RESUMO
BACKGROUND: Increased risk of intracranial aneurysm rupture with subsequent subarachnoid haemorrhage (SAH) is related to several possible factors, including first-grade familial aneurysms. METHODS AND RESULTS: Here we present a case of one ruptured and one unruptured identical twin-like anterior communicating artery (ACom) aneurysm present in two male siblings, without any proven genetic predisposition. According to evidence-based scores, aneurysm rupture risk for the younger (51 years old) sibling (with an unruptured ACom aneurysm) would be low, leaving the decision for either treatment or clinical follow-up to the discretion of the treating physician. CONCLUSIONS: From a clinical neurosurgical perspective, however, especially since his older brother suffered an aneurysmal SAH at age 57 (i.e. 6 life-years later) from a twin-like-appearing ACom aneurysm, in our opinion rupture seems almost inevitable, thus prompting treatment at an early stage.
Assuntos
Aneurisma Roto/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Irmãos , Aneurisma Roto/genética , Predisposição Genética para Doença , Humanos , Aneurisma Intracraniano/genética , Masculino , Pessoa de Meia-IdadeRESUMO
Forensic autopsy is still the criterion standard in legal investigations. Currently, notable transformation is occurring because postmortem imaging is being increasingly endorsed. This article highlights the effectiveness of postmortem computed tomography angiography by using a new contrast medium mixture as a solitary tool to define the cause and manner of death in a ruptured cerebral aneurysm case. Based on the imaging results, autopsy was not mandated and the case was closed.
Assuntos
Aneurisma Roto/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Meios de Contraste , Aneurisma Intracraniano/diagnóstico por imagem , Evolução Fatal , Feminino , Patologia Legal , Humanos , Soluções Isotônicas , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Ruptura Espontânea , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Ácidos Tri-IodobenzoicosRESUMO
The purpose of this study was to investigate papilledema (PA) as a diagnostic criterion for the presence of antemortem or agonal cerebral edema despite normal postmortem brain swelling on postmortem magnetic resonance imaging (PMMR) in comparison with conventional autopsy.One hundred subjects with head PMMR and autopsy were included in this study. The sensitivities, spec icities, positive predictive values (PPVs), negative predictive values (NPVs), and accuracies were calculated in terms of the PA, PMMR, and cerebral edema on autopsy. Spearman r tests were used to analyze the linear correlations of PA and the radiological and autoptic determination of cerebral edema.In autopsy, the sensitivity regarding the presence of PA and cerebral edema was 66.2% (PPV, 70.5%), and specificity was 48.6% (NPV, 28.3%), with an overall accuracy of 60%. On PMMR, the sensitivity was 86.6% (PPV, 95%). The specificity was 90.9% (NPV, 34%), with an overall accuracy of 88%. The Spearman correlation revealed a statistically significant result (P < 0.001), which indicated a strong linear correlation of the presence of PA and cerebral edema with the autopsy results and the PMMR results.The presence of PA may aid in the diagnoses of cerebral edema despite normal postmortem brain swelling based on PMMR.
Assuntos
Edema Encefálico/diagnóstico , Imageamento por Ressonância Magnética , Papiledema/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mudanças Depois da Morte , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
A case of fatal poisoning by ingesting formic acid, diphenhydramine, and ethanol by a 25-year-old woman who committed suicide is presented. Prior to autopsy, postmortem computed tomography and postmortem magnetic resonance tomography were performed and revealed severe damage to the stomach, the left thoracic wall, and parts of the liver. Imaging detected acid-induced fluid-fluid level within the thoracic cavity (fat-equivalent fluid and necrotic pleural effusion). This case report illustrates that postmortem cross-sectional imaging may facilitate dissection of severely damaged or complex regions, and may provide additional information compared to autopsy and toxicological examinations alone.