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1.
Cancer Radiother ; 25(2): 169-174, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33436284

RESUMO

Intramedullary spinal cord metastases (ISCM) is a rare, but devastating complication of malignant disease. Prognosis is poor, with an overall median survival (OS) of 4 months from the time of diagnosis. Yet, ISCMs are being increasingly diagnosed, related to advances and increased use of imaging and therapies that prolong survival in patients with cancer. Prompt and accurate diagnosis of ISCM is necessary for effective treatment, and magnetic resonance imaging (MRI) is the preferred imaging technique. The optimal management of these patients is controversial because of the multitude of clinical circumstances and the lack of controlled studies on the efficacy of the different therapeutic approaches. Increased awareness of this rare entity may lead to an earlier diagnosis at a stage when neurological deficits are reversible, and therefore, more effective palliation may be achieved. Therefore, we carried out this retrospective research of 3 observations of ISCM, associated with a detailed review of the literature describing the diagnostic, therapeutic and evolutionary characteristics of this special rare entity.


Assuntos
Adenocarcinoma/secundário , Carcinossarcoma/secundário , Doenças Raras/etiologia , Neoplasias da Medula Espinal/secundário , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/terapia , Adulto , Neoplasias da Mama/patologia , Carcinossarcoma/complicações , Carcinossarcoma/diagnóstico por imagem , Carcinossarcoma/terapia , Detecção Precoce de Câncer , Evolução Fatal , Feminino , Humanos , Vértebras Lombares , Neoplasias Pulmonares/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Raras/diagnóstico por imagem , Doenças Raras/terapia , Estudos Retrospectivos , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/terapia , Vértebras Torácicas
2.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334744

RESUMO

Myxopapillary ependymoma (MPE) is a rare glial tumour mainly located in the areas of the conus medullaris, cauda equina and filum terminale of the spinal cord. Ectopic MPE tends to behave more aggressively and distant metastases are often seen. Unfortunately, no standard treatment options are established as only small series of treated patients and a few reported cases are available in the literature. We report the case of a 25-year-old woman who was initially diagnosed with a metastatic MPE, with multiple bilateral lung metastases. She was treated with an investigational monoclonal antibody antiprogrammed cell death protein 1, called tislelizumab (BGB-A317), following surgical resection of the perisacral primary mass. The response was long-lasting and side effects nil. Immunotherapy is a treatment modality to be considered in patients with rare tumours.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Drogas em Investigação/uso terapêutico , Ependimoma/terapia , Neoplasias Pulmonares/terapia , Neoplasias da Medula Espinal/terapia , Biópsia com Agulha de Grande Calibre , Quimioterapia Adjuvante/métodos , Ependimoma/complicações , Ependimoma/diagnóstico , Ependimoma/secundário , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/terapia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Imagem por Ressonância Magnética , Invasividade Neoplásica , Sacro/diagnóstico por imagem , Sacro/patologia , Sacro/cirurgia , Medula Espinal/patologia , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
3.
Rev. esp. anestesiol. reanim ; 67(6): 347-350, jun.-jul. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-199526

RESUMO

El glioblastoma espinal primario (GBM) es una entidad clínicamente rara, con progresión rápida y resultado inevitable, a pesar de su manejo intensivo. En una mujer embarazada, esta neoplasia es particularmente grave, ya que los beneficios potenciales para la madre que ofrece el tratamiento estándar para GBM deben sopesarse frente a los riesgos para el feto. Existen pocas directrices en la literatura sobre cómo manejar a las pacientes embarazadas con tumores neuroaxiales malignos y, en opinión de los autores, no se han publicado informes hasta la fecha sobre este neoplasma específico en dicha población. Este caso clínico describe el manejo de una paciente embarazada con GBM no diagnosticado previamente, con rápida progresión intramedular, a la que se realizó cesárea electiva para permitir el inicio de tratamiento oncológico. Debatimos los dilemas a los que se enfrentan los anestesistas, con esperanza de aportar directrices ante las futuras decisiones y de optimizar los resultados


