RESUMO
Perineurioma is a rare benign soft tissue tumor arising from the peripheral nerve sheath. To date only two cases of orbital perineurioma have been reported in literature. A 45-year-old, with no comorbidities, presented with protrusion of the right eye since one-year. Examination revealed 8mm proptosis of the right eye. Dilated fundoscopy of the right eye showed a pale optic disc with choroidal folds temporal to it. Computerised Tomogram (CT) of the orbit showed a well-defined intraconal mass in the inferotemporal part of the orbit. A trans conjunctival orbitotomy with lateral canthotomy was performed and the tumor was removed en bloc. On immunohistochemistry, the tumour was negative for S-100 and showed patchy weak Epithelial Membrane Antigen positivity which was suggestive of a soft tissue perineurioma.
Assuntos
Exoftalmia/etiologia , Neoplasias de Bainha Neural/complicações , Neoplasias Orbitárias/complicações , Neoplasias de Tecidos Moles/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias de Bainha Neural/diagnóstico por imagem , Neoplasias de Bainha Neural/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/cirurgia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Cavernomas arising from nerve roots in the cauda quina are extremely rare with less than 30 reported cases in world literature. We report a case of a 21-year old lady with a L3-4 cavernoma successfully managed by surgery thereby adding to the general fund of knowledge on this rare entity.
Assuntos
Cauda Equina/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Procedimentos Neurocirúrgicos/métodos , Dor nas Costas/etiologia , Cauda Equina/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Resultado do Tratamento , Adulto JovemRESUMO
Concomitant cerebral infarction developing soon after a parenchymal intracerebral hemorrhage is a rare occurrence. Usually, these remote site changes follow tumor decompression and are associated with hemorrhagic changes rather than infarcts. We report a case of a fatal malignant internal carotid territory infarct in a hospitalized patient being conservatively managed for a vermian hematoma and discuss the probable pathophysiology. Stroke physicians need to be aware that spontaneous intracerebral hematoma patients have a potential threat of developing large vessel occlusion with malignant cerebral infarcts, especially after surgical decompression. Although the exact pathogenesis is unknown, size of the clot, intraventricular hemorrhage, hydrocephalus, and aggressive reduction of blood pressure appear to be predictive factors.
RESUMO
Cavernous carotid aneurysms (CCA) pose considerable dilemmas in management. It is still unclear as to whether an asymptomatic CCA should be subjected to treatment. Similarly, the ideal management strategy for a symptomatic aneurysm is controversial. We present the case of a 60-year-old female with a giant CCA and discuss the management issues.
RESUMO
BACKGROUND: Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L) which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+) level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH. MATERIALS AND METHODS: This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1(st) January to 31(st) July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS) grading system. Discharge status was calculated using the Glasgow outcome score scale. RESULTS: Fifty nine patients were included in the study and 53 (89.8%) of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%). The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm. CONCLUSION: Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality.