

A 64-year-old man presented to the emergency department with sudden-onset upper abdominal pain and pain in the left chest area. His platelet count was 121.7×104/µl. Computed tomography (CT) showed bilateral adrenal swelling and inflammation of the adjacent tissue. Diffusion-weighted magnetic resonance imaging (MRI) showed hyperintensity in the bilateral adrenal glands. The patient was diagnosed with bilateral adrenal infarction. A bone marrow biopsy yielded a diagnosis of essential thrombocythemia, and a positive JAK2 V617F mutation was detected. He presented with recurrent adrenal infarction and developed aortic mural thrombosis and splenic infarction. We administered aspirin and performed cytoreductive therapy with hydroxyurea and anagrelide; however, the patient then went into heart failure resulting from coronary artery stenosis. We then added prasugrel to the list of medicines administered to manage his condition. Bilateral adrenal infarction is a very rare thrombotic event of essential thrombocythemia. CT and MRI were useful for making the diagnosis; however, we also had to rule out acute coronary syndrome or intestinal ischemia. Our patient presented with strong thrombotic diathesis, which prompted us to use dual antiplatelet therapy; however, further studies are needed to confirm the efficacy and safety of this treatment.


Assuntos
Doenças das Glândulas Suprarrenais/diagnóstico , Infarto/diagnóstico , Trombocitemia Essencial/diagnóstico , Doenças das Glândulas Suprarrenais/etiologia , Glândulas Suprarrenais/patologia , Idoso , Aspirina , Humanos , Hidroxiureia , Infarto/etiologia , Masculino , Trombocitemia Essencial/complicações , Trombose/etiologia
6.
BMJ Case Rep ; 12(2)2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30733248

RESUMO

Cushing's syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing's syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing's syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing's syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing's. A diagnosis of endogenous Cushing's syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.


Assuntos
Doenças da Aorta/diagnóstico por imagem , Síndrome de Cushing/diagnóstico , Trombofilia/diagnóstico , Trombose/diagnóstico por imagem , Hormônio Adrenocorticotrópico/sangue , Adulto , Anticoagulantes/uso terapêutico , Doenças da Aorta/etiologia , Artéria Celíaca/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Síndrome de Cushing/complicações , Síndrome de Cushing/tratamento farmacológico , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Hidrocortisona/sangue , Hidrocortisona/urina , Infarto/diagnóstico por imagem , Infarto/etiologia , Cetoconazol/uso terapêutico , Nefropatias/diagnóstico por imagem , Nefropatias/etiologia , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Trombose/tratamento farmacológico , Trombose/etiologia
7.
Ann Vasc Surg ; 58: 45-53.e1, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30738151

RESUMO

BACKGROUND: Fenestrated endovascular aortic repair (FEVAR) of complex aneurysm can require the coverage of polar renal artery. The aim of this study was to investigate the impact of the procedure on postoperative outcomes in patients with juxtarenal or thoracoabdominal aortic aneurysms. METHODS: Patients who had FEVAR for juxtarenal or type IV thoracoabdominal aortic aneurysm were retrospectively included between January 2010 and October 2017. The estimated glomerular filtration rate (eGFR) was recorded before and at 1 day, 7 days after surgery, and at the last follow-up. The occurrence of renal infarct was analyzed on the injected computed tomography scan images. RESULTS: Forty-three patients deemed at high-risk for open repair underwent FEVAR; 10 patients (23.3%) had polar renal artery coverage and were compared to patients without polar renal artery. The eGFR did not differ between the groups at 1 day and 7 days after FEVAR (69 vs 61.6 mL/mn/1.73 m2, P = 0.8708 and 68.4 mL/mn/1.73 m2 vs 68, P = 0.9440, respectively). For a median follow-up of 233 days, the eGFR at the latest follow-up was 38 mL/mn/1.73 m2 (21.8-56.3) in patients who had polar renal artery covered and 57 mL/mn/1.73 m2 (46.5-76) in patients without polar renal artery (P = 0.0748). Patients who had polar renal artery had a higher rate of postoperative kidney renal infarct (60% vs 21.2%, P = 0.0441). The proportion of vascular complications did not differ (30% vs 30.3%, P = 0.9999). No endoleak related to polar renal artery coverage was observed. The 30-day postoperative mortality was 4.7%. CONCLUSIONS: Polar renal artery coverage during FEVAR is not associated with critical renal and vascular short-term outcomes but could impact long-term renal function.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Rim/irrigação sanguínea , Artéria Renal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Taxa de Filtração Glomerular , Humanos , Infarto/diagnóstico por imagem , Infarto/etiologia , Infarto/fisiopatologia , Masculino , Desenho de Prótese , Artéria Renal/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
8.
J Stroke Cerebrovasc Dis ; 28(5): 1173-1177, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30665837