Primary spinal glioblastoma (GBM) is a clinically rare entity with rapid progression and a dismal outcome despite aggressive treatment. In a pregnant woman, this malignancy is particularly dramatic because the potential benefits to the mother offered by standard GBM treatment must be balanced against the risks to the fetus. There is little guidance in the literature on how to manage pregnant patients with malignant neuraxial tumours and, to the authors' knowledge, no reports have been published so far regarding this specific neoplasm in such population. This case report describes the management of a pregnant patient with a previously undiagnosed and rapidly progressive intramedullary GBM submitted to an elective caesarean delivery to allow subsequent onset of oncological treatment. Dilemmas faced by anaesthetists are discussed in hope to provide guidance for future decisions and optimize outcomes


Assuntos
Humanos , Feminino , Gravidez , Adulto , Glioblastoma/cirurgia , Cesárea/métodos , Anestesia/métodos , Anestésicos/administração & dosagem , Neoplasias da Medula Espinal/cirurgia , Laminectomia/métodos , Complicações Neoplásicas na Gravidez/cirurgia , Anestesia Obstétrica/métodos , Neoplasias da Medula Espinal/complicações
4.
World Neurosurg ; 140: 37-45, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32407913

RESUMO

BACKGROUND: Spinal arteriovenous fistula (AVF) may rarely associate with spinal dysraphism, that is, tethered spinal cord and spinal intradural lipoma. Spinal extradural angiolipoma coexisting with spinal AVF has not been reported in the literature. We reported an extremely rare case of sacral angiolipoma associated with tight filum terminale and sacral spina bifida coexisting with spinal AVF within this tumor. CASE DESCRIPTION: A 55-year-old women presented with progressive myelopathy for 10 months. She had a painless, slow-growing mass at her left buttock since birth. Magnetic resonance imaging of the lumbosacral spine showed an extradural mass at the level of S3-S4, extending from the spinal canal through the spina bifida to the subcutaneous fat of the left buttock. There was a low conus medullaris at S2. Magnetic resonance imaging of the thoracic spine disclosed venous congestion with tortuous intradural flow voids along both ventral and dorsal surfaces of the spinal cord. Magnetic resonance angiography and spinal angiography revealed a hypervascular mass at the sacral level and associated arteriovenous shunt with cranial drainage into an enlarged medullary vein. Due to an infected pressure sore on the mass, endovascular treatment was initially performed with minimal recovery. Six months after complete healing of her infected pressure ulcer, the patient underwent surgical removal of extradural mass containing the AVF, and subsequent release of the tight filum. Histologic findings were consistent with angiolipoma. CONCLUSIONS: Sacral extradural angiolipoma in the present case may be congenital in origin with development of an acquired spinal AVF within the tumor.


Assuntos
Angiolipoma/complicações , Malformações Vasculares do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Periférico/complicações , Neoplasias da Medula Espinal/complicações , Disrafismo Espinal/complicações , Angiolipoma/patologia , Cauda Equina/patologia , Malformações Vasculares do Sistema Nervoso Central/patologia , Feminino , Humanos , Região Lombossacral , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/patologia , Neoplasias da Medula Espinal/patologia , Disrafismo Espinal/patologia
6.
World Neurosurg ; 139: 39-50, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32298825

RESUMO

BACKGROUND: Epidermoid cysts are rare benign neoplasms within the neuroaxis and account for <1% of all intraspinal tumors. They can be congenital or acquired. Being a slow-growing tumor, the clinical presentation is widely variable depending on the location, size, or age of the patient. OBJECTIVES: Because of the rarity of this entity, the diagnosis and treatment are often delayed. We wanted to offer an updated overall view on spinal epidermoid cysts to facilitate diagnosis and treatment decisions. METHODS: We present the case of a patient with thoracic intramedullary epidermoid cyst and we conduct a review of reported cases in the literature using PubMed database. RESULTS: From 1962 to September 2019, we gathered 91 articles with a total of 139 cases (ours included). There is a slightly female predominance and a bimodal age distribution. Acquired cysts are seen in 38.1% of patients. The most frequent symptom was pain, followed by motor deficit, sensitive deficits, and sphincter deficiencies. The mean time delay to diagnosis is 26.36 ± 53.29 months. The most common localization was in the lumbar area and one third of the tumors were intramedullary. A good outcome was achieved in most of the treated cases. CONCLUSIONS: To achieve a good outcome, an early recognition of this disease is essential. The management consists in most cases of surgical resection. Although recurrence is low, it can significantly alter the quality of life of our patients, and, therefore, gross total resection should be our goal.


