RESUMO
We describe a case of spontaneous spinal extradural haematoma presenting as cardiac chest pain. Although a neurosurgical emergency, the diagnosis is initially missed until neurological deficit develops. Prompt MRI scans of the spine followed by rapid transfer to a neurosurgical unit for definitive intervention increase the chances of full recovery.
Assuntos
Dor no Peito/etiologia , Hematoma Epidural Espinal/complicações , Idoso , Descompressão Cirúrgica , Feminino , Hematoma Epidural Espinal/cirurgia , Humanos , Imageamento por Ressonância Magnética , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgiaRESUMO
Objective: Aneurysmal bone cysts (ABCs) rarely involve the cranium. We report a case arising in the ethmoid sinus with orbital and intracranial invasion. Imaging suggested an associated fibro-osseous lesion. The lesion was completely resected. Histology confirmed the imaging diagnosis of ABC on top of an ossifying fibroma. A multidisciplinary approach is essential for optimal surgical outcomes. Methods: We report a case of an 8-year-old boy with a 5 week history of painless, increasing prominence of the left eye. Clinical examination revealed non-pulsatile left proptosis. Visual acuity and ocular movements were normal. CT and MRI scans of the maxillofacial regions showed a large space-occupying lesion involving the left ethmoid air cells with left orbital and left inferior frontal intracranial extension. Multiple fluid levels with blood products were seen. Areas of the bony component of the lesion showed ground-glass density on CT. Imaging was consistent with an ABC with an underlying fibro-osseous lesion; probably fibrous dysplasia which was confirmed after surgical removal of the lesion. A multidisciplinary team of maxillofacial, neurosusugery and ENT surgeons performed the surgery. Results: ABC arising from an osseous fibroma of the skull is rare. Total resection can be achieved with a multidisciplinary surgical approach. Post-operative histology confirmed by the imaging findings.
RESUMO
Synovial cysts presenting within the cervical spine are rare. We describe a case of a synovial cyst presenting as a tumour and the successful management.
Assuntos
Vértebras Cervicais , Hipestesia/etiologia , Doenças da Coluna Vertebral/complicações , Cisto Sinovial/complicações , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Hipestesia/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Cisto Sinovial/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , CaminhadaRESUMO
MRC CRASH is a randomised controlled trial (ISRCTN74459797) of the effect of corticosteroids on death and disability after head injury. We randomly allocated 10,008 adults with head injury and a Glasgow Coma Scale score of 14 or less, within 8 h of injury, to a 48-h infusion of corticosteroid (methylprednisolone) or placebo. Data at 6 months were obtained for 9673 (96.7%) patients. The risk of death was higher in the corticosteroid group than in the placebo group (1248 [25.7%] vs 1075 [22.3%] deaths; relative risk 1.15, 95% CI 1.07-1.24; p=0.0001), as was the risk of death or severe disability (1828 [38.1%] vs 1728 [36.3%] dead or severely disabled; 1.05, 0.99-1.10; p=0.079). There was no evidence that the effect of corticosteroids differed by injury severity or time since injury. These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury.
Assuntos
Traumatismos Craniocerebrais/tratamento farmacológico , Glucocorticoides/administração & dosagem , Metilprednisolona/administração & dosagem , Traumatismos Craniocerebrais/mortalidade , Seguimentos , Humanos , Infusões Intravenosas , Fatores de Risco , Resultado do TratamentoAssuntos
Craniotomia/métodos , Descompressão Cirúrgica/métodos , Traumatismos Cranianos Fechados/cirurgia , Adolescente , Adulto , Humanos , Hipertensão Intracraniana/etiologia , Tempo de Internação , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial--a multicentre international collaboration--aimed to confirm or refute such an effect by recruiting 20000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. METHODS: 10008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. FINDINGS: Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21.1%] vs 893 [17.9%] deaths; relative risk 1.18 [95% CI 1.09-1.27]; p=0.0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0.22) or time since injury (p=0.05). INTERPRETATION: Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear.