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1.
World J Emerg Surg ; 15(1): 43, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32615987

RESUMO

BACKGROUND: Since its first documentation, a novel coronavirus (SARS-CoV-2) infection has emerged worldwide, with the consequent declaration of a pandemic disease (COVID-19). Severe forms of acute respiratory failure can develop. In addition, SARS-CoV-2 may affect organs other than the lung, such as the liver, with frequent onset of late cholestasis. We here report the histological findings of a COVID-19 patient, affected by a tardive complication of acute ischemic and gangrenous cholecystitis with a perforated and relaxed gallbladder needing urgent surgery. CASE PRESENTATION: A 59-year-old Caucasian male, affected by acute respiratory failure secondary to SARS-CoV-2 infection was admitted to our intensive care unit (ICU). Due to the severity of the disease, invasive mechanical ventilation was instituted and SARS-CoV-2 treatment (azithromycin 250 mg once-daily and hydroxychloroquine 200 mg trice-daily) started. Enoxaparin 8000 IU twice-daily was also administered subcutaneously. At day 8 of ICU admission, the clinical condition improved and patient was extubated. At day 32, patient revealed abdominal pain without signs of peritonism at examination, with increased inflammatory and cholestasis indexes at blood tests. At a first abdominal CT scan, perihepatic effusion and a relaxed gallbladder with dense content were detected. The surgeon decided to wait and see the evolution of clinical conditions. The day after, conditions further worsened and a laparotomic cholecystectomy was performed. A relaxed and perforated ischemic gangrenous gallbladder, with a local tissue inflammation and perihepatic fluid, was intraoperatively met. The gallbladder and a sample of omentum, adherent to the gallbladder, were also sent for histological examination. Hematoxylin-eosin-stained slides display inflammatory infiltration and endoluminal obliteration of vessels, with wall breakthrough, hemorrhagic infarction, and nerve hypertrophy of the gallbladder. The mucosa of the gallbladder appears also atrophic. Omentum vessels also appear largely thrombosed. Immunohistochemistry demonstrates an endothelial overexpression of medium-size vessels (anti-CD31), while not in micro-vessels, with a remarkable activity of macrophages (anti-CD68) and T helper lymphocytes (anti-CD4) against gallbladder vessels. All these findings define a histological diagnosis of vasculitis of the gallbladder. CONCLUSIONS: Ischemic gangrenous cholecystitis can be a tardive complication of COVID-19, and it is characterized by a dysregulated host inflammatory response and thrombosis of medium-size vessels.


Assuntos
Colecistectomia/métodos , Colecistite , Infecções por Coronavirus , Vesícula Biliar , Gangrena , Omento , Pandemias , Pneumonia Viral , Perfuração Espontânea , Betacoronavirus/isolamento & purificação , Colecistite/etiologia , Colecistite/patologia , Colecistite/fisiopatologia , Colecistite/cirurgia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Vesícula Biliar/irrigação sanguínea , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Gangrena/etiologia , Gangrena/patologia , Humanos , Imuno-Histoquímica , Infarto/etiologia , Infarto/patologia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Omento/irrigação sanguínea , Omento/patologia , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Perfuração Espontânea/diagnóstico , Perfuração Espontânea/etiologia , Perfuração Espontânea/fisiopatologia , Perfuração Espontânea/cirurgia , Trombose/etiologia , Trombose/patologia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(29): e21277, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702918