Assuntos
Cisto Epidérmico/cirurgia , Neoplasias da Medula Espinal/cirurgia , Dor nas Costas/etiologia , Cisto Epidérmico/complicações , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica/etiologia , Recuperação de Função Fisiológica , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/fisiopatologia , Vértebras Torácicas
7.
World Neurosurg ; 139: 136-141, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32283320

RESUMO

BACKGROUND: Granular cell tumors (GCT) are rare soft tissue neoplasms with a nerve sheath origin, most often found in female adult populations. When these tumors arise in the central nervous system, they most commonly appear intradurally in the thoracic or lumbar spine. GCT malignancy rates vary and recurrence rates can be relatively high, thereby necessitating complete resection. CASE DESCRIPTION: We present an exceedingly rare case of an intradural, extramedullary GCT originating in the anterior cervical spine of a male pediatric patient who presented with progressive neck pain and gait instability. CONCLUSIONS: The patient underwent an anterior C7 corpectomy for resection of the tumor, followed by stabilization and fusion, and recovered without neurologic deficit. A literature review of spinal GCTs is provided.


Assuntos
Vértebras Cervicais/cirurgia , Tumor de Células Granulares/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Medula Espinal/cirurgia , Adolescente , Tumor de Células Granulares/complicações , Tumor de Células Granulares/diagnóstico por imagem , Tumor de Células Granulares/patologia , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Cervicalgia/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Fusão Vertebral
8.
World Neurosurg ; 139: 266-267, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32289505

RESUMO

A 39-year-old man with a history of recurrent pituitary tumor, Cushing disease, and Nelson syndrome presented with neck stiffness. He previously had bilateral adrenalectomy and hypophysectomy 27 years ago. He subsequently had repeat pituitary surgery, stereotactic radiosurgery, and chemotherapy for recurrent pituitary tumor. During follow-up, he was noted to have rising basal adrenocorticotrophin (ACTH) level. On examination, he was neurologically intact with no signs of myelopathy. Magnetic resonance imaging of the spine showed a large intradural extramedullary lesion causing cord compression at the C2-3 level. He underwent a cervical laminectomy and debulking of the lesion under continuous monitoring of motor-evoked and somatosensory-evoked potentials. He remained neurologically intact postoperatively. Histologic analysis revealed a tumor of pituitary origin with synaptophysin and ACTH expression. Pituitary drop metastasis is a rare entity and should raise a high index of suspicion given this clinical presentation. The radiologic appearance can mimic benign lesions such as meningioma or schwannoma.


Assuntos
Carcinoma/secundário , Neoplasias Hipofisárias/patologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/secundário , Adulto , Carcinoma/cirurgia , Descompressão Cirúrgica , Humanos , Laminectomia , Masculino , Compressão da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia
9.
World Neurosurg ; 139: 20-22, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32251824

RESUMO

BACKGROUND: Ten-segment intramedullary tumors are rare lesions in adults. CASE DESCRIPTION: In this report, we describe the case of a 30-year-old woman who presented with a 2-year history of right lower limb numbness. Spinal magnetic resonance imaging showed an expansive 10-segment intramedullary lesion and syringomyelia. The final pathologic tests confirmed World Health Organization grade II ependymoma. She received a successful gross total tumorectomy with no obvious surgical-related complications. CONCLUSIONS: The postoperative recovery is far beyond our expectations.


Assuntos
Vértebras Cervicais/cirurgia , Craniotomia , Ependimoma/cirurgia , Laminectomia , Neoplasias da Medula Espinal/cirurgia , Siringomielia/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Adulto , Ependimoma/complicações , Ependimoma/diagnóstico por imagem , Ependimoma/patologia , Feminino , Forame Magno , Humanos , Hipestesia/etiologia , Imagem por Ressonância Magnética , Debilidade Muscular/etiologia , Reabilitação Neurológica , Procedimentos Neurocirúrgicos , Recuperação de Função Fisiológica , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia , Siringomielia/etiologia , Resultado do Tratamento
10.
BMC Neurol ; 20(1): 34, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31973698

