RESUMO
Pituitary apoplexy is usually the result of hemorrhagic infarction in a pituitary adenoma. The clinical presentation varies widely and includes asymptomatic cases, classical pituitary apoplexy and even sudden death. Cerebral ischemia due to pituitary apoplexy is very rare. It may be caused by vasospasm or direct compression of cerebral vessels by the tumor. We report a case of pituitary apoplexy associated with cerebral infarction and discuss the relationship between the two events.
Assuntos
Infarto Cerebral/etiologia , Apoplexia Hipofisária/complicações , Adenoma , Adulto , Isquemia Encefálica , Feminino , Humanos , Neoplasias HipofisáriasRESUMO
Multiple cerebral arteriovenous malformations (AVMs) are thought to be exceedingly rare lesions and have usually been reported as single cases. The incidence of multiple cerebral AVMs in major series ranges from 0.3% to 9% and, in the majority of cases, these malformations are associated with other vascular anomalies of the brain or soft tissues. We report a 62-year-old woman that presented with a left temporal haemorrhage. Angiography showed 3 AVMs located in the left temporal lobe, left cerebellar hemisphere and right temporal lobe. The lesions were treated with radiosurgery.
Assuntos
Malformações Arteriovenosas Intracranianas , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/terapia , Pessoa de Meia-IdadeRESUMO
Intracranial arachnoid cysts are fluid-filled cavities that arise within the cranial arachnoid, representing approximately 1%-2% of all intracranial lesions among the paediatric population. We present the case of a 2-year-old boy who presented with instability and episodes of ocular deviation. A computed tomography scan (CT scan) and magnetic resonance imaging (MRI) of the brain revealed a suprasellar cyst and obstructive hydrocephalus. At birth a transfontanellar ultrasound was normal. The cyst underwent endoscopic fenestration with complete remission of symptoms. In the review of the literature, we found only 6 previous cases of an intracranial arachnoid cyst whose origin was not clearly congenital or traumatic, and ours is the second case of a suprasellar arachnoid cyst to arise de novo. The clinical features, imaging characteristics and treatment of the previously reported cases are discussed.
Assuntos
Cistos Aracnóideos , Cistos Aracnóideos/diagnóstico , Cistos Aracnóideos/cirurgia , Pré-Escolar , Humanos , MasculinoAssuntos
Traumatismo do Nervo Abducente/etiologia , Nistagmo Patológico/etiologia , Transtornos da Motilidade Ocular/etiologia , Ponte/lesões , Traumatismo do Nervo Abducente/diagnóstico por imagem , Traumatismo do Nervo Abducente/fisiopatologia , Acidentes por Quedas , Idoso , Hemorragia Cerebral Traumática/diagnóstico por imagem , Hemorragia Cerebral Traumática/etiologia , Tontura/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Neuroimagem , Nistagmo Patológico/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Ponte/diagnóstico por imagem , Ponte/fisiopatologia , SíndromeRESUMO
Tension pneumocephalus is an extremely rare complication of positive-pressure ventilation in neonates, the diagnosis of which requires a high degree of clinical suspicion. We present the case of a preterm newborn, who received high-flow nasal cannula oxygen therapy because of hyaline membrane disease, due to his prematurity, and developed clinical signs of intracranial hypertension. Transfontanellar ultrasound and cranial CT scan revealed significant tension pneumocephalus, which was evacuated with direct needle puncture through the anterior fontanelle.
Assuntos
Hipertensão Intracraniana , Pneumocefalia , Humanos , Recém-Nascido , Oxigênio , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Pneumocefalia/terapia , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios XRESUMO
Colloid cyst are benign intracranial lesions located in the III ventricle in the region of the foramen of Monro. The majority present in the third and fourth decades of life and are rare under the age of ten. We report a case of an incidentally colloid cyst presented in a 2.5 -years-old girl who was managed conservatively; follow-up with MRI showed a progressive reduction in size. We review the four similar case previously reported.
RESUMO
INTRODUCTION: Spasticity represents a medical problem whose incidence is increasing during the last years due to pathologies such as cerebral palsy, stroke, multiple sclerosis, trauma or encephalopathy, affecting both adults and children. The treatments include rehabilitation, pharmacotherapy and surgery, among which we highlight intrathecal baclofen infusion devices. MATERIAL AND METHODS: Intrathecal baclofen devices implanted patients in Clinical Hospital of Santiago de Compostela from 2005 to 2018 were selected for retrospective analysis using assessment of spasticity scales, such as Ashworth scale. Complications are described. RESULTS: Surgery was performed in 17 patients for baclofen pump implant, achieving an improvement of 2 points on the Ashworth Scale in 88,2% of the patients and of 1 point on the Penn Scale in 94%. Complications were seen in 3 patients. CONCLUSIONS: Intrathecal baclofen is a simple technique with good results for improving the quality of life of patients with spasticity.