RESUMO

BACKGROUND AND PURPOSE: Patients with ischemic stroke of cardioembolic origin are at risk of visceral (renal or splenic) infarction. We hypothesized that serum troponin level at time of ischemic stroke would be associated with presence of visceral infarction. METHODS: Data were abstracted from a single center prospective stroke database over 18 months and included all patients with ischemic stroke who underwent contrast-enhanced computerized tomography (CT) of the abdomen and pelvis for clinical purposes within 1 year of stroke. The primary predictor was troponin concentration ≥.1ng/mL. The primary outcome was visceral infarct (renal and/or splenic) on CT abdomen and pelvis. Univariate and multivariable logistic regression models were used to estimate the odds ratio and 95% confidence intervals (OR, 95% CI) for the association of troponin with visceral infarction. RESULTS: Of 1233 patients with ischemic stroke, 259 patients had a qualifying visceral CT. Serum troponin level on admission was measured in 237 of 259 patients (93.3%) and 41 of 237 (17.3%) had positive troponin. There were 25 patients with visceral infarcts: 16 renal, 7 splenic, and 2 both. In univariate models, patients with a positive troponin level (versus negative) were more likely to have visceral infarcts (39.1% [9/23] versus 15.0% [32/214], P = .008) and this association persisted in multivariable models (adjusted OR 3.83; 95% CI 1.42-10.31, P = .006). CONCLUSIONS: In ischemic stroke patients, elevated serum troponin levels may help identify patients with visceral infarcts. This suggests that troponin in the acute stroke setting is a biomarker of embolic risk. Larger studies with systematic visceral imaging are needed to confirm our findings.


Assuntos
Isquemia Encefálica/sangue , Infarto/sangue , Rim/irrigação sanguínea , Infarto do Baço/sangue , Acidente Vascular Cerebral/sangue , Troponina I/sangue , Idoso , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Bases de Dados Factuais , Feminino , Humanos , Infarto/diagnóstico por imagem , Infarto/etiologia , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios X , Regulação para Cima
9.
Am J Case Rep ; 19: 1463-1466, 2018 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-30531677

RESUMO

BACKGROUND This is a case report of a male patient who presented with a history of right flank pain based on renal infarction. Initially the symptoms were misdiagnosed as acute pyelonephritis. CASE REPORT A 47-year-old male with a history of familial hypercholesterolemia and cerebral infarction presented at the Emergency Department with a 3-day history of acute right-sided flank pain. Physical examination revealed hypertension, subfebrile temperature, and costovertebral angle tenderness. Blood tests were unremarkable except for renal impairment, a high C-reactive protein level of 215 mg/L (normal <8 mg/dL) and an elevated lactate dehydrogenase (LDH) of 1289 U/L (normal <248 U/L). Renal ultrasonography was normal. He was admitted with a presumed diagnosis of acute pyelonephritis and treated accordingly. However, 2 days later, we rejected this diagnosis as the urine culture was sterile. Based on the acute onset of symptoms and the initial high LDH, renal infarction was suspected. A computed tomography scan confirmed right-sided partial renal and splenic infarctions likely due to spreading emboli from atherosclerosis of the descending aorta. CONCLUSIONS Acute renal infarction is often missed or delayed as a diagnosis because patients often present with flank pain that can resemble more frequently encountered conditions such as pyelonephritis and nephrolithiasis. Renal infarction should be considered in cases with acute flank pain accompanied by (low-grade) fever, high LDH level, increased C-reactive protein level, hypertension, and renal impairment, especially in those patients with an increased risk of thromboembolism.


Assuntos
Infarto Cerebral/complicações , Hiperlipoproteinemia Tipo II/complicações , Infarto/diagnóstico , Rim/irrigação sanguínea , Infarto do Baço/diagnóstico , Erros de Diagnóstico , Dor no Flanco/etiologia , Humanos , Infarto/etiologia , Masculino , Pessoa de Meia-Idade , Pielonefrite/diagnóstico , Infarto do Baço/etiologia , Tomografia Computadorizada por Raios X
10.
Medicine (Baltimore) ; 97(35): e12181, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30170466

RESUMO

RATIONALE: Spinal cord infarction is rarely caused by hypercoagulable states. Polycythemia vera (PV) is a myeloproliferative neoplasm that can contribute to thrombotic events due to increased blood viscosity. We report a case of spinal cord infarction due to extensive aortic thrombosis caused by PV. PATIENT CONCERNS: A 56-year-old man presented with acute paraplegia and urinary retention during heavy physical exertion. DIAGNOSES: Imaging studies revealed spinal cord infarction at the T9 to T12 levels and aortoiliac occlusive disease. PV was diagnosed during workup for elevated hemoglobin level INTERVENTIONS:: The patient received intravenous hydration and anticoagulation for spinal cord infarction. PV was managed with phlebotomy and hydroxyurea. Courses of inpatient and outpatient rehabilitation programs were also given. OUTCOMES: The patient became urinary catheter-free 5 months after disease onset, and was able to walk with walker. The American Spinal Injury Association Impairment scale also improved from C at diagnosis to D during last follow-up. LESSONS: Etiologic workup is important for patients with spinal cord infarction to direct specific treatment strategies. Physical exertion may act as a trigger for infarction in patients at risk for thrombotic events, and monitoring of neurologic status during and after periods of exercise is warranted.


Assuntos
Doenças da Aorta/complicações , Arteriopatias Oclusivas/complicações , Artéria Ilíaca/fisiopatologia , Infarto/etiologia , Esforço Físico/fisiologia , Policitemia Vera/complicações , Medula Espinal/irrigação sanguínea , Aorta/fisiopatologia , Doenças da Aorta/fisiopatologia , Arteriopatias Oclusivas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Policitemia Vera/fisiopatologia
11.
J Stroke Cerebrovasc Dis ; 27(10): 2810-2821, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30093205

RESUMO

INTRODUCTION: Spinal cord infarction is an uncommon disease varying in its clinical presentation. This study describes the clinical and radiological presentation of spinal cord infarcts in 17 consecutive patients. MATERIAL AND METHODS: Clinical and MR imaging data of 17 patients were reviewed. Inclusion criteria were acute or subacute presentation (peak within 72 hours) and MRI showing typical signal changes on T2WI compatible with spinal cord infarct. Exclusion criteria were clinical or MRI findings suggesting other etiologies. RESULTS: Clinical presentation included dissociative anesthesia, weakness of limbs, back or neck pain, and autonomic symptoms with symptom onset to peak time ranging from few minutes to 48 hours in patients with anterior spinal artery infarct (n = 16), and weakness and sensory loss in ipsilateral upper limb in patient with posterior spinal artery infarct (n = 1). One patient presented with "man-in-the-barrel syndrome (MIB)." MRI findings in anterior spinal artery infarcts included pencillike hyperintensities on T2 sagittal (n = 16, 100%) and "owl eye" appearance on T2 axial (n = 6, 37.5%) images. Diffusion restriction was noted in 8 cases and enhancement was noted in 2 cases. The posterior spinal artery infarct showed T2 hyperintensity in left posterior paramedian triangular distribution in cervical cord (C2-C7). Follow-up was available for 9 patients (period ranging from 15-41 months). Four patients had a favorable outcome who could walk independently, 1 patient could walk with support, and 2 patients were wheelchair bound. Two patients died. CONCLUSION: Spinal cord infarction is a rare but important cause of acute spinal syndrome. Typical distribution and appropriate imaging can help in timely diagnosis.