RESUMO

BACKGROUND: Progressive spinal deformity has become a well-recognized complication of intracanal tumors resection. However, the factors affecting post-operative spinal stability remain to be further research. Here, we described the current largest series of risk factors analysis for progressive spinal deformity following resection of intracanal tumors. METHODS: We retrospectively analyzed the medical records of the patients with resection of intracanal tumors between January 2009 and December 2018. All patients who underwent resection of intracanal tumors performed regular postoperative follow-up were identified and included in the study. Clinical, radiological, surgical, histopathological, and follow-up data were collected. The incidence of postoperative progressive kyphosis or scoliosis was calculated. The statistical relationship between postoperative progressive spinal deformity and radiographic, clinical, and surgical variables was assessed by using univariate tests and multivariate logistic regression analysis. RESULTS: Two hundred seventy-two patients (mean age 42.56 ± 16.18 years) with median preoperative modified McCormick score of 3 met the inclusion criteria. Among them, 7(2.6%)patients were found to have spinal deformity preoperatively, and the extent of spinal deformity in these 7 patients deteriorated after surgery. 36 (13.2%) were new cases of postoperative progressive deformity. The mean duration of follow-up was 21.8 months (median 14 months, range 6-114 months). In subsequent multivariate logistic regression analysis, age ≤ 18 years (p = 0.027), vertebral levels of tumor involvement (p = 0.019) and preoperative spinal deformity(p = 0.008) was the independent risk factors (p < 0.05), increasing the odds of postoperative progressive spinal deformity by 3.94-, 0.69- and 27.11-fold, respectively. CONCLUSIONS: The incidence of postoperative progressive spinal deformity was 15.8%, mostly in these patients who had younger age (≤18 years), tumors involved in multiple segments and preoperative spinal deformity. The risk factors of postoperative progressive spinal deformity warrants serious reconsideration that when performing resection of spinal cord tumors in these patients with such risk factors, the surgeons should consider conducting follow-ups more closely, and when patients suffering from severe symptoms or gradually increased spinal deformity, surgical spinal fusion may be a more suitable choice to reduce the risk of reoperation and improve the prognosis of patients.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Medula Espinal/cirurgia , Curvaturas da Coluna Vertebral/epidemiologia , Curvaturas da Coluna Vertebral/etiologia , Adolescente , Adulto , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Medula Espinal/complicações , Adulto Jovem
11.
World Neurosurg ; 136: 146-149, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954897

RESUMO

BACKGROUND: Intramedullary spinal cord cysts are benign, rare, fluid-filled lesions that can present anywhere along the craniospinal axis. However, when present at the level of the ventriculus terminalis, conus medullaris syndrome may occur. Radical resection of the cyst wall and evacuation of the cyst content are the 2 surgical procedures of choice. CASE DESCRIPTION: We present the case of a 54-year-old woman with a long-lasting history of left lower-extremity weakness and recent onset of bladder dysfunction. On further assessment, magnetic resonance imaging of the thoracic and lumbar spine showed a T10-L3 intramedullary cystic lesion. Surgical fenestration of the cyst was rendered, but no biopsy was taken due to the highly functional tissue along the full extension of lesion. CONCLUSIONS: Cystic lesions of the ventriculus terminalis are rare entities with a common presentation of severe, progressive neurologic impairment. Our case matches the classic presentation of conus medullaris syndrome. We describe and demonstrate through an operative video novel surgical techniques used to achieve successful fenestration of the cyst wall with remarkable neurologic symptom improvement. Moreover, the present case does not correlate with the classic radiographic characteristics available in current literature, such as involvement of 5 spinal segments.


Assuntos
Cistos do Sistema Nervoso Central/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/diagnóstico por imagem , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/cirurgia , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia
12.
World Neurosurg ; 136: 37-43, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31917306

RESUMO

BACKGROUND: Intramedullary spinal cord dermoid tumors are rare. Early diagnosis with appropriate imaging is of utmost importance for a good outcome. Gross total resection is the treatment of choice for optimal results. Neurosurgical intervention for any intramedullary lesion is fraught with problems because of the nature of the lesion and handling of the spinal cord, which is already compromised because of the intramedullary lesion. Recurrence of the intramedullary dermoid tumor is frequent because of incomplete resection of the tumor. Most commonly, patients present with worsening of neurologic deficits. Inadequate resection because of the fear of worsening the neurologic deficits is associated with significant complications. CASE DESCRIPTION: We report a case of an intramedullary dermoid tumor in a child that was associated with myriad of complications owing to incomplete resection of the tumor. The patient underwent multiple interventions at various centers which resulted in serious multiple complications before presenting at our center for further management. CONCLUSIONS: This report highlights the spectrum of complications that can develop in a patient varying from worsening of the deficits to meningitis and subsequent development of hydrocephalus.