Assuntos
Baclofeno/administração & dosagem , Bombas de Infusão Implantáveis , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Bombas de Infusão Implantáveis/efeitos adversos , Injeções Espinhais , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: Chronic subdural haematoma (CSDH) is one of the most common neurosurgical conditions and is especially prevalent among elderly individuals. The objective of this study was to analyse the demographic, clinical and radiological findings, and surgical outcomes in a series of chronic subdural haematoma in patients older than 85 years. PATIENTS AND METHODS: A review was carried out on all patients over 85 years with CSDH treated in our neurosurgical service from April 1986 to November 2015. A record was made of the baseline patient characteristics (age, sex, comorbidities, known risk factors, imaging characteristics, and number of burr-holes) and surgical outcomes (complications, especially recurrences and mortality). An analysis was carried out on the special characteristics of these patients, as well as the relationships between gender, clinical grade, anti-platelet or anticoagulant therapy, internal architecture of the haematoma, and midline shift, with mortality and recurrence of the haematoma. RESULTS: A total of 200 patients were included, with a mean age of 88.5 (range 85-104) years, and the male: female sex ratio was 1:1.1. History of injury was reported in 114 (57%) cases. Anti-platelet or anticoagulant therapy was being used by 71 (35.5%) patients. On admission, 114 patients (57%) were in satisfactory condition (Markwalder grades 0-2). The main symptom was behavioural disturbance in 82 (41%) cases. CSDH was left-sided in 89 (44.5%) patients, right-sided in 78 (39%) cases (39%), and bilateral in the remaining 33 (16.5%) cases). Postoperative complications were observed in 59 cases (29 recurrences). Preoperative Markwalder grade correlated significantly with recurrence rate and mortality (P<.0001). CONCLUSIONS: CSDH was a very common disease in very elderly patients. Behavioural disturbance and neurological deficits are the most common first symptom. Preoperative neurological status at admission is the most important factor in recurrences and mortality.
Assuntos
Hematoma Subdural Crônico , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Feminino , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/patologia , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
El neumoencéfalo a tensión es una complicación extremadamente rara en el uso de la ventilación a presión positiva en el neonato, cuyo diagnóstico requiere un alto grado de sospecha clínica. Presentamos el caso de un recién nacido prematuro, que recibió oxígeno a través de cánulas nasales de alto flujo debido a enfermedad de membrana hialina, propia de su prematuridad, y que desarrolló signos clínicos de hipertensión intracraneal. La ecografía transfontanelar y la TAC craneal pusieron de manifiesto un importante neumoencéfalo a tensión que fue evacuado a través de punción directa a través de la fontanela anterior (AU)
Tension pneumocephalus is an extremely rare complication of positive-pressure ventilation in neonates, the diagnosis of which requires a high degree of clinical suspicion. We present the case of a preterm newborn, who received high-flow nasal cannula oxygen therapy because of hyaline membrane disease, due to his prematurity, and developed clinical signs of intracranial hypertension. Transfontanellar ultrasound and cranial CT scan revealed significant tension pneumocephalus, which was evacuated with direct needle puncture through the anterior fontanelle (AU)
Assuntos
Humanos , Feminino , Recém-Nascido , Recém-Nascido Prematuro , Hipertensão Intracraniana/etiologia , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Tomografia Computadorizada por Raios X , Complicações Pós-OperatóriasRESUMO
No disponible
Assuntos
Humanos , Meningioma/etiologia , Siringomielia/complicações , Neoplasias da Medula EspinalRESUMO
No disponible
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Humanos , Masculino , Feminino , Idoso , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Nervos Cranianos/diagnóstico por imagem , Nervos Cranianos/patologia , Paralisia Cerebral/etiologia , Tomografia Computadorizada por Raios X , Imageamento por Ressonância MagnéticaRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Paralisia Cerebral/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Tegmento Mesencefálico/diagnóstico por imagem , Tegmento Mesencefálico/lesões , Traumatismos Cranianos Penetrantes/complicações , Coma/complicações , Escala de Coma de Glasgow , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/lesões , Traumatismos do Nervo Oculomotor/complicaçõesRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Meningioma/complicações , Meningioma/epidemiologia , Neurocirurgia/métodos , Craniotomia/métodos , Craniotomia , Prognóstico , Radiocirurgia/métodos , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Sobrevivência/fisiologia , Recidiva Local de Neoplasia/epidemiologiaRESUMO
