Assuntos
Aneurisma Roto , Transtornos da Cefaleia Primários , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Humanos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Transtornos da Cefaleia Primários/diagnóstico por imagem , Transtornos da Cefaleia Primários/etiologia , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Tomografia Computadorizada por Raios XAssuntos
AVC Isquêmico/cirurgia , Segurança do Paciente , Trombectomia/métodos , Consenso , Humanos , Sociedades Médicas , Reino UnidoRESUMO
PURPOSE: To present the results of the surgical management of metastatic renal cell tumours of the spine with cord compression who underwent pre-operative embolisation. METHODS: We conducted a retrospective cohort study of all embolised vascular metastatic renal cell tumours of the spine that underwent urgent surgical intervention over a 7-year period (2005-2011). All medical notes, images and angiography/embolisation details were studied. We recorded the timing (immediate vs. delayed) and grade of embolisation and compared this to the estimated blood loss (EBL); extent of metastatic spinal cord compression (using the Tomita score and Bilsky scores) was also compared to EBL. Finally, neurological (Frankel grade), surgical outcome and complications were reviewed in all patients. RESULTS: During the study period, we operated on 25 emergency patients with metastatic renal cell carcinoma causing spinal cord compression who had received pre-operative embolisation (mean age 59.6 (24-78) years; 8 females, 17 males). All but one of our patients had hypervascularisation/arterio-venous fistulae on angiography. We were able to achieve greater than 90 % embolisation in the majority (17/25, 68 %) The estimated blood loss was 1,696 (400-5,000) ml; mean operating time was 276 (90-690) min and an average of 2.3 (0-7) units of whole blood was transfused. Nine patients had a posterior only decompression/stabilisation, nine patients had a posterior decompression ± cement augmentation, six had combined anterior/posterior procedures and one had anterior corpectomy/reconstruction alone. There was no statistical difference in the EBL between immediate versus delayed surgery after embolisation or the grade of embolisation. Immediate surgery after embolisation and interestingly less complete embolisation showed a trend towards less EBL. The extent of the tumour as graded by the Bilsky score correlated with increased EBL (p = 0.042). No complications occurred during the embolisation procedure. The surgical complication rate was 32 % (8/25) including two major complications (septicaemia (1) and metal work failure (2)) and five minor complications. Postoperatively, 52 % (13/25) had no change in neurological status, 36 % (9/25) improved by at least one Frankel grade and 12 % (3/25) had neurological deterioration by one Frankel grade. The average survival following surgery was 14.1 (0.5-72) months. CONCLUSION: Blood loss (mean 1,696 ml) and complications (32 %) remain a concern in the operative treatment of vascular metastatic spinal cord compression. Most patients remained the same neurologically or improved by at least 1 grade (22/25, 88 %). Paradoxically, greater embolisation showed a trend to more blood loss which could be due to more extensive surgery in this group, a rebound 'reperfusion' phenomena or even the presence of arterio-venous fistulae. Interestingly, we also found that the extent of the tumour, as graded by the Bilsky score, correlated with increased blood loss suggesting that more extensive cord compression by metastases could lead to more blood loss intra-operatively.
Assuntos
Carcinoma de Células Renais/secundário , Embolização Terapêutica , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/secundário , Adulto , Idoso , Angiografia , Carcinoma de Células Renais/diagnóstico por imagem , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Compressão da Medula Espinal/mortalidade , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Reino Unido/epidemiologia , Adulto JovemRESUMO
AIM: To assess the efficacy of a primary-care imaging pathway for neurology outpatients, from inception to deployment, compared with traditional outpatient referral. MATERIALS AND METHODS: After local agreement, guidelines were generated providing pathways for diagnosis and treatment of common causes of headache, highlighting "red-flag" features requiring urgent neurology referral, and selecting patients for direct magnetic resonance imaging (MRI) referral. In addition, reports were clarified and standardized. To evaluate the efficacy of the access pathway, a retrospective sequential review of 100 MRI investigations was performed comparing general practitioner (GP) referral, with traditional neurology referral plus imaging, acquired before the pathway started. RESULTS: No statistically significant difference in rates of major abnormalities, incidental findings or ischaemic lesions were identified between the two cohorts. Reported patient satisfaction was high, with a cost reduction for groups using the pathway. CONCLUSION: The findings of the present study suggest that a defined access pathway for imaging to investigate chronic headache can be deployed appropriately in a primary-care setting.