Assuntos
Cisto Dermoide/cirurgia , Hidrocefalia/cirurgia , Meningite Asséptica/terapia , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/cirurgia , Sepse/terapia , Neoplasias da Medula Espinal/cirurgia , Derrame Subdural/cirurgia , Descompressão Cirúrgica , Cisto Dermoide/complicações , Cisto Dermoide/patologia , Feminino , Humanos , Lactente , Laminectomia , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Neoplasia Residual , Complicações Pós-Operatórias/diagnóstico por imagem , Reoperação , Sacro , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/patologia , Derrame Subdural/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Derivação Ventriculoperitoneal
14.
Neurosurg Rev ; 43(1): 169-175, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30171501

RESUMO

Spinal hemangioblastomas constitute 1.6-5.8% of all spinal cord tumors. Microsurgical excision of these tumors is challenging. The purpose of this study is to analyze the neurological improvement and long-term functional outcome of spinal hemangioblastomas. This retrospective study included 15 patients who underwent surgery for intramedullary spinal hemangioblastoma at the Department of Neurosurgery of Sri Chitra Tirunal Institute for Medical Sciences and Technology from January 2001 to June 2014. Eight patients (53%) were diagnosed to have von Hippel-Lindau (vHL) disease. Eight (53%) of them were females, and seven were males (47%). Mean age was 33.8 years (16-55 years). Duration of illness ranged from 2 weeks to 4 years, and average duration was 10.5 months. Most common symptom was motor weakness followed by sensory disturbances, pain, and bladder incontinence. Six (85.7%) sporadic spinal hemangioblastomas were in McCormick grade I; whereas, 7 (87.5%) of vHL spinal hemangioblastomas were in grade II or above. In the immediate postoperative period, three patients noticed improvement in their motor weakness. Six patients (40%) experienced deterioration of preoperative neurological status in the immediate postoperative period. Three of them were sporadic tumors, and others had vHL syndrome. Favorable long-term outcome was achieved in 80% of cases. Though neurological deterioration is common after surgical resection of spinal hemangioblastomas, majority of them are reversible. Long-term functional outcome is favorable with minimal postoperative morbidities. Both sporadic- and vHL-associated tumors share common clinical and radiological features, and neurological outcome is equally good in both.


Assuntos
Hemangioblastoma/diagnóstico , Hemangioblastoma/cirurgia , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Hemangioblastoma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Prognóstico , Estudos Retrospectivos , Neoplasias da Medula Espinal/complicações , Resultado do Tratamento , Adulto Jovem , Doença de von Hippel-Lindau/complicações , Doença de von Hippel-Lindau/diagnóstico , Doença de von Hippel-Lindau/cirurgia
15.
Br J Neurosurg ; 34(1): 104-106, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29271254

RESUMO

Spinal schwannomas coexisting with meningiomas in patient without neurofibromatosis are extremely rare lesions. Here we present a case of 59-year-old patient with concurrent spinal meningioma and schwannoma at L1-L2 spinal level. This is the first case of the concurrent intradural tumours at the same lumbar level.


Assuntos
Meningioma/complicações , Neurilemoma/complicações , Neoplasias da Medula Espinal/complicações , Humanos , Laminectomia , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neurofibromatoses , Procedimentos Neurocirúrgicos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
16.
Br J Community Nurs ; 25(1): 6-9, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31874087

RESUMO

Ease of access to vast amounts of information presents significant opportunities and challenges for nurses in the community as they seek to base their practice on the best available evidence. Growing expectations around evidence-based practice have developed alongside developments in evidence synthesis, which adopts robust approaches to identifying, appraising and synthesising key evidence for clinical decision-making. The context in which evidence-based practice occurs is key, and this article discusses the skills and knowledge needed for community nurses to discern how evidence and information should influence their decisions to review and change approaches to clinical practice. Importantly, if nurses understand the status of evidence underpinning areas of practice, they can ensure that the preferences and needs of patients and families are met.


