RESUMO
BACKGROUND: The optimal treatment of low grade intramedullary spinal cord tumours remains controversial. In many cases the tumours continue to progress even after surgery and radiation. Effective chemotherapy may be an important therapeutic adjunct in this setting. Temozolomide is widely used for brain gliomas, yet its role in the management of spinal cord tumours has not been reported. PROCEDURE: Two paediatric patients with low grade spinal cord astrocytomas were diagnosed to have progression of the tumour in spite of surgery and radiotherapy. They received temozolomide, 200 mg/m2 daily for five days every four weeks for 10 cycles, and were followed serially. RESULTS: Stabilization of the spinal tumour in both patients was observed at 18 months of follow-up. One of the patients developed haematological toxicity requiring platelet transfusion and dose reduction. CONCLUSION: Based on our findings in two paediatric patients, temozolomide may be a useful agent in the management of progressive recurrent low grade spinal cord astrocytomas.
Assuntos
Antineoplásicos Alquilantes/administração & dosagem , Astrocitoma/terapia , Dacarbazina/análogos & derivados , Neoplasias da Medula Espinal/terapia , Medula Espinal/patologia , Adolescente , Astrocitoma/diagnóstico , Astrocitoma/fisiopatologia , Criança , Dacarbazina/administração & dosagem , Progressão da Doença , Esquema de Medicação , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/secundário , Metástase Neoplásica/diagnóstico , Metástase Neoplásica/tratamento farmacológico , Metástase Neoplásica/fisiopatologia , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/fisiopatologia , Recidiva Local de Neoplasia/prevenção & controle , Procedimentos Neurocirúrgicos , Radioterapia , Medula Espinal/efeitos dos fármacos , Medula Espinal/fisiopatologia , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/fisiopatologia , Temozolomida , Resultado do TratamentoRESUMO
Spontaneous subdural haematoma is very rare in young patients. The complications of anabolic steroid intake in weight lifters are numerous, yet subdural haematomas have not been reported. We report on two cases of spontaneous subdural haematomas in young weight lifters. Both patients underwent surgical evacuation and made a full recovery. A review of the literature on the complications associated with valsalva manoeuvres is also presented including hemodynamic and intracranial changes. We propose that patients on chronic anabolic steroids may have vascular changes that predispose them to bleeding during a Valsalva manoeuvre (VM).