RESUMO

To report the clinical characteristics and retinal abnormalities associated with orbital infarction syndrome after cerebral aneurysm clipping surgery.In this retrospective case series, we evaluated 4 cases of orbital infarction syndrome using fluorescein angiography, optical coherence tomography, and computed tomography images from January 2011 to May 2014. The medical records of these patients including age, sex, laterality of the eyes, visual acuity, intraocular pressure, duration of the operation, location of the aneurysms, and surgical method with the type of approach used to reach the aneurysmal lesions were evaluated.Aneurysms were located in either the anterior or the posterior communicating artery. Two patients had subarachnoid hemorrhage arising from a ruptured aneurysm, whereas 2 other patients had unruptured aneurysms. Clipping was performed by 3 different surgeons using the pterional craniotomy. The mean time interval from aneurysmal clipping to awareness of vision loss was 10.75 ±â€Š13.8 days. In all patients, optic atrophy and irreversible deterioration of visual acuity ensued. Retinal edema, retinal vascular abnormality, or choroidal hypoperfusion was identified in these patients.Orbital infarction syndrome is a rare but devastating complication of brain aneurysm clipping surgery. The associated retinal ischemia is not only due to the involvement of the retinal vessels, but also the choroidal circulation.


Assuntos
Infarto/etiologia , Aneurisma Intracraniano/cirurgia , Órbita/irrigação sanguínea , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome , Tomografia de Coerência Óptica , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia
3.
Hipertens. riesgo vasc ; 37(2): 86-90, abr.-jun. 2020. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-189197

RESUMO

El infarto renal bilateral como complicación de la displasia fibromuscular (DFM) es extremadamente raro, y hasta el momento se han informado pocos casos. Reportamos el caso de un hombre de 44 años que presentó dolor abdominal e hipertensión severa. La tomografía computarizada de abdomen reveló infarto renal bilateral, y una angiografía renal confirmó la estenosis bilateral e irregular debida a DFM, en ausencia de vasculitis sistémica y otros factores de riesgo para eventos tromboembólicos. Por lo tanto, se realizó una angioplastia con balón para obtener una buena permeabilidad del vaso y mejorar la permeabilidad en el seguimiento a largo plazo. Después del tratamiento endovascular la presión arterial mejoró notablemente, manteniendo este resultado a los 3 meses de seguimiento. Nuestro caso destaca la importancia de reconocer el infarto renal como una presentación inicial de la DFM


Bilateral renal infarction complicating Fibromuscular Dysplasia (FMD) is extremely rare and has so far been reported only in a handful of cases. We report a 44-year-old man who presented with complaints of abdominal pain and severe hypertension. Computed tomography of the abdomen revealed bilateral renal infarction and a renal angiography confirmed the bilateral and irregular stenosis due to FMD, in the absence of systemic vasculitis and other risk factors for thromboembolic events. Therefore, angioplasty with balloon was performed in order to obtain a good vessel patency and to improve patency in the long term follow-up. After the endovascular treatment the blood pressure improved markedly, maintaining this result at 3-months follow-up. Our case highlight the importance of recognizing renal infarction as an initial presentation of FMD


Assuntos
Humanos , Masculino , Adulto , Infarto/etiologia , Displasia Fibromuscular/complicações , Hipertensão Renovascular/etiologia , Obstrução da Artéria Renal/etiologia , Infarto/diagnóstico , Artéria Renal/diagnóstico por imagem , Infarto/diagnóstico por imagem , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Radiografia Torácica , Anti-Hipertensivos/uso terapêutico , Valsartana/uso terapêutico , Angiografia
4.
Am J Kidney Dis ; 76(3): 431-435, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32479921

RESUMO

Coronavirus disease 2019 (COVID-19) is a contagious life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent findings indicate an increased risk for acute kidney injury during COVID-19 infection. The pathophysiologic mechanisms leading to acute kidney injury in COVID-19 infection are unclear but may include direct cytopathic effects of the virus on kidney tubular and endothelial cells, indirect damage caused by virus-induced cytokine release, and kidney hypoperfusion due to a restrictive fluid strategy. In this report of 2 cases, we propose an additional pathophysiologic mechanism. We describe 2 cases in which patients with COVID-19 infection developed a decrease in kidney function due to kidney infarction. These patients did not have atrial fibrillation. One of these patients was treated with therapeutic doses of low-molecular-weight heparin, after which no further deterioration in kidney function was observed. Our findings implicate that the differential diagnosis of acute kidney injury in COVID-19-infected patients should include kidney infarction, which may have important preventive and therapeutic implications.


Assuntos
Lesão Renal Aguda/diagnóstico por imagem , Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Infarto/diagnóstico por imagem , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Lesão Renal Aguda/tratamento farmacológico , Lesão Renal Aguda/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Diagnóstico Diferencial , Heparina de Baixo Peso Molecular/farmacologia , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Infarto/tratamento farmacológico , Infarto/etiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico
5.
Middle East Afr J Ophthalmol ; 27(1): 65-67, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549729

RESUMO

Repeated vaso-occlusive crises (VOCs) are the hallmark of sickle cell disease (SCD). These repeated crises can lead to bone infarcts, necrosis, and, over time, degenerative changes in the bone marrow. Orbital complications in SCD patients are infrequent and usually present as orbital cellulitis. We report the appearance of orbital bone infarction intraoperatively in the case of an 18-year-old Saudi male patient who has been diagnosed with SCD and presented with severe headaches and generalized body aches. He was admitted with a case of SCD with acute VOC and started on the hospital sickle cell protocol. During the admission, the patient developed bilateral periorbital swelling and left inferior dystopia secondary to bilateral frontoparietal bone infarction, which was evident on the magnetic resonance imaging.


Assuntos
Anemia Falciforme/complicações , Osso Frontal/irrigação sanguínea , Infarto/diagnóstico , Celulite Orbitária/diagnóstico , Adolescente , Anemia Falciforme/diagnóstico , Diagnóstico Diferencial , Osso Frontal/diagnóstico por imagem , Humanos , Infarto/diagnóstico por imagem , Infarto/etiologia , Imagem por Ressonância Magnética , Masculino , Acuidade Visual/fisiologia
8.
Int Heart J ; 61(2): 400-403, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32173705

RESUMO

Takotsubo cardiomyopathy (TC) is a temporal dysfunction of the left ventricle (LV) due to psychological or physiological stress; however, it rarely causes LV thrombus. We report a case of a 49-year-old woman who developed LV thrombi due to TC despite anticoagulation therapy. The thrombi caused acute systemic infarction, with the most severe occlusion being in the right renal artery. The patient underwent percutaneous catheter aspiration thrombectomy of the right renal artery and her renal function recovered shortly after. The results of this case suggest that catheter aspiration thrombectomy is effective in the treatment of thromboembolism in TC.


Assuntos
Infarto/terapia , Rim/irrigação sanguínea , Cardiomiopatia de Takotsubo/complicações , Trombectomia , Tromboembolia/terapia , Feminino , Humanos , Infarto/etiologia , Pessoa de Meia-Idade , Tromboembolia/complicações , Tromboembolia/diagnóstico por imagem
9.
Ann Biol Clin (Paris) ; 78(2): 195-197, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32162605

RESUMO

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) is a rare paraneoplastic disorder due to an underlying plasma cell dyscrasia. The diagnosis of POEMS syndrome requires a chronic polyneuropathy and a monoclonal lambda plasma cell-proliferative disorder (mandatory criteria), and various systematic symptoms such as sclerotic bone lesions, Castleman's disease, organomegaly, endocrinopathy, skin changes, papilloedema and biological abnormalities such as elevated vascular endothelial growth factor (VEGF), thrombocytosis or polycythaemia. We describe an observation of a patient with recurrent thrombosis with thrombocytosis that, after excluding a myeloproliferative neoplasm, proved to be due to POEMS syndrome. This case is unusual compared to the foreground thrombotic symptomatology. POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) is a rare multi-systematic paraneoplastic disorder due to an underlying plasma cell disorder. The diagnosis of POEMS syndrome requires the presence of both mandatory criteria (a chronic polyneuropathy and a monoclonal plasma cell-proliferative disorder, always lambda restricted); at least one major (among sclerotic bone lesions, Castleman's disease, elevated VEGF (vascular endothelial growth factor)) and one minor criterion (among organomegaly, endocrinopathy, skin changes (haemangiomas, hypertrichosis, hyperpigmentation), papilloedema and thrombocytosis or polycythaemia. We describe an unusual observation of a young patient with recurrent thrombosis with thrombocytosis that, after excluding a myeloproliferative neoplasm, proved to be due to POEMS syndrome.


Assuntos
Síndrome POEMS/diagnóstico , Trombose/diagnóstico , Doenças das Glândulas Suprarrenais/diagnóstico , Doenças das Glândulas Suprarrenais/etiologia , Glândulas Suprarrenais/irrigação sanguínea , Adulto , Diagnóstico Diferencial , Humanos , Infarto/diagnóstico , Infarto/etiologia , Masculino , Síndrome POEMS/complicações , Trombose/etiologia
10.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 132-137, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31201253

RESUMO

OBJECTIVE: To correlate neuron-specific enolase (NSE) levels in cerebrospinal fluid (CSF) in neonate infants with symptomatic neonatal arterial ischaemic stroke (NAIS) with the arterial distribution of infarct, infarct volume and outcome. DESIGN: Prospective observational multicentre cohort. SETTING: Three paediatric university hospitals in Spain. SUBJECTS: Thirty-eight neonates with more than 35 weeks' gestational age between 2006 and 2016 were studied. They were diagnosed with NAIS by MRI. They underwent a lumbar puncture to measure CSF-NSE concentrations within 96 hours after the onset of symptoms. Sixty-seven neonates admitted with suspected infections served as controls. We used a classification based on the arterial distribution, and the lesions were segmented with ITK-Snap software to determine their volume. Neurodevelopment was assessed at 24 months using the Bayley-III, Gross Motor Function Classification System and Bimanual Fine Motor Function. RESULTS: CSF-NSE levels were higher in patients with symptomatic NAIS when compared with controls. Neonates with multifocal NAIS and with NAIS located in middle cerebral artery (MCA)-M1 arterial territory showed higher CSF-NSE levels when compared with cases with MCA-M2-M3-M4 territories (p<0.001). A significant correlation was found between CSF-NSE and relative infarction volume (rs=0.597; p<0.001). CSF-NSE values were higher in those infants with symptomatic NAIS with adverse outcome compared with infants with good development (p=0.020). Infants with CSF-NSE values above 55 ng/mL had an OR of adverse outcome of 6.48 (95% CI 1.48 to 28.33). CONCLUSIONS: CSF-NSE is a potential early prognostic biomarker after an NAIS due to the relation between volume, topology and neurodevelopment at 2 years of age.


Assuntos
Isquemia Encefálica/patologia , Infarto/patologia , Fosfopiruvato Hidratase/líquido cefalorraquidiano , Acidente Vascular Cerebral/patologia , Biomarcadores , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Feminino , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Infarto/diagnóstico por imagem , Infarto/etiologia , Imagem por Ressonância Magnética , Masculino , Estudos Prospectivos , Espanha , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem
11.
BMC Neurol ; 19(1): 321, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31830940

RESUMO

BACKGROUND: Spinal cord infarction (SCI) is rarely caused by vertebral artery dissection (VAD), which is an important cause of posterior circulation stroke in young and middle-aged patients. We report the case of a middle-aged patient without obvious risk factors for atherosclerosis who had SCI from right VAD. CASE PRESENTATION: An otherwise healthy 40-year-old man presented with acute right-sided body weakness. Six days earlier, he had experienced posterior neck pain without obvious inducement. Neurologic examination revealed a right Brown-Séquard syndrome. Magnetic resonance imaging (MRI) of the head was normal. Further, cervical spine MRI showed spinal cord infarction (SCI) on the right at the C1-C3 level. Three-dimensional high-resolution MRI (3D HR-MRI) volumetric isotropic turbo spin echo acquisition (VISTA) scan showed evidence of vertebral artery dissection (VAD). The patient was significantly relieved of symptoms and demonstrated negative imaging findings after therapy with anticoagulation (AC) and antiplatelets (AP) for 3 months. CONCLUSIONS: The possibility of vertebral artery dissection (VAD) should be considered in the case of young and middle-aged patients without obvious risk factors for atherosclerosis. Furthermore the VISTA black blood sequence plays an important role in the pathological diagnosis of vertebral artery stenosis. Early correct diagnosis and active therapy are crucial to the prognosis.


Assuntos
Síndrome de Brown-Séquard/etiologia , Infarto/etiologia , Medula Espinal/irrigação sanguínea , Dissecação da Artéria Vertebral/complicações , Adulto , Humanos , Masculino , Medula Espinal/patologia , Doenças da Medula Espinal/etiologia
12.
Rev. patol. respir ; 22(4): 178-180, oct.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-189008

RESUMO

La hemoptisis puede representar una situación de riesgo vital que requiere de un inmediato diagnóstico y tratamiento con una gran variedad de causas subyacentes. Se recomienda una rápida intervención mediante fibrobroncoscopia para localizar e intentar controlar el sangrado. En los casos en los que no se puede controlar el sangrado, la embolización de las arterias bronquiales (EAB) es un tratamiento no quirúrgico seguro y efectivo para los pacientes con una hemoptisis masiva. Se han descrito complicaciones asociadas a la EAB, siendo la isquemia de la médula espinal la más grave. Informamos del caso de un paciente con hemoptisis masiva en contexto de una neumonía necrotizante, en el que se realizó una EAB tras no conseguir controlar el sangrado mediante fibrobroncoscopia


Hemoptysis may represent a life-threatening situation requiring immediate diagnosis and therapy and it can have a variety of underlying causes. It is recommended an early investigation with bronchoscopy for localization and control of bleeding. In those cases with non-controlled bleeding, bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. Complications of BAE have been reported, being spinal cord ischemia the most dangerous one. We report a case of a patient with massive hemoptysis in the context of necrotizing pneumonia, in whom a BAE was performed after an unsuccessful control of bleeding by bronchoscopy


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Medula Espinal/etiologia , Infarto/etiologia , Nefropatias/etiologia , Esplenopatias/etiologia , Hemoptise/terapia , Hemoptise/etiologia , Pneumonia Necrosante/terapia , Pneumonia Necrosante/complicações , Embolização Terapêutica , Doenças da Medula Espinal/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Infarto/diagnóstico por imagem , Broncoscopia/efeitos adversos , Tomografia Computadorizada por Raios X
13.
Rev Med Chil ; 147(7): 891-900, 2019 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-31859988

RESUMO

BACKGROUND: Renal infarction is a rare and usually underdiagnosed entity. AIM: To study the etiology of renal infarction in published series. MATERIAL AND METHODS: A systematic review was carried out selecting 28 series that included 1582 patients. RESULTS: The proposed cause was cardiac or aortic embolism in 718 cases (45%), an arterial injury in 253 (16%), prothrombotic factors in 146 (9%) and other causes in 79 (5%). 291 cases were classified as idiopathic (18.4%). Atrial fibrillation was present in 542 of the 718 patients with cardiac or aortic embolism. CONCLUSIONS: The main cause of renal infarction is cardiac or aortic embolism and among this group, most cases are due to atrial fibrillation. One out of five cases is labeled as idiopathic.


Assuntos
Infarto/etiologia , Nefropatias/etiologia , Rim/irrigação sanguínea , Humanos , Rim/patologia
14.
Pediatr Rheumatol Online J ; 17(1): 39, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291964

RESUMO

BACKGROUND: Deficiency of adenosine deaminase 2 (DADA2) is a rare autosomal recessive autoinflammatory condition. Recognised features include vasculitis predominantly affecting medium sized vessels, livedoid skin rash, central and peripheral nervous system involvement, variable degrees of immunodeficiency, and marrow failure, amongst other clinical presentations. We present the case of a six year old male with DADA2 who presented with acute testicular ischaemia secondary to vasculitis, the first such description in DADA2. CASE PRESENTATION: A six year old male presented acute right-sided testicular pain. His history included transient infantile neutropenia, resolved hepatosplenomegaly, and longstanding livedo racemosa, leading to screening and confirmation of DADA2 caused by homozygous c.139G > C (p.G47R) mutation of ADA2. As his only clinical feature was that of mild livedo racemosa with normal laboratory parameters at diagnosis, he was being actively monitored prior to starting any treatment. At a routine clinic follow-up a 24 h history of testicular pain was noted on systems review. He was afebrile, and his only physical signs were that of moderate livedo racemosa, and tenderness of the right testicle. Laboratory parameters revealed C-reactive protein (CRP) 8 mg/L (reference range [RR] < 20 mg/L); erythrocyte sedimentation rate (ESR) 28 mm/hr. (RR < 10); and serum amyloid A (SAA)5 mg/L (RR < 10). Ultrasound-scan of the scrotum revealed significantly reduced perfusion of the right testes, without torsion. Surgical scrotal exploration confirmed testicular ischaemia without torsion. Histology demonstrated ischaemic seminiferous tubules with intervening haemorrhage and acute inflammatory cells, consistent with vasculitis of the testis as the cause. He was treated with high dose intravenous methyl-prednisolone followed by a weaning course of oral prednisolone, and subcutaneous adalimumab (anti-tumour necrosis factor alpha, anti-TNFα). Repeat ultrasound-scan 3 weeks later revealed good testicular perfusion, with a small area of focal infarction. At last follow-up (11 months post-event) he remained asymptomatic, on treatment with adalimumab. CONCLUSION: The phenotype of DADA2 continues to expand, and we add testicular infarction to the features of DADA2. CRP and SAA cannot be relied on as reliable biomarkers to predict tissue ischaemia and hence who to target for anti-TNFα therapy in DADA2, since these remained steadfastly normal before, during, and after testicular infarction in this case.


Assuntos
Adenosina Desaminase/deficiência , Infarto/patologia , Peptídeos e Proteínas de Sinalização Intercelular/deficiência , Doenças Testiculares/patologia , Vasculite/patologia , Adenosina Desaminase/genética , Criança , Doenças Hereditárias Autoinflamatórias/complicações , Doenças Hereditárias Autoinflamatórias/genética , Humanos , Infarto/diagnóstico por imagem , Infarto/etiologia , Peptídeos e Proteínas de Sinalização Intercelular/genética , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Isquemia/patologia , Masculino , Doenças Testiculares/diagnóstico por imagem , Doenças Testiculares/etiologia , Testículo/irrigação sanguínea , Testículo/diagnóstico por imagem , Testículo/patologia , Vasculite/diagnóstico por imagem , Vasculite/etiologia
15.
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
18.
World Neurosurg ; 128: 422-425, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31108251

RESUMO

BACKGROUND: Malignant melanotic schwannian tumors (MMSTs) are rare peripheral nerve sheath tumors that typically exhibit benign clinical presentation and histopathology but malignant long-term behavior. CASE DESCRIPTION: We report a case of a 22-year-old male with a T9-11 MMST who presented with acute paraplegia and complete loss of sacral function. Despite emergent decompression, he did not recover motor, sensory or bladder function, although bowel function did normalize. CONCLUSIONS: The anatomic location and rapid presentation of permanent deficits are suggestive of infarction of the spinal cord supplied by the artery of Adamkiewicz, a rare presentation of this disorder and of spinal schwannomas in general.


Assuntos
Infarto/etiologia , Neurofibrossarcoma/complicações , Paraplegia/etiologia , Isquemia do Cordão Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Descompressão Cirúrgica , Humanos , Infarto/diagnóstico por imagem , Infarto/patologia , Masculino , Neurofibrossarcoma/diagnóstico por imagem , Neurofibrossarcoma/patologia , Neurofibrossarcoma/cirurgia , Distúrbios Somatossensoriais/etiologia , Isquemia do Cordão Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/patologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Adulto Jovem
20.
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
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