Assuntos
Imagem de Difusão por Ressonância Magnética , Infarto/diagnóstico por imagem , Isquemia do Cordão Espinal/diagnóstico por imagem , Medula Espinal/irrigação sanguínea , Medula Espinal/diagnóstico por imagem , Caminhada , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Deambulação com Auxílio , Avaliação da Deficiência , Feminino , Humanos , Infarto/etiologia , Infarto/fisiopatologia , Infarto/terapia , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Medula Espinal/fisiopatologia , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/fisiopatologia , Isquemia do Cordão Espinal/terapia , Fatores de Tempo , Resultado do Tratamento , Cadeiras de Rodas , Adulto Jovem
12.
Medicine (Baltimore) ; 97(27): e11409, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29979439

RESUMO

RATIONALE: Recurrent ovarian hemorrhage resulting in ovarian infarction may lead to a life-threatening intraperitoneal hemorrhage in women with bleeding disorders such as aplastic anemia (AA). Moreover, it is seen as ovarian tumors in the diagnosis. The authors report a clinical case with the aim of sharing our experiences and exploring the ways to diagnose, treat, and avoid ovarian hemorrhage. PATIENTS CONCERNS: A 48-year-old woman with AA had suffered from a serious abdominal distension for the past 24 hours, which had occurred intermittently for the past 15 years. DIAGNOSES: Pelvic ultrasonography had revealed a large anechoic area of fluid in the abdomen without any sign of primary hemorrhage each time she had experienced an episode over the past 15 years. The volume of pelvic fluid had decreased after anti-inflammatory and hemostatic treatment. At presentation, the abdominal computed tomography suggested an ovarian tumor with a massive hemoperitoneum (a right ovarian mass, 5.7 × 5.0 × 5.0 cm in size, with a large amount of abdominal and pelvic fluid). INTERVENTIONS: Surgery was performed with respect to the bilateral uterine adnexa. On laparotomy, there were blood clots of approximately 6.0 × 6.0 × 5.0 cm surrounding the right ovary and approximately 400 mL bloody fluid in the abdomen. OUTCOMES: The patient recovered without incident and was transferred to a hematology ward 1 week later. Postoperative pathology confirmed hemorrhagic infarction of the right ovary. LESSONS: In conclusion, continuous ovarian bleeding can cause ovarian infarction to women with bleeding disorders and it may be confused with an ovarian tumor. Moreover, an earlier ovariectomy procedure under stable conditions or treatment with gonadotropin-releasing hormone that prevent bleeding via ovulation suppression may be effective for such cases.


Assuntos
Anemia Aplástica/complicações , Hemorragia/etiologia , Infarto/diagnóstico , Ovário/patologia , Diagnóstico Diferencial , Feminino , Hemoperitônio/etiologia , Hemorragia/diagnóstico , Humanos , Infarto/etiologia , Laparotomia/métodos , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Ovariectomia/métodos , Tomografia Computadorizada por Raios X , Ultrassonografia
13.
World Neurosurg ; 117: 326-329, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29935323

RESUMO

BACKGROUND: Orbital infarction syndrome (OIS) is a rare entity defined as ischemia of all intraorbital and intraoccular structures including the optic nerve, extraocular muscles, and orbital fat. This entity is rare due to rich anastomotic orbital vascularization from both the internal carotid artery and external carotid artery. We report a case of a patient who suffered emboli to previously nonaffected territories to the ophthalmic artery and external carotid artery, which resulted in orbital infarction syndrome, and describe techniques to avoid such complications. CASE DESCRIPTION: A 66-year-old male presented to our institution with an acute ischemic stroke secondary to occlusion of the internal carotid artery terminus and M1 segment. The vessel was revascularized after 1 pass using a stent retriever. Postoperative angiography demonstrated sluggish flow in the distal right ophthalmic artery, as well as occlusion of the distal external carotid artery. Twenty-four hours following the procedure, the patient was noted to have complete ophthalmoplegia of the right eye, proptosis, and conjunctival chemosis. Computed tomography angiography demonstrated persistent occlusion of the distal right ophthalmic artery and external carotid artery. The right optic nerve was swollen, as were all extraocular muscles. A final diagnosis of orbital infarction syndrome was made given the clinical presentation, imaging findings, and occlusion of all vascular supply to the orbit on both conventional angiography and 24-hour computed tomography angiography. CONCLUSIONS: OIS is a rare entity that has not been previously described as a complication of mechanical thrombectomy for acute ischemic stroke. OIS should be considered when patients present with blindness, orbital pain, and total ophthalmoplegia post thrombectomy.