Introducción. El hematoma subdural crónico (HSC) es una patología frecuente en los servicios de neurocirugía, y especialmente prevalente entre los pacientes de edad avanzada. El objetivo de este estudio es analizar las características demográficas, clínicas y radiológicas en una serie de pacientes mayores de 85 años afectados de un HSC. Pacientes y métodos. Realizamos un estudio retrospectivo sobre una serie de pacientes mayores de 85 años entre abril de 1986 y noviembre de 2015. Se recogieron las características clínicas (edad, sexo, comorbilidades, factores de riesgo, características radiológicas) y los resultados quirúrgicos (complicaciones fundamentalmente centradas en las recidivas y mortalidad). Analizamos las particularidades de este grupo de edad y su relación entre edad, sexo, grado clínico, tratamiento antiagregante o anticoagulante, arquitectura del hematoma, desplazamiento de la línea media y número de trépanos realizados con la mortalidad y recidiva del hematoma. Resultados. Analizamos 200 pacientes con una edad media de 88,5 años (rango 85-104), con una relación varón:mujer de 1:1,1. Se recogió antecedente traumático en 114 casos (57%) y estaban sometidos a terapia anticoagulante o antiagregante 71 pacientes (35,5%). Al ingreso, 114 pacientes (57%) tenían un buen estado clínico (grado 0-2 de Markwalder). El principal síntoma fue el deterioro cognitivo en 82 casos (41%). El HSC estaba localizado en el hemisferio izquierdo en 89 (44,5%), derecho en 78 casos (39%) y bilateral en los restantes 33 (16,5%). Se presentaron 59 complicaciones en 59 casos (29 recidivas) y el grado clínico de Markwalder se relacionó con unos mayores índices de complicaciones y mortalidad (p<0,0001). Conclusiones. El HSC es una patología frecuente en los pacientes muy ancianos. Clínicamente se manifiesta con deterioro cognitivo y déficit neurológico. La situación clínica al ingreso representó en nuestra serie un importante factor predictivo tanto de complicaciones como de mortalidad (AU)
Introduction. Chronic subdural haematoma (CSDH) is one of the most common neurosurgical conditions and is especially prevalent among elderly individuals. The objective of this study was to analyse the demographic, clinical and radiological findings, and surgical outcomes in a series of chronic subdural haematoma in patients older than 85 years. Patients and methods. A review was carried out on all patients over 85 years with CSDH treated in our neurosurgical service from April 1986 to November 2015. A record was made of the baseline patient characteristics (age, sex, comorbidities, known risk factors, imaging characteristics, and number of burr-holes) and surgical outcomes (complications, especially recurrences and mortality). An analysis was carried out on the special characteristics of these patients, as well as the relationships between gender, clinical grade, anti-platelet or anticoagulant therapy, internal architecture of the haematoma, and midline shift, with mortality and recurrence of the haematoma. Results. A total of 200 patients were included, with a mean age of 88.5 (range 85-104) years, and the male: female sex ratio was 1:1.1. History of injury was reported in 114 (57%) cases. Anti-platelet or anticoagulant therapy was being used by 71 (35.5%) patients. On admission, 114 patients (57%) were in satisfactory condition (Markwalder grades 0-2). The main symptom was behavioural disturbance in 82 (41%) cases. CSDH was left-sided in 89 (44.5%) patients, right-sided in 78 (39%) cases (39%), and bilateral in the remaining 33 (16.5%) cases). Postoperative complications were observed in 59 cases (29 recurrences). Preoperative Markwalder grade correlated significantly with recurrence rate and mortality (P<.0001). Conclusions. CSDH was a very common disease in very elderly patients. Behavioural disturbance and neurological deficits are the most common first symptom. Preoperative neurological status at admission is the most important factor in recurrences and mortality (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Hematoma Subdural Crônico/diagnóstico , Hematoma Subdural Crônico/terapia , Anticoagulantes/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Hematoma Subdural/cirurgia , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada de Emissão/métodosRESUMO
Los quistes coloides son lesiones intracraneales benignas localizadas mayoritariamente en el III ventrículo en la región de los agujeros de Monro. La mayoría se presentan entre la tercera y cuartas décadas de la vida, y son poco frecuentes por debajo de los 10 años. Presentamos el caso de una niña de 2,5 años que presentaba un quiste coloide incidental que fue seguido de manera conservadora, observándose en los estudios de resonancia magnética una progresiva regresión en su tamaño. Realizamos una revisión de los 4 casos similares publicados con anterioridad (AU)
Colloid cyst are benign intracranial lesions located in the III ventricle in the region of the foramen of Monro. The majority present in the third and fourth decades of life and are rare under the age of ten. We report a case of an incidentally colloid cyst presented in a 2.5 -years-old girl who was managed conservatively; follow-up with MRI showed a progressive reduction in size. We review the four similar case previously reported (AU)