Assuntos
Enfermagem em Saúde Comunitária/métodos , Enfermagem Baseada em Evidências , Literatura de Revisão como Assunto , Revisões Sistemáticas como Assunto , Tomada de Decisão Clínica , Pesquisa em Enfermagem Clínica/métodos , Enfermagem em Saúde Comunitária/normas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/enfermagem , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/secundário
17.
World Neurosurg ; 133: 185-187, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606509

RESUMO

We report a rare case of bony diastematomyelia associated with intraspinal teratoma. The patient was surgically treated with bony diastematomyelia and intradural teratoma resection, followed by lumbar duroplasty, and posterior fusion from L2-L4 in order to maintain the spinal stability of the approached segments. Despite the risks, it was necessary to perform early surgical treatment because of rapid neurologic deterioration. The patient had a good postoperative outcome.


Assuntos
Vértebras Lombares/cirurgia , Defeitos do Tubo Neural/cirurgia , Neoplasias da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Teratoma/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/diagnóstico por imagem , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Teratoma/complicações , Teratoma/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
JAAPA ; 32(12): 14-20, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31714344

RESUMO

Low back pain in adolescents is a common complaint in primary care. With an average prevalence rate of 40%, adolescent low back pain correlates with greater healthcare use, higher incidences of adult back pain, and negative effects on overall well-being. A thorough history and physical examination can increase early detection and accurate diagnosis while ensuring the judicious use of diagnostic modalities. Although underlying serious pathology is rare in adolescents with low back pain, clinicians should recognize specific signs and symptoms that necessitate urgent evaluation and intervention. This article emphasizes the value of using a thorough history and physical examination to guide the initial diagnostic workup and to enhance the early detection and accurate diagnosis of adolescents who present with low back pain.


Assuntos
Dor Lombar/diagnóstico , Anamnese , Exame Físico , Adolescente , Criança , Diagnóstico Diferencial , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Oncologia , Ortopedia , Radiografia , Encaminhamento e Consulta , Reumatologia , Sarcoma de Ewing/complicações , Sarcoma de Ewing/diagnóstico , Escoliose/complicações , Escoliose/diagnóstico , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico , Espondilolistese/complicações , Espondilolistese/diagnóstico , Espondilólise/complicações , Espondilólise/diagnóstico , Entorses e Distensões/complicações , Entorses e Distensões/diagnóstico , Adulto Jovem
20.
BMC Neurol ; 19(1): 189, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395022

RESUMO

BACKGROUND: Lumbosacral lipomas (LLs) may remain asymptomatic or lead to progressive neurological deterioration. However, sudden neurological deterioration is a rare and severe event. Herein, we report rare occurrences of sudden clinical deterioration in two previously asymptomatic children harbouring intradural LLs without dermal sinus tracts or signs of occult dysraphism. A review of the pertinent literature is also included. CASE PRESENTATION: One child exhibited acute deterioration because of an epidural abscess associated with a filar lipoma without a sinus tract (probably caused by haematogenous spreading from a respiratory tract multiple infection), and the other child exhibited acute deterioration because of a very large, holocord syringomyelia-like cyst associated with a small conus lipoma. Both patients were 4 years old. In case #2, a previously undetected, severe tethered cord (conus at the S3-S4 level) was also present. A complete recovery was attained after an urgent surgical operation in both cases (in addition to targeted antibiotic therapy in case #1). All cases of deterioration in the literature were caused by abscess formation in dermal sinus tracts. CONCLUSIONS: Prophylactic surgery may be indicated even in asymptomatic children that have tethered cord and surgically favourable LLs (small dorsal and filar LLs), especially if the conditions are associated with progressive syringomyelia. Similarly, intradural dermal sinus tracts should be regarded as surgery-indicated, even if the conus is in its normal position and the patient is asymptomatic because there is a consistent risk of severe, infection-related complications. Finally, asymptomatic patients with filar LLs and a normally located conus can be candidates for surgery or an accurate clinical and radiological follow-up.


Assuntos
Lipoma/patologia , Neoplasias da Medula Espinal/patologia , Pré-Escolar , Humanos , Lipoma/complicações , Imagem por Ressonância Magnética , Masculino , Espinha Bífida Oculta/complicações , Neoplasias da Medula Espinal/complicações , Siringomielia/complicações
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