Assuntos
Exoftalmia/etiologia , Infarto/etiologia , Trombólise Mecânica , Oftalmoplegia/etiologia , Complicações Pós-Operatórias , Tromboembolia/etiologia , Idoso , Isquemia Encefálica/etiologia , Isquemia Encefálica/cirurgia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Exoftalmia/diagnóstico , Humanos , Infarto/diagnóstico , Masculino , Artéria Oftálmica/diagnóstico por imagem , Oftalmoplegia/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Síndrome , Tromboembolia/diagnóstico
14.
BMJ Case Rep ; 20182018 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-29866678

RESUMO

A 43-year-old woman with no known cardiovascular risk factors was admitted with a second episode of ischaemic stroke. She was not a known case of connective tissue disease like systemic lupus erythematosus or antiphospholipid syndrome (APS). During the current episode, she was found to have markedly deranged coagulation parameters and laboratory evidence of microangiopathic haemolysis, but no evidence of sepsis or active bleeding. Further investigation revealed multiple organ infarcts. A diagnosis of probable catastrophic APS was made and she improved dramatically with a combination of plasmapheresis, corticosteroids and therapeutic anticoagulation. Serological markers of APS were negative. Her hospital course was complicated by Libman Sacks endocarditis with significant aortic regurgitation that improved markedly with anticoagulation obviating the need for high-risk cardiac surgery. At discharge, she was stable and well and was advised long-term anticoagulation and rheumatology follow-up.


Assuntos
Síndrome Antifosfolipídica/diagnóstico , Embolia/diagnóstico por imagem , Endocardite/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Corticosteroides/uso terapêutico , Adulto , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/terapia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Encéfalo/diagnóstico por imagem , Doença Catastrófica , Intervenção Médica Precoce , Embolia/etiologia , Embolia/terapia , Endocardite/etiologia , Endocardite/terapia , Feminino , Humanos , Infarto/diagnóstico por imagem , Infarto/etiologia , Nefropatias/diagnóstico por imagem , Nefropatias/etiologia , Plasmaferese , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Recidiva , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Tomografia Computadorizada por Raios X
15.
World Neurosurg ; 117: 80-83, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29886303

RESUMO

BACKGROUND: Delayed infarction in the lenticulostriate artery (LSA) area after insular glioma resection is not common, and its pathophysiology remains unknown. CASE DESCRIPTION: A 32-year-old right-handed man with a giant insular low-grade glioma with frontal and temporal extension underwent awake craniotomy with an intentional staged surgery strategy. Preoperative radiologic images demonstrated a diagonally elevated middle cerebral artery (MCA) by the temporal tumor and a significantly compressed striatum. With intraoperative subcortical direct electrical stimulation, the resection was finalized in the temporal part of the tumor due to the semantic paraphasia induced in the temporal stem, fatigue, and loss of concentration. The immediate postoperative clinical course was uneventful. However, on postoperative day 20, he suddenly experienced right hemiparesis. Repeated images revealed infarction in the LSA area. The previously compressed striatum was then relieved and relocated to its original position in just 20 days, and the M1 segment of the MCA was remarkably downward, in which the MCA resembled a hammock. Angiography confirmed the hammock-shaped MCA and significantly stretched LSA, suggesting the combination of freed striatum from the compression and loss of temporal structure by the tumor resection as the key mechanism of severe dislocation of the MCA and delayed ischemia. CONCLUSIONS: In a staged resection of giant insular glioma, attention should be paid to a possible severe dislocation of the MCA in a delayed postoperative period, which may lead to LSA stretching and delayed infarction.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/etiologia , Neoplasias Encefálicas/cirurgia , Doenças Arteriais Cerebrais/etiologia , Glioma/cirurgia , Infarto/etiologia , Complicações Pós-Operatórias , Adulto , Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Doenças Arteriais Cerebrais/diagnóstico por imagem , Glioma/diagnóstico por imagem , Humanos , Infarto/diagnóstico por imagem , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Fatores de Tempo
16.
Asian Cardiovasc Thorac Ann ; 26(5): 371-376, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29734831

RESUMO

Background Lung infarction is a rare complication of lung resection, developing mainly because of technical errors. In some cases, a specific reason cannot be identified. This study aimed to investigate the occurrence, characteristics, and outcome of this pathology in a series of patients. Methods The medical records of patients who underwent reoperation for lung infarction without an apparent cause (based on imaging, reoperation findings, and histopathology) after major lung resection at our institution from 2006 to 2015, were investigated. Results Seven patients were identified. The mean age was 62.2 years (range 51-75 years), and 5 were male. Copious dissection or adverse events during surgery were recorded in all but 2 cases. The main presenting symptom was unsettling frank hemoptysis (4 cases) with a variable time of onset of symptoms (4-164 h). All reoperations necessitated further lung resection (4 patients had a further lobectomy and 3 had a completion pneumonectomy). During reoperation, all vessels and bronchi were intact. No apparent cause of infarction could be identified according to the histopathology report. Morbidity after reoperation was atrial fibrillation in 3 cases and bronchopleural fistula in 2, one of which required a transsternal pneumonectomy and this was the only mortality. Length of stay ranged from 8 to 90 days. Conclusion Ipsilateral lung infarction after lobectomy is a rare complication and the reason may not be identifiable. Treatment usually requires reoperation. Extensive manipulation or adverse events during surgery could induce this rare complication.


Assuntos
Infarto/etiologia , Pulmão/irrigação sanguínea , Pneumonectomia/efeitos adversos , Idoso , Biópsia , Bases de Dados Factuais , Inglaterra , Feminino , Hemoptise/etiologia , Humanos , Infarto/diagnóstico por imagem , Infarto/mortalidade , Infarto/cirurgia , Tempo de Internação , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/mortalidade , Hemorragia Pós-Operatória/etiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Chirurgia (Bucur) ; 113(2): 266-269, 2018 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29733021

RESUMO

Meckel's diverticulum is a congenital anomaly which can become complicated or remain asymptomatic throughout life. During pregnancy, however, diverticulum infection could become a serious complication. Diverticulum necrosis and perforation are complications that increase morbidity in pregnancy, both maternal and fetal. The rarity of the condition and the maternal physiological changes in pregnancy make the diagnosis difficult. We present the case of a Meckel's diverticulum gangrene in third trimester pregnancy, atypical case due to advanced pregnancy where the risk-benefit balance was carefully evaluated on one hand because of the risk of infection associated with expectant management and on the other hand the risk and complications of iatrogenic preterm premature birth. The outcome was favorable for both mother and newborn.


Assuntos
Infarto/etiologia , Infarto/cirurgia , Divertículo Ileal/complicações , Divertículo Ileal/cirurgia , Complicações na Gravidez , Terceiro Trimestre da Gravidez , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia , Adulto , Cesárea , Feminino , Humanos , Infarto/diagnóstico por imagem , Divertículo Ileal/diagnóstico por imagem , Gravidez , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/etiologia , Resultado do Tratamento
19.
Clin Exp Rheumatol ; 36 Suppl 111(2): 174-175, 2018 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29745881
20.
Medicine (Baltimore) ; 97(11): e0111, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29538204

RESUMO

RATIONALE: Spinal cord infarction is one of the complications of epidural steroid injections (ESIs), but has only been reported in cervical vertebra by transforaminal injection and lumbar vertebra by transforaminal injection; and up to now, there is no reporting about spinal cord infarction caused by caudal injection. Here, we report a case. PATIENT CONCERNS: A 52-year-old man was admitted to our hospital. He was diagnosed as lumbar disc herniation in other hospital, and the patient suffered bilateral lower limb motor and sensory disorders after administration of caudal ESI. DIAGNOSIS: Spinal cord infarction, tethered cord syndrome (TCS), and acute myelitis. INTERVENTIONS: High doses of hormones, gamma globulin impact therapy, and rehabilitation were performed. OUTCOMES: The patient's condition was stable when he discharged from the hospital after 20 days of treatment. Discharge status: grade 0 of bilateral lower limbs muscle strength, inability to urinate and defecate by himself, slightly decreased touch, and needling sensation below the umbilical plane. LESSONS: When patients are diagnosed with lumbar disc herniation and need to receive invasive treatments, magnetic resonance imaging (MRI) should be performed before the invasive procedures.


Assuntos
Glucocorticoides/administração & dosagem , Infarto , Reação no Local da Injeção , Injeções Epidurais/efeitos adversos , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Medula Espinal , Humanos , Fatores Imunológicos/administração & dosagem , Infarto/diagnóstico , Infarto/etiologia , Infarto/fisiopatologia , Infarto/terapia , Reação no Local da Injeção/diagnóstico , Reação no Local da Injeção/fisiopatologia , Reação no Local da Injeção/terapia , Injeções Epidurais/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/métodos , Medula Espinal/irrigação sanguínea , Medula Espinal/patologia , Resultado do Tratamento , gama-Globulinas/administração & dosagem
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