Assuntos
Transtornos da Cefaleia/diagnóstico , Imageamento por Ressonância Magnética , Atenção Primária à Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Procedimentos Clínicos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemAssuntos
Trombólise Mecânica/mortalidade , Trombólise Mecânica/normas , Complicações Pós-Operatórias/mortalidade , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/cirurgia , Humanos , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento , Reino Unido/epidemiologia , Revisão da Utilização de Recursos de SaúdeRESUMO
BACKGROUND AND PURPOSE: Chest CT is a rapid, useful additional screening tool for coronavirus disease 2019 (COVID-19) in emergent procedures. We describe the feasibility and interim outcome of implementing a modified imaging algorithm for COVID-19 risk stratification across a regional network of primary stroke centers in the work-up of acute ischemic stroke referrals for time-critical mechanical thrombectomy. MATERIALS AND METHODS: We undertook a retrospective review of 49 patients referred to the regional neuroscience unit for consideration of mechanical thrombectomy between April 14, 2020, and May 21, 2020. During this time, all referring units followed a standard imaging protocol that included a chest CT in addition to a head CT and CT angiogram to identify Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infective pulmonary changes. RESULTS: Overall, 2 patients had typical COVID-19 radiologic features and tested positive, while 7 patients had indeterminate imaging findings and tested negative. The others had normal or atypical changes and were not diagnosed with or suspected of having COVID-19. There was an overall sensitivity of 100%, specificity of 74.1%, negative predictive value of 100%, and positive predictive value of 22.2% when using chest CT to diagnose COVID-19 in comparison with the real-time reverse transcriptase-polymerase chain reaction test. The mean additional time and radiation dose incurred for the chest CT were 184 ± 65.5 seconds and 2.47 ± 1.03 mSv. Multiple cardiovascular and pulmonary incidental findings of clinical relevance were identified in our patient population. CONCLUSIONS: Chest CT provides a pragmatic, rapid additional tool for COVID-19 risk stratification among patients referred for mechanical thrombectomy. Its inclusion in a standardized regional stroke imaging protocol has enabled efficient use of hospital resources with minimal compromise or delay to the overall patient treatment schedule.
Assuntos
Betacoronavirus , Isquemia Encefálica/diagnóstico por imagem , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/etiologia , Isquemia Encefálica/cirurgia , COVID-19 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Trombectomia , Tomografia Computadorizada por Raios XRESUMO
Angiograms were obtained in the harbor seal, Phoca vitulina, in air and during diving. During diving there is arterial constriction of the vascular beds of muscle, skin, kidney, liver, spleen, and presumably of all vascular beds except those perfusing the brain and heart. There is sudden constriction and narrowing of muscular arteries close to their origin from the aorta. Constriction of small arterial branches is so intense that blood flow is essentially lost in all involved organs.
Assuntos
Artérias/fisiologia , Carnívoros/fisiologia , Mergulho , Angiografia , Animais , Eletrocardiografia , Frequência Cardíaca/fisiologiaRESUMO
We report the case of a 47-year-old man who presented with a few months' history of right-sided headache and dysphagia, with ipsilateral tenth and twelfth cranial nerve palsies on examination. The initial MRI showed an enhancing mass lesion in relation to the right carotid sheath and jugular foramen, and was reported as a possible paraganglioma. Subsequent angiography performed to assess tumour vascularity demonstrated a dissection involving a tonsillar loop of the right internal carotid artery (ICA). Imaging findings at MRI and angiography and the presentations and mechanisms of ICA dissection are briefly discussed.
Assuntos
Dissecação da Artéria Carótida Interna/complicações , Doenças do Nervo Hipoglosso/etiologia , Doenças do Nervo Vago/etiologia , Dissecação da Artéria Carótida Interna/diagnóstico , Tumor do Corpo Carotídeo/diagnóstico , Diagnóstico Diferencial , Humanos , Doenças do Nervo Hipoglosso/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Vago/diagnósticoAssuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , COVID-19 , Humanos , Neuroimagem , SARS-CoV-2RESUMO
We present a case of asymptomatic, progressive, late occlusion of the left superior cerebellar artery (SCA) and an aneurysm arising from the junction of the SCA and basilar artery after embolization of an adjacent aneurysm arising between the left posterior cerebral artery and the left SCA. The delayed occlusion was associated with reconfiguration of the Guglielmi detachable coils at the neck of the treated aneurysm.
Assuntos
Arteriopatias Oclusivas/etiologia , Artéria Basilar , Cerebelo/irrigação sanguínea , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Angiografia Digital , Arteriopatias Oclusivas/diagnóstico por imagem , Artérias Cerebrais , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss. METHODS: A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery. RESULTS: All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply. CONCLUSION: Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed.
Assuntos
Endoscopia/efeitos adversos , Órbita/lesões , Doenças dos Seios Paranasais/cirurgia , Cegueira/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/terapia , Traumatismos do Nervo Óptico/diagnóstico , Traumatismos do Nervo Óptico/etiologia , Estudos RetrospectivosRESUMO
An intradiploic extension of a post-traumatic encephalocoele is described in an infant.